Good news for Texas Medicaid

Texas is thinking about doing something very smart.  They want to expand the current mandatory categorical eligibility for Medicaid for pregnant women that currently expires at sixty days after birth to a full year of eligibility after birth.

The Dallas Morning News has details:

To combat maternal mortality and morbidity, several Democrats and at least one Republican have proposed extending Medicaid coverage to one year after a woman gives birth or has an involuntary miscarriage.

“This is a really important bill because there is a gap in treatment, and this will ensure Texas women will continue to receive Medicaid coverage for 12 months,” said Rep. Shawn Thierry, D-Houston, who filed a bill to extend coverage. “I believe that this will reduce the maternal deaths.”

In 2016, Texas gained national attention for having the “highest maternal mortality rate in the developed world,” based on data from 2012 that was published in a study. Last year, the state found that inaccurate reporting inflated the data, but officials have continued efforts to lower the numbers.

Medicaid requires states to cover income qualified pregnant women for the pre-natal period and for sixty days after birth.  The theory is that work is difficult in this time period, the baby needs intensive parental attention and good healthcare for the mom will lead to better health and development outcomes for the baby.  Income restrictions are much higher for this adult population than many other adult eligible populations.  In Texas, a woman can earn roughly $32,000/year to qualify as a pregnant woman with a single child.  After sixty days, the current income cut-off for the same family to get the mom Medicaid qualified is $2,400 per year.   Texas transitions women to a limited benefit plan if they don’t qualify for low income Medicaid sixty days after birth.

That is a huge cliff. And many women will fall off that cliff. If they are earning over 100% FPL, they are eligible for a subsidized exchange plan. If they earn under 100% FPL (~$16,480 for a family of two) they get no exchange subsidies and most likely earn too much to qualify for low income Medicaid. A lot of people fall off the cliff.

New Jersey is considering a similar change to their Medicaid program. They are a Medicaid expansion state but Medicaid expansion cuts off at 138% FPL while low income pregnant woman eligibility cuts off significantly higher. It would promote continuity of care.

This is interesting and potentially good news from Texas and New Jersey.

16 replies
  1. 1
    MazeDancer says:

    Anything that helps women – and the mortality rate around giving birth – is great news!

  2. 2
    Another Scott says:

    Interesting. Thanks for the report.

    Something got garbled in the text.

    “Income restrictions are much higher for this adult population than many other income.”


    One of the Top 10 things that President Baud should do is rationalize all of these stupid benefit-restriction-based-on-income cliffs. Maybe giving all new mothers baby boxes while he’s at it:

    Mothers have a choice between taking the box, or a cash grant, currently set at 140 euros, but 95% opt for the box as it’s worth much more.

    The tradition dates back to 1938. To begin with, the scheme was only available to families on low incomes, but that changed in 1949.

    “Not only was it offered to all mothers-to-be but new legislation meant in order to get the grant, or maternity box, they had to visit a doctor or municipal pre-natal clinic before their fourth month of pregnancy,” says Heidi Liesivesi, who works at Kela – the Social Insurance Institution of Finland.

    So the box provided mothers with what they needed to look after their baby, but it also helped steer pregnant women into the arms of the doctors and nurses of Finland’s nascent welfare state.

    In the 1930s Finland was a poor country and infant mortality was high – 65 out of 1,000 babies died. But the figures improved rapidly in the decades that followed.

    Mika Gissler, a professor at the National Institute for Health and Welfare in Helsinki, gives several reasons for this – the maternity box and pre-natal care for all women in the 1940s, followed in the 60s by a national health insurance system and the central hospital network.



  3. 3
    Baud says:

    @Another Scott:

    Baby! Baud! Boxes!

    Wonderful idea.

  4. 4
    O. Felix Culpa says:

    I don’t quite follow how the income restrictions work, but anything that makes access to medical care for mothers and babies in this fetus-loving, child-hating country is good by me.

    @Another Scott: The baby boxes are brilliant, also too. Thanks for the link.

  5. 5
    Brachiator says:


    Anything that helps women – and the mortality rate around giving birth – is great news!

    Yes. Absolutely agree.

  6. 6
    Yutsano says:

    @Another Scott: @O. Felix Culpa: It’s garbled wording, but what I grok from it is that the income to fall off of Medicaid eligibility is much higher than for standard Texas Medicaid. So a woman could earn much more than normal Texas Medicaid eligibility and still qualify. Hope that helps!

  7. 7
    p.a. says:

    Who will be the first ‘pro-lifer’ to condemn this spreading sock-a-lizm. Or has it already happened? Buy hey, Ivanka’s on point for paid maternity leave, so there’s that.

  8. 8
    TomatoQueen says:

    Another important factor in improving post-natal outcomes is the standard of health visitor turns up to visit new mom and baby at regular intervals after the birth, thus strengthening care arrangements and supporting new families at their most vulnerable time. The UK got good results doing this.

  9. 9
    BobS says:

    Mr. Anderson, I have a health insurance question not related to the OP.
    My wife and I have different employers, both of whom offer us insurance. She prefers mine, which is a wider network with providers who she’s been seeing for years. I pay the ’employee + spouse’ rate, however, because she declines coverage from her employer, my employer charges me another $60/pay period. Is this a provision of Obamacare (it was implemented around that time, I suspect intentionally to deflect blame), or am I correct in feeling that I’m being extorted to coerce my wife into leaving my insurance?

  10. 10
    Ruckus says:

    Not David but this was the system at my last employer long before the ACA. Singles paid $12/per pay period – 2 weeks, or a higher amount with dependents and I believe it was around $50/pay period. This was 16-17 yrs ago so the amounts are quite probably now out of wack. Prior to that healthcare insurance was no cost to us. No deductibles, no co-pays, no paycheck reimbursements.

  11. 11
    Anonymous At Work says:

    It’s a great idea but the actual higher-ups in the state are not mentioned, Governor Abbott, Dennis Bonnen, and Dan Patrick. Without all three onboard, or at least not rejecting Muslim-Socialist-Atheist-Obamacare type expansions, this won’t get anywhere.
    That said, it’s a great plan since babies don’t start taking care of themselves at 60 days old (usually around 40 years or so).

  12. 12
    O. Felix Culpa says:

    @Yutsano: Thank you for the explanation. :)

  13. 13
    BobS says:

    @Ruckus: Thank you.

  14. 14
    stinger says:

    This is promising. However, I note that David’s post begins, “Texas is thinking about doing…” so there’s still a chance the bill won’t pass, or will be diminished, or will also prohibit all abortions and require police investigations of “miscarriages”.

  15. 15
    rikyrah says:

    Why did they come around? It’s Texas..don’t trust them..looking for the ‘catch’.

  16. 16
    Sandia Blanca says:

    It’s the Democrats who are thinking about this, but the balance of the Lege has really changed thanks to the strong showing by Dems in the November election, and there’s a lot of energy around this issue. I had the privilege of hearing Rep. Thierry speak about her bill. She has a personal interest in it, as she experienced a very dangerous birth. The United Methodist Women (hear us roar!) met with our legislators a couple of weeks ago, and this is one of the initiatives we discussed with them. Thanks for spotlighting it, David!

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