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TWHC supports continuity of care improvement at the Texas Capitol

Updated: Jan 15, 2021

By Perdita Henry

As bills continue to make their way through committees, TWHC continues to provide written and oral testimony. In the past few weeks, we shared our support of House Bill 937 with the House Committee on Insurance, HB 744 with the House Committee on Human Services, HB 1641 with the House Committee on Public Health, and Senate Bill 2132 with the Senate Health and Human Services Committee.

This round of submissions focused on improving continuity of care for women. Proposed legislation focused on increasing the amount of prescription contraception a woman can receive at one time to to a 12-month supply, lengthening the Medicaid coverage time frame for postpartum women from 60 days to 12 months, and improving the initial Healthy Texas Women (HTW) correspondence for newly eligible, auto-enrolled women.

Contraceptive access improvement

HB 937, written by Rep. Sarah Davis, seeks to provide women with a 12-month supply of prescription contraception. Increasing the amount of available contraception to women in each prescription cycle has a substantial impact on reducing unplanned pregnancy rates, lessening the likelihood of inconsistent use of the medication, and decreasing state spending in the Medicaid program by avoiding costs associated with delivery, mother and infant care.

Studies show that women who receive a one-year supply of contraception are 30 percent less likely to have an unintended pregnancy, compared to women who only receive a one-to-three-month supply. Health plans often limit prescription birth control supplies anywhere between one-to-three months. National data, which supports these claims, shows that two-thirds of women report their plan or clinic allows them to receive only three months’ or less supply of contraception.[i] In Texas, a study on one of the women’s health programs found a wide variation in pill pack distribution, and that most providers offer three or fewer packs at one time.[ii] When women have access to more contraception they can use their prescribed methods consistently and accurately.

Missing a dose of prescription contraception can negate the medication’s effect, leading to a higher chance of unplanned pregnancy. These barriers to access are further exacerbated for women who experience a gap in prescription coverage due to switching jobs or insurance, or if they live long distances from a pharmacy.

The Centers for Disease Control, the American College of Obstetricians and Gynecologist, and other leading health organizations, also recognize a greater supply of birth control as a key to improving continuity of care, reducing unintended pregnancy rates, and providing quality care.

Extending the postpartum healthcare window

Rep. Toni Rose’s, HB 744, directs the Health and Human Services Commission to extend the amount of time postpartum women can receive healthcare under Pregnant Women’s Medicaid to 12-months. This bill stands to improve women’s continuity of care, reduce maternal mortality and morbidity rates, and improve health outcomes for mothers and babies.

Pregnant Women’s Medicaid currently provides 60-days postpartum coverage, in a state where three-out-of-ten women are low income and one-in-five are uninsured.[iii] For most low-income women, once they lose Medicaid coverage, there are no additional comprehensive healthcare options.

The Texas Maternal Mortality and Morbidity Task Force found that most maternal deaths occur more than 60-days postpartum and that many of them were preventable. Systemic contributing factors that were identified as major contributors to these outcomes included a lack in continuity of care due to the inability to secure outpatient postpartum care – and the inability to access pre-pregnancy care services.

This bill ultimately seeks to provide new mothers with the valuable resource of time. Once a woman gives birth, she’s learning to care for her newborn, adjusting to changing hormones, dealing with sleep deprivation, navigating breastfeeding, experiencing new or exacerbated mental health issues, and adjusting to pain and an increased stress level.[iv] Providing only 60-days postpartum comprehensive healthcare coverage may not be enough time for a woman to realize all of her needs, access care, and ultimately make a full recovery.

Improving HTW notifications

HB 1641, by Rep. Angie Button, and SB 2132, by Senator Beverly Powell, seeks to improve the information provided to postpartum women who are auto-enrolled into HTW.

After a woman covered by Pregnant Women’s Medicaid delivers, she remains on Medicaid for 60 days. On her 61-day postpartum, the client becomes eligible for services provided through HTW, which includes pelvic exams, contraceptive services, and screenings for chronic conditions like diabetes, high blood pressure, and cholesterol.

Currently, an auto-enrolled woman will receive an HTW-notification letter in the mail at 30-days postpartum. HB 1641 and SB 2132 will enhance this notification, by including clarifying information about the benefits they’re eligible for under the program and where they can go to receive them.

These bills have the potential to improve women’s preventative healthcare and access to contraception. We look forward to seeing the outcomes as they progress through the next phase of the legislative process.

[i] Salganicoff A. et al. Women and Health Care in the Early Years of the Affordable Care Act. Kaiser Family Foundation. May 15, 2014; 8590.

[ii] The University of Texas Policy Evaluation Project. Number of Pill Packs Dispensed by Provider Type and Funding Source. Information from interviews conducted with family planning providers in Texas, November 2014-January 2015. University of Texas at Austin, 2017.

[iii] Hamel, L., Wu, B., Brodie, M. Sim, S., & Marks, E. (2018). Views and Experiences Related to Women’s Health in Texas, Selected findings from the Kaiser Family Foundation/Episcopal Health Foundation 2018 Texas Health Policy Survey.

[iv] Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2014). Major Survey Findings of Listening to Mothers (SM) III: New Mothers Speak Out: Report of National Surveys of Women's Childbearing Experiences Conducted October-December 2012 and January-April 2013. The Journal of perinatal education, 23(1), 17-24.

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