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During the recent legislative session in Texas, low-income mothers achieved certain health improvements, mainly due to the extension of postpartum Medicaid benefits. However, rather than implementing extensive new initiatives, state lawmakers prioritized making adjustments to existing healthcare programs and allocating additional funds towards them.
Latest in the series: 2023 Session Recap
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For the most part this legislative session, state lawmakers stuck close to the familiar, leaving bolder measures on substance abuse and mental health treatment by the wayside. There was no expansion of eligibility for medical marijuana. The talk of decriminalizing fentanyl testing strips was just that. A Republican lawmaker’s bill to help address the mental health workforce shortage was left to die in committee. And of course, no bill was moved forward to remove the largest barrier for uninsured people in Texas: the expansion of Medicaid health coverage.
The state is one of 10 that have refused to expand Medicaid coverage to its residents after lawmakers in North Carolina reached a deal this year on expansion. It is a measure that both Gov. Greg Abbott and Lt. Gov. Dan Patrick have long opposed despite some 75% of Texans supporting expansion in some form.
Furthermore, despite having an additional revenue of nearly $33 billion this session, the state failed to devise a plan to proactively substitute federal pandemic relief funds that are set to expire between now and next year. Consequently, vital programs such as child care and student mental health, which greatly benefited from these funds, are now at risk.
Stephanie Rubin, CEO of Texans Care for Children, expressed her disappointment in the Legislature’s inability to pass several important measures for the well-being of Texas children and families, as stated in a post-session news release.
However, there were a number of healthcare beneficiaries during this legislative session.
Women’s health
Two House priorities related to women’s health passed both chambers. The first comes via Senate Bill 379, which eliminates sales tax on diapers, menstrual supplies and many pregnancy-related supplies.
The other priority was the successful extension of Medicaid coverage for moms, from two months to a year after childbirth. The measure garnered bipartisan support after debate over an anti-abortion amendment. Maintaining health care coverage for a year after giving birth has long been the top recommendation of the state’s maternal mortality task force.
Legislators threw some additional support to new parents in the form of protections for pregnant and parenting college students and eight weeks of paid parental leave for state employees.
A bipartisan coalition of lawmakers also passed House Bill 916, which requires health insurers that cover contraception to provide a year’s supply of the medication at once. This bill, which has been sent to the governor, was the only contraception-related legislation to receive a hearing in both chambers.
“Making it easier to obtain refills of birth control prescriptions will benefit thousands of Texas women,” Republican state Rep. Shelby Slawson of Stephenville, who helped author the bill, said in a statement after it passed the House. “HB 916 … will help busy Texas women by making the refill process more efficient.”
No meaningful changes to Texas’ abortion laws gained traction this session, the first to be held after the U.S. Supreme Court’s overturning of Roe v. Wade and the near-total ban on abortion in Texas. No new exceptions were added to the laws, which ban abortion in all cases except to save the life of a pregnant patient, but no additional restrictions were put in place either.
The main change came in House Bill 17, a bill that allows elected prosecutors to be removed from office if they say they will not enforce specific categories of crimes. This bill was a direct response to the handful of prosecutors in the state’s large, left-leaning counties who have said they won’t pursue abortion-related charges.
Nursing
Faced with an ongoing nursing shortage, the Legislature passed Senate Bill 25, which establishes scholarships, grants and loan repayment programs to support nursing students and faculty.
The bill was sponsored by Brenham Republican state Sen. Lois Kolkhorst at the suggestion of the lieutenant governor.
“In a statement, Patrick expressed that he had conceived the concept of a novel scholarship program, aimed at tackling the nursing shortage in Texas, during the previous autumn. He then approached Chair Kolkhorst to formulate the program, and commended her exceptional skills in developing this legislation.”
Hospitals across the United States are currently grappling with a critical staffing shortage. A combination of burnout among medical professionals, an alarming surge in violent attacks against healthcare workers, and the heightened workload caused by the COVID-19 pandemic are all contributing factors to this crisis.
More than half of Texas’ nurses reported being subject to workplace violence in their career, according to a 2016 state study. Nationwide, the rate of violence for health care workers increased more than 60% between 2011 and 2018, and the federal Occupational Safety and Health Administration has found the rate of serious violent incidents in health care is more than four times greater than for those in other industries.
With Senate Bill 240, by state Sen. Donna Campell, R-New Braunfels, health care facilities will be required to establish a workplace violence prevention committee, responsible for policies to prevent and respond to incidents of workplace violence. The bill further requires facilities to respond to workplace violence by providing post-incident services, including acute medical treatment if necessary, and protects employees’ right to report the incident internally and to law enforcement without retaliation.
Medical billing
Texas health care providers must send patients a detailed invoice for rendered services prior to seeking any payments.
Medical debt is a growing problem around the country as recent surveys and polls have shown a growing segment of the population has been saddled with outstanding health care payments due to patients not understanding the billing process.
Texas lawmakers passed Senate Bill 490 to require hospitals and physicians to provide a plain-language description of every service provided to help patients understand the costs.
Community mental health programs and state hospitals receive a boost
In the state budget, lawmakers have set aside about $4 billion for state behavioral health services over the next two years as they attempt to tackle a lingering mental health crisis. This is a substantial increase from the over $3 billion previously allocated to mental health. About a quarter of that money will go toward either the renovation of existing state psychiatric hospitals or the construction of new mental health facilities as part of a 2015 strategic plan to address the waitlist in county jails for inmates who need psychiatric treatment.
Over the next two years, the allocation of funds will prioritize several key areas. Approximately $20 million will be dedicated to mental health services for veterans, while $80 million will be set aside for a grant program aimed at reducing the recidivism rate among individuals with mental illness. Additionally, community mental health grant programs will receive a budget of slightly over $54 million, and $300 million will be allocated to ensure salary increases for front-line staff at mental health state hospitals are maintained.
In addition, the upcoming two-year budget allocates $7.4 million to facilitate telepsychiatry consultations specifically for rural hospitals.
Texas lawmakers also made the biggest investment for broadband development in state history last month with House Bill 9, filed by state Rep. Trent Ashby, R-Lufkin, which will create the Texas Broadband Infrastructure Fund. The bill allocates $1.5 billion to an infrastructure fund that is meant to expand internet availability in a state where 7 million people lack access to the service.
Also included is $15 million to be made available to hospitals and groups that set up and operate mental health programs, particularly for children.
However, the Medicaid reimbursement rate, which has been a major obstacle to achieving mental health equity, remains unchanged once more.
In Texas, many therapists decline to accept Medicaid insurance payments because the reimbursement rate for their services is far lower than that offered by private pay insurance. The low rate has been a problem for years, reducing treatment access for low-income Texans.
One short-term fix proposed this session came by way of House Bill 1879, which would have allowed a licensed master social worker or a licensed professional counselor associate to accept Medicaid reimbursement for their services while they are still training and pursuing a license. The bill failed to pass the Senate.
Dedicated school mental health funds missing from budget
During the initial legislative session following the tragic incident at Robb Elementary School, where 19 Uvalde students and two teachers lost their lives in a mass shooting, pleas for specific mental health funding for school districts were disregarded. Instead, lawmakers prioritized community grants, potentially jeopardizing numerous student behavioral health programs that may face closure.
That’s because, at the start of the COVID-19 pandemic in 2020, the federal government sent money to states from the Elementary and Secondary School Emergency Relief Fund, also known as ESSER.
Of the 714 school districts that participated in a statewide survey, over 73% reported using ESSER funds for mental health, primarily to help with rough transitions for students who faced numerous classroom disruptions because of the pandemic. These funds expire at the end of 2024 and little will be available to replace them.
Meanwhile, lawmakers sent House Bill 3, authored by Rep. Dustin Burrows, R-Lubbock, to Abbott, which would invest more than $300 million in school safety measures and give the state more control over how school districts are boosting security at their campuses. If districts don’t comply with the state’s guidelines, they can be placed under the Texas Education Agency’s supervision.
Furthermore, the state has also assigned $1.1 billion to the TEA to aid schools in fulfilling the safety mandates set by the state.
According to school administrators, the majority of the provided funds will be allocated towards meeting the new safety requirements, leaving limited resources for the establishment or growth of student mental health initiatives, although these funds can also be utilized for such programs.
Despite a request from 36 Texas health and wellness organizations, bills that could have sent more money to offset the loss of federal funding failed to make any progress this session. The groups had wanted the creation and funding of a separate “student mental health allotment” during the session.
During a House meeting last month, Kolkhorst expressed her opposition to the idea of schools acting as the conduit for our mental health system.
During this session, the Legislature approved a bill that grants schools the choice to allocate school safety funds towards employing unlicensed chaplains in mental health capacities. Furthermore, schools will now have the option to welcome volunteer chaplains on their premises.
The Texas Child Health Access Through Telemedicine (TCHATT) program, which links school districts with mental health professionals, emerged as a funding recipient. This funding boost from the state will amount to $140 million over the next two years. TCHATT enables mental health professionals to detect and evaluate students’ behavioral health requirements while facilitating their access to necessary services.
Child care faces an uncertain future
During the session, a plea for extra funding to aid the shrinking day care options statewide fell on deaf ears.
According to a recent survey from the Texas Association for the Education of Young Children, 44% of responding child care programs indicated their program is likely or maybe likely to close within the next year when federal COVID-19 relief funding expires.
Since 2020, more than $4 billion in COVID-19 relief funds went directly to 10,790 Texas child care providers in 85% of Texas counties to help cover costs for an estimated 836,000 children, according to the federal Administration for Children and Families’ Office of Child Care.
The House budget had proposed a $2.3 billion initiative aimed at supporting the struggling industry, as the federal aid provided during the pandemic is set to end. This plan intended to offer a direct payment of approximately $1,000 per child per year to day care providers, depending on the number of children they are licensed to care for. However, the Legislature opted not to include this funding in the final budget bill.
Child abuse reporting receives a change
The Texas Legislature has passed a bill aimed at preventing false reports of child abuse by prohibiting anonymous reporting.
House Bill 63, authored by state Rep. Valoree Swanson, R-Spring, was approved by lawmakers and sent to the governor last month. The bill is the latest measure to not only reduce the workload volume of the Texas Department of Family and Protective Services, but also marks a sea change in the way Texas alerts officials to potential child abuse.
Currently, anyone can call DFPS’ child abuse hotline — 800-252-5400 — or file a report online to anonymously notify investigators of potential neglect or abuse of a child. A child abuse investigator will then follow up on that tip and conduct a preliminary investigation. If the investigator finds no corroborating evidence, the report is considered unfounded and no other action is taken.
However, under this proposed bill, the child abuse agency would be obligated to collect the caller’s identity right from the beginning. A report would only be accepted if the caller or online reporter disclosed their personal information such as their name, phone number, and address. The caller’s identity would be kept confidential, accessible solely to DFPS employees.
Fentanyl test strip bill killed
Lawmakers in Texas have implemented various bills focusing on drug awareness and the distribution of Narcan in order to address the escalating number of fentanyl overdose fatalities.
Nevertheless, proponents of altering the drug policies in the state to legalize fentanyl test strips were disheartened to discover that their proposed legislation lost momentum following an initial endorsement from state authorities.
Debate in the Senate seemingly killed House Bill 362, which would have removed fentanyl test strips from the state’s list of drug paraphernalia, letting people avoid a potential misdemeanor charge for possessing one. Currently, possession of drug paraphernalia — items used to consume illegal substances that can include fentanyl testing strips, used syringes and pipes — is a Class C misdemeanor punishable by a fine of up to $500.
Instead, lawmakers took a more “tough on crime” approach to the fentanyl epidemic by passing House Bill 6, which will classify overdoses from the synthetic opioid as “poisonings,” triggering murder charges for those convicted of giving someone a fatal dose of the synthetic opioid.
Advocates of the legislation claim that the increased penalties provide law enforcement with additional resources to tackle a burgeoning crisis in the state by ensuring drug dealers are held responsible.
Over two years, from fiscal year 2019 to 2021, overdose deaths involving fentanyl in the state rose nearly 400%. The Centers for Disease Control and Prevention estimates that more than 5,000 people in Texas died of drug overdoses between July 2021 and July 2022.
After the tragic deaths of Texas teenagers and young adults due to fentanyl overdoses, the problem has attracted even greater public awareness. These individuals mistakenly believed that they were consuming Adderall, a medication commonly prescribed for attention-deficit/hyperactivity disorder.
This session, multiple bills were introduced with a specific focus on raising drug safety awareness among young individuals, primarily due to the severe impact of fentanyl on certain local school districts.
House Bill 3908 will allow for fentanyl abuse prevention and drug poisoning awareness education in public schools. While Senate Bill 629 covers a wide range of topics regarding the use of overdose reversal medications, including allowing physicians to dispense such medication to schools without requiring identification of the user and setting training standards for school personnel.
Medical marijuana expansion fails
Texans who suffer from chronic pain and potentially other debilitating conditions would have been able to access the state’s medical marijuana program under House Bill 1805 by House Public Health Chair Stephanie Klick, R-Fort Worth. The bill won overwhelming support in the Texas House but died in the Senate without a public hearing.
The bipartisan legislation would have been an expansion on the state’s 2015 “Compassionate Use” law — which has, in a number of legislative changes since it was created, allowed a growing number of patients in Texas to legally use cannabis to treat debilitating symptoms of conditions such as epilepsy, autism, cancer and post-traumatic stress disorder, or PTSD.
No Medicaid expansion, again
In 2021, there was optimism among Democrats and an increasing number of Republicans regarding the expansion of Medicaid to a wider population. However, the bill intended for this purpose failed to pass during that session, effectively putting an end to any potential future endeavors. In the current session, despite the introduction of bills aimed at expanding Medicaid access, none of them managed to reach a voting stage.
The state of Texas stands out among the 50 states as one of the few that has consistently declined to broaden Medicaid coverage for a larger population. The 2014 Patient Protection and Affordable Care Act presented states with the opportunity to extend access to this federal health insurance program.
However, during this session, legislators were presented with a substantial budget surplus of tens of billions of dollars, which diminished their incentive to enhance the program in return for the billions of dollars being provided by the federal government.
The state of Texas boasts both the highest percentage and quantity of individuals without insurance coverage in the nation.
Anne Dunkelberg, a senior fellow at Every Texan, a nonprofit policy institute, stated that approximately 80% of the uninsured adults in Texas who are eligible for Medicaid expansion are employed in fields such as construction, food services, and home health. She further explained that the remaining individuals who are not currently working are primarily responsible for caring for children and adults with disabilities or young children and are unable to earn sufficient income to afford childcare.
More legislation against COVID-19 restrictions
As a result of the COVID-19 pandemic, lawmakers moved to ban state and local governments from requiring masks, vaccines and business closures during future health emergencies. State Sen. Brian Birdwell’s Senate Bill 29, largely restrains government bodies from demanding private and public schools be closed or making businesses operate with specific restrictions to slow the spread of a contagious pathogen.
But it wasn’t the first time lawmakers targeted governmental efforts to rein in the pandemic that killed more than 92,000 Texans.
In 2021, just as vaccines were being made widely available and people were still dying every day from the virus, state lawmakers sent a slate of bills to the governor aimed at protecting Texans’ rights against a state pandemic response that conservative state leaders believed went too far. During that session, lawmakers passed bills that, among other things, prohibit so-called vaccine passports and ban the mandatory closure of churches and gun stores during an emergency declaration.
Disclosure: Every Texan and Texans Care for Children have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
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