By Stephen Simpson, Eleanor Klibanoff and Karen Brooks Harper
Originally appeared in the Texas Tribune
Pregnant moms on Medicaid will get health care coverage for a year, patients will get more detailed billing and nurses will get help with school loans. But efforts failed to gain steam for legalizing fentanyl test strips, increasing the pool of mental health professionals who accept Medicaid and expanding Medicaid benefits to more Texans.
Low-income mothers in Texas won some health gains during this past legislative session, primarily through the expansion of postpartum Medicaid benefits, but overall state lawmakers kept their eyes and dollars focused on law tweaks and boosting dollars to existing health care programs instead of launching sweeping new initiatives.
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.
Also, with deadlines approaching between now and next year for federal pandemic relief to end, there was no plan to preemptively replace that funding with state dollars, putting the funding of child care and student mental health programs that were the greatest beneficiaries at risk. That’s despite the state having nearly $33 billion in additional revenue available this session.
“We’re disappointed that the Legislature failed to pass a number of priorities for Texas kids and families,” Stephanie Rubin, CEO of Texans Care for Children, said in a post-session news release.
Still, there were several health care winners this legislative session.
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.
The bill was sponsored by Brenham Republican state Sen. Lois Kolkhorst at the suggestion of the lieutenant governor.
“Last fall I came up with the idea of a new scholarship program to address our nursing shortage in Texas,” Patrick said in a statement. “I asked Chair Kolkhorst to design the program and she has done a masterful job in crafting this legislation.”
A staffing crisis is playing out at hospitals all across the United States as medical professionals are leaving the field due to burnout, the number of violent attacks against medical workers has risen and the workload has increased because of the COVID-19 pandemic.
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.
Health care providers in Texas will be required to send patients an itemized bill of services before attempting to collect money from them.
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.
But one of the largest hurdles to mental health equity has been the Medicaid reimbursement rate, and once again it has been left untouched.
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
In the first legislative session since the mass shooting at Robb Elementary School that killed 19 Uvalde students and two teachers, requests for dedicated mental health funding to school districts were ignored as lawmakers focused on community grants instead. This puts many student behavioral health programs at risk of shutting down.
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.
In addition, the state also allocated $1.1 billion to the TEA to help schools meet the state’s safety requirements.
While these school safety funds can also be used to support the creation or further expansion of student mental health programs, school administrators say the new safety requirements will eat up most of the provided cash.
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.
“We don’t want our schools to become the delivery system for our mental health system,” Kolkhorst said during a House meeting last month.
The Legislature also passed a bill this session that gives schools the option to use school safety funds to pay for unlicensed chaplains to work in mental health roles. Volunteer chaplains will also be allowed in schools.
One funding winner was the state’s boost in funding to the Texas Child Health Access Through Telemedicine, or TCHATT, program that connects school districts with mental health professionals. Through TCHATT, mental health professionals can help identify and assess the behavioral health needs of students and help provide access to those services. The program is expected to receive $140 million for the next two years.
Child care faces an uncertain future
Day care options have been dwindling across the state, but a request for additional funding to support the industry went unheard during the session.
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’s “wish list” included a $2.3 billion proposal to help revive the already fragile industry as federal aid mobilized by the pandemic expires later this year. This would have provided a direct-to-provider payment of about $1,000 per child per year, based on the number of children a day care facility is licensed to serve. The Legislature didn’t include the funding in the final budget bill.
Child abuse reporting receives a change
In an attempt to weed out false reports of child abuse, the Texas Legislature has approved a bill that would bar Texans from making child abuse reports anonymously.
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.
But this bill would require the child abuse agency to obtain a caller’s identity from the start. No report would be taken unless the caller or the online reporter provided their own name, phone number and address. The identity of the caller would remain confidential to all except those who work at DFPS.
Fentanyl test strip bill killed
To combat the growing number of fentanyl overdose deaths in Texas, lawmakers passed a number of bills based on drug awareness and Narcan distribution.
However, advocates for changing the state’s drug policies to legalize test strips that can detect fentanyl found that their bill lost steam after initial support from state leadership.
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.
Supporters of the legislation argue the enhanced penalties give law enforcement more tools to help address a growing crisis in the state by holding dealers accountable.
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.
The issue has gained even more attention after the deaths of Texas teens and young adults from fentanyl overdoses. The victims had thought they were taking the attention-deficit/hyperactivity disorder drug Adderall.
Several bills this session specifically targeted drug safety awareness among young people as fentanyl has hit some local school districts hard.
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
Two years ago, Democrats and a growing number of Republicans were hopeful about expanding access to Medicaid to more people. But the bill to do that died during that 2021 session, spelling certain doom on any future efforts. This session, there were bills filed to expand Medicaid access but none made it to a vote.
Texas is one of only 10 states that has steadfastly refused to expand Medicaid coverage to more people. The federal health insurance program offered states the option to expand access in the 2014 Patient Protection and Affordable Care Act.
But this session, lawmakers had tens of billions in budget surplus and little motivation to expand the program in exchange for the billions of dollars being offered by the federal government as an incentive.
Texas has the highest rate and number of uninsured residents in the country.
“Of the Texas uninsured adults who could be covered with Medicaid expansion, nearly 8 in 10 are workers, in sectors like construction, food services and home health,” said Anne Dunkelberg, senior fellow at Every Texan, a nonprofit policy institute. “Those who aren’t working are caring for children and adults with disabilities or for young children and can’t earn enough to cover child care.”
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.