Author: Desiree Ingram
Women’s Health Policy Advisor
Texas Women’s Healthcare Coalition
House Bill 1575 (H.B. 1575), passed by the 88th Texas Legislature in 2023, represents a significant step forward to improve maternal health outcomes by addressing non-medical factors that affect low-income pregnant women.
The Texas Health and Human Services Commission (HHSC) oversees the implementation of H.B. 1575 and documents its progress in biennial reports to the legislature. The first report, released on December 1, 2024, highlights key milestones including the expansion of provider types in the Case Management for Children and Pregnant Women (CPW) program and mandatory trauma-informed training for all CPW providers. It also introduced a standardized non-medical screening tool for Managed Care Organization (MCOs) and Thriving Texas Families (TTF) service providers to utilize, along with insights from the MCO pilot study and TTF outreach efforts.
Expand CPW Provider Roles and Training
Traditionally, Case Management for Children and Pregnant Women (CPW) services were limited to licensed nurses and social workers. H.B. 1575 expands this to include community health workers (CHWs) and doulas as providers. This change opens new pathways for support, with CHWs certified by the Department of State Health Services (DSHS) and doulas gaining certification through experience or training. Additionally, HHSC revised and mandated CPW training to be trauma-informed, covering vital areas like social services, domestic violence, and informed consent policies to ensure they are equipped to address the complex needs of pregnant women effectively.
Standardized Non-Medical Screening Tool
A core element of H.B. 1575 is the development of standardized screening questions to identify non-medical needs among pregnant women, such as food insecurity, housing instability, and childcare. These screenings, conducted with informed consent, allow MCOs and TTF providers to proactively identify factors that could negatively impact maternal and infant health outcomes.
MCO Pilot Study Insights
Between June 1 and July 31, 2024, 11 MCOs participated in a pilot study, completing 1,159 screenings. Most pregnant women were enrolled in STAR managed care, with English being the primary language and Spanish as the second most common. Over half of the participants identified as Hispanic, approximately 57% as White, and about 18.5% as Black. Geographically, 83% resided in metro counties, 9.8% in rural counties, and 6.8% in micro counties.
Food insecurity and childcare emerged as the most common non-medical needs, while housing quality and utility bills followed closely. Interestingly, homelessness was not a significant issue reported among pregnant women.
The study also highlighted key pregnancy risk factors, approximately 17% of pregnant women had a diagnosis of anemia, 20% were overweight or obese, and 12% were diagnosed with a mental health condition such as depression or anxiety. Fewer than 10% were diagnosed with gestational diabetes or hypertension. Approximately 88% of the pregnancies resulted in deliveries, while 12% ended in pregnancy loss.
There were limitations to the study such as voluntary participation from MCOs, a short study duration and constraints in sample size. Future data will reflect long-term trends, outcomes, and offer a more accurate representation of the diverse population of pregnant women across the state.
TTF Provider Insights
In the 2023 fiscal year, the TTF program served 56,610 pregnant women. Nearly 94% were between the ages of 18 and 39. Almost half identified as Hispanic, approximately 26% as Black, and approximately 20.4% as White. Geographically, about 88% resided in metro counties, followed by 6.6% in rural and 5.3% in micro counties. TTF providers identified similar non-medical needs among pregnant women, including food insecurity, housing, transportation, and childcare.
Comprehensive Support and Future Reporting
As of September 1, 2024, Managed Care Organizations (MCOs) are required to screen pregnant members for non-medical health related needs within 30 days of enrollment or upon identification of pregnancy. Similarly, Thriving Texas Families (TTF) service providers began conducting these screenings on the same date and are mandated to submit monthly reports to the Texas Health and Human Services Commission (HHSC) as of October 2024. Both MCOs and TTF providers are responsible for coordinating services and referrals to community assistance programs based on non-medical needs screening outcomes.
Future biennial reports will summarize the collected screening data, provide insights into the non-medical needs of women receiving Case Management for Children and Pregnant Women (CPW) services, detail the number and types of referrals made to non-medical community assistance programs, and analyze perinatal health outcomes among women screened for non-medical needs.
Advocacy and Support for H.B. 1575
By expanding provider types, more women can access the personalized care and support they need. TWHC was invited to provide feedback on the non-medical screening tool. We’re encouraged by the progress service providers have made in utilizing the screening tool and look forward to their continued efforts in connecting women to the help they need to thrive. Providing low-income pregnant women with timely access to resources and support ensures both mother and baby receive the care they deserve, creating a lasting positive impact on families across Texas.