Texas lawmakers keep anti-abortion amendment in postpartum Medicaid extension proposal

Texas legislators have agreed on a plan to give new moms a full year of Medicaid coverage, but the compromise comes with a controversial anti-abortion amendment that could potentially imperil the extension. The bill now goes to both chambers for a final vote.

Texas is one of just 11 states that has not expanded Medicaid and has the highest uninsured rate in the nation. Medicaid pays for 50% of births in Texas, but currently, new moms lose their Medicaid coverage just two months after giving birth.

Maternal health advocates have been calling for a full year of postpartum Medicaid for years, and it’s long been the top recommendation from the state’s Maternal Mortality and Morbidity Review Committee. Texas’ maternal mortality rates, especially among Black women and uninsured patients, has been on the rise over the last decade.

This session, in the wake of the overturn of Roe v. Wade, the bill to expand postpartum Medicaid caught bipartisan support from a wide-ranging coalition of legislators and advocates, and it initially passed the House with overwhelming backing.

But the bill hit a snag in the Senate as Republicans demanded an amendment that specified women who had elective abortions do not qualify for the extended Medicaid coverage. The original bill said simply that the coverage began on the last day of pregnancy; it did not specify how that pregnancy had to end.

Abortion is banned in Texas except to save the life of the pregnant patient. Anti-abortion groups have said that allowing extended Medicaid coverage to go to women who had out-of-state or illicit abortions is tantamount to using state funds to support abortion.

Throughout the session, advocates called for the Legislature to pass a “clean” bill that matches the language in Medicaid guidelines to ensure the federal Centers for Medicare and Medicaid Services quickly accepts the state’s application for the extension.

Sen. Nathan Johnson, a Dallas Democrat, said on the floor Sunday that Republican senators’ amendment left “the entire program…vulnerable to not being approved.”

“I don’t want to gamble with women’s lives…so I wish you’d take these words out,” Johnson said.

Bill sponsor Sen. Lois Kolkhorst, R-Brenham, said this was a necessary compromise to get the bill to pass the Senate.

“My goal is to get this bill over the goal line and allay some of the … concerns of members on this floor,” she said. “I think that this is a compromise that is best.”

In a closed-door conference committee this week, House members agreed to accept the bill with a version of the Senate’s amendment, according to a copy of the report reviewed Friday by The Texas Tribune. The bill now includes a section that reads, “Out of the state’s profound respect for the lives of mothers and unborn children, Medicaid coverage is extended for mothers whose pregnancies end in the delivery of the child or end in the natural loss of the child.” If both chambers accept the bill and it passes into law, it will be up to the federal government to decide whether to approve Texas’ extension proposal.

State lawmakers have until Sunday at 11:59 p.m. to pass the bill out of both chambers.

This bill comes at a crucial moment, as millions of Texans face the end of Medicaid benefits for the first time since the COVID-19 pandemic began in March 2020. Texans who receive Medicaid benefits are encouraged to make sure their information is up to date at YourTexasBenefits.com.

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