Abbott-O-Meter

Fund treatment for postpartum depression for low-income mothers

"As a starting point, the coverage period for postpartum doctor visits for the mother under" the Children's Health Insurance Program's perinatal coverage "should be extended from 60 days to up to one year." Abbott calls for spending $3 million more over two years.


Sources:

Document, "Bicentennial Blueprint, Greg Abbott's Working Texans Plan," Oct. 28, 2013

News story and chart, "Divide pronounced on health care for Texans," Dallas Morning News, Oct. 14, 2014

Updates

Lawmakers again didn't embrace Abbott vow to fund more postpartum mental health treatment

Gov. Greg Abbott agreed with lawmakers this year on a move that could encourage more Texas mothers to get checked for postpartum depression. For a second time, though, Abbott's campaign call to spend money qualifying low-income mothers for a year's worth of mental health screenings and services after giving birth didn't pass into law.

Last year, we marked this Abbott promise Stalled on the Abbott-O-Meter, where we track progress on the Republican's major promises.

The 2015 Legislature had done little more than taken testimony on a proposal to expand mental health screenings and treatment. Let's take a fresh look at progress now that legislators have completed another regular session.

A promise tied to drownings

As a candidate, Abbott framed his case for expanding insurance coverage of treatment for postpartum depression in his campaign's compendium of promises — and by mentioning the 2001 drownings of five Texas children by their mother.

Abbott wrote in 2013:

"If left untreated, symptoms of postpartum depression may last for months or years, jeopardizing the health and safety of the mother and her child. In 2001. Clear Lake mother Andrea Yates drowned her five children while suffering from a rare disorder called postpartum psychosis. In the aftermath of this tragedy, lawmakers passed a bill requiring health care providers who provide prenatal care to a pregnant woman to give her a list of resources that provide postpartum counseling and assistance to parents. The Yates case, and laws passed in its aftermath, raised awareness of postpartum depression, but more needs to be done to ensure new moms have access to screening and care."

Abbott otherwise credited existing state plans to spend more on prenatal services and wrote: "Lawmakers should also consider expanding benefits under CHIP Perinatal and Medicaid for Pregnant Women to cover screening, diagnosis and treatment for postpartum depression." As a starting point, Abbott said, such coverage for mothers should be expanded from the existing 60 days after giving birth to up to a year.

The Children's Health Insurance Program offers low-cost health coverage to families of the working poor. Medicaid, the federal-state insurance program, benefits lower-income residents.

Abbott said that with the expansion he was urging, a "woman who reports having symptoms of postpartum depression to her postnatal care provider will be screened for postpartum depression and may be referred to a mental health care provider that accepts Medicaid for diagnosis and treatment." A state study had established the cost of establishing such a program to be $3 million in 2016-17.

In updating progress on this promise, we spotted no decisions in the 2017 legislative session to make women who give birth under CHIP eligible for mental health screenings and treatments more than 60 days after delivery. Some other actions still could benefit mothers going forward.

Developments in 2016

An October 2016 report requested by lawmakers states that in a recent year, the share of Texas mothers on Medicaid diagnosed with postpartum depression or other mental health challenges after giving birth considerably trailed national averages, which was possibly a finding of concern.

A few months earlier, the Texas Health and Human Services Commission had launched Healthy Texas Women, a program generally open to low-income women who are legal U.S. residents ages 18 through 44 who lack insurance coverage for family planning services. Commission spokeswoman Kelli Weldon told us that provisions were made to automatically enroll women in Healthy Texas Women 60 days after a Medicaid-covered birth.

Such mothers, Weldon advised, would remain eligible for mental health screenings and treatment. Weldon said by email: "Office visits for diagnostic evaluation, and basic follow-up and monitoring of treatment response, are covered. For those who require more intensive services, providers are requested to refer the patient to local behavioral health care providers." We couldn't confirm much, though, about the number of mothers who have taken advantage of those Healthy Texas Women benefits.

To our inquiry, an outside advocate, Stacy Wilson of the Children's Hospital Association of Texas, credited the program with making mental health screenings possible longer for mothers on Medicaid. But Wilson told us it remains to be seen how many women receive that treatment. Wilson pointed out that a June 2017 waiver request sent by the state to federal authorities says Healthy Texas Women covers screenings and "limited pharmaceutical treatment for postpartum depression."

To our inquiry on this front , Oliver Bernstein of the Center for Public Policy Priorities, which advocates for low-income Texans, told us by email that about 4,000 mothers a month have been shifted from Medicaid to Healthy Texas Women. Bernstein also pointed out a HTW policy manual stating: "As many as 80% of new mothers experience a brief episode of the 'baby blues' which may last up to about 2 weeks. Approximately 5-25% of new mothers will experience postpartum depression that warrants intervention. It typically begins in the first 4 to 6 weeks after birth of the infant, but may develop any time in the first year."

We unsuccessfully sought state figures for the number or share of mothers screened or treated for postpartum depression due to HTW. Christine Mann, a commission spokeswoman, replied by email that the automatic enrollment of mothers on Medicaid started in July 2016; she said that counts will come available in early 2018.

In 2017, lawmakers vote to gather data

So, what did the 2017 Legislature do per Abbott's promise?

Legislative records show a House panel approved a proposal in keeping with Abbott's promise that would have extended mental health screenings and treatment to low-income women through the first year of each baby's life. But House Bill 2135 by Rep. Garnet Coleman, D-Houston, died short of a House vote, perhaps  due to its projected cost. The legislation's fiscal note, prepared by the Legislative Budget Board, projects 2018-19 costs of $181 million in state and federal funds with more than 100,000 mothers estimated to become eligible for the extended services starting in September 2018.

Otherwise, we learned from Wilson that the 2018-19 budget signed into law by Abbott includes a provision expected to yield detailed data. It requires the HHSC to report by February 2019 on "the screening and treatment of postpartum depression, and include, wherever possible, claims data and codes for all postpartum depression screenings and any other reported clinical data relevant to postpartum depression in public health programs including the Medicaid program, local mental health authorities, and women's health programs."

A move to screen mothers

Also, members agreed on a measure potentially leading more mothers to be screened and treated. Abbott in June signed into law House Bill 2466 specifying that mothers of children whose births are covered by CHIP or Medicaid now qualify for mental health screenings and referrals (though not treatment) when the mothers take their infants in for a check-up.

The legislation's fiscal note says 53 percent of Texas births in 2014 were covered by Medicaid. The note projects that when the measure takes full effect in 2019, some 212,524 women will be eligible for a mental health screening; it says the commission can cover related costs from existing resources, meaning lawmakers could act without appropriating additional aid.

The measure's author, Harris County Rep. Sarah Davis, R-West University, told us by email that she expects mothers to embrace screenings by pediatricians. Separately in November 2017, Adriana Kohler of Texans Care for Children, an advocacy group, said in a statement emailed to us that rules to implement the new law, including how pediatric providers will provide the benefit, were under development.

Kohler confirmed otherwise: "Texas has not expanded the coverage period for postpartum doctor visits for the mother under CHIP Perinatal from 60 days to up to one year."

We emailed aides to Abbott about progress on this promise and didn't hear back.

We newly rate this vow a gubernatorial Promise Broken.


Promise Broken  – The promise has not been fulfilled.

We published this now-outdated promise update on June 1, 2016:

Greg Abbott campaigned for governor saying state law needs to give more mothers access to mental health services.

The Republican leader framed his case for expanding insurance coverage of treatment for "postpartum depression" in his campaign's compendium of promises — and by mentioning the 2001 drownings of five Texas children by their mother.

Abbott wrote:

"If left untreated, symptoms of postpartum depression may last for months or years, jeopardizing the health and safety of the mother and her child. In 2001. Clear Lake mother Andrea Yates drowned her five children while suffering from a rare disorder called postpartum psychosis. In the aftermath of this tragedy, lawmakers passed a bill requiring health care providers who provide prenatal care to a pregnant woman to give her a list of resources that provide postpartum counseling and assistance to parents. The Yates case, and laws passed in its aftermath, raised awareness of postpartum depression, but more needs to be done to ensure new moms have access to screening and care."

Abbott credited plans to spend more money on prenatal services, then said: "Lawmakers should also consider expanding benefits under CHIP Perinatal and Medicaid for Pregnant Women to cover screening, diagnosis and treatment for postpartum depression." As a starting point, Abbott said, the coverage period for postpartum doctor visits for mothers should be extended from the existing 60 days after birth to up to a year.

If this change happened, Abbott said, a "woman who reports having symptoms of postpartum depression to her postnatal care provider will be screened for postpartum depression and may be referred to a mental health care provider that accepts Medicaid for diagnosis and treatment." Abbott added that a state study established the cost of establishing such a program to be $3 million in 2016-17.

Refresher: The Children's Health Insurance Program offers low-cost health coverage to families of the working poor. Medicaid, the federal-state insurance program, benefits lower-income residents.

As of May 2016, Bryan Black, spokesman for the Texas Health and Human Services Commission, told us by email that Medicaid in Texas covers optional screening and treatment for postpartum depression, for eligible women for 60 days after birth. Black said mothers whose births are covered by CHIP can be screened for postpartum depression for 60 days afterward, but the program doesn't cover treatment--unless the mother is under age 19 and eligible for CHIP in her own right.

"To allow for treatment of postpartum depression under CHIP Perinatal," Black wrote, "Texas Medicaid would need legislative direction."

We asked Abbott's office about movement on his expansion promise and didn't hear back.

Separately to our query, Mandi Kimball of Houston-based Children at Risk, a nonprofit that says it focuses on children's needs, replied that legislation to widen access to postpartum mental health services didn't win approval in the 2015 legislative session.

By email, Kimball pointed out House Bill 3115, co-authored by Reps. Garnet Coleman, D-Houston, and John Zerwas, R-Richmond, and Senate Bill 1698 by Sen. Joan Huffman, R-Houston, each one calling for women giving birth and already enrolled for CHIP- or Medicaid-backed perinatal services to be eligible for "screening and treatment for postpartum depression for the 12-month period after the" child's birth.

Legislative records show the House Public Health Committee held a hearing on Coleman's measure, taking no further action; the Senate held no similar hearing.

We rate this previously unrated Abbott promise STALLED.


Stalled — There is no movement on the promise, perhaps because of limitations on money, opposition from lawmakers or a shift in priorities.

Sources:

Document, "Bicentennial Blueprint, Greg Abbott's Healthy Texans Plan," Oct. 28, 2013 (posted online September 2014)

News story and chart, "Divide pronounced on health care for Texans," Dallas Morning News, Oct. 14, 2014

Emails, Bryan Black, press officer, Texas Health and Human Services Commission, May 16 and 18, 2016

Web page,  "CHIP Perinatal Benefits," Texas Health and Human Services Commission, 2014 (viewed May 11, 2016)

Emails, Mandi Kimball, director of public policy and government affairs, Children at Risk, April 18-19, 2016

Background paper on postpartum depression issues, Children at Risk, December 2014 (received by email from Mandi Kimball, April 18, 2016)

Document, "Bicentennial Blueprint, Greg Abbott's Healthy Texans Plan," Oct. 28, 2013 (posted online September 2014)

Web pages showing history, text and fiscal note, House Bill 2466, 2017 regular session, Texas Legislature (accessed Aug. 18, 2017)

Email, Kelli Weldon, assistant press officer, Texas Health and Human Services Commission, June 21, 2017

Emails, state Rep. Sarah Davis, Aug. 18, 2017

Emails and phone interview, Stacy E. Wilson, president, Children's Hospital Association of Texas, Aug. 21-22, 2017

Waiver request including descriptions of postpartum depression screenings and treatment benefits, "Healthy Texas Women Section 1115 Demonstration Waiver Application," Texas HHSC, submitted to Centers for Medicare & Medicaid Services, Center for Medicaid & CHIP Service, June 30, 2017

Legislation, "S.B. No. 1, General Appropriations Bill" including Rider 189, "Reporting of Postpartum Depression Data," 2017 Legislature, May 23, 2017 (accessed Aug. 22, 2017)

Email, Christine Mann, press officer, Texas Health & Human Services Commission, Aug. 22, 2017

Report, "Postpartum Depression Among Women Utilizing Texas Medicaid," Texas HHSC, State Department of Health Services, October 2016

Email, Oliver Bernstein, communications director, Center for Public Policy Priorities, Aug. 22, 2017

Manual, "POLICY and PROCEDURE MANUAL For Healthy Texas Women (HTW), 2017," Texas Health and Human Services Commission, June 2016 (accessed Aug. 22, 2017)

Email, Peter Clark, communications director, Texans Care for Children, Nov. 29, 2017