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The House Committee on Human Services met on February 19 to take up and consider several bills related to medical transportation and youth services. This report focuses on discussions on HB 25 relating to the provision of services to certain children under the Medicaid medical transportation program.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

HB 25 (González, Mary) Relating to the provision of services to certain children under the Medicaid medical transportation program.

 

Rep. Mary Gonzalez lays out the bill

  • HB 25 deals with state’s high maternal mortality rate, directs HHSC to develop a pilot program to let managed care take care of medical transportation for new mothers
  • Gonzalez lays out the Committee Substitute: CS shifts existing Medicaid dollars for transportation to MCOs participating & lets MCOs subcontract with ridesharing entities, CS designed to address large fiscal note
  • Hinojosa – Already difficult to handle postpartum visits, seems like medical transportation is a “no brainer” to include in service package
    • Gonzalez – Bill is common sense, helps rural areas
  • Deshotel – What was driving the fiscal note?
    • Originally the MCOs had to be actuarially sound, MCOs had a lot of factors worked in like airplane transport, etc.
  • Frank – It’s also that you basically have to pay for each seat, so it’s an incremental cost
    • Yes, there have also been conversations with ride share entities
  • Frank and Gonzalez discuss how the CS is designed to address these issues
  • Rose – Bill states this is a pilot program, has the region been identified?
    • No, up to the region and HHSC
  • Noble – In areas where there is public transportation already available, would this not apply?
    • It is a separate issue, Medicaid transportation is for those who have no other transportation method, helps with access for new mothers
  • Frank – DO you have data on how many people we feel like we’re missing, could only find stats to say 90% are showing up to appointments
    • Don’t have stats on that, I do know that missed appointments cost the US Gov. $200 million
  • Frank – Was pleasantly surprised by the number making appointments, this will hopefully make it better
    • Mothers also discouraged from even making appointments if they have a newborn, we do know we have issues with maternal mortality

 

Frank Dominguez, El Paso Health – For

  • 1 out of every 10 pregnancies in Medicaid end up in NICU, even with 90% compliance you can miss critical issues
  • Bills benefits women with children and taxpayers, want to ensure women get into care
  • Frank – As an MCO, do you have the flexibility to do this?
    • We do this as a value-added service, but no funding; currently extended to all members
  • Dominguez notes that El Paso would be a good pilot area as it covers a large area & could streamline administrative needs
  • System should be concentrated on preventative care, need to focus on postpartum care

 

Junda Woo, San Antonio Metropolitan Health District – For

  • In San Antonio, 40% of births are to women with late or no prenatal care, transportation often cited as a main driver
  • The most important thing you can do is have a short wait time for appointments, but there are other issues like this that can chip away at problems

 

Moss Hampton, American College of Obstetricians and Gynecologists – For

  • Prenatal care is crucial for healthy mothers and births, need to improve access to care
  • While reasons for missed appointments are numerous, transportation is a component; ACOG has run several focus groups and this issue always comes up
  • Hinojosa – So 40% of your patients did not return for a postpartum visit?
    • Yes, also saw similar problems with people coming in early for prenatal care
  • Hinojosa – Could you help us understand the difference between the statistic the Chair quoted that 90% of appointments are met?
    • Have not seen those statistics
  • Frank – Very difficult to get ahold of real numbers
  • Hinojosa – Also have a large number you’ll never hear from again
    • 90% is quite a bit higher than anything than anything I’ve seen
  • Frank calls Stephanie Muth, HHSC to discuss statistics

 

Stephanie Muth, State Medicaid Director, HHSC – Resource

  • Does not have these numbers available, but can get numbers together
  • Frank – Looking at data on number of missed appointments, number of those not making appointments, etc.
    • We don’t have data on numbers for rescheduled appointments, etc., but can get some info together from encounter data

 

Linda Litzinger, Self – For

  • There were mothers displaced during Harvey to hotel rooms that were 3-4 hours away from their own home, impacted the ability of mothers to take children to appointments; would like to see transportation added for all the siblings

 

Rep. Gonzalez Closes

  • We need to address this issue, asked for & working on recommendations, working with stakeholders, etc.; trying to create a fiscal note
  • Clardy – Seems to be a healthy & robust competition to have opportunity to host the study, would like to plug East Texas
  • Clardy – Would you consider broadening the scope of the pilot program across the state? Would expect limited scope if it is putting children with the mother
    • I agree, program says at least 1 region, bill is seeing a lot of changes; we are speaking of statewide & currently having conversations with HHSC
  • Frank – I think if everyone can get together and work through some of the issues, work in ride-sharing, etc., we can get this addressed
    • When we started looking at ride-sharing, I think the complication was federal rules; trying to work through all issues to get program working

 

Substitute withdrawn, HB 25 left pending