Lege update: 12-month Medicaid for new moms, lower cost drugs

During the 88th legislative session, Texas 2036 supported 12 bills aimed at ensuring Texans can access the health care they need, when they need it, and at a price they can afford. Many of those bills were directly implemented by health care markets, but others required state agency action to execute.

Extended postpartum Medicaid clears regulatory hurdle

House Bill 12 was a landmark piece of legislation for Texas women. The bill extends postpartum Medicaid eligibility to 12 months, an increase over the current two months of eligibility offered.

On Jan. 17, Texas officials received word that the Center for Medicare and Medicaid Services (CMS) had approved the Medicaid State Plan Amendment necessary to proceed with bill implementation. With this crucial federal approval, Texas is on track to begin offering the extended coverage in March. CMS estimates that this extended eligibility will positively affect over 130,000 Texas women.

Drug importation program update

HB 25 requires the Texas Health and Human Services Commission (HHSC) to create a wholesale prescription drug importation program to provide Texans with lower cost prescriptions by importing them through Canada. In a recent report, HHSC laid out the challenges facing implementation of the bill and next steps necessary to pursue an importation program.

The initial barrier limiting HHSC’s implementation of the bill is the uncertainty of both costs to run the program and revenues resulting from the program. State importation plans are still relatively novel, and as such the fiscal note for HB 25 is not precise. HHSC is able to estimate the following annual costs for the initial years of the program: $2.6-$2.8 million for staff, $1.2 million for technology licenses, and $19.6 million to contract with distributors, wholesalers and Canadian suppliers.

The agency used Florida’s state importation plan (the first and only plan to receive FDA approval to move forward) as a reference point for calculating its own costs. The state of Florida anticipates spending $38 million to administer their program. Florida, like HHSC, is unable to estimate the costs of purchasing drugs.

HHSC recommends that the prescription drug importation program be moved underneath the newly created Texas Pharmaceutical Initiative, which was also established in the 88th legislative session with the intent to deliver low-cost prescriptions to Texans. Perhaps more importantly, this initiative received funding for implementation.

In early January, Gov. Greg Abbott appointed the three members of the Texas Pharmaceutical Initiative Governing Board, a first step toward any decision related to the importation plan.

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