Testimony: Address housing, nutrition needs of pregnant women

Key Takeaways:

• A commitment to measuring and tackling the non-medical drivers of health for pregnant women will make Texas a better place to raise a family.
• Housing instability is dangerous for both mother and baby.
• Ensuring that pregnant women have a safe and stable place to call home is foundational for addressing other important factors like transportation and child care difficulties.

Background

Non-medical drivers of health (NMDOH) — the conditions of the environments where Texans live and work that affect a wide range of health outcomes — are increasingly prominent in discussions of how to most efficiently and effectively improve the health of Texans. House Bill 1575 requires that pregnant women enrolled in Medicaid be screened for non-medical health related needs, and that data collected from that standardized screening be de-identified and reported on to the Legislature. The bill also established policies to allow doulas and community health workers to be case managers for this clientele and have their services reimbursed by Medicaid.

As awareness regarding the importance of NMDOH increases, Texas 2036 supports the ongoing implementation of HB 1575 as a crucial step in ensuring that the housing, food, transportation and childcare needs of pregnant women are prioritized as they prepare to raise the next generation of Texans.

Data and Next Steps

For pregnant women whose housing status is unstable, the consequences to both them and their babies are significant. A systematic review of existing literature published in the American Journal of Obstetrics and Gynecology found that 4-9% of pregnant women experience homelessness during their pregnancy. Homelessness and housing instability is associated with a reduction in birth weight, increased risk of preterm birth and delivery complications like hypertension.

A study posted in the Journal of Perinatology found that pregnant women experiencing homelessness suffered from premature rupture of membranes (PPROM), placental abruption and severe maternal morbidity at over twice the rate of women who were not homeless. Infants who experience homelessness during their first year of life visit the emergency department and hospital more often than those babies who never experienced homelessness, and when they are admitted to the NICU, babies who have experienced homelessness stay for longer periods. They also suffer from asthma, developmental disorders, respiratory infections and injuries at higher rates.

Measuring the scope of housing instability as it affects pregnant women enrolled in Medicaid is crucial not only for the clients themselves, but also for understanding this important NMDOH at a population level. To properly gauge the success of housing related referrals made to pregnant women in the long run, the Health and Human Services Commission should link that information with NMDOH information gathered during Texas Health Steps check ups delivered to those women’s children (if they remain enrolled in Medicaid).

In doing so, the agency will have longitudinal data about families’ housing situations that can be used to fine tune the referrals process.

Texas 2036 is grateful for the work of the Legislature and this committee on identifying innovative strategies to improve the lives of Texas moms and babies.

Read more:

• Lege update: 12-month Medicaid for new moms, lower cost drugs
• Prioritizing mothers and extending medicaid for postpartum women in Texas
• Statement: Extend mothers’ health coverage to a year

This written testimony was presented to the House Committee on Human Services on Aug. 27, 2024.