A Smarter Approach to Health Care in Texas

Preventing Illness Before It Starts

What if doctors could prevent illness before it starts, instead of just treating symptoms?

Take childhood asthma, for example, which affects nearly half a million Texans. Some children experience severe, uncontrolled asthma attacks, leading to missed school, hospital stays, and even death. Treating asthma costs over $930 million per year in Texas, but medication alone cannot stop the cycle. The real solution for some children requires eliminating asthma triggers like mold, dust mites, and pests in the home.

The reality is that where and how people live have a bigger impact on their health than medical care alone. Access to nutritious food, stable housing, and safe transportation plays a crucial role in overall well-being. These non-medical drivers of health affect a wide range of outcomes, from chronic disease to maternal mortality, which is why they are essential to health care.

By treating root causes, such as asthma triggers in the home, it is possible to prevent illness instead of merely managing it after it occurs. Fortunately, Texas lawmakers are considering ways to do just that this legislative session.

Smarter Medicaid Solutions

Six bills filed in the Texas Legislature’s 89th regular session (2025) propose using a Medicaid payment option known as “in lieu of services,” or ILOS, to address non-medical factors that are the root causes of illness. ILOS covers service alternatives to traditional medical treatment that are medically appropriate, cost-effective, and evidence-based.

Removing Asthma Triggers

Senate Bill 236, which would broadly apply ILOS to a list of state-approved non-medical services, could cover funding for home visits to remove asthma triggers, as outlined in Texas’ asthma control plan. Other states, such as Wisconsin, already use Medicaid to fund asthma trigger removal from homes, a strategy that has halved asthma-related hospitalizations and health care costs.

Food Is Medicine

The other ILOS bills — HB 26, SB 1661, SB 1753, HB 2946, and SB 3001 — focus specifically on Medicaid coverage for nutritional services that prevent and manage diet-related diseases. Two of these bills specifically include coverage for food prescriptions, prepared meals, or medically tailored meals — an approach referred to as food is medicine. These programs use food as a treatment for medical diagnoses like diabetes, high blood pressure, and kidney disease, directly linking food and disease management. Seven other states already use ILOS for food-is-medicine programs.

It is important to note that Medicaid’s role in these food programs is to treat illness, not address food insecurity. Programs like the Supplemental Nutrition Assistance Program (SNAP) address food insecurity by helping low-income families afford groceries, but SNAP is not designed as a clinical intervention.

A Healthier Future for Texas

The payment flexibility in ILOS is a smart way to manage rising health care expenses. Focusing on prevention and addressing the root causes of illness can help reduce the need for expensive treatments in the future. A healthier population requires less medical care, lowering costs for everyone.

These bills also represent common-sense bipartisan solutions. Over the past decade, states across the political spectrum have increased their investment in non-medical services because they improve health outcomes without running up health care costs. This approach aligns with federal efforts as well. President Donald Trump’s executive order creating the Make America Healthy Again Commission calls for “the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease prevention.” This means federal health insurance programs are encouraged to cover services addressing the non-medical drivers of health.

Building on Texas’ Existing Progress

The rising cost of health care presents more than a short-term challenge — it is a long-term trend. Attempts to cut costs by limiting medical care often backfire, leading to worsening chronic conditions and even higher expenses in the future. Therefore, it is encouraging to see Texas lawmakers embracing a smarter approach through legislation like HB 1575, passed in 2023, which allows Medicaid to pay for doulas and community health workers to assist pregnant and postpartum women with non-medical needs.

The bills filed this session — introduced by both Republicans and Democrats in the House and Senate — build on that premise. They deserve full consideration by the two legislative bodies. By passing legislation like this and creating solutions for non-medical needs, Texas can lead the way in making health care spending more efficient, effective, and focused on what truly keeps people well.

Managing chronic conditions like asthma or diabetes often requires support that extends beyond the doctor’s office into people’s homes, neighborhoods, and daily lives. Investing in solutions that promote wellness can lessen reliance on costly medical interventions later. Hospital systems, physicians, and health insurance plans increasingly address these non-medical drivers because they are key to better health outcomes. This legislative session, Texas policy has an opportunity to catch up.

This publication was produced on behalf of Rice University’s Baker Institute for Public Policy. Wherever feasible, the material was reviewed by external experts prior to its release. Any errors are the responsibility of the author(s) alone.

This material may be quoted or reproduced without prior permission, provided appropriate credit is given to the author(s) and Rice University’s Baker Institute for Public Policy. The views expressed herein are those of the individual author(s) and do not necessarily represent the views of Rice University’s Baker Institute for Public Policy.