Texas Lawmakers Focus on Non-Medical Drivers of Health

Overview

The 89th Texas legislative session has brought increased attention to policy solutions addressing the non-medical drivers of health (NMDOH) that shape health outcomes across the state. This shift reflects growing recognition that factors like food, housing, and transportation play a critical role in determining health and driving health care costs.

• In the previous legislative session, Texas passed its first law (HB 1575) that specifically identifies NMDOH services as a strategy for improving the health of pregnant and postpartum women and their children.
• In the current session, NMDOH approaches are gaining broader application, with two main policy themes emerging from the pending bills: Medicaid coverage for non-medical services and doula care.

Medicaid Payment for Non-Medical Services

Six bills introduced during the session propose using a Medicaid payment option known as “in lieu of services” (ILOS) to address non-medical factors that are the root causes of illness. ILOS allows Medicaid to reimburse NMDOH services that are medically appropriate, evidence-based, and aimed at reducing the need for future medical care. This approach has proven effective in other states to address housing, dietary needs, and other non-medical services for disease management.

The bills, proposed by different sponsors take slightly varied approaches to integrating NMDOH into Medicaid. Some focus more narrowly on nutrition services, while others offer broader flexibility to include a wider range of non-medical supports under the state Medicaid plan. Specifically:

• HB 26 and its companion SB 3001 propose adding reimbursement for nutritional counseling and education services from a list approved under the state Medicaid plan.
• HB 2946 and its companion SB 1661 propose covering nutritional support services, again from an approved list. Reimbursement would include food prescriptions, medically tailored meals, case management, and other nutrition-related services.
• SB 236 proposes allowing managed care organizations to be reimbursed for non-medical services. Unlike the previous bills, it is not limited to nutrition-related services and would offer flexibility in selecting services under the state Medicaid plan.
• SB 1753 proposes requiring Medicaid managed care contracts to allow organizations to offer, and be reimbursed for, certain nutrition services from a list approved by the Medicaid managed care advisory committee.

Doula Reimbursement

Doulas are trained professionals who provide non-medical support during pregnancy and childbirth. Medicaid coverage for doula care is a growing trend across the United States, with 15 states and Washington, D.C., offering this benefit to improve maternal health outcomes.

Four bills introduced this session aim to expand reimbursement for doulas to provide services addressing non-medical needs — such as childbirth education, coaching, and support services throughout pregnancy and the postpartum period — to help prevent pregnancy-related deaths and adverse birth outcomes.

• HB 1201 proposes creating a pilot program for Medicaid coverage of doula services.
• HB 2477 proposes adding doula services to the health plans offered under the group benefits program for governmental employees and retirees.
• HB 3121 proposes adding reimbursement for doula services under Medicaid.
• HB 5583 also proposes reimbursement for doula services and includes coverage for case management.

Policy Shifts That Prioritize Health

The legislature’s efforts to address non-medical needs through policy represent a meaningful step toward improving the health of Texans. These proposals reflect a growing commitment to treating health more holistically — investing not only in medical interventions, but also in the everyday conditions that contribute to good health.

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.

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