NCQA Fireside Chat: Texas Drives Medicaid Innovation
January 8, 2025 · Maya Spieske
NCQA Fireside Chats bring together national leaders from across the country to examine the most pressing issues in state health policy. Last quarter, we highlighted the Lone Star State.
We invited Dr. Ryan Van Ramshorst, Chief Medical Director for Medicaid and CHIP Services at the Texas Health and Human Services Commission (HHSC), to discuss the evolving landscape of Texas Medicaid and recent landmark legislation that is driving innovation. The conversation covered behavioral health integration, non-medical drivers of health and expanding postpartum coverage.
Keep reading for a look at these transformative initiatives and their impact on Texans.
Behavioral Health at the Heart of Texas Medicaid Services
Behavioral health has become a central component of primary care in Texas, a shift that many—Dr. Van Ramshorst included—didn’t anticipate. But despite that state’s progress, there are still challenges, particularly in underserved rural areas, where workforce shortages exacerbate the demand for behavioral health services.
Innovations like telemedicine have helped bridge gaps, says Dr. Van Ramshorst, but the need for more providers remains, especially in behavioral healthcare. To address this, Texas is using “in lieu of services” (alternatives to services covered by the state Medicaid plan) as an inpatient/outpatient coverage model.
The Texas legislature recently launched the Texas Child Mental Health Care Consortium with support from the University of Texas. A key initiative of the consortium, the Child Psychiatry Access Network, provides primary care pediatricians with quick access to child and adolescent psychiatrists for consultations. This program is crucial for managing complex cases, and significantly reduces wait times for children who need behavioral health services.
Addressing Non-Medical Drivers of Health for Vulnerable Populations
Texas has made significant strides in addressing non-medical drivers of health (NMDOH). With input from advocacy groups and Medicaid MCOs, HHSC recently released the state’s first NMDOH action plan, which prioritizes food, housing and transportation. Texas MCOs also participate in a learning collaborative that has strengthened their partnerships with community-based organizations.
Dr. Van Ramshorst praised the Texas legislature’s support for NMDOH, particularlyin helping new mothers. Beginning in 2023, MCOs were required to implement a health-related social needs questionnaire for all pregnant Medicaid recipients. In a groundbreaking movement, the state also passed legislation allowing doulas and community health workers to enroll in Medicaid and bill for case management services.
Texas MCOs Champion Value-Based Payment Models
Dr. Van Ramshorst says Texas has been a leader in value-based payment for Medicaid, especially with MCOs, and explained that state targets require 50% of managed care payments to be tied to alternative payment models, with 25% allocated to risk-based models. Texas is updating its model to introduce a points-based system that further incentivizes MCOs to adopt value-based payment. This updated model incorporates NMDOH to better address the needs of the state’s most vulnerable populations.
Innovation in Action: Expanding Postpartum Care and Embracing AI
Dr. Van Ramshorst highlighted the ongoing challenge of educating patients and providers about available services as Texas Medicaid seeks innovative ways to improve care. The state’s recent extension of postpartum coverage to 12 months was prompted by Texas Maternal Mortality and Morbidity Committee findings that many maternal deaths occurred after the original 2-month coverage period. The focus has shifted to ensure that mothers receive continuous care, including chronic illness management, from OB-GYNs or family physicians. Efforts are underway to educate providers and new mothers about this extended coverage and promote preventive care throughout the postpartum year.
Addressing the growing role of AI in health care, Dr. Van Ramshorst noted AI’s potential to streamline processes, drawing comparisons to the efficiencies achieved through telemedicine, while emphasizing the need for thoughtful and intentional implementation. He expects activity on this topic in the state’s upcoming 2025 legislative session.
NCQA thanks Dr. Van Ramshorst for sharing his time and thoughtful insights with our audience.
Visit our video gallery to watch the full Fireside Chat recording.
