Shao-Chee Sim, Executive Vice President for Health Policy, Research & Strategic Partnerships, Episcopal Health Foundation
At Episcopal Health Foundation (EHF), our vision is to build healthy communities for all by focusing on health beyond the walls of the doctor’s office. In 2024, we launched a new strategic framework that centers on three major action areas: health and health care services, healthy communities, and health policies. Across these areas, we also are prioritizing food and nutrition security, maternal health, and diabetes prevention, as these are critical levers for improving health outcomes in Texas.
Legislative Wins That Move the Needle
In the 2025 Texas legislative session, EHF and partners helped advance several policies that take important steps in addressing chronic disease and maternal health through Medicaid. These include:
- Expanding Diabetes Prevention: A budget directive now requires the Texas Health and Human Services Commission (HHSC) to evaluate whether the national Diabetes Prevention Program can be offered as a covered Medicaid benefit. This program is designed to help people at high risk make lifestyle changes that prevent type-2 diabetes, potentially saving both lives and state dollars.
- Nutrition Support for Pregnant Texans: House Bill 26 introduces a Medicaid policy tool known as In Lieu of Services (ILOS). ILOS gives Medicaid health plans flexibility to cover services that are not traditionally paid for but can improve health and reduce costs. Under HB 26, health plans can now offer nutrition counseling and test a pilot program that delivers medically tailored meals to pregnant Texans with chronic conditions. These services can be provided “in lieu of” more expensive medical care when they are shown to be clinically appropriate and cost-effective. This is the first time Texas Medicaid will use ILOS to directly address food and nutrition as part of health care.
- Investments in Maternal Health: Lawmakers approved $5 million over the next two years to support maternal health programs across the state. These investments aim to address the high rates of maternal morbidity and mortality in Texas by strengthening access to evidence-based interventions.
Taken together, these wins signal growing recognition among state leaders that investing in prevention and non-medical services through Medicaid is both urgent and achievable.
Navigating a Shifting Federal Policy Landscape
The state-level progress also reflects national momentum. With new leadership at the U.S. Department of Health and Human Services and the rise of initiatives like the “Make America Healthy Again” agenda, prevention and chronic disease management have moved higher on the policy agenda. Texas legislators responded by supporting policies that align with this national conversation, showing how prevention and cost-effective care strategies are shaping the future of Medicaid.
Making the Economic Case for Health Policy
Ahead of the Texas legislative session, EHF released two reports: Prevalence and Costs of Diabetes in Texas Medicaid and High-Risk Pregnancies in Texas Medicaid. Together they showed how chronic conditions and maternal health complications drive high Medicaid costs. More than 1 in 10 adult Medicaid enrollees have diabetes, and their care costs on average more than twice as much as those without the disease. The report estimates that total health care costs for individuals with diabetes covered by Medicaid in Texas may have been between $6 billion and $8 billion (Prevalence and Costs of Diabetes in Texas Medicaid). Medicaid also covers over half of all births in Texas, with high-risk pregnancies costing nearly three times more than routine deliveries (High-Risk Pregnancies in Texas Medicaid). These findings, widely shared with legislators and cited in committee hearings, underscored how prevention and targeted supports can improve health while saving the state money.
Elevating Non-Medical Drivers of Health
EHF published a report titled Opportunities to Address the Non-Medical Drivers of Health in Texas, which called for innovative Medicaid financing strategies to support food-as-medicine interventions and nutritional counseling. The report’s recommendations were included in HHSC’s Value-Based Payment and Quality Improvement Advisory Committee’s biennial report to the legislature. The passage of HB 26 is the second major legislation that addresses the non-medical drivers of health (NMDOH) needs of the Medicaid population. As shared in a previous Views from the Field article, the Texas legislature passed HB 1575 in 2023, a bill that requires the development of standardized screening questions related to NMDOH needs and allows community health workers and doulas to become billable provider types under HHSC’s children and pregnant women’s program.
The Power of Partnerships
None of this progress happened alone. EHF partnered with Feeding Texas, Texas Pediatric Society, and Texas Association of Community Health Plans to advance nutrition services, supported a maternal health coalition in Dallas-Fort Worth to secure the new state maternal health outcome funding, and collaborated with the Texas Diabetes Association to move the diabetes prevention directive forward. These relationships help build bipartisan support needed to pass meaningful legislation.
From Legislation to Implementation: The Long Game.
Passing bills is only the beginning. EHF’s focus now shifts to implementation, which often requires educating stakeholders, clarifying legislative intent, and sustained collaboration. Just as we saw with the successful 2023 Texas law that expanded Medicaid reimbursement for community health workers and doulas, real change comes from ensuring policies are carried out effectively on the ground. While it took EHF and its partners about 6 months in getting HB 1575 passed, it has been a much longer time window to implement the bill given the complex nature of implementing the bill between HHSC and Medicaid health plans, as well as the critical task of educating and engaging community health workers and doulas in terms of what it takes to become a Medicaid provider.
In the years ahead, EHF will continue working with state agencies, Medicaid health plans, peer funders, and community organizations to make sure these new policies translate into better health for Texans. By serving as a neutral convener and providing resources to fill gaps, EHF will help ensure that these wins move from legislation into lasting improvements in community health.