State Law Banning Refusal of Care to Certain Unvaccinated Patients Takes Effect
By Emma Freer

Starting Sept. 1, a new state law prohibits clinicians caring for patients enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) to refuse health care services based on their vaccination status.  

During the 2023 regular legislative session, the Texas Medical Association opposed House Bill 44 by Rep. Valoree Swanson (R-Spring) while working with state lawmakers to narrow its scope. In its original form, HB 44 would have kicked physicians out of Medicaid and CHIP for having a “discriminatory” vaccination policy, such as deciding not to see unvaccinated patients.  

The amended version of HB 44, which ultimately passed, allows practices to implement a vaccination policy but requires them to permit conscientious, religious, or medical exemptions like those seen in schools, explains a new TMA white paper on the law. 

Some physicians have raised questions about whether HB 44 applies to prospective as well as established patients. The language of the bill prohibits refusing services to Medicaid and CHIP enrollees based on failure or refusal to obtain a vaccination. The bill’s prohibitory language does not differentiate between prospective and established patients.

Although the law is set to take effect Sept. 1, the Texas Health and Human Services Commission (HHSC) has indicated it will not finalize rules related to its implementation until late 2024. In the meantime, HHSC may withhold Medicaid and CHIP payment to violators of the law until they comply with its provisions. 

Specialists in oncology and organ transplant services are exempt from the law. 

Jason Terk, MD, a pediatrician in Keller and immediate past chair of the Texas Public Health Coalition, recently told Texas Medicine that HB 44 still is “bad policy” because it adds another regulatory layer to already burdensome programs. This could, in turn, exacerbate access-to-care problems at a time when Medicaid and CHIP patients already struggle to find physicians able to care for them. 

Matt Dowling, TMA’s lobbyist on public health issues, said physicians and health care professionals often implement vaccination policies “to ensure patients who are unable to receive certain vaccines, such as newborns or those who are medically vulnerable, are further protected in [their] office.” 

While testifying in opposition to HB 44 in May on behalf of TMA and the dozens of other organizations that belong to TPHC, Michelle Gallas, DO, cautioned HB 44 would infringe on physicians’ autonomy and unfairly target those who care for Medicaid and CHIP patients. 

“Children and families will suffer because their physicians and [health care professionals] were punished for opting to do their best to protect all their clinic’s patients,” the Austin pediatrician told the Senate Health and Human Services Committee on May 10. 

For more information on HB 44, check out TMA’s new white paper. And visit TMA’s Physician Advocacy webpage for a summary of the 2023 legislative session.   

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