NMDOH Strategies: Findings from a 2026 Survey of Managed Care Organizations in Texas

Treaty Oak Strategies conducted a statewide survey this January to capture Medicaid managed care organizations' (MCOs') ongling activities to address non-medical drivers of health (NMDOH) and identify strategies for successful implementation and uptake of community health workers (CHWs) and doulas as case managers in the Medicaid program. This is the fourth survey of its kind.

Prior Surveys

In late 2018, the Episcopal Health Foundation (EHF) partnered with the Texas Association of Health Plans and the Texas Association of Community Health Plans to conduct the first ever statewide survey capturing Medicaid health plans’ activities to address NMDOH. The survey highlighted that while MCOs were committed to addressing NMDOH, there were challenges in financing, incentivizing and sustaining non-medical interventions. The survey findings were published in a Health Affairs blog article and resulted in the formation of the Texas MCO NMDOH Learning Collaborative.

The 2020 survey, focused on the impacts of the COVID-19 pandemic, highlighted increased NMDOH needs among Medicaid members and the strain placed on community-based organizations (CBOs) to meet those demands with limited funding, as well as increased NMDOH screening efforts by MCOs.

The 2023 survey identified potential policy changes to incentivize health plan investment; findings informed legislative initiatives, including the passage of HB 1575 (88th Texas Legislative Session), which established a standardized NMDOH screening tool for pregnant women and the addition of doulas and community health workers (CHWs) as case managers in the Texas Medicaid program.

Findings

Findings from the 2026 survey indicate continued progress in how health plans identify and respond to non-medical drivers of health (NMDOH), alongside persistent operational and policy barriers that limit scale and sustainability.

• Food insecurity remains the most frequently identified NMDOH need, followed by childcare, transportation, and difficulty paying utilities. The elevated ranking of childcare reflects the impact of HB 1575’s standardized screening requirements for pregnant members.

  
  

• Implementation of HB 1575 has significantly expanded NMDOH screening and formally integrated community health workers (CHWs) and doulas into Medicaid case management. However, MCOs report ongoing challenges related to provider enrollment, billing, limited provider capacity, and concerns about duplication with existing service coordination functions.

  
  

• Administrative burden and data-sharing limitations persist across survey years, particularly for provider-based screening and referrals to community-based organizations (CBOs). MCOs continue to cite lack of interoperability, inconsistent data standards, and limited CBO infrastructure as major constraints.

  
  

• MCOs continue to invest in NMDOH interventions through value-added services (VAS), performance improvement programs (PIPs), and quality improvement (QI) activities, but report uncertainty about how to classify NMDOH investments as allowable Medicaid costs—especially when working with non-traditional providers.

  
  

• Interest in nutrition-related in-lieu of services (ILOS) authorized under HB 26 is high, but MCOs emphasized that participation will depend on timely, clear guidance from HHSC regarding eligible provider types, billing codes, reporting requirements, and cost-effectiveness expectations.

Implications

While recent legislation has created important new opportunities to address NMDOH in Texas Medicaid, survey findings suggest that policy authorization alone is insufficient. Clear guidance, operational flexibility, and targeted technical assistance will be necessary to translate these policy changes into sustainable, scalable practice.

As the Texas MCO NMDOH Learning Collaborative enters its seventh year, these findings will inform targeted convenings, implementation support, and policy recommendations aimed at strengthening NMDOH infrastructure and improving outcomes for Medicaid members.

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