According to the Legislative Budget Board (LBB), the fiscal implications of HB 136 are modest but notable for the state’s Medicaid program. Over the biennium ending August 31, 2027, the bill is expected to result in a net cost to General Revenue-related funds of approximately $1.99 million. The costs stem primarily from the requirement that the Health and Human Services Commission (HHSC) provide Medicaid coverage for lactation consultation services delivered by certified providers. These expenses include both upfront administrative costs and ongoing service reimbursements.

In fiscal year 2026, HHSC is projected to need $247,535 in General Revenue for system development, including creating new provider types and initiating related policy and rate processes. The service delivery itself is assumed to begin by September 1, 2026, with the first full year of implementation falling in FY 2027. That year, the state anticipates 54,861 average monthly utilizers, leading to client services costs of nearly $1.79 million in General Revenue (approximately $4.46 million in All Funds), based on an average of two lactation sessions per person at a per diem rate of $54.20.

Offsetting some of these costs are expected gains in revenue due to increased insurance premium tax collections related to managed care payments. For example, in FY 2027, these gains are estimated at $97,019 to the General Revenue Fund, with 25% of that total ($32,399) allocated to the Foundation School Fund per state law. Additionally, some long-term savings may accrue through improved infant health outcomes, potentially reducing other medical expenditures, though these offsets are not fully quantified in the analysis.

Technology implementation also accounts for a significant one-time cost of approximately $1.69 million in All Funds in FY 2026, with ongoing updates costing $39,467 annually thereafter. No significant fiscal impact is anticipated for local governments. Overall, the fiscal footprint is moderate and potentially cost-effective in the long run, especially if health outcome improvements materialize.

HB 136, while framed as a narrowly tailored maternal health initiative, represents a clear expansion of Texas's Medicaid program—a taxpayer-funded welfare entitlement. The bill mandates that Medicaid cover lactation consultation services and requires the creation of a new provider type within the Health and Human Services Commission (HHSC). Though the benefit is focused on supporting breastfeeding mothers, the legislation expands the scope of government involvement in healthcare and increases the services available under an already costly entitlement program. For those who prioritize limited government, this raises concerns about mission creep and long-term program growth.

The bill also imposes a new cost to taxpayers, with the Legislative Budget Board estimating nearly $2 million in new General Revenue spending over the next biennium and additional ongoing costs in subsequent years. Even with modest offsets through increased insurance premium tax revenues, the measure reflects an ongoing fiscal burden that contributes to the unsustainable growth of welfare programs. These taxpayer dollars could be better preserved or allocated to core government functions, particularly in a state that has emphasized fiscal responsibility.

Moreover, HB 136 sets a precedent for the future inclusion of other narrowly defined, non-emergency services into Medicaid, further eroding the program’s original intent to serve the most essential health needs of the most vulnerable. While promoting breastfeeding is a valuable goal, the question remains whether it should be the responsibility of the state to fund this through public assistance, especially when other existing programs, such as WIC, already offer some level of support.

In sum, while the policy intent may appear modest and beneficial on the surface, the underlying effect is an expansion of the welfare state and taxpayer obligation. From a limited government, fiscally conservative standpoint, the bill moves in the wrong direction. As such, Texas Policy Research recommends that lawmakers vote NO on HB 136.

• Individual Liberty: On one hand, the bill may support individual liberty by increasing access to lactation consultation services for low-income mothers, giving them more informed choices in infant care. It empowers recipients to make better health decisions for themselves and their children. However, because this access is facilitated through an expansion of a government welfare program (Medicaid), it introduces a tension: the benefit is gained at the expense of taxpayer liberty, as others are compelled to fund this service. Thus, the liberty of some is arguably expanded at the cost of others’ freedom from state-imposed obligations.
• Personal Responsibility: While encouraging breastfeeding can promote better health outcomes, the mechanism used—state-funded consultation—risks disincentivizing personal initiative or reliance on private or community support resources. By placing the financial responsibility for a non-emergency personal health choice on the state, the bill may unintentionally weaken the principle that individuals and families should be responsible for their own healthcare decisions and expenses when feasible.
• Free Enterprise: Creating a state-reimbursed provider category for lactation consultants integrates a new subset of health professionals into the government payment system. While it could be argued that it legitimizes and supports a professional field, this also draws more healthcare delivery into the public sector, reducing reliance on private market mechanisms. It may discourage market-based competition by subsidizing services that might otherwise be delivered through nonprofit, private, or faith-based providers.
• Private Property Rights: The bill does not directly affect land use, ownership, or regulatory takings. Private property rights remain unchanged
• Limited Government: This is the most directly impacted liberty principle. The bill expands the scope of a welfare entitlement program, increases public spending, and grows the administrative responsibilities of the Health and Human Services Commission. It moves healthcare provision further into the public domain, rather than reducing state involvement in personal or family matters. For advocates of limited government, this bill represents a concerning step toward deeper entrenchment of state-run social services.