According to the Legislative Budget Board (LBB), HB 37 is not expected to have a significant fiscal implication for the state. While the Department of State Health Services (DSHS) would be responsible for administering the new Perinatal Bereavement Care Initiative, the agency plans to leverage existing infrastructure, specifically the Texas Alliance for Innovation on Maternal Health (TexasAIM), to deliver training and educational resources. This approach helps contain costs by building on current resources and stakeholder networks already in place for maternal health improvements.

DSHS does anticipate the need for additional staff to fully implement the initiative. However, the fiscal note assumes that these staffing and administrative needs could be absorbed within existing appropriations. Notably, the fiscal impact analysis does not account for the cost of grants that may be awarded to hospitals, instead focusing solely on the administrative costs to manage the program. This means that the financial exposure to the state would largely depend on how much is ultimately appropriated for grants or received through donations, which are authorized under the bill.

The legislation also authorizes the development of a hospital recognition program in collaboration with the Perinatal Advisory Council. This component of the bill is also expected to be implemented without significant additional cost, under the assumption that DSHS and the Health and Human Services Commission can utilize current resources for rulemaking and program management. Additionally, no significant fiscal impact is expected at the local government level, suggesting minimal burden on municipal or county hospital systems participating in the program.

HB 37 represents a compassionate and well-structured effort to ensure that families who suffer the tragic loss of a child during pregnancy or shortly after birth receive meaningful, consistent, and respectful care across Texas hospitals. It creates a perinatal bereavement care initiative within the Department of State Health Services (DSHS) to improve the availability of bereavement support, including counseling and specialized devices that allow families time to grieve with their child. The bill also establishes a hospital recognition program to encourage and acknowledge excellence in bereavement care.

This legislation reflects a limited and targeted approach to addressing a significant gap in Texas’s maternal health system. Currently, no standardized statewide framework exists for this type of support, leaving many families without access to the compassionate care they need during one of life’s most painful moments. By focusing only on hospitals already designated for maternal level care, the bill narrowly applies to institutions that are already regulated under the Texas Health and Safety Code. Importantly, HB 37 imposes no new regulations on private businesses, individuals, or general employers, and its scope is carefully confined to a specific class of medical facilities.

From a fiscal standpoint, the Legislative Budget Board has determined that the bill poses no significant cost to the state. The program would be implemented using existing infrastructure—namely, the TexasAIM maternal health initiative—and the bill explicitly allows for the use of donations, grants, and appropriated funds. While some may be concerned about the potential for future budget growth or dependency on public funds, the bill’s design allows the legislature to control the scale of the program through the appropriations process. Grants to hospitals are authorized, not mandated, and DSHS retains discretion in targeting resources to the hospitals with the most need.

It’s reasonable for limited-government advocates to raise questions about even modest expansions of state programming. There’s always a risk that what begins as a small, well-targeted initiative could evolve into a larger mandate or line-item in future budgets. However, in this case, the bill is written with restraint. It creates a non-compulsory initiative and a recognition program, not a regulatory regime. It also maintains a strong respect for voluntary participation and local implementation, giving the state a light but supportive touch.

Finally, this legislation aligns with core liberty principles in several key ways. It enhances individual liberty and personal dignity by offering bereavement services without coercion. It supports personal responsibility by equipping families and healthcare professionals with tools to navigate grief in a constructive, respectful manner. It does not encroach on private property rights or restrict economic activity, and it maintains a limited-government framework by avoiding sweeping mandates or broad taxpayer burdens.

While some philosophical concerns about state scope and future funding are valid and should be revisited in future budget cycles, the present version of HB 37 strikes a reasonable, humane balance between compassion and constraint. It reflects prudent policymaking in service of families at their most vulnerable, and as such, Texas Policy Research recommends that lawmakers vote YES on HB 37.

• Individual Liberty: The bill enhances individual liberty by ensuring that grieving families have access to supportive services and options, rather than being left to navigate profound loss on their own. Importantly, the bill does not mandate the use of bereavement counseling or devices; it simply requires hospitals already designated for advanced maternal care to make these options available. Families retain full autonomy in whether or how to engage with the support offered. This preserves liberty while promoting dignity and compassion in medical care.
• Personal Responsibility: By equipping medical professionals with tools and training to support families during perinatal loss, the bill reinforces personal and professional responsibility. Hospitals and providers are expected to treat these moments with the respect and sensitivity they deserve, and families are empowered to process loss in a setting that acknowledges their grief and provides informed choices. It promotes responsible care practices and avoids paternalistic intervention.
• Free Enterprise: The bill does not interfere with market competition or introduce new regulations that would inhibit private enterprise. It applies only to hospitals already licensed and designated under maternal care rules, and it allows for participation in a recognition program that could, in fact, incentivize innovation and voluntary excellence in care. The bill does not dictate pricing, restrict private providers, or interfere with business practices outside this narrow scope.
• Private Property Rights: There is no impact on private property rights. The bill neither restricts the use of property nor imposes eminent domain or other government action on private owners. It deals solely with standards of care in hospitals operating under existing state licensure and maternal care regulations.
• Limited Government: This principle requires more careful consideration. On the one hand, the bill does expand the role of government by creating a new initiative within the Department of State Health Services. However, the expansion is narrow, non-intrusive, and fiscally restrained. It does not involve new taxation, enforcement agencies, or broad mandates. The initiative is flexible and subject to appropriations, meaning the legislature retains control over its growth. Furthermore, the bill allows for donations and grants to fund the program, reinforcing a limited-government approach by encouraging private-sector partnerships rather than full public funding.

• HB 2058 (Same As)