According to the Legislative Budget Board (LBB), the fiscal implications of HB 5155 are minimal at the state level. The bill directs the Health and Human Services Commission (HHSC) to continue implementing the Maternal Opioid Misuse (MOM) model of care, but only to the extent that funding is available. Importantly, the bill allows for the use of funds from the opioid abatement account to support this program. These funds originate from settlements related to the opioid crisis and are designated for remediation purposes, thereby reducing the need for new state appropriations.

The LBB’s fiscal note concludes that no significant fiscal implication to the State is anticipated. This is based on the assumption that HHSC could absorb any costs associated with the bill within existing resources, especially given the ability to use dedicated opioid abatement funds. This mitigates budgetary risk and makes the bill fiscally conservative in its implementation approach.

Additionally, the LBB found no significant fiscal impact on local governments, indicating that counties and municipalities would not bear any new administrative or financial burdens as a result of this legislation. Overall, the bill offers a fiscally neutral approach to extending a targeted healthcare intervention, leveraging pre-existing financial structures without expanding government expenditure.

HB 5155 continues a program originally launched through federal funding—the Maternal Opioid Misuse (MOM) model of care—that seeks to improve health outcomes for pregnant and postpartum women with opioid use disorder and their children enrolled in Medicaid. The bill authorizes the Health and Human Services Commission (HHSC) to continue implementing the program, but only if funding is available. Specifically, it allows for money from the opioid abatement account, derived from opioid-related legal settlements, to be appropriated to support the program's operations.

The bill includes important guardrails, such as a sunset provision on September 1, 2029, and makes implementation conditional on available funds, with no mandate if appropriations are not specifically made. According to the Legislative Budget Board, the bill would not have a significant fiscal impact on the state or local governments, as any associated costs could be absorbed with current resources or existing settlement funds. Additionally, the bill imposes no new regulations on individuals or businesses and avoids growing the scope of government or expanding taxpayer obligations in the near term.

However, while the bill is fiscally neutral in the short term, concerns remain regarding its long-term implications. The opioid abatement funds are limited and finite. Once those settlement dollars are depleted, the state could face pressure—either politically or administratively—to sustain the program using general revenue funds or to incorporate it as an ongoing Medicaid service. Without a statutory funding limitation, the bill creates an open pathway for a de facto expansion of Medicaid coverage and spending in future sessions. While not an immediate budgetary threat, this potential makes it difficult to fully endorse the measure without additional financial off-ramps or restrictions.

Because of these concerns, Texas Policy Research remains NEUTRAL on HB 5155, reflecting a balanced position: support for the health and humanitarian goals of the program, tempered by the need for stronger long-term fiscal safeguards. The bill would be significantly improved with an amendment that limits implementation strictly to non-general revenue sources and includes a mandatory sunset trigger should opioid settlement funds be exhausted before the current expiration date.

In summary, HB 5155 represents a well-intentioned and limited health intervention but requires further clarity to ensure it does not result in the unintended expansion of government or new obligations for Texas taxpayers in future budget cycles.

• Individual Liberty: The bill supports individual liberty by expanding voluntary access to healthcare services for a specific and vulnerable population: pregnant and postpartum women struggling with opioid use disorder. Participation in the program is not mandatory; it empowers women on Medicaid to seek treatment and improve outcomes for themselves and their children without coercion or loss of autonomy. This approach respects personal medical decision-making while addressing a public health need. There are no restrictions placed on individuals or private actors as part of this program.
• Personal Responsibility: By facilitating access to treatment and support during and after pregnancy, the bill encourages women to take personal responsibility for their recovery and the well-being of their children. However, there is some tension in using public resources—albeit from settlement funds—to sustain personal healthcare choices, which may be viewed by some as diminishing individual accountability if extended indefinitely or expanded through general revenue. The bill’s short-term approach, based on pre-existing harm settlement funds, leans toward enabling responsibility rather than subsidizing dependency.
• Free Enterprise: The bill does not interfere with private healthcare markets, nor does it impose new regulations or mandates on providers or businesses. It could indirectly benefit private treatment facilities or nonprofit providers by offering more Medicaid-funded clients, but it does not create competitive disadvantages or barriers. It operates within the existing Medicaid system and leaves private enterprise undisturbed, making it largely neutral in its impact on this principle.
• Private Property Rights: The bill does not touch land use, eminent domain, civil asset forfeiture, or any other area related to private property rights. It strictly addresses healthcare service delivery within Medicaid. As such, it has no effect, positive or negative, on this principle.
• Limited Government: While the bill includes important limiting provisions (a 2029 sunset clause, conditional implementation tied to available funds, and no mandate to act without appropriations), it raises red flags for limited government advocates due to the potential for future program expansion. Once created or continued, state programs—especially in healthcare—are often politically difficult to wind down. If opioid abatement funds are depleted and the program is continued or expanded using state general revenue or broader Medicaid authority, it could undermine the principle of limited government. Without a strict funding limitation or automatic off-ramp, there is a possibility that a targeted program today becomes a recurring state obligation tomorrow.