By Stacey Pogue
This week, the Governor and HHSC Executive Commissioner announced a wise decision to continue with the Medicaid Women’s Health Program while courts decide whether the state can exclude Planned Parenthood. The state is postponing plans to convert the program into a fully state-funded program designed to exclude Planned Parenthood, the largest provider of preventive health care in the Women’s Health Program. CPPP applauds this move, which we previously recommended because it will ensure continued access to vital health services for low-income women and to millions in federal matching funds while legal questions are answered.
The Medicaid Women’s Health Program (WHP) provides essential well-woman services including Pap smears, breast exams, and birth control to low-income women. It does not cover abortion. In fact, doctors and clinics who perform abortions have never been allowed to participate in WHP. WHP saves the state over $40 million every year in the cost of unplanned births, and, by reducing unplanned pregnancies, it reduces abortions. WHP accomplishes all of these important goals in the most cost-effective manner for the state—as part of Medicaid, a federal-state partnership. For every one dollar the state spends in the program, the federal government provides nine more.
Federal funding in WHP was jeopardized when Texas wrote new rules designed solely to exclude Planned Parenthood. The Planned Parenthood clinics that participate in WHP do not provide abortion, but the state is trying to exclude them because they “affiliate” with abortion providers. This policy conflicts with federal Medicaid law by denying women freedom of choice to select their own health care providers, and is currently being challenged in court.
HHSC previously planned on converting to a fully state-funded program that excluded Planned Parenthood on November 1, and the agency had just finalized the rules for that new version of the program. CPPP had serious concerns about the program rules HHSC initially proposed. In addition to excluding Planned Parenthood, the proposed rule placed onerous restrictions on participating providers that would have dramatically reduced the number of providers who would participate in WHP, leaving eligible women without access to check-ups, family planning, and contraception. The final rules removed the “gag rule” that would have kept doctors from talking about abortion at all with their patients, even women who are not enrolled in WHP. We will explain other changes to the final rules in a blog post next week.
What stayed the same in the final rules were the provisions to exclude Planned Parenthood if/when the state does transition WHP from Medicaid to a state-funded program. But the providers remaining in the program will simply not have the capacity to care for the tens of thousands of former Planned Parenthood clients. Access through the network of non-Planned Parenthood, safety-net family planning providers has been severely crippled by the legislature’s drastic DSHS family planning budget cuts in 2011. The legislature reduced DSHS family planning funding by two-thirds, ending access for 150,000 low-income Texans. Already 22 percent of clinics (over 50 statewide) that used to be funded by DSHS have closed and another 16 percent have reduced their hours. These recent cuts make it particularly hard for other providers to build needed capacity to meet the needs of women now served by Planned Parenthood.
Access to birth control is central to maintaining the health of women and children and ensuring economic opportunity for families. Women need birth control to reduce high and growing rates of pre-term births, births too close together causing medical risks for the newborn and mother, and births to unmarried teen moms. Birth control to plan the timing and size of families is also critical to ensuring Texas families can escape poverty and join the middle class. With more than half of all Texas births unplanned, our state should be expanding, not restricting, access to birth control.