What's Next for the State Women's Health Programs?

Texas' women's health and family planning programs have been mired in politics and uncertainty in recent years, and they could be in for another big change as a review panel of legislators and policy experts considers a major overhaul of state health departments.

The Sunset Advisory Commission, which is charged with reviewing state agencies every 12 years, is considering combining all five state health departments into one behemoth of an agency. Millions of Texans rely on these agencies for everything from Medicaid and disability services to mental health care. And in the name of efficiency and streamlining administrative costs, the commission may also consolidate the three state women's health and family planning programs.

While women's health care providers and advocates aren't against the idea, the commission must, they say, ensure that services are widely available and low-income women don't miss out on the critical preventive and contraceptive care they need, especially given the ongoing impact of the 2011 budget cuts.

At a mid-November hearing, advocates reminded commission members that major cuts left the safety net in tatters and urged them to take care with the still fragile family-planning provider network. The Republican-orchestrated cuts resulted in the loss of more than $70 million in state funding for family planning and led to the closure of more than 60 clinics, causing thousands of women to lose access to services. The lower Rio Grande Valley was hit especially hard, losing nine out of 32 clinics to the cuts.

In 2013, the Legislature restored just enough money to serve the same number of women prior to the cuts, though the programs are still only meeting about a third of the total need. While the restored funding did allow some clinics to reopen, not all of them can or will.

Dr. Janet Realini represents the Texas Women's Healthcare Coalition, which is made up of more than 40 health care and policy groups. She urged the commission to ensure providers are compensated in a way that allows them to keep their doors open. Currently, some family planning providers in Texas get money from multiple programs to serve low-income Texas women. The Texas Women's Health Program, administered by the Health and Human Services Commission, pays through what's called a "fee-for-service" model, in which providers bill for specific, often less-lucrative, services. The state family planning program, which is run through the Department of State Health Services, grants money upfront, which providers rely on for administrative and operational costs. The program can also reimburse those costs. The commission is considering implementing an across-the-board fee-for-service model for its new proposed women's health program, which could amount to less money for some providers.

"We need more providers and more access," Realini told the Current. "We need a way for a system of grants or cost reimbursement, not simply fee-for-service only ... they need to be able to have both kinds of funding."

Realini said it's also crucial that the providers maintain the ability to determine a woman's eligibility to receive subsidized services onsite, a practice known as "presumptive eligibility." Under the commission's proposed new program, eligibility determination would take longer and could delay services, potentially resulting in unplanned pregnancies or untreated health concerns.

"We need something that helps provide that presumptive eligibility onsite, without a system that penalizes good faith efforts, so that women can be seen when they present for this urgent need, whether it's an infection or need for family planning," she told the commission in November.

The proposed program would extend eligibility to more women by lowering the minimum age from 18 to 15. Amanda Stevenson with the Texas Policy Evaluation Project suggested it expand even more to include women who have been sterilized, who need preventive care like anyone else, and men who want vasectomies. Stevenson also pushed the commission to ensure better access to long-acting reversible contraception such as intrauterine devices and implants. According to Texas Policy Evaluation Project research released over the summer, only 27 percent of the women who want these forms of birth control after pregnancy are getting them.

"Texas has an opportunity to provide women with the methods that they want," she told the commission.

Other groups, including the National Latina Institute for Reproductive Health and NARAL Pro-Choice Texas, urged the commission to do away with the state's parental consent provision, which requires that Texas teens 17 or younger get their parents' permission to receive state-funded contraceptive services. Susan Hays, representing NARAL at the commission hearing, pointed out that the state rule conflicts with the federal confidentiality laws.

"What we have done as a matter of policy in Texas is prevent kids who want effective contraception from getting it," she said.

On top of the 2011 cuts, Republican lawmakers wrote Planned Parenthood out of the state's Medicaid Women's Health Program. The provision is known as the "affiliate ban" because it barred family planning providers that have any association with abortion providers from participating in the program—even if the entities are legally and financially separate, as in the case of Planned Parenthood clinics. The politically charged rule resulted in the loss of a 90 percent match in federal dollars to fund the program. The newly named Texas Women's Health Program launched last year without the single largest family planning provider and now operates solely on state funds. Written testimony submitted by NARAL to the commission suggested repealing the affiliate ban to allow all potential providers to participate in the program.

The final vote for the health and human services Sunset recommendations is Wednesday, December 10. Should the commission approve the consolidation recommendation, the details of the new women's health program will require legislative action, but the reversal of the affiliate ban or parental consent provision might be a tough sell given our Republican-dominated Legislature's penchant for legislating women's bodies.

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