December 16, 2013 — Enrollment in the Texas Women's Health Program, as well as claims for birth control services and wellness exams, have declined since the state prohibited Planned Parenthood clinics and other affiliates of abortion providers from participating in the program, according to data from the Texas Health and Human Services Commission, the Texas Tribune reports (Aaronson, Texas Tribune, 12/13).
Texas in 2011 began enforcing a state rule that barred affiliates of abortion providers from participating in the Medicaid Women's Health Program, which the federal government had financed with $9 for every $1 the state contributed. In response to the state's move, the federal government cut off the funding -- costing Texas more than $30 million annually (Women's Health Policy Report, 8/1).
By law, none of the providers in the program offered abortions, even before the change in state rules. This January, the state launched its own program that excluded Planned Parenthood and other women's clinics that are affiliated with abortion providers (Texas Tribune, 12/13).
In an attempt to mitigate the effects of the funding change and additional cuts to family planning in the 2011 budget, Texas legislators in the 2014-2015 state budget increased women's health funding to $214 million, up from $109 million in the previous budget. Of those funds, $100 million is dedicated to expanding primary care for an additional 170,000 women; $71 million will go toward operating the Texas Women's Health Program; and $43 million will be used to replace the family planning grants that the federal government awarded to another organization to distribute (Women's Health Policy Report, 8/9).
According to the Tribune's analysis of state data, enrollment in the Women's Health Program declined from 127,000 in January 2012 to 110,900 in May 2013.
The number of reimbursement claims for contraception declined by 38%, while the number of claims for wellness exams decreased by 23%. Claims for long-acting, reversible contraceptives dropped by 17%. In addition, claims for barrier methods, such as condoms or diaphragms, declined from 25,535 in 2012 to 15,318 in 2013, while claims for hormonal methods decreased from 48,674 to 27,380.
The data also showed that claims for some services increased. Sterilization claims increased from 781 in 2012 to 1,041 in 2013, while claims for education and counseling increased from 135 to 373. In addition, the number of providers participating in the program increased from 827 to 877, according to the state figures.
Texas Health and Human Services Commissioner Kyle Janek said, "There can still be some pockets where we don't have a provider and we did before," adding, "Planned Parenthood may have been the only game in that area." According to the Tribune, Planned Parenthood provided 40% of Women's Health Program services in 2012, and the program has struggled to replace those providers in some parts of the state.
Janek argued that birth control services have not declined as much as the claims data suggest. He said the majority of providers that replaced Planned Parenthood clinics are physician groups that direct consumers to pharmacies to fill their prescriptions, rather than distributing them on-site like family planning clinics do.
Janek also said the lower number of claims for long-acting reversible contraceptives was the result of the state not paying providers enough to cover the procedure, a mistake that he said has been corrected.
According to the Tribune, the state is conducting targeted outreach to boost enrollment in the program. State officials said program enrollment increased by more than 9,000 women after the state sent out mailers in October and November to women who are registered with other state programs.
Mixed Effect on Clinics
Some providers said a decrease in Women's Health Program patients has strained them financially, while others said they have easily absorbed new patients who previously received care at Planned Parenthood clinics. For example, Haven Health Clinic in Amarillo saw a 20% decline in the number of Women's Health Program patients between 2012 and 2013, while Parkland Health and Hospital System in Dallas saw an increase over the same time period, from 8,655 patients in 2012 to 9,180 in 2013.
The effects of the 2011 cuts cannot easily be undone, some women's health advocates said. Texas Women's Healthcare Coalition Chair Janet Realini noted, "The Texas Women's Health Program has great potential, but it has not taken off in private practice yet."
Haven Health Clinic CEO Carolina Cogdill said, "We're struggling now, but we'd be out of business if the program closed completely, which would be devastating for this part of the state" (Texas Tribune, 12/13).