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Texas Women's Health Program Leaves Physician Groups, Patients With Gaps in Coverage

Texas Women's Health Program Leaves Physician Groups, Patients With Gaps in Coverage

January 10, 2014 — Texas physician groups are facing financial obstacles to caring for participants in the state's Women's Health Program, creating problems for both providers and patients, the Texas Tribune reports (Aaronson, Texas Tribune, 1/9).

The state in January 2013 launched its own Women's Health Program after the federal government cut off funding for a previous version because the state barred participation by Planned Parenthood and other affiliates of abortion providers. By law, none of the providers in the program offered abortions, even before the change in state rules. The federal government had financed the program with $9 for every $1 the state contributed, and the loss of the match cost Texas more than $30 million annually (Women's Health Policy Report, 12/16/13).

The new Texas Women's Health Program covers all services covered in the previous program, such as cancer screening, well-women exams and contraceptives. The state broadened the new plan's scope to also cover testing and some limited treatment for sexually transmitted infections.

Physician Groups Absorbing Costs

To fill the void left by ousting many clinics from the plan, the state has recruited new providers -- mostly physician groups -- to participate.

However, while many reproductive health clinics qualify for federal family planning grants to provide services to low-income women, physician groups typically do not receive public money to cover the costs of services that are not included in the Texas Women's Health Program.

While physician groups can absorb some of the additional costs, patients often must pay for uncovered services out of pocket or find a provider that offers subsidized care, according to the Tribune.

Some Services Not Covered

For example, the program will cover Pap tests but does not cover additional treatments if a patient tests positive for the human papillomavirus, according to Emma Moreno, assistant manager at Valley Women's Specialists, which participates in the Texas Women's Health Program. Sometimes the clinic can refer the patient to another provider or set up a payment plan, while other times the provider absorbs the additional cost.

Texas Health and Human Services Commission spokesperson Stephanie Goodman said the agency is examining the concerns. She noted that the agency recently hired a women's health coordinator to work with providers to improve the referral process for patients who need to seek additional services elsewhere (Texas Tribune, 1/9).