This is the fourth story in our Collateral Damage series examining the impact of family planning cuts in Texas. You can read the third story in the series here.
Texas lawmakers have spent the past two years attacking family planning services in the state, cutting funds for programs that provide women with birth control and wellness exams. Now family planning advocates are fighting back.
A coalition of providers plans to bypass Gov. Rick Perry and the Texas Legislature and apply directly to the federal government for family planning funds. If the coalition wins the federal grant—called Title X (Title 10)—a slice of Texas’ family planning money would no longer go to the state health department—and would no longer be subject to the whims of the Legislature. Instead, the coalition, organized by Fran Hagerty of the Women’s Health and Family Planning Association of Texas, would distribute the money to family planning providers statewide, including perhaps Planned Parenthood, and restore services to tens of thousands of Texans.
Since 1982, the Department of State Health Services has received Title X grants in Texas, though any group can apply to the federal government for the money. The department then distributes the money, alongside cash from other federal and state grants, to providers delivering family planning and preventive care. The Title X grant is worth $14.5 million per year, part of the $111.5 million pot of money the state had to spend on family planning.
However, in the 2011 legislative session, state lawmakers slashed that $111.5 million by two thirds. To institute the deep cuts, lawmakers grouped family planning providers into a tiered system to determine which clinics were eligible for the remaining cash. It was a funding formula designed to disqualify Planned Parenthood from getting any family planning money. But there were unintended consequences: Many non-Planned Parenthood clinics ended up in the lowest priority tier too. Effectively, all providers in the bottom tier stopped receiving money, including Title X funds, for family planning.
The effects have been devastating. By the summer of 2012, more than 60 family planning clinics had closed across the state—many of them independent clinics that had no connection to Planned Parenthood. Meanwhile, the number of Texans receiving services through Title X has dropped by 50 percent since last year, according to an annual review by the Texas Department of State Health Services.
If Hagerty’s coalition wins its bid, the Title X allocation will be shared more equally with a wider array of providers across Texas. This could bolster struggling clinics and restore access to birth control for 90,000 women and men.
“There is great potential here to make a difference,” Hagerty said. She added that, after a difficult two years for family planning services in Texas, applying directly for federal funds is “the first ray of light.”
Why Title X matters
At $14.5 million per year, the Title X grant comprises only a small slice of Texas’ annual family planning budget. But it’s worth much more than its dollar value. That’s because Title X money comes with a confidentiality clause not always attached to other funding streams. This means that providers need only $1 from Title X to cast privacy protection over all their clients, especially teens who would otherwise need parental consent to access birth control.
Similarly, Title X recipients get a discount on pharmaceuticals. With this discount, clinics can buy drugs at half the wholesale cost. Again, just $1 of Title X casts this discounted rate over every drug purchased by the clinic. That often helps clinics prescribe the more effective, yet more expensive, types of birth control.
The protections afforded by Title X demonstrate how complex and delicate clinic funding arrangements are. Having it means that some providers, whose clinics teeter on the edge of financial viability, could continue operations. “When providers lost Title X funding, they lost much more than just the money,” Hagerty said. They also lost their patient confidentiality, discounted drugs and the more discretionary spending that Title X allows. Restoring those protections to providers is what Hagerty said gave her the impetus to take the project on.
Carole Belver, executive director of Community Action Inc. of Central Texas—a family planning provider in Hays, Caldwell and Bastrop counties—is hopeful. Recent funding cuts have caused six of her clinics to close, and of the two that remain, one is on the verge of collapse. Without discounted drug prices, her clinics can’t afford to dispense long-acting contraception; without the confidentiality protection, teens must gain parental permission for birth control; without the discretionary power of Title X spending, she can’t serve any women outside the strict eligibility requirements of her remaining funding source, the Women’s Health Program. Belver’s organization has joined Hagerty’s coalition, and she hopes that, in winning the grant, her clinics will once again receive Title X funds. “It means that we’ll probably be able to continue to provide service to our clients,” she said. “This will mean a lot.”
Not an easy process
The Title X grant operates on a three-year cycle and is up for renewal next year. Hagerty’s coalition has till December 31 to submit its application to the federal government. “The grant-writing process is heavy lifting,” she said, because applicants must detail every provider and every population they will serve. This means that Hagerty must recruit the entire network of providers before she can submit the grant.
This is not easy. “Some providers are taking a ‘wait and see’ attitude,” she noted, but emphasized that it isn’t in their interests to do so. Title X can fund only those providers named in the application.
It’s not unprecedented for Texas non-profits to apply for parts of the Title X grant, but Hagerty’s coalition is different because it’s applying for all the money. Hagerty acknowledged that the federal government might choose to give Title X money to multiple grantees, which is why she thought it crucial that providers sign up for all grant applications. “You never know whom the federal government might choose,” she said.
The state health department is competing for the money as well. When asked what impact the loss of Title X funds would have on the state health department’s family planning efforts, spokesperson Carrie Williams’ email reply was sanguine: “Title X dollars pay for the vast majority of our agency’s family planning program. If those dollars go elsewhere, we wouldn’t be able to provide family planning services out of our agency, but they’d be provided by whoever gets the award for Texas.”
Rolling back the clock
Hagerty hopes to win the entire Title X grant, and in doing so, roll back the clock. She’s trying to recruit as many of the original providers who received Title X funds before the 2011 cuts as possible. “The recruitment process is going well,” she said but, for confidentiality reasons, declined to say whether Planned Parenthood had signed up.
When asked about their participation in the bid, Sarah Wheat, vice-president for community affairs for Planned Parenthood of Greater Texas, said in an emailed statement that Planned Parenthood didn’t have specific comments yet. But she added: “Considering that Texas politics have directly interfered with the [Department of State Health Services’] ability to provide vital health care exams and services to uninsured Texans, I hope that these funds can be used more effectively in the future.”
But Hagerty remains upbeat about her efforts. “There’s everything to gain and nothing to lose” from the bid she said, adding that it felt good to reclaim some control. She went on: “If we’re not selected as the grantee, then the status quo continues. The losses have already occurred. We’re at the bottom now. Things can only change for the better.”