Texas Tackles Reweaving a Tangled Repro Health Safety Net Without Planned Parenthood

As Texas consolidates its multi-pronged family planning programs, doctors air their concerns about meeting patients' needs with limited resources.

The waiting room of Planned Parenthood in Waco. Since losing funding through the Women’s Health Program, this Planned Parenthood location relies on private donations and grants to help alleviate the cost for low-income clients.
Jen Reel
Planned Parenthood’s waiting room in
Waco. Since losing public funding for safety net care, the location relies on private donations and grants to help alleviate the cost for low-income clients.

At Wednesday’s Women’s Health Advisory Committee meeting — the second convening of the nine-member committee assembled to help bureaucrats navigate the consolidation of Texas’ reproductive health safety net — state health officials laid out which services will be covered through the new Healthy Texas Women program — a consolidation of what is now the Texas Women’s Health Program (TWHP) and the Expanded Primary Health Care program — and the expanded Family Planning Program. The new programs are set to launch on July 1, 2016.

As part of the ongoing retooling process, the state Health and Human Services Commission also announced a two-week public comment period regarding the programs’ benefits, beginning Wednesday.

“We would like everyone’s input on this,” Lesley French, the associate commissioner for women’s health services, told committee members.

Over the next eight months, the committee is tasked with redesigning how the state delivers health services to poor Texans, four years after the Legislature cut family planning funding by more than two-thirds and then created a complicated web of services in the wake of lawmakers’ ouster of Planned Parenthood as a safety net provider.

State officials largely modeled the proposed benefits packages after Centers for Disease Control and Prevention’s family planning recommendations, which offer best practices for how providers can offer the most well-rounded menu of family planning services. Both proposed programs will cover contraceptive services, including oral birth control pills, long-acting reversible contraceptive methods (LARCs) such as intrauterine devices and hormonal implants, and sterilization; Pap smears and screenings for hypertension, diabetes and high cholesterol; STI testing and counseling; pregnancy testing and counseling, and postpartum counseling.

The programs will also cover what the state has identified as preventive services related to family planning, but not directly related to pregnancy, such as breast exams and treatment for cervical cancer, and immunizations for communicable diseases and the human papilloma virus. Where the two programs differ are the third type of services: the proposed Healthy Texas Women program would newly cover lab work for things like vitamin deficiencies and other routine tests, while the expanded Family Planning Program would cover prenatal care, previously available through a separate program.

Several doctors on the committee appeared encouraged by the proposed list of benefits, particularly calling attention to the prenatal services and cervical cancer treatment that would be covered, but offered a few suggestions on what else to add: uterine or ovarian cancer screenings, or screenings for colorectal cancer, the third most common cancer among women after breast and lung. They wondered: Will the new programs cover the insertion of a LARC as well as a followup visit? What about lactation services? Providers cautioned that the state must find a balance between making sure family planning services — the core of these programs — are fully funded and accessible, while also providing a wider range of preventive services.

Dr. Moss Hampton, committee member and chair of the OB-GYN department at Texas Tech Health Science Center in Midland, said he wants to see the programs cover more treatment for different types of cancer, as the existing programs only focus on screenings. Sometimes, he said, when physicians find cervical cancer in a low-income or undocumented patient who then needs a hysterectomy, or breast cancer in a patient who then needs immediate radiation or chemotherapy, getting them into treatment is an ongoing challenge.

“It’s hard to find people to take over treatment for those folks, or getting them the appropriate meds. What’s the answer? I don’t know, other than more money, right?” he told the Observer after the meeting. “I think that’s part of the reality of the programs: the margins are so thin on Medicaid rates, sometimes it’s hard to find people who are willing to participate because they’re not making any money, or in some cases are losing money.”

Another feature of the new Healthy Texas Women program is access to birth control for 15- to 17-year-olds, with parental consent. Dr. Janet Realini, vice chair of the committee and director of the Texas Women’s Healthcare Coalition, pointed out that many of those teenagers are already enrolled in the Children’s Health Insurance Program, which offers a wider range of services for adolescents but doesn’t cover birth control. Right now, the state’s eligibility does not allow an individual to be dually enrolled in state health programs, so Realini flagged the issue for the commission to consider.

“I don’t think people would leave that full coverage of CHIP to go to the smaller program,” Realini said. “How will the young woman on CHIP…be able to access contraception?

Committee members also voiced long-standing concerns about participation in the Texas Women’s Health Program, created in 2013 with state funding after the federal government yanked a healthy 9-to-1 funding match when the Legislature booted Planned Parenthood from participating. Realini reminded the group that the number of patients served has dropped.

“There’s a concern about adequacy of provider network,” she said. “TWHP spending has gone down and the numbers of claims have gone down. I wonder if there’s a mechanism to evaluate, monitor that and seek a change in that.”

According to a survey released by the Texas Policy Evaluation Project just hours after the meeting wrapped, 65 percent of family physicians either don’t know what TWHP is, or don’t participate.

French maintains that the problem isn’t access, but messaging. She pointed out that the Legislature increased funding for women’s health services by $50 million in 2015, and in response to Realini’s concern, French said that the commission currently lists 4,664 providers participating in the Texas Women’s Health Program. They aim to add more, via a massive “outreach campaign” about the HealthyTexasWomen.org website, which launched in 2014.

“You should be able to call any [provider listed on website] and get an appointment,” she said. “We have not done any outreach and messaging to make sure that we know that these services are out there.”

But despite the website’s provider listings and the Lege’s funding increase, confusion among women still exists, said Ana Rodriguez Defrates, Texas policy and advocacy director for the National Latina Institute for Reproductive Health. In her work with community health workers and organizers in the lower Rio Grande Valley, Defrates said, patients still don’t know where to go for services, what is and isn’t covered, or they run into problems accessing their preferred method of contraception.

One way to utilize new funds and clear up some of that confusion, she suggested, would be to better utilize promotoras — state-licensed community health workers — who are already working directly with women seeking health care services.

“There’s still an unmet need given the confusion that exists,” she told the committee, calling the promotoras a “real opportunity” to increase outreach and education, “if we can do it in a way that doesn’t take away or detract from providing medical services.”

The deadline to submit public comment on the new medical benefits package is November 9 at 4 p.m. Comments can be sent to HHSC staffer Kristen Gonzales.

Alexa Garcia-Ditta is a staff writer (and former intern) covering women's health, reproductive health and health care access.

Published at 5:59 pm CST