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Womens Health Program Introduction

Texas Rank Compared to Other States:


Overall Birth Ratei-------------------------------------------------------2nd
Teenage Birth Rate Ages 15-19ii--------------------------------------5th
Percent of Non-Elderly Women Uninsurediii----------------------50th
Rate of Women Aged 40+ Who Received
Mammograms in the Past Two Yearsiv-----------------------------42nd
Rate of Women Aged 21-64 Who Received
Pap Smears in the Past Three Yearsv------------------------------42nd
Breast Cancer Ratevi

-----------------------------------------------------49th

Cervical Cancer Ratevii--------------------------------------------------Tied 6th


Women Needing Contraceptive Services and Suppliesviii-------2nd

In 2011 the state legislature cut the state budget for family planning by two thirds to $37.9 million
dollars and changed the way the funds were distributed.ix After the 2011 legislative session the Texas
Health and Human Services Commission began enforcing the affiliate rule.x This effectively barred
Planned Parenthood from receiving state funds for womens health because of their affiliations with
abortion performing clinicsxi.

76 medical facilities in the Valley have closed or stopped providing services due to a lack of
funding.xii 39% percent of the closure affected specialized family planning clinics.

Clinics that didnt close were forced to make staff and other budget cuts resulting in fewer
services and an inability to meet the demand generated by closures.xiii

28% of clinics funded by Texas Department of State Health Services closed by 2012.

Statewide in 2012, 144,000 less women were provided with family planning services than in
2010. The number of women in the Valley seeking family planning services from DSHS
funded clinics fell from 19,595 in 2010 to 5,470 in 2012.xiv

In, 2013 the state legislature passed HB2 which imposed harsh regulations on clinics that provide
abortions, forcing the closure of clinics in Texass rural and underserved area. Regulations on doctor
admitting privilege and strict standards on facilities have now removed services provided by these clinics,
not limited to abortion. The damage done by the 2011 legislative session has been staggering and results
of the budget cuts are having real effects on the lives of Texans, particularly those in medically
underserved areas.

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WHP Overview
The Womens Health Program (WHP) provides low-income, uninsured women who would qualify for
Medicaid if pregnant, with family planning services including well womens exams and birth control. The
purpose of the program is to help reduce the number of unintended pregnancies through awareness
and access to contraception.
The Medicaid WHP in Texas was started in January 2007. The 79th Texas Legislature passed SB 747 in
2005 directing the Texas Health and Human Services Commission to establish a five-year demonstration
project to improve and expand access to family planning services for women. The program was funded
with a 9-to1 federal match through the Medicaid program. Since the inception of the program, the WHP
prohibited abortion providers from participating as a contract provider of the program.
Helping women and families prepare and plan for a family when they decide the time is right is critical to
a healthy pregnancy, a healthy baby and reducing unintended pregnancies. In 2011, prior to massive
budget cuts taking effect, the Womens Health Program and the Department of State Health Services
(DSHS) Family Planning Program served over 330,000 low-income women.
Provider Controversy
Primarily in an effort to eliminate Planned Parenthood from receiving any state dollars or participating in
state run programs, the state took shortsighted actions to strip funds from family planning efforts in the
2011 Legislative Session. By 2013, the massive budget cuts in the 2012-13 biennium to DSHSs Family
Planning Program left over 170,000 low-income women without access to preventative and family
planning services because of reduced capacity and closure of at least 56 specialized clinics.xv

Patients Served
2011

WHP

127425

2013

108522

202968

65000

DSHS Family Planning Program


0

50000

100000 150000 200000 250000 300000 350000

WHP

2013
108522

2011
127425

DSHS Family Planning Program

65000

202968

Source: Texas Health & Human Services, Department of State Health Services, Legislative Budget Board
Estimates

On top of the budget cuts, the state lost crucial federal matching funds to the WHP due to the decision
by the state to prohibit certain providers from participating in the program. After years of attacking
Planned Parenthood and similar entities and attempting to expel the organization from the Medicaid
Womens Health Program, the Republican led pressure prevailed in 2013. Expanding on a budget
requirement, S.B. 7, 82nd Legislature, First Called Special Session included a change in statute to further
prohibit any funds spent on the WHP or a successor program from being used to perform or promote
elective abortions or to contract or be affiliated with an entity that performs such services officially
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banning Planned Parenthood and other providers from the program.


Planned Parenthood provided services to over 40,000 patients through the WHP in 2012. The last year
the organization participated in the WHP. xvi
The Texas Legislatures decision and state agency rules that were adopted as part of S.B.7 created a legal
and public opinion battle that not only resulted in the state losing federal matching funds for the WHP
but also led to DSHS losing Title X funds for their family planning programs. The federal government
decided in 2013 to instead award Title X (Family Planning Block Grant) to the Womens Health and
Family Planning Association of Texas, a private network of publicly funded family planning providers.
Transition to Texas Womens Health Program
In the aftermath of the states decision to expel Planned Parenthood from the WHP, the state reworked
the program as the Texas Womens Health Program and transitioned to state funding only on January 1,
2013. The state also broadened the services covered under the new program, which was underway prior
to switching over to general revenue only, by adding testing and some limited treatment for sexually
transmitted diseases. xvii
According to the Health and Human Services Commission and Department of State Health Services, the
agencies have been working overtime to increase recruitment of physician groups to fill the provider
void for family planning services. The state appropriated $71.3 million for the program in the 2014-15
biennium, fully replacing lost federal funding with general revenue. Although the WHP did not face
major budget reductions, the overall reductions to family planning services and ousting Planned
Parenthood, the WHPs largest provider, damaged capacity for services and the infrastructure of
providers available to perform services, especially in already underserved areas.
In January 2015, HHSC released a study on the effects of the cuts to the WHP. It found that the new
program served 12,000 fewer women and that the 103,000 fewer claims were processed for oral
contraceptives.xviii
This reduction in family planning services also results in a much larger increase in Medicaid covered
birth costs. The Legislative Budget Board estimated the new cost of unplanned pregnancies to reach
$200 million, $98 million of which would come from General Revenue.xix
In 2015, the state began further consolidation of womens health programs into one, larger program,
and appropriated even more funding.xx Even with the hundreds of millions of dollars in new dollars that
are being spent to offset the loss in federal funding, it is clear that the program fails to function at the
same level as the previous program that included Planned Parenthood.
Many Texas low-income women depend on these programs for family planning services and primary
care services that include contraception, STD testing and physical exams that include diabetes screening,
mental health, and breast and cervical cancer exams.
The demand for services and strain on the health network will only continue as the Texas population
grows and the state continues to limit qualified providers. Texas lawmakers need to fully support the
efforts of these programs that are crucial to empowering women to live healthier lives.
Ultimately, the legislature chose to make a political decision in 2011 to remove Planned Parenthood
from the WHP and attack funding for contraceptive. The state doubled down in the 2013 and 2015
legislative sessions, despite broad evidence that decision was ill advised. In return, the state is spending
hundreds of millions of additional dollars to provide fewer services to fewer women.
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Texas should restore the funding to the Womens Health Program, remove the affiliate rule, and reenroll
in the federal program to again draw down the 9-1 match in dollars.

US Centers for Disease Control & Prevention. National Vital Statistics Report, 62(09), Births: Final Data for 2012. Online. Available at:
http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf. Page 36.
ii Id. Page 6.
iii The Henry J. Kaiser Family Foundation. Uninsured Rates for Nonelderly Adults by Gender, 2013. Online. Available at:
http://kff.org/uninsured/state-indicator/rate-by-gender/.
iv
The Henry J. Kaiser Family Foundation. Percent of Women Age 40 and Older who Report Having Had a Mammogram within the Past Two
Years, 2013. Online. Available at: http://kff.org/womens-health-policy/state-indicator/percent-of-women-age-40-and-older-who-report-havinghad-a-mammogram-within-the-past-two-years/.
v The Henry J. Kaiser Family Foundation. Percent of Women Ages 21-64 who Report Having Had a Pap Smear within the Past Three Years, 2012.
Online. Available at: http://kff.org/disparities-policy/state-indicator/percent-of-women-ages-21-64-who-report-having-had-a-pap-smearwithin-the-past-three-years/.
vi US Centers for Disease Control & Prevention. United States Cancer Statistics. Rankings by State, Female Breast, 2011. Online. Available at:
http://apps.nccd.cdc.gov/uscs/cancersrankedbystate.aspx.
vii Id.
viii Guttmacher Institute. Contraceptive Needs and Services: National and State Date, 2012 Update. Online. Available at:
http://www.guttmacher.org/pubs/win/contraceptive-needs-2012.pdf. Page 11.
ix Physicians who worry about Womens access to care; www.texmed.org/template.aspx?id=24707#sstash.cp6romcl.dpuf
x

Act effective Sept. 1, 2005, ch. 816, 1(h), 2005 Tex. Gen. Laws 2818
Planned Parenthood Assn of Hidalgo Cnty. Texas Inc. v. Suehs, 828 F.Supp.2d 872
xii
Legislature Restores some family planning cuts; NYT, nytimes.com/2013/08/09/us/legislature-re-stores-some-family-planning-cuts.html
xiii
Texas Policy Evaluation Project; Survey of Reproductive Health Clinics in Texas, www.utexas.edu/cola/txpep/_files/pdf/txpep-researchbriefsurveyofreproductivehealthclinics.pdf
xiv Texas Policy Evaluation Project
xv Pogue, Stacey. Sizing Up the 2014-15 Texas Budget: Family Planning. Center for Public Policy Priorities. 15 August 2013. Pg. 1. Accessed
March 2014. Available online at http://forabettertexas.org/images/HC_2013_08_PP_Budget_FamilyPlanning.pdf.
xvi Aaronson, Becca. Interactive: Are There Enough Providers in the Texas Women's Health Program? Texas Tribune. 21 January 2013.
Accessed online March 2014. Available online at http://www.texastribune.org/library/data/texas-womens-health-program-survey-providers/.
xvii Aaronson, Becca. New Providers Face Obstacles in Texas Women's Health Program. Kaiser Health News and Texas Tribune. 9 January 2014.
Available online at http://www.kaiserhealthnews.org/Stories/2014/January/09/providers-face-obstacles-in-texas-women-health-program.aspx.
Accessed March 2014.
xviii
http://www.hhsc.state.tx.us/reports/2015/tx-womens-health-program-rider-44-report.pdf
xix http://www.lrl.state.tx.us/scanned/archive/2011/15623.pdf
xx http://www.texastribune.org/2015/09/23/state-womens-health-programs-consolidate-july/
xi

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