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Family Planning Clinics to Seek Federal Funds on Own

Cutting the state out of women's health
Jordan Smith, 6:22pm, Mon. Nov. 19, 2012
Illustration by Jason Stout

It's been a rough few years for the state's family planning providers, who've had to contend with drastic funding cuts and clinic closures – and now they're fighting back. In the new year a group of providers is hoping to take the reins and provide funding directly to providers, cutting the state health department out of the loop.

At issue is who will get Texas' portion of Title X funding from the feds, money dedicated to funding family planning services, and for covering clinics' infrastructure costs. Next year there will be roughly $14.5 million in funds to distribute and Fran Hagerty, CEO of the Women's Health and Family Planning Association of Texas, says her group will be applying for receipt of as much of that pot as the feds will provide. Until 2009, there were multiple grantees in the state, including the Department of State Health Services, which was by far the largest recipient of funds. Indeed, because that was the case the government that year asked if the smaller grantees – including Austin's El Buen Samaritano – if they'd consider forgoing their individual application in favor of receiving funds from the state as a single grantee. They apparently agreed – though that turned out to be a fatal mistake, not only for El Buen, but for dozens of providers defunded last year as a result of the drastic cutting of the overall budget for family planning by lawmakers hellbent on defunding Planned Parenthood.

Some Texas lawmakers have for years considered the defunding of PP their singular goal; last year they cut the roughly $100 million budget for family planning down to just roughly $37 million over the biennium, by taking all the other sources of funding that it could out of the pot. In the end, only the Title X funds were left – and that's only because they are dedicated to funding family planning. Lawmakers also devised a new funding matrix, ranking grantees, and putting on the third tier stand-alone family planning clinics, including PP clinics. The result was not only that PP clinics were denied Title X grants, but also so were dozens of other long-term grantees, not only because they landed on second- or third-tier ranking, but because there simply wasn't enough cash to go around. As a result, by midyear 2012, 50% fewer clients were severed by the state's family planning program that since 2005 has on average seen 244,000 clients per year. The cuts have also resulted in 53 clinic closures so far across the state and to reduced hours at 38 other clinics, according to an article published in September in the New England Journal of Medicine.

To make matters worse, the state last year also began requiring grantees to receive their Title X funds on a fee-for-service basis and not in a lump sum, something that had never before been done, says Hagerty who is heading up the new effort to apply for Title X grant funds in an effort to take over the process of granting funds to the state's family planning providers. Title X is among scarce grant funding that allows funds to be used for infrastructure – like rent and salaries. It's not particularly "warm and fuzzy" to talk about using grant funds to pay for such things, she said, "but it's critical. You have to be able to pay rent before you can provide services." Indeed, she said the reason behind a number of smaller provider closures has been because the providers simply couldn't pay the rent.

Title X also allows for group pricing for birth control, including for the more expensive long-acting reversible methods like IUD's. Without Title X funds many clinics have had to stop providing more expensive forms of birth control or have to charge more for birth control pills. Importantly, Title X funds also come with a confidentiality requirement, which allows women, and particularly teens, to access family planning services without any threat that someone they don't want to know about it will find out.

For all these reasons – and more – Hagerty is working with a team that intends to apply for a Title X grant directly, in order to take charge and allow the family planning program to work without interference from political concerns. The application is due on Dec. 31, and while she won't say how many providers from across the state have pledged to sign on to her group's grant application, she said they will be going after as much funding as possible. (It would stand to reason that PP will go after funding too, since their clinics have been completely shut out of funding this year, save for several extension grants early in the year to cover women in areas where the state didn't have any other provider options.) If the group is successful, she believes it will be a "big step forward" for Texas family planning – that is, in so far as it will return objectivity to the funding allocation and "make it like it used to be in some small way."

The Texas Observer was the first to report on this development in the ongoing fight over family planning, and you can read their coverage here.

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