Are Women Being Served?
Preliminary numbers from Texas' Health and Human Services Commission show that claims made in January for services provided under the new Texas Women's Health Program lag only slightly behind numbers for the same period in 2012, when the program was Medicaid-paid and included Planned Parenthood as the single largest provider of WHP services.
Whether these numbers say anything about the larger health of the new program, which specifically excludes Planned Parenthood, is unclear. The data is preliminary and, more importantly, incomplete. According to HHSC, as of March 3, 14,124 claims for services provided in January had been received and paid by the state. By March 1, 2012, 14,908 claims had been received and paid for services rendered in January last year. For 2012, those claims represented 63% of all claims ultimately paid for services delivered in January 2012; under payment rules, providers have six months to file paperwork seeking reimbursement.
State officials say they don't know what percentage of all January 2013 claims has been paid. In other words, the numbers could be on track with 2012, or claims could ultimately be either higher or lower than last year. "It's too early to draw any conclusions," HHSC spokeswoman Stephanie Goodman wrote in an email, "but this is a good sign that women still have access to family planning services through the state program."
Indeed, it will be at least summer before a "good picture" develops as to whether the exclusion of Planned Parenthood from participation in the program – coupled with the closure of nearly five dozen additional family-planning providers due to other budget cuts – will have caused a reduction in the number of low-income and uninsured women covered by the program, says Fran Hagerty CEO of the Texas Women's Health and Family Planning Association of Texas.
The original WHP was conceived as a way to provide basic health services to more women than were being served under the state's traditional family planning budget, women who would not be covered by Medicaid unless pregnant. Under the old WHP, for every $1 invested by Texas, the feds kicked in $9, saving the state tens of millions each of the five years it was in operation. Moreover, the program helped to reduce by thousands each year the number of unplanned Medicaid-paid births in the state – no small issue for Texas where more than half of all births are paid for by Medicaid.
Planned Parenthood was the single largest provider of services under the old WHP, serving more than 40% of program clients. But because some Planned Parenthood clinics provide abortions, some state lawmakers sought to have every Planned Parenthood clinic excluded from participation – one argument used by the state posited that allowing the participation of clinics with the name Planned Parenthood somehow dilutes the program's allegedly pro-life message. In reality, the program was devised to reduce unwanted pregnancies; pregnant women are not eligible for the program, nor are clinics that provide abortions.
The move to exclude the clinics cost the state the 90% federal funding – federal law does not allow states to restrict a woman's choice from among qualified Medicaid providers, of which Planned Parenthood is one – and prompted Gov. Rick Perry to commit the state to starting the new state-paid and regulated program that specifically excludes Planned Parenthood from participation.
While paid-claim data will likely provide the best picture of how well the state has done to recruit other providers – and how well those providers are doing at covering the more than 40,000 women that previously received care at a Planned Parenthood clinic – there is some evidence to suggest that the number of women being served has declined more significantly than the preliminary claim data shows. According to enrollment numbers, just shy of 114,000 women were enrolled in the Medicaid-funded program in January 2012, while just less than 110,000 were enrolled in the state-run program in January 2013. Roughly 113,000 women were enrolled in the Medicaid-funded program in March 2012, while currently there are just more than 105,000 women enrolled.