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Women's Coalition Wins Fed Family Planning Funding

Title X funds stripped from state health department
Jordan Smith, 4:52pm, Mon. Mar. 25, 2013
Illustration by Jason Stout

UPDATE: In an emailed statement, Texas Department of State Health Services spokeswoman Carrie Williams says that the agency just received notice that it will lose the Title X grant and is "reviewing the information to get a sense of the full impact." The agency hopes the transition is smooth and the provider base remains strong, she wrote.

EARLIER: The federal government has pulled from the state of Texas millions in family planning funding, granting the money instead to a coalition led by the Women's Health and Family Planning Association of Texas, which says it can serve a greater number of women with the available funds.

For more than four decades, federal Title X funding has been dedicated to funding family planning services and covering clinics' infrastructure costs. The funds are generally granted to providers (like Planned Parenthood) and/or to state health agencies. In Texas since 1980, the majority of the fundingĀ has been administered by the Department of State Health Services -- roughly $18 million in 2012, for example; since 2009, DSHS has been the sole grantor of Title X funds.

The grant award gives the WHFPT coalition control of the Title X funding for three years; the first allocation for a partial year of services is for $6.54 million. The total yearly amount of funding isn't yet determined because of federal budget cuts, says WHFPT CEO Fran Hagerty. The group's network of providers includes 34 contractors operating 121 clinics across the state. The group has estimated providing care for more than 190,000 women; with federal budget cuts that will likely change, though by how much is still unclear, Hagerty says. "We are all ready and eager for this opportunity to provide family planning care," Hagerty says, and she is "really confident" that her group will be able to begin repairing the damage done to the state's networks of women's health care as a result of recent and drastic cuts to the family planning budget.

Until 2011, Texas had combined its Title X funding with other sources of federal money in order to provide, per year on average, roughly 244,000 low-income, uninsured women with basic reproductive health care, cancer screenings, and birth control – a group of services together referred to as a well woman check. According to the Guttmacher Institute, there are more than 1 million women in Texas in need of these services. Nonetheless, in the last legislative session, lawmakers stripped two-thirds of funding from what had been a roughly $100 million biennial budget for women's health, leaving only the Title X funding – the pot of money it was powerless to divert to other programs. The effects were immediate: nearly five dozen family planning providers shuttered operations and just 75,160 women received services in 2012.

The destructive budget cuts and their impact on the state's infrastructure for women's health began earlier in the decade with a legislative push to try to defund Planned Parenthood, historically among the state's largest providers of women's health services. Although Planned Parenthood clinics had long been among the most efficient and cost-effective providers of women's health and family planning services, some lawmakers determined that because a small percentage of the non-profit's business is in providing abortion care – care provided with private fundsĀ – it should not be allowed to contract with the state or receive any funds at all to provide health services to women.

Lawmakers first tried a more indirect approach, requiring in a 2005 budget rider that allocated the first $10 million per year in family planning money to Federally Qualified Health Centers. That wasn't particularly effective at barring Planned Parenthood from participation because millions went unused by the FQHCs and had to be reallocated mid-year. By 2011, lawmakers just cut straight to the chase by removing all other sources of federal funds from family planning, keeping in place the FQHC-favoring rider, and then crafting a new rider that put in place an even more restrictive funding matrix. Under that scheme, a three-tiered, favored provider plan, Planned Parenthood was placed on the lowest tier of providers, only allowed to be funded if any money remained after first funding FQHCs and other comprehensive community-based providers, like local health departments.

The plan worked to remove most Title X funding from Planned Parenthood, but because so few funds dollars were left at all, it also meant that lots of local health departments and other family-planning specialists were punished too, leading to the record number of clinic closures in 2012.

It was in this environment that WHFPT entered the fray, led by Hagerty, who working with her members to build an impressive coalition of providers across the state – including Planned Parenthood – to apply for, and now to take over, the Title X funds. Indeed, under her group's application for funding, money would be allocated based only on the ability to efficiently serve as many women as possible – a strategy that the state seems to have abandoned. "No one is going to be excluded based on any political consideration," Hagerty told us in February. "When you're not beholden to the Legislature, or to politicians calling you and saying, 'do this, do that,' when you don't have anything else to consider, it's pretty simple: getting women served."

Hagerty got the news about her group's successful application over the weekend, by email. "I am thrilled," she said. "I'm still in a bit of shock about it, but I am thrilled." The group will take over the administration of Title X on April 1.

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