Texas Women's Health Care: Costs More, Does Less

The number of clients served by the state's family planning budget dropped dramatically in fiscal year 2012, while the cost of serving those patients actually increased, according to Department of State Health Services records.

According to documents filed with the State Health Services Council agenda for Nov. 28, the state served just 75,160 family planning clients during the 2012 fiscal year, a decrease of 63% over 2011, when more than 200,000 clients were served. Meanwhile, the cost of serving each of those clients rose nearly 15%, from an average of roughly $206 per client per year in 2011 to nearly $237 per client in 2012.

The numbers are just the latest indication of the extent to which last year's gutting of the family planning budget by Texas lawmakers on April Fools Day has hurt low-income and uninsured women who rely on access to family planning services for basic health care. Moreover, the overall numbers statewide seem to indicate that the situation is even worse than it appeared earlier in the year.

In addition to slashing the state's annual family-planning budget by nearly two-thirds – taking every dollar away save for the federal Title X money that is dedicated to family planning and thus cannot be diverted to other programs – lawmakers in 2011 also instituted a new funding matrix, directing the state health department allocation of the remaining roughly $18 million for each year of the 2012-13 biennium. The matrix was designed to exclude Planned Parenthood, even though Planned Parenthood and other specialty family planning providers traditionally provide services to the largest number of clients for the least amount of money per client.

As a result of the new funding matrix, the majority of these clinics, including Planned Parenthood clinics, were shut out from receiving any Title X funding, in favor of first funding “federally qualified health centers” and other public entities that typically cost more – because of their status, and the overhead and fee schedules that come with it – to serve fewer clients. For example, in 2010, FQHCs served just 13% of family planning clients at an average cost of $225 per client, while Planned Parenthood clinics alone saw some 28% of family planning clients at an average cost of just $168 per client for the same services.

It appears that this difference has persisted: in FY2012, the cost rose to nearly $237 per client from the roughly $206 in 2011; in 2010, the cost was $205 per client. But DSHS spokeswoman Christine Mann wrote in an email that the cost increase for service in FY2012 is not related to the constraints of the new funding matrix. As "agencies have started to decrease their capacity and/or size" due to the budget cuts "some infrastructure costs have not decreased at the same rate," she wrote. "This should resolve itself over time and costs should return to previous levels," she continued. "What we're seeing is the result of doing business on a smaller scale."

But Fran Hagerty, CEO of the Women's Health and Family Planning Association of Texas, thinks the matrix is exactly the reason the state is spending more to serve fewer clients. "FQHCs and public entities have the highest costs. That's always been the case. And Planned Parenthood has always had the lowest cost per client," she said. But because the "bottom tier" on the matrix included "all of the specialty family-planning providers" none of the most efficient providers were able to continue serving clients this year. "The lean and mean family planning providers that have been doing this for decades. They're the experts and they've always been the most cost effective. Now we're funding the most expensive and sometimes the least efficient providers."

Moreover, as it turns out, previous numbers provided by DSHS to family planning contractors in October – which reflected that roughly 90,000 clients had been served for the six-month period from December 2011 through May 2012 – also included the number of traditional Medicaid and Women's Health Program clients served by contractors also receiving Title X funds. (In other words, that number included the number of clients the FQHCs and public providers had served not only with Title X, but also via the WHP and other Medicaid funds.) With just more than 111,000 currently enrolled in the WHP, the low number of clients served through mid-year by the state's preferred providers suggests again that these providers – who will be presumably remain in the WHP once Planned Parenthood is excluded (as the state intends will happen by Jan. 1) – appear to be incapable of providing services for the tens of thousands of women who will be left without access to care from their provider of choice.