Fewer Women Served Under Texas Women's Health Program

As expected, the number of women served by the state-funded Texas Women's Health Program – designed to preclude women from obtaining services from Planned Parenthood – has at midyear served significantly fewer women than were served by the previous program, funded by the federal government and including Planned Parenthood.

As of June 1, the Health and Human Services Commission had processed 79,663 claims for family planning and reproductive health services provided under the TWHP, 77% of the claims processed during the first five months of 2012 (and just 71% of the total claims posted for the same time period in 2012), when the program was known as the Women's Health Program and included Planned Parenthood as a service provider.

The WHP was originally conceived as a way to provide basic family planning and health services for low income women who would not be eligible for care subsidized by Medicaid unless pregnant. Under the old WHP, for every $1 invested by Texas, the feds kicked in $9; the program saved the state millions each of five years it was operational. Moreover, the WHP was designed to help reduce the costs associated with Medicaid births in Texas; more than half of all births in Texas are paid for by Medicaid, which in 2009 alone cost the state some $2.9 billion.

Planned Parenthood was the single largest service provider under the original WHP, serving more than 40% of the up to roughly 130,000 women enrolled in a single month. But as part of the coordinated efforts since 2011 (though the stage was set years earlier) to deny Texas women the ability to seek care from Planned Parenthood, conservative Texas lawmakers initiated the rewriting of rules for the WHP in order to exclude Planned Parenthood from participation. That was accomplished by redefining the term "affiliate," such that all Planned Parenthood family planning clinics would be considered affiliated with Planned Parenthood clinics that perform abortion, based largely on the fact that they share the same name. The change was successful – although, because it violated federal law, it caused the state to lose the 90% funding the program had enjoyed. Gov. Rick Perry said the state would go it alone under a rebranded Texas WHP, and without the funding, and so the state has – but without reaching nearly as many women as did the original program. Notably, none of the Planned Parenthood clinics that participated in the WHP provide abortion care; and, as a program designed to prevent unwanted pregnancy, the WHP did not cover abortion care.

According to enrollment numbers for 2013, the number of women participating in the program has steadily declined each month this year, to a low of 96,686 enrolled and eligible to receive services in August. The number of claims that have been submitted for services rendered have also declined significantly; in April the program posted its highest numbers, with 16,499 claims versus 20,442 made in 2013 – or 81% of those served in 2012.

Still, HHSC is confident that women are still being served: "We expected to see a drop off in the number of claims when we moved to the state program because we knew some women wouldn't want to change doctors" – that is, leave Planned Parenthood – HHSC Communications Director Stephanie Goodman said in a statement. "We've been able to find new doctors for women who call us, and we've got the capacity to increase the number of women we're serving in the state program." Why it is that enrollment continues to decline, then, is unclear.

Goodman also notes that the monthly numbers released yesterday don't necessarily reflect what will be the final number of claims made for each month; under the rules providers have 95 days to submit a claim for service and 120 days to appeal a claim. In essence, Goodman says, it takes six to eight months for the claim data to become final.

This billing cycle is the same as under Medicaid, and as such the change in claims from preliminary data to final data for 2012 – when the WHP was an actual Medicaid program and PP was a program participant – may prove informative. For example, for January 2012 claims paid through June 2012, HHSC posted 23,407 claims; in total for January 2012 the agency paid out on 23,692. Meaning that in January alone, the midyear count represented 99% of all claims paid. The comparison is similarly high for preliminary and final claims for February and March 2012. In other words, it seems fair to suggest that numbers for 2013, at least through March, are likely similarly settled. For January 2013, claims paid amounted to just 75% of those received in January 2012; in February, it paid 76% of claims, compared to February 2012; and for March 2013, the agency paid out just 70% of the total number of claims it paid in March 2012.

Sarah Wheat, vice president for community affairs for Planned Parenthood of Greater Texas, which includes Austin's clinics, is not surprised by the data. "We know that politics is bad medicine for women's health and the latest data from the state show that, once again, women in Texas have been cut off from vital health care exams and screenings," she said. "The Medicaid[-paid WHP] was one of those health programs that worked – it made sure that uninsured women had access to health screenings, HIV tests, and birth control to plan and space their pregnancies, and it saved the state public health dollars," she continued. "To score political points...Perry dismantled this program and dictated where women could receive their exams and birth control. Texas women lost access to cancer screenings and annual exams, and the taxpayers lost federal funding and savings from this program – that is what happens when politics drives public health."