Planned Parenthood Sues Texas Over Medicaid Exclusion

The provider claims the state is breaking federal law

Planned Parenthood supporters rally at the Texas State Capitol earlier this month.
Planned Parenthood supporters rally at the Texas State Capitol earlier this month. (Photo by John Anderson)

Planned Parenthood has filed suit against the state of Texas over its decision to exclude the reproductive health provider from the Medicaid program.

On Oct. 19, citing “evidence of Medicaid program violations” the Office of Inspector General at the Texas Health and Human Services Commission delivered a “termination letter” of Medicaid enrollment to the provider. The decision followed the release of highly edited and widely discredited videos released by the anti-choice Center for Medical Progress, charging Planned Parenthood providers profited off the sale of fetal tissue. The OIG also contends PP engaged in Medicaid fraud, but have provided no concrete evidence.

The class action suit, which features 10 anonymous patient co-plaintiffs including three North Austin clinic patients, was filed in federal district court in Austin this morning, said Planned Parenthood representatives during a press call earlier today. It charges the state with breaking federal Medicaid law under the Social Security Act, which ensures patients have a right to choose their own provider as long as that provider is qualified. Plaintiffs also say the state has violated the 14th Amendment’s Equal Protection clause. The decision, “will cause significant and irreparable harm" to the provider and to the patients, who “will lose their provider of choice [and] will find their family planning services interrupted, and in many cases will be left with reduced access to care,” the suit reads.

The state makes four central claims against the provider, including altering the timing of abortion to procure fetal tissue and failing to prevent conditions that would spread infectious disease – Planned Parenthood adamantly counters all accusations are false. PP Federation of America attorney Jennifer Sandman called the state’s allegations “trumped up justifications.”

Kicking Planned Parenthood out of Medicaid would eliminate $3 million in federal funds and banish at least 13,500 low-income women – including 1,000 Austin clients who come to the clinics each year – from their trusted source of preventive reproductive health care, including birth control, cancer screenings, and STI testing. Planned Parenthood of Greater Texas, which includes three Austin clinics as well as clinics in Waco and Tyler, received more than 10,000 visits for more than 5,000 Medicaid program patients. With half of the Texas centers located in underserved areas, it’s highly likely that if a woman cannot visit PP there is no close option for basic care.

Dr. Hal C. Lawrence, executive vice president and CEO of the American Congress of Obstetricians and Gynecologists, debunked the oft-peddled claim by conservative state officials and lawmakers that ample health providers besides Planned Parenthood exist to adequately serve women. “That is just simply impossible,” said Lawrence. The Texas health care system is far from equipped to handle the level of need, as providers are already overwhelmed and unable to absorb additional patients. As a result of funding cuts made by the Texas Legislature, more than 80 family planning clinics have shut their doors, according to research from the UT-Austin based Texas Policy Evaluation Project (TxPEP). The state’s family planning program served 54% fewer clients than they had before massive cuts to women’s health in 2011, according to a 2014 study published in the American Journal of Public Health by the TxPEP researchers.

Straining the network even further is a shortage of Medicaid providers across the country, he said, and the problem is even worse among OB-GYNS. “Now is the time to look at ways to improve how we serve Medicaid patients, not to make it even harder to find a doctor by removing so many health centers from the program,” said Lawrence. “…We cannot continue imposing barriers to care on women. And when we do it in a way that disproportionately impacts underserved or low-income women, we are growing the health disparities that we should be focused on reducing.”

The move in Texas is part of a strategic nationwide effort, say PP representatives. The provider optimistically notes federal courts have blocked similar attempts in Utah, Arkansas, Louisiana, and Alabama. The 7th and 9th Circuit Courts have also ruled against states that tried to push abortion providers out from Medicaid.

This is just the latest shot in a long string of attacks on the reproductive health care provider: During the most recent legislative session, anti-choice lawmakers banned Planned Parenthood from participating in the Breast and Cervical Cancer Services program. In 2012, the state barred PP from the Medicaid-based Women’s Health Program, sending 50,000 patients scrambling to find another provider. During that time, the provider filed suit to block the rule. In the end, Texas left behind $9-$1 in federal matching grants, subsidizing the program without Planned Parenthood involved. The state’s own calculations revealed around 30,000 fewer women received care through the new, Planned Parenthood-free Texas Women’s Health Program.

One of those Medicaid patients, Kendra Hudson of Houston joined the Monday press call. Hudson says PP helped her detect pre-cancerous cells after a biopsy test and worked on preventing the disease with treatments. She lost her coverage after the Republican-led rule went into effect. “There weren’t real alternatives. I was really overwhelmed. It took weeks or even months to get an appointment somewhere else,” she said. “They were my provider for years. I trusted them and felt comfortable there.” Today, Hudson pays out of pocket for the preventative care that helped save her life.

“Women in Texas today have fewer rights than they did when I was growing up and less access to health care,” said Cecile Richards, Planned Parenthood Federation of America president. “And this time, yet again, they are targeting some of the most vulnerable Texans. These patients are low income, young people, students, mothers, and folks who work multiple jobs and already face enormous hurdles to getting the health care they need.” Indeed, patients who qualify are met with steep requirements: For example, a woman with children qualifies for Medicaid only if she earns up to 15% of the federal poverty level, or $3,013.50, for a family of three, the provider points out.

Patients could lose coverage as early as December 8. Planned Parenthood has asked the courts for emergency relief.

As for the subsequent, unannounced raid of Planned Parenthood offices by state officials conducted just days after the decision to cut them from Medicaid, PP says they are working closely to ensure the request of thousands of patient documents is narrowed to protect patient privacy. “The timing of those inspections shows them for what they are, which was a politically motivated attempt to try to trump up additional basis for termination,” said Sandman, when asked by the Chronicle if the provider would respond to the raid with any legal action. “But at this point the only thing that the administration has claimed against us are false allegations.”

This story has been updated throughout.

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