The State's Planned Parenthood Trap

Sarah Wheat of Planned Parenthood of the Texas Capital Region says PP groups in Texas and Indiana are weathering politically motivated threats to Medicaid funding despite federal government warnings that such defunding is illegal.

Today (Thursday) the state's Health and Human Services Commission's Medical Care Advisory Committee is set to hear public input on a proposed rule that would eliminate Planned Parenthood from providing services under the successful Women's Health Program. Although there seems little doubt that the rule will go through and be implemented later this year, whether it will get the blessing of the federal government is another story.

In a not-so-unexpected move, on June 1, the administrator of the U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services penned a memo to state officials in Indiana to say that their recently enacted scheme to cut PP from receiving any federal Medicaid funding to provide basic health care services would not pass legal muster. "We assume this decision is not unexpected," Dr. Donald Berwick, the CMS administrator, wrote.

Indiana sought to cut PP out of funding – as lawmakers have tried to do here – because in addition to basic preventative care it provides to thousands of low-income women in Indiana, the nearly 100-year-old nonprofit also provides, with private funds, legally protected abortion services. (No federal funds can be used to pay for abortions except in extremely limited circumstances.) The new Indiana law "would eliminate the ability of Medicaid beneficiaries to receive services from specific providers for reasons not related to their qualifications to provide such services," Berwick wrote. "Medicaid programs may not exclude qualified health care providers from providing services that are funded under the program because of a provider's scope of practice." There's no doubt that unless Texas changes its tune pertaining to PP, the state will receive a similar letter from the federal agency.

In addition to making drastic cuts to the state's family-planning budget, the state, at the behest of Sen. Robert Deuell, R-Greenville, is reworking its definition of the word "affiliate" in order to cut PP out of providing health services to women enrolled in the WHP, a Medicaid-waiver program that in 2008 alone saved the state $40 million in Medicaid costs. The program enrolls women for services who wouldn't otherwise be eligible for Medicaid unless they were pregnant. This is no small issue considering that more than half of all the state's births are paid for by Medicaid – at a cost in 2009 alone of $2.7 billion. Currently, PP provides services for some 40% of program patients.

Nonetheless, the HHSC has drafted a new definition of "affiliate" that would ban the state from contracting for WHP services with any provider that also provides elective abortion care. That means PP in general, regardless of whether individual clinics actually provide any abortion services, would be cut from participation – a move that Attorney General Greg Abbott has said should be legal but which seems questionable especially in light of the Indiana memo. The real question is what the state will do if it is told that the new plan to cut PP out of providing services doesn't fly: Unlike the plan to cut PP out of all Medicaid services in Indiana, Texas is seeking to cut PP from a Medicaid-waiver program, a program that must be approved by the feds. The WHP got the nod of the federal government for its first five years, but whether the feds will sign off on the program again with new restrictions seems unlikely. That would leave the state with a choice: dump the new definition of "affiliate" or dump the program. Given state lawmakers' attitude toward women's health issues, it seems safe to bet that they would be more inclined to dump the program. The situations in Texas and Indiana are "definitely related," says Sarah Wheat, interim co-CEO of Planned Parenthood of the Texas Capital Region, "but how it all plays out, I don't know."