State Blackmail on Health Care Funds?

Texas may force providers to choose between Title X and state health care funds

Fran Hagerty is CEO of the Women's Health and Family Planning Association of Texas, which earlier this year won the right to allocate millions of dollars in federal ­family planning ("Title X") funding that had previously been granted directly to the state for allocation. Clinics that shuttered due to the devastating budget cuts of 2011 are slowly beginning to reopen, serving some of the more than 100,000 women who lost services as a result of the cuts. In all, 60 providers shuttered operations – and while only three clinics have announced reopening, says Hagerty, "It's turning the corner and going in the right direction."

But Hagerty says that some of the more than three dozen providers who initially signed on to her network have withdrawn, because the state of Texas has informed providers that if they choose to avail themselves of the Title X funds, they might jeopardize their eligibility for any funding from the state – specifically, funds put back into the 2013 state budget to support reproductive health and family planning services. The Depart­ment of State Health Services, which previously administered Title X funds, is apparently warning providers there might be consequences for accepting the new Title X funding from the WHFPT.

The federal government allowed DSHS to continue to grant Title X funding left over from its final funding cycle – $2.3 million to be spent before Aug. 31. Hagerty says that set up a conflict for some providers who'd joined the WHFPT network when the group applied last year to accept all Title X funding; the network proposed that it could use all the money granted and serve up to 190,000 clients in the first year, versus 75,160 that DSHS-granted funds served in all of 2012.

Hagerty said she's been told by a number of providers that DSHS officials have told them that they have a choice: continue contracting with DSHS for Title X funds through August and be eligible for other funds – e.g., from the more than $100 million lawmakers are pumping into the state's Primary Health Care Program – or go with WHFPT and possibly lose access to primary care or other state-granted funding opportunities. "They let people know that if they stay with our Title X network," Hagerty said, "they won't be eligible for any other funding." As a result, eight providers have decided to leave WHFPT.

DSHS spokeswoman Christine Mann wrote in an email that due to "limited funding," the state chose to spend its final Title X funds on providers who weren't receiving those funds via WHFPT, "based solely on the need to ensure that these agencies had the ability to continue seeing family-planning clients." Moreover, she wrote, the agency "encourages all entities interested in the expanded Primary Health Care Program to apply for funding, including Title X recipients."

Dr. Peggy Smith, director of the Baylor Uni­versity-affiliated Teen Health Clinic, said she was told that there can "only be one Title X provider" and so with DSHS still technically in the game – if only for a limited time – providers were told they had to choose. "We had to make a choice," Smith said. "We're aligned with the state of Texas."

Mann insisted that the state "strives to expand access to family-planning services whenever possible." To date, however, Hager­ty says she hasn't gotten any concrete indication that the state is interested in collaboration with WHFPT to broaden access. She's hopeful that will change.

For more detail on the WHFPT story, see the Newsdesk blog for Thursday, June 20.

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News, Women's Health and Family Planning Association of Texas, Title X, Primary Health Care Program, Christine Mann, Teen Health Clinic, Department of State Health Services, Fran Hagerty

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