State: Give Us That Medicaid Money We Said We Didn’t Want
Texas lost out on a boatload of money when it declined to expand Medicaid. Now it wants that cash.
Texas health officials are asking the Trump administration to condone Texas' move to kick Planned Parenthood out of a Medicaid waiver program for low-income women, a decision that flew in the face of federal health law. Should they succeed, Texas could forge a national blueprint for other anti-choice states looking to expel the reproductive health network without any legal or monetary backlash.
When the state booted the dominant provider and its 50,000 patients from the joint federal-state Women's Health Program in 2012, they forfeited their right to the fed's 90% share, totaling $35 million each year, because the exclusion violated the freedom of provider choice provision in Medicaid law. (No funds went toward abortion, instead going for basic preventive health care like birth control and cancer screenings for the state's poorest women.) Texas went it alone, financing Healthy Texas Women, a new version of the program, in 2013. Now, audaciously, the state is asking for $405 million over five years, money it originally gave up for sticking to its anti-choice politics. And considering the new administration's stance on Planned Parenthood – and the anti-abortion figureheads now leading the federal health department – they just might get it.
"There is a new administration, and we're looking at what opportunities may exist for us," wrote Carrie Williams, a spokesperson with the Texas Health and Human Services Commission, in an email to the Chronicle. "This is about possible funding options for the state, not about making changes to the program itself here in Texas."
Stacey Pogue, senior policy analyst for Center for Public Policy Priorities, expressed concerns over the Section 1115 demonstration waiver request during the health commission's Women's Health Advisory Committee meeting on May 15. "We have tried for five years to repair the provider network that was damaged with family planning cuts and removing Planned Parenthood," she said. "And that damage still has not been repaired." Indeed, since Planned Parenthood got forced out, the program serves thousands fewer clients ("Report: Texas Women's Health Program Hit Hard," April 3, 2015).
Yvonne Gutierrez, executive director for Planned Parenthood Texas Votes, tells the Chronicle that greenlighting the request is tantamount to "rewarding" bad behavior. "This is the state saying, once again, not only do we not want to include Planned Parenthood, but we want to be validated for our decision to go ahead with a new program that has proven to be unsuccessful without them," she said. If the Trump administration breaks with the longstanding Social Security Act law that cost Texas the funds, it could open the door to patient discrimination in other states. "The damage could extend far beyond Planned Parenthood," said Gutierrez. "If they mess with the law that protects Medicaid patients from their preferred provider, what's next?"
HHSC points to Texas holding the highest birth rate in the U.S. (more than half paid for through Medicaid), and one of the highest teen pregnancy rates in the country, plus the fact that one-third of pregnancies are unplanned, as reasons for the state's effort to obtain the federal money. But in yet another ironic thread in the GOP's reproductive health policy, Medicaid births – most likely unplanned pregnancies – rose in areas where access to PP was barred, according to The New England Journal of Medicine ("Study: Less Contraception, More Medicaid Births After Planned Parenthood Ban," Feb. 3, 2016). Meanwhile, according to the health commission's own data, the program averted thousands of unplanned pregnancies before Planned Parenthood was removed.
The public has until Monday, June 12, to submit public comment to the Texas Health and Human Services Commission on the Section 1115 demonstration waiver request. Email: firstname.lastname@example.org.