Women's Health Program in the Balance

The federal government has rejected Texas' application to renew the Women's Health Program (WHP). On December 12, the Centers for Medicare and Medicaid Services (CMS) notified the Texas Health and Human Services Commission (HHSC) that the application's exclusion of providers who offer abortion -- or who affiliate with providers who offer abortion -- is not compatible with the federal Medicaid statute.

Although it did not approve the renewal, CMS did grant Texas a 90-day extension of WHP, until March 31, 2012. During this time, state and federal officials will be able to "work on the renewal." However, it is not clear if -- or how -- the impasse can be overcome. To save the program, it appears that Texas would have to back down from excluding Planned Parenthood, since the federal government must enforce Medicaid's "any willing provider" provision.

Without such a development, WHP will end in a little over 3 months.

Family planning providers around the state, including public hospitals, small community clinics, and family planning clinics, are already reeling from the severe cuts in the Family Planning program, the other program that provides preventive care and birth control for low-income Texans.  

Loss of WHP would mean that many clinics would dramatically reduce services, lay off staff, or shut down completely. The state's network of community clinics that provide low-income women with preventive care, cancer screenings, and birth control would be all but gone. The larger public institutions, such as University Health System in San Antonio and Parkland in Dallas will offer far less in family planning services.

WHP is a Medicaid program that provides check-ups, screenings, and birth control, but not abortion, to women age 18 to 44 who are at or below 185% of the Federal Poverty Level (about $ 41,350 per year for a family of 4). WHP reaches approximately 120,000 women each year. In 2009 alone, the program saved Texas over $20 million in Medicaid costs by preventing unplanned pregnancies and births.    

Texas' request to exclude certain providers was the result of efforts in the 2011 legislative session to exclude Planned Parenthood from participating in the program. Currently, Planned Parenthood clinics are the largest provider of WHP services, reaching nearly half (about 46%) of the women served by the program. Planned Parenthood has legally and financially separated its preventive care from abortion services, which do not receive federal dollars or WHP funds.

In the letter to HHSC, the director of the federal Center for Medicaid and CHIP Services said that Texas' WHP renewal request was not acceptable because it would restrict patients' choice of qualified providers. The Social Security Act, the law under which Medicaid was created, provides that Medicaid beneficiaries may obtain covered services from any qualified provider willing to undertake the service.  

The survival of WHP is uncertain, to say the least.  Sadly, as reported in the Texas Tribune, "family planning in Texas is trapped in a culture war."