2015 Texas Women’s Health Program Report

Our Research

In 2011, Texas slashed funding for family planning and restructured its program to eliminate the experienced, effective participation of Planned

Parenthood’s established network of clinics. Facing criticism that half the Women’s Health Program’s clients were being served by Planned Parent-hood and Texas women would suffer because of this misplaced animus toward Planned Parenthood, Texas promised it would replace the lost services with a revamped Texas Women’s Health Program (TWHP) made readily available to women via a website directory of providers.

At a recent Senate Finance Hearing, the Health and Human Services Commission Women’s Health Coordinator claimed that Texas had 4,012 “providers” enrolled in TWHP as of December 31, 2014, purportedly up from 1,647 in 2010.1

Contrary to this claim, the TWHP website continues to have inaccurate in-formation about their providers and an inflated provider count — making it difficult for Texans using the website to access care.

1Sen. Finance Committee Hearing, Feb. 18, 2015, at 2:58:20, available at http://tlcsenate.granicus.com/MediaPlayer.php?view_id=30&clip_id=9118 (Lesley French responding to questions from Sen. Watson). 1

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2 State Releases Reduced List of Women’s Health Clinics, Texas Tribune, Dec. 17, 2012, available at http://www.texastribune.org/2012/01/17/state-releases-family-planning-contractor-list/3 Texas Women’s Healthcare Coalition, Texas Women’s Healthcare in Crisis at 4 (chart) (Jan. 2013), available at http://www.texaswhc.org/wp-content/uploads/2013/01/Texas-Womens-Healthcare-in-Crisis.pdf.4 Texas Women’s Healthcare Coalition, 2013 Legislative Agenda at 2 (Jan. 2013), available at http://www.texaswhc.org/wp-content/uploads/2013/01/TWHC-2013-Legislative-Agenda-Approved-1-23-13.pdf.

From January 18 - February 12, 2015, NARAL Pro-Choice Texas conducted an in-depth spot check of all the TWHP provider listings in 26 Texas counties. We found that of the 681 listings, there are only 236 unique offices.

Many of the offices listed on the TWHP did not offer preventative gynecologi-cal services that the TWHP is supposed to cover. Of the listings on the TWHP website in the counties we checked, only 16.6 percent actually provide pre-ventative gynecological services and currently accept TWHP patients.

Dismantling Women’s Health Care

The 2011 Texas Legislature cut family planning funding by $73.6 million, a two-thirds decrease from the previous two years’ funding.2 At the time,

Texas was only serving approximately one-third of the people who needed access to family planning in the state.3

Texas was also participating in the Medicaid Women’s Health Program, allowing Texas to re-ceive nine dollars from the federal government for every dollar the state spent.4 In an attack on Planned Parenthood, the State began enforcing the Legislature’s “abortion affiliate” ban, blocking any clinic “affiliated” with an abortion provider from participating in the Women’s Health Pro-gram.

However, since 1977 when the Hyde Amendment prohibited federal Medicaid funds from covering abortion, neither state nor federal funds have

paid for abortion services in Texas. Abortion services and family planning dollars have been and are completely separate. Because Texas excluded a qualified provider from the program, the state was in violation of federal law and willingly lost the $9:$1 federal-state match.

The state then chose to establish the TWHP and fund the program with only state dollars rather than comply with federal law and stopnot discriminatinge against a qualified health care provider like Planned Parenthood. By 2012, 60 clinics had closed, with a particularly harsh impact on many of which were in

We found that of the 681 TWHP provider listings, there are only 236 unique offices — nearly a two-thirds decrease. Of these, many did not routinely offer the preventative gynecological services that TWHP is meant to cover because they are emer-gency rooms, fertility clinics and, in one instance, a Subway Sandwich shop.

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Where did the phone numbers on the TWHP website go?...a subway sandwich shop.

...a personal cell phone (“Where did you get this number?!”)

...to a fertility clinic, cancer centers, urologists, emergency rooms and homeless shelters.

5 Carolyn Jones, “’Everything is Gone’: Family Planning Clinics Disappear From Rural Texas, Texas Observer, Feb. 27, 2013.6 According to the Texas Policy Evaluation Project research, confirmed on February 19, 2015. Published research pending.7 Written Testimony of Dr. Joseph Potter, Sen. Finance Committee hearing, Feburary 19, 2015.8 Sunset Advisory Commission, Health & Human Services System Issues, Issue 8 (January 2015 revision), available at https://www.sunset.texas.gov/public/uploads/files/reports/HHSC%20and%20System%20Issues%20Commission%20Deci-sions_Revised%20January%202015.pdf.

rural communities.5

Texas also has a three-tiered system to determine which types of health care providers receive family planning funding. The top priorities for fund-ing are state, county and community health clinics. The second tier includes non-public entities that provide screenings as part of comprehensive care, such as private practitioners.

Specialized clinics, like family planning providers, are the lowest priority and only receive funding if a higher-tier provider is not available. As a result of the funding cuts and the tiered system, 83 family planning clinics in Texas have closed since 2011.6

In 2013, the Texas Legislature re-stored funding to the 2011 levels (without taking into account the increase in Texas’ population), but maintained the tiered system and the affiliate ban. Instead of directly funding family planning, the Leg-islature directed funding to a new program, Expanded Primary Health Care (EPHC). Most of the shuttered family planning clinics remained closed.

The state claimed that the tiered system and funding through EPHC would allow women to access comprehensive care by sending them to general practitioners instead of specialized clinics. However, these providers report that they are not always successful at integrating family planning into primary care and that some of them lack the training and confidence to discuss family planning with their clients.7 Further, having multiple programs with different qualifications and reimbursement streams has proven to be inefficient and difficult to manage, as the Sunset Commission recently found.8

Family planning clinics have medical providers and staff who specialize in these services. Texans deserve access to family planning specialists because they provide a higher standard of care at better price.

Before the changes to the women’s health care program in Texas, patients had access to the provider that best suited their needs. By removing funding from those clinics, the state left TWHP participants scrambling to find a new provider, which caused disruptions in care and use of contraceptives.9

What We Found

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9 Center for Reproductive Rights and the National Latina Institute for Reproductive Health, Nuestro Voz, Nuestro Salud, Nuestro Texas: The Fight for Reproductive Health Care in the Rio Grande Valley at 18 (Nov. 2013), available at www.nues-trotexas.org.

Of the 26 counties NARAL Pro-Choice Texas surveyed, five did not have any provider listings that provided preventative gynecological services.County Actual Unique Percent of actual providers

BaileyBee

BrazoriaBrewsterCameron

CollinDallamEctor

GalvestonGreggHardinHaskell

HendersonLa Salle

LeonNacogdoches

PecosPolk

PotterRed River

TarrantTaylorUvalde

Van ZandtWebb

WilliamsonTotal

0270

19214571031044281

13240

167

113 236 16.59%

03

130

31917

112510912

1143

161

351244

2112

0%33.33%38.89%

0%26.03%12.50%

100.00%11.76%6.67%9.59%

100.00%0%

10.34%100.00%

0.00%36.36%57.14%50.00%22.22%50.00%8.07%

11.76%44.44%0.00%

41.03%11.29%

Listed06

180

73161

34757310

2912

1174

362

1611794

3962

681

The state claimed that the 2011 redistribution and funding cuts would not diminish access, but they did. The state continues to claim that the TWHP

website is helpful and improving, but it’s not. The state claims there are more than 4,000 providers in TWHP, but an invalid, duplicative listing is not an actu-al health care provider.

In a recent Senate Finance Committee hearing, Chair Nelson asked the de-partment’s Women’s Health Coordinator whether “there are more providers today in the Texas Women’s Health Program than we had in the federal pro-gram?” The answer: “According to the numbers, yes.”

Unfortunately, these “numbers” do not translate into access to care. Texas women deserve better than inflated “numbers.” Knowledgeable, accessible

family planning providers were what women had in the nondiscriminato-ry federal program that included specialized family planning clinics, even

those who “affiliated” with or dared mention abortion. And, such acces-sible, knowledgeable providers are what Texas women want and need now.

Duplicate listings abound on the website. One doctor may be listed multiple times, with minor variations in the name. Sometimes, the doctor was listed at two different locations, or at the same location with a different phone

number. Multiple providers listed at the same office, such every doctor — gynecologist or not — at a large hospital or clinic

dominate the website listings. These providers would usually have the same phone number and address which may or may not be a

location where services are offered. For someone trying to make an appoint-ment, one office is one phone call, one receptionist and one estimated wait time, even if there are multiple doctors.

Despite claims that the website has improved or is “a good website,” as of February 2015, in the 26 counties we researched, only 34.7 percent of the offices listed were unique listings. Only 16.6 percent of the phone numbers listed on the website reached actual women’s health care providers who are accepting new TWHP patients.

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Methodology

NARAL Pro-Choice Texas made calls to the offices listed in 26 counties se-lected as a cross-section of size and geography, including urban, subur-

ban, midsize, and rural counties. Callers asked the same question that a TWHP participant would ask if they were looking for an appointment and for funding assistance. They asked (1) whether the office accepted the TWHP; (2) wheth-er the office was accepting new patients; (3) what kinds of birth control were offered at the office; and (4) when the next available appointment was.

In 2014, because the TWHP website only searches by miles from a city or zip code, we ran searches for a county by a centrally located zip code. This time we refined our searches for more accurate results, manually excluding loca-tions outside a given county. The denominator for our final accuracy ratio is the total number of listings in a county. The numerator is the total number of valid, unique TWHP providers accepting patients.

To obtain the total number of offices that were accepting new TWHP patients in each county, we took the total number of listings from the TWHP website for the counties and subtracted (1) provider duplicates, (2) multiple provid-ers listed at the same office, (3) offices that were not gynecological or family practice offices, and (4) such offices that did not accept TWHP or were not accepting new patients. In other words, we counted unique listings that would actually provide the family planning services TWHP was intended to fund after Planned Parenthood and other specialized providers were banned from or deprioritized out of the program.

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