Updated Aug. 1, 5:30 p.m.
State Sen. Jane Nelson, R-Flower Mound, has responded to the Texas Women’s Healthcare Coalition’s concerns that the state’s $100 million expansion of a primary care program would not meet lawmakers' intent of restoring access to family planning services.
“Not only do I appreciate your advocacy, I agree wholeheartedly that this new budget strategy must proceed in a manner that truly meets the needs of Texas women,” Nelson wrote in a letter to the coalition’s chairwoman, Dr. Janet Realini. Nelson, who chairs the Senate Finance Subcommittee on Health and Human Services, added that her office has been assured by the Department of State Health Services that the program “will achieve our objectives, and I will be closely monitoring the roll-out to ensure that this happens.”
Earlier in the week, the coalition sent letters to lawmakers and DSHS expressing concerns that the program did not prioritize family planning services in its rules for contracting with providers, maximize the ability of participating providers to also utilize federal Title X dollars for family planning services, or adequately screen for intimate partner violence and reproductive coercion.
In a separate letter to Kyle Janek, the executive commissioner of Texas Health and Human Services, Nelson shared her thoughts on the concerns raised by the coalition.
While she agreed that the state should ensure that at least 60 percent of the primary care program expansion goes toward family planning services, she believes that could be achieved through individual contract negotiations. While providers are encouraged to participate in the Title X program, she said the financing streams should be kept separate, so legislative committees can “understand the number of Texas women being served in each program and what steps are being undertaken to ensure that these programs complement each other and do not duplicate services.” She also requested that the state add a requirement that providers screen for intimate partner violence and reproductive coercion.
The Texas Women’s Healthcare Coalition has raised concerns that a bipartisan effort to restore access to family planning services by expanding a state-run primary care program isn’t shaping up as planned.
During hearings in the regular legislative session, David Lakey, the commissioner of the Department of State Health Services, told lawmakers that 60 percent of the $100 million allotted to expand the primary care program for women’s health care in the 2014-15 biennium would be used to provide family planning services and contraception. But the forms created by DSHS for health providers to apply to take part in the program do not explicitly state that 60 percent of providers’ services must go toward family planning.
In a letter sent Monday to DSHS and lawmakers, the coalition — which counts the Texas Medical Association, Texas Academy of Family Physicians and Texas Association of Community Health Centers among its 39 members — argued that the proposed rules don’t ensure that the program will achieve lawmakers’ intent of restoring access to family planning services.
“We’re concerned that this was really like a bait and switch,” Dr. Janet Realini, chairwoman of the coalition, said in an interview. Although she does not believe DSHS has intentionally disregarded the legislative intent to increase family planning services, she said, "the system to do that is missing an essential piece of direction for the contractors.”
Carrie Williams, a spokeswoman for DSHS, said the department received the coalition's letter and is working to clear up misunderstandings about the program.
"We’ve been very open in developing and talking about this program, so it was disappointing to see these inaccuracies being promoted as fact," Williams said in an email to the Tribune.
She added that family planning services are emphasized throughout the department's materials on the program, but that the program does not exclusively provide family planning services.
"The 60 percent target for family planning was what we have been proposing all along. While that threshold is not explicitly stated in the materials, it has long been the plan and we have never indicated otherwise," said Williams.
In its letter, the coalition recommended that the department explicitly prioritize family planning services by setting specific targets and performance measures for contractors. The state could save money and avert unintended pregnancies, the coalition argues, by setting performance targets for family planning services and giving funding priority to contractors that have demonstrated the ability to provide these types of services.
“I think putting it in the materials to let contractors know what you’re looking for is important,” said Realini.
Although contracted providers won’t be specifically required to provide 60 percent family planning services, a legislative aide indicated that DSHS still plans to provide that level of family planning services by negotiating individually with contractors. All providers, for example, will be required to have a Class D pharmacy onsite to ensure access to contraceptives, including long-acting reversible contraceptives such as intrauterine devices (IUDs).
“Family planning is crucial to reducing unplanned pregnancies, and our clear legislative intent is to prioritize family planning within this budget strategy,” state Sen. Jane Nelson, R-Flower Mound, and chairwoman of the finance subcommittee on health and human services, said in a statement responding to the coalition’s letter.
“I have been assured that the bar we set can be achieved via the contracting process, and I will be closely monitoring the roll-out to ensure that happens.”
Texas lawmakers cut family planning financing by two-thirds in the 2011 session, which caused more than 50 family planning clinics to close and 147,000 women to lose access to family planning services. The Health and Human Services Commission estimated an additional 24,000 babies would be born as a result of unintended pregnancies, costing the state Medicaid program at least $103 million.
Lawmakers reached a bipartisan deal in the 2013 session to restore access to women’s health services by infusing $100 million for women’s health services into a state-run primary care program; increasing family planning financing by $32.1 million to replace federal dollars for Title X family planning services that were awarded to another association; and adding $71.3 million to finance the Texas Women’s Health Program, which lost its share of federal financing when the state ousted Planned Parenthood from the program in 2011.
Even before the 2011 cuts took effect, Texas only met 32 percent of impoverished women’s need for family planning services, said Realini. Although lawmakers hope the increased financing in the 2014-15 biennium will restore access to women’s health services, she fears that the state is already falling short of expectations.
As an example, she cited the decline in the number of services provided by the Texas Women’s Health Program since the state ousted Planned Parenthood, which previously provided 40 percent of the program’s services.
“These are the building blocks of the safety net, if you will, for women and for healthy pregnancies,” said Realini. “The building blocks are getting smaller as we watch and we’re not even in the fiscal year, yet.”
This story was produced with the support of the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg School of Journalism's California Endowment for Health Journalism Fellowships.