Texas Medicaid Family Planning Proposal Threatens Women’s Access to Preventive Care

WASHINGTON, DC (June 22, 2017) — A Texas 1115 Medicaid family planning demonstration proposal that would tie coverage to an exclusion of Planned Parenthood would severely constrain access for covered women, thereby defeating, rather than advancing, Medicaid’s core objectives.  This conclusion is contained in an analysis carried out by researchers from the Geiger Gibson Program in Community Health Policy at the George Washington University Milken Institute School of Public Health (Milken Institute SPH). The analysis was submitted as part of public comments to the Texas Health and Human Services Commission. The comments document that the state’s 73 community health center grantees – critical primary care providers in medically underserved urban and rural communities – would be unable to expand services quickly enough to offset the capacity that would be lost were the state to deny some 700,000 newly insured women the ability to use their family planning coverage at Planned Parenthood clinics. 

“Health centers are vital to the health of Texas women and their families,” said Sara Rosenbaum, JD, a co-author of the comments and the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH. “Expansion capabilities for these health centers are limited by the deeply impoverished nature of their patients, the absence of a broad Medicaid expansion for all working-age adults that brings desperately needed revenues to community programs such as health centers, federal funding uncertainties, and the challenges inherent in hiring new staff and adding hours and locations.  Health centers would need roughly two decades of expansion growth simply to replace the care lost by the exclusion of Planned Parenthood from the demonstration. Cutting out a health care provider serving over one-quarter of those who depend on publicly funded clinics for preventive care and birth control runs directly contrary to the central purpose of 1115 Medicaid demonstrations — to improve care, not impede it.”

Rosenbaum and her colleagues note that the Texas Health and Human Services Commission’s draft Section 1115 family planning demonstration proposal excludes providers not in compliance with Texas Human Resource Code § 32.024 (c-1), which covers health care facilities that either provide “elective” abortions (as defined by the state) or are affiliated with such providers. The exclusion would presumably preclude Planned Parenthood, and some family planning Title X clinics, hospitals, and private physicians from participating in the demonstration, the authors conclude.

The comment cites data from the Guttmacher Institute showing that Texas’ Planned Parenthood clinics currently serve more than one in four of the 411,000 low-income and medically underserved Texas women who depend on publicly funded family planning programs.  The authors calculate that the state’s community health centers would have to more than double their capacity by 2018 to offset the elimination of Planned Parenthood as a provider for such women. 

The comment explains in detail why the researchers concluded that the Texas health centers lack the capacity to grow at the rate necessary to replace lost services of Planned Parenthood and other providers excluded by the new proposal.  Using data from the Uniform Data System (UDS), the federal government’s database on health center grantees, the authors’ analysis shows the recent growth of the state’s community health centers and patients served and the relatively low number of providers in the network who are obstetricians/gynecologists or nurse midwives.  The comment also provides data and details about the state’s poverty rates; the limited reach of the “full benefit” Medicaid program as a state that has not adopted Medicaid expansion; the impact of previous Medicaid program restrictions; and the challenges currently facing health centers, including uncertain federal funding.  Finally, the researchers point out that many of the communities that rely on Planned Parenthood clinics have few to no health centers to compensate for the elimination of Planned Parenthood as a Medicaid provider under the demonstration.

“While health centers are remarkably effective at caring for low-income and medically underserved patients, they cannot grow at a rate fast enough to compensate for the lack of access to Planned Parenthood,” says Feygele Jacobs, President and CEO of the RCHN Community Health Foundation. “Health centers are known for their high-quality and efficient care, but could not absorb the immense number of patients currently seen by Planned Parenthood throughout the state.” The RCHN Community Health Foundation helps support the Geiger Gibson Program in Community Health Policy at Milken Institute SPH.

The Geiger Gibson Program in Community Health Policy is a special initiative of Milken Institute SPH, which was established to honor Drs. H. Jack Geiger and Count Gibson, pioneers in community health practice and tireless advocates for civil and human rights. The Geiger Gibson Program has worked since 2004 to help eliminate medical underservice and disparities in population health through education, training and research projects. 

The comments submitted by researchers at the Geiger Gibson Program in Community Health Policy can be accessed here.