Since ousting Planned Parenthood clinics from the Women's Health Program, which provides cancer screening, well-woman exams and contraception for low-income women, Texas leaders have made a concerted effort to recruit physician groups to fill the void.
They also widened the services covered, adding testing and some limited treatment for sexually transmitted diseases.
But unlike specialty family planning clinics, physician groups generally don't receive additional government funding to help low-income women access services not expressly covered by the program -- and that has created obstacles for both providers and patients.
“Physicians cannot afford to really embrace the Texas Women’s Health Program patient,” said Fran Hagerty, CEO of the Women’s Health and Family Planning Association of Texas, “because they end up getting stuck, again, with the responsibility for the full patient care where there’s no funding available to them for that.”
In 2011, under pressure from Republican leaders, state health officials began enforcing a provision lawmakers wrote to exclude Planned Parenthood and any clinics with organizational ties to abortion providers from the Women's Health Program. At the time, Planned Parenthood clinics provided 40 percent of the program’s services and often subsidized services not expressly covered by it.
To replace Planned Parenthood, the state recruited new providers, the majority of which are physician groups, to participate in the reimagined program. But unlike many reproductive health clinics, which qualify for additional federal family planning grants, physician groups generally don’t have the public financing to pay for services that aren’t covered by the state program. While physician groups can absorb some of these additional costs, in most cases a patient must pay out of pocket for additional services or find an alternative provider that receives federal subsidies, which can delay care.
Emma Moreno, assistant manager at Valley Women’s Specialists, a physician group in Weslaco that participates in the Women's Health Program, said the program covers Pap smears, for example, but if a patient tests positive for the human papillomavirus and needs further treatment, that care isn't covered.
“If you’re going to provide a program or a service, provide the full service and not just half of it,” said Moreno, whose physician group still encourages women who may be eligible to apply for the state program.
Valley Women’s Specialists offers a variety of payment plans and refers patients to other clinics for treatment if they can’t pay. For some conditions that aren’t covered by the program, such as yeast infections, the physician will provide the treatment free of charge.
The physician "just loses out on it, but he’s not going to leave the patient untreated,” Moreno said.
Stephanie Goodman, a spokeswoman for the Health and Human Services Commission, said the agency is looking into these concerns. HHSC recently hired a women’s health coordinator who will be working with providers to improve the referral process for patients who need additional services from a federally qualified health center or rural health clinic, she said.
“We've always had to work with our providers to take care of other needs a woman might have,” she said in an email. “Now that we have many new providers in the program, we need to make sure they know about the resources that exist to help women with other health issues.”
To be eligible for the Women's Health Program, a woman must have an income at or below 185 percent of the federal poverty threshold, or less than $1,800 a month for an individual. The original Women's Health Program, which was jointly funded by the state and the federal government, was an offshoot of Medicaid. The federal government discontinued its $9-to-$1 match for the program in January 2012. That followed the state's exclusion of Planned Parenthood clinics, despite the fact that those clinics were already prohibited from performing abortions because they accepted taxpayer dollars.
The Texas Women’s Health Program is nearly identical to the former Medicaid program in scope, though it now covers STD testing and some routine treatment, and is run entirely with state funding — $35.6 million a year.
In the first six months of the state-run program, enrollment and claims for services dropped significantly.
“While these numbers were collected before we added increased funding [for] women's health in the last legislative session, they are exactly the type of data we will be carefully reviewing in the months ahead," state Sen. Jane Nelson, R-Flower Mound, the chairwoman of the Senate Health and Human Services Committee, said in an email to The Texas Tribune last month. "It is important that we make sure the dollars we invested are providing meaningful preventive health services for the women of Texas."
Hagerty said the Women's Health Program was originally designed to be one piece in a patchwork quilt of family planning funding. Federally qualified health centers and family planning clinics that receive additional grants, such as the federal Title X grants that her organization manages, are better equipped to serve patients participating in the program, she said, because they have additional resources to provide services that aren’t covered.
By excluding Planned Parenthood, formerly the biggest provider in the program, a drop in claims was inevitable, she said.
“Someone needs to come to their senses and lift that ban,” Hagerty said. “But that’s political and until the political winds change that’s not going to happen.”