We Can’t Wait to See Controversial Report On Texas Family Planning

The Texas Health and Human Services agency (HHSC) is required by May 1 to release an updated report on the state’s two family planning programs—the Healthy Texas Women (HTW) program and the Family Planning Program (FPP). In 2017, the Texas Legislature adopted a budget “rider” (HHSC Rider 97) that expands what data HHSC must publicly report on the programs’ services, providers, and estimated savings. The report will include lots of data, some of it publicly available for the first time.
Here are four things we will be looking for:

  1. Have the number of clients served returned to 2010-11 levels yet? Will the report provide an explanation?
    There’s no question about whether the number of people the programs have enrolled and “served” will be up in 2017 over last year – they certainly will. The state has made substantial new investments to drive enrollment: a $5 million marketing campaign in 2016-17, new automatic enrollment into Healthy Texas Women for moms after they give birth and lose pregnancy-related Medicaid, and an additional $50 million from the state starting in the 2016-17 state budget.
    After making all of these significant investments, has Texas finally restored care to the number of women who received it back in 2010 and 2011, the years before the state’s massive cuts to family planning funding and providers? In other words, has the state repaired the significant damage it caused in 2011?

    Our concern is that we won’t be able to tell. Last year, HHSC changed the way it counts the number of clients that receive services. That means we may not be able to accurately compare 2017 data with any year before 2016. If HHSC only provides 2017 numbers without using the old method as well, we will only be able to make one-year comparisons to 2016.
  2. How many providers on HHSC’s often-touted and growing list of certified Healthy Texas Women providers actually serve no clients, or just a handful? How does the average number of clients served by provider in 2017 compare to previous years?
    Having enough medical providers in the Healthy Texas Women program has been an issue since the state removed Planned Parenthood from the program in 2013. HHSC often points to its long and growing list of HTW “certified providers” as an indication of access. However, the number of providers on the list is essentially meaningless in terms of gauging capacity because (1) the list itself – on multiple occasions – has been found to be inflated and full of errors, and (2) most providers on the list probably serve zero or a just a handful of women in a year – something this report should show.
    Last year’s report contained a more meaningful glimpse of the changing capacity of the network of providers. It showed a significant drop in the average number of clients per provider in the Texas Women’s Health Program, from 150 in 2011 to 103 in 2015, as the program lost high-volume providers and added low-volume ones. An update of these data should be in the upcoming report as well.
  3. Is the Healthy Texas Women program serving any teens?
    Low-income teens ages 15-17 are eligible to enroll in HTW with parental consent, if they are uninsured. Teens at these income levels shouldn’t be uninsured, however, because they would be eligible for better coverage in either Texas Medicaid or the Children’s Health Insurance Program (CHIP). If a teen enrolls in HTW instead, one of two things went wrong. Either the teen: (1) didn’t know that she would be eligible for full Medicaid or CHIP coverage (HTW applications do not collect enough information for HHSC to also determine eligibility for Medicaid or CHIP), or (2) is eligible for CHIP, but has decided to enroll in limited HTW coverage instead of broad CHIP coverage because Texas CHIP does not cover contraception. If teens have enrolled in HTW, that points to problems that state leaders could and should fix.
  4. How is contraception use growing?
    Long-acting reversible contraception (LARC) – like intrauterine devices – is the most effective type of contraception. The Texas Legislature and HHSC have emphasized the importance of increasing access to LARC. Increasing access will require overcoming barriers like cost, awareness, billing issues for providers, and lack of clinical experience with LARC, especially in primary care organizations that are new to family planning programs.
    Now that we know what to look for, we will watch for the new report. Check back on CPPP’s blog for our take after the report is out.
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