A Dangerous Precedent for Texas Women

We have seen lots of confusing statements recently about the state’s proposed Medicaid 1115 waiver for the Healthy Texas Women program.
Here are some reminders about what this particular waiver would and would not do, as Texas proposed in our state’s waiver application to the federal government.
What it WON’T do:

  • change the existing Healthy Texas Women program in innovative ways
  • increase access or serve more women
  • reduce total program costs
  • increase total program savings, or
  • change anything from the patient or provider perspective from the existing program.

What it WILL do: The current Healthy Texas Women program, started in 2016, is supported by only state funds (“General Revenue”). The Medicaid 1115 waiver application seeks only to get federal Medicaid dollars to cover 90 percent of program costs, replacing existing state funds. That’s it. The request is to refinance the existing program.
On June 30, 2017, the Texas Health and Human Services Commission (HHSC) submitted an 1115 waiver application formally asking the federal Medicaid program to pay for an existing, state-funded family planning program called Healthy Texas Women. Texas forfeited this same federal funding at the end of 2012 when it banned all providers that have an affiliation with an abortion provider despite the fact that the program has never covered abortion. This move, which conflicted with federal law, was explicitly aimed at removing Planned Parenthood from the program even though Planned Parenthood had been the program’s largest provider, serving more than 40 percent of program clients with birth control, cancer screenings, and other preventive health care.
Outcomes from this policy change have been extensively studied over the last five years. Overwhelming evidence shows that after Planned Parenthood was removed from the program, women in Texas lost access to critical health care services. Even after recent, significant investments in the program, it appears that fewer women were served in 2017 than back in 2011.
In Texas, the waiver requested won’t change any current policy or practice or repair the damage already done to the capacity of the family planning safety net to deliver services to women in need.
The stakes are high at the national level. If the federal government approves Texas’ request, it will be a dangerous and unprecedented departure from long-standing federal protections that ensure Medicaid clients can access family planning services from the provider of their choice. If the federal Medicaid agency approves the request, it will be easier for other states to follow Texas’ misguided path.
CPPP has commented to the federal Medicaid agency about Texas’ waiver application and pointed out several problems with the proposal:

  • The request to waive “freedom of choice” protections that let women see the family planning provider of their choice does not further the goals of the federal Medicaid program or test any program innovation;
  • Texas has asked to deviate from the standard methodology used to count income when determining financial eligibility for Medicaid without justification. This federal-law requirement is not waivable;
  • Texas has asked to deviate from standard Medicaid policies designed to remove administrative barriers during application and renewal. They are not waivable;
  • Texas has asked to prevent teens to accessing contraception without parental consent, a barrier that would reduce access to care; and
  • The waiver would not implement an experimental, pilot, or demonstration project and would not be budget neutral for the federal government, both requirements for waivers.
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