Since 2011, changes to Texas’s family planning programs, such as provider exclusion policies and significant funding shifts, have contributed to a steady decline in access to essential reproductive health care services. Although enrollment in the Healthy Texas Women (HTW) program has grown in recent years, state data show that fewer women are receiving care—particularly contraceptive services—compared to a decade ago, following Texas’s decision to exclude Planned Parenthood and other providers from participating in the program. The average number of clients served per provider has dropped by more than half, and the proportion of enrollees who are accessing care fell from 90% in 2011 to 59% in 2023. Contraceptive use through the program declined by 56% over the same period. These outcomes suggest persistent gaps in provider capacity and meaningful access after the exclusion of Planned Parenthood providers, despite the formal expansion of the provider network. As Texas seeks to extend its 1115 Medicaid waiver for HTW and reviews the program through the Health and Human Services Commission (HHSC) sunset process (a periodic review to evaluate the performance and effectiveness of state agencies), there is an urgent need to evaluate whether current policies are meeting the state’s stated goals to improve maternal health, reduce unintended pregnancies, and support the well-being of Texas women and families.
