Without Planned Parenthood, What's Next for Health Program?

A state rule that forces Planned Parenthood out of Texas' Women's Health Program takes effect today, and in response, the Obama administration is preparing to halt federal funding for the program. But the change won't be immediate: Texas health officials say it will take a few weeks to transition to a fully state-run program from one that had been 90-percent funded by the federal government. 

Since the standoff between Texas and the federal government erupted over the state's decision to write clinics "affiliated" with abortion providers out of the Women's Health Program, abortion opponents have argued that there are thousands of more comprehensive health care providers available to take Planned Parenthood's place. By law, none of the clinics enrolled in the five-year-old program were performing abortions.

But Fran Hagerty, the head of the Women's Health and Family Planning Association of Texas — which represents non-Planned Parenthood providers in Texas, including clinics, hospitals and medical schools — said she seriously doubts Gov. Rick Perry will be able to keep the pledge he made last week to maintain the roughly $30 million-per-year program without federal help. She said the "monstrous" family-planning funding cuts of the last legislative session, made before the Women's Health Program was jeopardized, have eroded trust and have forced clinics to shut their doors. 

"The funds made available to family planning providers through the Women’s Health Program is what is keeping most of them going at this point," she said in a statement. "No one trusts Gov. Perry to find state money to fund them at the same level as the Medicaid program."

The Obama administration has said Texas' plan to exclude Planned Parenthood from the program violates a federal law that lets Medicaid patients choose their own providers, an argument Perry's staff disputes. Anticipating that the federal government would turn off the funding tap, Perry announced last week that he would keep the family planning program, which serves more than 100,000 low-income Texas women, in place. But it remains unclear where the state money will come from in a tough budget year. 

Perry spokeswoman Catherine Frazier said the governor has tasked the state's health commissioner with finding the money "from existing state funds" — and that it will be done. "The governor wouldn't have called on him to do so if the money was not there," she said.  

Texas Health and Human Services Commission spokeswoman Stephanie Goodman said the agency will know more about the exact costs involved after the federal government gives formal word that the funding is ending. On Friday in Houston, U.S. Health and Human Services Secretary Kathleen Sebelius said the federal government would not renew the program if the state refused to include Planned Parenthood, the provider of choice for more than 40 percent of the program's clients in Texas. (See the video here.) She has not sent official word to Perry's office.

Goodman said that HHSC is creating guidelines for providers for the new state-run program, and that the agency won't officially disenroll those who don't qualify — like Planned Parenthood clinics, for example — until May 1. If the agency can't identify full funding for the new program immediately, she said, health officials could come back to the Legislature in January to seek supplemental dollars. 

"Our goal is make the transition as seamless as possible. We’re still looking at the funding options, but the most likely scenario involves changing the source of the funding at the state level without changing how the program works for the clients or providers," Goodman wrote in an email. "We’re still working through the details, but this approach would be virtually invisible to the clients and providers."

One of those providers is Lone Star Circle of Care, a federally qualified health center in Central Texas. Spokeswoman Rebekah Haynes said that because Lone Star is not affiliated with an abortion provider, it plans to reapply by April 30 to be part of the new Women's Health Program, regardless of who runs it or pays for it.

Last year, Haynes said Lone Star treated 2,264 Women's Health Program clients and was reimbursed about $700,000. But it is reeling from last legislative session's massive cuts to family planning. Haynes said she anticipates more Women's Health Program patients will come to Lone Star for birth control and cancer screenings without Planned Parenthood clinics available, but she is not sure how they will pay for them.

"If the funding is made available to us either through [the Women's Health Program] or another source, [Lone Star] anticipates that we could have the capacity to provide care to women who are unable to find access to these services elsewhere in Central Texas" she said. "But without the necessary funding, our capacity would be considerably more limited."

As the state prepares to end its funding for Planned Parenthood, the organization is on a media blitz. Its supporters rolled into Austin on Tuesday night to wrap up a statewide bus tour, with supporters vowing to pressure lawmakers to restore funding to Planned Parenthood. 

"We'll continue to make sure our clients can count on Planned Parenthood health centers for breast and cervical cancer screenings, HIV tests, birth control and other essential health screenings as permissible," said Sarah Wheat, the interim co-CEO of Planned Parenthood of the Texas Capital Region. "In the meantime, Texans will continue to urge Gov. Perry to stop playing politics with women's health and support the continuation of the Medicaid Women's Health Program."

Frazier said the only thing Planned Parenthood is accomplishing with its bus tour is "throwing Texas women under it with their scare tactics."

"Gov. Perry has committed to continuing these services even if the Obama administration won't," she said.