The Department of Health and Human Services is currently considering a waiver that would allow Texas to receive federal Medicaid family planning funds despite the state’s refusal to follow federal law by banning providers who offer abortion care, like Planned Parenthood, from receiving federal Medicaid family planning funds. Texas also wants HHS permission to impose dangerous and unlawful barriers that would jeopardize access to healthcare for minors and immigrants. People have until August 4 to submit comments to HHS.
Under federal law, Medicaid patients are supposed to be guaranteed the ability to receive medical services from any qualified person or institution that provides such care. The Centers for Medicare and Medicaid Services, as well as the courts, has consistently upheld this right, and forbidden states from defunding a provider simply because they offer a legal medical service, such as abortion.
Texas has already demonstrated that excluding qualified providers from the family planning network severely reduces low-income women’s access to care. Since 2011, the state has refused federal family planning money due to the fact that they would then be required to fund family planning clinics that offer abortion services. This decision cut Texas’s family planning budget by 66 percent. The results have been startling.
After ten years of stability, Texas’s maternal mortality rate almost doubled between 2010 and 2012. The American Journal of Obstetrics and Gynecology called the spike hard to explain “in the absence of war, natural disaster, or severe economic upheaval.”
Since 2011, 82 family planning clinics across Texas have been forced to close. Prior to the state’s draconian funding cuts, 60 percent of low-income Texas women accessed their healthcare through Planned Parenthood, and the majority of these women were redirected to state and charitable hospitals where the demand has overwhelmed their capacity to provide services. Last year, 26% of Texas women enrolled in Medicaid never received healthcare services from a covered provider, up from 10% in 2011. Between 2011 and 2015, prescriptions for birth control dropped 41%.
In addition to barring legal and qualified family planning providers, Texas is also seeking permission to require minors to receive parental approval for all medical treatments, including access to birth control, STD testing and other sensitive services.
Far from protecting minors, this policy could put them at greater risk. For example, over half of single, sexually active girls under age 18 surveyed in family planning health centers in Wisconsin reported that they would stop using all services if parental notification for birth control became mandatory. 99% of those girls indicated that despite stopping the use of birth control, they would continue to have sex.
Texas is also seeking federal approval to deny coverage to otherwise eligible Medicaid applicants should they not be able to confirm citizenship or immigration status within 30 days, or if they are currently enrolled and renewing, within 10 days. Under federal law, people otherwise eligible for Medicaid are allowed at least 90 days to verify their status. Texas’s proposal would create unreasonable administrative hurdles and delay or completely prevent coverage.
Despite Texas’s track record of having their anti-abortion laws stopped by federal courts and agencies, advocates are fearful that the new Secretary of HHS, Tom Price, will be sympathetic to their waiver request. As a Congressman, Price co-sponsored legislation that would make some forms of birth control illegal and voted repeatedly to defund Planned Parenthood. During his confirmation hearing for HHS Secretary, Price refused to accept Congressional Budget Office data showing that in one year 400,000 women would lose access to all healthcare if Planned Parenthood were defunded. In addition, Texas frequently pushes the lie that fetuses can feel pain at 20 weeks, a false claim off which Price introduced multiple 20-week abortion bans in the House.
Media Resources: Health Affairs Blog 7/18/17; Feminist Majority Foundation 8/31/16, 1/25/17; National Institute of Health 8/14/02;