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West Texas providers face difficulties meeting patient demand following state defunding efforts

Texas lawmakers' defunding of abortion providers has strained efforts to provide care for low-income women in West Texas, the Midland Reporter-Telegram reports (Stone, Midland Reporter-Telegram, 6/12).

Background

The state Legislature in 2011 cut the state's family planning budget by two-thirds and blocked funding to Planned Parenthood and other women's health clinics. As a result of the cuts, 82 of Texas' family planning clinics closed, according to the Texas Policy Evaluation Project (TxPEP). Of those clinics, about one-third were Planned Parenthood affiliates.

According to TxPEP research, 60 percent of low-income, reproductive-age Texas women received care at a Planned Parenthood clinic prior to additional cuts in 2013 (Women's Health Policy Report, 2/4).

In the wake of the 2011 cuts, Texas established a version of the Women's Health Program (WHP) to help fund care for low-income and uninsured women. The state lost federal funding for the program at the end of 2012 because it decided to bar abortion providers from participating.

The program became the Texas Women's Health Program (TWHP) in 2013. According to the Reporter-Telegram, program participants are eligible for an annual family planning exam, as well as follow-up visits regarding their selected contraceptive method.

Care access prior to cuts

Karen Hildebrand, former CEO of Planned Parenthood of West Texas (PPWT), noted that prior to the state's decision to prohibit abortion providers from the state family planning program, Planned Parenthood's clinics in Midland and Odessa had provided reproductive health care services to about 10,000 to 15,000 patients annually. Those services included family planning, screening and treatment for sexuality transmitted infections, cancer screenings and abortion care.

"We were the main family planning center for Midland, Odessa and smaller West Texas," she said, adding, "It was for women who didn't have the money to go to a private doctor, or weren't eligible for Medicaid -- which is only a small percentage of the population -- and didn't have insurance."

According to Carla Holeva, CEO of the Midland Planned Parenthood, the Midland clinic closed in 2013. "The main reason we were not able to continue providing family planning care was due to the state pretty much blocking all [PPWT clinics] from being part of the state family planning program," she said, adding, "We were very reliant on that funding, that was how we got paid for services provided and when the state blocked our agency from being able to access that service ... that's what really closed the Planned Parenthood."

Effects of cuts

According to the Reporter-Telegram, most of the former Planned Parenthood patients were directed to Texas Tech University and Midland County Health Services (MCHS). MCHS, which is a federally qualified health provider, is now the main health care provider for low-income residents in the area, the Report-Telegram reports.

Michael Austin, director at MCHS, said, "We hired another OBGYN so we'll have some more capacity there, but let's face it, (Planned Parenthood) was running two full-time clinics here in the area (Midland and Odessa) and when it goes out of circulation ... that's a lot for basically one doc[tor] to absorb."

In addition, Austin cited barriers to receiving state funding. Noting that MCHS treats uninsured patients, he said, "We try to tap into what state grants are out there, but basically the state has eliminated or severely messed up a lot of their women's health programs. It's a horrible Catch-22." He stated, "There are women [who] need these services but can't afford them and we see as many as we can, but the state program to help these folks along has basically evaporated. So I'm afraid there are probably a lot of folks flying under the radar who need care and aren't getting it."

Further, Austin said while MCHS is part of TWHP, the state's programs have complicated MCHS' ability to help low-income women. "Some of the other more targeted (family planning) funding programs (through state-funded resources) have become so convolutedly complex that we either can't apply for them or if we do, they're only going to Austin or San Antonio, the big population centers, even though there is a tremendous need in this area," he said.

According to the Reporter-Telegram, the number of Texas women enrolled in the TWHP in 2013 was lower than the number enrolled in the TWHP in 2011. Data from the Texas Health and Human Services Commission (HHSC) show that 188,245 women were enrolled in TWHP in fiscal year (FY) 2013, 9 percent less than the 207,041 enrolled in TWHP in FY 2011. Overall, HHSC data show that only about 273 Midland County women were enrolled in TWHP last year.

Citing MCHS' relationship with Midland Memorial Hospital and its "excellent eligibility in patient referral, patient care coordinators," Austin said, "We try to work with the patient to get them the care they need, but it's been an uphill battle the past couple years" (Midland Reporter-Telegram, 6/12).