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Texas Violates Medicaid Law, Loses Federal Funds for Women’s Health Program

In late February 2012, the Texas Department of Health and Human Services announced that it will proceed with a state law preventing clinics that provide abortion services or are “affiliates of abortion providers” from receiving Medicaid funds from the Texas Women’s Health Program.[1] The implementation of this law follows a request made by the state to the United States Department of Human and Health Services (HHS) in December 2011 for a federal waiver to exclude certain providers from the Women’s Health Program. The request was rejected because it violates federal rules, including those in the Social Security Act, which prohibit Medicaid programs from excluding particular providers and guarantees patients the right to choose their health care provider.[2] In spite of HHS granting a three-month extension to the Texas Department of Health and Human Services to reach a resolution, the new state law went into effect March 14, 2012. The following day the federal government announced it would cut funding to the Texas Women’s Health Program.[3]
Family planning services have a long and successful history in the United States, first being signed into federal law by President Richard Nixon under the Family Planning Services and Population Research Act of 1970.The Centers for Disease and Control and Prevention cite family planning as one of the top ten public health advancements of the 20th century, and the Guttmacher Institute released a report in 2009 estimating that family planning services help women and couples avoid approximately two million unplanned pregnancies nationwide every year.[4]
It is estimated that the Texas state law will adversely affect at least 130,000 low-income women who “will lose access to cancer screenings, well-woman exams and contraception.”[5] Additionally, the state will need to reallocate approximately $35 million in its state budget, which was previously provided by Medicaid funding, to continue funding services through the Women’s Health Program for low-income women in Texas. In spite of Republican governor Rick Perry’s assertion that the state will “find the money,” there is doubt that Texas can afford such a law. U.S. Senator Kay Bailey Hutchison (R-TX) stated in an interview, “We cannot afford to lose the Medicaid funding for low-income women to have health care services. We can’t keep turning back federal funds that every state gets and then try to find money in our budget that is already being cut in key areas like education.”[6] Finally, the ability of approved providers across the state to take on 130,000 new patients is expected to be a slow and ineffective process for women, who will now need to research approved providers and potentially wait weeks for a first appointment and travel longer distances for their reproductive health care.[7]
This law follows a significant loss in state funds to family planning services last year, when Texas lawmakers cut approximately two-thirds of the budget, over $70 million.[8] These cuts resulted in the closing of more than half of state-funded family planning clinics.[9] Opponents are skeptical of the GOP’s commitment to family planning services for women, especially since the services provided by the banned clinics were the only source of health care for many low-income women.[10]
Regarding the federal decision to hold Texas accountable to Medicaid law and halt funds, Alison Castle, a spokesperson for Governor Perry, argued that “the Obama administration is trying to force Texas to violate our own state laws.”[11] Cindy Mann, director of the Centers for Medicare and Medicaid Services, explains that regardless of the Texas law, “Medicaid law is clear—patients, not state government officials, are able to choose the health-care providers that are best for them and their families.”[12]
The Texas law comes at a time when other states are also severely slashing their family planning budgets or eliminating them altogether. For example, Montana and New Jersey have completely eliminated their state family planning programs, and New Hampshire cut its funding by 57 percent.[13] Though Planned Parenthood has enjoyed widespread bipartisan support in Texas for decades, its exclusion from receiving any funds from the state will result in the loss of all Medicaid funds and increase the difficulty of accessing health care services for tens of thousands of low-income women.[14] Planned Parenthood Gulf Coast President and CEO Peter J. Durkin says of the Texas law, “No one’s politics should interfere with a woman’s access to health care. . . . It is shameful that Governor Perry and [Texas Department of Health and Human Services] Commissioner [Tom] Suehs continue to politicize lifesaving breast cancer screenings and birth control access for low-income women.”[15]

[1] Emily Ramshaw, “Seuhs Signs Bill Banning Abortion Affiliates,” 23 February 2012, accessed 8 March 2012, <>.

[2] National Partnership for Women and Families, “HHS Rejects Texas’ Request to Exclude Planned Parenthood, Other Providers from Medicaid,” Women’s Health Policy Report, 15 December 2011, accessed 8 March 2012, <>.

[3] Will Weissert, “Feds to Halt Texas Women’s Health Program Funding,” Associated Press, 15 March 2012, accessed 20 March 2012, <>.

[4] Rachel Benson Gold et al., “Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System,” 2009, accessed 23 March 2012, <>.

[5] Ramshaw, “Seuhs Signs Bill Banning Abortion Affiliates.”

[6] Steve Benen, “GOP Senator Bucks Party on Planned Parenthood Funding,” Maddow Blog, 22 March 2012, accessed 27 March 2012, <>.

[7] Andrea Grimes, “What Will Texas’ New State-Funded Women’s Health Program Look Like?”RHReality Check, 22 March 2012, accessed 23 March 2012, <>.

[8] Mary Ann Roser, “Austin-area Care Providers Brace for State Cuts,” Austin American-Statesman, 11 July 2011, accessed 15 March 2012, <>.

[9] Ibid.

[10] Chris Tomlinson, “New Texas Rule Could End Women’s Health Program,” Lubbock-Avalanche Journal, 24 February 2012, accessed 8 March 2012, <>.

[11] Ibid.

[12] Weissert, “Feds to Halt Texas Women’s Health Program Funding.”

[14] National Partnership for Women and Families, “States’ Family Planning Cuts End Services for Tens of Thousands of Low-income Women,” Women’s Health Policy Report,5 March 2012, accessed 8 March 2012, <

[15] Ramshaw, “Seuhs Signs Bill Banning Abortion Affiliates.”