TEXAS WOMEN S HEALTHCARE COALITION Women s Preventive Healthcare 85 th Texas Legislature JULY 2017
67 healthcare, advocacy, faith organizations Access to preventive healthcare, including contraception, for ALL Texas women www.texaswhc.org
Janet Realini, MD, MPH Chair, TWHC Founder and Associate Vice President, Healthy Futures of Texas Alice Bufkin, MPAff Director of Policy and Advocacy, TWHC Leah Gonzalez, MSSW Policy and Advocacy Associate, TWHC
Leading Up to the 85 th Legislative Session
Women s Healthcare History in Texas 2011 2013 2015 Texas Legislature deeply cuts family planning budget DSHS Family Planning program Women s Health Program (Medicaid waiver) Restored funding: Expanded Primary Health Care Texas Women s Health Program (All GR) DSHS Family Planning Title X funding awarded to private network of family planning providers Consolidation: Healthy Texas Women Family Planning Program 2016 Healthy Texas Women and Family Planning programs launch
Impact of Family Planning Cuts and Policy Changes 82 clinic closures 41% Reduced hours and services Reduced access to most effective forms of contraception decrease in clients served across women s health programs between FY 2010 and FY 2012 Increased costs to Medicaid Texas Health and Human Services, HHS Women s Health Update, April 2017. Dr. Kari White, Co-investigator on Texas Policy Evaluation Project, Testimony to the Texas Senate Health and Human Services Committee, September 13, 2016, http://liberalarts.utexas.edu/txpep/legislative-testimony/hhsc%20white.php
Protecting Women s Healthcare: Now More Than Ever Maternal Mortality The Texas maternal mortality rate doubled between 2011 and 2012 1 Though only 11.4% of all 2011/2012 births in Texas were to black women, they accounted for 28.8% of all maternal deaths 2 1. MacDorman et al., Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends from Measurement Issues. Obstetrics & Gynecology. 128(3). September 2016. 2. Texas Department of State Health Services. Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report. July 2016.
Protecting Women s Healthcare: Now More Than Ever Maternal Mortality 1) Family planning helps reduce unintended pregnancy = Better health outcomes for moms and babies 2) Family planning provides a critical entry point for women s healthcare Help prevent, detect, and manage chronic conditions Increase access to postpartum and interconception health care Improve continuity of care
Protecting Women s Healthcare: Now More Than Ever Zika The Zika virus has been linked to microcephaly, a condition that causes babies to be born with abnormally small heads and improper brain development. Zika has also been linked to other problems in infants, including eye defects, hearing loss and impaired growth. US Department of Health and Human Services Centers for Disease Control and Prevention. CDC s Response to Zika: What to Know if Your Doctor Suspects Microcephaly During Pregnancy. December 23, 2016. https://www.cdc.gov/zika/pdfs/whattoknow-doctor-suspects-microcephaly.pdf
Protecting Women s Healthcare: Now More Than Ever Zika 338 6 cases 1 Zika-related cases of Zika have been reported by Texas Department of State Health Services since 2015 of locally transmitted Zika in Texas fatality of an infant infected with the virus Because of the potential for Zika virus to affect pregnant women and their fetuses, strategies to prevent unintended pregnancy are a critical part of current efforts to prevent Zikarelated health effects. Texas Health and Human Services Commission, Texas Department of State Health Services. Zika in Texas: http://texaszika.org/index.htm Centers for Disease Control and Prevention, CDC Issues Updated Zika Recommendations: Timing of Pregnancy after Zika Exposure, Prevention of Sexual Transmission, Considerations for Reducing Unintended Pregnancy in Areas with Zika Transmission, March 2016.
Protecting Women s Healthcare: Now More Than Ever Federal Uncertainties Affordable Care Act Repeal Excluding contraception from covered preventive care Medicaid block grants/caps Title X changes
Women s Preventive Healthcare and the 85 th Legislature
Stable Funding in a Difficult Year Budget Overview: 2016-17 vs 2018-19 Appropriations DSHS FP EPHC TWHP BCCS Women s health services TOTAL 2016-17 $ millions/biennium $41.6 $100 $69.3 $23.7 $50 $284.6 Strategy D.1.1 Women s Health Program: HTW, FPP, BCCS TOTAL 2018-19 $ millions/biennium $284.6 $284.6 *According to the Legislative Budget Board, 2018/2019 Appropriations represent a $30.9 million (All Funds) increase over FY 2016/2017 Expenditures.
New State Budget Assumes Application For Healthy Texas Women 1115 Demonstration Waiver HHSC Rider 161 Rider assumes $10 million in General Revenue and $90 million in matching Federal Funds in FY 2019 If federal matching funds do not become available or are available in a lesser amount in FY 2019, HHSC shall seek direction from the LBB prior to making any reductions to program funding or service levels. CMS completed preliminary review of HHSC s waiver application on July 5 th. The waiver is open for public comment until August 4 th.
Healthy Texas Women 1115 Demonstration Waiver TWHC Concerns and Recommendations Ensure an adequate network of qualified providers Protect the Family Planning Program Preserve and improve core services and benefits Address issues with client eligibility Streamline access to care
Positive Budget Riders Women s Preventive Healthcare HHSC Rider 54 Improves data collection for women s health programs HHSC Rider 198 Requires five-year strategic plan for long-acting reversible contraceptive access (implants and IUDs) HHSC Rider 209 Requires reporting on cost savings for auto-enrolling clients aging out of CHIP and Children s Medicaid into HTW
Positive Bills and Riders Maternal Health HB 2466 (Davis) Covers maternal depression screenings in well-child visits; Allows pregnant women to receive important health updates by text, call, or email SB 1599 (Miles) Requires better reporting on pregnancy-related deaths SB 1680 (Lucio) Establishes task force on border health HHSC Rider 216 Requires study of trends, rates, disparities in pregnancyrelated deaths and options to reduce maternal mortality
Missed Opportunities (Not Passed) HB 1161 (Davis) - Requires providers to offer one-year supply of prescription contraception SB 790 (Miles) - Extends the Women s Health Advisory Committee through September 2019 SB 1929 (Kolkhorst) - Extends the Maternal Mortality and Morbidity Task Force through September 2023
Goal: Ensure funding for women s preventive healthcare, including contraception, can fully meet the growing need among low-income, uninsured women. Report Card: Progress on TWHC Policy Priorities 1. 2. 3. Goal: Ensure Goal: Identify areas with a shortage of qualified family planning providers and develop strategies to increase provider participation in the state s women s health programs. women have access to the full range of FDAapproved contraceptives of their choice, including the most effective forms of contraception implants and intrauterine devices (IUDs).
Progress on TWHC Policy Priorities 4. 5. Goal: Increase Goal: Maximize the continuity of care for ability of the women s women by eliminating healthcare safety net to barriers to preventive reach more women and healthcare access. save Texas taxpayer dollars. ç
More Work Remains
Family Planning Program WHP/TWHP /HTW Expanded Primary Health Care 350000 300000 250000 200000 150000 100000 50000 0 Clients Served By State-Funded Programs FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 Sources: *Texas Health and Human Services, HHS Women s Health Update, April 2017. EPHC numbers represent 60% of all EPHC clients to reflect proportion of EPHC funding designated for core family planning services. HHS data covers 11 months of FY 2016; data has been prorated to reflect a 12-month period.
Clients Served by State-Funded Programs Family Planning Program WHP/TWHP /HTW Expanded Primary Health Care Women in Need 2000000 1800000 1600000 1400000 1200000 1000000 800000 600000 400000 200000 0 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 Women In Need Sources: *Texas Health and Human Services, HHS Women s Health Update, April 2017. EPHC numbers represent 60% of all EPHC clients to reflect proportion of EPHC funding designated for core family planning services. HHS data covers 11 months of FY 2016; data has been prorated to reflect a 12-month period. **Frost JJ, et al. "Contraceptive Needs and Services, 2014 Update," New York: Guttmacher Institute, 2016. FY 2016
Looking Ahead Priorities in the Interim Advocate during special session (begins on July 18 th ) Monitor provider capacity and quality Strengthen the Family Planning Program Track the progress of the state s 1115 Family Planning Waiver application Engage the community and educate the public Identify strategies for increasing access to LARC Study auto-enrollment into HTW Advocate against federal policies that harm Texas women
Get Involved! Sign up for our newsletter www.texaswhc.org Call in or attend a meeting in Austin Reach out to the TWHC with recommendations and concerns Provide your expertise during the interim
Thank You! Janet Realini, MD, MPH Chair, TWHC JRealini@HF-TX.org Alice Bufkin, MPAff Director of Policy and Advocacy, TWHC ABufkin@TexasWHC.org Leah Gonzalez, MSSW Advocacy Associate, TWHC LGonzalez@TexasWHC.org