1. Women’s Preventive Healthcare
TEXAS WOMEN’S HEALTHCARE COALITION
Women’s Preventive Healthcare
February 2019

2. Our Staff Evelyn Delgado Leah Gonzalez, MSSW Erika Ramirez, MPA
Chair, TWHC
President, Healthy Futures of Texas
Leah Gonzalez, MSSW
Policy & Advocacy Associate, TWHC
Erika Ramirez, MPA
Director of Policy & Advocacy, TWHC
Perdita Henry
Communications Specialist, TWHC

3. Texas Women’s Healthcare Coalition
Who We Are:
83 healthcare, advocacy, faith organizations
What We Do:
Strive towards access to preventive healthcare, including contraception, for ALL Texas women

4. Background

5. Women’s Preventive Healthcare Services
Well-woman exams
Screenings
Contraceptive services
counseling, methods, and supplies
Additional services
* State-funded program do not cover abortions
Not Abortion

6. Healthy Texas Women (HTW)
Covered Services
Well woman visit
Contraceptive services
Breast and Cervical Cancer
Screenings & Diagnostic Services, Cervical dysplasia treatment
Screening, limited treatment for
Hypertension, diabetes, cholesterol, postpartum depression
STD screening and treatment
Sterilizations
Immunizations
Other preventive services
Client Eligibility
Women ages 15-44
15-17 w/ parental consent
200% Federal Poverty Level
Citizen/Eligible Immigrant
Not pregnant
Eligibility Determinations
Client eligibility is determined by HHSC
Apply online or paper application
Fee-For-Service (with a few contracts)
Program does not offer full coverage, it has a limited service array which includes family planning services and limited preventive health services.

7. Family Planning Program (FPP)
Eligibility:
Women and Men
Age 64 or younger
250% of the Federal Poverty
Level (FPL)
Texas residents
Not be eligible for any similar
program, including HTW
Eligibility is determined at the point
of service by family planning
contractors
Covered Services:
Well woman visit
Contraceptive services
Breast and cervical cancer screening &
diagnostic services
Screening for
Hypertension, diabetes, cholesterol
STD screening and treatment
Sterilizations
Immunizations
Prenatal Services
Program does not offer full coverage, it has a limited service array which includes family planning services and limited preventive health services screenings. The main difference in FPP from HTW is it serves men, wider age range, and some prenatal services.

8. Women’s Health Program Budget & Clients Served
2011 – legislature approved deep cuts to family planning budget
2013 – “restored” funding for EPHC, TWHC, FPP
2015 – program consolidation
2016 – July 2016 HTW and FPP Launch
2017 – legislature approved level funding for next biennium
Need to prioritize women’s health funding and programmatic administration to stabilize programs, encourage provider enrollment, and ultimately reach more women and men in need
Still 1.8 million women (of reproductive age ~ 15 – 44) in need of publicly funded contraceptive services
Sources:
*Texas Health and Human Services, “HHS Women’s Health Update,” April 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, FY 2016
Updated FY 2017 service number: HTW - 132,464; FPP - 97,653
Texas Health and Human Services. “Presentation to the House Committee on Public Health: Overview of Women’s Health Services in Texas.” September 13, 2018.

9. Maternal Mortality
The Texas maternal mortality rate saw a sharp increase in New data analysis show the increase was not as sharp as originally reported, but is still worse than other states. Significant disparities still exist, as Black women are at the highest risk for maternal death.
The Maternal Mortality and Morbidity Task Force and DSHS Joint Biennial Report found that chronic health diseases such as pre-pregnancy obesity, diabetes, and hypertension were factors associated with an increased risk for maternal death. Family planning helps prevent, detect, and manage chronic conditions such as these.

10. Selected Recommendations from the
TX Maternal Mortality and Morbidity Task Force 1.
Increase access to health services during the year after pregnancy & throughout the inter-conception period
Enhance screening and appropriate referral for maternal risk conditions.
Improve postpartum care management and discharge education for patients and families
Increase maternal health programming to target high-risk populations, especially Black women. 2. 3.
These are the recommendations that are most closely tied to the work of the TWHC. And you will see that the TWHC priorities help support these recommendations from the Maternal Mortality and Morbidity Task Force.
Texas Department of State Health Services. “Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report.” Sept 4.

11. Benefits of Family Planning
3/28/18
Benefits of Family Planning
Reduces unintended pregnancies & allows healthy birth spacing
Reduces maternal & infant complication risks
Results in better maternal & infant health outcomes
Provides a critical entry point into healthcare services:
Helps prevent, detect, and manage chronic conditions before pregnancy
Increases access to postpartum and inter-conception health care
Improves continuity of care
Fiscal Benefit: Every dollar investing in family planning, saves taxpayers $7.09

12. Women’s Preventive Healthcare and the
86th Legislature

13. TWHC Policy Priorities1. 3.
Ensure funding for women’s preventive healthcare, including contraception.
Identify areas with a shortage of qualified family planning providers, develop strategies to increase provider participation in the state’s women’s health programs.
Ensure women have access to the full range of FDA-approved contraceptives of their choice, including LARC.
Increase continuity of care for women by eliminating barriers to preventive healthcare access.
Maximize the ability of the women’s healthcare safety net to reach more women and save Texas taxpayer dollars. 2. 4. 5.

14. TWHC Policy Priorities1.
Ensure funding for women’s preventive healthcare, including contraception.
Nearly 1.8 million Texas women are in need of publicly funded preventive services
At a minimum, maintain the funding levels for the state’s women health programs, with the goal of increasing funding to meet the need for services statewide. 
House and Senate versions of the Budget 
Items we would like to see funded/in the budgets:
Fund the Family Planning Program at the level requested in the Health and Human Services Legislative Appropriations Request. - The Health and Human Services requested funding for the program that would meet the anticipated 20% growth in average monthly number of women served through 2021.
Increase access to the most effective, long-lasting forms of contraception (implants and intrauterine devices). - TWHC recommends helping the state build upon the advances it has already made in promoting access to effective contraception, particularly by helping reduce the upfront costs to providers and alleviating some of the financial and administrative barriers to making these highly effective methods available.
Support the Department of State Health Services Exceptional Item to Combat Maternal Mortality and Morbidity in Texas

15. TWHC Policy Priorities2.
Identify areas with a shortage of qualified family planning providers, develop strategies to increase provider participation in the state’s women’s health programs.
Identify areas of greatest need by collecting and analyzing data that provides an accurate picture of unduplicated provider capacity and fund distributions to contractors in the state. 
Increase provider outreach and eliminate barriers to provider participation. 
Require HHSC to provide complete date in the Women’s Health Programs Savings and Performance Annual Report
HB 992 (Calanni)

16. TWHC Policy Priorities3.
Ensure women have access to the full range of FDA-approved contraceptives of their choice, including LARC.
Increase access to long-acting reversible contraceptives (implants and IUDs). 
Enable women to receive a 12-month supply of birth control at a single pharmacy visit, if prescribed. 
Ensure adequate provider training that aligns with Quality Family Planning (QFP) best practices recommended by the Centers for Disease Control and Prevention. 
HB 30 (Hinojosa), HB 937 (Davis)

17. TWHC Policy Priorities4.
Increase continuity of care for women by eliminating barriers to preventive healthcare access.
Address policy and system limitations preventing eligible CHIP clients from receiving services through Healthy Texas Women. 
Ensure women receive effective referral services into women’s healthcare programs and other treatment as needed. 
Automatically enroll eligible 19-year-olds into Healthy Texas Women when their CHIP or Children’s Medicaid certification period ends. 
SB 189 (Miles)/HB 606 (Thierry)
HB 60 (Ortega)/SB 256 (Rodriguez)

18. TWHC Policy Priorities5.
Maximize the ability of the women’s healthcare safety net to reach more women and save Texas taxpayer dollars.
Develop a workable solution for the coverage gap that will maximize federal funding and substantially increase the number of women able to access a medical home where they can receive critical preventive care and family planning services. 
Extending Medicaid coverage for women up to a year postpartum. 
Improve maternal and child health by creating a tailored coverage option for women to access care before, during, and after pregnancy. 
HB 241 (Farrar)/HB 411 (Thierry)/HB 610 (Walle)/HB 744 (Rose)/SB 147 (Rodriguez)
HB 1110 (Davis)
SB 308 (Watson)

19. Texas Women’s Healthcare Coalition
Get Involved!
Sign up for our newsletter –
Call in or attend a meeting in Austin
Reach out to TWHC with recommendations and concerns
Provide your expertise through legislative visits and testimony

20. Thank You! Evelyn Delgado Leah Gonzalez, MSSW Erika Ramirez, MPA
Chair, TWHC
President, Healthy Futures of Texas
Leah Gonzalez, MSSW
Policy & Advocacy Associate, TWHC
Erika Ramirez, MPA
Director of Policy & Advocacy, TWHC
Perdita Henry
Communications Specialist, TWHC

21. TWHC Bills of Interest
HB 992 (Calanni) - Relating to the capacity of certain minors to consent to maternal health care.
HB 30 (Hinojosa) - Relating to the transfer of unused long-acting reversible contraceptive products under Medicaid and the Healthy Texas Women program.
HB 937 (Davis) - Relating to health benefit plan coverage of prescription contraceptive drugs
SB 189 (Miles)/HB 606 (Thierry) - Relating to the automatic enrollment of certain women in the Healthy Texas Women program.

22. TWHC Bills of Interest
HB 60 (Ortega)/SB 256 (Rodriguez) - Relating to a requirement that public institutions of higher education provide certain information regarding certain women's health programs to students.
All following bills have the same caption:
Relating to the Medicaid eligibility of certain women after a pregnancy.
HB 241 (Farrar)/HB 411 (Thierry)/HB 610 (Walle)/HB 744 (Rose)/SB 147 (Rodriguez)
HB 1110 (Davis)
SB 308 (Watson)