By Perdita Henry
It’s been a busy few weeks at TWHC as things continue to pick up at the Capitol. Just a few weeks after Committee assignments were made public, the Senate Finance Committee and the House Appropriations Committee gave stakeholders one of their first opportunities to testify.
Over the past two weeks, TWHC provided written and oral Article II testimony to Senate Finance committee members during the Health and Human Services Appropriations hearings, and submitted additional written and oral testimony to the House Appropriations Committee (HAC) during the Health and Human Services Appropriations hearing and the Department of State Health Services Appropriations hearing, as both legislative bodies continue budgetary preparation for the next biennium.
While we welcomed the announcement of level funding for women’s health programs in the Senate version of the budget, funding was reduced in the House version, and neither of the proposed budgets considered inflation or an increase in client caseload for the 2020-2021 biennium.
Our submitted testimonies focused on highlighting the importance of the Family Planning Program receiving adequate funding, continuing the great work of increasing client access to long acting reversible contraception (LARC), and asking for specific support in the ongoing goal of strengthening the women’s healthcare safety net through continuity of care. Below is an overview of what we shared with the Senate Finance and the House of Appropriations Committees.
1) Fund the Family Planning Program at the level requested in the Health and Human Services Legislative Appropriations Request.
HHSC has requested funding for the program to meet the anticipated 20 percent growth in the average monthly number of women served through 2021.[i]
We know that an investment in family planning ultimately leads to cost savings for the state. Providing preventive services to low-income women saves costs primarily by helping women avoid unplanned pregnancy, which in turn averts Medicaid costs associated with pregnancy, birth, and infant healthcare.
Preventive care and birth control are as important to the state’s fiscal health as they are to the health of women and their babies. Every dollar used to provide contraceptive care for a woman saves $7.09 in public costs.[ii] Medicaid pays for 53 percent of the births in Texas, resulting in the state spending $3.5 billion per year for birth and delivery-related services for mothers and infants in the first year of life.[iii] In Fiscal Year 2017 alone, it was estimated that the Family Planning Program saved $44.2 million in general revenue and $8.5 million in net savings.[iv] In tough financial times, funding for family planning is a smart investment for families and for the state.
2) Increase access to the most effective, long-lasting forms of contraception (implants and intrauterine devices).
Access to contraception – particularly the highly effective LARCs – is still a challenge for many low-income women. During the previous Session, lawmakers included rider language directing the agency to work on expanding LARC access. Coupled with advocate and provider efforts, we saw a modest increase in LARC utilization in both Healthy Texas Women and the Family Planning Program.
Removing financial and informational barriers is still a work in progress. We encourage lawmakers to continue helping the state build upon the advances it’s already made in promoting access to effective contraception, particularly by making additional funds available to help reduce the upfront costs to providers and alleviate some of the financial and administrative barriers to making these highly effective methods more available to women.
3) Support the Department of State Health Services Exceptional Item to Combat Maternal Mortality and Morbidity in Texas.
Ensuring women have and can maintain access to healthcare is a major component of our mission to continue strengthening the women’s health safety net. However, making sure women receive high-quality care when they enter the healthcare system is equally important.
To continue the work of keeping expectant mothers safe, the Department of State Health Services (DSHS) put forward an Exceptional Item (EI) request for funding to implement maternal safety initiatives statewide, to implement a maternal care coordination pilot for women, and to increase public awareness and prevention activities.
4) Account for additional funds needed to implement improvements to continuity of care for women.
Lawmakers have great opportunities to maximize the ability of the women’s healthcare safety net to reach more women and save Texas taxpayer dollars this biennium.
One of those ways is to implement an auto-enrollment process for 19-year-olds aging out of the Children’s Medicaid program and the Children’s Health Insurance Program (CHIP) into Healthy Texas Women (HTW). Seventy percent of teen births in the state are to 18 and 19-year-olds. Transitioning this otherwise vulnerable demographic into HTW would reduce barriers to preventive healthcare access, remove the burden of re-applying for a new program, and improve access to family planning services.
This policy would not only improve maternal health, child health, and continuity of care, it would reduce state General Revenue costs. HHSC estimates a savings of $58.7 million in GR ($102.6 million All Funds) over five years. The bulk of that savings would be through the estimated 11,275 averted births that could be realized without the improvement of continuity of care and access to family planning services.
We hope that legislators are inspired to continue pushing forward with dedication and innovation for the women of Texas.
[i] Health and Human Services, “Legislative Appropriations Request for Fiscal Years 2020-2021,” August 2018. Accessed at https://hhs.texas.gov/sites/default/files/documents/about-hhs/budget-planning/lar/hhsc-legislative-appropriations-request-2020-2021.pdf
[ii] Frost JJ, Sonfield A, Zolna MR and Finer LB, Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program, Milbank Quarterly, 2014, doi: 10.1111/1468 0009.12080,http://onlinelibrary.wiley.com/enhanced/doi/10.1111/1468-0009.12080/, August 12, 2016.
[iii] French, Lesley and Delgado, Evelyn, “Presentation to the House Committee on Public Health: Better Birth Outcomes,” Health and Human Services Commission, May 19, 2016.
[iv] Health and Human Services Commission, “Texas Women’s Health Program Report Fiscal Year 2017,” May 2018. Accessed at https://hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2018/womens-health-program-savings-performance-report-may-2018.pdf