Women’s Health Threatened by Restrictions to Medicaid Services

When the Affordable Care Act was signed into law by President Barack Obama in 2010, states were given the opportunity to expand Medicaid coverage. After a 2012 Supreme Court decision that allowed states to opt-out of expanding Medicaid, 19 states chose opt-out while 32 states and the District of Columbia chose to expand Medicaid. Texas chose not to expand Medicaid and has looked for creative ways to cover its large population such as employing programs through a Section 1115 Medicaid demonstration waiver. Section 1115 of the Social Security Act allows the Secretary of Health and Human Services to waive provisions of Medicaid law in order for states to have flexibility to plan and improve eligible programs.

There are several purposes of Section 1115 waivers: expand eligibility to those not covered by traditional Medicaid, provide services not typically provided by Medicaid, and use an innovative delivery system that improves care and reduces cost. While Texas has had a Section 1115 waiver to implement improved care delivery and increase coverage for uninsured and underinsured residents, Texas has also applied for a family planning waiver that would restrict access to patients.

Texas has applied for a Section 1115 family planning demonstration waiver, which would expand its existing state-funded program. As the Women’s Health Program, the Obama Administration denied the 1115 waiver application, so the program has operated as a state-funded initiative since 2011. This year, the re-named Healthy Texas Women program proposes to exclude abortion providers from program participation. This means that organizations affiliated with abortion providers cannot participate in the program.

The Healthy Texas Women program has negative public health impacts – tested by the state’s own data – and does not introduce a new or innovative project nor does it expand access or strengthen coverage. By 2016, Texas saw a decline of 35% in access to birth control for women on Medicaid. Over four years, Texas saw a three-fold increase in the maternal mortality rate. By 2016, 26% of the women enrolled in the program had never received health care services from a provider participating in the program.

During my time in Congress, I have pushed for the renewal of the Section 1115 waiver which helps to cover our uninsured and underinsured population. However, this family planning waiver is misleading and unfair to those who seek health care and actual family planning services. Several of my colleagues and I sent a letter to the Centers for Medicare and Medicaid Services to oppose this waiver proposal. The protection of freedom of choice of family planning providers is important to me. We must protect our most vulnerable, especially Medicaid beneficiaries, who otherwise would have nowhere to turn.