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The committee met to discuss the following interim charge: 

Build on previous legislative achievements in women's healthcare by examining women’s access to preventative health care, pregnancy services, and postpartum care, and exploring ways to expand access and improve quality, particularly in rural and underserved areas of the state. Monitor the implementation of women's health programs in Texas. Assess these programs' impact on outcomes such as improving access to preventative services, reducing unplanned pregnancies, and achieving cost savings. Recommend ways to better coordinate the various programs in a manner that increases the number of women served, ensures adequate provider capacity statewide, and maximizes efficiencies to the state.
 
Chair Jane Nelson:

  • Women’s Health should be a top priority for the state
  • Women need access to family planning services and preventative screenings
  • Made significant investment last session, adding $240M to the budget to reach an additional 170,000 women
    • Funding is now at record levels
    • Surpassed the capacity under the federal program
  • Wants to get honest numbers, want to identify gaps and where resources should be focused
  • Four major priorities:
    • Better educate women
    • Better coordinate and consolidate for a seamless system
      • Have various funding sources and programs with different eligibility guidelines
    • Need to address pockets of Texas that have capacity issues
    • Must continue to prioritize family planning across all programs
  • How do we make sure women can access to all the services they need, and know where to go?
    • Janek – we need to make sure that the providers are educated and know where to go

Kyle Janek, Commissioner, health and Human Services Commission

  • Texas is experiencing a substantial population growth and 42% of women are of childbearing age

Dr. David Lakey, Commissioner, Department of State Health Services

  • Breaks down ethnic demographics for childbearing- age women
    • Approximately 3.3M women are at or below the FPL
    • Larger concentrations in the border communities
    • 10% decrease in fertility rate in the past 10 years
      • Ethnic difference has narrowed significantly
    • Teenage pregnancy rate has dropped over 10% in the past 10 years
    • Senator Royce West asked for data on repeat teen pregnancy, believes it is higher than many other states
      • HHSC has contracts in 11 communities to promote teen pregnancy education and try to decrease rate
    • Senator West – Texas is still higher than the rest of the US in pre-term births; did the prior to 39 week induction prohibition lower the numbers?
      • What are you doing about the ethnic disparities?
      • Worked across industries and institutions to form a group to form ideas that the legislature has implemented in the past sessions
      • Working in local communities to implement best practices and address disproportionality
    • Senator Joan Huffman – I had a bill that established a maternity care management pilot – wouldn’t this be a good strategy to address individual women’s needs?
    • Lakey – We have a group of 80 people meeting quarterly that are the best minds in this area in the state under the Healthy Babies Collaborative program

Commissioner Janek:

  • 54% of all Texas births are paid by Medicaid, $2.2B a year
  • Senator West – has HB 1983 yielded the results we wanted it to yield?
    • Still have a lot of work to do (eliminating non-medically indicated deliveries paid for through the Medicaid program)
    • Varies across the state
    • Senator Charles Schwertner – from a legislative standpoint, we can put in laws that are not in the best interest of the patient, it is a slippery slope
  • Janek – Doctors are making decisions in the patient’s best interests – this is identified by doctors still doing inductions before 39 weeks because it is obvious it is not for the money – we need move towards rewarding for good clinical judgment
  • There needs to be a seamless system between Medicaid and TWHP for continuity of care before and after delivery
  • Title X money is not within DSHS anymore, working to coordinate with them to utilize those funds ($27M) in addition to the $240M
    • Confusion over where all the funding streams are coming from, and how the funds are utilized with in each program
    • Nelson asked about the 1115 waiver funding for women’s health
      • 118M over 3 demonstration years
    • We need to know exactly what we are spending and from what source
    • Janek is interested in reaching out to the University health centers to get their data on family planning/women’s services and grant them money based on their performance
  • Senator Judith Zaffirini – How can we consider inflation and population growth in these figures?
    • Will get back to her
  • DSHS has been working hard to expand primary care physician base with FQHCs, large public hospitals, academic centers and local providers
  • Senator Zaffirini wants a comprehensive chart of all funds and all programs, including all clients served
  • Senator Nelson – there are so many different entities, how can women figure out where to go if the legislators cannot figure it out?
    • Hopefully this can be addressed in the sunset process
  • Janek – the data could be incomplete because they might not be catching all the contraceptives provided through the VDP
  • Senator Nelson – we need all the information we can get to make recommendations for the interim report, as well as for Sunset
  • TWHP
  • Discussed the background of the Women’s Health program, and the transition to the state funded TWHP
    • Treatment of STDs is a new benefit from the old Women’s health program
    • Approximately 3,000 certified providers are listed on the TWHP Online Provider Lookup
  • Senator West – As it relates to covered services, are certain health care conditions covered that could lead to infant mortality and preterm births?
    • The covered services are the same as under the original WHP, so no
    • Lakey – there may be some more flexibility in the program now since it is a state and not a federal program
    • Senator West – should we not cover these predisposed conditions and services to reduce negative outcomes?
      • Janek will need to converse with his experts to focus in on these predisposed conditions and how dollars can be allocated to address them
  • TWHP services are delivered on a FFS basis

DSHS Women’s Health Services

  • Family planning service array is slightly different than the expanded primary health care program
  • Fund 18 contractors across the state
  • Title X funding shifted to the private sector in the spring of 2013 (Women’s heal and family planning association)
    • Offered a 6 week extension to ensure continuity of contractor base
    • Granted an extension of the Title X grant
  • 18 contractors decided that they wanted to remain with the state funding, 19 stayed with the Title X funding
  • $16M received through rider 91
  • $43M appropriated for FY 14-15
  • Established mechanism for all contractors to have access to the 340B program
  • Women’s Health and Family Planning Association of Texas
    • Receives $13.7M annually in Title X funding
    • 28 contractors
    • 93 clinics
    • Do not know the actual number of women being served
  • Zaffirini asked again for total numbers of dollars and women served across all programs in the State

Expanded Primary Health Care (EPHC)

  • $50M annually serving 170,000 clients
  • 55 contractors, 222 clinics
  • Integration of family planning with comprehensive care
  • Significant cost savings to the state with the births averted due to increased contraceptive services
  • Added prenatal dental services to the array provided
  • $5M awarded to 5 hospital/hospital districts effective 9/1/13
    • Bexar County, Dallas County, Harris County, Tarrant County, UTMB
  • Identified regions with coverage gaps, and DSHS continues to negotiate with potential contractors
    • Nelson – where do the biggest gaps remain?
      • Challenge in Amarillo, Texas Tech stepped up
      • Information is coming back from the contractors to help identify capacity issues that remain
    • Initiated project with TMHP to develop a FFS billing system effective 9/1/14

Breast and Cervical Cancer Services

  • $12.3M (both GR and Federal) annually
  • 41 contractors at 195 clinics
  • Serves 43,000 clients annually

Title V Prenatal

  • $1.5M (GR and fed annually)
  • 7,741 clients annually with 26 contractors at 107 clinics

Health Texas Baby initiative – working to formalize this a collaborative across industries and states
HHSC Next Steps

  • Comprehensive women’s health website
  • Transition services between programs
  • Efficient wraparound services and client referrals
  • Identifying new service locations
  • Studying best practices to improve birth outcomes and spacing
  • Potential consolidation of programs
  • Review pharmacy requirements to offer more flexibility
  • Survey contractors on ability to expand capacity

 
 
Public Testimony
Ellen Swiss, self

  • Frustrated with HB 2
  • Doesn’t see any achievements made in women’s health

Amanda Stevenson, UT Texas – Texas Policy Evaluation Project

  • Followed post-partum women to see if they could access their desired contraceptives
  • 70% of women who had an unplanned pregnancies did not have access to IUDs
  • Primary health care providers fail largely to be trained and use IUD devices
  • FQHCs are not prepared to use state of the art methods in family planning
    • LARCs are recommended, not required in the EPHC
    • Problem is there is a lack of training
    • New innovative training for family planning specialists, so the older trained docs are not up to date on the new research and recommendations
  • Nelson – we need to consider this in our goals for recommendation

Abigail Akin, Texas Policy Evaluation Project

  • Postpartum demand for IUDs, LARCs is high but not being adequately met
  • Only 29% were able to access these methods
    • Lack of prenatal plan with doctor
    • Lack of training
  • Recommend high quality prenatal counseling
  • Recommend all hospitals stock an adequate amount of devices
  • Senator Jose Rodriguez – does this need legislation?
    • The idea is that it would be tied to funding – if you receive these funds you must have training and are required to provide LARCs
  • Nelson – The department says that the training will be required by 2015, and will eventually require access to LARCs

Joan Smith, Consortium of Certified Nurse Midwives

  • Advocates for the Centering Pregnancy Program
    • Model of prenatal group care
    • Wants the state to establish a funding stream

Cathy Blanc, Texas Oral Health Coalition

  • Promoting good and preventative oral health for women during pregnancy and postpartum stages

Grace Shreen, League of Women Voters

  • Do not think that legislative actions should be viewed as achievements in Women’s Health
  • 2011 150,000 women lost access to care
    • Understand that they are working to restore that and are thankful
    • Concerned with high number of teen pregnancies in Texas
  • Teens need confidential contraception which they cannot receive now
  • Teens need quick appointments
  • Wants more comprehensive sex education
  • Nelson – would the League of Women Voters support the 4 key priorities identified at the beginning of the meeting?
    • Yes, definitely

Caroline Calabrese, on behalf of woman in Weslaco Texas

  • Personal story about how she couldn’t find access to care due to the removal of funding from Planned Parenthood
  • Had surgery through the county indigent program, but cannot find a place to get follow up visits due to overbooked clinics or places that do not have funding

Elisia Bogresso, testimony from a South Texas Promotora

  • Has had to go to Mexico to find affordable services due to the lack of clinics in the Valley
  • Some clinics have reopened but there still is an access problem

Janet Realini, Texas Women’s Health Care Coalition

  • The need for preventative care services is massive, 1.3M in 2010 in Texas and we are only reaching 1 in 3
  • Each program has its unique population it serves
  • Since the safety net has been in so much turmoil, we need to understand how the new system works best and analyze how well the capacity and functions go – need to measure effectiveness and get good data on outcomes
  • Senator Nelson – would the coalition have any problems with the 4 priorities outlined? I am trying to find things we can all agree on
  • One concern might be with the word “consolidation” to make sure we don’t skip over any services
  • The family planning program has been historically the most efficient in reducing costs
  • In favor of integrating family planning into the whole range of services – but it doesn’t work that easy for all providers
  • Nelson – so many entities providing different things with different funding sources, I am having a really hard time wrapping my arms around it – we need good, complete data to make good decisions as policymakers
  • Senator Rodriguez – Your written testimony states that even with the recent investment of $100M, the state has only the ability to reach 1/3 of women in need?

JoAnne Holly, Secular Texas

  • Testimony was dismissed in the special session on HB 2
  • Texans are suffering

Alice Dopkin, Texans Care for Children

  • Appreciates inclusion of pregnancy and postpartum care, as well as the focus on continuity of care
  • Very important to provide the spectrum of care
  • Want to focus on the seamless transition between programs, and want to ensure that women have access to the services they need

Christy Blanco, Women’s health care NP in El Paso

  • Story about an uninsured single woman who showed up at her clinic with breast cancer
  • Put her under the cancer consortium which provides care for indigent patients
  • Komen and CPRIT provide key services
  • Thankful for SB 406 regarding APRN delegation
  • Senator Rodriguez – asked about removing all requirements for delegation, thinks we should look at that next session
    • She had to move her practice into New Mexico because the delegation was too costly and they do not have those requirements in New Mexico

Stacy Pogue, CPPP

  • The women’s health safety net is in recovery mode
  • There are a lot of silos, and a comprehensive discussion of needs and holes in necessary for coordination

Angie McClure, American Lung Association

  • The COPD rate is higher than it ever has been
  • Women are 37% more likely to have it over men resulting in death
  • Trying to advocate for education and funding for COPD

Amy Clint, Teacher

  • It is shameful the amount of women without access to healthcare
  • Personal stories about students without access to appropriate care

John Sego, Texas Right to Life

  • Pointed out that Planned Parenthood is still receiving tax payer dollars through the breast and cervical screening program
  • Patchwork method with all the different programs and strategies for women’s health care is not working

Jan Soyfer, Chairwoman of the Texas Democratic Party

  • Texas women should have access and the ability to make their own healthcare decisions
  • Texas is suffering from Republican politicians

Paula Tericky, Parkland

  • EPHC awardee, preparing for the changes and have trained 200 employees
  • There are Title X reporting conflicts with EPHC reporting

Renata Sims, Parent

  • Advocates for a curriculum that promotes only sex after marriage

Dan Boone, Clinical Psychologist

  • Has patients that are pregnant with nowhere to go
  • Need to return right to women to make their own choices with their doctors

Heather Ross, self

  • Epileptic but doesn’t qualify for disability
  • Was raped and got the morning access pill
  • Women with disabilities need access

Brenda Collier, self

  • “torture of Texas women”

Cindy Noland, self

  • It is the parent’s responsibility to teach their kids about sex
  • The dignity of a woman begins with family planning which abortion is part of

Nick Lee, Secular Coalition of Texas

  • Would like a demonstration project for disadvantage women
  • Crisis centers are usually faith-based and funded by the state which is unconstitutional

Alexis Losey, self

  • There are politically motivated tags on women’s healthcare
  • Lost access because the clinic she used closed
  • Wants Planned Parenthood to be a provider

Shelby Alexander, representing Austin Chamber of Commerce member Martinez

  • Austin is one of the only places to get a full spectrum of women’s healthcare due to HB 2 and the slashing of funds in the 82nd

Cheryl Foster, self

  • Works at the Planned Parenthood in Waco
  • Cannot provide abortions anymore, closest place for patients to go is Austin or Dallas
  • Puts up a significant barrier to access

Catherine Pratt

  • Works for an organization that counsels women on abortions

Susan Chase, self

  • Promoting comprehensive sex education and access to birth control

Stacy Alexander, self

  • Supporter of Planned Parenthood, breast cancer survivor

Joe Potter, Professor at UT

  • Most effective method of birth control is a vasectomy
  • Need dedicated funding stream to pay for vasectomies
  • Public outreach campaign is needed

Molly Terry, self

  • 76 Women’s Health clinics closed
  • There are areas in South Texas without access to care
  • Women are going to Mexico for “miscarriage management”

Selena Wells, self

  • Risk avoidance sex ed is the best option for a better future

Suzanne Hemphill

  • Works for an organization that raises money to help women have safe and legal abortions

David Campbell, self

  • Appreciates the extra funds but referring to the recent actions as “achievements” is disingenuous

Lizzie Burr, Texas Women’s Vote Project

  • What happened to the system when the cuts were made? Need a full analysis
  • Where were the clinics located that closed and where do those women go now?

 
Senator Nelson – Obviously we have a lot of work to do, notifications will be sent when they schedule their next meeting date and time.

To view the HHSC presentation to the committee, please use the following link:  http://www.hhsc.state.tx.us/news/presentations/2014/022014-womens-health.pdf