Federal Medicaid Agency Lays Out Just How The Women's Health Program Will End

What prompted Governor Rick Perry's frenzied bout of outraged tweeting about the Women's Health Program yesterday? As much as we'd like to speculate that it was a bad batch of PCP (and will continue to do so privately, purely for our own amusement, not because it's at all true), it was actually one of those ill-advised things you do in the throes of a particularly bad breakup.

In the governor's case, as you're probably aware by now, the feds and the state of Texas have decided to part ways over the WHP. In a conference call with reporters late yesterday, announced only about 20 minutes before it began, and a letter which followed, officials from the federal Centers for Medicare and Medicaid Services (CMS) laid out exactly how the program will come to an end. At the same time, they emphasized how disappointed they are to see the WHP die, and laid the blame back at the feet of Perry and the Texas Legislature. There are also a few distant rumblings about how Perry may be planning to finance his own, state-funded version of the WHP -- and those are pretty worrying too.

During the conference call, Cindy Mann, the deputy administrator for CMS and the director for Medicaid and CHIP services, told reporters that as a direct result of Texas choosing to to ban from the program any health care provider with abortion affiliates -- that would be Planned Parenthood -- CMS has no choice but to implement a two-stage process to phase out the WHP.

"We very much regret that the state of Texas has taken this course," she said. "The state and CMS both agree this has been a very valuable program for women in Texas since it was begun in 2006." But "longstanding federal law requires that Medicaid beneficiaries can choose their provider," she said, "and neither the federal government nor the state government are permitted" to restrict that. Texas' new rule, she added, "will prevent tens of thousands of women from receiving critical care."

Mann said the two-stage phaseout will work like this: In the first three months, the state will be expected to take all necessary steps to prepare for the end of the program. They'll try to identify women who may be eligible for services under another Medicaid program, as well as notify both those providers and patients. The state also must establish a referral process for women whose providers have been dropped from the program, per the new state rule, which went into effect yesterday. (Again, we're talking about women who were examined at a Planned Parenthood clinic, some 40 percent of WHP patients).

Perry has said he'll move to a fully state-funded program, though it's still not clear just where the money will come from. Mann said if that happens within the first three months, CMS will confirm the program, terminate its own and let the state take over. If that state-funded version of the WHP doesn't appear, the second phase will begin: over the next six months, Texas will stop enrolling new patients, let existing patients know just when the program will end, offer assistance transitioning to other programs and continue any "ongoing courses of treatment," Mann said, to "ensure women's health and safety."

The state is expected to submit a draft plan for phasing out the federal WHP by April 16.

"We want to again underscore how disappointed we are in having to take this action," Mann said. "We had hoped not to be at this point ... Medicaid law is clear. Patients, not the state government officials, are able to choose doctors and healthcare providers."

The gist of some of Perry's tweets was that he was angry that the press was notified of all this before the state government. But he's still insisting on Twitter and elsewhere that finding roughly $35 million for a brand-new state program will be simple. Yesterday, the Burnt Orange Report had a disturbing little tidbit about how he may be planning to do that: by cutting more money out of other parts of the Health and Human Services budget.

BOR claims that on a statewide conference call with a conservative group called Empower Texans, Perry said:

There's absolutely no reason to go into the Rainy Day Fund. There's no reason to raise taxes. What we'll do is we'll go back into the programs that are at Health & Human Services. We'll make prioritizations about what is important ... we'll find savings in the programs that are there.

Health and Human Services is of course where the family planning budget used to be -- until Legislature cut $73 million from it, or about two-thirds of the total, earlier this year, in another attempt to hurt abortion providers by hurting everyone but abortion providers. As BOR also points out, Perry appears to be saying that all the programs where that money was diverted -- autism, mental health services for children, EMS and trauma care -- will be the ones who lose their funding to pay for a new, Planned Parenthood-free version of the WHP.

Let's place a little bet right now. If HHSC programs are cut to make way for a new WHP, we can think of at least one thing that we're willing to wager won't lose a nickel: the $8 million that was given to crisis pregnancy centers, anti-abortion and abstinence programs.

The full letter from CMS to the state is below.

CMS Letter to Texas 3.15.12

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Anna Merlan
Contact: Anna Merlan