Advocating for women's health in the 86th Texas Legislature

Tags: Texas Women’s Healthcare Coalition, CHIP, children's medicaid, HTW, TWHC, Texas legislative session

By Evelyn Delgado
Texas Women’s Healthcare Coalition Chair and Healthy Futures of Texas President/Executive Director

The texas women’s healthcare coalition is a nonpartisan organization dedicated to improving the health and well-being of women, babies, and families by ensuring access to preventive care — including contraception — for all Texas women. Our membership includes health care organizations, provider organizations, advocacy organizations, and faith organizations from across the state. We strive toward our mission by working with state legislators on women’s health policy issues, educating the public on the landscape of women’s health in Texas, and through building relationships with state agency leaders to improve the programs serving Texas women.

Since its formation, TWHC has advocated for priority issues during each Texas legislative session with the goal of improving access to women’s health services. The No. 1 priority is always to protect funding for the state’s women’s health programs and advocate for more funding to meet the statewide need for family planning and preventive health services.

At the end of the 85th Legislative Session, we saw the Legislature fund the state’s women’s health programs at the same level as the previous biennium, and at a higher level than actual 2016-2017 expenditures. The Legislature also pushed through several positive bills and riders, including measures that:

  • improve data collection for the state’s women’s health programs,
  • study auto-enrolling young women from CHIP and Medicaid into the Healthy Texas Women program,
  • require the Health and Human Services Commission to develop a strategic plan to increase access to long-acting reversible contraception, and
  • look at different ways to address the state’s high maternal mortality rates.

In the interim, TWHC has been monitoring the implementation of the above positive bills and riders. We also hosted community engagement events to receive input from stakeholders on successes and challenges with the state’s women’s health programs. Collecting all this information enables us to continue to build support for policy changes not addressed in the last legislative session.

In preparation for the 86th Legislative Session, TWHC developed policy priorities to continue working toward a Texas where all women have meaningful access to preventive health care services. The areas of focus are:

  • funding;
  • quality provider network;
  • access to all FDA approved forms of contraception and medically accurate, adequate counseling; and
  • continuity of care and maximizing the number of women served.

The primary priority will build on the legislative support shown during the 85th Legislature and focuses on ensuring funding for women’s preventive health care. TWHC wants to ensure the distribution of funding between the state’s women’s health programs matches the need within each program. Especially with no word yet from the Centers for Medicare and Medicaid Services on the state’s application for an 1115 waiver to support the HTW program with federal funds, legislators must keep women’s health a priority as the network of providers is being rebuilt.

Quality provider network
Texas needs more providers to deliver preventive care to women, especially in rural areas. The women’s health care safety net is still recovering from cuts to family planning programs in 2011 and the exclusion of some of the state’s largest providers. A consistent piece of feedback TWHC hears from providers is the need for improved provider outreach and trainings.

Implementing these programs is a huge administrative task and clinics across the state need timely, consistent, and program-specific support from the agency. In addition to technical assistance, there is inconsistent provider knowledge on program services. Questions still arise on key elements of the HTW program, like auto-enrollment from Medicaid for Pregnant Women into HTW, and covered services. TWHC will seek to promote best practices and adequate provider training.

Access to contraception and medically accurate counseling
Ensuring women have access to the most effective form of contraception that works for them is key to enabling women to plan and space their pregnancies. But, access alone is not enough. Providing women with medically accurate counseling on all forms of contraception is just as critical so women have the knowledge needed to decide what is best for them. This is especially necessary in light of the proposed revisions to Title X regulations.

Instead of providing women access to a comprehensive array of family-planning options, Title X grantees would emphasize “natural family planning” and abstinence. While both are valid choices, they should not make more effective methods less available. Also under these new guidelines, HHS would no longer require clinics to provide medically approved forms of contraception. TWHC does not want to see the state’s women’s health programs adopt similar, concerning changes.

Continuity of care and maximizing the number of women served
With the recent attention on the high maternal mortality in Texas, providers, lawmakers, and stakeholders from across the state have also been discussing issues around continuity of care. When women can plan and space their pregnancies, they are better able to prepare for possible complications pregnancy and delivery can bring. Maternal health starts well before a woman becomes pregnant, and access to health care, including consistent and effective contraception, can greatly improve health outcomes. Enabling eligible women to access and maintain continuous health care coverage improves health outcomes and reduces costs to the state.

TWHC has identified several opportunities to ensure this continuous coverage, including improvements to the HTW auto-enrollment feature, applying the HTW auto-enrollment feature to women aging out of Children’s Medicaid and CHIP, and extending health care coverage for women in Medicaid for Pregnant Women to  12-months postpartum. TWHC is committed to exploring solutions to the coverage gap in order to maximize the number of women who are able to access critical preventive services and family planning services before, during, and after pregnancy.

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