Redesigned Women’s Health Programs Are Good News for Texas Moms and Babies, But Improvements are Needed Moving Forward

We all want children to be healthy, succeed in school, and grow up to be our next generation of great teachers, helpful co-workers, and effective leaders. The first step is ensuring healthy pregnancies and healthy births. One of the most effective strategies to improve health outcomes for moms and babies is to make sure moms receive the care they need before, during, and after pregnancy. 

That’s why the July 1st launch of two newly redesigned programs in Texas – the Healthy Texas Women (HTW) program and the Family Planning Program (FPP) – is so important. Through these two programs, eligible low-income women can get preventive health screenings, women’s health exams, and family planning, including contraception, at little or no cost. When women can plan and space their pregnancies and get health care they need before, during, and between pregnancies, their kids are better off and have healthier outcomes. To learn more about how preventive care improves mom’s health, saves money, and impacts birth outcomes, read our testimony here.

We appreciate the hard work of legislators and HHSC staff on the redesign and launch of these programs. Also, as a member of the Texas Women’s Healthcare Coalition, we greatly value the dedicated efforts of the coalition and its broad network of organizations in advocating for women’s preventive healthcare in Texas.

What’s Available through Healthy Texas Women and the Family Planning Program?

There’s been a lot of talk about these new programs. The good news is the revamped website and FAQs provide more details on what’s covered and how providers and consumers can sign up. Through HTW and FPP, women can go to a participating provider in their area to get health screenings and preventive care, such as pelvic exams, pap tests, health education and counseling, and family planning services and counseling. Access to these services not only reduces unplanned pregnancies and improves general health, but also makes future pregnancies healthier and lowers the risk of babies being born too early or too small (i.e. preterm birth and low birth weight). 

These programs encourage women to talk with their providers about their “reproductive life plan,” meaning a discussion about if and when they want to have a child and the spacing of their pregnancies. HTW and FPP offer long-acting reversible contraception (LARC), which include birth control methods that are the most effective at preventing unplanned pregnancies, but can be very costly for the patient. Most services, including LARCs, are provided at no cost to the woman served by these programs, empowering women to select the birth control method that works best for their health and life. 

While the HTW and FPP cover many of the same services, there are some important differences. 

• FPP covers both men and women up to age 64 and provides access to some prenatal care. 
• HTW also provides screening and limited treatment for diabetes, hypertension (high blood pressure), and high cholesterol – conditions that are critical to treat before pregnancy so a pregnancy is healthier for both mom and baby and less costly down the road. For instance, treating diabetes and hypertension before pregnancy reduces the risk of pregnancy complications, including preeclampsia, premature birth, low birth weight, birth defects, and infant death.
• Pregnant women enrolled in Medicaid for Pregnant Women will be automatically signed up for HTW after Medicaid coverage expires, which is about 60 days after delivery of a child. Automatic enrollment is a new policy step that we are glad to see as it seeks to reduce gaps in care and empower women to maintain access to basic primary care services between pregnancies.

HTW covers postpartum depression screening and treatment, such as anti-depression medications and basic counseling with a primary care provider. FPP covers screening for postpartum depression during an office visit. This is a new change that’s also in line with Gov. Greg Abbott’s 2014 Healthy Texans campaign platform, in which he called for action on postpartum depression to make sure moms stay healthy after their baby is born. Early identification and treatment for postpartum depression are critical for the health of new moms and positively affects a baby’s social and brain development, so we are glad to see this step in the right direction. In fact, while about 5 to 25 percent of pregnant, postpartum, and parenting women have some type of depression, for women with low incomes and parenting teens, rates of depressive symptoms are between 40 and 60 percent. 

It’s important to know, however, that under HTW and FPP, if a woman and her clinician decide more comprehensive mental health counseling is needed, these services likely won’t be covered through HTW or FPP and she would be referred to a local mental health provider or specialist to get more targeted therapy. It will be important for advocates and policymakers to monitor access to care and wait times at local mental health providers to ensure new moms facing postpartum depression get the mental health counseling they need.

Comparing HTW and FPP

	Healthy Texas Women Program	Family Planning Program
Who is covered?
Monthly income limit	200% of federal poverty level ($1,980 monthly income for household of 1; $4,050 monthly income for family of 4)	250% of federal poverty level ($2,452 monthly income for household of 1; $5,052 monthly income for family of 4)
Services provided to men		✓
Services provided to minors	Ages 15-17 With Parental Consent (Not available if child is covered through CHIP)	✓
Services provided to pregnant women		✓ (limited prenatal care)
Up to age 44	✓
Up to age 64		✓
Services to available only to U.S. citizens or legal immigrants	✓
Automatic enrollment after a Medicaid pregnancy and delivery	✓
What services are covered?
Annual Family Planning and Preventive Healthcare Visit	✓	✓
Contraceptive services	✓	✓
Preconception health screenings (Screening for obesity, hypertension, diabetes, cholesterol, smoking, and mental health)	✓	✓
Basic Infertility Services	✓	✓
Pregnancy Testing	✓	✓
Screening and Treatment of Cervical Cancer	✓	✓
STD/STI Screening and treatment	✓	✓
HIV Testing	✓	✓
Breast Cancer Screening and Diagnosis	✓	✓
Immunizations	✓	✓
Screening and Treatment of Postpartum Depression	✓	✓ (screening only)
Diabetes Screening and Treatment	✓	✓ (screening only)
Hypertension Screening and Treatment	✓	✓ (screening only)
Screening and treatment of elevated cholesterol	✓	✓ (screening only)
Prenatal Care Services		✓

How Do People Sign Up? 

Women enrolled in the current Texas Women's Health Program will be automatically enrolled into HTW. They should have received a new program card by mail in early July. For women new to the program, they can apply online for HTW here. Sign-up for FPP is available on-site at the doctor’s office or clinic. You can find a provider in FPP here: www.txclinics.com and you can find a doctor or clinic in HTW here: http://www.texaswomenshealth.org/providers.

What Can Be Done Moving Forward?

The launch of these programs is an important step forward. However, significant work remains.

• To make sure these programs are successful, it’s imperative that a strong network of health providers participate in HTW and FPP across Texas – both in urban and rural areas – to deliver preventive care. This launch represents an opportunity to increase provider outreach and capacity, particularly in rural and underserved areas.
• As it stands now, females enrolled in Children’s Health Insurance Program (available up to age 19) are not eligible for HTW, even though CHIP does not cover contraception. HTW is meant to be available to women ages 15 to 44. Yet, 15-to-19-year-old females with CHIP may not have access to affordable contraception and counseling through either program. While progress has been made, Texas still has one of the highest teen pregnancy rates in the country, ranking 46th out of the 50 states.  To reduce unintended pregnancy, we call on HHSC and policymakers to address the glitch that prevents eligible females enrolled in CHIP from receiving services through HTW. 
• HTW and FPP only have the capacity to reach a fraction of men and women with low incomes in need of affordable preventive care – and the programs only provides a limited scope of services. Access to comprehensive health coverage is limited in Texas. Many jobs do not provide insurance and subsidies on the Affordable Care Act (ACA) Marketplace are only available for individuals above the poverty line. Moving forward, the state should develop a workable solution for the coverage gap in order to maximize federal funds and substantially increase the number of women able to access a medical home where they can receive care before, during, and after pregnancy. This is a critical step to truly achieve healthy outcomes for moms and babies.