Four years after Texas gave up millions of dollars in federal Medicaid funds so it could ban Planned Parenthood from participating in a family planning program for low-income women, the state is asking the Trump administration for the money back.
The request presents an important early test for the administration of President Trump, who recently appointed an anti-abortion official to oversee federal family planning programs. Under President Obama, federal health officials would not allow Medicaid funds to flow to the Texas program after it excluded Planned Parenthood, because federal law requires states to give Medicaid beneficiaries their choice of “any willing provider.”
If the administration agrees to restore the funding for Texas, it could effectively give states the greenlight to ban Planned Parenthood from Medicaid family planning programs with no financial consequences.
“They’re asking the federal government to do a 180 on its Medicaid program rules,” said Elizabeth Nash, a policy analyst at the Guttmacher Institute, a research center that supports abortion rights. “And depending how this shakes out, you could see a number of other states follow suit.”
The issue, and the principle at stake, has put abortion rights supporters in the unusual position of opposing Medicaid funding for family planning services.
The Texas program, now called Healthy Texas Women, provides contraception and screenings for cancer, H.I.V. and sexually transmitted diseases, and as of last year, screening and treatment for diabetes, high cholesterol and high blood pressure, to women ages 15 to 44, with income up to 200 percent of the poverty level — about $23,760 for an individual — who do not qualify for Medicaid. It used to be what is known as a Medicaid waiver program, financed 90 percent by the federal government and 10 percent by the state. About half the states have similar programs for low-income women not otherwise eligible for Medicaid, Ms. Nash said.
But Texas turned its version into an entirely state-financed program in 2013, when it cut out providers that “perform or promote elective abortions,” or contract or affiliate with providers that do so.
Other states have recently expressed a willingness to forfeit Medicaid funds if doing so allows them to block Planned Parenthood from receiving tax dollars. This year, Missouri ended its Medicaid waiver program for family planning services and instead set up a state-financed program that excludes abortion providers. Iowa is planning to do the same.
The reduced funding in Texas has led to a drop in women receiving services through the program. The Texas program had an average monthly enrollment of about 79,000 last year, according to the state, down from 126,000 before it cut out Planned Parenthood and other abortion providers. In the first 18 months after the change — which resulted in a loss of $35 million a year in federal Medicaid funds — thousands of women stopped getting long-acting birth control, and Medicaid pregnancies increased by 27 percent, according to a research paper published last year in The New England Journal of Medicine.
In its draft waiver application, the state said it hoped that by turning Healthy Texas Women back into a Medicaid waiver program, it would improve access and participation. The application noted that Texas had the nation’s highest birthrate, with more than 400,000 births in 2015, more than half of which were paid for by Medicaid. It also noted than more than one-third of pregnancies in the state were reported as unintended, and that Texas had one of the highest teen birthrates in the country.
On Monday, at a public hearing on the plan in Austin, several women and representatives of health advocacy groups expressed concern about the request.
“A strong Healthy Texas Women program should include Planned Parenthood,” said Blanca Murillo, 25, who said she relied on Planned Parenthood for contraception that helped treat her polycystic ovary syndrome when she was a student at the University of Texas. “I’m asking the state to choose the health of Texas women — which it has a duty to protect — over scoring political points.”
Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities, a liberal research group, pointed to the so-called freedom of choice provision in Medicaid and said she was concerned that “submitting the waiver as is would invite litigation.”
A spokeswoman for the Centers for Medicare and Medicaid Services, or C.M.S., which oversees Medicaid waiver programs, declined to comment.
Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission, said, “We’re been encouraged to present new and innovative ideas to C.M.S. for discussion for possible funding. This is a new administration, and we’re looking at what funding opportunities may exist for us.”
Texas is also seeking to cut off all Medicaid funding to Planned Parenthood; a federal judge blocked the effort earlier this year, but the state is appealing the decision.
Conservatives have long targeted Planned Parenthood because its network is the largest provider of abortions, although about half of its affiliates do not perform the procedure. And federal funding is almost never used to pay for it; since 1977, a law known as the Hyde Amendment has prohibited using federal money for abortions except in cases of rape, incest or when a pregnant woman’s health is at risk.
Still, Mr. Trump has made a priority of restricting abortions. In April, he signed legislation aimed at cutting off a separate stream of federal family planning money from Planned Parenthood and other groups that perform abortions. And the House bill to repeal and replace the Affordable Care Act would defund Planned Parenthood for a year — so women on Medicaid could no longer seek care at its clinics — as well as ban the use of federal subsidies to buy insurance that pays for abortion.
“There have been many statements out of this administration about its hostility toward Planned Parenthood,” Ms. Nash said. “So this move by Texas is really testing all of that.”
Raegan McDonald-Mosely, the chief medical officer for Planned Parenthood Federation of America, said, “The Trump administration must shut down this latest attack on women, because if the rest of the nation goes the way of Texas, it would result in a public health crisis for millions of women.”
Correction: May 17, 2017
An article on Tuesday about a request by Texas to reinstate its Medicaid funds referred incorrectly to a law known as the Hyde Amendment. While it prohibits using federal money for abortions, there are exceptions in cases of rape, incest or when a pregnant woman’s health is at risk; it is not the case that federal funding is never used to pay for abortions.