Funding Travesty Cripples Health Clinics

Nurse Holli Jackson readies an exam room at Planned Parenthood's East Seventh Street clinic, which will receive zero funding from the state. (Photo by Jana Birchum)

After nearly 40 years of partnership, the state has cut its ties to Planned Parenthood of Austin, defunding its East Seventh Street clinic, which provides basic reproductive health care and family planning services to low-income and uninsured women. The clinic last year received $474,000 to provide services to approximately 3,700 women; now it will get nothing, and neither will its clients. Notice of the cuts came just four days before the beginning of the new fiscal year, leaving area providers scrambling. "We didn't expect zero funding with four days' notice," Sarah Wheat, interim co-CEO of Planned Parenthood of the Texas Capital Region, said at a press conference last week.

The loss of funding is being felt all around the state as the pot of money for providing basic health care for women was cut drastically during the 82nd Legislature, leaving roughly $38 million, out of roughly $111 million, over the biennium to meet the needs of more than 250,000 women who receive services each year. Not surprisingly, with the start of the new fiscal year, Sept. 1, a large number of those women will now likely find themselves without access to any health care. Where those women will go remains unclear to providers across Austin and the state.

In its first round of allocations, the Depart­ment of State Health Services cut 15 contractors from funding – including Austin's Planned Parenthood and several larger providers, like Planned Parent­hood of Hidalgo County, which received more than $3 million in 2010 and served nearly 14,000 clients. Based on numbers from 2010, the most recent year for which all data is available, the defunding of these 15 contractors will leave more than 52,935 clients without access to services. Whether the remaining contractors will be able to absorb those clients is unclear.

Locally, People's Community Clinic and El Buen Samaritano were also cut off from any family planning funding. In 2011, says Regina Rogoff, People's CEO, the three local contractors used roughly $1.4 million in funding to provide more than 13,000 women and men with a host of basic services, including annual gynecological exams and screenings for cancer (including cervical, breast, and testicular), hypertension, and sexually transmitted infections. More than 7,000 were provided with birth control.

Of the contractors previously funded in the Austin area, only CommUnityCare and Lone Star Circle of Care have been allocated money this year. As expected, they will also lose money. CommUnityCare received just over $611,000 in 2010 to provide services for 5,858 clients; for the first three months of fiscal year 2012, the federally qualified health center is slated to receive just $138,745 – while also presumably picking up some of the clients from the providers who have been defunded. Moreover, whether CommUnityCare and other contractors across the state will be funded for the rest of the fiscal year or how much they will receive remains unclear.

In order to gut the family planning budget, lawmakers this spring removed millions of federal title dollars that had been allocated for family planning and transferred them to other programs; what looked like a half-baked attempt to cover a portion of the state's gaping $27 billion budget shortfall, was really a much more pointed attempt to defund conservative lawmakers' favorite punching bag, Planned Parenthood. To a host of Texas lawmakers, funding family planning is just a way to fund abortion. No federal funds may be used for abortion services, but that hasn't stopped lawmakers from trying to excise the provider from delivering any health services whatsoever, even if PP is a woman's provider of choice. The only pot of money lawmakers were powerless to divert is contained in Title X, money dedicated to providing family planning services.

In addition to drastic cuts, lawmakers are now also requiring DSHS to fund agencies in a particular order: First funded are Federally Qualified Health Centers like CommUnityCare, which are supposed to provide patients a "medical home" but are already teeming with clients; second funded are public providers, including county health departments; third funded is everyone else – including PP and other small clinics. But because there are so few dollars left, even groups among the second tier, like People's, have lost funding. (The largest public provider is Parkland Hospital in Dallas, which received more than $6 million in funding in 2010 and served nearly 33,000 people; for the first quarter of 2012, it will get just $760,000 – with most of that coming from funding sources that will soon dry up. If Parkland were to receive a year's worth of Title X funding at its current allocation level, the hospital would get roughly $1 million total in 2012.)

According to DSHS spokeswoman Carrie Williams, the state agency has only funded the contractors for the first three months of FY 2012 to help ease the transition to the new funding scheme; a new request for proposals will go out to contractors soon. Unfortunately, it appears that this short-term funding allocation is creating more uncertainty. For example, Central Health may be in a position to help extend its lines of service to pick up some of the clients that other Austin providers will have to drop, but until the health district can get its hands on solid data showing exactly how many folks will be in need of care, it is hesitant to move forward, says spokeswoman Christie Garbe.

Although lawmakers have said they believe the new funding scheme will help FQHCs to take over the bulk of the family planning care in Texas, it is unlikely that this will happen, especially at such low levels of funding. Moreover, because of the way FQHCs have a unique structure, these one-stop health shops generally spend more money per client to provide the same services as a family planning clinic or PP. For example, in 2010, the state's FQHCs saw just 13% of the state's clients, at a cost-per-client for basic women's health services of $225; PP, in contrast, saw 31% of the clients at a cost of $168 each.

Right now, nobody knows exactly how things will go, but everyone agrees that the picture isn't pretty. "The impact is going to be even bigger than we can even calculate at this point," says Wheat.