Author: Desiree Ingram
Women’s Health Policy Advisor
Texas Women’s Healthcare Coalition
For many women in Texas, access to affordable healthcare is a pressing concern, especially for those who are not eligible for traditional Medicaid or the Children’s Health Insurance Program (CHIP). Fortunately, the state offers critical safety net programs aimed at bridging this gap. The Healthy Texas Women (HTW) program, Family Planning Program (FPP), and Breast and Cervical Cancer Services (BCCS) program provide vital services to underserved women across the state, ensuring they have access to preventive care, family planning, and cancer screenings. Additionally, these programs not only benefit the health of Texas women but are also projected to save the state general revenue funds—an estimated $87.93 million between fiscal years 2023 and 2026 by reducing Medicaid claims for prenatal care, labor, delivery, and infant healthcare.
In this blog, we’ll dive into the findings of the Texas Women’s Health Report for Fiscal Year 2023, shedding light on how these programs are making a difference in the lives of women in Texas.
End of Continuous Medicaid Coverage
During the COVID-19 pandemic, Congress implemented legislation that temporarily blocked states from removing individuals from Medicaid, even if they became ineligible. This provision ensured continuous healthcare coverage during the public health emergency. On April 1, 2023, this legislation expired, and states began reassessing Medicaid eligibility.
As a result, many women faced the risk of losing their Medicaid coverage, especially those whose household income had changed. On April 10, 2024, the Texas Health and Human Services Commission (HHSC) reported a significant decrease in Medicaid enrollment. A total of 52,855 women transitioned to the Healthy Texas Women (HTW) program from Medicaid, 46,448 women transitioned from Medicaid for Pregnant Women, and 85,298 women were newly enrolled in HTW. In total, more than 184,000 women transitioned to HTW following the Medicaid renewal process.
For women who did not qualify for either Medicaid or HTW, the only option was to turn to the federal health marketplace, where many struggle with unaffordable premiums.
Family Planning Program (FPP) Program
The Family Planning Program (FPP) ensures access to preventative healthcare services to low-income women and men. FPP services include preconception health screenings, contraceptive counseling, pregnancy testing, STI screenings, and immunizations. Women eligible for FPP are guaranteed an appointment within 30 days, ensuring timely access to care.
In Fiscal Year 2023, FPP served 102,454 women, providing over 793,709 services across Texas. A notable demographic shift occurred, with a 3.14% decrease in participation among young women aged 18-24, while women aged 25-44 saw a 0.81% increase in participation. Overall, FPP utilization increased by 1.08%, highlighting the ongoing need for these essential services.
The Gulf Coast, Lower South Texas, and Metroplex HHS regions had the highest FPP utilization rates. Services like lab tests for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis-related antibodies, urine pregnancy tests and contraceptive counseling were the top FPP services provided. 8,775 women chose a long-acting reversible contraceptive (LARC) method for its effectiveness in preventing pregnancy through this program.
Healthy Texas Women (HTW) and HTW Plus Programs
The Healthy Texas Women (HTW) program provides eligible women with access to women’s health and family planning services at no cost. These services include annual exams, STI testing, breast and cervical cancer screenings, contraceptive counseling, and tubal ligation. For postpartum women, the HTW Plus program offers enhanced services aimed at addressing chronic conditions that contribute to maternal morbidity, such as postpartum depression, cardiovascular diseases, and substance use disorders.
In Fiscal Year 2023, HTW and HTW Plus combined served 142,220 women, providing over 1.13 million services. Monthly enrollment in HTW increased by 5.55%, but there was a significant decline in enrollment among younger women. Specifically, participation among women aged 18-24 decreased by 52.97%, and participation among those aged 25-44 dropped by 20.18%. These decreases may be related to challenges from the Medicaid unwind, as many women struggled with awareness or administrative delays.
HTW pharmacy claims exceeded 102,279, with oral contraceptives, medications for infections, depression, and COVID-19 among the most prescribed treatments. 5,221 women received long-acting reversible contraception (LARC) through HTW, underscoring the program’s role in empowering women to take control of their reproductive health. However, regions like Northwest Texas, Southeast Texas, and the Upper East Texas HHS regions had lower rates of LARC utilization.
HTW Plus served 3,185 clients, providing specialized services for postpartum women. The most common medical procedures included heart function tests and screenings for blood clots and prolactin hormone levels. HTW Plus also saw a decrease in medical and pharmacy claims from the previous year, largely due to the extended Medicaid coverage provided during the COVID-19 public health emergency.
Breast and Cervical Cancer Services (BCCS) Program
The Breast and Cervical Cancer Services (BCCS) program provides uninsured and underinsured women with access to free screenings and diagnostic services, focusing on early detection of breast and cervical cancer. Services include mammograms, Pap tests, HPV screenings, and diagnostic follow-ups. If cancer is detected through BCCS screenings, eligible women are referred to the Medicaid for Breast and Cervical Cancer program, ensuring patients receive timely treatment.
In Fiscal Year 2023, BCCS served over 31,429 women, providing 99,247 medical and patient navigation services. While overall enrollment in BCCS increased by 3.31%, participation among women aged 18-25 saw a sharp decline of 16.04%, and women aged 25-44 experienced a 1.87% decrease. The most common services included screening mammograms, pelvic exams, and Pap tests, which are essential for detecting cancer early and providing women with the necessary care.
Building Healthier Futures for Texas Women
The ripple effect of preventive care extends beyond the individual woman—it impacts families and future generations. A healthy woman contributes to healthy families, and the impact of these safety net programs fosters stable communities. Providing underserved women with access to preventive care and contraception helps reduce maternal and infant mortality, promotes healthy birth spacing, prevents chronic diseases, and improves overall health outcomes. Which results in long-term cost savings for the state by preventing complex health issues from arising and reducing the need for costly emergency interventions and long-term treatments.
Looking Ahead: Advocacy and Support for Women’s Health Programs
In the upcoming 89th Texas Legislature, The Texas Women’s Healthcare Coalition (TWHC) will advocate for increased funding for HTW, FPP, and BCCS programs, as well as support maternal health initiatives that address critical issues like postpartum depression and maternal morbidity.
Enrollment challenges persist for college-aged women, TWHC will continue to advocate for a simplified, shorter enrollment form for the HTW program to make access easier and more efficient.
TWHC is also committed to working with providers and stakeholders to offer technical assistance. By investing in these safety net programs, Texas can continue to improve the health and well-being for all women and build stronger, healthier communities.