As the U.S. Centers for Medicare and Medicaid Services approves work requirements for low-income healthcare recipients, Texas officials and abortion rights advocates are waiting for the agency's decision on another controversial proposal.
Texas Republican Gov. Greg Abbott in June 2017 asked for a waiver from Medicaid rules to allow it to again receive tens of millions a year in federal family planning dollars while continuing to bar any of the money from going to groups like Planned Parenthood.
Texas in 2011 barred Medicaid funds from going to providers that perform abortions, running afoul of a federal requirement that recipients be able to see whomever they want for services like contraceptive care or cervical cancer screenings, including Planned Parenthood.
The state that year appealed to the Obama administration to waive the rule, but when it was refused, Texas continued to fund its Women's Health Program with only state dollars, making it one of three nationally not to take federal Medicaid funds because it did not want the funds to go to entities connected to abortions.
The use of Medicaid funds for abortions was not affected because it was already banned by state and federal law. However, eliminating women's access to Planned Parenthood for other care led to a drop in women getting contraceptives by about a third, according to a 2016 study in the New England Journal of Medicine.
Texas has the fourth highest birth rate in the U.S., and about a third of the pregnancies were unplanned, the state said in its waiver proposal.
But with a new administration in place, the state is again seeking a five-year waiver, which would allow it to receive about $56 million in fiscal year 2019, growing to $74 million in 2023, despite the funding ban.
A CMS spokesman would not say when a decision might be announced. The proposal is being opposed by pro-choice proponents. It could encourage more states to bar Medicaid funds from groups like Planned Parenthood if they would still be able to get federal dollars, said Stacey Pogue, senior health analyst for the left-leaning Center for Public Policy Priorities in Austin, Texas.
Iowa and Missouri also opted in 2017 not to receive federal Medicaid family planning dollars because of state bans on funding groups that perform abortions. Spokespeople for the health departments in those states declined to say whether they would pursue similar waivers as Texas if it is approved.
Pogue said the Texas proposal also raises legal questions because Medicaid waivers are only supposed to be given out for innovative ideas.
But in its proposal, the state is saying, "We don't want to pay for the program. Will you guys pay for it?" Pogue said in an interview.
In addition, critics say the waiver would run counter to the notion of letting patients choose their medical provider without government interference.
"Part of this is whether people in this country can go to the provider who best meets their needs," said Adam Sonfield, senior policy manager at the Guttmacher Institute, a reproductive rights think tank. In some areas, Planned Parenthood is the only option for family planning care, he said in an interview.
A Texas health and human services commission spokeswoman declined in an email to say whether the state is optimistic about getting the waiver, saying only that it is the federal government's decision.
In applying for the waiver, the state said it would not close the Healthy Texas Women's program if the waiver is denied. Nevertheless, it argued that funding preventative care and avoiding unintentional pregnancies would save Medicaid millions.
CMS under the Trump administration has not shied away from controversy, granting waivers to allow Kentucky, Indiana and Arkansas to impose work requirements on Medicaid recipients. Critics said it will hurt the ability of some low-income people to get healthcare, and the Kentucky law is being challenged in federal court.