Four years ago, federal health officials gave Texas an ultimatum: Block Planned Parenthood from participating in a state family planning programs, and we'll cut Texas off from millions of dollars in federal funding.
The state chose to surrender the money anyway. But now, with a new presidential administration in power, Texas wants those millions back. And if the state's request succeeds, its impact could be felt far beyond Texas' borders, as it would signal to other states that they may be able to cut Planned Parenthood out of Medicaid without facing any financial consequences.
"There is a new administration, and we're looking at what opportunities may exist for us," Carrie Williams, a spokesperson for the Texas Health and Human Services Commission, said in a statement late last week.
In 2013, Texas sought to eliminate Planned Parenthood from a Medicaid waiver program that provided family planning services to low-income women. But Obama-era federal officials pointed to a federal law decreeing that individuals eligible for Medicaid have the right to "free choice of provider," claimed that Texas was violating this provision, and refused to let Medicaid money go to the state's program if Planned Parenthood wasn't in it.
At the time, federal Medicaid waivers covered about 90 percent of the program's health care costs. Still, Texas became the first state to choose to lose the funding. Its family planning program is now entirely state-funded and excludes abortion providers or clinics associated with abortion providers from participating, even if they're just offering similar family planning services. (It is already illegal for taxpayer dollars to pay for abortion services, except in certain exceptions such as rape, incest, or medical emergencies).
This decision appears to have had consequences on the health of low-income women across the state. Two years after Texas decided to lose its family planning Medicaid dollars, researchers found, low-income Texan women were less able to find contraception and the rate of childbirth covered by Medicaid had spiked.
But if Texas gets that money back, the many states that have tried and failed to cut off Medicaid payments for Planned Parenthood may decide to go through with their plans after all, as there'd likely be no downside. Alabama, Arizona, Arkansas, Florida, Kansas, Louisiana, Mississippi, Ohio and Oklahoma have all announced various initiatives to eliminate Planned Parenthood from Medicaid programs in the past few years, many following the release of videos that purport to show Planned Parenthood employees discussing the provider's fetal tissue donation program.
But lawsuits over the "free choice of provider" provision have largely stopped those states from following through on these initiatives, and states have been reluctant to take that extra step of actually surrendering federal funding and starting their own state-funded programs. So far, only Missouri has also done so, though Iowa plans to cut Planned Parenthood off soon too.
"No other state has something like that [waiver] in the works. And I'm kind of guessing that people are thinking of Texas as a test case," Elizabeth Nash, a policy analyst at the Guttmacher Institute, told VICE News. "This would be a real change in how Medicaid operates."
Topics: womens health