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Texas Womens Health Program

Transition Plan

April 16, 2012

Background

S.B. 747, 79th

Legislature, Regular Session, 2005, directed the Health and HumanServices Commission (HHSC) to establish a five-year demonstration program to expand

access to family planning services for women through Medicaid. HHSC submitted a

Section 1115(a) research and demonstration waiver to the Centers for Medicare and

Medicaid Services (CMS), which became effective January 1, 2007, and was due toexpire December 31, 2011.

Pursuant to the 2012-13 General Appropriations Act (Article II, Health and HumanServices Commission, Rider 62, House Bill 1, 82nd Legislature, Regular Session, 2011)

HHSC sought a renewal of the Medicaid Womens Health Program demonstration

waiver; however, CMS has confirmed that they will not renew the program becauseHHSC must adhere to the state law directing that affiliates of abortion providers are

prohibited from participating in the Womens Health Program.

Therefore, in accordance with Governor Perrys directive, Texas has elected to continue

the Womens Health Program without Title XIX funding and to transition it to a purely

state-funded program outside of the Title XIX medical assistance program. The

Medicaid Womens Health Program will be renamed the Texas Womens HealthProgram (TWHP), and will be established within the Texas Department of State Health

Services (DSHS) pursuant to the departments authority under state law to administerPrimary Health Care Program services. DSHS will contract with HHSC through an

interagency contract to administer the day-to-day operations of the TWHP. HHSC has

developed a plan to phase out Medicaid funding and transition the Medicaid program to aprogram funded exclusively with state general revenue. This will be a seamless transition

for clients and providers.

There will be no disruption in client services during the transition to a state-funded

program. HHSC will need to make a number of administrative and operational changes

to implement TWHP. The transition plan provides proposed timelines and detail on whatactions are necessary by HHSC and DSHS to ensure transition of the program without

disruption for clients and providers.

The Texas Womens Health Program

The Texas Womens Health Program, like its Medicaid predecessor program, will offer

family planning services for low-income women. The goals of the program are to:

(1) Improve health outcomes for low-income women and babies;(2)Reduce expenditures for Medicaid-paid births and other state and local health care

and social services costs;

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(3)Ensure continuity of care for women who currently receive services through theMedicaid Womens Health Program following termination of the Medicaid program;

and

(4)Facilitate access to state-qualified health care providers.Covered Populations

The transition plan does not change who qualifies for the program. TWHP will continueto offer family planning services to women ages 18 through 44 with incomes at or below 185

percent of the Federal Poverty Level. Women must be United States citizens or qualifiedaliens, as well as Texas residents.

Eligible Services

Women participating in TWHP will receive the same services they do today under the

Medicaid demonstration waiver as well as a new service: treatment for sexually

transmitted diseases.

Specifically, TWHP will provide the following services.

Comprehensive health history and evaluation; Physical examination; Screening for and treatment of sexually transmitted diseases; The full range of allowable Medicaid family planning services, including

screenings for diabetes, hypertension, elevated serum cholesterol level, anemia,vaginal infection, and tuberculosis, as well as breast and cervical cancer;

Assessment of health risk factors;o Client-centered counseling and education regarding:o Basic human reproductive anatomy and physiology;o Sexual abstinence as the only 100 percent effective method of preventing

pregnancy or infection with sexually transmitted diseases (includingHuman Immunodeficiency Virus, or HIV);

o Promotion of abstinence as the preferred choice of behavior related to allsexual activity for unmarried persons;

o Reduction of health risks;o All Food and Drug Administration-approved methods of contraception,

except emergency contraception; and

o Individualized counseling on any contraceptive method selected by theclient, except emergency contraception;

Provision of a contraceptive method, except emergency contraception, based onclient choice and absence of medical contraindications;

Information on potential resources for the treatment of non-covered healthconditions identified by Womens Health Program services; and

Referral of non-covered medical problems to appropriate specialty healthproviders.

A participant who is identified as at-risk for cardiovascular disease and diabeteswill receive preventive counseling at the initial family planning visit and any

follow-up family planning visits to ensure that her preferred method of

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contraception is suitable to her current condition or risk factors, which mayinclude:

o Hypertension;o Elevated cholesterol;o Obesity/Overweight (as measured by Body Mass Index);o

Smoking;o Alcohol abuse; ando Low physical activity.

Treatment for sexually transmitted diseases.As noted, the state will expand TWHP to include sexually transmitted disease treatment so

that a client with a sexually transmitted disease can receive treatment from her regular family

planning provider without being referred elsewhere. While the Medicaid Womens Health

Program includes basic health screenings that identify the presence of specific diseases and

health conditions, women who are diagnosed with a sexually transmitted disease at a family

planning exam must be referred for medical treatment and appropriate follow-up. TWHP will

pay the costs associated with the treatment of clients sexually transmitted diseases.

Outreach Plan

During the transition period, HHSC will employ a two-pronged outreach strategy

targeting both current Medicaid Womens Health Program providers and clients and

qualified TWHP providers and clients.

Client Outreach

The client outreach plan identifies a variety of methods that will be used to target clients,

including mailings, radio broadcasts and distribution of outreach materials throughcommunity-based organizations. The client outreach plan includes an active referral

process for clients if their current provider no longer qualifies to participate in the

program.

Client Referral process

To ensure clients can access a qualified provider, HHSC has developed an active clientreferral process during the transition process. HHSC is expanding the scope of the client

and provider call centers to assist current Medicaid Womens Health Program clients and

future TWHP clients locate a provider. TWHP clients will be directed to the call center if

they need assistance finding a provider. Call center staff will answer questions andprovide clients with a list of providers in their area and encourage clients to call back if

they need further assistance.

If a client calls back for assistance, call center staff will actively search for a provider thatwill accept the client. If a provider cannot be identified for the client, call center staffwill escalate to appropriate Medicaid and Provider Relations staff who will recruit

additional providers.

Provider Outreach

Provider outreach is another critical component of the transition plan. The plans

provider outreach priorities are to:

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Increase the number of providers accepting and actively serving TWHPclients and retain current providers.

Identify areas where more provider capacity is needed and employtargeted outreach in these areas.

Provider outreach strategies will vary according to the target audience and include bothcommunity-based and person-to-person outreach. A key strategy will be to work withcommunity partners and professional organizations. Other strategies will include

outreach through email, professional newsletter notifications, website updates, printed

material, professional newsletter notifications, and recruitment at provider conventions.

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