Federal Medicaid Agency Lays Out Just How The Women's Health Program Will End

Categories: Politics

Thumbnail image for perry cover.jpg
"Donchyew worry none, gals. I gotcha covered."
What prompted Governor Rick Perry's frenzied bout of outraged tweeting about the Women's Health Program yesterday? As much as we'd like to speculate that it was a bad batch of PCP (and will continue to do so privately, purely for our own amusement, not because it's at all true), it was actually one of those ill-advised things you do in the throes of a particularly bad breakup.

In the governor's case, as you're probably aware by now, the feds and the state of Texas have decided to part ways over the WHP. In a conference call with reporters late yesterday, announced only about 20 minutes before it began, and a letter which followed, officials from the federal Centers for Medicare and Medicaid Services (CMS) laid out exactly how the program will come to an end. At the same time, they emphasized how disappointed they are to see the WHP die, and laid the blame back at the feet of Perry and the Texas Legislature. There are also a few distant rumblings about how Perry may be planning to finance his own, state-funded version of the WHP -- and those are pretty worrying too.

During the conference call, Cindy Mann, the deputy administrator for CMS and the director for Medicaid and CHIP services, told reporters that as a direct result of Texas choosing to to ban from the program any health care provider with abortion affiliates -- that would be Planned Parenthood -- CMS has no choice but to implement a two-stage process to phase out the WHP.

"We very much regret that the state of Texas has taken this course," she said. "The state and CMS both agree this has been a very valuable program for women in Texas since it was begun in 2006." But "longstanding federal law requires that Medicaid beneficiaries can choose their provider," she said, "and neither the federal government nor the state government are permitted" to restrict that. Texas' new rule, she added, "will prevent tens of thousands of women from receiving critical care."

Mann said the two-stage phaseout will work like this: In the first three months, the state will be expected to take all necessary steps to prepare for the end of the program. They'll try to identify women who may be eligible for services under another Medicaid program, as well as notify both those providers and patients. The state also must establish a referral process for women whose providers have been dropped from the program, per the new state rule, which went into effect yesterday. (Again, we're talking about women who were examined at a Planned Parenthood clinic, some 40 percent of WHP patients).

Perry has said he'll move to a fully state-funded program, though it's still not clear just where the money will come from. Mann said if that happens within the first three months, CMS will confirm the program, terminate its own and let the state take over. If that state-funded version of the WHP doesn't appear, the second phase will begin: over the next six months, Texas will stop enrolling new patients, let existing patients know just when the program will end, offer assistance transitioning to other programs and continue any "ongoing courses of treatment," Mann said, to "ensure women's health and safety."

The state is expected to submit a draft plan for phasing out the federal WHP by April 16.

"We want to again underscore how disappointed we are in having to take this action," Mann said. "We had hoped not to be at this point ... Medicaid law is clear. Patients, not the state government officials, are able to choose doctors and healthcare providers."

The gist of some of Perry's tweets was that he was angry that the press was notified of all this before the state government. But he's still insisting on Twitter and elsewhere that finding roughly $35 million for a brand-new state program will be simple. Yesterday, the Burnt Orange Report had a disturbing little tidbit about how he may be planning to do that: by cutting more money out of other parts of the Health and Human Services budget.

BOR claims that on a statewide conference call with a conservative group called Empower Texans, Perry said:

There's absolutely no reason to go into the Rainy Day Fund. There's no reason to raise taxes. What we'll do is we'll go back into the programs that are at Health & Human Services. We'll make prioritizations about what is important ... we'll find savings in the programs that are there.

Health and Human Services is of course where the family planning budget used to be -- until Legislature cut $73 million from it, or about two-thirds of the total, earlier this year, in another attempt to hurt abortion providers by hurting everyone but abortion providers. As BOR also points out, Perry appears to be saying that all the programs where that money was diverted -- autism, mental health services for children, EMS and trauma care -- will be the ones who lose their funding to pay for a new, Planned Parenthood-free version of the WHP.

Let's place a little bet right now. If HHSC programs are cut to make way for a new WHP, we can think of at least one thing that we're willing to wager won't lose a nickel: the $8 million that was given to crisis pregnancy centers, anti-abortion and abstinence programs.

The full letter from CMS to the state is below.

CMS Letter to Texas 3.15.12



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36 comments
Bettyculbreath
Bettyculbreath

Rick Perry is a dam fool.A governor that will give millions of dollars away and put thousands of people out of work is a fool.It's not just the health service people deliver the service.

John_silencer
John_silencer

As usual , politics at play---only the patients needing that care willl be hurt--and the money will be taken from other helth care programs ecept those of absteince, anti-abortion, and crsis pregnantacy centers and they will be turned into health care providers replacing planned parenthood.  and now mental health will be parred back in a large amount of dollars lost and caused by the great politician Gov. Brainfreeze--I bet he eats lots of Blue Belll ice cream that causes those freeze up.

Cantread
Cantread

Now when all of this comes back to screw over all of the people that backed it, they can all look at Perry and say, "tell us who to blame next??"

Oak Cliff Townie
Oak Cliff Townie

You youngsters better start some Monologues about the Vaginas !

You are going to need them !!!!!!!!!!!!!!!

Because Little Ricky Santorum Is starting his own war on Broads or was that a broad war on porn ?If you noticed he is a seed spiller because of his need to wear glasses. At least he stopped before he went blind !

http://www.forbes.com/sites/jo...

Chris Danger
Chris Danger

The audacity of this man makes me ashamed to be a Texan...

Bob
Bob

If you ever see Perry's name on a ballot again (God forbid) you must, you absolutely must, remember what Rick Perry is doing to your healthcare and has done to your public education system (both public schools and higher education).  This man, and his extreme REPUBLICAN policies, are devasting our population now and for the foreseeable future.  Never forget, and never forgive.

Phelps
Phelps

Obama really does hate healthcare, doesn't he?  He would rather we not get any healthcare at all than the the specific healthcare he thinks we need.

downtownworker
downtownworker

Don't Mess with Texas: We're Talking About You, Vaginas.

really?really?
really?really?

 and I'm sure his boyfriend is equally embarrassed as well.

Phelps
Phelps

Seems to me that this is a better argument for getting government out of healthcare and education, rather than concentrating on one man.  Rick Perry is by no means unique.

Edward
Edward

The concept you seem to be preaching is the "every person for himself" version of healthcare, which is what we would end up with unless the government was there to step in as needed. 

To me, that version of healthcare is epitomized by the example of the Tea Party "patriot" throwing a dollar bill at the man suffering from Parkinsons disease.

I don't think that's the world that most Americans would like to live in.

Mavdog
Mavdog

It seems that your assertion is that Obama should violate the federal statutes and continue to send the dollars to Texas.

Odd, I was unaware that conservatives advocated ignoring the rule of law.

The statute being enforced against Texas proceeded the Obama administration by many years, it has been on the books for a long time and the Texas GOP must have been knowledgeable of the statute when they chose to pass a rule that produced this outcome.

Those who parrot the ridiculous assertions by Perry that portray the Obama administration with fault show their lack of honesty and intellect, not to mention their apparent willingness to break federal statutes. So the list includes duplicity, dishonesty and criminal intent. Quite a dubious list...

Edward
Edward

As the feds stated, the rules were clearly in place and Texas decided it didn't want to play by those rules.

Interesting how Republicans have been in a tizzy about "Obamacare" and the government "telling you how to run your own healthcare", yet the first thing they want to do is have the government tell pregnant women to stick something up their hoo-haws and what healthcare providers they can and cannot use.

downtownworker
downtownworker

I thought Obamacare was evil/socialist because it would lead to restricted choices in healthcare providers. I guess restricting choices is GROOVY now.

RC
RC

 Uh...I think the Bush Administration created the program and laid out the ground rules.You need to reread the article Rick. Nice try though.

John_silencer
John_silencer

Its the law Phelps, and Gov. Brainfreeze knew what would happen. Wonder if thsoe folks will be voting republican come election time. Perry is out to get the far right vote agin. After all he is double dipping from the state of texas while still working and having state paid insurance also. Wonder who benefits from this cut off of funds agin inthe health care --onlyhis friends in the health care business

Ed D.
Ed D.

Let's get government out of law enforcement and put it back in the hands of the free market. Sure, you call it a "protection racket" but I say "you've got a real nice house here and I'd hate to see anything happen to it or your family". Free market!

Mavdog
Mavdog

Oh, well said Phelps, Rick Perry is by no means unique. There are many many other misogynist men out there with the same lack of intellect, predilection for dishonesty and inflated self esteem as Rick Perry.

Phelps
Phelps

Your argument would have more weight had Obama not granted Obamacare waivers to pretty much every blue state in the union.

Phelps
Phelps

So which one do you want?  Do you want the government in charge of healthcare, or not?

This is really the fundamental argument for libertarianism.  The bigger you make government, the bigger the club you hand to your political enemies.  Whenever you come up with an idea for a new government program, ask yourself this -- would I be OK with my worst enemy running this program?  If not, it's a bad program, because our government see-saws back and forth, and eventually, your worst enemy will be in charge of it.

If you really think that Republicans are evil, racist, misogynist pigs, then you don't want the government in charge of healthcare, because the Republicans will eventually get control of the entire works.  When we have single payer healthcare, and the Republicans want to ban abortion, they don't have to actually ban it -- they just stop paying for it.  If they really are racist, then they just stop funding research into ethnically concentrated disorders like sickle cell.  

You are getting the government you asked for, and you are getting it good and hard.

Mavdog
Mavdog

In that it doesn't take effect for almost 2 years, hard to say if it "has been complied with" or it hasn't....

the fact is you asserted "There is no mechanism in the Act [for a waiver]. There is a mechanism that the Administration pulled out of its ass and splatted onto the Register ", which is completely, absolutely wrong. There IS a mechanism for a waiver in the act, and no, the Administration did NOT "pull it out of its ass".

But apparently you pulled your statement out of yours...

Phelps
Phelps

Are you implying that this section has been complied with?  (You might want to read it and take a look at the process that has actually happened before you reply.)

thefncrow
thefncrow

Actually, the reason waivers are granted is in order to allow the state to slowly come into compliance without their failure to meet federal regulations causing a negative impact on health care outcomes in the state.

If Texas had applied for a waiver on the basis that the requirement to forbid PP from participating in the Women's Health Program was a mistake that the state was working on rectifying, there would be a basis to perhaps grant a waiver in the interim.  Since the state is not working on remedying their violation of the federal requirements for participation in the program, they do not qualify for a waiver.

thefncrow
thefncrow

You might want to go check out Section 1332 of PPACA, because that's where the Act defines the mechanism by which HHS can offer waivers.  Meaning, yes, the act absolutely does define such a mechanism.

Phelps
Phelps

There is a mechanism contained in the Act allowing for waivers based on the affect implementing the Act has on premiums for the insured.

Actually, no.  There is no mechanism in the Act.  There is a mechanism that the Administration pulled out of its ass and splatted onto the Register when it realized that its law was so fundamentally flawed that it would result in utter chaos as written.

Mavdog
Mavdog

What does the issue of waivers and the Affordable Care Act have anything to do with this? Nothing.

There is a mechanism contained in the Act allowing for waivers based on the affect implementing the Act has on premiums for the insured.

There is no mechanism allowing for a waiver in the statute mandating that the patient, not the government, selects their healthcare provider.

Apples and oranges. Care to try again to conjure some credible rationalization for the Texas GOP decision to stop providing health care to some of our state's most needy?

Good luck, it's impossible.

Phelps
Phelps

Actually, you've made my point.  Only the illegal waivers for things that Obama likes get granted, while illegal waivers for things that he doesn't like (even if they are ultimately detrimental to women) never see the light of day.

thefncrow
thefncrow

Please indicate a single state that was allowed to prohibit federally-approved clinics from recieving funds from their state medicare program.

Yes, there are waivers, but aside from Texas, no one has applied for a waiver to be able to disallow federally-qualified clinics from their state-level program.

Magnet47
Magnet47

I am not a republican but you are right.Many physicians who provided this care to women are being squeezed out.Insurance companies have been making it difficult to get coverage and Medicaid coverage is a cover up for them so they can increase the premiuims.  Planned Parenthood is a cover up for this greedy insurance comapnies and also drug companies--a certain brand is sold by them.

Mavdog
Mavdog

Fewer insurers? why would there be fewer insurers? the exising insurers aren't exiting the market, and in fact the market will provide more policies to write. More policies=more premiums. Those insurers who do a good job of underwriting will enjoy the larger base of insured.

Fewer doctors will be in practice? why will doctors choose to stop practicing? They won't. Practicioners will continue to do just as they have been doing. Any attempt to argue otherwise flies in the face of reality, the majority of doctors do what they do because they enjoy the field of medicine, enjoy treating patients, and therefore they will continue their professional lives just the same.

Somehow your vision has some government bureaucrat deciding what doctors will do to treat a patient. It is not the government who insures the patient, it is private insurance providers.This far from socialized medicine, it has little in similarity to the British model.

The consumer is obligated to be insured; that policy will be from the consumer choosing from a list of possible policies at varied costs and with varied coverages. how that equates to "the government saying [what] they have to get" is inane. The government establishing basic principles is for the least amount of coverage, it goes in many different ways after that.

The Texas law bases the providor on who that providor associates with, not on what services are provided, the costs of those services or the proficiency of the provider. NO private insurer would take such a position on a provider. The Texas GOP is determining who can offer these services not based on professional criteria, but on a political basis. It's wrong, plain and simple.

Your comphrehension is off. I'm not asserting the Affordable Care Act is libertarian. It's far from it.

My assertion is that the GOP mandate removes the individual's right to choose  they see for their health care based on political, rather than professional, criteria. It would stand to reason that a person interested in individual liberty would be appalled by this GOP action.

Edward
Edward

Because I don't think of the "government" as one entity. There's the Republican government, and the Democratic government. 

I'm happy that the Democratic government thinks it's a good idea that women get healthcare.

I'm not thrilled the the Republican government thinks it's necessary to require women to be raped (vaginal entry against their will).

And I don't think that your "no government at all" philosophy is workable.

Phelps
Phelps

There's so many problems in this I don't even have to get to the spurious straw-man argument.

When ACA is fully implemented, individuals will have less choice about their own healthcare, and already have less choice because of it.  Individuals will select from fewer insurers, from fewer doctors taking less of a workload, and will make only healthcare decisions that are approved by the government.  

Insurance is purchased at the point of a gun, and only if that insurance is an acceptable level of coverage to the government, not the individual.  They get what teh government says they have to get, whether they want coverage for that or not.  

The Texas law is not at odds with individual choice unless you are on the public dole, in which case they step into the shoes of a private insurer, and do just what private insurers do -- decide which providers are accepted in the network, and which are not.  Only the most extravagant policies allow you to go to any provider you want, regardless of that provider's policies.  Public dole != Extravagant.

There is absolutely nothing at all libertarian about the ACA.  It is a giant shitheap of regulations heaped on an already over-regulated industry.

Mavdog
Mavdog

you're framing the question in the fashion of a straw man argument Phelps.

It's not a question of the "government in charge of healthcare" or the government not "in charge of healthcare". Not at all.

Individuals are in charge of decisions about their own healthcare today. When the Affordable Care Act is implemented individuals will still be in charge of decisions about their own healthcare. Individuals will select their insurer, their doctors, and will make their own healthcare decisions . Just like today.

Insurance is purchased by the individual, and the individual decides what coverage they purchase. That decision determines what will be included in the policy's coverage and what won't.

In fact, the statute that the Texas GOP is at odds with deals with the individual being the sole decisionmaker on their healthcare. the statute says only the individual will determine who provides the services, not the state.

Being a so called libertarian one would expect you would support the right of the individual over the state.

Phelps
Phelps

Then why are you bitching about the government telling women which medical devices get shoved up their hoohaws?

Edward
Edward

The Republicans are the ones confused about whether they want the government involved in healthcare, not me.

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