Local state health department clinics to cut family-planning services
By MEGAN WILDE / Presidio International (7/19/07)
FAR WEST TEXAS – More than a hundred low-income, immigrant women in the area may soon have to travel to Odessa or El Paso for family planning services.
For more than 25 years, low-income women have been able to get free birth control, annual gynecological exams, pap smears and prenatal care at local Texas Department of State Health Services clinics. But DSHS is notifying local clinics to stop providing these services after August 31. Brewster and Presidio county clients are being referred to other local doctors for free family planning and women’s wellness services, but for non-U.S. citizens, these services may only be available in El Paso and Midland-Odessa.
About two hundred low-income women in the area who qualify for Medicaid will still be able to get free birth control, gynecological exams, pap smears and other services through the new Medicaid Women’s Health Program, which was created at the start of this year. Local Women’s Health Program providers include Dr. David Sanchez’s Alpine and Presidio clinics and the Marfa Community Health Clinic.
Because the expanded Medicaid benefits include many family planning and women’s wellness services, DSHS decided to no longer provide these at its clinics, according to agency spokesperson Doug McBride.
“If you’re going to have Medicaid providers doing that, it might not make sense to have a duplicate effort going on,” McBride said.
But undocumented immigrants, or legal immigrants who entered the U.S. after August 1996, won’t qualify for the new Medicaid Women’s Health Program.
Until now, local clinics provided family planning and wellness services to these women through a federal funding program called Title V. But local clinics will soon stop receiving this type of funding, and these clients must be referred to the nearest Title V providers, which are in El Paso and Midland-Odessa.
Local clinic staff estimated more than 80 Presidio women, 20 Marfa women, and 50 Brewster County women won’t qualify for the new Medicaid Women’s Health Program.
“It doesn’t seem like big numbers, but when you see them one on one like we do, it seems like a major problem,” said Presidio clinic leader Rebecca Wainright.
Alpine clinic nurse Susan Bell serves women throughout Brewster County, but the majority of her Title V clients are in Terlingua and Lajitas.
“We’ve been providing this service for years and years,” she said. “There’s a lot of these people that we’re their safety net, we’re the ones they can rely on. They won’t have that anymore.”
For south Brewster County women, and women in Presidio, making a 500-mile roundtrip to Odessa or El Paso would be a hardship.
“That’s quite a few people we’re not going to be able to serve anymore who I feel like aren’t going to be able to go to Odessa to get family planning services,” Bell said. “These are the very people who may not have reliable transportation.”
Local clinics will still be able to provide condoms through the HIV/STD program, as long as funding is available for that program.
But clinic staff predict that more women will get pregnant if they have to go to Odessa or El Paso for family planning services. And if these women do get pregnant, the local clinics will no longer be providing prenatal care.
“It’s a vicious circle getting ready to form,” Wainright said. “I’m hoping something will change.”
Prenatal care will now be offered through the state Children’s Health Insurance Program perinatal program, which was also created at the start of the year. Unlike Medicaid, which is only available to U.S. citizens except in emergencies, CHIP has no residency requirements.
Ted Hughes, a spokesman for the Texas Health and Human Services Commission, explained that the new CHIP program insures care for unborn children, regardless of the mother’s citizenship status.
While the CHIP program is inclusive of non-citizens, local clinic staff are concerned about the distances area women will now have to travel for prenatal care.
In the tri-county area, there is only one CHIP perinatal provider, Dr. James Luecke in Alpine. Clinic staff hope Dr. Adrian Billings, who is expected to begin practicing in Alpine in August, will also become a CHIP perinatal provider.
“But that still leaves Presidio County with no prenatal care provider,” the Presidio clinic leader said.
So far Wainright has had two Presidio clients, who qualify for the CHIP program, tell her that they are unable to see Dr. Luecke in Alpine. She hopes the new Federally Qualified Health Center in Presidio will be able to find a doctor qualified to provide prenatal care here.
Clinic staff have other concerns about low-income women who won’t qualify for the new Medicaid program.
“People come in because they want birth control pills, but inadvertently they’re getting screenings done for cervical cancer and breast cancer,” Bell, the Alpine clinic nurse, said. “And now that’s not going to happen.”
The Alpine clinic also used to provide follow-up services when a low-income woman had an abnormal pap smear, according to Sharon Lindsey, the DSHS director of nursing for this region. Lindsey said these services are no longer funded by Title V, and the state health department is shifting this type of care to its Breast and Cervical Cancer Services division. The nearest providers in that program are also in El Paso and Midland-Odessa.
In the future, instead of providing family planning and other clinical services, local DSHS clinics will be engaging in “population-based activities,” Lindsey said. These activities include public health outreach and education programs, such as diabetes and childhood obesity prevention, teen pregnancy prevention and increasing access to prenatal care, according to local clinic staff.
The local clinics will also continue to provide immunizations, tuberculosis testing and STD/HIV screening. The changes this summer are not expected to affect the clinics’ employees.
Hughes, the Health and Human Services Commission spokesman, cautioned that DSHS views this as a transition period.
“They are notifying people to expect some changes,” he said of DSHS. “But they want to make sure anybody who shows up gets these services.”