Texas Womens Health Program Transition Plan April 16, 2012 Background S.B.

747, 79th Legislature, Regular Session, 2005, directed the Health and Human Services 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 to expire December 31, 2011. Pursuant to the 2012-13 General Appropriations Act (Article II, Health and Human Services 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 because HHSC 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 Health Program (TWHP), and will be established within the Texas Department of State Health Services (DSHS) pursuant to the departments authority under state law to administer Primary 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 a program 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 what actions 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;

(3) Ensure continuity of care for women who currently receive services through the Medicaid 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 continue to 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 qualified aliens, 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 (including Human Immunodeficiency Virus, or HIV); o Promotion of abstinence as the preferred choice of behavior related to all sexual 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 the client, except emergency contraception; Provision of a contraceptive method, except emergency contraception, based on client choice and absence of medical contraindications; Information on potential resources for the treatment of non-covered health conditions identified by Womens Health Program services; and Referral of non-covered medical problems to appropriate specialty health providers. A participant who is identified as at-risk for cardiovascular disease and diabetes will receive preventive counseling at the initial family planning visit and any follow-up family planning visits to ensure that her preferred method of

contraception is suitable to her current condition or risk factors, which may include: o Hypertension; o Elevated cholesterol; o Obesity/Overweight (as measured by Body Mass Index); o Smoking; o Alcohol abuse; and o 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 through community-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 client referral 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 and provide 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 that will accept the client. If a provider cannot be identified for the client, call center staff will 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: 3

Increase the number of providers accepting and actively serving TWHP clients and retain current providers. Identify areas where more provider capacity is needed and employ targeted outreach in these areas.

Provider outreach strategies will vary according to the target audience and include both community-based and person-to-person outreach. A key strategy will be to work with community 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.