By Winona Gbedey, Chelsea Gerlicki and Sarah Miller, MD, MPH

A Deep Dive into Texas Women’s Health Services

By Winona Gbedey, Chelsea Gerlicki and Sarah Miller, MD, MPH

With over 14.6 million women living in Texas, almost 30% of which are uninsured, health programs that aim to support and improve women’s health are of the utmost importance.1 However, many Texas women are unaware of the free and lowcost state-wide medical services available to them. Though each of these programs have their own unique set of services, they each contribute to an extensive network that addresses the barriers many women face when trying to find comprehensive and affordable obstetric and gynecological health care.

Join us as we explore Texas’ women’s health programs and how the outcomes of the Texas Legislative Session will impact them.

WOMEN’S HEALTH PROGRAMS Healthy Texas Women and Healthy Texas Women Plus:

Healthy Texas Women (HTW) is the most comprehensive women’s health program in Texas, providing a wide array of women’s health services to uninsured, low-income women. By enrolling in the program, eligible women gain access to innumerable services, including gynecological exams, pregnancy and STI testing, breast and cervical cancer screenings and family planning services, such as contraception and permanent sterilization.

Healthy Texas Women, the Texas Family Planning Program and Breast and Cervical Cancer Services all offer basic preventive services, such as cholesterol, diabetes and high blood pressure screenings. However, HTW also tends to women's mental, emotional and social wellness by collaborating with substance abuse programs, mental health inpatient care and housing and emergency hotlines.

While HTW itself is not available to women who are currently pregnant, HTW Plus provides services up to twelve months postpartum. This program offers enhanced postpartum care to support more than 375,000 births per year in Texas. Services include coverage for psychotherapy and peer specialists, imaging studies, medications, monitoring for cardiovascular and coronary conditions, and screening, intervention and counseling services for substance use disorders.2

Texas Family Planning Program:

As its name would suggest, the Texas Family Planning Program (TFPP) offers affordable and accessible reproductive health care and family planning services to women and men. These services are especially needed in Texas, where, over the past two decades, there has been an increase in unplanned pregnancies along with maternal and infant morbidity and mortality. In fact, Texas has some of the highest rates in the country, with nearly 300,000 unintended pregnancies every year and many maternal deaths.3,4,5 By emphasizing the importance of reproductive life plans, providing preconception counseling and improving ac-

cess to sexual and reproductive services, TFPP empowers couples to take charge of their reproductive health to ensure better health outcomes for both mother and baby.

Adequate preconception care is a critical component of health care for anyone of reproductive age — but despite its benefits, few women have regular or reliable access to it. Thus, TFPP has become an important weapon in the fight against maternal and infant mortality and morbidity. By addressing the major risk factors, such as obesity, diabetes and substance use that may compromise a woman’s health even before she becomes pregnant, they better prepare her physically for the physiologic changes that take place during pregnancy.

Breast and Cervical Cancer Services:

Cervical cancer is the third most common cause of cancer for Texas women aged 20 to 39 and the fifth most common for women aged 40 to 49.6 Even worse, breast cancer is the second most common cause of cancer death in Texas women.7 Still, upwards of 30% of the state’s women do not get regular pap smears or mammograms.8

Breast and Cervical Cancer Services (BCCS) also helps provide high quality, lowcost preventive care to eligible low-income, uninsured women. Regular breast and cervical cancer screenings are important for both pre- and post-menopausal women, because early detection of suspicious lumps increases the likelihood of treatment success. Once an abnormality is found, BCCS can direct patients toward additional diagnostic testing, cervical dysplasia management, treatment and assistance applying to the Medicaid for Breast and Cervical Cancer Program. This program grants full Medicaid coverage to patients in active treatment for cervical or breast cancer.

Other Programs:

Title X is the only federal program dedicated to providing family planning services to low-income families. Through Title X, over four million men and women annually receive wellness exams, cancer screenings, reproductive care and education, STI testing and treatment.

Title X caters to populations that are typically underserved in medicine and serves as an important safety net for those who may not be eligible for services through HTW, TFPP or BCCS.

Texas Legislative Session

Over the past several months, Texas legislators have evaluated hundreds of proposed legislation on dozens of overarching topics, such as transportation, economic development, criminal justice and health and human services. Now that the legislative session has concluded, we can attest that this has been a big session for women’s health.

Over the next two years, Healthy Texas Women, the Texas Family Planning Program and Breast and Cervical Cancer Services will benefit from a slight boost in funding for a total budget of $352.6 million.

Texas House Bill 133 will expand Medicaid postpartum coverage from two months to six months. Nationwide, maternal mortality has slowly been rising, with more rapid increases occurring in Texas. Most of these deaths, including those from preventable causes like substance use and postpartum depression occur more than 60 days postpartum.9 This bill will support the mothers of nearly half the babies born in Texas each year.10

Finally, Texas Senate Bill 1065 will improve insurance coverage for women with dense breast tissue or with a personal history of breast cancer. When this bill goes into effect, high risk patients will be able to receive diagnostic imaging studies, such as mammography, ultrasound and MRI with the same health plans used for regular screening mammograms.

A number of women’s health bills were adjourned sine die, many of which hoped to tackle some of the biggest contributors to maternal mortality in Texas. Nonetheless, the work that was accomplished at the 87th Legislative Session will help many people.

Many other bills were also proposed by the Texas Senate and House, each with their own unique benefits. Some wished to study and tackle the factors contributing to maternal and infant mortality (Texas House Bill 420), while others hoped to expand the rights pregnant women have to their bodies in life and death (Texas House Bill 102) and who can join them in the pregnancy suite (Texas

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House Bill 415). Despite the intentions of these bills, none of them gained as much support or traction as SB1065 or HB133, and they died in committee. Gaps and disparities still exist, but we are cautiously optimistic for the future. In the legislative sessions to come, we hope to see some of these adjourned bills revisited or new bills passed to further the care and well-being of Texas women. In the meantime, physicians can share this information with their patients to help them optimize their health.

References: 1. Texas | 2016 Health of Women and Children Report. United Health Foundation. https://www.americashealthrankings.org/ learn/reports/2016-health-of-womenand-children-report/state-summariestexas. Accessed June 14, 2021. 2. Texas | National Center for Health Statistics. Centers for Disease Control and Prevention. https://www.americashealth rankings.org/learn/reports/2016-healthof-women-and-children-report/state-summaries-texas. Updated March 19, 2021.

Accessed June 14, 2021. 3. Texas Summary 2018. United Health

Foundation. https://www.americashealthrankings.org/explore/health-ofwomen-and-children/measure/overall_mc h/state/TX?edition-year=2018. Accessed

June 14, 2021. 4. Texas Women’s Health Statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/data_stats/pdfs/texas.pdf. Accessed June 16, 2021. 5. Maternal Mortality Rate by State 2021.

World Population Review. https://worldpopulationreview.com/state-rankings/maternal-mortality-rate-by-state. Accessed

June 30, 2021. 6. Cervical Cancer. Texas Department of

State Health Services. https://www.dshs. state.tx.us/tcr/data/cervical-cancer.aspx.

Updated May 19, 2021. Accessed June 16, 2021. 7. Breast Cancer. Texas Department of State

Health Services. https://www.dshs.state. tx.us/tcr/data/breast-cancer.aspx. Updated

May 19, 2021. Accessed June 16, 2021. 8. Texas | State Profiles for Women’s Health.

Kaiser Family Foundation. https://www. kff.org/interactive/womens-health-profiles/?activeState=Texas&activeCategoryIndex=2&activeView=data. Published

January 15, 2021. Accessed June 16, 2021. 9. Extend Postpartum Medicaid Coverage.

The American College of Obstetricians and Gynecologists. https://www.acog.org /advocacy/policy-priorities/extend-postpartum-medicaid-coverage. Accessed June 30, 2021. 10. Najmabadi, S. Texas lawmakers split over how long to extend Medicaid health coverage for new mothers. The Texas Tribune.

Updated May 27, 2021. Accessed July 3, 2021.

Winona Gbedey is a medical student at the UT Health San Antonio Long School of Medicine. Chelsea Gerlicki is a medical student at the Texas Tech University Health Sciences Center School of Medicine. Sarah Miller, MD, MPH will begin her residency at the UC Davis Family and Community Medicine Residency Program.