Of the many blows that women's reproductive health care has been dealt in Texas over the past several years, at least one victory stood out in 2016.
The Texas Health and Human Services Commission made an effort to give women greater access to what doctors say is the most effective protection against unintended pregnancies: Long-Acting Reversible Contraceptives (LARCs), such as IUDs. The commission amended Medicaid rules to allow hospitals to be reimbursed for offering new moms on Medicaid the IUD or implant, which would be inserted immediately after they give birth in the delivery room. The LARC can last up to ten years, depending on the type, and can be removed when a woman wants to plan a pregnancy.
“With the option to offer reimbursement, the hope was that it would trigger some follow-up on the hospitals' side to start investigating how they could do this,” said Kami Geoffray, CEO of Women's Health and Family Planning Association of Texas.
Turns out, it hasn't been easy.
Despite the fact that the framework to offer this contraception to low-income women has been in place since January 2016, Geoffray and other experts say only a small handful of hospitals in the state have actually taken advantage of it. The Texas Health and Human Services Commission could not give the Houston Press an exact number. But its data through fiscal year 2016 show that the policy change has had virtually no effect on the number of women on Medicaid receiving the long-acting birth control, compared to fiscal year 2015. And data through the calendar year show only 174 women directly benefited from the new policy.
This is in spite of the fact that various recent studies by the Texas Policy Evaluation Project, composed of medical professionals from the University of Texas, have found significant demand for LARCs among women in Texas — demand their research found is far from being met.
According to the findings, pooled from a survey of 1,700 new moms in Texas, while 40 percent of women said they would prefer to use LARC, only 21 percent actually accessed it. Six months after delivery, roughly one-third of women who said they preferred the long-acting birth control simply resorted to using just condoms or withdrawal, because they couldn't access it.
“The first and most important thing this study highlighted is there's a large demand for highly effective contraception — that's to say both implants and IUDs and female sterilization,” said Dr. Joseph Potter, who worked on the study. “A lot more women would like to be using those methods, according to our study.”
The second big highlight of the study, Potter said, was the vast success of the LARC program at LBJ Hospital in Houston. LBJ is one of the only hospitals in the state that not only offer women on Medicaid LARC immediately after delivery, but it's also being reimbursed for it by the state — exactly how the policy is supposed to work. Thirty-six percent of all women offered the contraception have accepted it, according to the study's survey — which Potter says is indicative of what could be happening across Texas if all hospitals were to follow LBJ's lead.
“They've not only shown the demand, but also the supply — if you build it, they will come; let's put it that way,” he said.
So why aren't other hospitals following?
Well, for one, Potter said, with the exception of LBJ, the few that have tried aren't getting reimbursed, because managed-care organizations that receive the claims are not on the same page. Geoffray said multiple hospitals her organization has worked with have complained of the issue — among a host of other hurdles just to get started.
“Implementing an immediate postpartum LARC project in a hospital takes coordination across many departments,” Geoffray said. “You need to have administrative buy-in. You need to have buy-in from clinicians. You need to have buy-in from pharmaceutical. You've got to change clinical protocols and you've got to work on client education. It's a heavy lift for a hospital — and that's all before you get to billing and reimbursement. The hospitals, of course, ought to be sure that before they invest all this time, they'll be able to successfully bill and be reimbursed, as the policy outlines.”
LBJ Hospital, part of the publicly funded Harris Health System, was able to start offering LARC well before the 2016 policy even went into effect thanks to a grant. Other hospitals, however, have not been so lucky.
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“LBJ had funding that allowed them to create this program in their hospital and provide those costly devices without concern about potential billing problems,” Geoffray said. “That's why LBJ was on the cutting edge and is a lot further along.”
Both Geoffray and Potter said that the lack of hospitals jumping on board isn't for lack of trying — medical professionals and associations are currently looking for solutions to all the bureaucratic hurdles blocking women from receiving this top-notch family planning care. This includes how to make LARCs more accessible to women on private insurance plans, who face their own set of hurdles.
And in a state where the family planning budget was slashed by two-thirds in 2011, where the GOP has repeatedly sought to defund Planned Parenthood, thus increasing the risk of unintended pregnancies while restricting access to abortion, figuring that out is probably the least officials can do.
If Texas were to follow anyone's lead, it might look to Mexico: There, all women have been able to access LARCs for free for the last 30 years.