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The Senate of the State of Texas
Jaime 

Senate :Distri 12

February 12, 2016

Executive Commissioner Chris Traylor
Health and Human Services Commission

4900 N. Lamar 
Austin, Texas 78751

Dear Commissioner Traylor:

Committees:

FINANCE, CHAIR

TRANSITION LEGISLATIVE OVERSIGHT
COMMITTEE. CO-CHAIR

LEGISLATIVE AUDIT COMMITTEE

LEGISLATIVE BUDGET BOARD

STATE AFFAIRS

PARTNERSHIP ADVISORY COMMITTEE

JOINT COMMITTEE TO STUDY TRS
HEALTH BENEFIT PLANS

I am writing to request that the Texas Health and Human Services Commission review the Texas
Policy Evaluation Proj ect?s new report on women?s health.

While I appreciate efforts to shine light on policy challenges, it is important for that information to
paint an accurate picture. This study samples a narrow population within the Texas Women?s
Health Program (TWHP) -- which represented only 33 percent of the overall number of women
enrolled in our women's health programs in Fiscal Year (FY) 2014. This ignores hundreds of

thousands of women being served through the Expanded Primary Health Care Program; the Family
Flaming Program; and the 628,000 women of child-bearing age receiving full Medicaid bene?ts,
75 percent of which received contraceptive services in FY 14. Women often rotate in and out of our
state programs, so we must look across our entire system to determine whether we are truly meeting
their needs. Just because a claim for service was not submitted to TWHP does not mean a woman
went without that service.

The study also creates an impression that fewer Texas women are accessing long-acting reversible
contraceptives (LARCs). That?s simply not true. Across our state programs, there were more claims
for LARCs in FY 2014 than there were in FY 2012 when Planned Parenthood was still a

provider. Access to LARCs has been a major focus of our legislative efforts because they are
effective for three, ?ve or even 10 years.

As you conduct your review, please place a special focus on the suggested correlation with
Medicaid births. My understanding is that births are up across the state, both in and out of the
Medicaid population. This is also occurring nationally and tracks population trends in which birth

rates generally increase after a recession. However, if indeed the data supports this idea, we need to
know that. On that point, I would ask that you be as candid as possible. We need an objective
assessment of how our programs are working -- and how they are not working -- in order to address
any de?ciencies that may exist.

Speci?cally, I request:

0 Your analysis on the study?s methodology and ?ndings;

0 Data on contraception access in Texas Medicaid and the women?s health programs that were
ignored by this study, along with your assessment of overall trends in contraception access,
including the forms cited in the study;

0 Information on how factors outside of provider access may affect contraceptive use or the
number of Medicaid births (for example, timing of LARC use, increased access to
insurance, personal intent, etc.);

A county-by-county breakdown of Medicaid births between 2011 and 2014 -- and your
analysis as to whether any correlation exists between overall birth rates in counties where
Flamed Parenthood clinics closed; and

0 An explanation as to how two Commission employees' names appeared as co-authors of this
study, which was funded in part by the Susan T. Buffet Foundation -- a major supporter of
Planned Parenthood.

This Legislature has provided record-level funding for women's health and the capacity to serve
more women than ever before. We have grown our provider network and redesigned our programs
to make it easier for women to navigate care. Critical evaluation is essential to good government,
but women should not be misled into thinking the services they need are not available to

them. Those services are readily available, and Texas women need to know that.

I look forward to working with you as we continue our efforts to improve Texas? women?s health
network.

Very truly yours,

Senator Jane Nelson

CC: Governor Greg Abbott Speaker of the House Joe Straus
Lieutenant Governor Dan Patrick House Appropriations Committee Chairman
John Otto