TMA Testimony on HBs 1138 and 1478: Women's Health Program

Testimonies: House Bills 1138 and 1478 Women's Health Program

By: Janet Realini, MD, MPH
House Public Health Committee  

April 6, 2011

Good morning, Chairwoman Kolkorst and members of the committee. Thank you for the opportunity to testify.

I am Janet Realini, MD, MPH, a family physician and a volunteer for the Healthy Futures Alliance. The alliance is a community coalition dedicated to reducing teen and unplanned pregnancies in San Antonio and Texas. I also am here on behalf of the Texas Medical Association, the Texas Academy of Family Physicians, the Texas Association of Obstetricians and Gynecologists, the Texas Chapter of the American Congress of Obstetricians and Gynecologists, and the Texas Pediatric Society. I am speaking in strong support of House Bill 1478 by Rep. Beverly Woolley and HB 1138 by Rep. Eddie Rodriguez, both of which would continue the Medicaid Women’s Health Program (WHP).

In 2007, Texas launched the Women’s Health Program as a pilot aimed at reducing Medicaid costs by providing low-income women access to family planning services, excluding abortion. To participate in WHP, a woman must be between the ages of 18 and 44, a U.S. citizen or a legal immigrant, and uninsured. She must have an income at or below 185 percent of the federal poverty level. WHP participants receive basic health care screenings — such as for cancer, high blood pressure, and diabetes — and birth control.

The premise behind WHP is simple: By helping women better plan and space their pregnancies, mothers and babies will be healthier, and Medicaid will be able to reduce pregnancy and neonatal-related expenditures. Mistimed pregnancies are costly in both human and economic terms. Among single young women, more than 70 percent of pregnancies in Texas are unplanned.[i]

While most of the children born from unplanned pregnancies come to be wanted, loved, and cared for, the health risks are much higher for these pregnancies than for pregnancies that are planned. For example, unplanned pregnancies are associated with late prenatal care and with poor birth spacing, meaning pregnancies 18 months or less apart. Lack of prenatal care or too-close births contribute to low birth weight and/or premature babies. Babies born too soon or too small often have significant health problems, such as respiratory or developmental delays, contributing to higher medical costs at birth and as the child ages. In 2007, unplanned Medicaid births cost the state more than $1.2 billion.[ii]

According to the Legislative Budget Board (LBB), in 2009 it cost Texas Medicaid a combined $16,360 (all funds) for each delivery and first-year newborn health care costs. The average annual cost per woman participating in WHP is $241 (all funds), and Texas’ share is $24.

Since WHP’s inception, more than 235,000 Texas women have received family planning services.  In the first two years of the program, because of births averted, Texas saved more than $37.6 million in general revenue (GR). This represents a savings of more than $10 for every $1 of general revenue that Texas invested in the program.[iii]

As part of its biennial recommendations to improve government efficiency and effectiveness, the Legislative Budget Board recommended continuing and expanding the Women’s Health Program to achieve additional Medicaid savings and health gains.[iv] In addition to continuing WHP, the Legislative Budget Board recommended expansion of eligibility for the program to (1) women whose income would fall below 185 percent of the federal poverty level if they were pregnant, (2) male clients under 185 percent of poverty seeking vasectomies, and (3) income-eligible teenage females who have given birth while on Medicaid.  In addition, LBB recommended establishing targeted outreach to women who have given birth on Medicaid before their postpartum coverage expires. HB 1138 incorporates these LBB recommendations.

Continuing WHP is estimated by LBB to have a positive impact of more than $83.7 million in general revenue.[v] HB 1138, which includes expansions of WHP, is estimated by LBB to have a positive impact even larger: more than $89.1 million in GR.[vi]

Increasing the number of women who enroll in WHP after a Medicaid delivery is especially important.  For a new mother, enrolling in WHP is not always a top priority when she’s trying to juggle all the demands of caring for a new baby. Women who have had a Medicaid-funded delivery are at particularly high risk for subsequent pregnancy, often so soon that risks of prematurity and low birth weight are elevated.

Without legislative action, the Texas Women’s Health Program will expire in December 2011. Both HB 1478 and HB 1138 extend WHP, thereby allowing Texas to continue reaping the program’s positive human and economic benefits.

We urge you to support legislation to continue and strengthen the Texas Women’s Health Program.


[i] Texas DSHS communication; average for 2004-06.  

[ii] Based on data provided by Texas DSHS for 2007: Health and Human Services Commission average Medicaid birth cost.  

[iii] Texas Health and Human Services. Medicaid Women’s Health Program Implementation Report, December 2010.  

[iv] Legislative Budget Board. Texas State Government Effectiveness and Efficiency, January 2011, pp. 259-266.  

[v] Legislative Budget Board, Fiscal Note for HB 13, 82nd legislative regular session, April 5, 2011.  

[vi]Legislative Budget Board, Fiscal Note for HB 1138, 82nd legislative regular session, April 4, 2011.


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June 20, 2016