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Alternatives to Abortion insulated from state cuts to mental health, Medicaid


Whether the final state budget looks more like the Spartan version passed by the state House or the less-austere bill struggling in the Senate, Texas mental health care providers are bracing for significant cuts. Family planning dollars are also uncertain, with the Senate looking to spare what the House has gutted. Enjoying a relatively safer harbor, however, is the state’s Alternatives to Abortion Services Program, which pays nonprofits to provide ‘counseling/mentoring’ to pregnant women, with the goal of reducing the number of abortions.

“Unfortunately in this Legislature the folks in control have made it a priority to de-fund all of our strategies that aim to reduce unplanned pregnancies. This is a group that I would categorize as anti-science because that’s the only way I can explain how anybody could hold the position of being against abortion and against contraception,” said state Rep. Mike Villarreal (D-San Antonio).

He said, “This is a group that refuses to recognize the scientific research that explains how contraception actually reduces unplanned pregnancies, and thus abortions and since they are in control they are making these decisions. And the crisis pregnancy centers are really a tactic for diverting money from clinics like Planned Parenthood that are providing preventative health care services – not abortions, but contraception.”

Under the state program, primary contractor Texas Pregnancy Care Network reimburses subcontractors (almost all of which are faith-based charities) for providing services at rates negotiated with the Texas Health and Human Services Commission in 2005. The state pays service providers $1.05 per minute (or $63 per hour) for mentoring/counseling sessions conducted by individuals trained under TPCN guidelines, but who do not have formal education requirements and do not have to be licensed or certified by any professional regulatory body.

As the Texas Independent has previously reported, TPCN’s reimbursement rate is higher than what the state pays, under Medicaid, for nurses to provide family planning services. The rate is also higher than the Medicaid rate for therapeutic sessions with master’s-level counselors or social workers — but less than the Medicaid rate for doctorate-holding psychologists.

Because it is a distinct state program and its rates were negotiated directly by TPCN with HHSC, the Alternatives to Abortion program will not be affected by cuts to Medicaid reimbursement rates proposed in the House budget (cuts of 10 percent) or Senate budget (cuts of 3 percent). However, the Medicaid rate cuts would apply to the aforementioned services provided by nurses and mental health professionals.

Additionally, in a series of floor amendments, House lawmakers reduced by about two-thirds the overall pot of money available for family planning services. One amendment, proposed by state Rep. Randy Weber (R-Pearland), reallocated $7.3 million from family planning to refund the Alternatives to Abortion program for the next two years.

“It is a tragedy to see these dollars be diverted to ‘call centers’ that are not providing any health care service, they are just counseling, they are just making referrals, but they are not helping women receive health care,” Villarreal said.

The Senate version of the budget, meanwhile, has $8.3 million dedicated to Alternatives to Abortion, representing a slight increase in the program’s funding from current levels ($4 million per year).

On the other hand, Texas’ community mental health and mental retardation centers — dependent on direct funding from the state as well as through Medicaid — are not as well insulated from state budget cuts.

“Our crisis intervention hotline and our ability to intervene and screen and deliver services to mitigate mental health issues is dramatically at risk,” said Don Polzin, Executive Director of Gulf Bend Center, the MHMR serving seven counties between Houston and Corpus Christi.

With a current annual budget of a little less than $10 million, Gulf Bend receives about $3.5 million from state general revenue through a performance contract and $5.5 million from “local funds” — the majority of which is from Medicaid reimbursements. The remainder is mostly made up of local contributions, private donations and federal programs

Based on the House budget, Gulf Bend could be looking at an annual budget cut of $1.5 million-$2 million dollars, Polzin said. Almost all of the anticipated loss in revenue would come from state general revenue cuts, he said, and some of it from reductions in Medicaid rates.

“Right now that’s what it looks like, particularly looking at it from the budget that’s proposed by the House,” he said. “I’m hoping the Senate budget is a little bit less dramatic, and the two will offset each other, but that’s all speculation.”

(Additional reporting by Mary Tuma.)

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