The federal government on Thursday began making good on its promise to cut off all funding for the Texas Medicaid Women's Health Program amid an escalating fight over the state's ban on funding for clinics affiliated with abortion providers.
In a letter to state officials, Cindy Mann, director of the federal Centers for Medicare and Medicaid Services, said her agency regretted the move.
"We had hoped not to be at this point. But, unfortunately, as we've made clear to the state at all points in this process, we don't have a choice," Mann said on a conference call with reporters after sending the letter.
"Medicaid law is clear," she said. "Patients, not state government officials, are able to choose the doctor and health care providers that are best for them and their family."
The standoff stems from a law passed by the Legislature last summer and took effect Wednesday. It bars state funding for clinics affiliated with abortion providers. The Obama administration had pledged to stop funding the Women's Health Program because federal law requires women to be able to choose any qualified clinic.
Gov. Rick Perry counters that states have the right, under federal law, to determine qualified providers in the program.
The program provides care to about 130,000 women between the ages of 18 and 44 earning less than $20,000 a year or less than $41,000 for a family of four -- with federal funds paying 90 percent of its cost and Texas covering the rest. Mann said that last year it cost about $41 million, and about $34 million of that came from Washington.
About 29 other states have programs similar to the one in Texas, and all of them except Texas are continuing to participate in their programs with federal support, Mann said.
Perry, who slammed the federal government constantly during his short-lived bid for the Republican presidential nomination, has directed state health officials to find the funding to keep the program going from other parts of the budget, but he has promised not to raise revenues to cover the costs.
Planned Parenthood issued a statement criticizing the actions taken by Perry and the Texas Legislature.
"Perry's comments to the right-wing political group Empower Texans that he would take the funding from the already devastated Health and Human Services budget show just how insincere his claims are that he will continue to protect this program for the women and families in our state that rely on it," the statement said.
The law is part of a long-running campaign by conservatives in the Texas Legislature to shut down abortion providers by imposing strenuous regulations and cutting off state and federal funds for their non-abortion services. Perry and Republican state lawmakers specifically don't want Planned Parenthood clinics, which treat 40 percent of the program's patients, to get any state funding, even when that money is not spent on abortions.
"It is the height of political posturing for the Obama administration to put the interests of abortion providers and their affiliates, like Planned Parenthood, over the well-being of more than 100,000 low-income Texas women," Perry said in a statement Thursday. "I will not stand by and let this administration abandon these Texas women to advance its political agenda; Texas will fund these services with or without the federal government."
Perry had indicated that state officials were discussing the possibility of losing federal funding for the Women's Health Program for weeks. But asked if state leaders and their federal counterparts had been discussing a compromise prior to Thursday's letter, Mann said, "there hasn't been any negotiations on that, nor could there be."
Mann said the phase-out of federal funding will be gradual so women do not suddenly find themselves without health care. Texas will continue to receive funding for three more months, and if it assumes control of the program during that time, all federal funding would cease. If not, federal support would continue to be decreased over the next six months.
She said an entirely Texas-run program would not be subject to federal guidelines, but that Texas must present a plan to assume control of -- or entirely phase-out -- the Women's Health Program by April 16, and that the plan must be approved by federal authorities. Until then, Mann said, the state should continue enrolling women into the program to ensure those eligible aren't left without health care coverage.
Perry's spokeswoman Catherine Frazier challenged Mann's contention the state was to blame for ending the standoff.
"It is hypocrisy for CMS to say the state needs to ensure women are not left without health care coverage when they are ones responsible for attempting to end this coverage," she said.