The fight over Medicaid funding for Planned Parenthood moved to Texas this week.
Three days after Gov. Greg Abbott announced his decision to end Medicaid funding for Planned Parenthood, state health department investigators on Thursday showed up at Planned Parenthood health centers in Houston, Dallas, San Antonio and Brownsville with orders to turn over thousands of pages of documents, including patients’ records and employees’ home addresses and telephone numbers.
Some but not all of the extensive records sought by the state related specifically to abortion.
For example, Planned Parenthood South Texas was told to produce five years of records — whether electronic, paper or ultrasound — concerning any patients billed to Medicaid who had an abortion in which any part of the fetus was removed or preserved for research use. Planned Parenthood Gulf Coast was to turn over a complete copy of certain patients’ records, including doctors’ orders, nursing notes and lab tests, as well as the center’s appointment books, patient sign-in sheets and contracts.
"We’re concerned about the breadth and depth of what they’re asking for,"’ said Sarah Wheat, a spokeswoman for Planned Parenthood of Greater Texas.
The battle over Medicaid funding for Planned Parenthood has been at a high pitch nationwide since the release, starting in July, of videos secretly shot by abortion opponents posing as representatives of a biomedical firm seeking fetal tissue. The videos purported to show Planned Parenthood officials trying to illegally profit from the sale of fetal tissue, and their release has led many states to question whether Planned Parenthood should be eligible for continued Medicaid funding.
The organization said that the videos were heavily edited, and that it never violated federal law regarding the use of fetal tissue in medical research.
Alabama, Arkansas and Louisiana have also moved to cut off Medicaid funding for Planned Parenthood; the group has filed suit to stop the cuts in each of those states. In Texas, the group has 30 days to appeal the Medicaid termination.
In the notice of Medicaid termination that the Texas inspector general for the state’s Health and Human Services Commission, Stuart W. Bowen Jr., sent Monday to the Planned Parenthood affiliates, he said the state had determined that the group was "no longer capable of performing medical services in a professionally competent, safe, legal and ethical manner."
The notices cited two reasons for that decision: First, they said the videos showed that the organization had a policy of altering its abortion procedures to better procure fetal tissue, in violation of medical standards. In addition, they said the videos showed people posing as buyers of fetal tissue being allowed to handle bloody tissue wearing only gloves, in violation of infection-control standards.
The notices also said that the state had found a pattern of illegal billing practices that amounted to Medicaid fraud.
Chris Cutrone, a spokesman for the inspector general, said he could not discuss the Planned Parenthood investigation or what the health investigators were looking for in their orders to turn over records.
But Planned Parenthood said it saw the record requests as a politically motivated fishing expedition — and one more battle in the state’s long fight to limit abortion.
"It is completely outrageous that Texas officials are using thoroughly discredited fraudulent videos to cut women off from preventive health care, including cancer screening, HIV testing and birth control," said Dawn Laguens, executive vice president of Planned Parenthood Federation of American, in a statement.
Some Texas Democrats, too, objected.
"This is a gross invasion of client privacy, and I’m tired of watching low-income women become collateral damage in attacks on Planned Parenthood that are based on deceptive videos and political grandstanding," state Sen. José Rodríguez, chairman of the Texas Senate Democratic Caucus, said in a statement. "Texas should be increasing access to women’s health care and expanding Medicaid in order to take better care of our mothers and sisters, not shutting down health clinics and intimidating women from seeking services."
The inspector general said termination of Medicaid for Planned Parenthood would not affect access to care in Texas because there were thousands of alternate providers. But after Texas barred Planned Parenthood from participating in the state’s Women’s Health Program two years ago, a state health department report found that the program served 30,000 fewer women, with the biggest drops in areas where a Planned Parenthood clinic was forced to close.
In the past, two federal appeals courts have blocked laws excluding abortion providers from Medicaid in Indiana and Arizona. Medicaid rules say states are not permitted to prevent providers from participating solely on the basis of the range of medical services they provide.
In Louisiana, Gov. Bobby Jindal expected to end Planned Parenthood’s Medicaid funding Monday. But a federal judge, John W. deGravelles, delayed the termination Sunday. In language that left little doubt about the outcome, the judge ruled that the funding must continue for at least two weeks until a final ruling. Planned Parenthood, he said, would likely be able to prove that the attempt to end its funding was motivated by reasons unrelated to its competence.
"Uncontradicted evidence in the record at this time is that Planned Parenthood Gulf Coast does not perform abortions in Louisiana, is not involved in the sale of fetal tissue and none of the conduct in question occurred at the PPGC’s two Louisiana facilities," he wrote.
Other states have also grappled with the fallout of the videos. Officials in six states — Missouri, Georgia, Indiana, Massachusetts, Pennsylvania and South Dakota — opened investigations into Planned Parenthood’s practices with fetal tissue and found no wrongdoing. Another seven states declined to investigate, finding no grounds for suspicion.
In an effort to quiet the controversy, Planned Parenthood said Oct. 13 that although it had never violated the federal law, it would no longer accept reimbursement for the costs of providing fetal tissue, which made up only a tiny portion of the revenues of the one California affiliate that took reimbursement.