When Jazmine Johnson was in high school, she suffered from a heavy period that was so painfully debilitating that it affected her performance in school.
His medical insurance at the time was provided by the Texas Children’s Health Insurance Program, known as CHIP, which provides health care to teens whose families are low-income but earn too much to qualify for Medicaid. CHIP covered his medications, doctor’s appointments, and other medical needs, but unlike Medicaid, it usually doesn’t cover the cost of birth control – something Johnson needed to regulate his menstrual cycle.
“I started to miss school,” said Johnson, now 19 and a junior at the University of Texas at San Antonio. “I was trying to really focus on getting scholarships and making sure my grades were correct. But it’s hard to focus on the things you should love in high school when you can’t even get up for a week a month.
Texas, a state with the ninth highest rate of teenage pregnancy in the country, is one of only two states where the state’s children’s insurance program does not cover contraceptives to prevent pregnancy in low-income adolescent girls. The program makes exceptions for teens seeking birth control for medical conditions such as anemia, endometriosis, and heavy periods, but it requires multiple levels of authorization from the insurance to verify that it is not. is not used to prevent pregnancy.
“What we hear time and time again from providers and clients of CHIP is that even when they have a documented medical need, (CHIP) creates so much paperwork and documents and proves that medical need,” said Jen Biundo, the director of policy and data for the Texas campaign to prevent teenage pregnancy.
Johnson, who grew up in Jefferson, said that while her medical condition made her eligible for CHIP coverage, she was struggling to get her contraception topped consistently due to all the paperwork. Eventually, she sought out a family planning clinic for a more permanent solution.
To access birth control, low-income adolescents must turn to more limited public programs. The Healthy Texas Women’s Program, which provides free health care coverage around pregnancy, may offer birth control to teenage girls on CHIP, but they should forgo all other types of health coverage. They could also use the Texas Family Planning Program, which provides low-cost reproductive health and planning care, but should be able to visit any of the state’s 200 or so clinics.
Critics of the restrictions say it costs Texas taxpayers significantly more money because the state pays in full for the Texas family planning program. In comparison, the federal government accounts for over 75% of all services covered by the children’s health care plan.
In the last session, a bill to expand CHIP to cover contraceptives was passed by Texas House with bipartisan support, but died after the Senate failed to take it up. This session, House Bill 835, a similar bill drafted by Rep. Donna Howard, D-Austin, has not even received a committee hearing in the House – and it may be too late. At midnight Friday, House members must give preliminary approval to bills drafted by its members, with the exception of bills on the local calendar and the consent calendar.
“We’re one of only two states that doesn’t do this,” Howard said. “There is just no logical reason for it and no rational reason for it. It certainly doesn’t make budgetary sense not to include it. ”
Howard said there was no explicit reason for the bill’s lack of movement, but that she saw pressure against bills giving too much power to minors without including parental consent. But Howard’s bill would require parental consent for their children to have access to contraception.
“There’s just a feeling that whenever you talk about minors, if you don’t have the consent of the minors’ parents, then you are being excessive,” Howard said.
Supporters of the bill also point to the effectiveness of birth control in preventing teenage pregnancies.
In 2018, nearly 1,600 Texas teenage girls enrolled in CHIP experienced pregnancy, according to a report from the Texas Campaign to Prevent Teenage Pregnancy. Teenage pregnancies have steadily declined over the past 30 years across the country, in part due to higher rates of contraception.
Biundo said that because minors near family planning clinics can still access birth control, the issue with CHIP is not whether contraceptives should be prohibited for adolescents. It is a question of knowing how much the State wants to pay.
“Basically we’re just leaving a huge amount of federal money on the table,” Biundo said of the money the federal government would match for birth control under CHIP rather than state programs.
Biundo said Texas family planning clinics are also centered in population centers and 74% of counties in Texas do not have one of these clinics.
Texan pediatrician Maria Monge said CHIP’s lack of easy coverage had a direct impact on her patients. One of Monge’s 12-year-old patients was rushed to the emergency room with heavy menstrual bleeding, and doctors at the hospital prescribed birth control. But because CHIP took too long to provide coverage, the patient’s bleeding worsened and she had to receive a blood transfusion two weeks later.
“It’s about health equity more than anything else,” said Texas pediatrician Monge. “We have patients who, because of the way hormones are not covered but require authorization, need blood transfusions. While private insurance for these same drugs almost never requires the same level of control.
Due to the mosaic of birth control programs and the delay that insurance authorization can cause, Erika Ramirez, director of policy and advocacy for the Texas Women’s Healthcare Coalition, said the bill was important. for women’s health when she testified in support of CHIP’s expansion in 2019.
“Navigating through multiple programs is a barrier to access and puts the burden on the young woman and her family,” Ramirez said.
Shannon Najmabadi contributed to this report.
Correction, May 14, 2021: This story incorrectly stated that the state pays the full cost of the Healthy Texas Women’s program. The state recently began receiving federal grants for the Healthy Texas Women’s Program. It pays for the Texas family planning program in full.