The number of claims filed for medical and family planning services in the new state-run Texas Women's Health Program has dropped since the state ousted Planned Parenthood from it and set up its own program without federal financing, according to figures from the Health and Human Services Commission.

Stephanie Goodman, a spokeswoman for the commission, wrote in an email that the program is "running at about 77 percent of the number of claims this year compared to last year." She added that the agency expects to "see a similar trend with the number of women served," though those numbers are more difficult to calculate.

Reimbursement Claims* Filed for TWHP in First Six Months of 2012, 2013

Source: Health and Human Services Commission

January February March April May 2013 17,757 16,253 15,562 16,499 13,592 2012 23,407 20,854 21,213 20,442 17,423 *One clinic visit can result in multiple claims, as separate claims can be filed for a well-woman exam, birth control prescriptions and clinical tests, such as cancer screenings.

“We expected to see a drop-off in the number of claims when we moved to the state program because we knew some women wouldn’t want to change doctors,” Goodman said. “We’ve been able to find new doctors for women who call us, and we’ve got the capacity to increase the number of women we’re serving in the state program.”

In 2011, Texas lawmakers demanded that the state enforce a rule prohibiting women's health care providers affiliated with abortion facilities, such as Planned Parenthood, from participating in the Medicaid Women’s Health Program. At the time, Planned Parenthood clinics — which could not perform abortions at facilities accepting state and federal funding through the program — served 40 percent of women enrolled in it, according to the health commission.

The federal government responded to Texas' enforcement of the rule by cutting off its $9-to-$1 match for the program — more than $30 million annually — and the state launched the Texas Women’s Health Program without federal financing on Jan. 1. Lawmakers have budgeted $71 million in state funds to pay for the program in the 2014-15 biennium.

While Planned Parenthood continues to provide services with community donations and other revenue, Danielle Wells, a spokeswoman with Planned Parenthood of Greater Texas, said many patients have expressed frustration “that politicians are telling them where they should and should not go for their health care.”

“We’re still hearing from patients who were in the program and were unable to locate a provider or schedule services in a timely manner,” she said. The exclusion of Planned Parenthood requires many women to travel farther to find an available provider, she said, and to make "tough decisions about paying out of pocket for care or simply putting off vital care that could potentially save lives."

Amanda Stevenson, a research associate at the University of Texas at Austin's Texas Policy Evaluation Project, a three-year study evaluating the impact of the 2011 women's health policy changes, said determining whether women still have adequate access to care is complicated. While the health commission is working hard to enroll new providers to replace Planned Parenthood, she said women may delay care because they do not know which providers are available or end up paying out of pocket costs by continuing to seek services at a Planned Parenthood clinic.

“We’re seeing obviously that access is diminishing in places, particularly [those] that rely heavily on Planned Parenthood providers,” she said. But other areas of the state have not been as affected by the policy changes, she added, referencing a data application created by the researchers that shows how the 2011 policy changes and funding cuts have affected women’s health services regionally.

She also noted that more data is necessary to determine whether the percent reduction in claims represents a persistent trend.

“If things were getting better then we would expect consistent reduction in that proportion, but it’s not happening,” Stevenson said. “There might be a trend, and we might see it, but it’s not enough here to say that it is.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

This story was produced with the support of the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg School of Journalism's California Endowment for Health Journalism Fellowships.