Texas pays higher rate for abortion alternatives counselors/mentors than for family planning nurses

Created: April 08, 2011 15:55 | Last updated: July 31, 2020 00:00

When Texas representatives voted to move $7.3 million into the state’s Alternatives to Abortion Services Program from family planning services, they shifted funds to an initiative that pays $63 an hour for unlicensed volunteers to counsel/mentor pregnant women and refer them to other social services — a higher rate, oftentimes, than the state reimburses clinics for medical professionals to provide health care services to women, in addition to the education and referrals that occur during visits.

“I think it is a very, very poor use of state dollars, particularly at a time when they’re hacking and slashing,” said Amanda Stukenberg, executive director of Family Planning of the Coastal Bend (FPCB), which operates two clinics — which do not offer abortions — in Corpus Christi.

FPCB clinics are primarily staffed by nurse practitioners (requiring a masters-level degree) with oversight from a medical director and some aspects of visits performed by medical assistants, she said.

For the most basic type of visit — consisting of a pregnancy test and about 45 minutes spent providing the woman with information about resources such as social services and drug/alcohol counseling –the state would reimburse FPCB about $20 for a returning patient and $31 for a new patient, according to Medicaid program rates, Stukenberg said.

She said her clinics probably see about 2,500-3,000 pregnant women per year who come in for a pregnancy test and referral to Medicaid and other social services.

The most common type of visit to FPCB — which would also include a physical exam, cancer screening, and education about birth control and sexually transmitted diseases — might cost the state about $40 under Medicaid rates, she said.

For the most complex visit for a new patient — also including STD testing, blood testing, Pap test, assessments for obesity/drinking/drug use/abuse, etc. — FPCB would be reimbursed, at most, $70 under Medicaid rates, Stukenberg said.

Meanwhile, the state’s Alternatives to Abortion contractor Texas Pregnancy Care Network reimburses their service providers at the following base rates: $1.05 per minute for counseling/mentoring, $1.05 per minute for referrals, $21 per class (more than one student), $10.50 per visit for material assistance (with 20 minutes of counseling/mentoring, to be billed separately, also required).

Those per-minute rates were drawn from a 108-page “TPCN Training Manual” posted on the website of Austin LifeCare, a crisis pregnancy center receiving funds through the Alternatives to Abortion program.

TPCN’s official quarterly reports to the Health and Human Services Commission, obtained by the Texas Independent through a public information request, refer simply to “Counsel Time” and “Referral Time” and do not specify that those numbers are in minute increments. However the ratios of clinic reimbursement amounts to the number of billable units in the quarterly reports do match up with the reimbursement rates specified in the “TPCN Training Manual.”

“The rates you’ve provided appear accurate,” TPCN Executive Director Vincent Friedewald said in an email.

HHSC also confirmed that the counseling rate is $1.05 per minute under the Alternatives to Abortion contract.

“Materials assistance (pantry) visits are capped at 12 visits per pregnancy, and the 20 minutes of counseling tied to each visit are for the purpose of making sure the Program isn’t a portal for handouts, and instead is always in touch with the most recent needs of every client,” Friedewald said.

“The rates were proposed by TPCN and agreed to by HHSC in 2005,” he said.

“The level of reimbursement that they’re suggesting simply is incomparable in any way to what medical providers receive for doing a multi-faceted visit,” said Stukenberg, adding that her clinics don’t even have the option of billing for counseling or referrals; that’s just a standard part of visits to the clinics.

Friedewald said, “The rates are modeled after those used in other crisis intervention social services programs, like domestic violence and rape crisis. The rates reflect the unique skill set required to help women who are in crisis from the beginning of their unplanned pregnancy up until the child’s first birthday.”

He said, “Remember, these women are alone and under pressure by others to end a pregnancy they otherwise wish to keep, but don’t know how. The Alternatives Program is the only program in Texas that specializes in serving this special client, so you may be straining if you are attempting to compare its reimbursement rates to those of a non-emergency health services program. A more appropriate comparison might be between two crisis intervention social services programs. In my view it’s apples and oranges, otherwise.”

Extrapolating the reimbursement rate of $1.05 per minute means the state would pay Alternatives to Abortion service providers $126,000 per year for the equivalent of a full-time counselor/mentor ($1.05 x 60 minutes x 40 hours x 50 weeks).

According to the U.S. Bureau of Labor Statistics, registered nurses in Texas earn a median wage of about $63,000 per year, while the 90th percentile among Texas nurses earns about $86,000 per year. Nurse practitioners are registered nurses who have additional education in a specialty.

Licensed professional counselors in Texas must have a master’s in counseling or a related field, plus additional practical training and education, according to the Texas State Board of Professional Counselors. Among many other duties, counselors are trained in crisis intervention counseling.

Counselors’ salaries vary by the specific type of counselor, but according to BLS, Texas counselors earn a median annual wage of anywhere from $34,000 to $59,000, with the 90th percentile earning about $50,000-$80,000.

Licensed social workers have several different levels of certification, with requirements ranging from a bachelor’s degree on up, plus additional practical training and education. Depending on the type, social workers earn a median annual wage of $33,000-$46,000, with the 90th percentile earning $51,000-$75,000, according to BLS.

Additionally, all law enforcement officers in Texas must undergo crisis intervention and de-escalation training. According to BLS, police and sheriff’s patrol officers in Texas earn a median annual wage of about $50,000, with the 90th percentile earning $69,000.

According to the TPCN Training Manual — each page of which carries the label, “Proprietary to Real Alternatives-Do Not Share” and has a copyright date of 2003-2011 — to be certified as a counselor/mentor eligible to secure state reimbursement for the service provider, a person must: Attend an annual TPCN training session (or be trained by someone who attended the annual training session); Read and agree to comply with the 108-page training manual and program rules; Review and complete a 35-question quiz in the manual; Receive “pregnancy counseling skills orientation training” through the service provider (or have a four-year degree in social services or nursing); and pass a child abuse/neglect and criminal background check each year.

The requirements for TPCN counselors do not include official licensing by the state or having a paid position with the service provider. Real Alternatives is the nonprofit that runs the Pennsylvania program after which Texas’ Alternatives to Abortion program is modeled, and that provides guidance to TPCN.

Friedewald noted that his program’s services are free to clients, while state reimbursement rates for family planning vary according to clients’ ability to pay. The rates Stukenberg cited are based on no contribution from the client, she said.

“If they qualify for Medicaid, I can’t charge them,” she said.

Stukenberg said her organization — which, because it does not offer abortion services, severed its affiliation with the Planned Parenthood Federation of America at the beginning of the year — would suffer if the House’s 60 percent cut to family planning services stands. In a series of GOP-sponsored budget amendments introduced on the House floor, lawmakers reallocated more than $60 million from family planning to other programs, reducing the budget for family planning to $38 million for the next two years. The Senate’s version of the budget has $8.3 million allocated to Alternatives to Abortiion.

“In a time of fiscal shortfall, to move money out of family planning is very illogical. There’s a lot of drama and hoopla over abortion,” Stukenberg said. “For me this is just a public health issue, and the need to address it. I respect if the state has a majority of legislators that say we don’t want family planning dollars to go to abortion providers — then they shouldn’t go to abortion providers. But they shouldn’t get so torque out of shape they say to do away with family planning altogether, which is what is threatened to happen this legislative session.”

“This is an example of ideology trumping reason,” said state Rep. Mike Villarreal (D-San Antonio).

An aide to state Rep. Randy Weber (R-Pearland), who proposed the budget amendment to re-fund the Alternatives to Abortion program with family planning money, said Weber would be unavailable for comment Friday because he was tied up with bringing two subject bills on the House floor.

Villarreal, who argued against Weber’s amendment, said he was not aware of the reimbursement rates for Alternatives to Abortion service providers.

“But I am aware of how Alternatives to Abortion is a total waste of state money,” Villarreal said Friday. “And I am aware that it is counterproductive to move family planning dollars to Alternatives to Abortion programs because that does the exact opposite of what is intended. One decreases unplanned pregnancies and therefore decreases abortions; the second one is sort of after-the-fact help.

“Every woman in the state of Texas should be outraged that this Legislature, led mostly by men, is taking away their preventive health care services,” Villarreal said. “They’re taking away preventive health care services to the most needy, low-income women in the state, while at the same time cutting education for their children.”

“There is a limited amount of dollars for poor women to access basic family planning services, and those dollars should not be taken and given to a nonmedical counseling-type encounter. And if people are concerned about abortion, they need to find other sources to fund those projects,” Stukenberg said. “By defunding family planning services under the guise of wanting to reduce abortion, you are doing the very thing that is most likely to increase abortion because we are the clinics that help women not to get pregnant. And if they’re not pregnant, whatever percentage would go on to choose abortion won’t be able to choose abortion.

She said, “This ill-moving of money will feed the very thing they fear most: more women going to clinics for abortions.”