Update, 2 p.m.: Texas Health and Human Services Commission spokesperson Bryan Black told the Observer that the BCCS provider list is “always a work in progress,” and that “every effort is being made to ensure there is adequate access to services across our large state.”

Original story:

When the Legislature excluded Planned Parenthood from the Breast and Cervical Cancer Services (BCCS) program earlier this year, Houston state Representative Sarah Davis, a Republican, inserted a last-minute budget rider meant to ensure that any changes to the program wouldn’t leave regions of the state without a provider. Anti-abortion lawmakers said Planned Parenthood shouldn’t be able to participate in BCCS because they believe the organization is an abortion “affiliate,” but in some areas of the state, Planned Parenthood was the sole BCCS provider for services to low-income Texans at risk for, and living with, cancer.

Davis’ rider reads: “If the department is unable to locate a sufficient number of eligible providers in a certain region, the department may compensate other local providers for the provision of breast and cervical cancer screening services.”

But the very situation that the rider was meant to prevent has materialized anyway — in the Waco area.

According to a finalized list of BCCS clinics for the 2016-17 fiscal year, obtained Wednesday by the Observer, at least one area of the state where Planned Parenthood was previously the only BCCS provider still remains without one: McLennan County.

Tonya Capson, health center manager at the Planned Parenthood clinic in Waco, said that in the two months since the fiscal year began September 1, she has received phone calls from at least seven patients who have been diagnosed with cancer and need help enrolling in Medicaid for breast and cervical cancer treatment. Assistance with quick Medicaid coverage is unique to the BCCS program; only a state contracted provider can directly enroll a patient.

“I have to call them back and explain that we are no longer contracted with BCCS and we are no longer able to help with those applications,” Capson told the Observer, adding that Planned Parenthood has directed patients to the state Health and Human Services Commission’s online clinic locator, but has not directly heard from the agency concerning where to send BCCS patients.

In late October, HHSC spokesperson Bryan Black wrote in an email that the agency was “in discussions with providers capable of providing BCCS services in the McLennan County area.” HHSC did not respond to requests for comment for this story as of press time.

The BCCS program serves approximately 34,000 poor Texas women every year by providing initial cancer screenings, diagnostic and treatment services, and case management. “I have to call them back and explain that we are no longer contracted with BCCS and we are no longer able to help with those applications.” Last fiscal year, 40 health care providers operating 195 clinics participated in the BCCS program. Planned Parenthood operated 17 of those clinics and served nearly 10 percent of BCCS patients. According to the new list for the current fiscal year, 35 providers now operate 131 clinics statewide.

In Waco, Planned Parenthood still has some private funding to help local residents pay for some services, like breast exams or mammograms through a sub-contractor. However, Capson said, many of the clinic’s BCCS patients came from surrounding counties. The clinic doesn’t have enough private funding to cover services to patients who don’t live in McLennan County.

“The biggest challenge now is finding funding for other geographical areas, such as Limestone or Hill County,” Capson said.

According to HHSC’s finalized list, Austin is also without a BCCS provider. CommUnity Care in Austin, a federally qualified health center that operates multiple clinics, is also no longer participating due to the program’s administrative and financial burden on its organization, said spokesperson Monica Saavedra. Saavedra said the community health center has other funding sources to provide the same services covered by BCCS.

The next closest BCCS providers are in the surrounding counties of Bastrop and Hays, each with two clinics.

In late October, the Observer spoke with Davis about her rider. In response to a question about the exclusion of Planned Parenthood, Davis said: “In fact, a provider can be qualified provider if there are no others in the area that meet certain requirements. So, the truth of the matter is that if Planned Parenthood is the only qualified provider in an area, then they can still apply.”

This week, Davis told the Observer she crafted her rider in response to a proposed budget change that would have affected not just Planned Parenthood, but other specialty family planning providers in the program. In the end, though, the Legislature narrowed its focus, singling out Planned Parenthood for exclusion and inserting a rule that no abortion-affiliated provider could participate. Davis has not responded to requests for comment about the latest BCCS provider list.

Sarah Wheat, vice president for public affairs at Planned Parenthood Greater Texas, which operates the Waco clinic, told the Observer that the organization did apply to be a BCCS contractor, but was denied.

“This program gave you that entry point into [cancer] services, even if it wasn’t a service that you could get at our health center,” Wheat said. “Especially if you’re uninsured, you need a door open to you into the health care system to navigate the services you need.”

Editorial intern Hannah McBride contributed to this story.