Saturday, December 23, 2006

Women's Health Program

I got this from someone who sent the following to all his/her would be great if any and everyone could take this letter and send it to their reps as well:

I sent this email or a little longer version to all the State representatives and Senators (also dewhurst) I may not be working by the end of the week, but I will get heard..

Dear Representative whoever:

Let me start by introducing myself. My name is Worker (used my real name and Town in the emails) and I am a Texas Works Advisor in Whereeveryouare, TX. As you most likely know by now, HHSC has been trying to push to get privatization for the issuance of State benefits (Food Stamps, Medicaid and TANF) for quite some time now, and have had limited success to say the least. The Feds have put a hold on any further rolling out of the system until HHSC can show that the system works.

HHSC is going to start a new Medicaid program on January 1st, called "The Women's Health Program." It is explained in Texas Works Bulletin 07-05 ( In theory, it sounds like it could benefit a lot of women in Texas, but there are a couple of issues that I am concerned with.

The program is designed to help women between the ages of 18 through 44 who meet the eligibility criteria. This limited benefit Medicaid program provides health screenings and risk assessment exams for preventable conditions. It also provides family planning counseling and contraceptives to eligible women. The problems that I have with the program have really started to bother me:

1.) It is not a full coverage Medicaid program. The women that would qualify for this program are probably not going to be able to get any treatment for problems that are found…It provides coverage for gynecological exams, related screenings, and birth control. If during any of the exams or screenings a problem is found, they have no medical coverage to pay for any related treatments or medications. They are probably over the income limit for adult Medicaid and TANF, or they would more than likely be on one of those programs already. It doesn't make sense to me to cover someone for a diagnosis, but then not let them be helped for treatment.

2.) This program is being worked through the TIERS system. It has already been shown that this system is flawed, and the government has put a hold on any further rolling out of this system. All of these women between 18 and 44 that apply and are certified for this Medicaid program are going to be in the TIERS system, which means that all associated cases that they have (Food Stamps, Children's Medicaid, etc.) are going to be converted to TIERS cases, along with all other people on those associated cases. In my estimation, in any given week probably 40% to 60% of the women applying for Adult Medicaid in my office are doing so to get birth control. Being the pessimist that I am, I am seeing this program as a ploy to get more people into the TIERS system, so that if and when the powers that be realize that the system is too flawed and cannot save the state any money, there will be too many clients in the "new" system to just trash it and return t the "old" system (which is still working fine.) Once a person is taken off of the SAVERR system and put into TIERS, they can't be put back (although there used to be a way to correct mistakes that would put clients back into the SAVERR system.)If I were a woman between the ages of 18 and 45, and there was a program that would help me to get birth control plus medical screenings for women's problems, I think I would jump at it. If I knew anything about the problems with the TIERS system, and knew that I was going to have to have all of my cases worked through that system for the rest of time, I might think twice before applying. Couldn't this program be implemented through the SAVERR system? They have created more complex programs through this system before.What I am trying to say is that the public (and our government) need to be informed COMPLETELY about this program before it is implemented. Something has to be done to keep all of these clients from being converted to the TIERS system, or there may be more problems than anyone wants to deal with.Thank you for your time, and I apologize that I am sending this so late in the game. I am not a political activist; I just kinda go with the flow of things…usually.

This whole privatization issue has bothered me from the start, mainly because of the way that things were done, not the privatization itself, and I guess I have just gotten fed up. It seems that since HHSC has been stopped from rolling out anywhere else, they are going to virtually roll out with numbers of clients instead of with actual offices in areas.This privatization is adversely affecting workers, clients and it seems the general public now.

Please feel free to forward, cut & paste, or otherwise get this letter to whomsoever you see fit to inform them of the issue. I would rather be kept anonymous for obvious reasons, but if you need or want to, you may use my name and address as a source.

The sender then received a response to his/her letter which - with permission - is being posted below:

Dear Mr./Mrs. (Worker):

Thank you for your information regarding The Woman's Health Program. I understand your concerns with this issue, and it is something our office will research further. I agree with you about the problems associated with the Texas Integrated Eligibility Redesign System (TIERS).

In a report issued by the Texas Comptroller' s office in October, TIERS was credited with having many difficulties, such as not processing dates correctly, not distinguishing between eligible and ineligible members in a household, and failing to determine residency status.Thank you again for the additional information, we appreciate it.

If you have any questions in the future, please do not hesitate to contact our office again.


Katherine Frolow
State Representative
Pete P. Gallego
Texas State Capitol - 4S.5(o) 512-463-0566(Second e-mail)

One thing I found interesting was that in the Q&A last week (was it last week?) someone had asked about this:

According to Texas Works Bulletin 07-05, applications for the Women’s Health Program are to be processed by special Texas Works Advisors in TIERS. Does this mean the rollout has resumed? This will increase the workload for the workers who are trained in TIERS. Is the state looking at providing training for this program?

Applications for the Women’s Health Program, which begins Jan. 1, will be processed in TIERS by a new HHSC eligibility unit created just for this program. The new unit has 34 staff, including 25 eligibility advisors, who will process all Women’s Health Program applications statewide. These employees are receiving training in TIERS and the new program and will be ready to process applications Jan. 1. The rollout of the new eligibility system remains on hold.

Of course, you realize the Q&A did NOT address the fact that once a client is certified for this program, all cases will convert to TIERS which means LOCAL ART WORKERS will be the ones having to process those applications and reviews. The "new unit" will only certify someone for the WHP, not have to deal with overflow that will occur when this client's other cases end up in TIERS.


Anonymous said...

I wanted to add that I submitted the question about the WHP process and my question was modified when it was answered. Whomever responded, omitted part of the question where I mentioned about the cases being converted to TIERS and there is not enough staff to handle the thousands of cases that will be converted. In my personal opinion, I think that some powers that be decided to roll the state into TIERS since the rollout of TIERS was stopped from rolling out to the state. Forethought, if enough cases roll into TIERS there will be no option but to roll TIERS out. As it has already occurred in Williamson County.

Anonymous said...

Another response!!!!!
This was from the Comptroller's office:
Dear (worker):
Comptroller Strayhorn has received your e-mail regarding Medicaid¹s new
Women¹s Health Program, its potential negative impact on the troubled TIERS
system and potential problems that could result for families receiving other
types of financial assistance. She has asked me to respond to you. We are
forwarding a copy of your e-mail without your name to the attention of Anne
Heiligenstein, Deputy Executive Commissioner for Program Services, Health
and Human Services Commission.

Alert local employees are often the first to realize potential problems and
issues involved in the application of new policies, programs and procedures
within the context of complex systems. It is important for staff to stand
up and be heard so that unforeseen negative consequences can be avoided. We
applaud you for having the courage to do so.

We are confident that Ms. Heiligenstein will investigate your concerns and
make any appropriate changes in the Commission¹s plans so that the new
program can proceed without creating additional problems for our state¹s
neediest families.

If you need further assistance, please contact me by e-mail at

Vicki Anderson

Unknown said...

Wow! a nice article about women's health . It has good information about women's