Mondays are Access Esperanza’s busiest days. Some of the women who come seeking care may wait for a couple of hours but, CEO Patricio Gonzales said, “We do not turn away patients.” For his clients—most low-income and uninsured—waiting is worth it because the services are free.
Access Esperanza runs four family planning clinics serving roughly 15,000 patients a year in McAllen and nearby cities in the Rio Grande Valley where the average income is less than $20,000 per year. Gonzales said that for many of his patients, their yearly visit to one of his clinics may be the only time they even get their vitals checked. “We’re their only medical provider,” he said—it’s Access Esperanza or the emergency room.
In vast stretches of Texas, family planning clinics like Access Esperanza are a thin and threatened lifeline for low-income families. Getting any kind of healthcare can be difficult, especially in rural areas where the nearest hospital or clinic may be hours away and finding help to pay for it can be a nightmare. Until recently, patients could come in, fill out a relatively simple two-page application, and get care on the same day under a program called Healthy Texas Women (HTW). The program, which is the state’s largest safety net for reproductive healthcare, is a vital funding source for such clinics. It serves about 190,000 people a year.
In the past, clinic operators sent the applications off to the Texas Health and Human Services Commision (HHSC) in Austin and, usually within a couple of weeks, most were approved and the clinic was paid.
Not all the patients’ medical needs are covered by the program, but the basic screenings and exams save lives all the time—like the 55-year-old woman who came into Access Esperanza’s clinic in Mission “looking extremely pale, weak, and in need of a medical examination,” Gonzales said. Clinic workers determined she badly needed a blood transfusion and got her to a hospital ER. The next day, Gonzales got word that the clinic workers’ actions had saved the woman’s life.
But now the Healthy Texas Women program is unraveling, according to providers and healthcare advocates interviewed for this story.
In March 2021, in the midst of the COVID-19 pandemic and with little explanation to clinic operators, HHSC switched out the relatively simple HTW application for a 13-page application for Medicaid assistance. Things went downhill after that.
Family planning providers and others described the new paperwork as extremely complicated and, for many women, intimidating. As a result, they said, many applicants give up and go away, which
