What really happened with WIC?

The Oklahoma State Health Department (OSDH) recently terminated Planned Parenthood’s contract to administer a federal program called Women, Infants & Children (WIC).  The notification letter sent to Planned Parenthood does not provide a reason for ending the contract.  Planned Parenthood has been administering WIC for 18 years and operates three Tulsa County clinics serving 3,000 low-income women, children, and babies each month.  The abrupt termination comes on the heels of a failed legislative attempt to target Planned Parenthood’s WIC funding.

The WIC program is not and should not be controversial.  Since 1975, WIC clinics have offered low-income women and their very young children nutritious food, diapers, post-natal care, and face-to-face visits with primary care providers.  Free office visits with a doctor, nurse, or medical assistant is invaluable for young mothers and new parents – especially the uninsured.  WIC moms can get breastfeeding instruction (it’s not as easy as it might look), information about what to feed infants and toddlers, and answers to any other personal health questions they might have.

Why did OSDH close the Planned Parenthood clinics?  The program’s director, Terry Bryce, explained that clinic contracts had been reevaluated in expectation of federal budget cuts.  Out of 12 contractors statewide, Bryce said Planned Parenthood was chosen because their caseloads were shrinking, there were problems with a routine internal audit, and their cost per case was above-average.  As the Tulsa World reported,

The state Health Department has denied that the contract’s discontinuation was politically motivated and presented data showing that the Planned Parenthood WIC clinics have a relatively high cost per participant and have had a decrease in case load. It also produced an audit finding fault with some of Planned Parenthood’s billing practices.

These seem like plausible explanations, but on closer examination the Health Department’s claims don’t appear to be accurate.

The first explanation is that Planned Parenthood was singled-out for termination because their caseloads were shrinking.  The chart to the left shows the percentage change in caseload for the last four quarters where data is available, from July 2011 to June 2012.  In three of those quarters, Planned Parenthood outperformed Tulsa County’s other contract clinics in terms of caseload. 

The second explanation is that Planned Parenthood was singled-out for termination because of an audit finding fault with their billing practices. Documents provided to the press on this question included only records for Planned Parenthood, even though these are routine annual audits performed on all of the state’s contract clinics – an internal departmental process which regularly includes requests for more information or clarification to facilitate payment.  Another Tulsa County clinic’s audit revealed that 40 percent of their contract was flagged as potentially questionable by auditors, far higher than the 18 percent for Planned Parenthood.

Finally, was Planned Parenthood singled-out for termination because it costs them more per participant to administer WIC?  It’s unclear exactly how OSDH came up with the figures they released publicly, and when I requested the raw data directly, I was told staff was still ‘working on’ putting it together.  Using OSDH vendor payment records from data.ok.gov, I calculated a straightforward cost-per-participant figure: Payments issued to WIC contractor  ÷ Participants served by WIC contractor = Cost per participant.  

Planned Parenthood’s comparative cost-per-participant is actually quite low, even when excluding potentially outlying, higher-cost rural clinics.  None of the reasons given by OSDH for the abrupt termination of Planned Parenthood’s WIC program are accurate representations of the facts. 

Much of the reporting on this story has noted that these Planned Parenthood clinics do not perform abortions, but they do give abortion ‘referrals.’  This is beside the point – abortion is totally irrelevant to WIC.  Unless of course you consider that these are low-income women who already elected to have their babies (or are pregnant and carrying their babies to term), rather than terminate their pregnancies.

The consequences for the women and children who have been accessing services at one of the three Planned Parenthood clinics will be keenly felt.  Planned Parenthood has historically served (and continues to serve) as the largest independent provider of WIC in Tulsa County.  They’ve handled nearly 60 percent of independent clinic cases since 2006, as shown in the adjacent pie chart. 

Many families will have a difficult time accessing another clinic – some 1.2 to 3 miles away.  Without a vehicle or easy access to public transportation, some of these mothers (many of whom are pregnant) will have to make the trip on foot with small children in tow – through a cityscape that is hostile to pedestrians.  Even mothers with access to transportation are already on months-long waiting lists for appointments.  Given that pregnancy only lasts nine months and the first few months of infancy are critical – waiting lists amount to closed doors.

Three weeks ago OK Policy participated in an OSDH leadership summit on Oklahoma’s high infant death rate, themed ‘It’s Everyone’s Responsibility’ (we blogged about it here).  It won’t be easy to lead a broad and whole-hearted campaign against infant mortality while playing politics with the state’s infant and maternal health programs.  For OSDH to unilaterally and abruptly terminate WIC services to thousands of women, and to have done so as cavalierly as it now seems, is deeply troubling.  They owe the public, and especially the mothers whose access to WIC is now in jeopardy, a forthright explanation.