Budget cuts hit county health departments

JEFFERSON CITY, Mo. -- For a decade, the state appropriation for family planning services was among the most controversial components of the Missouri budget.

But as lawmakers struggled to balance the current state spending plan, the $5.1 million that helped provide preventive health care to low-income women was eliminated. As a result, county health departments are being forced to either scale back services or increase out-of-pocket expenses for the women who use them.

Kay Griffin, a women's health care nurse practitioner with the Scott County Health Department, said her agency lost $140,000 and had to eliminate a nursing position and other expenses.

"This was a big blow to a lot of counties and a lot of people," Griffin said. "This was money that was spent wisely. It saved the state a lot of money in the long run."

It is more cost effective to catch health problems early, Griffin said, than it is to treat fully developed conditions.

The program targeted women who didn't qualify for Medicaid but who lacked adequate private health insurance.

Because Planned Parenthood, Missouri's only abortion provider, received a share of the funding to offer family planning services unrelated to abortion, the program sparked fierce legislative debates and lawsuits that fueled the perception that the money went solely for birth control services.

The program was far more expansive, however, also offering women health screenings for breast and cervical cancer and diabetes and advice on nutrition and exercise, said Tricia Schlechte, deputy director of the Department of Health and Senior Services.

"It was really a comprehensive wellness examination," Schlechte said. "For most individuals, that was their only point of contact for health services."

The department allocated the family planning funds, which were first authorized in 1993, through contracts with both public and private health-care providers.

Brandi Moyers, 24, of Cape Girardeau has taken advantage of the services offered through the Cape Girardeau County Public Health Center for several years.

"When I had no job and no insurance, it was free, and they just asked for a donation," Moyers said. "Just because you have a job doesn't mean you can afford $28 for a pack of birth-control pills."

Because the divorced mother of a 3-year-old son now qualifies for Medicaid, she will continue to receive services.

Vicky McDowell, a registered nurse at the county health center, said fees that were once optional have become mandatory.

"It was more of a donation; if a person couldn't afford to pay they still received the services," McDowell said. "Now we have gone to a fixed fee schedule that they have to pay."

In addition to charging more fees, the center will scale back its clinics from once a week to twice a month. The state funding cuts cost the center $40,000.

The Scott County Health Department has begun asking for minimal fees, such as $10 for an examination, but Griffin said those costs will be waived based on ability to pay.

"If they can pay any of that, all of that or none of that, we will still see them," Griffin said.

mpowers@semissourian.com

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