Access to reproductive health care is important, especially for those without insurance coverage. Publicly funded programs help ensure that everyone has access to contraception, STI testing and treatment, screenings for reproductive cancers, and other related services. In Texas, state and federal funds work together to support those with low incomes by offering care at federally qualified health centers (FQHCs), public health departments, non-profit women’s health centers, and hospital-based clinics.

From 2011-2021, Texas made several changes that impacted how reproductive health funding is distributed and what services are covered. Because of these changes and the state’s decision not to expand Medicaid, many low-income individuals have had to navigate a complicated and evolving system to get the reproductive health care they need. This has made it harder for those most in need to access evidence-based care.

Recent estimates suggest that around 25% of women aged 15-49 in Texas—about 1.7 million—are uninsured. Without Medicaid expansion, many of these women fall into a “coverage gap,” meaning they don’t qualify for Medicaid or subsidies to buy insurance through the Marketplace. The issue is even more significant among Latinx, Black, and undocumented immigrants, as changes in Texas have had a greater impact on these groups.

Policies that create equitable access to comprehensive, evidence-based reproductive health care are essential to public health. This can be achieved through a coordinated and inclusive strategy across federally and state-funded programs that expands the safety net and closes the gaps in access to reproductive health care for Texans who are in need.

In this brief, we summarize key changes to Texas’ funding for reproductive health care for people with low incomes, focusing on 2011-2021.

• 2011-2013 Cutting funding and prioritizing primary care providers
• 2013 – 2016: Expanding and later narrowing the scope of services
• 2016 – 2021: Remaining needs in the patchwork of programs

We also look ahead to the future directions Texas’ family planning programs could take.