As Oklahoma’s Republican lawmakers pass the nation’s strictest anti-abortion laws, an internal audit by the Oklahoma State Department of Health shows the agency has serious concerns about the performance of a vendor selected to provide reimbursements for care to pregnant women at crisis centers that counsel against abortions.

Despite the concerns, the Health Department recently renewed the contract with the Oklahoma Pregnancy Care Network for another year. Officials said they issued multiple requests for proposals, but the network was the only entity to respond.

The proposed budget for fiscal year 2023, which passed the Legislature last week and awaits action by Gov. Kevin Stitt, earmarked $3 million for the program to help crisis pregnancy centers. Stitt signed Senate Bill 1043, which included the funding, on Wednesday.

The internal audit, which was limited in scope, said the Oklahoma Pregnancy Care Network “appears to be seriously underperforming and not utilizing the funds for this contract in the manner identified in the contract or the legislation that created this funding.” It said the contract called for 9,300 women to be helped in the two-year contract period. Just 524 women had been provided assistance through December 2021.

“Although Internal Audit acknowledges this is a completely new program for this subrecipient, the level of performance to date is concerning as well as the limited number of women actually being served,” said the audit, dated April 20.

Madeline Craig, executive director of the Oklahoma Pregnancy Care Network, said the Health Department didn’t share the internal audit with the organization and she was unaware of it until Oklahoma Watch asked about it. She said the original contract had a “fatal flaw” that meant the group wasn’t able to start signing up providers until May 2021.

“Our first year was spent laying the foundation for what will be an excellent, long-standing program serving the women and mothers of Oklahoma,” Craig said in an email. “The program has now hit a tipping point. It is now providing over $80,000 a month to providers serving clients in over 20 Oklahoma counties and growing exponentially.”

Choosing Childbirth Act

The contract with Oklahoma Pregnancy Care Network was awarded through the Choosing Childbirth Act, a law passed in 2017 under former Gov. Mary Fallin. It provides reimbursements to private organizations — including many religious organizations — for expenses used to provide information, referrals and assistance to women to carry their unborn children to term. The money is not allowed to go to organizations that provide abortion services.

Such crisis pregnancy centers can provide ultrasounds, prenatal care, conduct sexually transmitted disease testing, offer infant supplies and counsel pregnant women away from abortion. More than 1.85 million people received services from 2,700 centers across the country in 2019, according to a report by the Lozier Institute. Many are run by affiliates of churches but few are licensed medical clinics.

The Legislature provided $2 million in funds for the Oklahoma program for the first time in 2019 through a line-item appropriation, largely because the state was facing a budget shortfall when the bill passed in 2017. The Oklahoma program was modeled after those in Texas and Pennsylvania, Majority Floor Leader Jon Echols, R-Oklahoma City, said when the funding bill came before the House in March 2019.

Three years later, Echols said his main concern is getting the money to the people who need it. He said a change may be needed in either the vendor or the agency administering the program.

“Whether we need to make a change or not, and it sounds like we do, it hasn’t shaken my faith in the idea,” Echols said Tuesday. “We still need to be providing support to people who choose. We can fight over the abortion issue all we want, but I still think there’s room for us to lock arms, no matter where you are on the issue, and be in favor of funding women who need help if they choose to have their child.”

A bill at the Legislature would have given the state Health Department more flexibility over monitoring contracts and reimbursements to crisis pregnancy centers under the Choosing Childbirth Act. Senate Bill 1552 passed the Senate in March but didn’t make it out of a House committee.

Bid Details

The Oklahoma Pregnancy Care Network Inc. formed in May 2019 and received its nonprofit designation from the Internal Revenue Service in April 2020. Its response to the bid from the Health Department includes at least 10 potential crisis pregnancy centers across the state, including Willow Pregnancy Center, Catholic Charities of Oklahoma and Birthright of Stillwater.

“In sum, OPCN’s network will provide significant reach of the program into every part of the state so that services are accessible,” the organization said in its initial bid. “The goal will be to serve clients that reside in the combined Oklahoma counties where over 99% of the abortions in the state are occurring.”

The bid response details the network’s plan to deal with unexpected pregnancies.

“Just as no person should make life-changing decisions under duress, no woman should feel like she has to terminate her pregnancy because she is scared, alone, pressured or without other options,” the bid said. “The program seeks to serve as a refuge for such women.”

In the first two years of the $2 million contract, the program paid out $392,000. Almost $287,000 of that went to the Oklahoma Pregnancy Care Network. Just $106,000 went to reimburse crisis pregnancy centers, according to Health Department financial records.

“The Choosing Childbirth Program will be OPCN’s first program/service, but OPCN has competitive advantages that no other applicant for this grant will have,” the organization said in its initial bid documents.

It mentions the group’s ties to John McNamara, the executive director of the Texas Pregnancy Care Network. Texas recently put more than $100 million into its Alternatives to Abortion program, which started in 2005. After critics complained about accountability, Texas lawmakers required more disclosure about the outcomes and the nonprofit subcontractors. The Texas Pregnancy Care Network was the sole contractor for that program until 2018.

In Oklahoma, the Health Department’s internal audit raised questions about the Oklahoma Pregnancy Care Network spending $3,100 on travel and office supplies that weren’t covered under the contract. It said little guidance was provided to the vendor and previous Health Department staff approved the expenditures in an email.

In its most recent bid response, the Oklahoma Pregnancy Care Network said it was slow to start because of what it called “onerous insurance requirements” the prior contract had for subcontractors. 

“Many of the small, faith-based providers were not even eligible to obtain $5 million in insurance under multiple categories,” the December bid response said. “In May 2021, these requirements were finally reduced and the current nine locations were brought on board. OPCN is now in the midst of ongoing conversations with at least 25 new provider locations that are interested in joining the program.”

Craig, the network’s executive director, said Wednesday it now has 12 locations and intends to have at least 20 by the end of the year.

“These locations include more than just pregnancy centers,” Craig said. “They are also adoption agencies, social service agencies and residential facilities for moms. We serve clients during their entire pregnancy and for 12 months after the birth of their child.”

In a statement, the Health Department said it remains “committed to making sure money gets out the door to reimburse key providers through the Choosing Childbirth Act.”

“These organizations play a vital role in providing critical services to expecting mothers throughout the state when it comes to counseling, classes, referrals and material assistance,” the agency said. “OSDH will continue to ensure that reimbursement spending happens in an urgent and timely manner. We will continue to work diligently with our contracted vendor to accomplish our ultimate goal, which is to serve Oklahomans.”

Paul Monies has been a reporter with Oklahoma Watch since 2017 and covers state agencies and public health. Contact him at (571) 319-3289 or pmonies@oklahomawatch.org. Follow him on Twitter @pmonies.

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