Changes In The Senate
While presenting the Senate version of House Bill 133 to her colleagues in the upper chamber, state Sen. Lois Kolkhorst, R-Brenham, defended the shortened extension.
The media has portrayed our version of this, as cutting it from 12 to six, said Kolkhorst, who also sponsored the bill. I want to make sure that we clarify that we are adding four months, and we will become one of the first states in the nation to extend it beyond two months.
Aside from extended postpartum care, provisions the Senate added to HB 133 include transitioning case management services for children and pregnant women on Medicaid and in the Healthy Texas Women program to managed care. The state plans to move away from a fee-for-service model to contracting with managed care organizations that work with a certain network of providers.
Ramirez said that could mean better service for women experiencing postpartum issues, but the real impact of the change remains to be seen. Thats especially true for traditional family planning providers that may not have much experience working with managed care organizations.
Adriana Kohler, a policy director with the childrens policy nonprofit Texans Care for Children, said that although HB 133 is set to go into effect on Sept. 1, it could still take a while to see the actual benefits play out because it will take time for state and federal officials to secure funding.
What Services Are Not Covered
CHIP perinatal provides a basic prenatal care package. Participating health plans will distribute a provider manual that includes covered and non-covered benefits. Below are examples of non-covered services:
- Inpatient hospital care for the mother of the unborn child that is not related to labor with delivery, such as a serious injury, illness and more
- Labor without delivery of the baby
- Most outpatient specialty services, such as mental health and substance abuse treatment, asthma management, and cardiac care
A pregnant woman may apply for Emergency Medicaid in emergency situations. However, the bar-coded Form H3038-P that HHS mails to a pregnant woman with income at or below 198 percent of the FPL only may be used to apply for Emergency Medicaid for her labor with delivery. She may not use her bar-coded H3038-P, mailed by HHS, for services such as:
- Labor with no delivery
- Other non-delivery emergency services, such as hospitalization for a serious injury, illness and more
How Long Does The Eligibility And Enrollment Process Take
Texas Health and Human Services staff have 15 business days to process the application from the day they received it. Once eligibility is determined, the pregnant woman enrolls in a CHIP perinatal health plan on behalf of her unborn child. She has 15 calendar days to select a health plan from the day she gets a letter stating she can get CHIP perinatal benefits. If she does not choose a medical plan within the 15-day timeframe, HHS will choose one for her.
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Who Can Be A Provider
Physicians, community clinics and providers who offer prenatal care within their scope of practice can provide CHIP perinatal prenatal care. This includes obstetricians/gynecologists, family practitioners, general practitioners, nurse practitioners, internists, nurse midwives or other qualified health care providers.
Those who can provide CHIP perinatal care for newborns are the same types of providers as traditional CHIP.
CHIP perinatal care is provided by all CHIP health plans throughout the state. Health plans recruit physicians and providers for their respective networks. To become part of a network, physicians and providers must meet requirements of the respective health plan, such as credentialing standards, and have a contract with the health plan.
Medicaid For Pregnant Women & Chip Perinatal
Need Services?
SNAP, TANF and Lone Star Card Information
Pregnant women without health insurance might be able to get free health coverage during their pregnancy through Medicaid for Pregnant Women or the CHIP Perinatal program.
Medicaid provides health coverage to low-income pregnant women during pregnancy and up to two months after the birth of the baby.
CHIP Perinatal provides similar coverage for women who can’t get Medicaid and don’t have health insurance.
To get Medicaid for Pregnant Women or CHIP Perinatal, you must be a Texas resident and a U.S. citizen or qualified non-citizen.
When you apply, we’ll ask about your family’s monthly income to see if you can get Medicaid or CHIP Perinatal.
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What Are The Benefits Once The Child Is Born
- Two postpartum visits for the mother.
- Once a child is discharged from the initial hospital admission, the child receives the traditional CHIP benefit package, or Medicaid, depending on their income. CHIP or Medicaid benefits include regular checkups, immunizations and prescriptions for the baby after he or she leaves the hospital.
- Depending on income, the newborn may get Medicaid from birth to their 1st birthday. Most CHIP perinatal infants qualify for Medicaid. If the baby is eligible to get Medicaid, the mother will receive a letter and Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification, in the mail before delivery.
Star Medicaid Managed Care Program
Most people who have Medicaid in Texas get their coverage through the STAR managed care program. STAR covers low-income children, pregnant women and families. STAR members get their services through health plans they choose.
If you’re new to STAR, you’ll choose a health plan from the ones available in your service area . Learn more about how to choose or change your health plan.
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How Does A Woman Enroll In A Chip Perinatal Health Plan
Once a woman is found to be eligible for CHIP perinatal services, her unborn child must be enrolled in a health plan. The woman has 15 calendar days to select a health plan. The 15-day window opens the day she receives a letter from HHSC saying she qualifies for CHIP perinatal services on behalf of her unborn child. If she does not choose a health plan within the 15-day timeframe, HHS will choose one for her.
Once she has enrolled, the woman will receive an ID card from her health plan that specifies CHIP Perinatal Program.
Apply For Medicaid In Texas
You can enroll through HealthCare.gov or the state Medicaid website. You can enroll by phone at 800-318-2596.
Eligibility: The aged, blind, and disabled. Also, parents with dependent children are eligible with household incomes up to 15% of FPL. Children are eligible for Medicaid or CHIP with household incomes up to 201% of FPL, and pregnant women are eligible with household incomes up to 198% of FPL.
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Texas Wic Income Guidelines
WIC is open to many incomes and families. If you are on Medicaid, TANF, or SNAP you meet the income eligibility guidelines for WIC. If you dont qualify for these programs, you may still qualify for WIC by meeting the income guidelines for your household. The Recovery Rebate Credit, also known as stimulus checks, and the Child Tax Credit direct payments are not included when calculating your income to determine eligibility.
| Number of Household Members* |
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*A pregnant womans household is increased by the number of infants she is expecting. For more than six household members, or if you have any income questions, call your local WIC clinic.
** Income can also be determined on a weekly or biweekly basis.
Texas Has Not Accepted Federal Medicaid Expansion
- 5,000,327 Number of Texans covered by Medicaid/CHIP as of May 2021
- 1,748,000 Number of additional Texas residents who would be covered if the state accepted expansion
- 771,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
- $15.3 billion Federal money Texas is leaving on the table in 2022 by not expanding Medicaid
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Who Is Eligible For Medicaid
The general guidelines for eligibility for Medicaid are set by the Federal government however, each state sets up their own specific requirements for eligibility and these can differ from state to state.
All States are required to include certain individuals or groups of people in their Medicaid plan.
The state eligibility groups are:
- Categorically needy
- Medically needy
- Special groups
In the categorically needy group, this will cover pregnant women whose income level is at or below 133% of the Federal Poverty level.
In the medically needy group, this will cover a pregnant woman who makes too much money to qualify in the categorically needy group. This means that women, who may have been denied Medicaid before, may be able to qualify now.
Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
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How Is A Hospital Reimbursed For Labor With Delivery Charges For Chip Perinatal Patients With Incomes At Or Below 198 Percent Of The Fpl
The hospital will need to complete and submit the mother’s bar-coded CHIP Perinatal – Emergency Medical Services Certification to establish Emergency Medicaid for labor with delivery. This form is mailed to the woman before her delivery, and she is instructed to bring it with her to the hospital when she delivers. The form includes a place to add the dates the woman received emergency medical services . Once HHS receives the completed Form H3038-P, emergency Medicaid coverage will be established for the mother for the period of time reflected on the form, and her baby will receive 12 months of Medicaid coverage from date of birth.
In these situations, facility charges for both mom and the newborn are billed to TMHP. Professional charges for the mother are always billed to the CHIP perinatal health plan, while professional charges for the newborn are billed to TMHP.
How Do I Find My Main Doctor’s Name And Phone Number It’s Not On The Card Same With My Dentist How Do I Get This Information
- If you get your services through Medicaid medical or dental plans, you can get the name and phone number of your main doctor or dentist by calling your plan.
- If you don’t know your plan’s email address or phone number, call the number below. You also can get your plan’s phone number and mailing address on YourTexasBenefits.com.
Phone
Note:
- If you are 20 or younger, you’ll need to call your dental plan to find out about services or to get your dentist’s phone number and email address.
- If you are 21 or older, you don’t have a Medicaid dental plan. For answers to questions about Medicaid dental services, call your Medicaid medical plan.
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What Benefits Does Pregnancy Medicaid Provide
Similar to other health care assistance programs, Medicaid does not pay monetary benefits directly to covered participants. Certain health care providers and health care facilities have a contract with Medicaid to treat those who are covered by Medicaid insurance.
When receiving Medicaid benefits, you should be given a list of medical providers who accept Medicaid or given a website to look for a provider in your area. As long as you receive care from a Medicaid provider, your health care costs will be submitted through Medicaid and will be covered. Pregnant women are covered for all care related to the pregnancy, delivery and any complications that may occur during pregnancy and up to 60 days postpartum.
Additionally, pregnant women also may qualify for care that was received for their pregnancy before they applied and received Medicaid. Some states call this Presumptive Eligibility and it was put in place so that all women would start necessary prenatal care as early in pregnancy as possible.
Talk with your local office to find out if you qualify for presumptive eligibility.
Pregnant women are usually given priority in determining Medicaid eligibility. Most offices try to qualify a pregnant woman within about 2-4 weeks. If you need medical treatment before then, talk with your local office about a temporary card.
What Is Pregnancy Medicaid
Medicaid is a government-sponsored health insurance program for low-income families who have no medical insurance or inadequate insurance. All states offer Medicaid or a program similar to Medicaid to help pregnant women receive adequate prenatal and postpartum care. Medicaid also offers health insurance to seniors, children, and people with disabilities.
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How Do I Know Who To Bill
Claims for the Mother
Facilities
- Facilities that need to bill TMHP should look at the patient’s CHIP perinatal health plan ID card. It should have TMHP or Medicaid Claims Administrator under Hospital Facility Billing.
- Facilities that need to bill the CHIP perinatal health plan should find the health plan’s name under Hospital Facility Billing.
Professional charges
How Do I Know If My Child Is Due For A Texas Health Steps Checkup
Texas Health Steps will send you a letter when it’s time for your child’s medical and dental checkups. You can also visit YourTexasBenefits.com or call the number below to find out if your child is due for a checkup.
Phone
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How Do I Enroll In Medicaid In Texas
If you believe you may be eligible to enroll in Medicaid in Texas:
- You can enroll through HealthCare.gov, either online or by phone at 1-800-318-2596.
- You can enroll through the Medicaid website maintained by the Texas Health and Human Services Commission.
- You can also download and print a paper application, or request that one be mailed to you, by using this page on the Texas Medicaid website.
What Benefits Can I Claim When Pregnant And Unemployed In Texas
Temporary Assistance for Needy Families program provides grants to pregnant women and families with low income. If you are unemployed, about to be unemployed, or receive a low income, you may qualify for a TANF grant. You can check to see if you are eligible for financial assistance on the TANF website.
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What Other Documents Do Women Need To Send With Their Application
Women applying for CHIP perinatal services need to submit the following documents of proof:
Proof of Income
Proof must show current income for each person in the home. Proof can be:
- Pay check stub from the last 60 days showing pay before taxes or deductions
- Last year’s tax return
- Proof of self-employment
- Letter from your employer. This letter takes the place of a paycheck stub. It should how much you make now and how often you get paid. It also should include your name, the employer’s name, and the employer’s signature.
- Social Security statement
Austin, TX 78714-9968
In person
Finished applications and copies of required information can be turned in to a local HHS benefits office. To find the office nearest you, call 2-1-1 or 877-541-7905 after you pick a language, press 2.
What If I Change My Mind About Sharing My Medicaid Health Information
You can opt in or opt out whenever you want. To change your settings, go to www.YourTexasBenefits.com and then:
You can also change your settings by calling 800-252-8263.
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Unitedhealthcare Connected For Mycare Ohio
UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.
Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .
I’m Not Sure If I Am In A Medicaid Program Or Not How Can I Find Out Which Program I’m In
You can find out if you have Medicaid by phone or through the web.
Phone
Web
Note: If you are a legally authorized representative, you must click on the client drop-down menu on the upper right side, and choose a name from the list to see who has Medicaid and the plan and program names.
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