Texas Healthy Women’s Medicaid Coverage


Medicaid For Pregnant Women & Chip Perinatal

TMA Legislative Hotline: Physician-Led Care Womens Medicaid Coverage and Prior Authorization

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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.

Mothers Find Their Own Stopgaps In The Face Of Crisis

The urgent need to fix the gaps in postpartum care has captured the attention of national reformers, who see it as a critical step toward narrowing racial disparities in maternal mortality. Several 2020 Democratic presidential candidates have proposed federal legislation to extend pregnancy Medicaid to a full year postpartum, and state lawmakers have introduced a wave of similar bills. Missouri passed a limited extension last year and Illinois a far more sweeping one this past July both plans are awaiting federal approval.

The enthusiasm extended to Texas, where a broad coalition, led by the maternal mortality review task force, came together this past legislative session to support a full-year extension. The effort passed the House but stalled in the Senate. All the oxygen in the room this session was taken up by school finance reform, the legislative priority of the states top Republicans, said Tim Schauer, an Austin-based lobbyist on womens health issues.

The five-year cost of extending postpartum coverage was estimated at nearly $1 billion in state and federal funds, according to Politico. Rep. Shawn Thierry , who introduced one of the extension bills, had to counter skeptics who thought that the states alarming maternal mortality numbers were, as she said, kind of a hoax and that increasing benefits for new mothers was just a stealth tactic aimed at expanding Medicaid more widely.

How Do I Make Referrals To Other Providers And Programs

Primary care referrals

If a woman covered by Healthy Texas Women does not want to pay out-of-pocket for services not covered by the program, providers must refer the woman to another physician or clinic. Providers should make referrals when health issues are identified and necessary services related to those health issues are not covered under the program.Texas Health and Human Services prefers referrals to local indigent care services, but 2-1-1 can assist with locating other primary care providers, if needed.

Breast and cervical cancer screening

The Breast and Cervical Cancer Services program offers breast and cervical cancer screening and diagnostic services and cervical dysplasia treatment throughout Texas for free or at low cost to eligible women.

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When You Really Really Really Need It Youre Denied

How Texas came to have the worst insurance gaps in the country is no mystery: It was an accumulation of deliberate policy choices by state lawmakers going back decades, driven largely by an aversion to government-mandated insurance and a desire to keep taxes low.

The design of our entire system is to be very limited, and historically we are very distrustful of government in general, said Texas Rep. Sarah Davis, a Houston Republican who chairs the House Appropriations Subcommittee on Health and Human Services. Dr. Amy Raines-Milenkov, a University of North Texas Health Science Center professor and member of the states maternal mortality review committee, believes the states culture of personal responsibility leads it to abandon its most vulnerable. We dont have the belief here that people should have access to health care, she said. Even the safety nets are built on keeping people out rather than pulling people in.

People who dont have children or disabilities cant receive Medicaid, no matter how poor they are. A single mother with two children only qualifies if she earns the equivalent of 17 percent of the federal poverty level or less $230 to $319 per month, depending on whos doing the calculation.

But after the US Supreme Court ruled that states couldnt be forced to accept the Medicaid expansion, Texas became one of 14 states that opted not to a decision that has denied coverage to 1.4 million Texans who would have otherwise qualified for insurance.

What If A Client Needs To Report A Change To Her Case

Texas Medicaid 101

Report changes on Form H1019, Report of Change. The form is available in English and Spanish.

  • Clients do not have to submit a copy of their Social Security cards, and the card cannot be used as proof of citizenship or identity.
  • If the woman changed her name legally but did not report the change to the Social Security Administration, she can visit the Social Security Administration website to find out how to change or correct the name on her card.

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How Does Texas Health And Human Services Protect A Woman’s Confidentiality

The application allows women to list a separate mailing address where all correspondence can be sent. The woman must list her home street address on the application but she can list a P.O. box as a mailing address.If the woman has private health insurance coverage, providers do not bill the private insurance first because this could risk her confidentiality.

What Information And Documents Need To Be Submitted With An Application

Documentation is needed for:

  • Social Security number
  • Household expenses

Note: Documentation of household expenses is not required, but Texas Health and Human Services recommends that women send the following, if available:

  • Expenses for dependent care .
  • Expenses for child support paid by the household .

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Who Can Provide Healthy Texas Women Services

Providers who meet certain criteria might qualify to provide services. These criteria include:

  • Must deliver the types of services available through the program.
  • Have completed the Medicaid enrollment process through the Texas Medicaid & Healthcare Partnership.
  • Can certify that they do not perform or promote elective abortions or affiliate with an entity that performs or promotes elective abortions in accordance with the Healthy Texas Women program rules located in the Texas Administrative Code Title 1, Part 15, Chapter 382, Subchapter A, §§382.1 382.29.

Visit the Healthy Texas Women page on the Texas Medicaid & Healthcare Partnership website to learn more about the requirements and find links to the certification documents.

I’m Pregnant And Need Health Insurance But I Can’t Get Medicaid

Texas removes Planned Parenthood from Medicaid program

CHIP Perinatal is a similar program for pregnant women who can’t get Medicaid and don’t have health insurance.

CHIP Perinatal includes prenatal visits, prenatal vitamins, labor and delivery and postpartum care.

To find out if you can get CHIP Perinatal, apply for Medicaid and we’ll determine if you qualify.

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W1920 Eligibility Begin Dates

Revision 21-3 Effective July 1, 2021

The applicant is eligible the first day of the file date month or, if ineligible the month of application for certain reasons, the first day of the month following the month of application.

Women who transition into HTW from another Medicaid program or CHIP have an effective date of the first day of the month following the end of their previous certification period.

Example: If the TP 40, Medicaid for Pregnant Women, certification end date is Sept. 30, then the HTW effective date is Oct. 1.

A woman is ineligible to receive HTW benefits if she applies the month after her 45th birthday.

Texas Women Start Prenatal Care Later And Not By Choice

Tiffany Revilla didnt know she was 13 weeks pregnant when she went to the emergency room in Fort Worth this past spring all she knew was that something in her belly wasnt right. The pain felt like a dull knife, carving her insides. As the doctor moved an ultrasound wand near one of her C-section scars, he sounded frightened: Its very cloudy in there. Please get help as soon as you can.

Then, like tens of thousands of expectant mothers in Texas every year, she waited.

Texas has the worst record of first-trimester care in the country. About 21 percent of women who give birth in the state some 80,000 annually dont see a doctor or midwife until the second trimester, according to the CDC another one in 10 doesnt start until the third trimester or receive any pregnancy care at all. Such delays can increase the risk of premature birth and infant mortality as well as maternal complications. In Texas, almost 11 percent of babies are born premature.

Thats what happened with Revillas fourth pregnancy in 2016. Shed barely started prenatal care at around 29 weeks when her placental sac had begun to slip out of her vagina, necessitating an emergency caesarean section her son was in the neonatal intensive care unit for three and a half months. The type of incision doctors had been forced to make,from the top of the uterus to the bottom, put her at significant risk for future complications.

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I Have Breast Or Cervical Cancer And I Don’t Have Health Insurance

Medicaid for Breast and Cervical Cancer provides health care services for low-income women who have breast or cervical cancer.

Services include cancer treatment, lab tests, hospital care and service coordination provided by a nurse.

You must contact a Breast and Cervical Cancer Services provider who can help you apply.

Examples Of Proof We Need

Texas Medicaid 101

Proof showing how much money you receive:

  • Paycheck stub or copy of a check from the last 60 days.
  • A letter from an employer.
  • Court papers, divorce decree or separation agreement that show you get alimony
  • Unemployment benefit award letter or pay stubs.
  • Supplemental Security Income award letter or pay stubs.

Proof showing how much you pay:

Court papers, divorce decree or separation agreement that shows how much you pay for alimony. Proof showing your citizenship and identity:

  • A U.S. passport.
  • A certificate of naturalization.
  • A certificate of U.S. citizenship.
  • The three items above prove both citizenship and identity. If you dont have one of these documents, you will need to show two documents, one from each list below:

Proof of Citizenship

Affidavit from 2 adults establishing the date and place of birth in the United States

An example of an item that shows proof of immigration status is an alien registration card or document from the Bureau for Citizenship and Immigration Services .

You have to prove citizenship, immigration and identity only one time. You dont need to send these items again if you reapply.

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Texas Women Can Still Have Healthcare Needs Met Despite Covid

SAN ANGELO, Texas Healthy Texas Womens Medicaid is not a new program, but because of the COVID-19 pandemic, more women may have just become eligible to this resource they didnt know about.

The program is designed for U.S. women ages 18-44 who live in Texas, are not pregnant, meet the income requirements and do not have insurance.

Dana Bell, Shannon Medical Center practice manager for OB/GYN and nephrology, said she sees women join the Healthy Texas Womens program all the time, a process that hasnt been delayed by the pandemic.

Once accepted, women can receive birth control, yearly checkups, STI testing and treatment, permanent sterilization through tubal ligation, and basic health tests such as mammograms and pap smears all at no cost to the patient.

If a woman is pregnant or becomes pregnant while in the Healthy Texas Womens benefits plan, she may be eligible instead for the pregnancy Medicaid program, which will cover all prenatal doctors visits and delivery. However, pregnancy Medicaid only covers a woman eight weeks after she gives birth. Texas recently made a change where those women can now join Healthy Texas Women and receive care for a full year after delivery. This will help her receive birth control and treatment for any postpartum depression she may experience.

To apply for the benefits, go to healthytexaswomen.org or yourtexasbenefits.com to find the full application and areas to upload documents.

In Other News

How Do I Know If An Applicant I Have Treated Is Enrolled In Healthy Texas Women And Her Claim Will Be Paid

To see if a woman is enrolled in the program:

Providers should make sure that a woman is enrolled in the program before billing. Claims received before enrollment will be denied, but providers can resubmit claims once a woman is enrolled. Providers have 95 calendar days from service delivery to bill the program.

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Texas Women Deserve Better Than A Safety Net

Thursday, December 16, 2021

Study after study shows that women with health care coverage, whether its private or government-funded, have better health outcomes.

Texas Women Deserve Better Than A Safety Net

This week, the U.S. Department of Health and Human Services released a new report showing that if states extend 12 months of postpartum coverage to women enrolled in Medicaid or CHIP, 720,000 beneficiaries would have a full year of coverage.

Why does this matter? Because study after study shows that women with health care coverage, whether its private or government-funded, have better health outcomes. Texas women deserve access to affordable, comprehensive health care coverage regardless of their income, health status, or pre-existing conditions.

Texas has the highest uninsured rate in the nation at 18.4% and falls especially short on covering Texas women, who have an even higher uninsured rate at 23%. While some of these women may receive emergency, safety net care, they do not have access to non-emergency health care services that are necessary to address long-term health and well-being.

Women with health coverage are more likely to receive preventive, primary, and specialty care services and have better access to new advances in womens health. Compared to women with insurance, uninsured women use fewer preventive services such as mammograms, pap tests, and timely blood pressure checks. They are also less likely to report having a regular doctor.

Womens Health Insurance Coverage

‘It should not matter how much you make’ | Family continually denied Medicaid coverage for kids

Health insurance coverage is an important factor in making health care affordable and accessible to women. Among the 98 million women ages 19 to 64 residing in the U.S., most had some form of coverage in 2020. However, gaps in private sector and publicly funded programs and lack of affordability left a little over one in ten women uninsured. Over the past decade, the Affordable Care Act has expanded access to affordable coverage through a combination of Medicaid expansions, private insurance reforms, and premium tax credits. This factsheet reviews major sources of coverage for women residing in the U.S. in 2020, as the coronavirus pandemic continued in the U.S. and globally, discusses the impact of the ACA on womens coverage, and the coverage challenges that many women continue to face.

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Can Women Who Have Medicaid For Pregnant Women Transition To Healthy Texas Women To Avoid A Gap In Coverage

Yes. At the end of a woman’s Medicaid for Pregnant Women coverage, she will be automatically enrolled in Healthy Texas Women. The woman will get a notification letter in the mail about her auto-enrollment into Healthy Texas Women and she will have the option to opt out of the program. To be auto-enrolled, a woman must:

  • Be 1844 years of age
  • Not be receiving active third-party resources at the time of auto-enrollment
  • Be unable to get any other Medicaid or CHIP programs

If a woman cannot be auto-enrolled in Healthy Texas Women, she can apply for the program in the last month she is eligible for pregnancy coverage. If she meets the eligibility criteria, her Healthy Texas Women coverage will begin the first day of the month following the end of her Medicaid or CHIP Perinatal coverage.

Scope Of Coverage And Affordability

The ACA set national standards for the scope of benefits offered in private plans. In addition to the broad categories of essential health benefits offered by marketplace plans, all privately purchased plans must cover maternity care which had been historically excluded from most individually purchased plans. In addition, most private plans must cover preventive services without co-payments or other cost sharing. This includes screenings for breast and cervical cancers, well woman visits , prescribed contraceptives, breastfeeding supplies and supports such as breast pumps, and several STI services. Conversely, abortion services are explicitly prohibited from being included as EHBs, and 26 states have laws banning coverage of most abortions from the plans available through the state Marketplaces.

Affordability of coverage and care continues to be a significant concern for many women, both for those who are uninsured as well as those with coverage. The leading reason why uninsured nonelderly adults report that they havent obtained coverage is that it is too expensive. Under employer-sponsored insurance, the major source of coverage for women, 57% of all covered workers with a general annual deductible have deductibles of at least $1,000 for single coverage. Thirty-seven percent of women with employer sponsored coverage report that it is difficult to meet their deductibles.9

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Texas Has A Program For Pregnant Noncitizens But The Program Doesnt Actually Care For Them

There is one category of patients who pose a particular conundrum for obstetric providers in Texas: immigrants. The state has the highest number of births to noncitizens outside of California, and many of those women are low-income. The large majority cant access pregnancy Medicaid, even though most other states allow longtime legal residents to participate.

Texas does have a prenatal care program for noncitizens. Theres a huge caveat, however: It doesnt actually cover the mother, just the fetus she is carrying. It may be the ultimate example of the states fragmented maternal care system and how that system prioritizes babies.

The program dates back to President George W. Bush, who extended the Childrens Health Insurance Program to cover unborn babies. At the time, the idea the fetus is a child and a future citizen and should therefore receive prenatal care attracted more attention for its anti-abortion origins than for its potential to help immigrant mothers. In many of the 16 states that have adopted it, the type of care women receive isnt much different than what they would get under pregnancy Medicaid.


California decided it was tired of women bleeding to death in childbirth

Some of the programs biggest limitations come after the baby has been delivered. While new mothers get two routine checkups, those whose needs are not routine must fend for themselves.

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