Revision 22-3; Effective July 1, 2022

HTW provides for a continuous 12-month certification period with the following limited health care benefits:

• Annual family planning exams
• Family planning counseling and education
• Treatment of certain sexually transmitted infections
• Birth control (except emergency birth control), including methods to permanently prevent pregnancy (tubal ligations or Essure)
• Follow-up family planning visits related to the method of birth control

Note: For people 15-17, a parent or legal guardian's signature is required.

HTW Plus (HTW+)

Enhanced and limited postpartum care services are available to HTW members whose pregnancies ended within the 12 months preceding their enrollment into HTW.

Enhanced postpartum benefits include services that address:

• postpartum depression and other mental health conditions;
• cardiovascular and coronary conditions; and 
• substance use disorders, including drug, alcohol and tobacco use.

There is no separate eligibility determination for HTW+. If a woman is determined eligible for HTW and her pregnancy ended within the 12 months before her HTW eligibility date, she is eligible for HTW+ benefits during her 12-month HTW certification period. TIERS automatically adds an HTW+ indicator flag to the woman’s HTW EDG.

W—111 Type of Assistance (TA) 41 – MA – Healthy Texas Women

Revision 21-3; Effective July 1, 2021

To be eligible for HTW, applicants must:

• be female, 15 through 44;
  • a parent or legal guardian must apply on behalf of applicants 15-17;
• have countable income of less than or equal to 204.2% of the federal poverty level;
• be a U.S. citizen or a legally admitted alien who meets all eligibility requirements for Medicaid;
• be a Texas resident;
• not be pregnant;
• not have creditable health insurance that covers family planning services; and
• not currently receive Medicaid, Medicare Part A or B, or Children's Health Insurance Program benefits.

Notes:

• A legal guardian is a person appointed by a judge to care for a child younger than 18.
• Deny applications received for minors, 15-17, without a parent or legal guardian signature if they are not eligible for full coverage Medicaid or CHIP. Use the denial reason, “Denied 15-17 without parent or legal guardian’s signature."
• Married minors, 15-17, are not eligible for HTW. Deny applications for married minors if they are not eligible for full coverage Medicaid or CHIP. Use the denial reason, “Denied 15-17 married minors.”

Related Policy

Income Limits, C-131
General Policy, W-510

W—112 Application Procedures

Revision 21-3; Effective July 1, 2021

Applicants can use any Texas Works medical benefits application form to apply for HTW.

Related Policy

Application Requests and Submissions, A-113

W—113 Requesting an Application

Revision 21-3; Effective July 1, 2021

Applicants can request and submit an application using any of the medical program application channels.

If an applicant applies in-person at a local office or through participating family planning providers or other community-based organizations and requests help completing an application, a volunteer or staff member must give help and initial the parts completed or sign the application to show the applicant received help.

Related Policy

Application Requests and Submissions, A-113

W—121 Reserved for Future Use

Revision 21-3; Effective July 1, 2021

W—122 Telephonic Signatures

Revision 21-3; Effective July 1, 2021

An applicant or designated Authorized Representative (AR) can complete and sign an application using a telephonic signature. Follow the telephonic signature policy for medical programs.

Related Policy

Receipt of Application, A-121
Application Signature, A-122.1

W—123 File Date

Revision 21-3; Effective July 1, 2021

Follow policy for medical programs to determine if the application is valid and the application’s file date.

Document why a certain file date was used to determine eligibility when:

• a file date differs from the received date on the application; or
• the application has two received dates (stamp dates).

Related Policy

Receipt of Application, A-121
Filing the Application, A-122
General Policy, W-910

W—124 Faxed Applications

Revision 21-3; Effective July 1, 2021

The file date for faxed applications is the day the application is received by the HHSC fax line.

Verbally inform the applicant or provider to fax the confirmation page and original application to determine the correct file date when: an applicant or provider states that an application was faxed to the HHSC fax line; but the fax was not received.

If HHSC receives the fax confirmation page and the original application:

• Within 30 days of the submission of the original application, the file date is the submission date as shown on the fax confirmation page. Use the date printed by the fax machine to verify the original submission date.
• More than 30 days after the original submission date, the file date is the date the application is resubmitted.

W—131 General Policy

Revision 17-2; Effective April 1, 2017

An interview is not required when applying for or renewing an application for HTW. Schedule a telephone interview only if the individual requests an interview. Process an application or renewal by mail or telephone.

Note: Do not deny the application if the applicant misses the interview; continue determining eligibility.

Revision 21-3; Effective July 1, 2021

Follow the Texas Works medical programs household composition policy to determine household composition.

Related Policy

General Policy, A-210

 

W—211 Budget Group

Revision 21-3; Effective July 1, 2021

Follow the Texas Works medical programs budget policy to determine the applicant’s budget group.

Related Policy

Budget Group, A-241

 

W—212 Certified Group

Revision 17-2; Effective April 1, 2017

Treat women age 18 as adults. The certified group consists only of the woman (adult or minor) applying, and there can only be one certified woman on an HTW EDG. Do not certify an incarcerated woman or married minors.

W—220 Verification Requirements

Revision 21-3; Effective July 1, 2021

Follow the Texas Works medical programs policy for verification requirements.

Related Policy

Verification Requirements, A-250

Revision 20-3; Effective July 1, 2020

The Healthy Texas Women (HTW) program follows the Medical Programs citizenship policy in A-300, Citizenship.

Applicants, who are U.S. citizens and certain legally admitted alien residents, are eligible for HTW if they meet all other eligibility criteria.

Related Policy

Citizenship, A-300

Revision 20-2; Effective April 1, 2020

All applicants must provide a Social Security number (SSN) or apply for one through the Social Security Administration (SSA) before certification.

The Healthy Texas Women (HTW) program follows the SSN policy in A-400, Social Security Number, under the All Programs or Medical Programs headings.

Revision 21-3; Effective July 1, 2021

To receive Healthy Texas Women (HTW) benefits, the recipient must be 15 through 44. An applicant is considered 15 the month of her 15th birthday and age 44 through the month of her 45th birthday. A parent or legal guardian must apply on behalf of minors 15 through 17.

Ten days prior to a woman turning 18 years old, she will receive Form H1871, HTW Client Turning 18 Years Old, to inform her she is now responsible for managing her own HTW Eligibility Determination Group (EDG). The form also provides information about how to report a confidential address.

Married minors are not eligible for HTW; the TF0001 will inform the minor of other services they may be eligible to receive.

Examples:

In these examples, the applicant has already been determined ineligible for full coverage Medicaid and the Children’s Health Insurance Program (CHIP) and is now being tested for HTW eligibility.

• A woman turns 15 on Feb. 9. Her parent filed an application on Jan. 17. The woman is ineligible to receive HTW as she is not turning 15 in the application month. A parent or legal guardian must reapply in the month of February to meet the age requirements.
• A woman turns 18 on July 27. Her parent filed an application on June 5. The woman is eligible for HTW if other eligibility criteria are met. Ten days prior to her 18th birthday on July 17, Form H1871 is generated to inform her once she turns 18 she is responsible for managing her own HTW EDG.
• A woman turns 45 on May 5. She will no longer be eligible to receive HTW benefits effective June 1.

Age is self-declared. If questionable, verify the applicant's age using the Bureau of Vital Statistics (BVS). If unable to verify using BVS, attempt to contact the applicant to clear the discrepancy. Use information provided by the applicant on a previous EDG, if possible.

If the applicant is not eligible for full coverage Medicaid or CHIP and the application is received in a month the applicant:

• is 14, and the application is processed in a month she becomes 15, deny the application because of age;
• is 44, and the application is processed in a month she becomes 45, if otherwise eligible, certify for the month of application and the month of her 45th birthday; or
• becomes 45, and the application is processed the month after her 45th birthday, if otherwise eligible, certify for the month of application only.

Use the following denial reason:

• English — You do not meet the age requirement for the Healthy Texas Women program. To receive benefits under this program, you must be 15 through 44 years of age.
• Spanish — Usted no llena los requisitos de edad del programa Healthy Texas Women. Para recibir beneficios bajo este programa, tiene que tener entre 15 y 44 años de edad.

Married minors 15 through 17 are not eligible for HTW. If the married minor is not eligible for Medicaid and CHIP, use the denial reason, “Denied 15-17 married minors” for HTW. The TF0001, Notice of Case Action, will include the following language:

English:

Notice Language –You are not able to get Healthy Texas Women services because you are an emancipated minor. You might be able to get services through other programs:

Medicaid or CHIP. Apply by: (1) going to YourTexasBenefits.com or (2) calling 2-1-1 or 877-541-7905 for an application (after you pick a language, press 2).

Family Planning Program services. Apply by: (1) going to HealthyTexasWomen.org or (2) calling 2-1-1 or 877-541-7905 (after you pick a language, press 2).

Spanish:

Notice Language – Usted no puede recibir servicios de Healthy Texas Women porque es una menor de edad emancipada. Es posible que usted pueda recibir servicios a través de otros programas:

Medicaid o CHIP. Para hacer la solicitud: (1) vaya a YourTexasBenefits.com o (2) llame al 2-1-1 o al 877-541-7905 para pedir una solicitud (después de seleccionar un idioma, oprima el 2).

Servicios del Programa de Planificación Familiar. Para hacer la solicitud: (1) vaya a HealthyTexasWomen.org o (2) llame al 2-1-1 o al 877-541-7905 (después de seleccionar un idioma, oprima el 2).

When a minor between 15 and 17 submits an application without a parent or guardian and the minor is not eligible for Medicaid or CHIP, use the denial reason of, “Denied 15 -17 without parent or legal guardian’s signature”. The TF0001, Notice of Case Action will include the following language: 

Notice Language–You are not able to get Healthy Texas Women services. A parent or legal guardian must apply for young women ages 15 to 17 -- that was not done in this case. You might be able to get services through other programs:

Medicaid or CHIP. Apply by: (1) going to YourTexasBenefits.com or (2) calling 2-1-1 or 877-541-7905 for an application (after you pick a language, press 2).

Family Planning Program services. Apply by: (1) going to HealthyTexasWomen.org or (2) calling 2-1-1 or 877-541-7905 (after you pick a language, press 2).

Spanish:

Notice Language – Usted no puede recibir servicios de Healthy Texas Women. Uno de los padres o un tutor deben llenar la solicitud para jovencitas de 15 a 17 años, lo cual no se hizo en este caso. Es posible que usted pueda recibir servicios a través de otros programas:

Medicaid o CHIP. Para hacer la solicitud: (1) vaya a YourTexasBenefits.com o (2) llame al 2-1-1 o al 877-541-7905 para pedir una solicitud (después de seleccionar un idioma, oprima el 2).

Servicios del Programa de Planificación Familiar. Para hacer la solicitud: (1) vaya a HealthyTexasWomen.org o (2) llame al 2-1-1 o al 877-541-7905 (después de seleccionar un idioma, oprima el 2).

Related Policy

Verification Sources, A-531
Reuse of an Application Form After Denial, B-111

Revision 07-0; Effective July 1, 2007

Accept self-declaration as verification of age.

Revision 07-0; Effective July 1, 2007

Document the individual's self-declaration establishing her age.

Revision 21-3; Effective July 1, 2021

Follow the Texas Works medical programs budget group policy to determine who is included in the budget group.

Related Policy

Medical Programs, A-240
Budget Group, A-241

Revision 07-0; Effective July 1, 2007

Accept self-declaration as verification for establishing relationship.

Revision 07-0; Effective July 1, 2007

Advisors must document the individual's self-declaration for establishing relationship.

Revision 13-1; Effective January 1, 2013

To establish identity, follow policy for Medical Programs in A-600, Identity.

Revision 17-2; Effective April1, 2017

The Healthy Texas Women (HTW) program follows Children's Medicaid policy in A-700, Residence, to determine acceptable residence eligibility.

Revision 21-3; Effective July 1, 2021

A woman is continuously eligible for 12 months beginning the first day of the month all eligibility criteria are met. There is no three months prior eligibility for the Healthy Texas Women (HTW) program.

Note: An HTW applicant can apply for and receive three months prior benefits under another Medicaid program (e.g. Medically Needy with Spend Down).

The medical effective date (MED) cannot precede the month of the woman's 15th birthday.

Follow applicable policy if the woman is confined in any public institution.

HTW is a fee-for-service program. Fee-for-service allows access to any health care provider and self-referral to specialists. The provider submits claims directly to the claims administrator for reimbursement of covered services.

If a household fails to report required information at the time of the application that causes the woman to be ineligible for HTW, deny the case.

HTW uses an administrative renewal process.

Note: Women are eligible to receive HTW during their Pay for Performance forfeit month(s).

Related Policy

Pay for Performance, A-2150
Medical Program Administrative Renewals, B-122.4
Termination of Medical Coverage for People Confined in a Public Institution, B-510
Eligibility Begin Dates, W-1920

W—911 Current Medicaid, Medicare (Part A or B) and Children's Health Insurance Program (CHIP) Recipients

Revision 22-3; Effective July 1, 2022

A woman is not eligible to receive HTW benefits if she is currently receiving another type of Medicaid, Medicare (Part A or B) or CHIP.

Note: HTW can briefly overlap full coverage Medicaid in the following situations: 

• HTW and Medicaid for Pregnant Women (TP 40): If a woman certified for HTW reports her pregnancy, HTW and TP 40 coverage may overlap because HTW does not provide prenatal or pregnancy benefits. Terminate HTW coverage prospectively and certify TP 40 beginning the first of the month the woman meets all eligibility criteria.
• HTW and Medically Needy with Spend Down (TP 56): HTW and TP 56 coverage may overlap if the HTW woman has unpaid medical bills because HTW does not provide full coverage benefits. HTW coverage is sustained in this scenario.
• HTW and Medicaid for Breast and Cervical Cancer (MBCC): If a woman certified for HTW becomes eligible for MBCC, there may be an overlap in coverage for the month she applies for MBCC. MBCC eligibility begins the date an applicant meets all eligibility criteria and cannot precede the day after the diagnosis date. After the woman is determined eligible for MBCC, terminate HTW prospectively. 

When determining HTW eligibility after a woman is determined ineligible for full Medicaid and CHIP, verify via State Online Query (SOLQ) that the applicant is not currently enrolled in Medicare (Part A or B).

If an HTW applicant is actively receiving Medicare (Part A or B) deny the application using the following disposition denial reason:

• English — You are ineligible to receive Healthy Texas Women services as you are currently receiving assistance under Medicare.
• Spanish — Usted no llena los requisitos para recibir los servicios del Healthy Texas Women ya que actualmente recibe ayuda de Medicare.

Related Policy

Regular Medicaid Coverage, A-820
Pregnant Women, W-912
Eligibility Begin Dates, W-1920
Medicaid Coverage, X-920
Medicaid Effective Date (MED), X-921

W—912 Pregnant Women

Revision 22-3; Effective July 1, 2022

Pregnant women cannot receive HTW benefits. If the applicant does not answer the question “Are you pregnant?”, pend the application and allow the applicant normal processing time frames to provide an answer to the pregnancy question. Accept the applicant’s statement as verification. Deny the application for failure to provide verification if the applicant does not provide an answer to the question “Are you pregnant?”.

If the woman reports a pregnancy on her application, determine if she meets eligibility requirements for Medicaid for Pregnant Women (TP 40) or CHIP-Perinatal (CHIP-P).

If the HTW recipient reports a pregnancy during her 12-month continuous coverage period, determine if she meets eligibility requirements for TP 40 or CHIP-P. Do not require the recipient to complete a new application. If the HTW recipient meets the eligibility requirements for TP 40, allow her to receive HTW and TP 40 in the same month since HTW does not provide full coverage benefits. TIERS will deny the HTW EDG prospectively once the recipient is certified for TP 40 coverage.

Related Policy

Processing Applications for Pregnant Women, A-128
Regular Medicaid Coverage, A-820

W—913 Third-Party Resource (TPR)

Revision 22-4; Effective Oct. 1, 2022

A woman cannot receive HTW benefits when she has creditable health coverage. Creditable health coverage is private health insurance that covers family planning services.

Private health insurance covers family planning services if it provides both:

• family planning-related physician office visits and procedures; and
• contraceptive drugs and devices.

In making this determination, only consider if the private health insurance provides coverage and do not consider other issues such as high deductibles or dollar limits on drug coverage.

Applications for medical programs ask the following questions:

1. Does the health insurance cover family planning services?
2. If yes: If we file a claim on your health insurance will it cause you physical, emotional, or other harm from your spouse, parents or other person?
3. If yes: Tell us why filing a claim with your health insurance would cause you harm.

Note: A person applying for HTW with creditable health coverage is eligible to receive HTW benefits only if identifying and providing information to assist in pursuing third parties is against her best interest.

When determining HTW eligibility after the woman has been determined ineligible for full Medicaid and CHIP:

• Pend the person applying for HTW if she does not answer question 1, question 2 or both.
• Allow the person applying for HTW normal processing time frames to provide an answer. Verification is self-declared by the person applying for HTW.
• If the person applying for HTW does not self-declare the answer to question 1, question 2 or both by the deadline, deny the application for failure to provide.

Note: TPR questions must be addressed at application and renewal.

If the person applying for HTW states Yes to question 1 and question 2 but leaves question 3 blank, do not pend the person applying for HTW for an answer. Continue determining eligibility.

If the person applying for HTW states Yes to question 1 and No to question 2, deny the application using the following denial reason code and add the statement below to the comment section of Form TF0001, Notice of Case Action.

• English — On your application you told us you are covered by other health insurance. Women who are covered by other health insurance cannot receive Healthy Texas Women benefits.
• Spanish — En la solicitud, usted nos dijo que tiene cobertura de otro seguro médico. Las mujeres con cobertura de otro seguro médico no pueden recibir beneficios del programa Healthy Texas Women.

If the person receiving HTW reports having creditable health insurance during the 12-month continuous coverage period, record the change and take action on the TPR information at the next renewal.

W—914 Automatic Eligibility Determination for HTW

Revision 21-3; Effective July 1, 2021

HTW is part of the Modified Adjusted Gross Income (MAGI) cascade. Unless the woman opts out, all women are automatically tested for HTW eligibility when they are determined ineligible for other MAGI Medicaid programs and CHIP.   

Women can opt out of the automatic HTW eligibility determination by indicating they want to waive HTW testing on their initial or renewal application.

When processing the following alerts, run the full MAGI cascade. If the cascade results in a denial of Medicaid and CHIP because the woman does not meet eligibility requirements, refer the woman to the Marketplace and test her for HTW eligibility.

• Alert 819, CHIP Child Aging Out Test MAGI
• Alert 823, MA Child Aging Out Test MAGI
• Alert 824, Pregnancy Ending Test MAGI
• Alert 825, Transitional MA Ending Test MAGI
• Alert 903, Test MAGI – Individual Aging out of TP 70 or TA 82

Note: Women receiving Medicaid for Pregnant Women (TP 40) are tested for HTW eligibility at the end of their TP 40 certification period even if they:

• voluntarily withdraw from Medicaid for Parents and Caretaker Relatives (TP 08), including before an eligibility determination is made; or
• are determined to be potentially eligible for Medicaid for Parents and Caretaker Relatives (TP 08) but fail to complete the interview.

When transitioning to HTW from another MAGI Medicaid program or CHIP, the effective date of the HTW EDG is the first day of the month following the end of the previous benefit’s certification period.

When a woman is determined eligible for HTW, TIERS generates:

• a TF0001, Notice of Case Action; and
• Form H1872, HTW Opting Out and Reporting Confidential Address.

Form H1872 provides the HTW recipient an opportunity to voluntarily withdraw (opt out) and report a confidential address. Form TF0001 and H1872 are addressed to the HTW recipient and mailed to the:  

• confidential address; or
• case address if a confidential address has not been provided.

Related Policy

Confidentiality, W-2400

Revision 17-2; Effective April 1, 2017

Accept self-declaration of pregnancy and TPR.

 

Revision 07-0; Effective July 1, 2007

For TPR, staff must document in case comments:

• the availability of TPR for family planning services;
• if filing a claim would cause physical, emotional or other harm to the individual; and
• why, if provided.

Revision 21-3; Effective July 1, 2021

Domicile requirements do not apply to the Healthy Texas Women (HTW) program.

Related Policy

General Policy, A-910

 

W—1020 Verification Requirements

Revision 07-0; Effective July 1, 2007

 

Accept self-declaration as verification of domicile.

Revision 17-2; Effective April 1, 2017

Resources are exempt for Healthy Texas Women (HTW). However, staff must remember to verify income, such as royalties, dividends or interest generated by a resource.

Revision 21-3; Effective July 1, 2021

Use Modified Adjusted Gross Income (MAGI) rules to determine financial eligibility for Healthy Texas Women (HTW) following the Texas Works medical programs policy.

Related Policy

Income, A-1300

 

W—1411 Types of Income

Revision 21-3; Effective July 1, 2021

Use the Texas Works medical programs policy to determine the countable and exempt income types for HTW.

Related Policy

Types of Income, A-1320

 

W—1412 Types of Payments

Revision 21-3; Effective July 1, 2021

Use the Texas Works medical programs policy to determine if a payment is countable or exempt for HTW.

Related Policy

Types of Payments, A-1330 

 

W—1413 Income Limits

Revision 21-3; Effective July 1, 2021

Use income limit for HTW (TA 41).

Related Policy

Federal Poverty Level (FPL), C-131.1

 

W—1414 Calculating Household Income

Revision 21-3; Effective July 1, 2021

Use the Texas Works medical programs policy to calculate household income.

Related Policy

Income Limits and Eligibility Tests, A-1341
Calculating Household Income, A-1350

 

W—1415 Determining Countable Income in Special Household Situations

Revision 21-3; Effective July 1, 2021

Use the Texas Works medical programs policy to calculate household income in special household situations.

Related Policy

Determining Countable Income in Special Household Situations, A-1360

Revision 21-3; Effective July 1, 2021

Revision 21-3; Effective July 1, 2021

Follow the Texas Works medical programs policy, including reasonable compatibility, to verify income.

Related Policy

Verification Requirements, A-1370
Verification Sources, A-1371

Revision 21-3; Effective July 1, 2021

Follow the Texas Works medical programs policy for documenting income.

Related Policy

Documentation Requirements, A-1380

Revision 21-3; Effective July 1, 2021

Use Modified Adjusted Gross Income (MAGI) rules and the Texas Works medical programs policy to determine allowable deductions for Healthy Texas Women (HTW).

Related Policy

General Policy, A-1410

 

W—1511 Rules That Apply to Deductions

Revision 21-3; Effective July 1, 2021

Use MAGI rules and the Texas Works medical programs policy to determine allowable deductions for HTW.

Related Policy

Rules That Apply to Deductions, A-1411

 

W—1512 Types of Deductions

Revision 21-3; Effective July 1, 2021

Use MAGI rules and the Texas Works medical programs policy to determine allowable deductions for HTW.

Related Policy

General Policy, A-1410

Revision 21-3; Effective July 1, 2021

Use the Texas Works medical programs policy to verify allowable deductions for HTW.

Related Policy

Verification Requirements, A-1440

Revision 21-3; Effective July 1, 2021

Use the Texas Works medical programs policy to document allowable deductions for HTW.

Related Policy

Documentation Requirements, A-1450

Revision 21-3; Effective July 1, 2021

Before certifying or recertifying a woman for Healthy Texas Women (HTW), ensure the applicant completes each question and signs and dates their application or renewal form.

Note: HTW applications and renewals may have a telephonic signature when the woman calls 2-1-1 and applies for or renews eligibility for HTW.

• During processing or during an interview, note if the applicant indicates changes on the application. Document the nature of the change and when the change is expected to occur.
• Give the applicant Form H1019, Report of Change. Explain that they must report address changes within 10 days after knowing about the change. Indicate the appropriate reporting requirement on page one.
• Refer the applicant to other programs she might be eligible for such as:
  • the Supplemental Nutrition Assistance Program (SNAP);
  • Temporary Assistance for Needy Families (TANF);
  • Family Planning;
  • Supplemental Security Income (SSI); and
  • Women, Infants and Children (WIC); and Social Security.  
• Refer people with disabilities or people who are 65 and older and ineligible for Medical Programs for families and children to the Texas Health and Hu man Services Commission (HHSC) Medicaid for the Elderly and People with Disabilities (MEPD) program.
• Inform the applicant of her right to appeal any HHSC action that affects her eligibility.
• Inform the applicant that the information she provides is subject to verification by third parties.

There is no requirement to inform people to report accidents.

Related Policy

Application Signatures, A-122.1
General Reminders, A-1510

Revision 21-3; Effective July 1, 2021

Document that Form H0025, HHSC Application for Voter Registration, was given to the applicant in the Agency Use Only section of her application form.

Related Policy

Registering to Vote, A-1521

Revision 22-4; Effective Oct. 1, 2022

At the end of the interview or during the processing of the woman’s application, give her one or more of the following notices as appropriate. If the case is:

• pended;
• certified;
• sustained; or
• denied.

Form H1020, Request for Information or Action, to inform the woman of the:

• reason the case is pending;
• action she or HHSC staff must take;
• date by which she or HHSC staff must take action; and
• date staff must deny the application or case if she does not take action, if applicable; or

Form TF0001, Notice of Case Action, to inform the woman of the:

• date benefits begin;
• date of denial;
• right to appeal; and
• address and phone number of free legal services available in the area.

Note: Form TF0001 for HTW only includes information about HTW benefits and is sent separately from the TF0001 for other benefits.

Women who transition to Healthy Texas Women (HTW) from another Medicaid program or the Children’s Health Insurance Program (CHIP) receive Form H1872, HTW Opting Out and Reporting Confidential Address, along with Form TF0001. The Form H1872 informs the woman of the:

• options to voluntary withdraw from HTW; and
• process to report a confidential address.

HTW recipients turning 18 years old receive Form H1871, HTW Client Turning 18 Years Old, ten days before their 18th birthday. The Form H1871 informs the woman of:

• the process to report a confidential address; and
• their responsibility to manage their HTW benefits.

Note: For women who only speak Spanish, ensure that all comments provided are in Spanish.

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.

Related Policy

Current Medicaid, Medicare (Part A or B) and Children's Health Insurance Program (CHIP) Recipients, W-911

Revision 17-2; Effective April 1, 2017

The Texas Integrated Eligibility Redesign System (TIERS) calculates an end date from the date the advisor certifies the application/renewal as follows:

• Applications — initial certification month plus 11 months.
• Renewals — 12 months from the last certification month.

Women are continuously eligible for Healthy Texas Women benefits for 12 months or through the month of the woman's 45th birthday, whichever is earlier.

Exception: A woman does not receive her 12 months of continuous eligibility if she:

• is found eligible for Medicaid, Medicare (Part A or B) or the Children's Health Insurance Program;
• dies;
• voluntarily withdraws; or
• moves out of Texas.

Revision 07-0; Effective July 1, 2007

Do not set a special review even if a known change is to occur during the woman's 12-month continuous eligibility period. Document the known change and use the information at the next renewal. Follow current procedures and report the known change if the applicant has other active Eligibility Determination Group cases.

Revision 15-4; Effective October 1, 2015

Any household receiving a notice of adverse action has the right to request a fair hearing. In some situations, households may continue benefits pending an appeal. After certification, give households advance notice of adverse actions to deny benefits except for reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice), and A-2344.2, No Form TF0001 Required.

For adverse action, use current policy in A-2340, Adverse Action.

Revision 21-3; Effective July 1, 2021

Make an eligibility determination by the 45th day from the file date.

Follow policy for medical programs when reopening an application denied for failing to furnish information or verification.

Follow policy for medical programs when reopening a renewal application denied for failing to furnish information or verification.

Related Policy  

Reuse of an Application Form After Denial, B-111
Denied for Failure to Provide Information/Verification, B-122.3.2

Revision 21-3; Effective July 1, 2021

Provide Form TF0001, Notice of Case Action, the same day eligibility is determined for an application but no later than 45 days from the file date.

 

Revision 07-0; Effective July 1, 2007

No appointment is required to process an application or renewal unless requested by the applicant/individual. If requested, provide the applicant/individual a telephone interview. If she fails to keep the appointment, do not deny the application/renewal but continue to process.

Revision 15-4; Effective October 1, 2015

Advisors must request documents that are readily available to the household to be sufficient verification. Each handbook section lists potential verification sources. C-900,Verification and Documentation, gives information on verification procedures.

In determining eligibility, advisors must consider any information the individual reports between the application date and the decision date. Include any information the individual reports during the application decision process.

 

Revision 21-3; Effective July 1, 2021

The Texas Integrated Eligibility Redesign System (TIERS) generates HTW renewal correspondence automatically, following the procedures for other medical programs. Determine if a woman is eligible to continue to receive HTW benefits using the same eligibility requirements for an application.

If the woman states on her application that she has creditable health insurance that covers family planning services and that filing a claim will not cause her physical, emotional or other harm, deny the renewal using the third-party resource denial reason language.

Related Policy

Receipt of Application, A-121
Notice of Redetermination/Certification Expiration, B-121
Third-Party Resource, W-914

W—2061 How to Process a Renewal

Revision 21-3; Effective July 1, 2021

There is not an interview requirement for HTW renewals. Follow medical program administrative renewal policy to process HTW renewals.  

Related Policy

Medical Program Administrative Renewals, B-122.4

W—2062 Summary of Due Dates for Form H1020, Request for Information or Action

Revision 07-0; Effective July 1, 2007

Case Action	Due Date	Final Due Date
Application	10 days	30 days, or 10th day if 10 days end after 30th day
Untimely renewal	10 days	30 days, or 10th day if 10 days end after 30th day
Timely renewal	10 days	last workday of last benefit month, or 10th day if 10 days end after last benefit month
Incomplete review	10 days	10 days

Note: Staff have until the 45th day of the file date to determine eligibility.

Revision 21-3; Effective July 1, 2021

Use the medical program administrative renewal timeliness guidelines.

Related Policy

Medical Program Administrative Renewals, B-122.4

 

Revision 21-3; Effective July 1, 2021

If the applicant cannot furnish all required verification during the interview or with the application, allow the household at least 10 days to provide verification. The due date must be a workday. Determine what sources of verification are readily available to the household and request those first. If the applicant has an active or inactive EDG, check to see if any verification previously provided on another EDG can be used to determine eligibility for HTW.

HTW uses reasonable compatibility to verify household income.

Note: Do not use verification that is more than 60 days older than the HTW file date.

Use verification accepted for Temporary Assistance for Needy Families (TANF), Medical Programs or the Supplemental Nutrition Assistance Program (SNAP) for HTW. Exception: Verification of U.S. citizenship for applicants must be from a Medicaid acceptable source.

To ensure their confidentiality, women have an opportunity to provide a different mailing address and contact phone number on their application and renewal form. Since HTW provides family planning services, it is imperative to respect the privacy of HTW applicants and recipients.

Related Policy

Verification Requirements, A-1370
Confidentiality, W-2400

Revision 21-3; Effective July 1, 2021

Women enrolled in Healthy Texas Women (HTW) can report changes:

• via YourTexasBenefits.com;
• via Your Texas Benefits mobile app;
• by calling or visiting a local Texas Health and Human Services Commission (HHSC) benefits office;
• in writing, by mail or fax;
• by completing Form H1019, Report of Change, and mailing or faxing the form to a local HHSC benefits office; or
• by calling 2-1-1.

Note: When a change is reported by calling 2-1-1, verify that the person speaking has the authority to report a change.

A woman is continuously eligible for HTW for 12 months or through the month of her 45th birthday, whichever is earlier.

HTW recipients are required to report the following changes:

• a person's change of address;
• death;
• pregnancy;
• receipt of creditable health coverage; or
• moves out of Texas.

Process required changes, except for receipt of creditable health coverage, following medical programs change policy.

Note: Update the case information for all reported changes regardless of whether the recipient is required to report the change.

Exception: If the person failed to report required information at the time of the application that causes the person to be ineligible for HTW, deny the case.

Related Policy

Changes, B-600
Pregnant Women, W-912

 

W—2111 Changes Received by Phone

Revision 21-3; Effective July 1, 2021

When a person reports a change by phone for a case that includes an HTW Eligibility Determination Group (EDG), verify that the person reporting the change is one of the following before discussing any information regarding the HTW EDG:

• the HTW applicant or recipient;
• the woman’s authorized representative; or
• the parent or legal guardian of HTW minor recipients.

If the person has the authority to report a change for the HTW EDG, ask them which EDGs the change pertains to – all EDGs including HTW, all EDGs excluding HTW or only the HTW EDG, and take the appropriate action.

If the person does not have authority to report a change for the HTW EDG, do not discuss the HTW EDG information with this person; only discuss the information regarding the other EDGs.

If the change is a mailing address change for only the HTW EDG, enter the mailing or confidential address into the Issuance Address page for the HTW EDG. Do not enter the new mailing address in the Address page, as this will change the Case Level Address for all other EDGs.

Related Policy

Authorized Representative, A-170

 

W—2112 Changes Received via Mail

Revision 19-1; Effective January 1, 2019

When a person reports a change by mail and there is an HTW EDG in the case, staff must determine if the change pertains to all EDGs including HTW, all EDGs excluding HTW, or only the HTW EDG.

If the written change:

• does not specifically state that the mailing address change is for the HTW EDG, only take action on the appropriate EDGs, excluding the HTW EDG;
• specifically states the change is for only the HTW EDG, only make changes to the HTW EDG and no other EDGs; or
• specifically states the change is for all EDGs including the HTW, take action on all EDGs as stated by the HTW recipient.

Note: The written report of change must specifically state the name of the person reporting the change to process an HTW change. Compare the name provided to the HTW recipient, or parent or legal guardian for HTW minors. If this person is not the HTW recipient or parent or legal guardian, do not change the mailing or confidential address for the HTW EDG.

 

W—2113 Changes Received at a Local HHSC Benefits Office

Revision 17-2; Effective April 1, 2017

If an individual visits a local eligibility office, staff must determine the person is the HTW applicant/recipient or parent/legal guardian of an HTW minor.

If the individual is the HTW applicant/recipient or parent/legal guardian, ask the individual which EDGs the change pertains to – all EDGs including HTW, all EDGs excluding HTW or only HTW, and take the appropriate action.

If the individual is not the HTW applicant/recipient or parent/legal guardian, do not discuss the HTW EDG information with this person; only discuss the information regarding the other EDGs.

Revision 15-4; Effective October 1, 2015

If an individual reports a change or the advisor receives an agency-generated change during the 12-month continuous eligibility period and has:

• No associated EDG, document the change and handle at renewal, unless it is a change of address, the certified woman dies, a voluntary withdrawal, or the individual moves out of Texas.
• An associated EDG, document the change and handle at renewal unless it is a change of address, the certified woman dies, a voluntary withdrawal, or the individual moves out of Texas. Process the change for an associated EDG using current process.
• A change of address, mail the individual Form H0025, HHSC Application for Voter Registration, to register to vote based on the new address. If the individual contacts the local eligibility office or 2-1-1 to decline the opportunity to register to vote after receipt of Form H0025, mail Form H1350, Opportunity to Register to Vote, to the individual for a signature. File Form H1350 in the case record when the individual returns the form and retain the form for at least 22 months.

Related Policy

Registering to Vote, A-1521

Revision 17-2; Effective April 1, 2017

When an advisor processes a HTW application/renewal during a Temporary Assistance for Needy Families (TANF)/Medicaid/Supplemental Nutrition Assistance Program (SNAP) certification period and a household member's source of income currently budgeted on another active EDG has not changed, the advisor must determine whether the member is reporting a change in income. To do this, the advisor determines if the income verification the applicant provided with the HTW application/renewal is:

• a more recent payment than previously verified; and
• within the range of payments previously verified that are currently used in the budget for the associated active case(s), whether the individual provides only one or more than one payment.

If a change is reported during the HTW application/renewal, the advisor processing the HTW EDG must take action on the associated TANF/Medicaid/SNAP EDG. The file date is considered the report date for purposes of determining the effective date of the change. The date the advisor works the HTW EDG and becomes aware of the change is day zero for purposes of taking action on the change for the associated EDG. The individual must provide any requested verification by the due date on Form H1020, Request for Information or Action, to be considered timely verification.

For more information, see policy in B-623.1, Determining Whether New Income Information Is a Reported Change.

Revision 21-3; Effective July 1, 2021

Healthy Texas Women (HTW) follows the appeals policy for medical programs.

Related Policy

Fair Hearings, B-1000

 

 

Revision 15-4; Effective October 1, 2015

Advisors must follow the policy explained in C-817, Electronic Data Sources (ELDS), and C-820, Data Broker.

Revision 21-3; Effective July 1, 2021

If there is a current mailing address in the Texas Integrated Eligibility Redesign System (TIERS), determine if it is the same as the mailing or confidential address on the woman’s application.

If ...	then ...
the current mailing address is different from the address provided on the HTW application or no case information exists in TIERS	enter the mailing or confidential address provided on the HTW application in the Issuance Address LUW for the HTW EDG.
the current mailing address is the same as the address provided on the HTW application	no action is required.

If the physical address is different on the application than what is verified in TIERS, report the new address using current change processes for the other EDGs.

Related Policy

Changes, B-600
How to Report a Change, W-2110

Revision 21-3; Effective July 1, 2021

TIERS mails out the HTW renewal application in the 9th month of the 12-month certification period. TIERS uses the Form TF0001, Notice of Case Action, address hierarchy when mailing this correspondence.

Determine if the HTW recipient has provided a new mailing or confidential address for the HTW EDG on their HTW renewal application. Perform an inquiry in the Issuance Address page to determine if the mailing or confidential address has changed or was not entered.

Determine if the person has a different mailing address for the HTW renewal than their other EDGs.

If the mailing or confidential address:

• is different from their other EDGs, then enter the mailing or confidential address into the Issuance Address page for the HTW EDG;
• is different from the Issuance Address page, enter the new mailing or confidential address into the Issuance Address page for the HTW EDG;
• was never provided, enter the mailing or confidential address into the Issuance Address page; and
• is the same as the current mailing address for the other EDGs, no action is required.

If the physical address is different on the HTW renewal packet than what is verified in TIERS, report the new address using current change processes for the other EDGs.

Related Policy

Medical Program Administrative Renewals, B-122.4
Changes, B-600
How to Report a Change, W-2110

Revision 17-2; Effective April 1, 2017

Staff must determine if the telephone number provided by the HTW applicant is different than what was provided for the other EDGs.

If the telephone number is different, document the following in the case comments:

Use (insert telephone number) when contacting the individual regarding HTW EDG information.

Revision 21-3; Effective July 1, 2021

Determine if a new case is needed when a woman is tested for HTW eligibility.

If the applicant …	and …	then …
does not have an existing HTW EDG,	she or her spouse (or non-spouse with mutual children in the budget group) is the case name on an existing case,	associate her application with that case.
does not have an existing HTW EDG,	she is included in an EDG in someone else’s case such as her mother, father, non-spouse with no mutual children, etc.,	create a new case for her and associate the application with the new case.