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 (TAC) 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.

What services are covered in Healthy Texas Women?

  • Contraceptive services
  • Clinical breast exams
  • Pregnancy testing and counseling
  • Preconception health screenings (e.g., screening for obesity, hypertension, diabetes, cholesterol, smoking and mental health)
  • Sexually transmitted infection services
  • Sterilizations
  • Treatment for the following chronic conditions:
    • Hypertension
    • Diabetes
    • High cholesterol
  • Treatment of postpartum depression
  • Breast and cervical cancer screening and diagnostic services
    • Radiological procedures, including mammograms
    • Screening and diagnosis of breast cancer
    • Diagnosis and treatment of cervical dysplasia
  • Immunizations

Note: Medications will be reimbursed through the Medicaid Vendor Drug Program.
To learn more, visit the Online Fee Lookup for Texas Medicaid.

Long-Acting Reversible Contraception

Long-acting reversible contraception is a highly effective contraceptive option with high rates of patient satisfaction and method continuation. To learn more about implementing the Texas Medicaid policy on providing LARC services, see the Texas LARC Toolkit (PDF).

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:

  • Call the Texas Medicaid & Healthcare Partnership Contact Center at 800-925-9126.
  • Check in the Texas Medicaid Provider section of the Texas Medicaid & Healthcare Partnership website. (Look for the “Go to TexMedConnect” button in the upper right corner of the screen).
  • Check online at YourTexasBenefitsCard.com.

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.

How does a client get contraception through Healthy Texas Women?

Contraception, except emergency contraception, is provided through a family planning clinic or by prescription at a pharmacy that participates in the Medicaid Vendor Drug Program.

Do clients have any cost-sharing responsibility?

No. Benefits are available for free to the woman, though she might be asked to pay for some services or treatment Healthy Texas Women doesn't cover.

Can providers charge co-payments to women covered by Healthy Texas Women?

No.

Do I have to bill private health insurance first?

No. Prior insurance billing is not allowed for women getting services through Healthy Texas Women. Family planning client information is confidential under federal and state regulations. Asking for information from third-party insurance resources might risk confidentiality.

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.

Patients diagnosed with breast and/or cervical cancer

Medicaid for Breast and Cervical Cancer offers access to cancer treatment through full Medicaid benefits for qualified women diagnosed with breast or cervical cancer.

Who is eligible for Healthy Texas Women?

The program is for women who:

  • Are ages 18–44. A woman is considered 18 on the day of her 18th birthday and 44 through the last day of the month of her 45th birthday.
  • Are ages 15–17 and have a parent or legal guardian apply, renew and report changes to her case on her behalf. Women are considered 15 the first day of the month of her 15th birthday and 17 through the day before her 18th birthday.
  • Are U.S. citizens or qualified immigrants.
  • Live in Texas.
  • Do not currently get full Medicaid benefits, CHIP or Medicare Part A or B.
  • Are not pregnant.
  • Do not have private health insurance that covers family planning services (unless filing a claim on the health insurance would cause physical, emotional or other harm from a spouse, parent or other person).
  • Have a countable household income at or below 200 percent of the federal poverty level.

Monthly Income Limits for Healthy Texas Women

Household Size Monthly Income

1

$2,024

2

$2,744

3

$3,464

4

$4,184

5

$4,904

6

$5,624

7

$6,344

Do all women have to prove income eligibility?

No. If a woman or one of her family members receives Temporary Assistance for Needy Families, SNAP food benefits, the Women, Infants and Children Program or Children's Medicaid, she has already proven income eligibility for Healthy Texas Women. She does not have to fill out the income section of the Healthy Texas Women application. This is sometimes called “adjunctive eligibility.” Women can give proof of participation in one of these programs as proof of income eligibility.
Any of the following documents serve as proof of participation:

  • Active WIC Verification of Certification
  • Active WIC voucher
  • Active WIC/ Electronic Benefit Transfer shopping card

A woman can also prove income eligibility if someone in her household, such as a child, has Medicaid. Providers can check Medicaid eligibility using TexMedConnect on the Texas Medicaid & Healthcare Partnership website. Look for the “Go to TexMedConnect” button on the upper right corner of the screen.

Are women who have been sterilized eligible?

Yes.

Can pregnant women enroll?

No. Providers can refer pregnant women to Texas Health and Human Services to determine their eligibility for Medicaid for Pregnant Women or CHIP Perinatal coverage. If a woman becomes pregnant while she is covered by Healthy Texas Women, she may apply for Medicaid for Pregnant Women or CHIP Perinatal. Once enrolled in one of those two programs, she will be automatically removed from Healthy Texas Women.

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 18–44 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.

Can women with health insurance coverage enroll?

Women enrolled in Medicaid, CHIP or Medicare Part A or B are not able to get Healthy Texas Women. A woman who has private health insurance is not eligible for the program unless:

  • her private insurance does not cover family planning services (physician office visits and procedures, as well as contraceptive drug and devices); or
  • filing a claim on her health insurance would cause physical, emotional or other harm from her spouse, parents or other person.

For women ages 15–17, when is parental consent needed?

If a woman is age 15-17, she must have a parent or legal guardian apply, renew and report changes on her behalf to receive Healthy Texas Women services.
All program services must be provided with consent from the minor's parent, managing conservator or guardian as authorized by Texas Family Code, Chapter 32, or by federal law or regulations.
To learn more about health and health-related legal issues that apply to minors, see the DSHS resource, Adolescent Health: A Guide for Providers (PDF).

How do women apply for the program?

Online Application

Women can apply by filling out an online application (works on desktop computers only):

Mailed Application

They can mail or fax a completed application and required documents to:
Healthy Texas Women
P.O. Box 149021
Austin, TX 78714-9021
Fax: 866-993-9971 (toll free)

Download applications at:

In-person Application

Women can also apply at Texas Health and Human Services family planning clinics, local Texas HHS benefit offices, participating WIC offices and participating community-based organizations. Call 2-1-1 to find offices near you.
To order large quantities of the application, use the online order form.
Notes:

  • Providers and community-based organizations can help women fill out and fax their applications to Texas Health and Human Services.
  • If a woman fills out an application at the clinic or doctor's office and Texas Health and Human Services gets it that same month, the services she receives that day will be covered if she meets program eligibility requirements.
  • Texas Health and Human Services has developed an English screening tool, a Spanish screening tool and an income worksheet to help providers screen for eligibility and identify acceptable forms of proof of citizenship, identity and income. These tools are found in the Healthy Texas Women Policy and Procedure Manual (PDF). Do not fax the screening tool with the application.

What name should the woman use on her application?

She should use the name printed on her current Social Security card.

What information and documents need to be submitted with an application?

Documentation is needed for:

  • Household income
  • Paycheck stub issued in the last 60 days
  • Letter from employer
  • Proof of self-employment income (i.e., recent tax statements, unemployment benefits, child support, Supplemental Security Income or other contributions)
  • Proof of educational assistance

If a woman has no countable household income, she should write that on the income section of the application. She does not need to show proof of income. Texas Health and Human Services eligibility staff may contact her for more information.
A woman can give a letter to confirm income or expenses. For example, a letter from an employer or from someone giving financial support is acceptable for verifying income. A letter from a provider confirming child care payments is an example of a document that can verify expenses. A letter must be from the person providing income or being paid expenses, not the woman applying. Letters must show the amount and frequency of the payment or expense, as well as the author's phone number and address. All letters must be signed and dated by the author.

Note: The letter does not need to say that the information is being requested for determining eligibility for Healthy Texas Women.
Women must also prove citizenship and identity using one of the following documents:

  • U.S. passport
  • Certificate of naturalization
  • Certificate of U.S. citizenship

Women who are covered by Healthy Texas Women do not have to resubmit proof of citizenship or identification if they renew or reapply in the future.
Women who don't have any of the documents listed above must give two documents — one from each of the lists below:

To verify citizenship:

  • U.S. birth certificate
  • U.S. citizen ID card
  • Hospital record of birth
  • Northern Mariana ID card
  • American Indian card with classification code KIC
  • Religious record of birth with date and place of birth, such as baptism record
  • Affidavit from two adults establishing the date and place of birth in the U.S.

To verify identity:

  • Current driver's license with photo
  • Texas Department of Public Safety ID with photo (Texas ID card)
  • Work or school ID card with photo.

Documentation is not required for:

  • Address
  • Residency status
  • Household information
  • 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 (statement or current bill from provider, current receipts, income tax return, etc.).
  • Expenses for child support paid by the household (Attorney General collection and distribution records, county clerk records, cancelled checks, wage withholding statements, withholding statements from unemployment compensation, or statement from the custodial parent regarding direct payments or third-party payments paid on their behalf).

How long does it take for Texas Health and Human Services to process applications?

It usually takes 45 days to process applications. Times may vary depending on the number of applications received.

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.

How often do women need to reapply for the program?

  • Women have continuous coverage for 12 months. Texas Health and Human Services sends a renewal packet two months before coverage ends. Women must mail back the renewal forms by the deadline shown in the renewal letter. Clients that miss the deadline will need to reapply for coverage.
  • Renewal packets include a postage-paid return envelope. If the envelope is lost, clients can mail their renewals to: Texas Health and Human Services, P.O. Box 149021, Austin, TX 78714-9021.
  • Clients can call 866-993-9972 if they lose the renewal packet and need a replacement.
  • Texas Health and Human Services does not accept renewals by fax.

What if a client needs to report a change to her case?

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 (due to marriage, divorce or some other reason) 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.

When does coverage start?

The enrollment effective date is the first day of the month that Texas Health and Human Services receives the application. For example, if we receive a woman's application on Jan. 20 and she is determined eligible for the program, her coverage begins Jan. 1. Call 866-993-9972 if you have questions about the enrollment effective date or think there might be an error.

Does enrollment in Healthy Texas Women affect other Texas Health and Human Services benefits?

A woman's enrollment in Healthy Texas Women does not make a household ineligible for other program benefits such as Medicaid, TANF or SNAP. But the information reported when applying for Healthy Texas Women might affect the household's other benefits if it's different than what was previously reported for other programs.

Who can we call for help?

  • Check client eligibility: 866-993-9972
  • Provider questions: 800-925-9126 (TMHP contact center, pick option 5)
  • Client questions or to find a provider: 800-335-8957 (pick a language, then pick option 5)