Revision 17-2; Effective April 1, 2017

 

 

 

W—110 Healthy Texas Women (HTW)

Revision 17-2; Effective April 1, 2017

 

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 individuals ages 15-17, a parent or legal guardian's signature is required.

 

W—111 Type of Assistance (TA) 41 – Health Care – HTW

Revision 17-2; Effective April 1, 2017

 

To qualify for HTW, applicants must:

  • be female, ages 15 through 44 (for applicants ages 15-17, a parent or legal guardian must apply on their behalf);
  • have countable income of less than or equal to the 200% federal poverty income limit;
  • be a U.S. citizen or legally admitted alien who meets all eligibility requirements for Medicaid;
  • be a Texas resident;
  • not be pregnant;
  • not have creditable health insurance; and
  • not currently receive Medicaid, Medicare (Part A or B) or Children's Health Insurance Program benefits.

HTW applications and renewals are processed and disposed by specialized Texas Works advisors located at the San Antonio customer care center.

Notes:

  • A legal guardian is a person who has been appointed by a judge to take care of a child younger than age 18.
  • Applications received for individual ages 15-17 without a parent or legal guardian signature must be denied using the denial reason, “Denied 15-17 without parent or legal guardian’s signature."
  • Married minors ages 15-17 are not eligible for HTW. The HTW application must be denied using the denial reason, “Denied 15-17 married minors”.

Related Policy
General Policy, W-510

 

W—112 Application Procedures

Revision 17-2; Effective April 1, 2017

 

Applicants must complete Form H1867/H1867-S, Healthy Texas Women Application Form, or Form H1867-R/H1867-RS, Healthy Texas Women Renewal.

Note: No other application can be used to apply for HTW.

 

W—113 Requesting an Application

Revision 17-2; Effective April 1, 2017

 

Form H1867/H1867-S, Healthy Texas Women Application, may be downloaded from the HHSC Texas Works Handbook and is also available:

  • online at www.YourTexasBenefits.com;
  • online at www.healthytexaswomen.org;
  • by calling 2-1-1;
  • by calling toll-free 1-866-993-9972;
  • at the local Texas Health and Human Services Commission (HHSC) benefits office;
  • from participating family planning or participating providers; and
  • at participating Supplemental Nutritional Assistance for Women, Infants and Children (WIC) offices and community-based organizations.

On the same day the request is received, provide the applicant an application packet that includes the following:

  • Form H1867 or Form H1867-S
  • Form H0025, HHSC Application for Voter Registration
  • A postage-paid envelope addressed to:

    Texas Health and Human Services Commission
    P.O. Box 149021
    Austin, TX 78714-9021

Note: Form H0050, Parent Profile Questionnaire, is not required.

If an applicant requests help completing Form H1867/H1867-S or Form H0025, a volunteer or staff member must give help and initial the parts completed or sign Form H1867/H1867-S to show the applicant received help.

Related Policy
Registering to Vote, A-1521

 

W—120 Office Procedures

Revision 17-2; Effective April 1, 2017
 

 

W—121 Filing an Application

Revision 17-2; Effective April 1, 2017

 

Applicants submit Form H1867/H1867-S, Healthy Texas Women Application:

Texas Health and Human Services Commission
P.O. Box 149021
Austin, TX 78714-9021

  • by fax toll-free to 1-866-993-9971 (HTW designated fax line);
  • at a local HHSC benefits office; or
  • at participating family planning provider offices.

If a local HHSC benefits office receives any Form H1867/H1867-S; Form H1867-R/H1867-RS, Healthy Texas Women Application; Form H1867-R/H1867-RS, Healthy Texas Women Renewal; or Form H1831, Adjunctive Eligibility Letter, staff must date stamp and fax it to the designated fax line no later than the next business day. When an HHSC office receives Form H1867-R/H1867-RS or Form H1831, staff must date stamp and fax it to the Document Processing Center using current procedures.

Accept all submitted forms if they have the applicant's name, address and signature. HHSC does not need an original signature for faxed applications.

 

W—122 Telephonic Signatures

Revision 17-2; Effective April 1, 2017

 

The HTW program allows individuals who apply via 2-1-1 to submit applications using a telephonic signature. HHSC will send the following correspondence based on the actions taken by the individual.

Action Correspondence
Individual telephonically signs the application. Form H1031, Telephonic Signatures Cover Letter, notifies the HTW applicant or parent/legal guardian of a minor HTW applicant they submitted a telephonically signed application or renewal.
Individual declines to telephonically sign the application. Form M5021A, Signature Form, notifies the individual a signature is needed to complete the application process, and Form H1867, Healthy Texas Women Application, populated with the information provided over the phone.

 

W—123 File Date

Revision 17-2; Effective April 1, 2017

 

The file date is the day any HHSC benefits office accepts Form H1867/H1867-S, Healthy Texas Women Application; Form H1867-R/H1867-RS, Healthy Texas Women Renewal; or Form H1831, Adjunctive Eligibility Letter, containing the applicant's name, address and appropriate signature. This is day zero in the application process.

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).

Note: Because family planning providers may have extended weekend hours and will fax a majority of the applications, the file date is the day it is faxed to the HTW fax line.

Related Policy
General Policy, W-910

 

W—124 Faxed Applications

Revision 17-2; Effective April 1, 2017

 

When an individual or provider states that an application was faxed to the HTW designated fax line, but it is determined that the fax was not received, verbally inform the individual or provider to fax the confirmation page and original application to determine the correct file date.

If HTW staff 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—130 Interviews

Revision 07-0; Effective July 1, 2007
 

 

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.