Health Care Coverage: Women

Medicaid for Low-income Pregnant Women

A pregnant woman may receive Medicaid benefits during pregnancy and up to two months after birth if she meets certain income requirements.

[Medicaid Application]

Children’s Health Insurance Program (CHIP) Perinatal Coverage

CHIP perinatal coverage provides prenatal care for pregnant women who meet certain income requirements, who do not qualify for Medicaid and who do not have any other health coverage.

Benefits include:

• Up to 20 prenatal visits.
• Prescriptions and prenatal vitamins.
• Labor with delivery of the child. (Coverage will depend on family income. Some women may be asked to apply for Emergency Medicaid to cover their hospital stay.)
• Two checkups for the mother after the birth of the baby.
• Regular check-ups, immunizations, prescriptions and other CHIP health care benefits for the baby after leaving the hospital.

[CHIP Perinatal Application]

CHIP Perinatal Statewide Webinars on Changes to the Program Effective September 1, 2010

The Health and Human Services Commission held two statewide webinars (August 25th and a repeat session August 30th) on changes to the CHIP Perinatal program effective September 1, 2010.  These changes impact eligibility and billing, primarily for newborns at or below 185% of the federal poverty level.   HHSC also provided a basic overview of the program and benefits.  The powerpoint, as well as the recorded audio and visual from the August 30th webinar are located below.  Of note, there were minor changes to the August 30th presentation, that differed from presentation on the 25th.  These changes include:  1) the form H3038 can be returned up to 90 days after receiving a birth outcome letter (mailed post delivery), rather than 30 days post delivery, as stated in the August 25th presentation.  It is recommended that the birthing hospital assist the woman in faxing this form to HHSC before discharge, to help minimize the timeframe needed to establish coverage for the mother and infant.  Also, 2) the contact information for HHSC’s Data Integrity unit (when a Medicaid ID number cannot be located, for example) has changed. 

August 30th Powerpoint | August 30th webinar | Form H3038

To learn more about CHIP perinatal coverage, call 1-877-543-7669 (1-877-KIDS-NOW).

Women’s Health Program

The Women’s Health Program provides some Medicaid services to women ages 18 to 44 who have low incomes. This program provides one year of coverage and can be renewed each year the woman qualifies.

Benefits include:

• Comprehensive health history.
• Gynecological exam and Pap smear.
• Screening for diabetes, sexually transmitted diseases, high blood pressure, and breast and cervical cancers.
• Assessment of health risk factors, such as smoking, obesity and exercise.
• Counseling and education on birth control methods, including the health benefits of abstinence.
• Birth control, except emergency contraception.

[Women’s Health Program Application]

Medicaid for Breast and Cervical Cancer

Women who have been diagnosed with breast or cervical cancer may be able to get health care coverage for cancer treatment through full Medicaid benefits.

If a woman is found to have breast or cervical cancer, a Breast and Cervical Cancer Services clinic will review her diagnosis to help decide if she can receive Medicaid. The clinic will help her fill out and submit an application to the Health and Human Services Commission. She cannot apply at an HHSC benefits office.

To receive Medicaid for Breast and Cervical Cancer, a woman must:

• Need treatment for a qualifying breast or cervical cancer diagnosis, including a precancerous condition, metastasis or recurrence of breast or cervical cancer.  
• Meet income requirements.
• Not have insurance coverage for treatment of the cancer.
• Be under age 65.

A woman eligible for Medicaid for Breast and Cervical Cancer receives full Medicaid benefits beginning the day after she received a qualifying diagnosis. She can continue to receive Medicaid benefits as long as she meets the eligibility criteria and provides proof from her doctor that she is receiving cancer treatment.

Breast and Cervical Cancer Service clinics work with the Department of State Health Services to provide low-income women with free or low-cost breast and cervical cancer screenings and diagnostic services. To locate a Breast and Cervical Cancer Services clinic near you, visit the Department of State Health Services’ website.

MAXIMUM MONTHLY INCOME LIMITS
FOR HEALTH CARE BENEFITS PROGRAMS FOR WOMEN