Healthy Texas Women Information for Providers
New Materials for Healthy Texas Women Now Available
English and Spanish applications and outreach materials for Healthy Texas Women are available for distribution. To order these materials, fill out the online order form.
The program offers women’s health and family planning services to low-income women such as woman’s health exams, health screenings, and birth control.
For more detailed information about provider enrollment, claims filing and billing procedures, services, benefits, limitations, and prior authorization, see the Texas Medicaid Provider Procedures Manual.
Healthy Texas Women Contractor Resources:
FY17 Healthy Texas Women Policy & Procedure Manual
Common Questions for Providers and Other Stakeholders:
- Who can provide Healthy Texas Women services?
- Who is eligible for the program?
- How do women apply for the program?
- Who can we call for help?
Providers who meet certain criteria may qualify to provide services. These criteria include the following:
- Deliver the type of services available through the program.
- Have completed the Medicaid-enrollment process through the Texas Medicaid & Healthcare Partnership (TMHP).
- 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 HTW program rules located in the Texas Administrative Code (TAC) Title 1, Part 15, Chapter 382, Subchapter A, §§382.1 – 382.29.
- Visit the TMHP website for more information about the requirement and 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 (STI) services
- Treatment for the following chronic conditions:
- 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
Long-acting reversible contraception (LARC)
Long-acting reversible contraception (LARC) is a highly effective contraceptive option with high rates of patient satisfaction and method continuation. For more information on implementing the Texas Medicaid policy on providing LARC services, see the Texas LARC Toolkit.
How do I know if an applicant I have treated is enrolled in Healthy Texas Women and her claim will be paid?
To verify that a woman is enrolled in the program:
- Call the TMHP Contact Center at 1-800-925-9126.
- Check online in the Texas Medicaid Provider section of www.tmhp.com (Look for the “Go to TexMed Connect” button in the upper right corner of the screen).
- Check online at www.YourTexasBenefitsCard.com.
Note: Providers should verify 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 at no cost to the woman, though she might incur some cost for services or treatment Healthy Texas Women doesn’t cover.
Can providers charge co-payments to women covered by Healthy Texas Women?
Am I required to bill private health insurance first?
No. Prior insurance billing is not permitted 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 may jeopardize 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. This referral should occur when health issues are identified and necessary services related to those health issues are not covered under the program.
- HHSC prefers referrals to local indigent care services; however, 2-1-1 can assist with locating other primary care providers, if needed.
Breast and cervical cancer screening
- The Breast and Cervical Cancer Services (BCCS) program offers breast and cervical cancer screening and diagnostic services, and cervical dysplasia treatment throughout Texas at no or low-cost to eligible women.
Patients diagnosed with breast and/or cervical cancer
- Medicaid for Breast and Cervical Cancer (MBCC) offers access to cancer treatment through full Medicaid benefits for qualified women diagnosed with breast or cervical cancer.
The program is for women who:
- Are ages 18 to 44. Women are considered 18 years of age on the day of her 18th birthday and 44 years of age through the last day of the month of her 45th birthday.
- Are ages 15 to 17 and has a parent or legal guardian apply, renew, and report changes to her case on her behalf. Women are considered 15 years of age the first day of the month of her 15th birthday and 17 years of age 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 (FPL).
Monthly Income Limits for Healthy Texas Women
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Do all women have to prove income eligibility?
No. If a woman or one of her family members receives Temporary Assistance for Needy Families (TANF), SNAP food benefits, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), 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 referred to as “adjunctive eligibility.” Women can provide 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 (EBT) Shopping Card
A woman may also prove income eligibility if someone in her household (such as a child) has Medicaid. Providers can verify Medicaid eligibility using TexMed Connect on the TMHP website.
Are women who have been sterilized eligible?
Can pregnant women enroll?
No. Providers may refer pregnant women to HHSC 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 disenrolled from Healthy Texas Women.
Can women who have Medicaid for Pregnant Women (MPW) 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 into Healthy Texas Women. The woman will receive a notification letter in the mail regarding her auto-enrollment into HTW, and will have the option to opt out of receiving HTW. To be auto-enrolled, a female must:
- Be 18-44 years of age
- Not be receiving active third-party resources at the time of auto-enrollment
- Be ineligible for any other Medicaid or CHIP programs
If a woman is not eligible to be auto-enrolled into HTW, she may 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 Parts A or B are not eligible for Healthy Texas Women. A woman who has private health insurance is not eligible for the program unless:
- Her private coverage 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 required?
If a woman is between the ages of 15-17, inclusive, she must have a parent or legal guardian apply, renew, and report changes on her behalf to receive HTW services.
All HTW 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.
For more information on health and health-related legal issues that apply to minors, please see the DSHS resource - Adolescent Health: A Guide for Providers.
Women can apply by faxing a completed application and required documents to 1-866-993-9971 (toll-free).
Applications are available:
- Here: [English Application Form] [Spanish Application Form]
- At HHSC family planning clinics, local HHSC 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 one-page application, use the online order form.
- Providers and community-based organizations can help women fill out and fax their applications to HHSC for processing.
- If a woman fills out an application at the clinic or doctor’s office and HHSC gets it that same month, the services she receives that day will be covered if she meets program eligibility requirements.
- HHSC has developed a screening tool (DOC) [Spanish screening tool (DOC) ] and an income worksheet (DOC) to help providers screen for eligibility and identify acceptable forms of proof of citizenship, identity, and income. Please do not fax the screening tool with the application.
What name should the woman use on her application?
The name printed on her current Social Security card.
What information and documents are required to be submitted with an application?
Documentation is required 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 (SSI), or other contributions)
- Proof of educational assistance
If an applicant 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. HHSC eligibility staff may contact her for more information.
Applicants may provide a letter to confirm income or expenses. For example, a letter from an employer or from someone providing 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 applicant. Letters must indicate 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 state that the information is being requested for determining eligibility for Healthy Texas Women.
Citizenship and identity:
- 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.
Applicants that don’t have any of the documents listed above must provide two documents—one from each side of the list below:
To Verify Citizenship
To Verify Identity
U.S. birth certificate
Current driver’s license with photo
U.S. citizen ID card
DPS ID with photo (Texas ID card)
Hospital record of birth
Work or school ID card with photo.
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 United States
Documentation is not required for:
- Residency status
- Household information
- Social Security number
- Household expenses
Note: Documentation of household expenses is not required, but HHSC 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, statement from the custodial parent regarding direct payments or third-party payments paid on their behalf).
How long does it take for applications to be processed?
It usually takes 45 days to process applications. Times may vary depending on the number of applications received.
How does HHSC protect a woman’s confidentiality?
- The application allows women to list a separate mailing address where all correspondence can be sent. Note: The applicant must list her home street address on the application, but she can list a post office box as a mailing address.
- If the woman has private health insurance coverage, providers do not bill the private insurance first, as this could jeopardize her confidentiality.
How often do women need to reapply for the program?
Women have continuous coverage for 12 months. HHSC sends a renewal packet two months before coverage expires. Women must mail back the renewal forms by the deadline indicated 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: HHSC, P.O. Box 149021, Austin, TX 78714-9021.
- Clients can call 1-866-993-9972 if they lose the renewal packet and need a replacement.
- HHSC does not accept renewals by fax.
What if a client needs to report a change to her case?
- Applicants 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 go to Social Security Online 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 HHSC receives the application. For example, if HHSC receives a woman’s application on January 20 and she is determined eligible for the program, her coverage begins January 1. Call 1-866-993-9972 if you have questions about the enrollment effective date, or think there may be an error.
Does enrollment in Healthy Texas Women affect other HHSC 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 food benefits. However, information reported when applying for Healthy Texas Women may affect the household’s other benefits if it’s different than what was previously reported for other programs.
- Verify client eligibility: 1-866-993-9972
- Provider inquiries: 1-800-925-9126 (TMHP contact center, pick option 5)
- Client questions or to find a provider: 1-800-335-8957 (pick a language, then pick option 5)