New Medicaid Women's Benefits

Starting April 1, the state Medicaid Women's Health Program is offering new benefits. They are:

  • An additional office visit,
  • Additional radiology exams,
  • Services related to an implantable contraceptive device (Implanon),
  • A thyroid-stimulating hormone test,
  • Herpes tests, and 
  • Services related to a nonsurgical sterilization method (Essure).

However, although the new benefits take effect April 1, claims for those services will be denied until July 1, when the Texas Medicaid and Healthcare Partnership (TMHP) will automatically reprocess them. Additional information on billing requirements for diagnosis codes for the new benefits [ PDF ] is posted on the TMHP Web site.  

The Texas Health and Human Services Commission began the program to improve preventive health among low-income women. To qualify, a woman must be aged 18 to 44, have a family income at or below 185 percent of the federal poverty level ($2,247 per month for a two-person family; $3,400 per month for a four-person family), and be a U.S. citizen, a legal permanent resident (a foreign national who has been granted the right to reside permanently in the United States) , or other qualified immigrant such as an asylee or refugee. 

In addition to the new benefits, the program covers:

  • Annual family planning exam and Pap test,
  • Contraception,
  • Follow-up visit, related to the contraceptive method (all office visits can include counseling on specific methods and use of contraception, including natural family planning and excluding emergency contraception),
  • Pregnancy test,
  • Routine urinalysis and urine culture,
  • Complete blood count,
  • Blood glucose screening, as well as lipid panel, and 
  • Tubal ligations, including facility fees.

 

Action , April 1, 2009


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