Healthy Texas Women (HTW) has changed how it determines eligibility for low-income women who use the program, which could put a greater burden on physicians and other health care professionals who help patients get and stay with these services.
The Texas Medical Association is concerned the change “could result in fewer women being enrolled [in Healthy Texas Women],” said Helen Kent Davis, TMA associate vice president of governmental affairs.
Healthy Texas Women, which is run by the Texas Health and Human Services Commission (HHSC), offers free women's health and family planning services to eligible, low-income women during and after pregnancy.
Before the recent changes, which took effect March 20, new mothers who had been in Pregnant Women’s Medicaid were automatically enrolled in HTW. In addition, women who were eligible for programs such as Women Infants and Children (WIC) or the Supplemental Nutrition Assistance Program would automatically be eligible for Healthy Texas Women under “adjunctive eligibility.”
However, new rules stemming from the 1115 Healthy Texas Women demonstration waiver – which the Centers for Medicare & Medicaid Services (CMS) approved in January 2020 – changed the program’s eligibility requirements. Because HTW receives federal funds through the waiver, the program must now follow Medicaid rules, which determine eligibility based on modified adjusted gross income.
The Texas Women’s Healthcare Coalition (TWHC), which includes TMA, says the new rules have required HHSC to make three crucial changes:
- New mothers in Pregnant Women’s Medicaid will no longer be automatically enrolled;
- “Adjunctive eligibility” with other programs such as WIC is no longer possible; and
- Healthy Texas Women will now require a longer and more complicated application form.
Physician offices should make sure staff are aware of the changes and become familiar with the new Healthy Texas Women registration form, said Erika Ramirez, TWHC policy and advocacy director.
“If [physicians] don’t know what to tell [patients] to show up with [when they enroll] to streamline that process, it’s going to take them longer to work out the kinks,” she said.
HHSC has notified physicians who serve HTW patients about the changes and posted information about them online. The agency told Texas Medicine in an email that it plans to update its website with information about the waiver but that “no trainings are planned for fee-for-service providers.”
Still, Ms. Ramirez said TWHC is “hearing from long-time women’s health care [physicians and health care professionals that] they have concerns on their ability to enroll women into [Healthy Texas Women] as seamlessly with the new changes. While it is understandable that these changes are required to comply with federal rules, namely modified adjusted gross income rules, providers are still requesting some further training or Q&A session to ensure they are complying and enrolling women properly to avoid any unpaid claims.”
Physicians with complaints or questions about the 1115 demonstration waiver can contact TWHC via email. The organization is compiling data about the impact of the new HTW rules and will present that information to HHSC.