Provider Alert! 12-Month Postpartum Eligibility Extension for Medicaid and CHIP Pregnant Members
Date: February 13, 2024
Attention: Primary Care, Family Medicine, and Obstetric Care Providers
Effective: March 1, 2024
Call to action: Texas Children’s Health Plan (TCHP) would like to share great news with providers about postpartum Medicaid coverage. The Texas Health and Human Services Commission (HHSC) extended postpartum Medicaid coverage from two to 12 months for eligible women, effective March 1, 2024, as part of House Bill 12 (H.B. 12), 88th Legislature, Regular Session, 2023.
Also effective March 1, 2024, HHSC will be providing 12 months of postpartum Children’s Health Insurance Program (CHIP) coverage. The 12 months of postpartum coverage begins the month after a pregnancy has ended.
Medicaid and CHIP members do not need to reapply to have their coverage extended.
Eligibility
Effective March 1, 2024, eligible recipients include:
- Medicaid or CHIP members who are pregnant or become pregnant.
- Exclusion to eligibility: CHIP Perinatal (CHIP-P) members are not eligible for 12 months of postpartum coverage. They will continue to receive CHIP-P coverage through the end of the month when their pregnancy ends and two postpartum care visits.
- Medicaid or CHIP members who were enrolled in Medicaid or CHIP while pregnant, are no longer pregnant, but are still within their 12-month postpartum period and remain Texas residents.
- Women who transitioned from Medicaid or CHIP to Healthy Texas Women (HTW) after their pregnancy ended and who are within their 12-month postpartum period will be reinstated to full coverage Medicaid or CHIP.
- Women who received services while pregnant in Texas that would have been covered by Medicaid, but who apply for Medicaid after their pregnancy ends. Medicaid applicants with unpaid medical bills can apply for coverage for up to three months prior to their application month. This does not apply to CHIP applicants.
Coverage Details
- Pregnant Medicaid and CHIP members will continue to receive postpartum coverage in their existing type program (TP)/type of assistance (TA) and risk group.
- HHSC is not creating new TPs/TAs or risk groups to implement 12 month postpartum coverage. Therefore, reinstated members will return to their previous TP/TA and risk group for the remainder of their 12-month postpartum coverage period.
- For example: Most members will remain in Pregnant Women’s Medicaid under TP 40 and CHIP under TA 84.
- CHIP members will not need to pay another enrollment fee to get 12-month postpartum coverage.
- The full array of Medicaid or CHIP covered services remain available in the 12-month postpartum period, including, but not limited to:
- Regular checkups with the doctor.
- Prescription drugs and vaccines.
- Hospital care and services.
- X-rays and lab tests.
- Vision and hearing care.
- Access to medical specialists and mental health care.
- Treatment of special health needs and pre-existing conditions.
Exceptions to Eligibility
Eligible Medicaid and CHIP members will receive extended coverage through their postpartum period regardless of any change in circumstances, unless they:
- Voluntarily withdraw;
- Move out of state;
- Die; or
- Are determined to be ineligible because of fraud, abuse, or perjury.
How will individuals who are eligible for the 12-month postpartum coverage period be notified?
A notice will be sent in the mail or through a patient’s Your Texas Benefits account (if they have chosen to receive notices electronically). Medicaid and CHIP members should ensure their mailing address and contact information are up to date.
Medicaid or CHIP Member ID cards
If a member is currently receiving Medicaid or CHIP services, the member will not receive a new Medicaid or CHIP MCO Member ID card for the 12-month postpartum coverage period.
If a member previously received Medicaid or CHIP services that are being reinstated or is newly applying for coverage, they will receive a new Medicaid or CHIP Member ID card.
Resources
Next step for providers: Providers are encouraged to share this important update with their staff and patients. Please encourage your eligible patients to ensure their Your Texas Benefits account information is up-to-date.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org
For access to all Provider Alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
