Texas Medicaid
Medical and Dental
Information Series
Module 6
2/22/2013
1
Module 6
Medicaid Curriculum Overview
Module 1: General Structure of the Texas Medicaid System
Module 2: Understanding Medicaid Clients and Health Literacy
Module 3: Texas Health Steps
Module 4: Navigating Insurance and Managed Care
Module 5: Interfacing with Medicaid as a Provider
Module 6: Special Medicaid Programs
Module 7: Special Medical Issues
Module 8: Special Dental Issues
2
Module 6
Special Medicaid Programs
For Families, Children
and Women
3
Module 6
Module 6: Objectives
After completing this module, you should be able to:
Review the structure and purpose of Texas Medicaid
Explain the purpose, goals, and eligible populations of
special Medicaid programs for families
Explain the purpose, goals, and eligible populations of
special Medicaid programs for children
Explain the purpose, goals, and eligible populations of
special Medicaid programs for women
Describe the anticipated impact of the Affordable Care
Act (health care reform) on women’s health care
Find Medicaid resources to support patients and
providers
4
Module 6
Caring for Families
Beyond Texas Health Steps
Medicaid serves primarily low-income families, nondisabled children, related caretakers of dependent
children, pregnant women, the elderly, and people
with disabilities.
Texas chooses to extend Medicaid eligibility to
pregnant women and infants up to 185% of the
federal poverty level (FPL) as well as to the “medically
needy,” including children and women whose income
exceeds Medicaid eligibility limits, but who do not
have the resources required to meet their medical
expenses.
This module addresses special Medicaid programs
for:
Families
Children
Women
5
Module 6
True or False?
Test Your Knowledge about Special Medicaid Programs for
Families, Children & Women
Case Management assists families with resources
such as educational, financial, or housing needs.
ECI provides services to families of medically fragile
children who keep their children at home instead of
placing them in nursing facilities.
The Children with Special Health Care Needs
program helps people of any age with cystic fibrosis.
One goal of a Caries Risk Assessment is to Identify
the oral health status of the child and other family
members.
The Nurse-Family Partnership provides post-natal
home visits until the child is 1 year old.
6
Module 6
What is Medicaid?
Medicaid is a federal health care program that is jointly funded by federal
and state money. Medicaid is jointly funded by the state and federal
governments:
About one-third funded by the State of Texas
About two-thirds funded by the Federal Government
In December 2011, about 1 in 7 Texans relied on Medicaid for health
insurance or long-term services (3.7 million of the 25.9 million).
Medicaid was created through Title XIX of the 1965 Social Security Act, and
established in Texas in 1967.
In Texas, Medicaid is administered by the Texas Health and Human
Services Commission (HHSC).
Medicaid is an entitlement program, which means:
The number of eligible people who can enroll cannot be limited.
Any services covered under the program must be paid.
7
Module 6
REVIEW: Medicaid Functions
Department of State
Health Services (DSHS)
Governor
of Texas
Health &
Human
Services
(HHSC)
Executive
Commissioner
Single State
Agency
(HHSC)
Department of Assistive
& Rehabilitative
Services (DARS)
Department of Aging &
Disability Services
(DADS)
8
Module 6
REVIEW:
Responsibilities
TMHP acts as the state's Medicaid fiscal agent and is responsible
for paying acute care claims, while the state of Texas is responsible
for covering the cost of claims.
Acts as the fee-for-service Medicaid claims administrator
Manages policy development
Collects HMO encounter data
Enrolls providers
Supplies provider relations representatives to enrolled providers
9
Module 6
REVIEW:
Texas Medicaid Recipients
Unduplicated Clients
SFY 2011 = 4,567,077
State Fiscal Year 2011
Ethnicity
54%
22%
Hispanic
Age
Caucasian
36%
30%
0-5
6-14
Gender
17%
20%
30%
6%
65+
45%
Female
10%
Other
17%
21-64
55%
0%
AfricanAmerican
11%
15-20
8%
Male
40%
50%
60%
70%
80%
90%
100%
10
Module 6
Common Medicaid Myths
Myth
Medicaid is a rigid, one size fits all
program.
Fact
States have taken advantage of
Medicaid’s flexibility to customize
their program-about two-thirds of
Medicaid spending is for
“optional” services or populations.
Medicaid is designed with
minimum federal standards,
which require states to cover
certain populations and provide
certain benefits to key
populations.
In many ways, Medicaid is a
system that operates as 50
separate state coverage
programs, with states having
the choice to cover populations
and services beyond minimum
standards.
The Youth Empowerment
Services (YES) and Medically
Dependent Children Program
(MDCP) are both examples of
Medicaid waiver programs that
allow coverage flexibility.
11
Module 6
Special Medicaid
Programs for
Families
Case Management for
Children and Pregnant
Women
Health Insurance
Premium Payment
12
Module 6
Case Management (CM)
Case Management provides services that assist
Medicaid patients in gaining access to needed
medical, dental, mental health, social,
educational and other services.
Case Managers (such as a nurse, social worker,
or mental health professional) assess a patient’s
needs and strengths, then develop and monitor
an individualized care plan.
Case Management is available through such
programs as Case Management for Children &
Pregnant Women, Early Childhood Intervention
(ECI), and local mental health/mental retardation
services.
13
Module 6
REVIEW:
Case Management for Children and Pregnant Women
Case managers assist children,
women who are pregnant, and their
families in getting help with:
Access to needed medical,
dental, and mental health
services, including transportation
Educational or school issues
Financial or housing problems
Medical supplies or equipment
What do case managers do?
Find out what families need
Make plans to meet those
needs
Refer and teach families how to
access community resources
and services near where they
live
Follow up regularly with families
to make sure their needs have
been met
14
Module 6
Case Management for
Children & Pregnant Women
Eligible Populations
Infants, children, teens and young adults
from birth through age 20 can get case
management if they:
Are eligible for Medicaid
Have or are at-risk for having a health
problem that keeps them from doing things
that other kids their age do
Need help accessing and getting services to
keep health problems from getting worse
Women who are pregnant can get case
management if they:
Are eligible for Medicaid
Have a high-risk pregnancy
Need the services to prevent more problems
with pregnancy
To request CM for
a patient or
family:
•
Fax a referral form to
Texas Health Steps
•
Call toll-free at 1877-THSTEPS
•
Contact a provider
directly; providers
are listed by Texas
Health Regions on
the Department of
State Health
Services website
15
Module 6
Health Insurance Premium
Payment (HIPP) Program
HIPP helps families pay for private health
insurance. It is a program for families with
at least one person who gets Medicaid.
Families may be eligible for HIPP if at
least one family member receives
Medicaid and if someone in the family can
get health insurance at work.
HIPP reimburses families for private
health insurance premiums that are paid
to an employer-sponsored group plan.
16
Module 6
What HIPP Pays for
HIPP pays the premiums
Family member who gets HIPP
& Medicaid
✓
Family member who gets HIPP
but doesn’t get Medicaid
✓
Medicaid pays the copays when services are
given by a Medicaid
provider
✓
Medicaid pays the
deductibles when
services are given by a
Medicaid provider
✓
17
Module 6
Special Medicaid
Programs for
Children
Early Childhood Intervention
Medically Dependent
Children Program
Children with Special Health
Care Needs
YES Waiver
Oral Health and Fluoride
Varnish in the Medical
Home
18
Module 6
Early Childhood Intervention
(ECI)
ECI serves babies and toddlers (birth to age 3) with developmental
delays as well as those with medically diagnosed conditions such as
autism, spina bifida, cerebral palsy and Down syndrome.
ECI providers create customized therapy programs for each child,
using specialized teams of physical, occupational and speech
therapists, social workers, dieticians and early intervention
specialists.
ECI services are designed to enhance children’s long term
development and ensure they reach their full potential.
The Department of Assistive and Rehabilitative Services (DARS)
oversees the ECI program.
19
Module 6
ECI Cost and Access
The following services are provided at no cost regardless of income:
Evaluation/assessment
Development of the Individual Family Service Plan (IFSP)
Service coordination
Translation and interpretation services, if needed
Services for children with auditory and visual impairments who are
eligible for services from ECI and local school districts
Services for children in foster care or in conservatorship of the state
Families with children enrolled in Medicaid or CHIP, or whose
income is below 250% of the Federal Poverty Level, do not pay for
any ECI services. Other families pay a cost-share determined by a
sliding fee scale based on family size and net income after allowable
deductions.
For ECI information, contact the DARS Inquiries Line: 1-800-6285115
20
Module 6
ECI Services and Eligibility
2009 ECI Patient Profile
Gender and Funding Source
• Males
63%
• Females
37%
• Medicaid
61%
Referral Sources
• Medical/ Health Services 32%
• Parent/Family/Friends
27%
• Social Services
32%
• ECI Programs
7%
• Educational
2%
Service Types
• Developmental Services 86%
• Speech-Language Therapy51%
• Occupational Therapy
29%
• Physical Therapy
23%
• Nutrition Services
13%
• Family Training/ Counseling 9%
• Behavioral Intervention
3%
• Vision Services
2%
• Audiology
2%
• Psychology
2%
ECI Eligible Populations:
Children younger than 3 who are
Delayed or behind their peers in
cognitive, motor, socialemotional, communication, or
self-help skills
Have a medically diagnosed
condition with a high probability
of developmental delay
ECI determines eligibility for
children birth to 36 months, but
income is not a factor.
21
Module 6
Medically Dependent Children
Program (MDCP)
MDCP is a Medicaid waiver that provides services to families of
medically fragile children who choose to keep their children at home
instead of placing them in nursing facilities.
To be eligible for MDCP, the child must:
Be under 21 years of age
Be eligible for Medicaid, based on the child’s
income and resources
Meet the medical necessity criteria for admission
into a nursing facility
Reside in Texas
Meet disability criteria
The Department of Aging and Disability Services
(DADS) oversees the MDCP program.
22
Module 6
MDCP Services
Helpful Definitions
Respite: Direct care to an individual to provide a caregiver
temporary relief from caregiving activities
Adjunct support services: Specific direct care services needed by
the child to participate in child care, education or independent living
when the caregiver is at work or school
Adaptive aids: A device that helps a child perform the activities of
daily living or control the environment
Minor home modifications: A physical change to the family’s
residence that is needed to prevent institutionalization,
such as bathroom modifications, door widening, or ramp.
Transition Assistance Services: Services that support the
transition from a nursing home to the community
Financial Management Services: Services that assist an
individual or family with managing funds
23
Module 6
Children with Special Health Care
Needs (CSHCN) Services Program
The CSHCN Services Program helps children with special healthcare needs and people of any age with cystic fibrosis.
The program helps clients with their
Medical, dental and mental health care needs
Drugs and special therapies
Case management and family support services
Travel to health care visits
Insurance premiums
To be eligible for CSHCN, the child
must be younger than 21 years of age
and have chronic physical or developmental
condition expected to last
at least 12 months.
The Department of State Health Services
(DSHS) oversees the CSHCN program.
24
Module 6
CSHCN Services Program
All CSHCN Services Program Health Benefits must
be medically necessary for the care and treatment of
an eligible person with a chronic physical or
developmental condition.
Medicaid, CHIP, and commercial health insurance
benefits, if any, must be used before using the
CSHCN Services Program health benefits.
More information is available about CSHCN Services
Program through the CSHCN Inquiry Line at 1-800252-8023.
25
Module 6
Youth Empowerment Services
YES Waiver
A Medicaid waiver program for children with severe emotional disturbances
whose parents feel they have reached or exceeded their financial,
emotional or health care support resources and are unable to cover the
costs of their child’s mental health treatment.
The YES program provides home and community-based services to youth
who would otherwise need institutional care (e.g., psychiatric inpatient
care) or whose parents would turn to state custody for care.
Allows Texas to cover youth who are not otherwise Medicaid-eligible
when living in the community (parental income is not included in financial
eligibility calculation).
The Department of State Health Services (DSHS) oversees the YES
Waiver program, which is currently in place in Travis and Bexar counties
and may be expanded to Tarrant and Harris counties.
26
Module 6
Goals of the YES Waiver
Provide a complete continuum of flexible community-based services and
supports for children and adolescents with severe emotional disturbance
and their families
Ensure access to other flexible non-traditional support services, including
the parent partners
Develop individualized plans of care through a family-centered planning
process
Prevent or reduce inpatient psychiatric admissions for children and
adolescents with severe emotional disturbance
Reduce and prevent out-of-home placements by all child-serving agencies
Improve the clinical and functional outcomes of children and adolescents
with severed emotional disturbances
27
Module 6
YES Waiver Services and
Eligibility
YES Waiver Services
Respite
Community Living Supports
Family Supports
Transitional Services
Adaptive Aids & Support
Minor Home Modifications
Non-Medical Transportation
Paraprofessional Services
Professional services
Supportive Family Based
Alternatives
YES Waiver Eligibility
Age 3-18 years
Reside in Bexar or Travis County, in a noninstitutional setting with the parent or
legally authorized representative or in their
own home or apartment, if legally
emancipated
Be eligible for Medicaid; parental income is
not included in financial eligibility
determination
Meet DSHS clinical guidelines and qualify
for inpatient care under the Texas
Medicaid inpatient psychiatric admission
guidelines
Enrollment information is available on the
DSHS website
28
Module 6
Oral Health Care:
Recommendations for Physicians
Institute oral health risk assessments into well-child visits
Provide patient education regarding oral health
Provide appropriate prevention interventions (eg, feeding practices,
hygiene)
Document findings and follow-up
Train office staff in oral health assessment
Identify dentists (pediatric/general) in your area who accept new
patients/Medicaid patients
Take a dentist to lunch to establish a referral relationship
Investigate fluoride content in area water supply
29
Module 6
First Dental Home Components
Caries Risk
Assessment
Dental
prophylaxis
Oral hygiene
instructions with
primary care giver
Establishment of a
recall schedule
Dental
anticipatory
guidance
30
Module 6
Oral Evaluation and Fluoride
Varnish (OEFV) in the Medical Home
The OEFV initiative is aimed at improving the oral health of children
6-35 months of age.
The goal of the program is to allow medical and dental providers to
work together to improve the oral health of children.
Providers include physicians, physician assistants and advanced
practice nurses who have completed OEFV training.
Upon completion of training, dental providers are eligible to provide
intermediate oral evaluation, apply fluoride varnish, and bill Texas
Medicaid for enhanced reimbursement.
31
Module 6
OEFV Visit Components
During a Texas Health Steps
Medical Checkup
32
Module 6
Special Medicaid
Programs for
Women
Texas Women’s Health
Program
Programs for Pregnant
Women
Nurse-Family Partnership
Breast and Cervical
Cancer Programs
33
Module 6
Texas Women’s Health Program
The Texas Women’s Health Program (TWHP)
provides low-income women with free family
planning exams, related health screenings, and
birth control through Texas Medicaid.
Patients pay no premiums or co-pays for
services provided by the TWHP.
Applications are available to women at provider offices, local state
eligibility offices, participating Women, Infant, and Children program
(WIC) offices, through community-based organizations, and online.
The TWHP launched in January 2013, following a state district
judge’s decision that cleared the way for HHSC to launch the
program as a replacement to a previous Medicaid waiver program.
34
Module 6
TWHP Eligible Populations
TWHP is for women who meet the following qualifications:
Ages 18 to 44
U.S. citizens and qualified immigrants
Reside in Texas
Do not currently receive full Medicaid benefits, including
Medicaid for pregnant women, CHIP, or Medicare Part A or B
Have a countable household income at or below 185% FPL
Are not pregnant, sterile, infertile, or unable to get pregnant due to medical
reasons
Do not have private health insurance that covers family planning services,
unless filing a claim through their health insurance would cause physical,
emotional, or other harm from a spouse, parent, or other person
35
Module 6
TWHP Benefits
One family planning exam each year,
which might include:
Covered Birth Control:

Birth control pill

Vaginal ring

Hormone patch

Diaphragm

Male and female condoms

Spermicide

Intrauterine device (IUD)
Treatment of certain sexually transmitted
diseases

Cervical cap

Depo-Provera
Follow-up family planning visits related to
the method of birth control.

Devices placed under the
skin, such as Implanon

Methods to permanently
prevent pregnancy (tubal
ligations or Essure)
Pap smear
Screening for breast and cervical
cancers, diabetes, sexually
transmitted diseases, and high blood
pressure
Family planning counseling and
education, which can include natural
family planning and abstinence
36
Module 6
Programs for Pregnant Women
Percent of Births Paid by Medicaid, 2001-2008
100%
90%
80%
70%
60%
50%
40%
30%
20%
51.7
53.6
55.8
56.5
56.3
47.5
48.7
55.4
2001
2002
2003
2004
2005
2006
2007
2008
10%
0%
Medicaid-Paid Births
37
Module 6
Pregnant Women Served by
Texas Medicaid
Pregnant Women on
Medicaid by Age Group
Pregnant Women on
Medicaid by Race/Ethnicity
Ages 40+
1%
Ages 3039
15%
Ages 2529
24%
Other
2%
Ages 0-18
13%
Caucasian
30%
Hispanic
50%
Ages 1924
47%
African
American
18%
38
Module 6
Programs for Pregnant 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.
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.
The Neonatal Care Management
Program (NCMP)
NCMP provides help for low-birthweight, medically complex, and highrisk infants in the neonatal intensive
care unit (NICU). The program
provides educational materials, care
management nurses, and a 24-hour
help line.
Medicaid Health Moms and
Babies
Medicaid Healthy Moms and Babies
is a program that provides OB risk
assessment and educational services
to expectant mothers and case
management services to mothers
who have high-risk pregnancies. The
program provides educational
materials, health assessments, and a
help line for questions and concerns.
39
Module 6
CHIP Perinatal Coverage
Eligible Populations
Uninsured pregnant women who are Texas
residents and:
Have a household income greater than
185% FPL but not greater than 200% FPL
Have a household income at or below
200% FPL, but do not qualify for Medicaid
because of immigration status
An applicant is not eligible for CHIP
perinatal services if she gives birth prior to
an eligibility decision
40
Module 6
CHIP Perinatal Benefits
Up to 20 prenatal care visits
First 28 weeks of pregnancy – 1 visit every 4 weeks
28 to 36 weeks of pregnancy – 1 visit every 2-3 weeks
36 weeks to delivery – 1 visit per week
Additional visits allowed if medically necessary
Prescriptions based on CHIP formulary
Case management and care coordination
Ultrasound of the baby when medically indicated
Labor with delivery of child
2 postpartum visits for mother
Regular check-ups, immunizations, and
prescriptions for baby after leaving the hospital
41
Module 6
Medicaid Healthy Moms and
Babies Program Benefits
Educational materials on pregnancy-related issues
Access to online program information
Access to the toll-free BabyLine®, which is answered by
experienced obstetrical (OB) nurses, 24 hours a day, 7 days a week
The book, Your Journey Through Pregnancy, which has information
about early pregnancy through the baby’s first weeks
Three assessments, before and after delivery
Referral to case management program
Reports for enrollees and their physicians
42
Module 6
Neonatal Care Management
Program (NCMP)
The NCMP coordinates care for low birthweight, medically complex,
and high-risk infants born to Texas Medicaid fee-for-service clients.
The program began in July 2012 for infants hospitalized in neonatal
intensive care units (NICU) and specialty care nurseries.
NCMP serves only eligible Texas Medicaid fee-for-service clients
who agree to participate in the program. Clients who are enrolled in
a managed care organization are not eligible.
HHSC and TMHP are partnering with Alere Women’s & Children’s
Health and its affiliates to implement NCMP.
HHSC and TMHP are partnering with
Alere Women’s & Children’s Health
and its affiliates to implement NCMP
and the Medicaid Health Moms and
Babies Program
43
Module 6
Nurse-Family Partnership
The Texas Nurse-Family Partnership (TNFP) pairs Bachelor’s
prepared, registered nurses with low-income, first-time mothers to
improve prenatal care and provide one-on-one child development
education and counseling.
Women are enrolled in the program early in the second trimester of
their pregnancy, when TNFP nurses begin home visits.
The visits continue
throughout the woman’s pregnancy
and until her child is 2 years old.
The nurses provide support,
education and counseling on
health, parenting, developmental
issues and life skills.
44
Module 6
NFP By the Numbers
NFP programs have existed for over 23 years and are
currently operating in 31 states, serving over 20,000
mothers. Benefits to both children and mothers include:
56% reduction in emergency visits for accidents and poisonings
32% reduction in emergency visits in the second year of life
39% fewer injuries among children of low resource mothers
79% reduction in preterm delivery
23% fewer subsequent pregnancies
31% fewer closely-spaced (less than 6 months) subsequent pregnancies
20% reduction in welfare use
48% reduction in child abuse and neglect at child age 15
83% increase in mother’s labor force participation by child’s 4th birthday
67% reduction in behavioral/intellectual problems at child age 6
45
Module 6
Breast & Cervical Cancer in Texas
Expected New Cases & Death Rates in Texas Women, 2010
Expected Cancer Deaths
Expected New Cases
7th most commonly
diagnosed cancer among
Texas women
378
Cervical Cancer
1,219
The most commonly diagnosed cancer
among Texas women; an additional
100 Texas men are diagnosed with
breast cancer annually
2,794
Breast Cancer
15,347
0
Source: www.texascancer.info
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
46
Module 6
Breast and Cervical Cancer
Services (BCCS) Program
BCCS offers clinical breast examinations, mammograms, pelvic
examinations, and Pap tests throughout Texas at no or low-cost to
eligible women.
BCCS is partly funded by the Centers for Disease Control and
Prevention (CDC) National Breast and Cervical Cancer Early
Detection Program (NBCCEDP).
Since 1991, the BCCS program has screened 260,912 unduplicated
women for breast or cervical cancer. Approximately 189,259 women
received breast cancer screenings and
161,669 women received cervical cancer
screenings.
Breast and cervical cancer screening
services are available through health
care providers across Texas.
http://batchgeo.com/map/bccstexascliniclocator
47
Module 6
BCCS Eligible Populations
Low-income women (at or below 200% of the Federal Poverty
Income Guidelines)
Uninsured or underinsured
Age 40-64 years for breast cancer screening and diagnostic
services
Age 21-64 years for cervical cancer screening services
Age 18-64 years for cervical cancer diagnostic services
High Priority Populations:
Breast Cancer: Ages 50-64
Cervical Cancer: Ages 21-64 years
48
Module 6
BCCS Services
Screening services:
Clinical breast examinations
Mammograms
Pap tests
Education
Diagnostic services:
Diagnostic Mammograms
Breast Ultrasounds
Breast biopsies
Colposcopies and biopsies
Cervical Dysplasia
Treatment Services:
Loop Electrode Excision
Procedure (LEEP)
Cryotherapy
Laser
Office visit in conjunction with
treatment
49
Module 6
Medicaid for Breast & Cervical
Cancer (MBCC)
MBCC Eligible Population:
MBCC is a special Medicaid
program authorized by federal
and state laws to provide
access to cancer treatment
services for qualified, lowincome women.
The same agencies that
provide screening services
through BCCS assist women
with receiving treatment for
breast cancer through MBCC.
Diagnosed and in need of treatment
for a biopsy-confirmed definitive
breast or cervical diagnosis
Income at or below 200% FPL
No insurance for the treatment of the
cancer
Under age 65
A Texas resident and a U.S. citizen
or eligible immigrant.
50
Module 6
The Face of Medicaid
Anna’s Story
As a junior in college, Anna
found herself pregnant and
unemployed; even worse,
Anna had no insurance
Among Anna’s limited
options:
Terminate her parental
rights
Take advantage of state
assistance programs
How can Texas Medicaid help
Anna?
51
Module 6
The Face of Medicaid
Anna’s Story
Anna was eligible for Medicaid for
Pregnant Women under the CHIP
Perinatal Program
During her pregnancy, Anna received
Case Management for Children & Pregnant Women
Medicaid covered the hospital and doctor costs when Ryan was born
Until Ryan turned 2, a nurse from the Nurse-Family
Partnership made regular home visits
Throughout his Medicaid eligibility,
Texas Health Steps paid for Ryan’s check-ups,
immunizations, labs and assessments, in his
medical and dental homes
52
Module 6
The Face of Medicaid
Anna’s Story
When she returned to school,
Temporary Assistance for Needy
Families (TANF) provided financial
support to keep Ryan and Anna
clothed and nourished.
When Ryan was 3, Anna completed
her college degree and started to
work, moving to private insurance.
Although she no longer needs
Medicaid, Anna credits Texas
Medicaid for giving her and her son
a healthy start on their lives.
53
Module 6
Impact of Health Reform on Women’s
and Children’s Health Care
Freestanding birthing centers are eligible for
Medicaid reimbursement
Tobacco cessation counseling added as a
Medicaid benefit for pregnant women
Children enrolled in Medicaid and CHIP can elect hospice care
without waiving their rights to treatment
Extended dependent coverage to age 26
No lifetime limits or annual benefit restrictions
No pre-existing condition exclusions
No out-of-pocket expenses for preventive services
54
Module 6
True or False?
Test Your Knowledge about Special Medicaid Programs
for Families, Children & Women
1. Case Management assists families with resources such as
educational, financial, or housing needs.
TRUE: Case Management assists Medicaid families in gaining
access to needed medical, social, educational, and other services.
2. ECI provides services to families of medically fragile children who
keep their children at home instead of placing them in nursing
facilities.
FALSE: MDCP provides services to parents who choose to keep
their medically fragile children at home. ECI serves babies and
toddlers with developmental delays or atypical development.
3. The Children with Special Health Care Needs program helps
people of any age with cystic fibrosis.
TRUE: CSHCN helps children with special health care needs and
people of any age with CF.
55
Module 6
True or False?
Test Your Knowledge about Special Medicaid Programs
for Families, Children & Women
4. One goal of a Caries Risk Assessment is to Identify the oral
health status of the child and other family members.
TRUE: Other goals include identifying potential bacterial
transmission sources and determining a recall periodicity
schedule for additional dental visits.
5. The Nurse-Family Partnership provides post-natal home visits
until the child is 1 year old.
FALSE: Home visits to eligible families conducted through the
Nurse-Family Partnership continue until the child is 2 years old.
56
Module 6
Medicaid Resources
Texas Health & Human Services Commission
www.hhsc.state.tx.us/medicaid
Texas Medicaid & Healthcare Partnership
www.tmhp.com
Texas Health Steps
www.dshs.state.tx.us/thsteps/providers.shtm
www.dshs.state.tx.us/dental/thsteps_dental.shtm
www.dshs.state.tx.us/thsteps/default.shtm
CHIP/ Children’s Medicaid
www.chipmedicaid.org
57
This Texas Medicaid curriculum
was prepared by
Betsy Goebel Jones, EdD
Project Director
Tim Hayes, MAM
Project Designer
Authors: Module 6
Betsy Goebel Jones, EdD
David Trotter, MA
Module 6
58