Women’s Health Program
Overview
Community-Based Organization Training and Information
Table of Contents
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Introduction
Benefits
Referrals
Eligibility
Application
Examples
Renewals
Outreach Activities
Resources
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Introduction
Introduction
• What is the Women’s Health Program?
 The Legislature passed Senate Bill 747 in 2005, which
established the Women’s Health Program.
 The Women’s Health Program offers a limited, Medicaid-paid
family planning benefit to women ages 18-44 with countable
monthly incomes at or below 185 percent of the federal
poverty level (FPL).
 Benefits of the program include an annual family planning
exam and choice of contraception for 12 continuous months.
 The program is effective January 1, 2007. Applications will
be accepted starting January 1, 2007. No women will be
enrolled prior to that date.
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Introduction
 Applications will be available to women at provider’s offices,
local state eligibility offices, participating WIC offices,
through community-based organizations, and online.
 All Medicaid providers are eligible to participate. There is
not a separate provider enrollment process or a Women’s
Health Program network.
 There is no cost-sharing, premiums, or co-pays for services
provided by the Women’s Health Program.
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Benefits
Benefits
• The Women’s Health Program provides limited family
planning benefits. It is not the full Medicaid package.
• Specific benefits of the Women’s Health Program
 Comprehensive health history and evaluation;
 Gynecological exam and Pap smear;
 Screening for diabetes, sexually transmitted diseases, high blood
pressure, and breast and cervical cancers;
 Assessment of health risk factors—i.e., smoking, obesity, exercise,
etc.—as they relate to choice of contraception;
 Family planning counseling and education;
 All contraception, except emergency contraception.
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Benefits
•
Due to the limited nature of Women’s Health Program, the
following are not covered benefits:
 Mammography. Screening for breast cancer is limited to a Clinical
Breast Exam (CBE);
 Treatment for any conditions diagnosed during a Women’s Health
Program visit.
•
A detailed Provider Procedure Code list of allowable services is
available online at the Women’s Health Program webpage
(www.hhsc.state.tx.us/womenshealth.htm).
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Benefits
Prescription Drugs
•
All covered prescription drugs are limited to contraception.
•
Since Women's Health Program services may be provided prior to a
woman’s certification in the program, a one- or two-month supply of
contraception may need to be provided through a Class D pharmacy or
other arrangement.
•
Once a woman is certified in the program, she will receive a Women’s
Health Medicaid ID that she can present at a local pharmacy with a
prescription, or she may continue to receive contraception through a
provider Class D pharmacy.
•
The list of prescription drugs and methods of contraception that a client
can obtain by taking a prescription to a pharmacy is posted on the
Women’s Health Program website.
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Referrals
Referrals
•
Providers must refer women to primary care when medically necessary.
 Treatment for conditions identified in the course of a family planning visit are
not covered by the Women’s Health Program.
 If a Women’s Health Program participant is diagnosed with a health problem
such as diabetes, high blood pressure, a pap test abnormality, or a sexually
transmitted infection, family planning providers are required to refer her to a
doctor or clinic that can treat her.
 A woman who may have breast or cervical cancer should be referred to the
Breast and Cervical Cancer Control (BCCC) program for diagnoses. BCCC
provides screening and diagnostic services at no cost to low income women
who have no health insurance at over 200 sites throughout Texas.
** If a low-income woman who is not eligible for Medicaid is diagnosed with
breast or cervical cancer through BCCC, she will have access to Medicaid
coverage. If she is diagnosed by a provider outside of the BCCC program,
she will NOT be eligible for Medicaid.**
•
Limitations:
 Referrals are limited to providers who do not perform or promote elective
abortion or contract or affiliate with entities that perform or promote elective
abortions.
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Eligibility
Eligibility
• Who is Eligible for the Women’s Health Program?
 Women aged 18-44 who:
• have a monthly countable family income at or below the 185
percent FPL;
• are U.S. Citizens or certain qualified immigrants;
• reside in Texas; and
• do not currently receive full Medicaid benefits, CHIP, or
Medicare Part A or B.
 If all other criteria are met, women are eligible for the
Women’s Health Program if they apply the month of their 18th
birthday through the month of their 45th birthday.
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Eligibility
• HHSC has developed an eligibility screening tool and an
income worksheet for organizations to use to determine
whether a woman may be eligible for the Women’s Health
Program.
• The screening tool addresses each eligibility point and will help
identify the documentation that a woman can provide as proof of
citizenship, identity, and income.
• The income worksheet will help providers determine a client’s
monthly countable household income.
• The screening tool and income spreadsheet are available for
download at www.hhsc.state.tx.us/womenshealth.htm.
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Women’s Health Program
Screening Tool (front)
Page 15
Women’s Health Program
Screening Tool (back)
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Application
Application
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Women’s Health Program participants will fill out a simplified onepage application. Applications will be available through the
following:
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Participating family planning clinics and Medicaid provider offices;
Local Health and Human Services offices;
Participating WIC offices;
Participating community-based organizations; and
Online at http://www.hhsc.state.tx.us.
By calling the Women’s Health Program office at 1-866-993-9972.
Women can fill out an application at the point of service delivery
(participating doctor’s office), and receive services the same day.
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Application
• Entities that help women apply will need to collect,
document, and fax to state eligibility workers proof of:
 Household Income
 Household Expenses
 Citizenship
 Identity
 Adjunctive eligibility (if applicable)
• Entities can accept a woman’s statement on her address
and residency status, her household information, and her
Social Security number. No further documentation is
required for these eligibility points. However,
documentation is required for income, citizenship, and
identity.
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Application
•
Proof of Household Income:
 One check stub issued in the last 60 days
 Letter from employer (confirming employment and income)
 Proof of self-employment income, unemployment benefits, child
support, SSI, other contributions, etc.
•
Proof of Household Expenses:
 Dependent care
• Statement or a current bill from provider, current receipts,
income tax return
 Child Support Paid by Household
• Attorney General collection and distribution records, or County
Clerk records
• Cancelled checks or wage withholding statements
• Withholding statements from unemployment compensation
• Statement from the custodial parent regarding direct payments
or third party payments paid on their behalf.
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Application
•
Combined Proof of Citizenship and Identity:
 U.S. Passport
 Certificate of Naturalization (Form N-550 or N-570)
 Certification of U.S. Citizenship (Form N-560 or N-561).
•
Proof of Citizenship:

A U.S. birth certificate
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For an out-of-state birth, women my obtain a birth certificate through
http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm
For women born in Texas without a birth certificate, HHSC eligibility workers can verify
citizenship. The application must include the woman’s first and last name, her maiden
name and her mother’s maiden name.
 A U.S. Citizen Identification card (Form I-179 or I-197)
•
Proof of Identity:
 Current driver’s license (from Texas or another state)
 Texas ID card issued by DPS
 Work or school ID card with photo
•
There are more documents that are acceptable as proof of citizenship and identity. For
more information, see www.hhs.state.tx.us/medicaid/flyer.pdf or the screening tool at
www.hhsc.state.tx.us/womenshealth.htm.
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Application
•
Adjunctive Eligibility:
 A woman is adjunctively income-eligible for the Women’s Health
Program if she or a member of her family currently participates in:
• Temporary Assistance for Needy Families (TANF) cash
assistance,
• Food Stamps,
• the Supplemental Nutrition Program for Women, Infants, and
Children (WIC), or
• Children’s Medicaid.
 Proof of current participation in any of these programs means a
woman has already proven her income eligibility for the Women’s
Health Program to the State.
• She will still have to provide verification of citizenship and
identity.
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Application
• Proof of Adjunctive Eligibility includes:
 Current Children’s Medicaid ID letter
 Active WIC Verification of Certification
 Active WIC Voucher
 Active WIC/EBT Shopping List
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Example of documentation: WIC Verification of
Certification
SAMPLE
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Example of documentation: WIC Voucher
Page 25
Example of documentation: WIC/EBT Shopping list
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Income Determination
• To determine income eligibility for women who do not
have proof of adjunctive eligibility, you must
determine:
 Household composition/size
 Monthly income and expenses
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Income Determination
•
Household Composition
 The budget group consists of the applicant, her spouse, and all mutual and non-mutual
children.
 If an unmarried woman lives with a partner, ONLY count his income and children as
part of the budget group IF the woman and her partner have mutual children together.
 Treat applicants who are 18 years of age as adults.
 No children aged 19 and older or other adults living in the household should be
counted as part of the budget group.
•
Examples:
 Mrs. Thomason is married and has 3 children. The budget group consists of herself,
her spouse, and any mutual and non-mutual children.
 Ms. Thomason lives with the father of her children and is not married. The budget
group consists of herself, the father of the children and their mutual children.
 Ms. Small lives with her parents and does not have children. The budget group
consists of only Ms. Small.
 Ms. Small and her 2 children live with her parents. The budget group consists of Ms.
Small and her children.
•
There are no verification requirements for household determination.
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Income Determination
•
Converting income to Monthly Income:
 Use the income spreadsheet available at www.hhsc.state.tx.us/womenshealth.htm to
help determine monthly household countable income.
 You will frequently be required to convert income to a monthly amount. To convert
income, multiply:
• weekly amounts by 4.33,
• biweekly amounts by 2.17 and
• semi-monthly amounts by 2.
•
Example: Ms. Johnson works for T-Mart and is paid weekly. She provides two check
stubs: 11-01-06 for $235 and 11-22-06 for $225. Both are representative. Use the most
recent check stub and multiple by 4.33. $225 x 4.33 = $974.25. This is her monthly gross
income.
•
Note: When income is new or terminated, and only a partial month's income is in the start or
terminate month, do not convert the income. Use actual (income already received),
unconverted income.
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Income Determination
•
To determine if a woman is income eligible, check the allowable
converted income for the appropriate family size, using the 185% FPIL
income chart located at:
http://www.dads.state.tx.us/handbooks/TexasWorks/C/100/131.htm
•
This information changes annually. Please be sure to use the most
updated chart.
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Application
•
The Women’s Health Program has its own one-page, simplified
application available in English and Spanish to facilitate women
receiving services.
•
Organizations will be able to order applications online at
http://www.dads.state.tx.us/news_info/publications/handbooks/#forms
 Click on “Order Printed Forms” link, fill out form, and email it to the
listed email address.
 Allow two weeks for delivery.
•
If a woman is adjunctively income-eligible and she has acceptable
proof of participation in other gateway programs, she only has to fill out
the personal information and household demographic information
sections of the application, but not the income section.
•
All applications must be signed by the applicant.
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Women’s Health Program
Application (front)
Sample
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Women’s Health Program
Application (back)
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Application
• Once an application is completed, fax only the front page of the
application to the toll-free number included on the application.
Please ensure the application is complete and signed.
• Verification of income, expenses, or adjunctive eligibility, identity,
and citizenship must also be faxed with the application. To
minimize paperwork and the chance that verification will be lost,
please photocopy the appropriate verification to fit on one sheet,
if possible.
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Enrollment
Enrollment
• Women’s Health Program Effective date: A woman’s
enrollment in the Women’s Health Program will be effective from
the first day of the month the state receives an application for
the program. There will be no eligibility effective date prior to
January 1, 2007, the program state date.
 Example: a woman applies for the Women’s Health Program on
January 20th. When certified, her enrollment will be effective from
January 1st.
 If there is missing information and the application is pended until
receipt of that information, as long as a woman provides the
missing information within 30 days from the file date, the effective
date remains the same.
 If there is missing information and the woman does NOT provide
the missing information within 30 days, she will be denied and will
need to reapply.
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Enrollment
• Women’s Health Program Application Processing:
 Eligibility workers (both out-stationed and at HHSC offices) can
help women apply, but CANNOT make a final eligibility
determination. HHSC has a staff of 34 eligibility workers dedicated
solely to the Women’s Health Program.
 State eligibility workers have 45 days to process applications.
 When an organization faxes an application and all supporting
documentation to the State, HHSC anticipates this processing time
will be much shorter because there is:
• Dedicated Women’s Health Program eligibility staff, and
• A simplified one-page application.
 Application processing is dependent on caseload.
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Enrollment
•
Once a woman is certified, she will receive a unique Women’s Health
Program Medicaid Identification form (MedID) each month (Form
H3087).
•
The Women’s Health Program MedID will clearly indicate that it is for
Women’s Health Program services only.
•
In the event that a woman misplaces or does not receive her monthly
MedID, she will be issued a temporary MedID (Form H1027-A), that is
also acceptable as proof of Women's Health Program participation.
 To receive a temporary MedID, a woman should contact the local HHSC
benefits office. To locate the local HHSC benefits office, a woman may dial
2-1-1.
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Women’s Health Program Medicaid Identification
(Form H3087)
SAMPLE
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Women’s Health Program Temporary MedID
(Form H1027-A)
Women’s Health Program
SAMPLE
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Examples
Example 1
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A 29-year-old woman calls to schedule an appointment at her local
family planning clinic.
It is determined she is a U.S. citizen, a resident of Texas, and has a
child on WIC.
She is instructed to bring proof of WIC participation, identity, and
citizenship.
She brings the requested information to the appointment, and fills out
a Women’s Health Program application.
She sees a provider that day and receives Women’s Health Program
services.
The provider photocopies the woman’s documentation and faxes it
with her application to the toll-free Women's Health Program fax
number.
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Example 2
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2.
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A 21-year-old woman meets with a community-based organization
outreach worker.
To determine if she is eligible, the outreach worker uses the
screening tool, asks for proof of income, citizenship, and identity, and
determines that the client is a resident of Texas.
The client produces a recent pay check stub, a birth certificate, and a
driver’s license.
The outreach worker helps the client fill out a Women’s Health
Program application.
The outreach worker photocopies the woman’s documentation and
faxes it with her application to the toll-free Women's Health Program
fax number or mails it in using the pre-printed, postage-paid
envelope.
Once the woman’s eligibility is certified by state workers, she receives
her Medicaid ID in the mail.
The woman calls 2-1-1 to find a family planning clinic and schedules
an appointment.
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Renewals
Renewals
•
In the 10th month of a woman’s participation in the Women’s Health
Program, the TIERS eligibility system will check to see if she is
currently part of a household participating in Children’s Medicaid, Food
Stamps, or TANF.
 If a woman is a member of a household participating in the abovelisted programs, she is adjunctively eligible for continued
participation in the Women’s Health Program. She will be sent a
one-page adjunctive eligibility letter explaining her status, and
requesting her signature and return of letter if she would like to
continue receiving Women's Health Program benefits.
 If a woman is not currently a member of a household participating
in these programs, she will be sent the simplified, one-page
application and be instructed to apply again.
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Outreach Activities
• How the Women’s Health Program is letting
stakeholders know about the program:
 Printed and shipped brochures and posters to local eligibility
offices, provider offices, and CBOs.
 Conducted provider and CBO trainings
 Submitted articles to association newsletters
 Created a Women’s Health Program website
 Presented program overviews at conferences and meetings
 Will conduct training for promotoras
 YOU! Word of mouth
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Resources
• For more Women's Health Program information:
 www.hhsc.state.tx.us/womenshealth.htm
• Outreach materials, including downloadable brochures and
posters
• Applications
• FAQs
• Eligibility screening tool
• Training materials
• Acceptable forms of proof of income and citizenship
 Or call the Women’s Health Program office at
1-866-993-9972.
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