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Womens Health Program


The Women's Health Program (WHP) has been in operation since January 1, 2007. ... most recent federal poverty limit guidelines on April 1. Providers may always ... – PowerPoint PPT presentation

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Title: Womens Health Program

Womens Health Program
Program Updates Provider Training and
Information April 10, 2007
Table of Contents
  • Introduction
  • Eligibility Changes
  • Implementation Update
  • Reminders
  • Resources
  • Question and Answer

  • The Womens Health Program (WHP) has been in
    operation since January 1, 2007.
  • Number of applications received
  • Number of women certified

Eligibility Changes
Eligibility Criteria
  • The Womens Health Program is for women who meet
    the following qualifications
  • Ages 18 to 44. Women can apply the month of their
    18th birthday through the month of their 45th
  • U.S. citizens and qualified immigrants.
  • Reside in Texas.
  • Do not currently receive full Medicaid benefits,
    CHIP, or Medicare Part A or B.
  • Have a countable household income at or below 185
    percent of the federal poverty level.
  • Are not pregnant (effective May 1, 2007).
  • Are not sterile, infertile, or unable to get
    pregnant due to medical reasons (effective May 1,
  • Do not have private health insurance that covers
    family planning services, unless filing a claim
    on the health insurance would cause physical,
    emotional, or other harm from a spouse, parent,
    or other person (effective May 1, 2007).

Eligibility Changes
  • The purpose of the Womens Health Program is to
    achieve cost savings by averting unintended,
    Medicaid-paid births.
  • Because of this intent, as of May 1, 2007, the
    following eligibility changes will take effect.

Eligibility Changes
  • Pregnant women
  • Pregnant women are not eligible to receive
    services through the Womens Health Program.
  • As a reminder, if a woman is determined pregnant
    on her first visit, services cannot be billed to
    WHP. Providers may refer women to local HHSC
    eligibility offices to apply for Medicaid for
    Pregnant Women. Medicaid for Pregnant Women may
    cover unpaid medical bills declared by eligible
    clients that were incurred in the 3 months prior
    to the month the client applied for Medicaid for
    Pregnant Women.
  • If a client becomes pregnant after she is
    certified for WHP, she may apply for Medicaid for
    Pregnant Women. Medicaid for Pregnant Women
    covers prenatal care and other services not
    covered by WHP. A woman will be automatically
    disenrolled from WHP if she applies for and is
    certified for Medicaid for Pregnant Women.

Eligibility Changes
  • Women who have received sterilization surgery or
    have another condition resulting in sterility
  • Women who are sterile, infertile, or are unable
    to get pregnant due to other medical reasons will
    no longer be able to access services through the
    Womens Health Program.

Eligibility Changes
  • Clients with private health insurance
  • Women who have private health insurance are not
    eligible for WHP unless
  • Their private insurance does not cover family
    planning services or
  • Filing a claim on their health insurance would
    cause physical, emotional, or other harm from a
    spouse, parent, or other person.

Eligibility Changes
  • WHP participants have one year of continuous
  • Participants who were certified prior to May 1,
    2007, but do not meet all of these new
    eligibility criteria will NOT be disenrolled.
  • Upon renewal, participants will have to meet all
    eligibility criteria, including the new criteria,
    to be re-determined eligible.

Eligibility Changes
  • The updated screening tool and application will
    help clarify these eligibility changes.
  • The updated screening tool should not be used
    until May 1, 2007.
  • The updated screening tool can be downloaded on
    April 16 from www.hhsc.state.tx.us/WomensHealth/In
  • New applications can be used now. Old
    applications will not be accepted April 30, 2007.
  • New applications can be ordered in bulk in
    late-April at www.dads.state.tx.us/
  • New applications can be downloaded and printed
    individually on April 16 from www.hhsc.state.tx.us

Updated Screening Tool
Updated Screening Tool
Updated Application
Updated Application
  • WHP and interaction with other benefits
  • Receiving WHP benefits does not make a client or
    a clients household ineligible for other program
    benefits such as Medicaid, TANF or food stamps. 
  • However, the information reported when applying
    for WHP may affect the households other benefits
    if the information reported is different from
    information previously reported by the household.
  • For example, if a client reports a significantly
    higher income on her WHP application than she did
    on her application for Food Stamps, her Food
    Stamp amount may be adjusted to reflect her new

  • What is TIERS?
  • TIERS, the Texas Integrated Eligibility Redesign
    System, is the new, modernized data system used
    by the State to store client information and
    assist in determining eligibility for social
  • All Womens Health Program clients are converted
    into TIERS as they are certified for the Womens
    Health Program.

  • TIERS and WHP do not
  • Make a client or a clients household ineligible
    for other benefits, such as food stamps or
  • Freeze a clients other benefits.
  • Prevent a client from going to an HHSC benefits
    office to receive help in person.
  • Change eligibility criteria, services, or the way
    services are delivered to clients.

  • Duplicate Patient Identification Number
  • When attempting to verify a clients eligibility
    for WHP through the Texas Medicaid and Healthcare
    Partnership (TMHP) website or TDH Connect, some
    providers have reported getting a Duplicate
    Patient ID Found message.
  • This error occurs when a client had previous
    periods of Medicaid eligibility and TMHPs system
    has more than one client ID for the individual.
  • HHSC is working with TMHP to address this issue.
  • If you search for a WHP applicant and receive the
    Duplicate Patient ID Found error message,
    please call the TMHP contact center at
    1-800-925-9126 and talk with a representative to
    determine if a client has been certified for the
    program and to request her patient ID number.

  • WHP Enrollment Date
  • Some providers and clients have reported an
    incorrect client enrollment date.
  • For example, a client may have received program
    services and been certified for WHP in February,
    but received a letter stating a period of program
    eligibility starting in March.
  • Providers have discovered incorrect enrollment
    dates in the following ways
  • A client contacts her provider when she receives
    her eligibility certification notice that lists
    an eligibility period beginning in the future.
  • A provider checks a clients eligibility by
    calling TMHPs contact center and discovers that
    the client is eligible starting on a date after
    the date of service.
  • A provider searches for a clients eligibility on
    www.tmhp.com using an eligibility period that
    extends beyond the month of the date of service,
    and the effective date shown is after the
    application month.

  • WHP Enrollment Date
  • HHSC is using a manual work-around to prevent
    this error and also is working on an automated
  • HHSC can manually correct enrollment dates, if
  • If you discover that a client has been assigned
    an enrollment date after her date of service,
    please report the clients name, her social
    security number, and her birth date by calling
    1-866-993-9972 so that the problem can be
  • If you find an incorrect enrollment date using
    TMHPs website, please wait to report it until
    one week from the add date for the WHP
    eligibility segment. This will give HHSCs
    manual work-around time to update in TMHPs
  • HHSC will investigate all reports of potentially
    incorrect enrollment dates reported by providers
    and clients. If the enrollment date is
    incorrect, HHSC will correct the problem and send
    the client a new eligibility certification notice
    with the correct enrollment date.

  • Correctly searching for client eligibility
  • When using TMHPs website to search for client
    eligibility, limit the eligibility date search to
    the month of the date of service that will be
  • For example, if the date of service is April 20,
    please search for eligibility using a start date
    of April 1 and an end date of April 30.
  • If you receive Title V or XX funds from DSHS, you
    may bill a WHP applicants visit to Title V or XX
  • The applicants WHP eligibility information is
    not available from TMHP 45 days from the date the
    WHP application was submitted (providers may
    assume the applicant was denied from WHP) and
  • The applicant was screened and eligible for Title
    V or XX at the time of service.

  • Application/Certification Process
  • An application is not valid and cannot be
    processed without a name, address and signature. 
    The address must contain a street number and
    name, city and zip code. Clients should use
    their legal name.
  • If the application is missing eligibility
    verification, HHSC eligibility staff will pend
    the application and send a letter to the client
    asking for the missing information. If the
    client fails to provide the requested
    verification by the stated deadline, the
    application will be denied for failure to

  • If you are faxing supporting documentation only
    (i.e. birth certificate, drivers license, etc.)
    for an application already submitted, you must
    write the clients name and social security
    number on the documentation, as well as the WHP
    eligibility workers name, if available.  
  • Applicants who are adjunctively-income eligible
    must still provide proof of citizenship and
    identity.  If an applicant shows proof of
    adjunctive-income eligibility, such as a
    Childrens Medicaid ID letter, that applicant
    does not need to show further proof of income
    however, she must still provide proof of
    citizenship and identity. 
  • Approximately 80 of applications are pended due
    to missing information. Please remember to ask
    clients to bring all WHP verification
    information, such as pay stubs and
    identification, to appointments.

  • Please send each application with a cover page
    that includes a contact name, phone number and
    email address for your office. 
  • Fax only one application at a time.  Each fax
    transmission should contain the cover page,
    application, and supporting documentation for
    only one applicant. 
  • Remind clients that the Womens Health Program is
    a Medicaid program. When they apply for the
    program, they are applying to receive a limited
    Medicaid benefit.
  • If a client screens ineligible for the program
    but still wants to apply, providers should offer
    her an application so she may apply on her own.

  • Contacting WHP
  • Please do not call the WHP number
    (1-866-993-9972) to verify a clients enrollment
    in the program. This number is available
    primarily to assist clients. Providers can
    receive eligibility verification information from
  • Please do not call the WHP number with questions
    about CHIP perinatal coverage and do not send
    applications for CHIP perinatal coverage to the
    WHP fax number.  The correct fax number for each
    program is
  • Womens Health Program 1-866-993-9971
  • CHIP Perinatal 1-877-542-5951

  • Reminders

Follow-up Visits
  • Womens Health Program office visits are limited
    to one annual exam per year and follow-up visits
    related to a clients method of contraception
  • Examples of reimburseable follow-up visits
  • A visit to receive a Depo-Provera injection
  • A visit to discuss complication with a current
    form of contraception and explore alternative
    contraceptive options.
  • Examples of non-reimburseable follow-up visits
  • Testing for STIs
  • A second pap smear following an initial pap smear
    with abnormal results

Reporting Changes
  • WHP clients can report changes to their
    information by
  • Calling 2-1-1
  • When calling 2-1-1, if given an option to dial 1
    for Information and Referral or dial 2 for
    information on Medicaid and other benefits and
    services, the participant should dial 2 to report
    the change. 
  • Calling or visiting a local HHSC eligibility

Application Status
  • 2-1-1 Information and Referral can not give an
    applicant information about her application
  • Applicants, not providers, must call
    1-866-993-9972 to receive information about
    their application status.
  • WHP eligibility staff can only give providers
    limited information about a clients status in
    the program. However, providers can check a
    clients application status through TMHP.

Other Reminders
  • HHSC will switch to the most recent federal
    poverty limit guidelines on April 1. Providers
    may always access the current 185 FPL income
    chart at http//www.dads.state.tx.us/handbooks/Tex
  • Providers must bill on the appropriate claim form
    based on their provider type. Family planning
    agencies who also contract with DSHS for Title V,
    X, or XX must bill in an approved electronic
    format or on the Family Planning 2017 claim form.
  • All covered prescription drugs are limited to
    contraception. The list of prescription drugs
    that a client can obtain by taking a prescription
    to a pharmacy is posted on the WHP website.

  • For more Women's Health Program information
  • Up-to-date provider announcements, training
    materials, FAQs, and other materials are
    available at www.hhsc.state.tx.us/womenshealth.ht
  • Billing information and client eligibility
    verification information www.tmhp.com or

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