What Does Pregnancy Medicaid Cover in Texas?

Pregnancy Medicaid in Texas is a joint state and federal program designed to provide comprehensive healthcare coverage to eligible pregnant individuals. It ensures access to necessary medical services throughout pregnancy and beyond, supporting maternal and infant health. This program supports low-income Texans who might otherwise face barriers to receiving prenatal care, delivery services, and postpartum support.

Eligibility and Application Steps

Qualifying for Texas Pregnancy Medicaid involves meeting specific criteria related to residency, citizenship status, and income. Applicants must be Texas residents and either U.S. citizens or qualified non-citizens. Income limits are set at a higher threshold for pregnant individuals compared to other Medicaid categories, typically around 203% of the Federal Poverty Level (FPL).

Before initiating the application, gather specific documentation. This includes proof of identity for all adults in the household, such as a driver’s license or passport. Proof of Texas residency, like a recent utility bill or lease agreement, is also required. Applicants must provide income verification, which can involve recent pay stubs, tax returns, or an employer statement. Social Security numbers for all household members are necessary, along with medical documentation confirming the pregnancy, such as a due date or a Report of Pregnancy form signed by a healthcare provider.

Once all necessary information is compiled, the application can be submitted through various channels. The most common method is online via the Your Texas Benefits website. Alternatively, applications can be mailed or submitted in person at a Texas Health and Human Services benefits office or a partner organization. For those preferring phone assistance, calling 2-1-1 or 877-541-7905 can guide applicants through the process.

Covered Healthcare Services

Texas Pregnancy Medicaid provides many healthcare services. This includes prenatal care, covering regular doctor visits, diagnostic tests like ultrasounds and blood work, and prescribed prenatal vitamins. Counseling related to pregnancy health is also covered.

Coverage extends to delivery services, encompassing labor, childbirth, and hospital stays. Physician fees for obstetricians and anesthesiologists are included, as are C-sections when medically necessary. Following childbirth, postpartum care is covered, with follow-up appointments for the mother, mental health screenings, and lactation support services.

Prescription medications related to pregnancy are covered. Medically necessary specialist services, such as visits to high-risk pregnancy specialists, cardiologists, or endocrinologists, are also included. Emergency services directly related to pregnancy are covered.

Dental and vision benefits include regular vision and hearing care. Non-emergency medical transportation (NEMT) services are available for Medicaid clients who have no other means of getting to appointments, including rides to the doctor, dentist, hospital, or pharmacy. Mental health services, including screenings for depression and anxiety and counseling, are also covered.

Coverage Duration and Postpartum Support

Texas Pregnancy Medicaid coverage initiates upon eligibility determination and continues throughout the entire pregnancy.

Postpartum coverage has been extended to 12 months after the end of pregnancy, effective March 1, 2024. This extension provides continuity of care for new mothers.

For the newborn, the baby born to a mother receiving Pregnancy Medicaid is automatically covered under Medicaid or the Children’s Health Insurance Program (CHIP) for a period.

Related Perinatal Programs

Texas offers other programs that provide support to pregnant individuals and new families. CHIP Perinatal is for pregnant individuals who may not qualify for full Medicaid due to slightly higher income levels. This program provides limited benefits focused on prenatal care, labor, and delivery, but offers only two postpartum visits for the mother within 60 days of delivery, unlike the extended Medicaid postpartum coverage. The unborn child receives coverage through CHIP Perinatal, and upon birth, the infant transitions to full CHIP or Medicaid benefits depending on household income.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support and education. This program assists pregnant individuals, new mothers, and children up to age five by offering healthy foods, nutrition counseling, and access to basic health services. WIC operates independently of Medicaid, but individuals receiving Medicaid often meet WIC’s income eligibility requirements, making it a complementary resource.

Healthy Texas Women (HTW) also offers women’s health and family planning services. While distinct from pregnancy-specific Medicaid, HTW can be a resource for pre-conception care or for women transitioning from Medicaid postpartum coverage, providing services like contraception and cancer screenings. This program supports overall reproductive health and can serve as a bridge to continued care after pregnancy-related Medicaid coverage ends.