As the 12-month postpartum coverage the Texas Legislature approved took effect March 1, physicians and their practice staff should take note of subsequent payment complexities, Texas Medical Association experts caution.
The Texas Health and Human Services Commission (HHSC) extended coverage under Medicaid and the Children’s Health Insurance Program (CHIP) for eligible postpartum patients after the Texas Medical Association and its allies successfully backed House Bill 12 by Rep. Toni Rose (D-Dallas) during the 2023 regular state legislative session.
However, payment for services provided before the extension could be affected by ongoing or changing coverage brought on by HB 12. TMA experts recommend practices not only ask patients about coverage but also check if they had prior postpartum coverage to confirm whether they are part of the reinstatement.
Eligible Medicaid and CHIP patients not currently enrolled in those programs in Texas – but who were recipients while pregnant and are still within their 12-month postpartum period – don’t need to reapply to have their coverage extended as HHSC is in the process of reinstating it. However, Medicaid will not pay for any services rendered before coverage was extended March 1.
For example, if a patient had a baby on April 1, 2023, she would receive benefits starting March 1, 2024, when the new law took effect. However, any services the patient received prior to March 1, 2024, would not be covered or payable.
The 12-month postpartum coverage begins the month after a pregnancy has ended, including in the case of miscarriages and still births. Medicaid- or CHIP-covered services remain available in the 12-month postpartum period, including:
- Regular medical and dental checkups;
- 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; and
- The treatment of special health needs and pre-existing conditions.
Additionally, practice staff should check with eligible Medicaid and CHIP patients to find out if they received a notice about their coverage by mail or through their Texas Benefits account. Those patients would receive the extended coverage through their postpartum period unless they:
- Voluntarily withdraw;
- Move out of Texas; or
- Are determined ineligible because of fraud, abuse, or perjury.
The extension does not apply to those enrolled in CHIP Perinatal, which covers the unborn children of eligible pregnant women. Such women are eligible for the state’s Family Planning Program, which provides basic health care services, including contraception and screening for chronic conditions.
For more information on the HB 12 postpartum coverage extension, check out HHSC’s FAQ, general information flyer, and social media toolkit.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469