Pregnant in Texas? Here’s what you need to know to access Medicaid and CHIP Perinatal

From KERA:

Texas has two main programs serving pregnant people without insurance: pregnancy Medicaid and CHIP Perinatal. Both programs have income requirements based on federal guidelines and limited coverage options past delivery. Medicaid programs like these cover half of all births in Texas, according to a Kasier Family Foundation Report from 2020.

People can apply online at YourTexasBenefits.com or in-person at a Texas Health and Human Services benefits office or partner organization, which can include community clinics like Los Barrios Unidos in Dallas or food banks and churches.

Here’s what you need to know to apply, plus and tips from community providers.

Close to half a million pregnant Texans are currently enrolled in pregnancy Medicaid, and just under 27,000 in CHIP Perinatal, according to the latest data from December 2022 from Texas Health and Human Services.

Bethanne Keating, the director of patient access for Parkland Health in Dallas, coordinates the team that helps sign people up for health coverage at the hospital system. She said Parkland can see up to 40 births a day, so her team aims to work quickly to help patients get connected to all types of funding to cover costs.

“[Patients are] relieved to hear that there’s funding options out there,” she said. “We want to see them, especially for prenatal care. We don’t like when they show up just to deliver because those tend to be more complicated deliveries. We want you to get all the prenatal care that you should have. We want you to have a safe, healthy baby.”

Crystal Marcial, a community health outreach associate for Children’s Defense Fund, assists families applying for CHIP and Medicaid in East Texas. She’s been working with the organization for seven years, and as a mom knows how overwhelming the paperwork can be.

“I have a little boy, and even though I’ve been doing this work, I understand how clients can get a little bit scared of doing the application,” Marcial said. “Some parents actually never send their application in because they just don’t know who to ask for help.”

Jetta Ellis got connected to Marcial, who helped her enroll her children in CHIP, and was on-hand as a resource when she found out she was pregnant again last year. Ellis doesn’t have internet at her home, and so Marcial walked her through the process in-person.

“If I had been stuck trying to do it on my phone, I wouldn’t have done it,” she said. “It’s too much of a headache — I can’t tell what I’ve signed up for, what I need, what documents I need to send them. I’m so glad Crystal was able to help me.”

Pregnancy Medicaid and CHIP Perinatal information

Requirements

Pregnancy Medicaid is currently for U.S. citizens and a very limited number of immigrants. They can’t have insurance through a job or family member. Texas measures this in monthly income; federally this is measured by yearly income. You have to make at or below this amount to qualify:

CHIP Perinatal is for people who are undocumented, most immigrants who are lawful permanent residents (often called green card holders), or don’t qualify for Medicaid because of their income. Here’s a chart that shows the highest amount you can make a month to qualify:

Documents and IDs needed

Something to confirm your identity and any other adult in your house, including a driver’s license, school ID card, passport.

Something to confirm you’ve live in Texas (must be from the past two months), like a utility bill, rent receipt, letter from landlord, ID, or mail with your name and address.

Something to confirm your job, including a completed employment verification form from your employer, last two paychecks, or pay stubs.

Information on pregnancy, such as due date or additional Report of Pregnancy form signed by a doctor or nurse to confirm pregnancy.

Unemployment paperwork (if unemployed and receiving benefits).

Any healthcare bills from the past three months that you want Medicaid to consider covering.

Tiffany Young, the press officer for Texas Health and Human Services, said people have 30 days from the time they apply to get all the verification paperwork submitted.

Processing and Approval

Pregnancy Medicaid and CHIP Perinatal applications are supposed to be processed in 15 days, “even if they’re missing stuff,” said Keating from Parkland Health.

Marcial with Children’s Defense Fund said she’s seen people get approved in three days for CHIP Perinatal, but usually she allows for two weeks of processing time from the Texas Health and Human Services Commission.

Keating said Medicaid workers do have up to 45 days to process a case, but some can be delayed if people are missing income paperwork or other documents.

“I always explained to patients: Sometimes you have to be forceful or upfront,” she said. “If you don’t give me this, then I can’t get it covered.”

According to Young, the department averages about 19 days for processing pregnancy Medicaid applications, and about 20 days for CHIP Perinatal applications. The latest data from February 2023 showed the state only processed about 52% of all submitted Medicaid applications (which includes pregnancy Medicaid) within that 45-day time frame.

Keating said the key is to get an application started as soon as possible.

“Medicaid is not like a faucet; you can’t just turn it on and turn it off real easy,” she said. “It takes a lot to get it on and off.”

Coverage

Pregnancy Medicaid is full Medicaid coverage, up to two months after giving birth. That includes Medicaid coverage for all health care visits, plus prenatal care, labor and delivery, and postpartum care.

CHIP Perinatal is more limited because it covers health care visits only related to the baby’s health. That includes up to 20 prenatal visits and prenatal vitamins. Labor and delivery are covered through emergency Medicaid. Coverage ends after giving birth, but pregnant Texans are allowed two postpartum visits within two months of delivery.

Jetta Ellis was considered a high-risk pregnancy because of her age. She was surprised at how many things were covered under Medicaid.

“I had to have an ultrasound twice a week for the last month of my pregnancy, so that’s pretty pricey,” Ellis said. “I had to be induced and I did get an epidural, which if I hadn’t had Medicaid, I would not have opted for.”

She said she’s paid for births out of pocket before and knows how expensive things can get. She was grateful for the coverage.

“I didn’t have to think, ‘Oh, man, how much is this costing? They’re drawing her blood again, that’s another $300.’ My focus totally got to be on how my baby was doing and what was best for her,” said Ellis.

Are doulas and midwives covered under Medicaid or CHIP Perinatal in Texas?

Marcial said the biggest question she gets from patients is whether doulas are covered under Medicaid. Doulas are not covered, but State Rep. Shawn Thierry (D-Houston) has introduced two bills this legislative session that would launch a pilot program to have doulas covered under Medicaid (House Bill 1958, House Bill 465).

Midwifes and Medicaid-enrolled birthing centers are covered by Medicaid and CHIP Perinatal. A midwife provides all the same care as a doctor or nurse at an OBGYN office

“I’m your person to do everything,” said Krystal Brown, certified midwife and owner of Lovers Lane Birth Center in Richardson. “I do your vital signs, your lab work, your visit, I do it all.”

Midwifery services are usually recommended for low-risk patients. Brown said she screens folks before services to make sure they have insurance coverage and they don’t have any pre-existing conditions that could complicate birth, like seizure disorders or high blood pressure.

“Because you do go home so soon after birth,” she said, “you just don’t have that watchful eye. So, we do try to do what’s the safest for both mom and baby.”

She’s one of the only birthing centers in North Texas that accepts Medicaid. One of the reasons is because approval can take a while.

“The process of getting approved for Medicaid can take anywhere between six months to a year,” Brown said. “Currently, I have someone on staff that I am waiting to be approved for Medicaid, and she’s seeing people and we could potentially not get reimbursed for this.”

The other is because reimbursement rates can be about half the price of private insurance, Brown said.

“I’ve had many midwives come to me and ask, ‘How are you able to do it? They are paying pennies,’” she said. “I’m able to do it because I have no other choice. These are my mamas, and if I don’t see them, then who will?”

Without insurance, midwife services can be anywhere between $4,800 to $7,500 across the Southwest, according to a 2021 article from the International Journal of Environmental Research and Public Health.

“I do not feel like this level of care should be reserved for the moms that can afford it,” Brown said. “I don’t think that’s fair.”

She said she wants everyone to have the option to give birth where they want.

“It’s important for people to know that I’m here,” she said. “Because our moms need us. I mean, literally, our moms need us.”

What’s the future of pregnancy Medicaid coverage in Texas?

A series of maternal health bills have been introduced in the current legislative session, in addition to the pilot program for doula coverage. Arguably the most impactful would expand pregnancy Medicaid to 12 months postpartum, which Ellis said would have helped her after her pregnancy in December. She was scheduled to have surgery on a hernia she got during pregnancy at the end of February, just days before her Medicaid expired.

“If I didn’t have Medicaid, I would have been paying the hospital bill for having birth and then also paying for the surgery,” Ellis said. “That was a lot of anxiety because I’m thinking, OK, this [could be] an $11,000 surgery.”

She said she’s grateful doctors got her a referral quickly, but the time crunch was complicated.

“I very well could have not found this hernia until two or three months down the road, because it is quite a long healing process after you have a baby,” Ellis said. “I’m very thankful, and I have to tell myself that when I get anxious about it.”

Marcial helped more than 100 moms apply for pregnancy Medicaid in 2022 at a resource center in East Texas and thinks extended coverage would help health outcomes for parents and children.

“Anything can happen in a year,” she said. “Mental health and physical health [are] the two most important things that you need to take care of in order to take care of your newborn.”

Brown wants to see quicker processing times for birth centers enrolling in Medicaid and better reimbursement rates. She said that’s all tied together with equitable access to care for patients.

It’s about “looking at us and valuing us as true providers,” Brown said.

Keating said the best advice she has for patients navigating the system is to ask people for help.

“I always tell my staff, it’s a game,” she said. “You have to know the rules to play the game, and the rules change all the time. That’s why it’s difficult for our patients to navigate on their own without advocates. And that’s why I tell anybody who’s trying to do it, ask questions, ask for help. There are people that will help you.”

Contact information to apply for pregnancy Medicaid and CHIP coverage

Texas Health and Human Services resources

Apply and renew benefits online at YourTexasBenefits.com. Benefits can include pregnancy Medicaid, CHIP, SNAP, and support services like resources for caregivers and mental health programs.

Call 211 or 877-541-7905 for help over the phone for applications. To apply in person, find a Texas Health and Human Services benefits office by searching at this link.

Community resources

Medicaid-enrolled clinics, hospitals, and community partners can also help you fill out an application. You can search for these places at this link, but here’s a sample list:

Parkland Health Patient Financial Services – 214-590-8831

Los Barrios Unidos Community Clinic – 214-540-0300

Mosaic Family Services – 214-821-5393

The Concilio – 214-818-0481

Children’s Defense Fund: East Texas office (Smith, Cherokee, Rusk and Gregg counties) – 903-253-8325
Rio Grande Valley (Hidalgo, Cameron and Willacy counties) – 956-483-1544

This is the second in a series of stories investigating maternal and pregnancy health in Texas. If you have questions or tips, email erivera@kera.org. You can follow Elena on Twitter @elenaiswriting.

If you found the reporting above valuable, please consider making a donation here. Your gift helps pay for everything you find on texasstandard.org and KERA. Thanks for donating today.