On March 28, 2024, the Texas Health and Human Services Commission (HHSC) submitted an application to extend the Health Care For Healthy Texas Women Program, a Medicaid 1115(a) demonstration waiver, to the Centers for Medicare and Medicaid Services (CMS). This extension aims to continue providing crucial health services to low-income Texas women.
Key Changes Proposed for the Healthy Texas Women Program
The proposed extension for the Health Care for Healthy Texas Women program requests a five-year continuation, from January 1, 2025, through December 31, 2029. A significant change proposed is the transition from a fee-for-service model to a managed care model. This shift aims to improve cost efficiency, enhance access to care, and better integrate services for women transitioning between different life stages and healthcare programs. Tribal members will have the option to remain in the fee-for-service model.
This transition to managed care within the Health Care for Healthy Texas Women program is projected to start in the first quarter of the 2026 state fiscal year. This structural change is expected to reduce costs, improve access to preventive care, and strengthen care coordination through primary care providers and tailored services. The goal is to ensure a seamless transition for women moving between programs like STAR, CHIP, and HTW, providing continuous care throughout their lives.
Public Comment Period and Application Details
A 30-day federal public comment period began on April 4, 2024, following CMS’s preliminary review. The complete application packet for the Health Care for Healthy Texas Women program extension, including responses to previous public comments, is available for download on the HHSC website.
The extension application also addresses an increase in the state’s comparable income limit, aligning it with the Modified Adjusted Gross Income (MAGI) standard. This adjustment allows more women to qualify for the program.
Focus on Evaluation and Continued Improvement of the Healthy Texas Women Program
HHSC is committed to ongoing evaluation of the Health Care for Healthy Texas Women program. This evaluation will focus on the impact of the transition to managed care, analyzing its effects on access, quality, and cost of care. New evaluation components will be implemented as needed to thoroughly assess the effectiveness of the program under the managed care model.
Program Goals and Objectives
The core goals of the Health Care for Healthy Texas Women program remain consistent:
- Preventing unintended pregnancies through improved access to family planning and women’s health services.
- Improving maternal health outcomes and reducing maternal mortality.
- Enhancing access to preventive care, including screenings and treatment for chronic conditions.
- Promoting early detection of breast and cervical cancer.
- Ensuring cost-effective, quality care for low-income Texas women.
The program will continue to operate statewide, with no changes to eligibility requirements or client cost-sharing. The transition to managed care is the primary proposed change, designed to optimize service delivery and improve health outcomes for Texas women. More information about the Health Care for Healthy Texas Women program can be found on the HHSC website.
