Email, Bryan Black, press officer, Texas Health and Human Services Commission, May 16 and 18, 2016
3:18 p.m.
Q - I write to check on whether the CHIP program provides perinatal coverage for up to a year. If not, what time period of perinatal care does the CHIP cover? What would it take for the program to provide one-year coverage?
A - For CHIP Perinate members whose household income is greater than 185 percent FPL, coverage lasts during their mother's pregnancy and continues after birth for the remainder of the 12-month period. For CHIP Perinate members whose household income is less than or equal to 185 percent FPL, CHIP coverage lasts through their mother's pregnancy, and at birth, they are eligible for, and are enrolled in Medicaid.
Q - Do CHIP perinatal care and Medicaid both provide for optional screening and treatment for postpartum depression for eligible women? If not, what would it take for that to change?
A - Texas Medicaid provides coverage, including optional screening and treatment for postpartum depression, for eligible women 60-days postpartum.
The Texas CHIP Perinatal program is provided through an option to include in the definition of a "targeted low-income child" the period from conception to birth (42 CFR 457.10). Under this option, the coverage is for the unborn child, and not the mother. Texas has elected to provide CHIP Perinatal services through this option and offer a benefit package limited to pregnancy-related services. States can choose to provide limited postpartum care if it is paid for as part of a bundled payment that includes prenatal, labor, delivery and postpartum services (State Health Official Letter #02-004, November 12, 2003). The Texas CHIP Perinatal program covers two postpartum visits, which could include an optional screening for postpartum depression, within 60 days of birth through the bundled payment option. Treatment for postpartum depression is not covered, because the Texas CHIP Perinatal program does not include mental health benefits for the mother. (Please note if the mother were under age 19 and eligible herself for CHIP services, treatment for postpartum depression would be a covered benefit.)
To allow for treatment of postpartum depression under CHIP Perinatal, Texas Medicaid would need legislative direction to implement one of two options. One option would be to expand the benefit package under the unborn child option to include additional services, including mental health benefits. The other option would be to cover pregnant women in CHIP who are at income levels in excess of the Medicaid threshold of 185 percent FPIL. Congress added this option to cover pregnant woman, including services for the mother 60 days postpartum, under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).
8:31 a.m.
May 18, 2016
We need to correct our response regarding perinatal coverage to show Medicaid eligibility is up to and including 198 percent Federal Poverty Income Limit (FPIL), not 185 percent FPIL. Also, we added some clarifying language in the first response regarding applying for Medicaid. Sorry for any confusion this may have caused.
Q - I write to check on whether the CHIP program provides perinatal coverage for up to a year. If not, what time period of perinatal care does the CHIP cover? What would it take for the program to provide one-year coverage?
A - For CHIP Perinate members whose household income is greater than 198 percent of the federal poverty income limit (FPIL), the mother's coverage lasts until the member is born at which time the member continues to receive CHIP Perinate for the remainder of the 12-month period.
For CHIP Perinate members whose household income is less than or equal to 198 percent FPIL, CHIP Perinate coverage lasts through the end of the month of the mother's pregnancy (birth of member). At that time, the mother must apply for Emergency Medicaid. Emergency Medicaid only covers labor and delivery services and does not provide for ongoing Medicaid benefits. Once the mother has been determined eligible for Emergency Medicaid, the newborn is deemed eligible to receive Medicaid for 12 months from birth.
Q - Do CHIP perinatal care and Medicaid both provide for optional screening and treatment for postpartum depression for eligible women? If not, what would it take for that to change?
A - Texas Medicaid provides coverage, including optional screening and treatment for postpartum depression, for eligible women 60-days postpartum.
The Texas CHIP Perinatal program is provided through an option to include in the definition of a "targeted low-income child" the period from conception to birth (42 CFR 457.10). Under this option, the coverage is for the unborn child, and not the mother. Texas has elected to provide CHIP Perinatal services through this option and offer a benefit package limited to pregnancy-related services. States can choose to provide limited postpartum care if it is paid for as part of a bundled payment that includes prenatal, labor, delivery and postpartum services (State Health Official Letter #02-004, November 12, 2003). The Texas CHIP Perinatal program covers two postpartum visits, which could include an optional screening for postpartum depression, within 60 days of birth through the bundled payment option. Treatment for postpartum depression is not covered, because the Texas CHIP Perinatal program does not include mental health benefits for the mother. (Please note if the mother were under age 19 and eligible herself for CHIP services, treatment for postpartum depression would be a covered benefit.)
To allow for treatment of postpartum depression under CHIP Perinatal, Texas Medicaid would need legislative direction to implement one of two options. One option would be to expand the benefit package under the unborn child option to include additional services, including mental health benefits. The other option would be to cover pregnant women in CHIP who are at income levels in excess of the Medicaid threshold of 198 percent FPIL. Congress added this option to cover pregnant woman, including services for the mother 60 days postpartum, under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).