As of March 1, 2024, the Texas Health and Human Services Commission (HHSC) has implemented a new policy that provides 12 months of postpartum Medicaid coverage for women who are enrolled in Medicaid when their pregnancy ends. This change was made possible through House Bill 12, passed by the 88th Texas Legislature.
What This Means for You:
If you were covered by Medicaid during your pregnancy, you may now qualify for continued Medicaid coverage for up to 12 months after your pregnancy ends. However, some Members have recently experienced coverage denials or disruptions in their Medicaid benefits during this postpartum period.
HHSC has received cases submitted by health plans and has taken action to correct any errors. In cases where coverage was incorrectly denied, HHSC has reinstated Medicaid eligibility without a gap in coverage. Affected Members will receive a Form TF0001 – Notice of Case Action confirming their eligibility.
Why Coverage May Be Denied:
There are certain reasons why postpartum coverage may be denied, including:
- Voluntarily withdrawing from benefits
- Not meeting eligibility requirements at the time of certification
- Failing to submit required documents
- Moving out of Texas
- In the unfortunate event of a member’s passing
What Happens Next:
- If your eligibility was restored but coverage has ended, you may receive fee-for-service Medicaid for those months.
- If your eligibility is ongoing, you will be automatically re-enrolled in your previous health plan and continue receiving managed care coverage.
For example:
- If your postpartum coverage was reinstated for March–August 2025, and your eligibility was confirmed before March, your managed care will continue without interruption.
- If eligibility was reinstated after coverage ended, services for those months may be covered through fee-for-service Medicaid rather than through your health plan.
Need Help or Have Questions?
If you were impacted and have questions about your Medicaid coverage or billing for services during this time:
- Call 2-1-1, then choose Option 4 for Medicaid support.
- Or contact Community First Member Services at 1-855-607-7827
You can also learn more about postpartum Medicaid coverage by visiting the resources below from the Texas Health and Human Services Commission (HHSC):
We’re here to help you understand your coverage and support your continued access to care during the postpartum period.