The CHIP perinate program will provide services to the unborn children of low-income women who do not qualify for Medicaid or CHIP. In the past, services were provided to these women through a federal-state block grant program known as Title V as well as other local funding.
Benefits/covered services for the Unborn Child (pregnant woman) will be limited to prenatal care, labor with delivery, and postpartum care associated with the birth of the child. Services for the CHIP Perinate Member (Mother of the UNBORN CHIP Perinate Newborn) ARE NOT the standard HMO benefit. After the birth, the CHIP Perinate Newborn will be covered under the standard CHIP HMO benefit package.
The CHIP perinate program begins enrollment 1/1/2007 CFHP and Superior are the health plans who will serve this population in the Bexar Service area. The Bexar service area is inclusive of Bexar County and the surrounding counties - Atascosa, Bandera, Comal, Guadalupe, Kendall, Medina, and Wilson.
For the latest information on the Children's Health Insurance Program (CHIP) visit the Texas Health and Human Services Commission CHIP website.
New Definitions
CHIP Perinate Member: This means the Mother of the UNBORN CHIP Perinate Newborn who is eligible to receive Medically Necessary Covered Services related to antepartum care, labor and delivery services and two post partum visits.
CHIP Perinate Newborn: This means the Newborn child of a CHIP Perinate Member who is eligible to receive Medically Necessary Covered Services through the CHIP Perinatal Benefit Program for the remainder of the twelve-month eligibility period.
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Four Coverage Levels
- Eligible pregnant women in families with incomes at or below 185% of the Federal Poverty Level (FPL)
- Eligible pregnant women in families with incomes between 186% and 200% of the FPL
- CHIP Perinatal Newborn in families with incomes at or below 185% of the FPL
- CHIP Perinatal Newborn in families with incomes between 186% and 200% of the FPL
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Key Components
- 12 month continuous eligibility for unborn children - begins the first of the month the unborn child is eligible (retro enrollment)
- Exempt from 90-day waiting period
- Exempt from CHIP asset test and all cost-sharing
? Parent or guardian may file a Medicaid application at any time
- A renewal application will be mailed in the 10th month of coverage. Subsequent enrollment in 'traditional' CHIP
- Eligible participants that fail to choose a health plan will be defaulted. CHIP families must remain in one plan; siblings of an unborn child will be moved to the plan that the unborn child's plan effective the first possible month, based on cut-off.
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CHIP Perinate Network Structure
- Hospital Facility: University Health System
- Physician Providers: San Antonio Metropolitan Health District, Barrio Comprehensive, El Centro, UT Medicine, CMA
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CHIP Perinate (Mother) with income at or below 185% of the
FPL
COVERED SERVICES:
- Limited, basic prenatal and postpartum care similar to prenatal and postpartum services for Medicaid eligible
- Prenatal care and two post partum visits within 60 days of delivery
- Pharmacy (Vendor Drug Program); limited lab testing; assessments; planning services; education and counseling
- Professional charges for newborn delivery paid by CFHP
- Hospital facility charges for labor with delivery inpatient stay, the initial newborn admission including NICU will be paid by TMHP provided the facility completes the application process for Emergency Medicaid
Limitation: Inpatient stays for conditions other than labor with delivery, including antepartum conditions are not covered.
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CHIP Perinate (Mother) with incomes between 186% and 200%
of the FPL
COVERED SERVICES:
- Limited, basic prenatal and postpartum care similar to prenatal and postpartum services for Medicaid eligible
- Prenatal care and two post partum visits within 60 days of delivery
- Pharmacy (Vendor Drug Program); limited lab testing; assessments; planning services; education and counseling
- Hospital facility and professional charges for labor with delivery inpatient stay only are paid by CFHP
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Limitation:
Inpatient stays for conditions other than labor with delivery, including antepartum conditions are not covered.
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CHIP Perinate Newborn with income at or below 185% of the
FPL
COVERED SERVICES:
- Newborn receives standard CHIP benefits
- Facility charges related to newborn care during initial inpatient stay including NICU will be covered by emergency Medicaid and paid by TMHP if hospital completes the application process
- Professional charges for newborn paid by CFHP
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CHIP Perinate Newborn with income between 186% and 200%
of the FPL
- Standard CHIP coverage without any copay responsibility
- Facility and professional charges for all services related to newborn care are paid by CFHP
- THE CHIP Perinate Newborn benefits are identical to standard CHIP with two exceptions: Smaller network and no copay.
Network:
- Hospital Facilities: University Health System in Bexar County.
Rural hospitals are McKenna in New Braunfels, Guadalupe Valley in Seguin, Medina Community Hospital in Hondo, Connally Memorial in Floresville and South Texas Regional Hospital in Jourdanton.
- Physician Providers: San Antonio Metropolitan Health District, Barrio Comprehensive, El Centro, UT Medicine, CMA
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