Medical Programs
A pregnant woman who enters the state prison system is sent to the Texas Department of Criminal Justice women's facility. Before the baby is born, the prison social worker assists the pregnant woman to arrange for a responsible individual to pick up the baby from the hospital. The pregnant woman is sent to a prison section of the University of Texas Medical Branch (UTMB) in Galveston a few weeks before she is due to deliver, unless an emergency occurs earlier. If an emergency does occur, she will deliver at a closer facility when necessary. Before releasing the baby from the hospital, UTMB requires the individual who picks up the baby to complete an application for Medicaid. Designated Texas Works advisors ensure that the baby is certified for Medicaid using special application processing procedures and follow-up activities.
The designated advisors coordinate Medicaid certification by other advisors in special situations when the newborn needs to be added to an active case. Upon request by the designated advisors, which must be documented in the case record, an advisor must certify the newborn:
for Medicaid (TP 43) from the date of birth (DOB), not the day the caretaker brought the baby home from the hospital; or
after normal application time frames have passed. If needed, staff may follow procedures to request a timeliness exception.
State law requires Medicaid coverage for Texas newborns for at least 28 days after birth and possibly longer if the child is hospitalized at that time. If the hospital followed required procedures before releasing the baby, but the baby does not meet eligibility requirements for Medicaid, the designated advisor and State Office Data Integrity (SODI) staff certify the baby for TA 62, MA - State-Paid Coverage. Examples of not meeting eligibility requirements are:
the individual caring for the child does not reside in Texas, and the baby will be taken out of state;
the individual caring for the child refuses to apply for Medicaid; or
the household is over the income limit.