Income Above the Limit for Medicaid for Pregnant Women (TP 40)

When a CHIP perinatal mother whose household income is above the income limit for TP 40 applies for Medicaid for her newborn and HHSC hospital-based staff have information from the applicant or the hospital that the newborn is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the newborn using the following process:

Upon receipt of an application for a Medicaid NICU newborn, HHSC hospital-based staff must perform inquiry to determine if the mother is on CHIP perinatal or whether the newborn has been assigned a TIERS individual identification (ID) number and is active on Medicaid.

If the newborn is not active on Medicaid, staff must deny the CHIP perinatal and certify the eligible newborn for TP 43, if eligible, following existing policy.

If not eligible, test the newborn for TP 56 and do not deny the newborn’s CHIP perinatal coverage.

If eligible, the newborn may receive TP 56 and CHIP perinatal coverage.