Healthy Texas Women 1115 Waiver

The Texas Health and Human Services Commission and the Centers for Medicare and Medicaid Services have reached an agreement to provide comprehensive women’s health services through a Medicaid demonstration waiver over the next five years.

HHS launched the Healthy Texas Women (HTW) program on July 1, 2016. The program provides women's health and family planning services at no cost to eligible, low-income Texas women.

In compliance with Special Term and Condition (STC) 64 Public Access, HHS is posting the CMS approved Evaluation Design for the HTW 1115 waiver. Click to view the CMS approval letter (PDF) and CMS approved HTW Evaluation Design (PDF).

CMS has determined the Implementation plan is complete. Completeness letter (PDF) (1/4/21). The Implementation Plan is included in the CMS approved Healthy Texas Women Section 1115 Demonstration waiver PDF as an attachment.

Post-award Public Forum

On June 21, 2021, at 1 p.m., HHSC will hold a virtual only public forum to present implementation updates on the Healthy Texas Women 1115 waiver and receive public comment.

The most recent HTW annual monitoring report, Demonstration Year 1 (January 2020 – December 2020) is located here (PDF).

Virtual attendees register to attend the webinar here.

About the Demonstration

Through the HTW demonstration, HHS seeks to enhance women's health care services by increasing access to and participation in the HTW program. HTW demonstration services will be made available statewide to eligible women.

The goals and objectives of the HTW demonstration are to:

  • Increase access to women's health and family planning services to avert unintended pregnancies, positively affect the outcome of future pregnancies, and positively impact the health and well-being of women and their families.
  • Increase access to preventive health care, including screening and treatment for hypertension, diabetes and high cholesterol; to positively impact maternal health; and reduce maternal mortality.
  • Increase access to women's breast and cervical cancer services to promote early cancer detection.
  • Implement the state policy to favor childbirth and family planning services that do not include elective abortions or the promotion of elective abortions within the continuum of care or services and to avoid the direct or indirect use of state funds to promote or support elective abortions.
  • Reduce the overall cost of publicly funded health care (including federally funded health care) by providing low-income Texans access to safe, effective services consistent with these goals.

Client benefits and provider requirements are not changing. The waiver requires HHS to comply with federal Medicaid eligibility, application, verification, and demonstration regulations.

Effective February 18, 2020, clients will be provided 95 days (referred to as reasonable opportunity) to provide verification of citizenship or immigration status at initial application. Verification is only required at renewal if there was a change in citizenship or immigration status. If all other eligibility requirements are met besides citizenship or immigration status, an individual is eligible for HTW during the reasonable opportunity period.

Federal Review and Comment Period

On July 5, 2017, CMS notified HHS it has completed its preliminary review and determined the Healthy Texas Women Section 1115 Demonstration Waiver application to be complete, thus beginning the 30-day federal public comment period.

Click below to view the application documents on the CMS website.

Waiver Application Submission

On June 30, 2017, Texas submitted the Healthy Texas Women Section 1115 Demonstration Waiver application to CMS. You may download the submitted cover letter and waiver application by clicking below. The final waiver application submitted to CMS includes a summary of and response to comments received during the public comment period.

Public Notice of Intent

HHS published a public notice of its intent to submit a waiver application in the Texas Register on Friday, May 12, 2017. A more detailed public notice is available for download below.

Draft Waiver Application

You may download the draft waiver application by clicking below.

Additional Information

HHS will maintain this webpage and update it as necessary throughout the demonstration period.

You can learn more about Section 1115 demonstration waivers at the CMS website: – Section 1115 Demonstrations.

Learn about Texas' other Section 1115 demonstration waiver that allows the state to expand Medicaid managed care while preserving hospital funding, provides incentive payments for health care improvements, and directs more funding to hospitals that serve large numbers of uninsured patients: Texas 1115 Healthcare Transformation waiver.