Healthy Texas Women 1115 Demonstration

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

HHSC 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 demonstration. Read the CMS approval letter (PDF) and CMS approved HTW Evaluation Design (PDF).

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

Read the HTW annual monitoring report, Demonstration Year 3 (January 2022 – December 2022) (PDF).

Post-award Public Forum

On June 8, 2023, at 9 a.m., HHSC will hold a hybrid public forum with both virtual and in person options, pertaining to the progress of the Healthy Texas Women 1115 demonstration and receive public comment. The public forum will be held in conjunction with the quarterly Medical Care Advisory Committee (MCAC) meeting and will be located at the Texas Health and Human Services Commission, John H. Winters Building, Public Hearing Room 124, First Floor, 701 West 51st Street, Austin, Texas 78751. 

About the Demonstration

Through the HTW demonstration, HHSC 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 HHSC to comply with federal Medicaid eligibility, application, verification, and demonstration regulations.

Effective Feb. 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 HHSC 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.

Access 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 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

HHSC 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

Additional Information

HHSC 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.

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.