Regional Maternal Child Health Program
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Financial Assistance Screening Services

During your first appointment, a financial screener will determine if you quality for the any of programs listed below or for other financial assistance to help cover the cost of our services. We also accept other insurance and cash payments. Major credit cards are also accepted. 

Click here to download and print our brochure Financial Assistance Screening.                    In English or Spanish

Medicaid for Low-income for Pregnant Women
A pregnant woman may receive expanded Medicaid benefits during pregnancy and up to two months after birth if she is able to meet certain income and citizenship requirements.

Medicaid Application

CHIP Perinatal Coverage/Pregnant Woman
CHIP Perinatal coverage provides prenatal care for pregnant woman who meet certain income requirements regardless of citizenship, who do not qualify for Medicaid and who do not have any other health coverage.

Benefits include:

  • 20 prenatal visits
  • prescriptions and prenatal vitamins
  • labor and delivery
  • two checkups for the mother after childbirth
  • regular check-ups and immunization for the baby
  • other CHIP benefits for the baby once after leaving the hospital

Coverage will depend on family income. Some women may be asked to apply for Emergency Medicaid to cover their hospital stay.

CHIP Perinatal Application

UTMB Obstetrics Package
In an effort to keep our patient’s costs as low as possible, UTMB has developed a prepaid Obstetrics Package. If your income level is 200% or above the most recent federal poverty level and you are not eligible for the Medicaid or CHIP Perinatal Program, we offer a prenatal care/hospital delivery and nursery package. Further details about this package are available and will be provided to you during your first visit to our clinic.

Texas Women's Health Program
The Women's Health Program provides limited Medicaid services to women from the ages of 18 to 44, who meet certain income requirements. This program provides one year of coverage and can be renewed each year the woman qualifies.

Benefits include:

  • Comprehensive health history
  • Gynecological exam and Pap smear
  • Screening for diabetes, sexually transmitted diseases, high blood pressure, and breast and cervical cancers
  • Assessment of health risk factors such as smoking and obesity
  • Counseling and education on birth control methods, including abstinence excluding emergency contraception

Texas Women's Health Program Application

Breast & Cervical Cancer Screening Program
Women who are eligible for Cancer Stop services receive a comprehensive physical exam, Pap smear test, and screening mammogram on an annual basis at one of the RMCHP clinics. If an abnormality is detected, the patient may then be referred for further testing through the UTMB Departments of Radiology, Obstetrics/Gynecology or Surgery.

Medicaid for Breast and Cervical Cancer
Women who have been diagnosed with breast or cervical cancer may be able to get health care coverage for cancer treatment through Medicaid.

To receive Medicaid for breast and cervical cancer, a woman must be:

  • a US citizen
  • diagnosed on or after Sept 1, 2007
  • Found to need treatment for one of the following types of breast or cervical cancers
    • CIN III
    • severe cervical dysplasia
    • cervical carcinoma in-situ
    • invasive cervical cancer
    • ductal carcinoma in situ
    • invasive breast cancer
  • meet certain income requirements
  • not have other insurance coverage for the treatment of cancer
  • be under the age of 65

For more information on breast and cervical cancer services in Texas click the following link:
Texas DSHS Breast and Cervical Cancer Program

 

What do I need to bring with me for financial assistance screening?

We have many special programs that can financially assist you with your healthcare costs. Many of these programs are based on income. If you are interested in applying for a one of these programs, we request you bring the necessary documents with you to your first visit to the clinic.  A financial screener will help you apply for any state funded program for which you might qualify.

PLEASE BRING THE FOLLOWING DOCUMENTS WITH YOU TO YOUR FIRST VISIT TO THE CLINC:

  • PROOF OF RESIDENCY: Bring One
    • Current Utility bill showing name and address, or utility receipt with name and address
    • Current Medicaid Letter
    • Current Social Security Award Letter, Check or current printout
    • Current School Records verifying address
    • Current Billing Statement or business mail from State/Country/City
    • Current Pre-printed Rent Receipt or Lease Agreement
    • If you are living with a relative or friend, you must have a notarized letter stating such, with current utility bill or rent receipt
  • DEPENDENT INFORMATION:
    • Current Medicaid Eligibility Letter
    • Social Security Card
    • Birth Certificate(s)
    • Prior Year Income Tax Return
    • Any Reasonable document which shows the parent (guardian)- child relationship
  • INCOME INFORMATION: Bring ALL that apply.
    • Four (4) most recent paycheck stubs, two (2) stubs is paid biweekly; one (1) stub if paid monthly
    • Current Retirement Income check stub(s)
    • Current Social Security Award letter for both spouses and any children
    • Current Letter from employer on the company letterhead (only if paid in cash)
    • Current Veterans Administrator Award Letter(s)
    • Current Child Support Statement (stub) or Divorce Decree
    • Current Documentation from the Texas Employment Commission – if not employed
    • Current Proof of Direct Deposit of Fixed Income Tax Form with all attachments
    • Current AFDC/Medicaid Check Copy or Award Letter
  • INSURANCE OR THIRD PARTY COVERAGE INFORMATION: If Applicable.
    • Copy of Insurance Card (front/back). Must show Insurance Company’s name; Address; Policy Number; Certificate Number
    • Medicare Identification Card
    • Letter from Country Indigent Health Program
    • Medicaid Identification Letter (current month)