Table of Contents Previous Next Index

2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 3. Women’s Health Program (Title XIX Family Planning) : 3.2 WHP Overview : 3.2.3 Abortions

Elective and non-elective abortions are not reimbursable services under the WHP.
In addition, Section 32.0248, Human Resources Code, prohibits payment of WHP funds to a provider that performs elective abortions. A provider that performs elective abortions (through either surgical or medical methods) for any patient is ineligible to serve WHP clients and cannot be reimbursed for those services. This prohibition has been in effect since September 1, 2005. This prohibition only applies to providers delivering services to WHP clients. The prohibition does not impact services delivered to Medicaid clients not enrolled in the WHP.
“Elective abortion” means the use of any means to terminate the pregnancy of a female whom the attending physician knows to be pregnant with the intention that the termination of the pregnancy by those means is reasonably likely to cause the death of the fetus, except that the term does not include an abortion: (1) to terminate a pregnancy that resulted from an act of rape or incest; or (2) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place a woman in danger of death unless an abortion is performed.
Each year, WHP providers must disclose to TMHP, in writing, whether or not they have performed elective abortions within the past calendar year. WHP providers must complete the WHP Provider Certification form with an original signature. Providers may also use the TMHP website to disclose the required information. The written form must be completed and submitted with an original handwritten signature, even if the information is additionally submitted online.
Submitting the certification online will display for clients on the Online Provider Lookup (OPL) that the provider renders WHP services.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.