Healthy Texas Women does not cover hysterectomy. The program is a limited family planning and preventive health benefit, and major surgery sits outside what it was built to pay for. If an HTW provider finds a condition that may call for a hysterectomy, you will be referred to another provider for the procedure and will need to find a different way to pay for it.1Healthy Texas Women. HTW Questions and Answers
What HTW Pays For
HTW operates under a federal Section 1115 Medicaid waiver that limits spending to family planning services, family planning-related services, preconception care, and limited postpartum care.2Medicaid.gov. HTW 1115 Demonstration Extension Approval It serves women ages 15 through 44 who are uninsured, not pregnant, and have household incomes at or below 204.2 percent of the federal poverty level.3Texas Medicaid & Healthcare Partnership. HTW Program Handbook, February 2026
Covered services include FDA-approved contraception (including tubal ligation for women 21 and older), pregnancy tests, pelvic exams, STI and HIV testing, breast and cervical cancer screenings, mammograms, screening and treatment for hypertension, diabetes, and high cholesterol, several immunizations, and screening and treatment for postpartum depression. The program’s own benefits page states it “pays only for the services listed above.”4Healthy Texas Women. HTW Benefits
Inpatient hospital services and general surgeries are expressly excluded from the demonstration’s benefit package.5Texas Health and Human Services Commission. HTW 1115 Waiver Application Draft HTW does pay for one surgical procedure — sterilization for permanent birth control — but the program handbook draws a clear line between that and hysterectomy, noting that the Title XIX Acknowledgment of Hysterectomy Information form “is not sterilization consent” and belongs to the broader Texas Medicaid program instead.6Texas Medicaid & Healthcare Partnership. HTW Program Handbook, January 2026
HTW Plus Does Not Change This
HTW Plus is an enhanced benefit for women who were pregnant within the previous 12 months. It adds postpartum mental health, cardiovascular, and substance use disorder services. It does not add surgical coverage. Legislative materials establishing the program spell out that services covered by Medicaid for Pregnant Women but not available through HTW Plus include “surgery, cancer treatment, physical therapy, emergency services, hospitalization, and prescription drugs for most medical conditions.”7Texas Legislature. HTW Plus Legislative Handout
What Happens If Your HTW Visit Shows You Need Surgery
Providers are required to refer HTW patients to another provider or clinic when a condition needs care beyond what HTW covers.8Texas Medicaid & Healthcare Partnership. HTW Program Handbook, May 2025 HTW will not pay for the referred services, and you may be responsible for the cost.1Healthy Texas Women. HTW Questions and Answers
There is one exception worth knowing. If a cervical cancer diagnosis comes out of an HTW screening and a hysterectomy is medically necessary as part of that treatment, you can be connected to the Medicaid for Breast and Cervical Cancer program, which provides full Medicaid benefits including cancer treatment and hospital care.9Texas Health and Human Services Commission. Medicaid Breast and Cervical Cancer Program
Full Texas Medicaid Does Cover Hysterectomy
Standard Texas Medicaid (Title XIX) is a different program from HTW, and it does cover hysterectomy as a gynecological service. The Texas Medicaid Provider Procedures Manual lists hysterectomy under gynecological health services and requires providers to obtain a Hysterectomy Acknowledgment form documenting that the patient was told the procedure would end her ability to reproduce.10Texas Medicaid & Healthcare Partnership. Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook, January 2026 For Medicaid managed care members, the procedure is reimbursable when medically necessary to treat an illness or injury, but not when performed solely for sterilization.11Wellpoint. Hysterectomy Reimbursement Policy
Qualifying for full Medicaid in Texas is the hard part. Pregnant women are eligible with incomes up to 198 percent of the federal poverty level, but that coverage ends roughly two months after delivery. Women with breast or cervical cancer can qualify through MBCC. Beyond those categories, eligibility is largely limited to people who are aged, blind, or disabled and receiving SSI, or to parents of minor children with extremely low incomes — roughly 12 percent of the federal poverty level for parents.12healthinsurance.org. Texas Medicaid Eligibility13Every Texan. Most Texas Adults With Serious and Chronic Illnesses Do Not Qualify for Medicaid A non-pregnant, non-disabled woman who needs a hysterectomy for a condition like fibroids will generally not qualify.
Other Ways to Pay for a Hysterectomy
Several Texas programs and policies can help cover the cost when HTW and full Medicaid both fall short.
County Indigent Health Care Program. Texas counties, hospital districts, and public hospitals administer this program for residents with incomes at or below 21 percent of the federal poverty level and resources under $2,000. Covered services include inpatient and outpatient hospital care, which can include surgery. Call 2-1-1 or visit 211Texas.org to find your local program.14Texas Health and Human Services Commission. County Indigent Health Care Program
Hospital district programs. Some districts run their own assistance programs with broader income limits. Montgomery County Hospital District, for example, covers healthcare for residents up to 150 percent of the federal poverty level through its Health Care Assistance Program.15Montgomery County Hospital District. Health Care Assistance Program
Hospital financial assistance. Nonprofit hospitals in Texas have financial assistance policies that can reduce or eliminate bills. The Woman’s Hospital of Texas offers a 100 percent charity discount for patients with incomes up to 200 percent of the federal poverty level.16Woman’s Hospital of Texas. Financial Assistance Texas Health Resources provides aid for patients with incomes up to 250 percent of the poverty level and reviews higher incomes case by case.17Texas Health Resources. Financial Assistance Ask the billing office of the hospital where the procedure would be performed for its specific policy.
Medicaid for Breast and Cervical Cancer. If the hysterectomy is needed because of cervical cancer diagnosed through an HTW or BCCS screening, MBCC can provide full Medicaid benefits covering the surgery and hospital stay.9Texas Health and Human Services Commission. Medicaid Breast and Cervical Cancer Program
HHSC Primary Health Care Services Program and 2-1-1. HTW providers are required to refer patients to this program and to the 2-1-1 hotline for help finding low-cost care.18Texas Health and Human Services Commission. Primary Health Care Program It focuses on primary and preventive care rather than surgery, but it is a useful starting point for mapping out what is available in your area.