Texas Form H3037, Report of Pregnancy, is the Texas Health and Human Services Commission (HHSC) document that verifies your pregnancy for Medicaid for Pregnant Women and CHIP Perinatal coverage. You don’t fill it out yourself. Your HHSC advisor prepares the identifying section and either mails the form directly to your prenatal provider or hands it to you to bring to an appointment; your provider completes the medical section, signs it, and returns it so HHSC can finalize eligibility.1Texas Health and Human Services. Form H3037, Report of Pregnancy
Who Prepares It and Who Signs It
The form has two parts. The advisor fills in the top: your name (listed as “Name of Patient”), the case name if the benefits case is in someone else’s name, and the HHSC case number. There is no Social Security number field.2Texas Health and Human Services Commission. H3037 Report of Pregnancy
The medical section and signature come from your provider. Texas accepts the form from four categories of medical professionals:
- A licensed physician.
- An advanced nurse practitioner, a category that includes certified nurse-midwives.
- A registered nurse practicing within their scope.
- Another medical professional acting under a physician’s orders, in which case the supervising physician’s name and phone number must also appear on the form.3Texas Health and Human Services. D-230, Application Processing Time Frames
The signer also prints their name, dates the form, and provides their address and phone number.2Texas Health and Human Services Commission. H3037 Report of Pregnancy A front-desk staff member or medical assistant signing on their own won’t be accepted unless they meet the fourth category and include the supervising physician’s information.
If the form isn’t returned within 10 days, the advisor follows up with the provider or with you.1Texas Health and Human Services. Form H3037, Report of Pregnancy
What the Provider Fills In
The medical section is short. Your provider records:
- The calendar month the pregnancy began.
- Whether more than one child is expected, and if so, how many. Texas counts each expected child in the household size, so this figure affects the benefit determination.
- The expected delivery date, which sets the coverage window.
- Any disabling conditions caused by the pregnancy, and whether you are in the sixth through ninth months.1Texas Health and Human Services. Form H3037, Report of Pregnancy
How To Submit the Completed Form
Most of the time the provider mails the signed form back to HHSC in the self-addressed envelope the advisor included. If it ends up in your hands, you can return it through any channel HHSC accepts for benefits documents.4Texas Health and Human Services. Benefits Application Next Steps
Upload Online or Through the App
Sign in at YourTexasBenefits.com and upload a scan or photo. You need a case access account, which is the account type that shows all your case details. The Your Texas Benefits mobile app also lets you upload from the Case Summary screen. Uploads are capped at 30 megabytes, roughly 20 photos.5Texas Presumptive Eligibility. Overview and Quick Tips: Your Texas Benefits App
Fax
Fax the form to 1-877-447-2839. Keep the confirmation as proof of the date and time.4Texas Health and Human Services. Benefits Application Next Steps
Send it to:
HHSC
P.O. Box 149027
Austin, TX 78714-90274Texas Health and Human Services. Benefits Application Next Steps
In Person
Bring the form to a local HHSC benefits office. Staff can scan it into your case while you wait, so there is no question about whether it arrived.
What Happens After HHSC Receives It
HHSC targets 15 business days from the date it received your application to make a decision, and the pregnancy verification is one piece of that timeline. If the form arrives promptly, it shouldn’t push the determination past that window.6Texas Health and Human Services. A-140, Expedited Service Most verification items other than identity can be postponed until the 30th calendar day, so coverage can sometimes start before every document has cleared.
You can track your case at YourTexasBenefits.com or in the app. If something is missing, HHSC sends Form H1020, Request for Information or Action, which lists what’s needed and sets a deadline.7Texas Health and Human Services. Form H1020, Request for Information or Action Missing that deadline can lead to denial.8Texas Health and Human Services. Form H1020 – Request for Information or Action Once everything checks out, HHSC sends a Notice of Case Action confirming approval.3Texas Health and Human Services. D-230, Application Processing Time Frames
Income Limits That Go With the Medical Verification
Form H3037 only handles the medical side. You also have to meet the income rule for one of two coverage paths:
- Medicaid for Pregnant Women covers pregnant individuals with household income up to 198% of the federal poverty level.9MACPAC. Medicaid and CHIP Income Eligibility Levels as a Percentage of the Federal Poverty Level for Children and Pregnant Women by State
- CHIP Perinatal covers the unborn child when household income falls between 199% and 202% of the FPL, and is also available at or below 202% FPL for those who don’t qualify for Medicaid due to immigration status.10Community First Health Plans. CHIP Perinatal
Neither program applies an asset test. Savings, a vehicle, and home value do not count against you. Only household income does.
If HHSC Denies Your Application
You have 90 calendar days from the date of the case action to request a fair hearing. You can file the appeal in writing, by calling 2-1-1, or at a local HHSC office.11Texas Health and Human Services. Fair and Fraud Hearings To keep current benefits running while the appeal is pending, file before the effective date on the Notice of Case Action. You can still file after 90 days; the hearings office decides whether you had good cause and whether to proceed.12Texas Health and Human Services. Appeals and Fair Hearings