Texas Medicaid Expansion

Texas does not participate in Medicaid Expansion under provisions of the Affordable Care Act (ACA). For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.

Medicaid in Texas

The Texas Health and Human Services Commission administers the Medicaid Program. Information about the state’s Medicaid program, including patient eligibility information, can be found at: http://www.hhsc.state.tx.us/.

Provider Participation

Providers must enroll in the Medicaid fee-for-service program to receive payments for covered services. Information about enrolling in the Medicaid fee-for-service program can be found at: http://www.tmhp.com/Pages/ProviderEnrollment/PE_TX_Medicaid_New.aspx.
The Medicaid website provides information about services covered by fee-for-service payments and payment amounts: http://www.hhsc.state.tx.us/.
In order to retain access to all Medicaid patients in the state, providers must also connect to the managed care plans individually.

Medicaid Managed Care

Some Texas Medicaid Program beneficiaries are enrolled in managed care plans, called STAR.
Basic information about STAR can be found at: http://www.tmhp.com/Pages/Medicaid/Medicaid_Managed_Care.aspx.
Some managed care plans cover individual Texas counties and independent cities. The Medicaid website has jurisdictional information: http://www.tmhp.com/Pages/Medicaid/Medicaid_Managed_Care.aspx.

STAR Beneficiaries Participating in Managed Care

Managed care plans participating in STAR offer detailed information about covered benefits for individuals enrolling in their plans. This information is available on the managed care websites shown below.

Reporting Problems

The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:

http://www.hhsc.state.tx.us/Medicaid/

888-834-7406

Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

Managed Care Plans Participating in STAR

Aetna Better Health
Plan Website: http://www.aetnamedicaid.com/faq3_en.asp?option=chip
Provider Enrollment: http://www.aetnamedicaid.com/faq3_en.asp?option=04

Amerigroup TX
Plan Website: https://www.myamerigroup.com/English/Medicaid/TX/about/Pages/SSI.aspx
Provider Enrollment: https://providers.amerigroup.com/pages/tx-2012.aspx

Blue Cross and Blue Shield of TX
Plan Website: http://www.bcbstx.com/medicaid/
Provider Enrollment: http://www.bcbstx.com/provider/network/medicaid.html

Christus Health Plan
Plan Website: http://www.christushealthplan.org/
Provider Enrollment: http://www.christushealthplan.org/providers/providers.aspx

Community First Health Plan
Plan Website: http://www.cfhp.com/
Provider Enrollment: http://www.cfhp.com/Providers/index.asp

Community Health Choice
Plan Website: https://www.chchealth.org/default_medicaid.aspx
Provider Enrollment: https://www.chchealth.org/ProviderPortal/Providers/ProviderSecure_Default.aspx

Cook Children’s Health Plan
Plan Website: http://www.cookchp.org/English/Pages/default.aspx
Provider Enrollment: http://www.cookchp.org/english/providers/pages/default.aspx

Driscoll Children’s Health Plan
Plan Website: http://www.dchpkids.com/chip/
Provider Enrollment: http://www.dchpkids.com/providers/login.php

El Paso First CHIP
Plan Website: http://www.epfirst.com/CHIP.html
Provider Enrollment: http://www.epfirst.com/Providers.html

El Paso First Premier Plan
Plan Website: http://www.epfirst.com/PremierPlan.html
Provider Enrollment: http://www.epfirst.com/Providers.html

FirstCare CHIP
Plan Website: https://www.chchealth.org/ProviderPortal/Providers/ProviderSecure_Default.aspx
Provider Enrollment: https://www.chchealth.org/ProviderPortal/Providers/ProviderSecure_Default.aspx

FirstCare STAR
Plan Website: http://www.firstcare.com/STAR_Medicaid
Provider Enrollment: http://www.firstcare.com/provider-relations

HealthSpring
Plan Website: http://starplus.myhealthspring.com/
Provider Enrollment: http://starplus.myhealthspring.com/STARPLUSContact

Molina Healthcare of Texas
Plan Website: http://www.molinahealthcare.com/members/tx/en-us/pages/home.aspx
Provider Enrollment: http://www.molinahealthcare.com/providers/tx/medicaid/Pages/home.aspx

Parkland HealthFirst
Plan Website: http://www.parklandhmo.com/healthfirst%20page.html
Provider Enrollment: http://www.parklandhmo.com/healthfirst%20page.html

Parkland KIDSFirst
Plan Website: http://www.parklandhmo.org/kidsfirst%20page.html
Provider Enrollment: http://www.parklandhmo.com/healthfirst%20page.html

Right Care Scott and White Health Plans
Plan Website: http://rightcare.swhp.org/homepage/rightcare
Provider Enrollment: http://rightcare.swhp.org/prov_contract_req

Sendero Health Plans
Plan Website: http://senderohealth.com/en/
Provider Enrollment: http://senderohealth.com/en/providers/join-our-network

Seton Health Plan
Plan Website: http://www.setonhealthplan.com/members/chip/
Provider Enrollment: http://www.setonhealthplan.com/providers/contact_seton_health_plan

Supervisor HealthPlan
Plan Website: http://www.superiorhealthplan.com/
Provider Enrollment: http://www.superiorhealthplan.com/for-providers/provider-network/

TX Children’s Health Plan
Plan Website: http://www.texaschildrenshealthplan.org/for-members/
Provider Enrollment: http://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.aspx

United Healthcare Community Plan
Plan Website: http://www.uhccommunityplan.com/plan/details/TX/316/CHIP/plan-details
Provider Enrollment: http://www.uhccommunityplan.com/health-professionals/TX/provider-information