The New Managed Care Environment in Texas:

A guide to anticipating common questions around the March 1st rollout

As March 1, 2012 draws nearer, Medicaid and CHIP enrollees across the state need to be prepared to operate in a new managed care environment. By now, Medicaid recipients in the Hidalgo and rural service areas have selected health plans and primary care providers (PCP) for the first time – or if they haven’t made these selections, the Health and Human Services Commission (HHSC) has assigned them using a default methodology. In other parts of the state that have already transitioned to managed care, some new health plans will be operating starting March 1st. And for the first time, Medicaid recipients will need to designate a dental plan and a main dentist.

The following information is effective as of March 1, 2012. For more details, health centers can consult the Uniform Managed Care Manual, which is available here on the Texas Health and Human Services Commission website.[1]

How to change a MEDICAIDhealth plan or dental plan

Medicaid enrollees can change their health or dental plan by calling the Texas STAR and STAR+PLUS Program Helpline at 1-800-964-2777. During the first 90 days after enrollment, members can changeplans one timefor any reason. After 90 days with a health or dental plan, members can change to another plan once more for any reason.[2] If there is a demonstration of good cause[3], an individual can also change health or dental plans at any time.

If an enrollee wishes to change his or her health plan and their PCP, the STAR and STAR+PLUS Program Helpline can assist with these changes. However, if the enrollee wishes only to change the PCP selection, then he or she must call the health or dental plan directly.

Please note that if the Medicaid recipient is in the hospital, a residential Substance Use Disorder (SUD) treatment facility, or residential detoxification facility for SUD, he or she will not be able to change health plans until he or she is discharged from the facility.

How to change a CHIPhealth plan or dental plan

CHIP enrollees can change their health or dental plan by calling the Texas CHIP Helpline at 1-800-647-6558. CHIP enrollees may change health or dental plans one time for any reason within the first 90 days after enrollment and for good cause at any time. These same policies apply to CHIP perinate enrollees. CHIP health plan enrollees may also change health plans during the annual CHIP re-enrollment period. CHIP dental enrollees cannot change plans if they have reached their annual dental benefit limit.

When health plan and dental plan changes take effect

The following timeframes apply to health and dental plan changes for both the Medicaid and CHIP programs. Requests to change a health or dental plan made on or before the 15th of the month will be effective on the first day of the next month. Requests to change a health or dental plan made after the 15th of the month will be effective on the first day of the second month after that. For example:

  • A change made on or before April 15 will be effective on May 1.
  • A change made after April 15 will be effective on June 1.

How to change a primary care provider or main dentist

There is no limit on how many times an individual can change a primary care provider (PCP) or main dentist. In order to do this, enrollees must call their health or dental plan directly. The contact numbers are listed in the table below, along with a link to the provider directory.

When primary care provider and main dentist changes take effect

The HHSC website notes that the change should be effective the first day of the following month,[4] but unfortunately there is no uniformity among health and dental plans regarding when these changes take effect. Amerigroup and DentaQuest indicate that changes are effective on the same day they are requested, whereas Molina indicates that the change will be effective on the first day of the next month. Superior states that changes will be effective the first day of the following month, but mentions that depending on the circumstances the change can be effective immediately. Health centers should encourage their patients to request that the PCP or main dentist change be effective immediately, and if it isn’t the patients should ask when the change will take effect.

Services that do not require a referral from the primary care provider

Some services do not require a referral from the primary care provider[5], including:

  • True Emergency Services;
  • Eye care from a health plan provider;
  • OB/GYN care from a health plan provider;
  • Women’s health screenings and contraceptives;
  • Mental health and substance abuse treatment from a health plan provider;
  • Texas Health Steps check-ups; and
  • After hours care – note that a specific modifier is needed for billing.

Updates to provider directories

In order for patients to select their health center as their PCP or main dentist, health centers must be listed appropriately in the provider directories. Health centers are encouraged to use the information in the table below to monitor how their providers and services are presented in the provider directories.

Keeping your center’s information current. Health centers should be aware that network providers must inform both the MCO and HHSC’s Administrative Services Contractor of any changes to the provider’s address, telephone number, group affiliation, or other change.[6] Centers are also advised that the process for updating each MCO provider directory will vary somewhat because each MCO uses a slightly different credentialing process.

Helping patients to find the most current version of the Provider Directory. The Uniform Managed Care Contract[7] sets out specific guidelines for updating the provider manuals. Each managed care organization (MCO) must update the Provider Directory on a quarterly basis. The MCO is required to make those changes available to existing members on request and to the HHSC Administrative Services Contractor at the beginning of each state fiscal quarter (September, December, March, June). At least once a year, each MCO must include written and verbal offers of the Provider Directory in its member outreach efforts and education materials.

MCOs are required to update the Online Provider Directory at least twice a month. The same guideline applies to the online Provider search function. If your patients can’t locate your health center in the provider directory, be sure they know that they can request the most recent version from the MCO and that the online directory will be even more current.

Resources for patients

In addition to the table below, which has the contact information for every STAR, STAR+PLUS, STAR Health, CHIP health and dental plan by service area, TACHC has also prepared bilingual handouts by region for centers to give to their patients that are available on the Managed Care section of the TACHC website. This information should prepare patients and health center to advocate for themselves and to ask the right questions as these managed care transitions take place. As always, please do not hesitate to contact TACHC if we can be of service to you.

Service Area / STAR Medicaid / STAR+PLUS Medicaid / CHIP
Bexar: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson / Aetna
Provider Directory
1-800-556-1555
TDD 1-800-735-2989
Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Community First
Provider Directory
(210) 358-6060
1-800-434-2347
TDD (210) 358-6080
1-800-390-1175
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
(866) 516-4501
TDD 1-800-735-2989 / Aetna
Provider Directory
1-800-556-1555
TDD 1-800-735-2989
Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Community First
Provider Directory
(210) 358-6300
TDD (210) 358-6080
1-800-390-1175
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989
Dallas: Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Parkland
Provider Directory
1-888-672-2277
TDD 1-800-735-2989 / Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
(866) 516-4501
TDD 1-800-735-2989 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Parkland
Provider Directory
1-888-814-2352
TDD 1-800-735-2989
Service Area / STAR Medicaid / STAR+PLUS Medicaid / CHIP
El Paso: El Paso, Hudspeth / El Paso First
Provider Directory
(915) 532-377
1-877-532-3778
TDD: 915-532-3740
1-855-532-3740
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954 / El Paso First
Provider Directory
(915) 532-377
1-877-532-3778
TDD: 915-532-3740
1-855-532-3740
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989
Harris: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, Wharton / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Community Health Choice
Provider Directory
(713)295-2294
1-888-760-2600
TDD 1-866-581-9328
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Texas Children’s
Provider Directory
1-866-959-2555
TDD 1-800-735-2989
United
Provider Directory
1-888-887-9003
TDD 711 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
United
Provider Directory
1-888-887-9003
TDD 711 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Community Health Choice
Provider Directory
(713)295-2294
1-888-760-2600
TDD 1-866-581-9328
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Texas Children’s
Provider Directory
1-866-959-6555
TDD 1-800-735-2989
United
Provider Directory
1-888-887-9003
TDD 711
Service Area / STAR Medicaid / STAR+PLUS Medicaid / CHIP
Hidalgo: Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, Zapata / Driscoll
Provider Directory
1-855-425-3247
TDD 1-800-855-2880
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989
United
Provider Directory
1-888-887-9003
TDD 711 / Health Spring
Important Numbers
1-877-966-9272
TDD 7-1-1
TDD (English):
800-735-2989
TDD (Spanish):
800-662-4954
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
(866) 516-4501
TDD 1-800-735-2989 / Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989
Jefferson: Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, Walker / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Community Health Choice
Provider Directory
(713)295-2294
1-888-760-2600
TDD 1-866-581-9328
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Texas Children’s
Provider Directory
1-866-959-2555
TDD 1-800-735-2989
United
Provider Directory
1-888-887-9003
TDD 711 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
United
Provider Directory
1-888-887-9003
TDD 711 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Community Health Choice
Provider Directory
(713)295-2294
1-888-760-2600
TDD 1-866-581-9328
Molina
Provider Directory
1-866-449-6849
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Texas Children’s
Provider Directory
1-866-959-6555
TDD 1-800-735-2989
United
Provider Directory
1-888-887-9003
TDD 711
Service Area / STAR Medicaid / STAR+PLUS Medicaid / CHIP
Lubbock: Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher, Terry / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
FirstCare
Provider Directory
1-800-431-7798
TDD 1-800-562-5259
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Superior
Provider Directory
(866) 516-4501
TDD 1-800-735-2989 / FirstCare
Provider Directory
1-800-431-7798
TDD 1-800-562-5259
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989
Nueces: Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio, Victoria / Christus
Provider Directory
1-877-428-3057
TDD 1-800-735-2689
Driscoll
Provider Directory
1-877-220-6376
TDD 1-800-855-2880
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989 / Superior
Provider Directory
(866) 516-4501
TDD 1-800-735-2989
United
Provider Directory
1-888-887-9003
TDD 711 / Christus
Provider Directory
1-800-359-5613
TDD 1-800-735-2689
Driscoll
Provider Directory
1-877-451-5598
TDD 1-800-855-2880
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989
Tarrant: Denton, Hood, Johnson, Parker, Tarrant, Wise / Aetna
Provider Directory
1-800-359-5613
TDD 1-800-735-2989
Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Cook Children’s
Provider Directory
1-800-964-2247
(682) 885-2247
TDD (682) 885-2138 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Bravo
Provider Directory
1-877-966-9272
TDD 7-1-1
TDD (English):
800-735-2989
TDD (Spanish):
800-662-4954 / Aetna
Provider Directory
1-800-359-5613
TDD 1-800-735-2989
Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Cook Children’s
Provider Directory
1-800-964-2247
(682) 885-2247
TDD (682) 885-2138
Service Area / STAR Medicaid / STAR+PLUS Medicaid / CHIP
Travis: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson / BCBS
Provider Directory
1-888-292-4480
TDD 1-888-292-4485
Seton
Provider Directory
1-877-451-5601
TDD 800-855-2880
Sendero
Provider Directory
1-855-526-73881-TDD 1-800-855-2880
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989 / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
United
Provider Directory
1-888-887-9003
TDD 711 / BCBS
Provider Directory
1-888-292-4480
TDD 1-888-292-4485
Seton
Provider Directory
1-877-451-5601
TDD 800-855-2880
Sendero
Provider Directory1-855-526-73881
TDD 1-800-855-2880
Superior
Provider Directory
1-800-783-5386
TDD 1-800-735-2989
MRSA* Central: Bell, Blanco, Bosque, Brazos, Burleson, Colorado, Comanche, Coryell, DeWitt, Erath, Falls, Freestone, Gillespie, Gonzales, Grimes, Hamilton, Hill, Jackson, Lampasas, Lavaca, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Somervell, Washington / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Scott & White
Provider Directory
1-855-897-4448
TDD 1-866-220-2880
Superior
Provider Directory
1-877-644-4494
TDD 1-800-735-2989 / Molina
Provider Directory
1-877-319-6826
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
1-800-820-5685
TDD 1-800-735-2989
MRSA* Northeast: Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Cooke, Delta, Fannin, Franklin, Grayson, Gregg, Harrison, Henderson, Hopkins, Houston, Lamar, Marion, Montague, Morris, Nacogdoches, Panola, Rains, Red River, Rusk, Sabine, San Augustine, Shelby, Smith, Titus, Trinity, Upshur, Van Zandt, Wood / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
Superior
Provider Directory
1-877-644-4494
TDD 1-800-735-2989 / Molina
Provider Directory
1-877-319-6826
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
1-800-820-5685
TDD 1-800-735-2989
Service Area / STAR Medicaid / STAR+PLUS Medicaid / CHIP
MRSA* West: Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Brewster, Briscoe, Brown, Callahan, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Concho, Cottle, Crane, Crockett, Culberson, Dallam, Dawson, Dickens, Dimmit, Donley, Eastland, Ector, Edwards, Fisher, Foard, Frio, Gaines, Glasscock, Gray, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Howard, Irion, Jack, Jeff Davis, Jones, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lipscomb, Loving, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Palo Pinto, Parmer, Pecos, Presidio, Reagan, Real, Reeves, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Taylor, Terrell, Throckmorton, Tom Green, Upton, Uvalde, Val Verde, Ward, Wheeler, Wichita, Wilbarger, Winkler, Yoakum, Young, Zavala / Amerigroup
Provider Directory
1-800-600-4441
TDD 1-800-855-2880
FirstCare
Provider Directory
1-800-431-7798
TDD 1-800-562-5259
Superior
Provider Directory
1-877-644-4494
TDD 1-800-735-2989 / Molina
Provider Directory
1-877-319-6826
TDD (English):
1-800-735-2989
TDD (Spanish):
1-800-662-4954
Superior
Provider Directory
1-800-820-5685
TDD 1-800-735-2989
Statewide – STAR Health / Superior STAR Health
Provider Directory
1-866-912-6283
TDD 1-800-735-2989
Statewide – Medicaid & CHIP Dental / Delta Dental
Medicaid: 1-877-535-5896
Medicaid member site
CHIP: 1-866-561-5892
CHIP member site
TDD 7-1-1
DentaQuest
Member site
Medicaid: 1-800-516-0165
CHIP: 1-800‐508‐6775
TDD 1- 800‐855‐2880
MCNA Dental
Member site
Medicaid & CHIP: 1-855-691-6262
TDD 1-800-735-29

[1] HHSC Uniform Managed Care Manual, Chapter 3.4 (Medicaid Managed Care Member Handbook), Chapter 3.5 (CHIP Member Handbook), 3.15 (STAR Health Member Handbook), 3.19 (CHIP Dental Member Handbook) and Chapter 3.26 (Medicaid Dental Member Handbook).

[2] Texas Government Code §533.0076 as amended by S.B. 7 in the 1st Called Session of the 82nd Legislature.

[3] Under federal law (42 CFR §438.56), the following are examples of cause:

  • the enrollee moves out of the managed care service area;
  • due to moral or religious objections, the plan does not cover service the enrollee seeks;
  • the enrollee needs related services (for example a cesarean section and a tubal ligation) to be performed at the same time but not all related services are available within the network, and the enrollee's primary care provider or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk; or
  • other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the enrollee's health care needs.

[4] HHSC STAR Client Information, Can I change my primary care provider? Retrieved February 22, 2012.

[5] HHSC STAR Client Information, What if I need a specialist or go to the hospital? Retrieved February 22, 2012.

[6]HHSC Uniform Managed Care Manual, Chapter 3.3 (Medicaid Managed Care/CHIP Provider Manual Combined Critical Elements).

[7] HHSC Uniform Managed Care Contract, Sections 8.1.5.4 & 8.1.5.5.