Welcome to the Texas Medicaid Program
Welcome, Provider, to the Texas Medicaid Program!!!!
The Texas Health and Human Services Commission (HHSC) contracts with the Texas Medicaid & Healthcare Partnership (TMHP) for enrollment of all Medicaid providers in the Texas Medicaid Program. You have been assigned a Provider Identifier which reflects that you have successfully completed the Medicaid enrollment process.. The following information will help you complete the next step, which is to become a successful provider in the Texas Medicaid Program.
We would like to take this opportunity to explain the organizational structure of the Texas Medicaid Managed Care Program before providing health care services to Medicaid clients. The Texas Medicaid Program has two managed care initiatives that affect the majority of Medicaid clients in Texas:
· The STAR Program – administered by HHSC
· The STAR+PLUS Program – administered by HHSC.
These two initiatives have contracted with health maintenance organizations (HMOs). There are different HMOs available in the different regions of Texas; a client’s county of residence determines which HMOs are available for client participation. The following charts identify the available HMOs in each area.
STAR Program HMOs:
Service Area / Counties / STAR HMO ChoicesBexar / Atascosa, Bexar, Comal,
Guadalupe, Kendall, Medina, Wilson / Community First Health Plans, Aetna Medicaid, Superior HealthPlan
Dallas / Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall / Amerigroup Community Care, Parkland HEALTHfirst,
Unicare Health Plans of Texas
Harris/Harris
Expansion / Brazoria, Fort Bend,
Galveston, Harris,
Montgomery, Waller / Amerigroup Community Care, United Healthcare–Texas, Molina Healthcare of Texas, Community Health Choice, Texas Children’s Health Plan
Lubbock / Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry / FirstCare STAR, Superior HealthPlan
Tarrant / Denton, Hood, Johnson, Parker, Tarrant, Wise / Amerigroup Community Care, Aetna Medicaid, Cook Children’s Health Plan
R HMO Choices
STAR+PLUS Program HMOs:
Bexar / Atascosa, Bexar, Comal,
Guadalupe, Kendall, Medina, Wilson / Molina Healthcare of Texas, Superior HealthPlan, Amerigroup Community Care
Harris/Harris
Expansion / Brazoria, Fort Bend,
Galveston, Harris,
Montgomery, Waller / Amerigroup Community Care, Evercare, Molina Healthcare of Texas
Nueces / Aransas, Bee, Calhoun, Jim Wells, Kleberg, Nueces, Refugio, San Patricio, Victoria / Evercare, Superior HealthPlan
Travis / Bastrop, Burnet, Caldwell, Hays, Lee, Travis, Williamson / Amerigroup Community Care, Evercare
Most Medicaid clients who reside in the listed counties are required to enroll in one of the HHSC-contracted HMOs. For you to provide services to a Medicaid client in these service areas (counties), you must contact the client’s HMO to obtain provider contracting information and out-of-network guidelines. For more information on Texas Medicaid Managed Care, review Medicaid Bulletin Nos. 195, 197, 198, and 199 or see the HHSC website at www.hhsc.state.tx.us.
The Texas Medicaid Managed Care program also includes the Primary Care Case Management (PCCM) program. PCCM is located in all Texas counties where the STAR and STAR +PLUS programs do not exist and it is available for Medicaid clients in those areas. Please click on this link for a list of PCCM counties. Under PCCM, only hospitals and providers who want to serve as primary care providers need to contract with TMHP. All enrolled Medicaid providers are automatically part of the PCCM referral network. PCCM is administered by TMHP. For additional information or assistance on PCCM, click here or call the TMHP Contact Center at 1 800-925-9126.