Texas Medicaid
Complete guide to Texas Medicaid enrollment, MCO contracting, and billing requirements
Enrollment Time
60-90 Days
MCOs
6 Plans
Timely Filing
95 Days
Model
Managed Care
Texas Medicaid Overview
Texas Medicaid operates primarily through managed care organizations (MCOs) under the STAR, STAR+PLUS, and STAR Kids programs. Over 90% of Texas Medicaid recipients are enrolled in managed care.
STAR
Children and families
STAR+PLUS
Seniors and people with disabilities
STAR Kids
Children with disabilities (under 21)
Enrollment Process
Step-by-Step Enrollment Guide
1. Determine Provider Type & Service Area
Texas Medicaid enrollment varies by provider type. You can enroll as:
- • Individual provider (physician, NP, PA, therapist)
- • Group practice
- • Behavioral health provider (LMFT, LPC, LCSW, psychologist)
- • Facility (clinic, hospital, treatment center)
2. Register with Texas Medicaid
Submit application through Texas Medicaid & Healthcare Partnership (TMHP):
- • Complete Provider Enrollment Application (PEA)
- • Provide NPI, TIN, and license information
- • Submit required attestations
- • Pay enrollment fee if applicable ($500 for some provider types)
3. Contract with MCOs
After Texas Medicaid enrollment, contract with individual MCOs:
- • Complete each MCO's credentialing application
- • Most use CAQH for primary source verification
- • Submit additional MCO-specific forms
- • Negotiate rates (if participating in rate negotiations)
Timeline
- • TMHP enrollment: 30-60 days
- • MCO credentialing: 60-90 days per MCO
- • Total process: 90-150 days from start to first payment
Required Documentation
Individual Providers
- ✓ Texas medical license
- ✓ DEA certificate (if prescribing)
- ✓ Board certification
- ✓ Malpractice insurance
- ✓ NPI (Type 1)
- ✓ W-9
Facilities/Groups
- ✓ Texas facility license
- ✓ Articles of incorporation
- ✓ Group NPI (Type 2)
- ✓ TIN documentation
- ✓ Ownership disclosure
- ✓ Site inspection (if required)
Texas Medicaid MCOs
Aetna Better Health of Texas
Amerigroup Texas
Blue Cross Blue Shield of Texas
Community Health Choice
Molina Healthcare of Texas
Superior HealthPlan
Tip: Most providers contract with 3-4 MCOs to maximize patient access. Aetna, Amerigroup, Molina, and Superior have the largest enrollment numbers statewide.
Behavioral Health Providers
Texas Medicaid Behavioral Health Coverage
Texas Medicaid covers behavioral health services through both MCOs and the state's fee-for-service system for some services.
Covered Services
- • Outpatient therapy (individual, group, family)
- • Psychiatric evaluation and medication management
- • Intensive Outpatient Programs (IOP)
- • Partial Hospitalization Programs (PHP)
- • Residential treatment (with authorization)
- • Crisis intervention services
- • Substance use disorder treatment
Special Requirements for BH Providers
- • Texas behavioral health license (LCSW, LPC, LMFT, psychologist)
- • Facilities must be licensed by HHSC
- • SUD facilities require DSHS licensure
- • Higher-level care (RTC, PHP) requires prior authorization
- • Some MCOs delegate BH to specialty behavioral health organizations