Texas Medicaid and CHIP
Medicaid and the Children’s Health Insurance Program (CHIP) provide medical coverage for more than 4 million low-income Texans.
The programs cover half of all children in the state and help provide care for two-thirds of people in nursing homes. In Texas, all CHIP services and most Medicaid services are delivered through managed care health plans under contract with the state.
Learn more about STAR+PLUS managed care expansion.
Learn about the new managed care expansion.
Enroll as a Medicaid provider, submit fee-for-service claims, and more at Texas Medicaid and Healthcare Partnership.
Apply for Medicaid, CHIP, SNAP food benefits and TANF cash help, renew benefits and update your case.
The Texas Medicaid/CHIP Vendor Drug Program (VDP) provides services for over 4,000 Texas pharmacies.
Texas Medicaid Fee-for-Service Monitoring Review Plan
The draft Texas Medicaid Fee-for-Service Access Monitoring Review Plan is available for public comment through September 27, 2016. You can email comments to MedicaidCHIP_Network_
Adequacy@hhsc.state.tx.us. You can send written comments to:
4900 North Lamar Boulevard
Austin, Texas 78751
Mosquito repellent is now available as a Medicaid benefit!
Texas Medicaid now covers certain mosquito repellent products (PDF) as a Medicaid benefit for the prevention of Zika virus. Zika can cause severe birth defects in unborn children whose mothers are infected while pregnant. Because there is not a vaccine to prevent the disease or medicine to treat it, it is important for women to use repellent to protect themselves and unborn babies.
Who is covered?
- Females ages 10-45 and Pregnant women of any age in the following programs:
- Children's Health Insurance Program (CHIP)
- Healthy Texas Women
- One can/bottle of mosquito repellent is permitted per prescription fill, with one refill allowed per calendar month.*
- This benefit ends on October 31st, 2016.
- Prescriptions for mosquito repellent will not count against the monthly 3 prescription limit for those clients with a monthly limit.
- Repellent will be provided at no cost to Medicaid clients.
- CHIP members may pay the generic copay or less, if the cost of the repellent is less than the copay.
How to get repellent:
- Many pharmacies will be able to provide you with mosquito repellent without needing to get a prescription from your doctor. Contact your favorite pharmacy to make sure they are participating in this benefit. To find your pharmacy's phone number, you may use the Provider Lookup feature on our website: www.txvendordrug.com. If you are enrolled in an MCO, please refer to that MCO's website, or call the Member Services number on the back of your Member ID card.
- If your pharmacy recommends getting a prescription, contact your healthcare provider, and then ask them to send it to your pharmacy
- Your provider can send a prescription to your pharmacy via phone, fax, or e-prescription
- Do not request an office visit only to request a prescription for mosquito repellent unless required by the healthcare provider
- Have this prescription filled at your pharmacy.
Where can I find more information about Zika and Zika prevention?
- Department of State Health Services: www.TexasZika.org and www.TexasZika.org/prevention
- Centers for Disease Control and Prevention: www.cdc.gov/zika/
Effective August 11th, 2016, the Children with Special Healthcare Needs (CSHCN) Services Program has added mosquito repellents as a covered drug benefit for eligible clients. Prescriptions are required.
The program will cover the cost of mosquito repellent for eligible females who are between the ages of 10 and 45 or are pregnant. Up to two cans per month are allowed through October 31st, 2016.
Clients or families can call their health care provider to ask for a prescription. The prescribing physician may call it in to the client’s pharmacy. Clients must pick it up at the pharmacy and present their CSHCN Services Program ID card.
Office visits should only be scheduled if there is a medical necessity.
Clients with questions may call the TMHP-CSHCN Call Center toll free at 1-877-888-2350.
*Supply may vary by location
San Antonio Transportation Services Moving to New Provider
Effective June 1, LogistiCare Solutions will begin providing nonemergency transportation services for Medicaid members in Bexar and 10 surrounding counties: Atascosa, Bandera, Comal, Frio, Guadalupe, Karnes, Kendall, Kerr, Medina and Wilson.
Medicaid members who live in those counties will not have to change the way they set up rides or other transportation services. They should continue to call 877-633-8747. Individual Transportation Providers enrolled in the mileage reimbursement program with the current provider, LeFleur, do not need to enroll again, but they will be required to keep documentation updated with the new provider, LogistiCare.
For more information, call 1-855-435-7182.
Managed Care Expansion
Visit the Medicaid Managed Care Initiatives page for more information, including frequently asked questions, timelines and maps on Medicaid managed care expansion.
STAR+PLUS Health Plans
Need help? Here's a list of phone numbers and website addresses for each STAR+PLUS health plan.