What Are The Medicaid Plans In Texas


Avoiding Medicaid Estate Recovery Program

Court blocks vaccine mandate for employees of Medicaid, Medicare providers in Texas

If the Medicaid Estate Recovery Program can only enforce its claim against the Medicaid recipients estate in probate court, then the solution to avoiding the Medicaid Estate Recovery Program is to avoid probate court. Without proper estate planning, however, avoiding probate is often difficult to accomplish when someone dies owning real property. Medicaid applicants sometimes attempt to avoid the need for probate by divesting themselves of any real property interests prior to dying. However, transferring property to someone else may cause transfer penalties when applying for Medicaid and could potentially prevent the applicant from receiving benefits. Therefore, professional guidance is often required to ensure that no transfer penalties are applied, that the Medicaid applicant leaves behind no probate estate, and that the Medicaid Estate Recovery Program can be avoided. While some prefer to rely on the statutory exemptions to a Medicaid Estate Recovery Program claim, such as a surviving spouse living in the property or the propertys value is less than $10,000, among a few other exemptions, others enjoy the peace of mind in knowing that the Medicaid Estate Recovery Program cannot enforce their claim.

Beware The Merp Texas Offers Huge Loophole To Recovery Program

MERP is the Texas Medicaid Estate Recovery Program. Its sole purpose is to seize money from the estates of deceased Medicaid recipients and then plop the recovered funds back into the states coffers. The government, acting through a contractor called Health Management Systems, Inc. , does this by filing a claim in probate.

Why is this a prudent financial maneuver by the government? Because although Medicaid is a needs-based program, not every Medicaid recipient is a pauper. The type of assets that a recipient can own and still be Medicaid -eligible such as a homestead, an automobile, and a retirement account can be valuable.

MERP claims can involve a significant amount of money. Long- term care alone for a Medicaid recipient can easily run into the hundreds of thousands of dollars.

Large government claim, finite probate assets the result is that a successful MERP claim can end up wiping out the entire value of a probate estate. The government wins and the probate estates distributees lose.

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How Does Medicare Work With Medicaid Managed Care

If someone is in both programs, the client will use Medicare for their health care needs, prescription drugs and medications. The clients Medicaid health plan will provide Medicaid long-term services and supports needs and will cover certain medications not covered at all, or only partially, by Medicare.

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Medicaid Income Limits Texas

The income limit dollar amount for both these services varies per month. Single people have a different income and asset limits compared to married people. It can change depending if only one spouse is applying or if both are. A trusted experienced lawyer can give you details on the exact amounts for each applicant.

All the applicants can only get benefits if they live in a nursing home.

Expansion Of Medicaid Managed Care

How To Apply For Medicaid In Texas

Most people in Texas who have Medicaid get their services through managed care. In this system the member picks a health plan and gets Medicaid services through that health plans network of providers. Most health plans offer Medicaid members extra services not available through traditional Medicaid.

Right now, there are three Medicaid managed care programs in Texas: STAR, STAR+PLUS, and STAR Health. The 2013 Texas Legislature approved several expansions of Medicaid managed care and directed HHSC to develop a performance-based payment system that rewards outcomes and enhances efficiencies. Managed care expansion plans include:

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American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Texas Health Steps Program

Through outreach,Texas Health Steps staff, or contractors encourage STAR Members to use Texas Health Steps preventive medical checkup services when they first become eligible for Medicaid/Texas Health Steps and when they are periodically due for their yearly medical checkup in their birthday month.

On request by the client, the Medical Transportation Program assists the client with scheduling transportation. Refer to the MTP section on page 23 of this Provider Manual for more detailed information.

Texas Health Steps medical providers must perform medical checkups on any client who is currently enrolled in Medicaid and who are ages of birth through 20 years of age. Providers also are encouraged to notify the client when he or she is due for the next medical checkup according to the Texas Health Steps Periodicity Schedule.

Note: Newly enrolled STAR Members must receive a Texas Health Steps medical checkup within 60 days from enrollment.

Provider Training Schedule

To register for training sessions, please call 358-6030 or email .

Free online provider education is available, and many include Continuing Education credits. Check out the online options offered by Texas Health and Human Services Commission .

For additional information visit Health & Human Services.

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Unitedhealthcare Connected For Mycare Ohio

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

What Is Medicaid Program

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Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. The federal government provides a portion of the funding for Medicaid and sets guidelines for the program. Medicaid programs vary from state to state. They may also have different names, like Medical Assistance or Medi-Cal.

Medicaid is the state and federal cooperative venture that provides medical coverage to eligible needy persons. The purpose of Medicaid in Texas is to improve the health of people in Texas who might otherwise go without medical care for themselves and their children.The mission of the program is to improve the health of Texans by:

  • Emphasizing prevention.

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How To Qualify For Medicaid In Texas

To determine your eligibility for long-term care services, any income you receive will be considered not just wages. Other income sources include IRA withdrawals, Social Security Income, Social Security disability income, and so on. Only the income of the applicant is considered if one spouse applies, but the applicant may be required to pay the non-applicant a certain amount.

What Services Does Star Cover

Community provides its Medicaid Members with access to comprehensive medical care, including services such as hospital care, surgery, X-rays, physical/speech/occupational therapies, prescription drugs, emergency services, transplants, regular health checkups, and immunizations.

Members receive unlimited medically necessary prescriptions through the Medicaid/CHIP Vendor Drug Formulary.

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Prior Authorization And Notification Resources

Demographic Information Updates with TMHP

To Providers: Please update your enrollment and demographic information with TMHP . TMHP is HHSCs provider enrollment administrator and serves as the authoritative source for HHSC Providers enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.

To make updates to your current enrollment , please access the web page titled Provider Enrollment and click on Enroll Today at the following URL: Provider Enrollment | TMHP.

For instructions on how to make demographic changes to your current enrollment, please access the web page titled Provider Enrollment and Management System : A Step-by-Step Guide at the following URL: Provider Enrollment and Management System | TMHP.

Otherwise, you can contact TMHP directly at 800-925-9126 for assistance.

Behavioral Health Providers

Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network is found in theUnitedHealthcare Community Plan Care Provider Manuals.

The Centers for Medicare & Medicaid Services established the Medicaid Managed Care Rule to:

Who Qualifies For Medicaid In Texas


To be eligible for Medicaid long-term care programs there are general criteria you must meet. But every program has its own eligibility requirements. Some of these programs include:

  • Medicaid Waivers/ Home and Community-based Services: There is likely to be a long waiting list for this because it is not an entitlement program. These services are provided to delay nursing home care as much as possible.
  • Institutional/Nursing Home Medicaid: People who are eligible can access this program but you only get the benefits if you live in a nursing home.
  • Regular Medicaid/ Elderly and People with Disabilities : You can access these services if you meet the requirements. With regular Medicaid, you may get long-term personal care assistance or adult daycare.

You can either take the Medicaid Eligibility test or read the requirements online to determine if you are immediately eligible for long-term care from a Texas Medicaid program.

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Texas Medicaid Wellness Program

The Texas Medicaid Wellness Program is a special health program for people who get Medicaid and have long-lasting or serious health conditions. These conditions can include asthma, diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease , and others.

People in this program can get help any time of day or night with:

  • Getting an answer to a health question.
  • Finding a main doctor.
  • Managing their health between doctor visits.
  • Learning more about their health conditions.
  • Knowing how to take their medicines.
  • Picking the best medical care for their health.

Learn more about the Wellness Program.

Your Texas Benefits Medicaid Card And Yourtexasbenefitscom

The Your Texas Benefits Medicaid card is your permanent card. Take it with you whenever you go to the doctor, dentist or drug store. Protect it the way you would your driver’s license or credit card. If you lose or damage your card, you can order a new one by visiting YourTexasBenefits.com or by calling toll-free at 800-252-8263.

You can see your available Medicaid health information through YourTexasBenefits.com‘s Medicaid Client Portal. Legally authorized representatives can see their children’s available Medicaid health information.

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Healthy Texas Women Program

Have you lost your Medicaid benefits? The Healthy Texas Women Program provides family planning exams, related health screenings, and birth control to women ages 18 to 44 whose household income is at or below the programs income limits .

You must submit an application to find out if you can get services through this program. Visit this site for more information.

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Star Medicaid Managed Care Program

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Most people who have Medicaid in Texas get their coverage through the STAR managed care program. STAR covers low-income children, pregnant women and families. STAR members get their services through health plans they choose.

If you’re new to STAR, you’ll choose a health plan from the ones available in your service area . Learn more about how to choose or change your health plan.

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Compare Each Plans Value

All health plans that provide STAR, CHIP or CHIP Perinate insurance offer traditional Medicaid health care services.

These include:

  • eye checkups, glasses and contact lenses
  • shots for children age 20 and younger
  • mental health services

However, some health plans offer a long list of extra benefits. These are called value-added services and paid rewards.

When you are comparing health plans in your information packet, be sure to take a close look at these extra benefits.

to see the full list.

Parkland HEALTHfirst, KIDSfirst CHIP and CHIP Perinate health plans include value-added services such as: Limitations and restrictions may apply.

  • Free cell phone for enrollees in the Federal Lifeline Program, including unlimited calls to Parkland Community Health Plan Member Services and free health education text messages.*
  • Free pregnancy classes
  • Free 6-month gym membership for qualifying children ages 13-20.
  • Sports physicals for children ages 3-19.
  • Adult dental care, up to $300 per year.*
  • And more

*For Medicaid STAR members only.

When you make healthy choices, you can earn valuable points with Parkland health plans. You can spend reward points on gift cards, baby supplies, sports equipment and more.

Earn points for completing activities like:

  • Registering on the Parkland member portal
  • Taking your baby and teen for checkups
  • Getting a flu shot
  • Managing ADHD and asthma
  • And more


Compare The Quality Ratings On The Health Plan Score Cards

The Texas HHS website includes reviews, also known as score cards, for all health plans in Texas. These reviews a wide range of items that are important to people who need care for themselves and their children.

You can learn more and see the score cards online.

The Medicaid STAR Adult Report Card shows scores for 10 different areas.

Parkland Community Health Plan rates especially high in the overall Experience of Care category. We are the only health plan to have a rating for Doctors listen carefully, explain clearly and spend enough time with people.

We also scored high for New mothers get checkups after giving birth.

See the entire STAR Adult Report Card here.

The CHIP Report Card measures healthcare services for infants, children, teens and pregnant women.

See the entire CHIP Report Card here.

Parkland Community Health Plan is the only health plan to earn five out of five stars in Overall Health Plan Quality, Parents give high ratings to their childs personal doctor and Children see the doctor for ADHD.

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How Can I Get More Information On Medicaid Estate Recovery

HHSC contracts with Health Management Systems, Inc. for the administration of the Medicaid Estate Recovery Program. For information regarding a specific case, call HMS toll-free at 800-641-9356 or email: .

Upon receipt of a clearance letter from HMS, estate representatives of deceased Medicaid recipients should contact HHSC Provider Recoupments and Holds department by calling 512-438-2200, option 4. HHSC Provider Recoupments and Holds department determines if there are other outstanding Medicaid claims against the estate that may be recoverable through other assets and if HHS is the residual beneficiary of the assets. Examples of assets potentially payable to HHS include trusts, annuities, torts and non-Medicaid insurance coverage.

If you have a problem or complaint you should first discuss it with the MERP program. Many times, they can explain specific policies or correct the problem immediately. If your problem or complaint is not resolved to your satisfaction, you can contact the HHS Office of the Ombudsman by calling 877-787-8999 or by making an online submission.

Will Managed Care Change The Types Or Amounts Of Services A Member Receives

Texas Medicaid Managed Care Plans Support Patients During ...

Members will continue to receive the types and amounts of services that most appropriately meet their medical needs. Needs are determined by the results of an assessment and development of an individual service plan, where appropriate. Medicaid health plans are required to provide all covered medically necessary services to members. Medically necessary means that services are:

  • Reasonably necessary to prevent illness or medical conditions, or provide early screening, interventions, and treatments for conditions that cause suffering or pain, cause physical deformity or limitations in function, threaten to cause or worsen a handicap, cause illness or infirmity of a recipient, or endanger life.
  • Provided at appropriate locations and at the appropriate levels of care for the treatment of clients conditions.
  • Consistent with health care practice guidelines and standards that are issued by professionally-recognized health care organizations or governmental agencies.
  • Consistent with the diagnoses of the conditions.
  • No more intrusive or restrictive than necessary to provide a proper balance of safety, effectiveness, and efficiency.

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We Carefully Review The Health Plans In Your Service Area

Health plan changes in service areas are usually the result of a formal business review we do every few years. This is one of the ways we ensure quality of services for members. Sometimes a health plan might decide to leave the program.

If your health plan is leaving your service area, youll have to pick a new plan. We will mail you a letter to explain the change and next steps you should take. There will be at least two plans to choose from. If you dont choose a new plan, we will choose one for you.

If theres been a change in your service area, you can find updates below.

How Much Does It Cost

Childrens Medicaid is free.

If we find your child can get Childrens Medicaid, there is no cost to receive services.

CHIP fees vary based on your income.

If we find your child can get CHIP, your enrollment fee and co-pays will be based on your familys income. Enrollment fees are $50 or less per family, per year.

Co-pays for doctor visits and medicine range from $3 to $5 for lower-income families and $20 to $35 for higher-income families.

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Hhsc / Medicaid Estate Recovery Program


  • Area Served:Atascosa, Bandera, Comal, Frio, Gillespie, Guadalupe, Karnes, Kendall, Kerr, McMullen, Medina, Wilson, Bexar
  • Fees:Please contact provider for fee information.
  • Application Process:Call or visit website for additional information.
  • Eligibility Requirements:Please call service provider or visit website to learn more about eligibility requirements.
  • Payment/Insurance Accepted:Please contact provider for accepted forms of payment.
  • ADA Access:Please contact facility for accessibility information.


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