Medicaid Agencies

The following groups and people make up the Medicaid Team .

  • Program Provider – An entity that provides services under a contract with the Health and Human Services (HHS) directly or through a contract with a MCO.
  • Managed Care Organization (MCO) – State-contracted entity that has been given delegated authority to provide acute and long-term services to support enrolled managed care members .
  • Texas Health and Human Services (HHS) – Texas state agency that provides long-term services and supports to older persons and people with physical, intellectual, and developmental disabilities .
    • HHS also regulates providers of long-term services and supports, and administers the state’s guardianship program.
    • Provides administrative oversight of Texas health and human services programs including:
      • the Medicaid acute care program,
      • Children’s Health Insurance Plan (CHIP),
      • State of Texas Access Reform (STAR),
      • State of Texas Access Reform PLUS (STAR+PLUS), and
    • provides direct administration of some programs.
    • Texas HHS Access and Eligibility Services (AES) determines eligibility for Medicaid.
  • Texas Medicaid & Healthcare Partnership (TMHP) – Contracted by the state as the claims administrator to process claims for providers under traditional Medicaid.
    • TMHP processes and approves claims for traditional LTC .
    • TMHP does not pay LTC claims; this is done by the comptroller .
    • Responsibilities also include the following:
      • Determination of MN
      • Provider Education
      • Provide timely processing of claims (except for services covered by the STAR+PLUS premium) and represent HHS at Fair Hearings
      • Provide yearly program manuals, quarterly LTC Provider Bulletins, and twice weekly Remittance and Status (R&S) Reports
      • Maintain the TMHP Call Center/Help Desk
      • Conduct training sessions for providers, which includes technical assistance on the LTC Online Portal and TexMedConnect online applications
  • Texas State Legislature – The state legislature allocates budgetary dollars for Texas Medicaid .
  • Centers for Medicare & Medicaid Services (CMS) – The agency in the U.S. Department of Health and Human Services that is responsible for federal administration of the Medicare, Medicaid, and State Children’s Health Insurance Program (CHIP) .