Medicaid Managed Care Initiatives

Effective June 1, 2012, Medicaid and CHIP Managed Care Organizations (MCOs) will begin paying local pharmacies to deliver pharmaceuticals to clients. Each MCO will develop its own participating pharmacy network for this delivery service. Pharmacies interested in receiving payment for the delivery of pharmaceuticals should contact their MCOs to request information on how to apply.

The Vendor Drug Program website has several managed care expansion resources for pharmacies. Please refer to the Enrollment Chart for the pharmacy contract phone number for each MCO.

Notice: HHSC has delayed the restriction that a Medicaid client must be served by their assigned main dentist through May 31, 2012. [Read Announcement (DOC)]

Notice: The Texas Health and Human Services Commission (HHSC) will conduct a Town Hall meeting in Brownsville on May 9, 2012. [More information on the May 9 meeting (DOC)]

Notice: The Texas Health and Human Services Commission (HHSC) will conduct Town Hall meetings in Edinburg on May 24, 2012.  [More information on the May 24 meeting (DOC)]

Initiatives effective September 1, 2011

• STAR and STAR+PLUS expansion to counties adjacent to existing managed care service areas.

Initiatives effective March 1, 2012

• El Paso and Lubbock STAR+PLUS expansion
• Hidalgo Service Area STAR and STAR+PLUS Expansion
• Medicaid Rural Service Area STAR Managed Care Expansion
• Medicaid Managed Care and CHIP Pharmacy Benefits
• Children’s Medicaid dental services through managed care statewide

Resources:

Provider Training Calendar

Award announcements for managed care contracts effective March 1, 2012

• Children’s Medicaid and CHIP dental services
• Medicaid and CHIP managed care services

Medicaid managed care service area maps

• STAR service areas
• STAR+PLUS service areas
• Medicaid rural service areas
• CHIP service areas

Webinars for providers

Right-click on the webinar below and select "Save Target As" save it to your desktop and it will play the video. Please make sure you have the most current Flash Player. If you can not open the document right-click on the icon and select "Open With" then select "Adobe Flash Player".

• STAR Medicaid Managed Care — December 16, 2011
• STAR+PLUS Medicaid Managed Care — December 16, 2011
• Children’s Medicaid and CHIP dental — December 16, 2011
• Medicaid and CHIP Managed Care Pharmacy Benefit — December 16, 2011
• STAR Medicaid Managed Care — December 20, 2011
• STAR+PLUS Medicaid Managed Care — December 20, 2011
• Children’s Medicaid and CHIP dental — December 20, 2011
• Medicaid and CHIP Managed Care Pharmacy Benefit — December 20, 2011

Presentations

• STAR Medicaid Rural Service Area Provider Presentation—April 2012
• STAR Medicaid Rural Service Area provider presentation—November 2011
• STAR Medicaid Managed Care provider presentation—September 2011
• STAR+PLUS Medicaid Managed Care provider presentation—September 2011
• Medicaid and CHIP Managed Care Pharmacy Benefit provider presentation—September 2011
• STAR+PLUS stakeholder presentation—June 2011
• Managed Care Initiatives stakeholder presentation—July 2011