Medicaid Managed Care Initiatives
Dentists who are not under contract with DentaQuest or MCNA, and who would like to provide services to Medicaid and CHIP clients, may contact provider services at the numbers listed below.
- DentaQuest: 1-800-896-2374
- MCNA: 1-855-776-6262
RFP for Medicaid managed care services: HHSC has issued a request for proposal (RFP) for Medicaid managed care services. The RFP includes expansion of STAR+PLUS to rural areas of the state. STAR+PLUS integrates acute care and community-based long-term care services for Medicaid clients who are age 65 and older and to those with disabilities.
Pharmacy Deliveries: Medicaid and CHIP Managed Care Organizations (MCOs) began paying local pharmacies to deliver pharmaceuticals to clients on June 1, 2012. 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.
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:
Medicaid managed care service area maps
Webinars for providers
On June 13 and June 14, 2012, the Texas Health and Human Services Commission (HHSC) hosted webinar trainings for substance use disorder treatment providers in each Medicaid Rural Service Area (RSA) region – West, Northeast and Central. Recordings of each webinar are available through the links in the chart below.
Each webinar is specific to a Medicaid RSA region and contains an overview of the Medicaid substance use disorder treatment benefits, followed by plan-specific billing and prior authorization requirements for Medicaid clients in the RSA. These clients were previously served through the Primary Care Case Management model, which was phased out and replaced with the Medicaid RSA effective March 1, 2012.
The files below are Adobe (previously Macromedia) Flash files. You must have a recent version of the Adobe Flash Player to open these files.
| Service Area | Medical Plans |
| Medicaid Rural Service Area - West Texas | Amerigroup, FirstCare, Superior |
| Medicaid Rural Service Area -Northeast Texas | Amerigroup, Superior |
| Medicaid Rural Service Area - Central Texas | Amerigroup, Superior, Scott & White |
Check the Medicaid RSA map to find the Medicaid Rural Service Area you’re in.
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
PowerPoint Presentations
- HHSC Overview: Medicaid Substance Use Disorder (SUD) Treatment Benefits – June 2012 (Training for Medicaid Rural Service Area Providers)
- Amerigroup SUD Training: Medicaid Rural Service Area – June 2012
- RightCare Scott and White Health Plan SUD Training: Medicaid Rural Service Area – June 2012
- Cenpatico (Superior) SUD Training: Medicaid Rural Service Area – June 2012
- FirstCare SUD Training: Medicaid Rural Service Area – June 2012
- 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
- Managed Care Initiatives stakeholder presentation—July 2011
- STAR+PLUS stakeholder presentation—June 2011
