Texas has many healthcare programs that provide medical and long term care benefits for qualified residents. The purpose of these programs is to improve the health of people who might otherwise go without medical care for themselves and their children.
For more information about specific programs, visit any of the links below:
Medicaid Overview
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 who might otherwise go without medical care for themselves and their children. The Texas Health and Human Services Commission's (HHSC) Medicaid Office is responsible for statewide oversight of the Texas Medicaid program.
Medicaid Contact Information
For information on Texas Medicaid, including eligibility, enrollment, and coverage please visit the HHSC Texas Medicaid Program website.
You may also call, toll-free:
- Medicaid Client Hotline: (800) 252-8263
You may also visit the Centers for Medicare & Medicaid Services (CMS) website.
If you are a Medicaid provider looking for specific information about the Medicaid, Children with Special Healthcare Needs (CSHCN), Family Planning, Texas Health Steps (THSteps) or other programs, visit the TMHP Medicaid provider page.
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CSHCN Overview
Since 1933, Texas has worked to improve the care of children with special health care needs through this program. Using state and federal funds, the Children with Special Health Care Needs (CSHCN) program provides health benefits to qualified families with children with special health care needs. Under Title V of the Social Security Act, the state receives a block grant to provide direct services (e.g., health benefits), as well as enabling services (e.g., case management) and population-based services (e.g., newborn screening). Title V programs, including CSHCN Program Health Benefits, provide and promote family-centered, community based, culturally competent, and coordinated health care and family support services. CSHCN recognizes the importance of the family as the focus of planning and service delivery, and promotes family choice and collaboration between parents and professionals. CSHCN strives to deliver services that honor and respect cultural beliefs, traditions, values, interpersonal styles, attitudes and behaviors.
Eligibility for CSHCN Program Services
To qualify for CSHCN health benefits, an applicant must be a person younger than 21 years of age who has a chronic physical or developmental condition,
- that will last or is expected to last for at least 12 months; and
- that results, or if not treated, may result in limits to one or more major life activities; and
- that requires health and related services of a type or amount beyond those required by children generally, and
- that must have a physical (body, bodily tissue or organ) manifestation; and
- that may exist with accompanying developmental, mental, behavioral or emotional conditions; but
- that is not solely a delay in intellectual development or solely a mental, behavioral and/or emotional condition.
OR
- a person of any age who has cystic fibrosis.
CSHCN Contact Information
- Children with Special Health Care Needs (TMHP Contact Center): 1-800-568-2413
- Department of State Health Services (DSHS)-CSHCN Inquiry Line 1-800-252-8023
CSHCN Helpful Links
If you are a CSHCN provider looking for specific information about CSHCN, visit the TMHP CSHCN provider page.
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Family Planning Overview
The Texas Department of State Health Services Family Planning Division (DSHS FPD) provides services for preventive health, medical services, counseling services, and educational services that assist individuals in managing their fertility and achieving optimal reproductive and general health. TMHP processes Family Planning claims and encounters for four different funding sources. The funding sources are categorized as Program 100 (Title XIX, Medicaid) and Program 300 (Titles V, X, and XX). For more information about the DSHS FPD and becoming a client, visit the DSHS client site for the Family Planning Division.
Family Planning Contact Information
- DSHS Family Planning Preventive and Primary Care Unit: 1-512-458-7796
- TMHP Family Planning Customer Service line: 1-800-925-9126 (choose option 4 for Family Planning)
- TMHP Family Planning Sterilization Form Fax line: 1-512-514-4229
- Automated Inquiry System (AIS) line: 1-800-925-9126
Family Planning Helpful Links
If you are a Family Planning provider looking for specific information about Family Planning, visit the TMHP Family Planning provider page.
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Long Term Care Programs Overview
The Texas Department of Aging and Disability Services (DADS) administer programs providing long term care in the community in nursing facilities and in other institutions. The Texas Medicaid & Healthcare Partnership (TMHP) LTC/team supports the provider community as they submit Client Assessment Review and Evaluation (CARE) Forms through the CARE Form System and LTC/NF claims for services rendered through the Claims Management System (CMS).
LTC support is offered through determination of medical necessity and level of care for clients who are Medicaid eligible and meet the medical necessity requirements of admission into a nursing home or a cost-effective alternative to institutionalization. The LTC Help Desk (1-800-626-4117 or 1-800-727-5436) provides customer-oriented support to providers and State staff regarding paper and electronic submissions of CARE Forms and LTC claims.
DADS administer programs ensuring eligible Medicaid and other qualifying clients receive the specialized health care and living assistance needed. For more information about Long Term Care/Nursing Facilities Policy, visit the Texas Department of Aging and Disability Services LTC Policy website.
If you are a LTC Programs provider looking for specific information about LTC, visit the TMHP Long Term Care Programs provider page .
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Texas Health Steps (THSteps) Overview
The Texas Health Steps program or THSteps, formerly known as Early and Periodic Screening, Diagnosis and Treatment (EPSDT), is a program under Medicaid which gives medical and dental checkups and care to children from birth to 21 years old who are enrolled in Medicaid.
The THSteps program assists eligible recipients and their parents or guardians to:
- Find a doctor or dentist for the client;
- Set up appointments to see a doctor or dentist;
- Arrange transportation or reimbursing gas money to see a doctor or dentist
- Answer questions about eligible services.
THSteps Contact Information
THSteps Helpful Links
If you are a THSteps provider looking for specific information about THSteps, visit the TMHP THSteps provider page .
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