TMHP - Medicaid

Overview

Medicaid is the State and Federal cooperative venture that provides medical coverage to eligible 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. For additional information, you can visit the HHSC website.

Click on the links below for more details about the Texas Medicaid Program:

Mission
Stakeholders
Claims Administration

Medicaid Resources on the TMHP website:

Medicaid Forms

TMHP General Inquiries Line: 1-800-925-9126
TMHP Contact Center: Visit this page to access toll free numbers to the TMHP Contact Center .

Medicaid Helpful Links

Mission

The mission of the Texas Medicaid program is to improve the health of Texans by:

Emphasizing prevention
Promoting continuity of care
Providing a medical home for Medicaid recipients
Ensuring that each recipient can receive high quality, comprehensive health care services within the recipient's community

Through this procurement, the State accomplishes its mission by contracting for measurable results that improve client access and satisfaction; maximize program efficiency, effectiveness, and responsiveness; and reduce operational costs.

Stakeholders of the Texas Medicaid Program

Texas Medicaid & Healthcare Partnership (TMHP): Effective January 1, 2004, a team of contractors headed by Affiliated Computer Services, Inc. (ACS) called the Texas Medicaid & Healthcare Partnership (TMHP), assumed Medicaid Claims Administrator duties for the State of Texas, under contract with the Health and Human Services Commission (HHSC). This new contract transitioned functions such as claims processing, the Medicaid automated inquiry system (AIS), and TexMedConnect to TMHP. TMHP is also the administrator for the Medicaid Managed Care Primary Care Case Management (PCCM) model known as the Texas Health Network (THN).
- TMHP team is comprised of the following entities: ACS (Affiliated Computer Services, Inc.) as the prime contractor, Accenture, as the technology partner, Mir Mitchell Corporation (MMC), the staffing support partner, as well as a number of other well-known hardware, software, and telecommunications organizations.
- TMHP distributes yearly manuals, bi-monthly and quarterly bulletins, weekly banner messages and R&S. TMHP offers the Automated Inquiry System (AIS), Customer Service through the Contact Center, and the EDI Helpdesk. TMHP conducts training sessions for providers and on-site provider visits. TMHP also provides training and technical assistance on the TexMedConnect software which gives providers access to electronic eligibility verification, claims submission, appeals submission and claim status inquiries.
Texas Health and Human Services Commission (HHSC): HHSC provides leadership and direction, and fosters the spirit of innovation needed to achieve an efficient and effective health and human services system for Texans. HHSC has oversight responsibilities for designated Health and Human Services agencies , and administers certain health and human services programs including the Texas Medicaid Program, Children's Health Insurance Program (CHIP), and Medicaid waste, fraud, and abuse investigations. HHSC is responsible for the Texas Medicaid Managed Care Program (State of Texas Access Reform or STAR and STAR+PLUS). HHSC is also responsible for determining the client's Medicaid eligibility.
Department of State Health Services (DSHS): DSHS, along with HHSC administers the Children with Special Health Care Needs (CSHCN) Services Program, Texas Health Steps (THSteps) and Family Planning programs.
Department of Aging and Disability Services (DADS): DADS, along with HHSC, administers the Long Term Care Programs (LTC).
Texas Legislature: The Texas legislature is responsible for determining the budget of the Texas Medicaid Program.
Providers: Providers are the crucial players in a quality health care program. Providers focus on providing the best medical care possible, while maximizing their reimbursement potential. The Medicaid Program allows for the enrollment of many different types of providers. Please visit the TMHP Provider Enrollment page.
Patients/Clients/Members: Patients/Clients/Members are the Texas citizens that the Medicaid Program serves. All stakeholders play an intricate role in the service that patients/clients receive.

Program Administration

The claims administrator for various programs is the Texas Medicaid & Healthcare Partnership (TMHP). There are a variety of programs that TMHP administers:

Long Term Care Programs (LTC): Medicaid covers a broad range of services for people who need assistance with day-to-day living. Such services include nursing home care, facilities for people with mental retardation, and a range of community care services for people with disabilities. These services are typically referred to as long term care. For more information about LTC Programs, visit the TMHP LTC Programs provider page.
Family Planning (Titles V, X and XX as well as Title XIX): The Family Planning Program assists low-income Texans to improve their health and to positively affect the outcome of future pregnancies. For more information about Family Planning, visit the TMHP Family Planning provider page and/or visit the Department of State Health Services (DSHS) Family Planning website.
Children with Special Health Care Needs (CSHCN) Services Program: The CSHCN Services Program is a medical services program designed to identify and medically assist children who might otherwise be unable to benefit from present or future educational or employment opportunities. To be determined eligible for CSHCN Services Program services, applicants must meet the medical, financial, and other criteria as stated in the CSHCN Services Program rules effective July 1, 2001. For more information about the CSHCN Services Program, visit the TMHP CSHCN Services Program provider page.
Texas Health Steps (THSteps) Medical/Dental and Comprehensive Care Programs (CCP): Formerly know as the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, THSteps is the largest and most comprehensive medical and dental prevention and treatment program for children of low-income families. The program provides comprehensive and periodic evaluation of a child's health, development, and nutritional status, as well as vision, dental, and hearing care. Texas Health Steps is the gateway for comprehensive health care for Medicaid enrolled children from birth to age 21 in Texas. For more information about THSteps, visit the TMHP THSteps provider page and/or visit the Department of State Health Services (DSHS) THSteps website .