Texas operates one of the nation's largest Medicaid managed care systems, serving over 6.7 million enrollees through a risk-based MCO model organized by population rather than region: STAR for the general population, STAR+PLUS for LTSS-eligible adults and duals, STAR Kids for children with disabilities, and STAR Health for children in foster care.
Four population-based MCO programs cover nearly all Texas Medicaid enrollees. STAR (general population) is served by Superior HealthPlan, Texas Children's Health Plan, Community Health Choice, UnitedHealthcare, and Molina statewide, plus regional plans in specific service areas. Effective September 1, 2024, STAR+PLUS underwent a major MCO recontracting, moving to 7 MCOs (three new to the program) across 13 service delivery areas. STAR Health (foster care) is served exclusively by Superior HealthPlan statewide under a single contract.
LTSS is integrated into managed care specifically through STAR+PLUS, which combines acute care and long-term services and supports for adults with disabilities, seniors 65+, and dual eligibles. LTSS is not integrated for the general STAR population. Effective December 31, 2025, Texas ended its STAR+PLUS Medicare-Medicaid Plan (MMP) dual demonstration; the MCOs that ran those plans began offering aligned Integrated Dual Eligible Special Needs Plans (D-SNPs) starting January 1, 2026 in Bexar, Dallas, El Paso, Harris, and Hidalgo counties.
Partially integrated into managed care
Behavioral health is carved in to MCOs statewide; each MCO is responsible for mental health and substance use disorder services for its own members, with no separate BHO/MBHO layer. The legacy NorthSTAR carve-out, a Dallas-area managed behavioral health organization model, ended December 31, 2016.
Carved in
Dental services for children are carved out from the medical MCOs and delivered through three statewide prepaid ambulatory health plans (PAHPs).
Pharmacy has been carved in to MCOs since 2012, but the model is decentralized; each MCO contracts its own Pharmacy Benefit Manager rather than the state using a single statewide PBM. The state's Vendor Drug Program continues to govern pharmacy policy and provider enrollment oversight.
Non-emergency medical transportation follows the same carve-in-but-decentralized pattern as pharmacy: for managed care members, NEMT is carved in to each MCO, which contracts its own regional broker. Effective January 1, 2026, SafeRide Health became the NEMT vendor for UnitedHealthcare Community Plan of Texas, joining its existing Texas Children's Health Plan and Superior HealthPlan STAR+PLUS transportation contracts. A separate state-run Medical Transportation Program (MTP) continues to serve the smaller fee-for-service-only population (non-MCO Medicaid, CSHCN Services Program, Transportation for Indigent Cancer Patients) through regional Managed Transportation Organizations and two Full-Risk Brokers in the Dallas-Fort Worth and Houston/Beaumont areas.
Texas Medicaid & Healthcare Partnership (TMHP) serves as the statewide Medicaid claims administrator and MMIS operator, including the Provider Enrollment and Management System (PEMS). HHSC is currently mid-way through a multi-year Medicaid Enterprise System (MES) modernization effort, reprocuring several modular contracts including a new Medicaid claims administration contract and a new Medicaid claims system.
299 agency updates tracked for Texas. Available with Pro.
See them with ProDallas-based Parkland Health's hospital-at-home program costs about 30% less per episode than traditional inpatient care, according to a Nov. 5 report by the Irving (Texas) Journal, citing a February evaluation. As of Aug. 17, the program had treated 1,660 patients and freed up 11,637 hospital bed days, with an average stay of 7.5 days in fiscal year 2026. Parkland launched the program in 2022 after receiving approval from CMS and the Texas Health and Human Services Commission, and has since expanded to treat higher-acuity conditions including infections, kidney and cardiac conditions, using daily virtual physician visits, twice-daily nurse visits, and remote monitoring equipment.
CMS announced $87 million in federal funding for 129 rural healthcare providers in Texas, according to a CMS Newsroom press release. The funding targets rural providers across the state, though the release does not specify the exact award program or allocation methodology for individual facilities. Texas providers receiving funds are expected to use the money to support rural healthcare delivery and infrastructure. The announcement comes as part of broader federal efforts to bolster rural healthcare access.
Texas Children's Hospital has opened a detransition clinic required under its settlement with Texas Attorney General Ken Paxton, the AG's office announced October 27. The clinic treats patients who previously received gender-transition treatment, offering detransition-related medical care through age 21 and obstetric/gynecologic care for older patients, with services spanning endocrinology, surgery, psychiatry, and case management. The hospital must fully fund the clinic's services at no cost to patients for five years under the settlement, announced in May, which also required Texas Children's to pay $10 million to resolve state claims that it improperly billed Texas Medicaid for gender-transition care. The hospital says the clinic is operational and it is complying with all settlement terms.
Gilead Sciences agreed to pay $45 million to settle allegations brought by the Texas attorney general and a whistleblower that the company paid kickbacks to improperly influence prescriptions billed to Texas Medicaid. The whistleblower lawsuit alleged Gilead paid a third-party company to deploy registered nurses to recommend its drugs and offered free support services to doctors in exchange for prescribing, practices that allegedly led to false claims submitted to government programs. The case traces back to lawsuits filed roughly a decade ago by Health Choice Advocates and related firms against multiple drugmakers over similar nurse-outreach arrangements. Gilead is the latest pharmaceutical company to reach a settlement with Texas over these marketing practices.
CMS announced $8 million in federal funding for 28 rural healthcare providers across Texas, part of an effort to strengthen rural healthcare delivery in the state. The press release does not specify the exact program mechanism, but frames the funding as support for rural provider capacity and access. Affected providers will receive awards intended to bolster rural healthcare infrastructure and services. The announcement does not detail specific effective dates or application timelines for future funding rounds.
22 active waivers tracked for Texas. Available with Pro.
See them with ProNo active solicitations currently tracked for Texas.
47 managed care contracts tracked for Texas. Available with Pro.
See them with Pro197 bills tracked for Texas. Available with Pro.
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