Texas Medicaid Eligibility: TexMedConnect Guide
By Dax Earl • October 9, 2026
Last updated: October 9, 2026.
For Texas Medicaid provider eligibility checks, start at TMHP My Account.
As of October 9, 2026, TMHP offers acute-care and long-term-care versions of TexMedConnect. The acute-care guide is the relevant starting point for this outpatient therapy workflow. Open TMHP’s TexMedConnect resources.
Sections
TexMedConnect eligibility: a provider workflow
The acute-care user guide describes the Eligibility screen, provider identifier, date-range fields and member search fields. It also describes viewing eligibility results as a PDF. Use the current acute-care user guide.
Sign in with your own authorized TMHP account and confirm the intended provider access. Select Eligibility and the applicable provider NPI/API, then set Eligibility From Date and Through Date for the service dates you need to verify.
Screenshot source: TexMedConnect Acute User Guide, page 10 (June 9, 2026).
Enter the identifiers required by the screen, using actual member information available to the authorized practice, then select Submit. The guide lists accepted combinations of member ID, Social Security number, birth date and name fields.
Screenshot source: TexMedConnect Acute User Guide, page 10 (June 9, 2026).
Review the Eligibility Verification Results. Use the PDF option to view or print results and retain the verification in the practice’s approved workflow. The manual example below illustrates the screen layout; its sample dates and plan values are not current coverage guidance.
Screenshot source: TexMedConnect Acute User Guide, page 11 (June 9, 2026).
The date matters. A result for today does not answer a coverage question about last month’s session. Recommended habit: explicitly record the service date checked beside the verification date.
What the biller should check before the session
TMHP’s Client Eligibility section describes provider verification methods and eligibility restrictions. Medicaid eligibility and managed-care enrollment dates can differ, so establish the responsible coverage for the actual date of service. Read the current eligibility instructions.
Recommended checklist, followed by any plan-specific confirmation:
Is coverage active for the scheduled service date?
Which program and MCO, if any, apply to that date?
Are there restrictions or other insurance that change the next step?
Does the actual clinician and location participate in the responsible plan?
Is the proposed service covered, and is authorization or another prerequisite needed?
An eligibility response does not by itself resolve network participation, medical necessity or authorization. Keep unresolved questions attached to the appointment or billing task until the responsible program answers them.
Your Texas Benefits is the member route
HHSC’s Medicaid-card page describes how a member uses their own Your Texas Benefits account: Log In, Manage, then Medicaid & CHIP Services quick links to view services and health information. This member route is different from a provider’s TMHP access. Read HHSC’s member instructions.
Do not ask a member to share their login or use it as the clinic’s billing account. The provider workflow should use authorized provider access; the member can review their own benefits through their own account.
When the provider screen is unavailable
TMHP also identifies the Medicaid Client Portal for Providers and the Automated Inquiry System at 800-925-9126 as eligibility-verification options. Follow the current official instructions for the selected method. Review provider verification alternatives.
Fix My Account permissions and biller access
Understand STAR MCO participation
Route the therapy claim after eligibility is confirmed
Frequently Asked Questions
Is Your Texas Benefits the provider billing login?
No. It is the member-facing benefits route. Providers use authorized TMHP eligibility tools, including TexMedConnect and the Medicaid Client Portal for Providers.
Which dates should I enter for eligibility?
Check the actual date or date range of service. A current-day check does not establish coverage for an earlier session.
Does an active Medicaid card guarantee a therapy claim will pay?
No. Verify the responsible service-date coverage, clinician participation, service requirements and any authorization before relying on payment.
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Founded by George Ruan, Dax Earl, and Andrey Goder, Bomi helps independent therapists and group practices with insurance billing, credentialing, and payer follow-up. Bomi grew out of Dax’s experience helping his mother with her therapy practice, with a clear purpose: reduce the administrative burden of insurance while keeping practice owners in control.
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