Texas Medicaid Enrollment vs STAR MCO Credentialing
By Dax Earl • October 9, 2026
Last updated: October 9, 2026.
Texas Medicaid enrollment and MCO participation are separate tasks. A TMHP provider record does not establish a contract with every STAR, STAR+PLUS or STAR Kids plan. As of October 9, 2026, use the current Medicaid Managed Care Handbook.
Sections
Three records to reconcile before seeing a plan member
Recommended participation worksheet:
State enrollment: identify the clinician, billing entity, location and approved Texas Medicaid record.
MCO participation: complete the applicable plan credentialing and contracting requirements.
Operational readiness: confirm the actual clinician/location roster, effective participation date and claim route with the plan.
Keep a separate owner and evidence for each step. An application confirmation, a signed contract and an effective provider roster answer different questions. Resolve discrepancies before treating the practice as participating.
Which MCOs serve my Texas service area now?
HHSC’s live service-area map reviewed for this article identifies plans serving clients as of September 2026 and is revised August 2026. Plan choices differ by program and service area. Use the live map rather than an old search excerpt or a statewide list copied into a checklist. Open HHSC’s managed-care service-area map.
HHSC’s plan-selection page links the official program comparisons and plan websites. Choose the relevant program and area.
STAR comparisons are published by county or service area. Find the STAR comparison charts.
STAR+PLUS has its own comparison charts and population-specific choices. Find the STAR+PLUS comparison charts.
STAR Kids uses separate service-area charts. Find the STAR Kids comparison charts.
These member-facing comparisons help identify the plans serving an area. They do not prove that a particular clinician is contracted, that a panel is open or that the plan will authorize a particular service. Confirm those points through the chosen plan’s current provider resources.
Verify the member, program and service date
Texas has different managed-care programs for different populations, including STAR, STAR+PLUS and STAR Kids. Start with the member’s actual program and plan rather than inferring a plan from age or county alone. Review HHSC’s program information.
Recommended scheduling check: record the service-date coverage, assigned MCO, clinician/location participation and any service-specific authorization requirement. If a member changes plans, recheck the new effective period rather than carrying the old plan forward.
TMHP claims or MCO claims?
The state enrollment task and the payment route must be reconciled separately. For each service, establish whether the benefit belongs to fee-for-service, the assigned MCO or a carved-out program. Do not send every Texas Medicaid therapy claim to TMHP solely because the clinician enrolled through PEMS.
Follow the PEMS enrollment checklist
Check eligibility before the session
Choose the behavioral-health claim route
Frequently Asked Questions
Does TMHP enrollment replace MCO credentialing?
No. Confirm state enrollment and the applicable MCO participation requirements separately.
Where is the current Texas Medicaid MCO list?
Use HHSC’s live service-area map and the STAR, STAR+PLUS or STAR Kids comparison page for the member’s program and area.
Does a plan comparison chart prove my practice is in network?
No. Verify the actual clinician, location and effective participation with the plan.
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