Texas Medicaid uses a different program structure than most states. Understanding the Texas-specific terminology before you start enrollment prevents the confusion that slows most applications down.
Texas Medicaid's STAR+PLUS program, HHSC licensing, TMHP billing, and MCO contracting each have requirements specific to Texas. Denise built her Houston agency eight years ago and made every mistake available. This page gives you the map she didn't have.
Texas Medicaid uses a different program structure than most states. Understanding the Texas-specific terminology before you start enrollment prevents the confusion that slows most applications down.
Texas Health and Human Services Commission. The state agency that licenses home care agencies and administers Texas Medicaid. Your license and your Medicaid enrollment both flow through HHSC.
Texas Medicaid & Healthcare Partnership. Texas's Medicaid claims administrator. Fee-for-service claims go through TMHP. Most PAS patients are in managed care, so MCO portals handle the majority of your billing.
Texas Medicaid managed care for long-term services. Most Texas Medicaid members who qualify for home care are in STAR+PLUS. You must contract with STAR+PLUS MCOs to serve most Medicaid PAS patients.
Personal Assistance Services. The Texas Medicaid service category for non-medical personal care — bathing, grooming, meal prep, mobility assistance. PAS agencies need a specific HHSC license and STAR+PLUS MCO contracts.
Home and Community Support Services Agency. A broader Texas license category that includes skilled nursing visits. If you plan to bill home health codes in addition to PAS, you need HCSSA licensure.
Service Delivery Area. Texas divides STAR+PLUS into geographic service areas. MCO availability varies by SDA — check which MCOs are contracted in your specific service area before applying.
Managed Care Organization. Amerigroup, Molina, Superior HealthPlan, and UnitedHealthcare are the primary STAR+PLUS MCOs. Each requires separate credentialing and contracting.
Electronic Visit Verification. Required for all Texas Medicaid PAS visits. Texas allows multiple compliant EVV vendor options that integrate with the state aggregator system.
National Provider Identifier. Required before HHSC enrollment. Apply for a Type 2 (organizational) NPI at NPPES.cms.gov — free, typically 5-10 business days.
MCO contracting is the Texas-specific step that most often delays new agencies. Start all MCO applications simultaneously — not after HHSC licensing completes — or you'll wait an extra three to four months before you can serve your first STAR+PLUS patient.
Texas PAS agencies providing personal care services need a license from HHSC before enrollment. The application requires ownership information, key personnel background checks, and policy documentation. HHSC conducts an initial survey as part of the licensing process. If you plan to provide skilled nursing visits under home health codes, you'll need HCSSA licensure instead of or in addition to PAS.
Obtain your Type 2 organizational NPI from NPPES before beginning TMHP enrollment. Texas Medicaid provider enrollment through TMHP requires your NPI, HHSC license number, and service-specific documentation. TMHP enrollment is required even if most of your patients will be in STAR+PLUS managed care — base Medicaid enrollment is a prerequisite for MCO contracting in Texas.
Contact each STAR+PLUS MCO serving your service delivery area and initiate the contracting process simultaneously. Amerigroup, Molina, Superior HealthPlan, and UnitedHealthcare are the primary MCOs, but availability varies by SDA. Each MCO has its own credentialing packet, participation requirements, and contracting timeline. This is the step that delays most Texas agencies — starting all MCO applications at once, as early as possible, is the most important timeline decision you'll make.
Texas requires EVV for all Medicaid PAS visits. Unlike Georgia, Texas allows agency choice among compliant EVV vendors that integrate with the state aggregator system. Select your EVV vendor before your first visit — operating without EVV results in claim denials. Your MCO contracts may specify EVV requirements in addition to the state baseline. Verify EVV requirements with each contracted MCO during the contracting process.
Set up TMHP portal access for fee-for-service claims and separate portal access for each contracted MCO's billing system. In practice, most of your billing activity will be through MCO portals — STAR+PLUS managed care handles the majority of Texas Medicaid PAS patients. Understanding the billing requirements for each MCO (including their specific service codes, authorization documentation requirements, and timely filing windows) is part of your pre-launch setup.
Scheduling, EVV configuration for your Texas MCOs, billing setup across TMHP and MCO portals, caregiver credentialing tracking to Texas HHSC standards, and authorization management for STAR+PLUS prior authorizations — all in place before your first patient. CareBravo's Texas setup covers each of these for the MCOs in your specific service area.
Denise runs a 90-patient agency in a Houston suburb. Eight years in, she's made every mistake available. The EVV system switch that took three months and almost broke her. The authorization hours she's watched expire on Sunday afternoons because she doesn't have a system that flags them automatically. The year-six state survey that made her throw up in the parking lot.
What she'd tell a Texas nurse starting today:
"Start your MCO contracting applications before your HHSC license is final. The MCOs don't care when your license was issued — they care when you submitted your credentialing packet. I waited until I had my license to apply to Amerigroup and Superior. I could have been in-network three months earlier if I'd applied during the licensing wait. That's three months of patients I couldn't serve and revenue I didn't collect."
"Set up your authorization tracking before your first patient. STAR+PLUS authorizations expire. The hours don't carry over. I found out in year two that I was leaving somewhere between $4,000 and $6,000 a month on the table because I didn't have a system watching every patient's utilization window every week. By then I had 40 patients and the problem was already large."
CareBravo configures your operational layer for Texas-specific requirements: EVV setup for your Texas MCOs, TMHP and MCO billing configuration, STAR+PLUS authorization tracking, caregiver credentialing to HHSC standards. The setup happens before your first patient, not under the pressure of your first 90 days of operations.
Texas setup includes: EVV configuration for your specific STAR+PLUS MCOs, TMHP billing setup for fee-for-service patients, MCO portal configuration for each contracted MCO, STAR+PLUS prior authorization tracking from patient one, caregiver credentialing tracking against Texas HHSC requirements. Built before you need it — not assembled in the first year while you're also trying to find patients and hire caregivers.
From initial application to first billable visit, most Texas agencies take 4-7 months. HHSC licensing typically takes 90-120 days. TMHP enrollment runs concurrently once your NPI is active. MCO contracting — the critical path item — takes 90-150 days per MCO and should be started as early as possible, ideally concurrent with or even before HHSC application. Agencies that start MCO contracting late add 3-4 months to their timeline unnecessarily.
You don't need all MCOs, but you should be contracted with the MCOs that have significant enrollment in your specific service delivery area. MCO market share varies significantly by Texas SDA — in the Houston metro area where Denise operates, Superior HealthPlan and UnitedHealthcare have strong enrollment alongside Amerigroup and Molina. Check HHSC's published MCO enrollment data for your target counties before deciding which MCOs to prioritize. Being in-network with only one or two MCOs in a service area with four MCOs means you can't serve roughly half the potential patient population.
STAR+PLUS prior authorizations are managed by each MCO's case manager. Authorizations specify the number of PAS hours approved per week, the authorization period, and the service codes covered. Like all Medicaid prior authorizations, STAR+PLUS authorizations expire — hours not delivered before the authorization period ends cannot be retroactively billed. Texas STAR+PLUS agencies that don't track authorization utilization continuously lose significant revenue to expired authorization hours. CareBravo's authorization management function watches every STAR+PLUS patient's utilization window every week.
Fee-for-service Texas Medicaid claims are submitted through TMHP using standard CMS billing formats. STAR+PLUS claims are submitted through each MCO's provider portal using the service codes and billing formats specified in your MCO contract — which may differ from the TMHP fee-for-service requirements. Each MCO also has its own timely filing window, claim correction process, and denial appeal procedure. Setting up billing correctly for each contracted MCO, before your first claims batch, prevents the errors that create the denial backlogs most Texas agencies are managing.
CareBravo's pricing is a percentage of your collections — there's no flat monthly fee running before you collect. During the pre-revenue period before your first STAR+PLUS payments arrive (Texas Medicaid payment cycles mean first payments typically arrive 60-90 days after your first visit), your cost is structured around a startup floor rather than full percentage rates. The specific number is on the pricing page and in the first conversation with CareBravo.
The first conversation starts with where you are in the Texas enrollment process. CareBravo configures for your specific Texas MCOs, your service delivery area, and your HHSC license type — so the operational layer is ready before your first visit, not assembled under pressure during your first 90 days.