Texas Medicaid confuses a lot of providers, for an understandable reason: there are two separate approvals that both sound like "getting into Medicaid." One is enrollment in Texas Medicaid itself, handled through TMHP. The other is contracting and credentialing with the managed care organizations (MCOs) that serve most Medicaid clients. You need the first before you can get the second, and the second is not automatic.
This guide explains how the two layers work, why they are separate, and what keeps them both active. For the TMHP side in more depth, see our Texas Medicaid TMHP enrollment guide.
Two layers: the state program and the health plans
Texas Medicaid enrollment is your relationship with the state program. TMHP, the state's claims administrator, processes enrollment on behalf of the Texas Health and Human Services Commission (HHSC) through its Provider Enrollment and Management System (PEMS). Enrollment confirms that you meet state and federal requirements to participate.
Managed care contracting and credentialing is your relationship with each health plan. Most Texas Medicaid and CHIP clients are enrolled in managed care programs such as STAR, STAR+PLUS, STAR Kids and STAR Health, and they get care through the MCO they are assigned to or choose. Each MCO decides which providers to contract with and credential for its network.
Why the order matters
HHSC and TMHP are clear that providers must be enrolled in Texas Medicaid before an MCO can enroll them. In practice, that means:
- Enroll in Texas Medicaid through TMHP.
- Contact each MCO you want to join and complete its separate contracting and credentialing process.
- Once both are in place, you can be paid for serving that plan's members.
TMHP's guidance also notes an important limit: enrollment in Texas Medicaid does not guarantee that any MCO will contract with or credential a particular provider. Plans manage their own networks.
How MCO credentialing works in Texas
Each MCO has its own contract and its own requirements. Texas has tried to reduce duplication in one important way: according to the Texas Medicaid Provider Procedures Manual, Medicaid MCOs use a common credentialing verification organization contracted through the Texas Association of Health Plans for credentialing and recredentialing. That shared verification step does not replace each plan's contract, but it does mean consistent, accurate information matters across all of them.
Many providers also use the Texas Standardized Credentialing Application and a CAQH profile as part of plan credentialing. Keeping your TMHP record, CAQH profile and license details aligned avoids many questions.
Choosing which plans to join
MCOs are assigned by service area, and not every plan operates in every part of Texas. Before applying, look at which plans serve your area and your patient population. A pediatric practice may prioritize STAR and STAR Kids plans, while a practice serving older adults or people with disabilities may focus on STAR+PLUS. Joining the plans your patients actually use matters more than joining as many as possible.
Revalidation keeps both layers alive
Texas Medicaid enrollment must be revalidated at least every five years, and some provider types more often. HHSC recommends submitting revalidation well ahead of the due date, and TMHP allows it to start up to 180 days early. The process has to be fully approved, not just submitted, by the due date.
Here is the part that catches people off guard: if your Texas Medicaid enrollment lapses, TMHP disenrolls you from all Texas state health care programs, including the MCOs. Your plan contracts may still exist on paper, but claims and prior authorizations will deny until you re-enroll. That is why revalidation dates deserve the same attention as plan contracts.
Common problems
- Applying to MCOs before TMHP enrollment is complete.
- Assuming one MCO contract covers all Medicaid clients.
- Different addresses or names on TMHP, CAQH and plan applications.
- Missing a revalidation date and losing access to every plan at once.
- Not updating TMHP and each MCO after a move or change in ownership. See our guide to reporting changes.
A quick map of the programs
Texas uses several managed care programs, each serving a different population. In broad terms, STAR serves most children, pregnant women and some adults; STAR+PLUS serves adults who have disabilities or are 65 and older; STAR Kids serves children and young adults with disabilities; STAR Health serves children in foster care; and CHIP covers children in families that earn too much for Medicaid but cannot afford private coverage. Program details and eligibility are set by HHSC and can change, so check HHSC's current descriptions when planning.
Why does this matter for credentialing? Because each program is served by specific plans in specific service areas, and plan contracts may cover some programs and not others. Knowing which programs your patients are in tells you which plans, and which contracts within those plans, you need.
Behavioral health and specialty services
Some services, including many behavioral health services, are delivered through the same managed care plans, but plans may manage them through a separate department or vendor with its own contracting contacts. ABA services for children with autism are one example covered in our ABA credentialing guide. Ask each plan who handles contracting for your specialty before you apply.
How Maverick can help with Texas Medicaid and managed care
- We sequence it correctly. We confirm your TMHP enrollment, choose the plans that serve your area and patients, and file with each MCO once the state enrollment is in place.
- A complete and accurate file. We gather, check and line up your documents and data before anything is submitted, so the application agrees with itself and with the other records a reviewer will check.
- Prompt submission. Once your file is complete, we submit it. It does not sit in a queue on our side.
- Regular follow-up. We follow up with the payer or agency and handle requests for more information on your behalf.
- Keeping you updated. You always know where each application stands and what, if anything, we need from you.
New Texas practices can include Texas Medicaid and MCO applications in Maverick Launch: Solo or Maverick Launch: Group. Already enrolled? Autopilot tracks TMHP revalidation and plan recredentialing so neither lapses. See our Medicare and Medicaid enrollment service and group enrollment and contracting service.
What we do not control is how long a payer, board or state agency takes to review your file. Those decisions belong to them, and we will never promise a date on their behalf.
Sources: Texas Medicaid Provider Procedures Manual, Vol. 1, Section 1 (Provider Enrollment) and Vol. 2, Medicaid Managed Care Handbook (TMHP); Texas HHSC, Medicaid and CHIP Enrollment and Revalidation (hhs.texas.gov); TMHP Enrollment Revalidation Quick Reference; 42 CFR 455.414. Verified October 2026.