Refunding CHIP Copayments for Recouped Services

Date: August 31, 2026

Attention: CHIP Providers

Effective date: September 1, 2026 

New provider obligation: Under UMCC Section 8.1.23.2, when an MCO, such as TCHP, recoups a payment from a provider for a service previously rendered to a CHIP member, the member cannot be left financially responsible for any out-of-pocket costs associated with the recouped service.

Accordingly, when a recoupment occurs and the provider previously collected a copayment from the CHIP member or the member’s family for that service, the provider is responsible for promptly refunding the applicable copayment to the CHIP member’s family.

Providers should ensure that appropriate processes are in place to:

• Identify CHIP member copayments associated with recouped services.
• Issue the required refund promptly to the member or member’s family.
• Maintain documentation of the refund for audit and compliance purposes.
• Ensure that the member does not remain financially responsible for the recouped service.

Providers are reminded that retaining a CHIP member’s copayment after the related service payment has been recouped is inconsistent with the UMCC requirements.

What happens next: Beginning in October, TCHP’s Provider Relations Account Leads and Liaisons will contact impacted CHIP providers each month via email to notify them of members requiring a refund. Providers will be contractually required to complete and return an online attestation within 30 calendar days of receipt. The completed attestation will be used for reporting purposes.

Next steps for providers: Providers are advised to share this communication with their staff and adjust their daily operations accordingly to accommodate the new requirements outlined in this communication.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.

For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.