Guidance on Member Allegations of Provider Discrimination Based on Immunization Status

Date: August 30, 2024
Attention: Providers
Update to Texas Medicaid Provider Procedures Manual: September 1, 2024

Call to action: The purpose of this communication is to inform providers of an update being made to the Texas Medicaid Provider Procedures Manual (TMPPM) on September 1, 2024 by the Texas Medicaid & Healthcare Partnership (TMHP). Section 1.7, Provider Responsibilities will read as follows, “ In accordance with H.B. 44, Medicaid providers are prohibited from refusing to provide health care services to any Medicaid client based solely on the client’s refusal or failure to obtain a vaccine or immunization for a particular infectious or communicable disease unless excepted by Texas Government Code §531.02119.”

Where to report non-compliance 

• Allegations of provider discrimination based on vaccine status are handled by HHSC and not by Texas Children’s Health Plan (TCHP), as applicable.
• HHSC receives these allegations through the HHS Office of Ombudsman.
• Ways to reach the HHS Office of Ombudsman include:
  • Toll-free phone call to the Managed Care Assistance Team 1-866-566-8989. A person who has a hearing or speech disability, call 7-1-1 or 800-735-2989.
  • Online at https://hhs.texas.gov/omcat.
  • Faxing toll-free to 888-780-8099.
  • Mailing to: Texas Health and Human Services Commission, Office of the Ombudsman, MC H-700, P.O. Box 13247, Austin, Texas 78711-3247.

Next step for Providers: Providers must adhere to the guidance outlined here and share this communication with their staff.

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

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.