Date: April 17, 2025
Attention: All Providers
Effective date: September 1, 2025
Call to action: The purpose of this communication is to inform providers that effective September 1, 2025, Rider 32 will be implemented. Rider 32 transitions dually eligible individuals enrolled in Medicaid managed care from a fee-for-service (FFS) model to a Medicaid-only managed care service delivery system.
Starting September 1, 2025, providers will be required to bill Managed Care Organizations (MCOs) directly for the Medicaid-only acute care services provided to dually eligible members that MCOs cover for members who do not have Medicare.
Next steps: We understand providers may have questions about how Rider 32 will impact their practice. Additional details – including which providers are affected, relevant CPT codes, and billing guidance – will be shared in the coming months. Additionally, Texas Children’s Health Plan will also conduct targeted outreach to impacted providers as the September 1, 2025, effective date approaches. Please check back soon for additional updates and information.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.