Date: August 31, 2026
Attention: CHIP Providers
Effective date: September 1, 2026
| IMPORTANT: Texas Children’s Health Plan (TCHP) would like to bring your attention to an upcoming change that will be effective on September 1, 2026, consistent with SFY27 Uniform Managed Care Contract (UMCC) 8.1.23.2, Refunding CHIP Copayments for Recouped Services. |
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. Link to attestation
Resource:Refunding CHIP Copayments for Recoupment Services FAQ
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.
