Rider 32 Implementation Reminder

Date: July 11, 2025

Attention: All Providers

Effective date: September 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that beginning September 1, 2025 the Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually eligible clients (patients who are eligible for both Medicare and Medicaid) enrolled in Medicaid managed care from a fee-for-service (FFS) to a managed care service delivery system.

Provider Responsibilities

Providers must submit claims for Medicaid-only services for dual eligible patients enrolled in Medicaid managed care directly to the Managed Care Organization (MCO). If a provider submits a claim to the Texas Medicaid & Healthcare Partnership (TMHP) in error:

• TMHP will forward the claim to the appropriate MCO; and
• TMHP’s claim response will reflect that the claim was forwarded, but TMHP will not issue an Electronic Remittance and Status (ER&S) Report.
• TCHP will be responsible for the adjudication of these claims

Next Steps

• TMHP will forward these claims based on dates of service on or after September 1, 2025. TMHP will no longer adjudicate these claims.
• Providers should contact the member’s MCO (TCHP) directly for claim status updates and questions related to adjudication.
• For a list of Medicaid-only services impacted by this change, see the Rider 32 Procedure Code List.
• We understand providers may have questions about how Rider 32 will affect their practice. Please reach out to your assigned Provider Relations Liaison or Account Lead with any questions.

Resources

• Rider 32 Overview Video
• FAQ Document

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.