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

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.