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Managed Care

The Health and Human Services Commission (HHSC) contracts with Managed Care Organizations (MCOs) to coordinate healthcare services for Medicaid and Children’s Health Insurance Program (CHIP) members through established provider networks.
MCOs must ensure members receive all medically necessary covered services.

MCOs manage Medicaid and CHIP benefits in all 254 Texas counties, including basic health care, psychiatric care, substance use disorder services, nursing care, inpatient benefits, medications, counseling services, and comprehensive mental health rehabilitative services for persons with serious and persistent mental illness. Medicaid MCOs also manage some community-based long-term services and supports for people with intellectual and developmental disabilities (IDD).

For persons with IDD, Centers serving as the Local IDD Authority provide Targeted Case Management to assist individuals and families with access to needed healthcare and community-based services. The vital role of Community Centers, statewide managed care and the 1115 Transformation Waiver creates opportunity to strengthen local collaborations and improve access to comprehensive care for vulnerable Texans with IDD, serious mental illness and substance use disorders.

A current map of Texas Managed Care Service Areas is available here.