Non-CE

Texas Medicaid Services for Children

Welcome to the training on Texas Medicaid Services for Children provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

Note: Health-care provider practices range from solo practitioners to large, multi-specialty groups. Some have entire departments dedicated to checking Medicaid eligibility, submitting and following up on claims, communicating with managed care plans, and credentialing. Others have a limited number of staff members who perform both administrative and clinical duties. Some Medicaid policies and procedures covered in this module may primarily involve administrative staff rather than the clinicians who are taking the training.

Goal

The goal of this module is to equip Texas Health Steps providers and others to follow legal requirements and employ best practices in delivering Texas Medicaid services to children birth through age 20 who are enrolled in Medicaid.

Target Audience

Texas Health Steps providers and other interested health-care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  • Apply knowledge of the medical and dental services that are available to children enrolled in Medicaid.
  • Specify requirements and processes for prior authorization and claims filing and adjudication.
  • Evaluate whether a medical service to diagnose or treat a condition would likely meet the definition of medical necessity.
  • Appraise whether a child enrolled in Medicaid could also be eligible for services under other Texas state health-care programs for children.

This module was released on 4/16/2020.

Provider Publications, Tools, Services, and Other Resources

Texas Medicaid & Healthcare Partnership 

Texas Health Steps

Medicaid and Other State Programs Providing Health-Care and Support Services

Texas Health and Human Services Commission

Texas Medicaid Managed Care Programs