Revision 19-2; Effective April 1, 2019

All Programs

Office of the Ombudsman operates a toll-free customer service hotline during normal office hours. The Office of the Ombudsman assists the public with issues or complaints about health and human services programs that have not been resolved under the agency's normal resolution process. If a person has a problem or complaint, they are encouraged to first discuss it with the person, program staff or office staff involved. They can often explain a specific policy or resolve the concern immediately.

People who need assistance or information about local resources or programs are encouraged to call 2-1-1 for access to information about health and human services in their community, including information on the location and phone number of local HHSC offices.

If a person has problems with or complaints about a health and human services program, service, or benefit that has not been resolved to their satisfaction, the person has four ways to send a question or file a complaint:

1. Call: Toll-free phone, relating to:
   1. A consumer, call 877-787-8999 (8 a.m. to 5 p.m., Central Standard Time, Monday through Friday).
   2. A consumer needing help with accessing services under a managed care plan, call 866-566-8989.
   3. A foster youth, call 844-286-0769.
   4. A consumer seeking behavioral health services, call 800-252-8154.
   5. A resident of a nursing facility or an assisted living facility, call 800-252-2412.
   6. A person who has a hearing or speech disability, call 7-1-1 or 800-735-2989.
2. Online: hhs.texas.gov/ombudsman
3. Fax: 888-780-8099 (toll-free)
4. Mail: Texas Health and Human Services Commission
   Office of the Ombudsman, MC H-700
   P.O. Box 13247
   Austin, Texas 78711-3247

Ombudsman staff:

• provide dispute resolution services;
• perform consumer protection and advocacy functions;
• collect consumer contact data;
• conduct reviews of complaints concerning HHSC policy or practices;
• ensure case actions related to complaints are consistent with applicable HHS policies;
• provide information to people about their rights and responsibilities;
• coordinate the resolution of complaints or requests for information with appropriate agency staff;
• refer people who request other state health and human services to the appropriate area;
• screen, document and track all complaints and inquiries received using the HHS Enterprise Administrative Report and Tracking System (HEART);
• compile and share various weekly, monthly and quarterly reports with designated executive, state and regional staff, providing complaint and inquiry volume and trend analysis.

Note: Ombudsman staff cannot determine eligibility or make changes to cases.

Medicaid Managed Care Helpline

The Medicaid Managed Care Helpline is designed to help people who receive Medicaid and need help accessing health care services. The HHSC Medicaid Managed Care Helpline helps people who receive Medicaid benefits:

• navigate the managed care system (STAR, STAR+PLUS, STAR Kids and STAR Health);
• understand their Medicaid coverage;
• understand their rights;
• advocate for themselves; and
• resolve problems, including access to care.

The Medicaid Managed Care Helpline also provides general information about managed care programs to providers, health plans, community based organizations and other stakeholders. People may contact the Medicaid Managed Care Helpline at 866-566-8989.

Related Policy

Managed Care, A-821.2
Managed Care Plans, C-1116