Medicaid and CHIP - Contact Us

Contacts for Clients

Questions about Medicaid Managed Care

Call the Medicaid client hotline at 800-252-8263 or visit the Managed Care page on our website. To apply for benefits, visit YourTexasBenefits.com.

Questions about Traditional Medicaid

Call Center General Inquiries Line at 800-925-9126 or visit the Contact Center website (link is external).

Community Resources

No matter where you live in Texas, you can dial 2-1-1 or 877-541-7905 to find information about resources in your local community. Whether you need help finding food or housing, child care, crisis counseling or substance abuse treatment, 1 number is all you need to know.

Client Complaint Resolution

If you have concerns or are unhappy with your health plan or the services you receive, you can submit a complaint.

How do I submit a complaint?

If you have a health plan, call your health plan first. Often they can help you more quickly.

Your health plan's phone number is on your health plan identification card. You can also look up the phone number for your health plan here.

If you don't have a health plan, call the Medicaid helpline at 800-335-8957.

What if I still need help?

If you've called your health plan or the Medicaid helpline and still need help, you can submit your complaint to the Office of the Ombudsman. They can help resolve problems with your Medicaid coverage.

To submit a complaint to the HHS Ombudsman, you can:

  • Fill out this online form.
  • Call 866-566-8989 8 a.m. to 5 p.m. Central Time, Monday through Friday and speak to someone that day.

The Ombudsman's team will get back to you within one business day. They will follow up with you every five business days until the complaint is resolved. The team will tell you the resolution and any next steps you might need to take.

If you have an urgent medical need, the team will handle your complaint as soon as possible.

What do I need when I submit a complaint?

Be ready to give us:

  • Your Medicaid ID card number.
  • Your name or the name of the person you are calling about.
  • Other important information, such as birthdays or home addresses.

We use this information to make sure we know who you are and the details of your case are secure.

If your complaint is about a doctor's office, pharmacy or medical equipment company, have their contact information handy. Have any documents related to your complaint, such as letters, bills or prescriptions, ready too.

Other Resources

If you just want information, use the resources below:

  • Eligibility questions – call 2-1-1, Option 2
  • Medicaid benefits questions – your health plan
  • All other questions – HHS Ombudsman, 1-866-566-8989

Children’s Health Insurance Program (CHIP) members

If you are not satisfied with the answer to your complaint, you can also complain to the Texas Department of Insurance by calling toll-free 800-252-3439. If you would like to make your request online or in writing, please send it to the addresses listed here.

Civil Rights issues

Call the Texas Health and Human Services Civil Rights Office if you need to talk to someone about concerns of discrimination or would like to file a discrimination complaint.

Civil Rights Office

Texas Health and Human Services Commission
701 W. 51st St.
MC W206
Austin, Texas 78751
888-388-6332 or 512-438-4313
TTY toll-free: 877-432-7232
HHSCivilRightsOffice@hhsc.state.tx.us

Texas Health and Human Services Commission (HHSC) Headquarters

Texas Health and Human Services Commission
Brown-Heatly Building
4900 N. Lamar Blvd.
Austin, TX 78751-2316
Phone: 512-424-6500
Media calls: 512-424-6951

Report Waste, Fraud, or Abuse

You can report suspected fraud, waste, or abuse in Texas HHS programs to the Office of Inspector General by filling out an online form or by calling 800-436-6184. You also may make a report to the Texas State Auditor's Office by calling 800-TX-AUDIT.

Contacts for Providers

Claims Administration and Provider Enrollment

Texas Medicaid & Healthcare Partnership (TMHP)  is the claims administrator for Texas Medicaid.

Technical Support for Filing Claims: 888-863-3638

Filing Claims for Managed Care Services

Claims for services administered by a medical or dental plan must be submitted to the plan. Providers may submit managed care claims by the following:

  • Submit acute, long term services, or dental claims directly to the appropriate medical or dental plan using the methods established by the plan.
  • Submit acute care or dental claims electronically to TMHP for routing to the appropriate medical or dental plan.

Provider Complaints and Appeals

Fee-For-Service

Medicaid fee-for-service providers must exhaust the administrative and medical appeals provider resolution process with the HHS claims administrator contractor before filing an appeal or complaint with HHSC. Written appeals and complaints may be sent to HHSC at:

Texas Health and Human Services Commission
HHSC Claims Administrator Contract Management
P.O. Box 204077
Mail Code 91-X
Austin, Texas 78720-4077

Medicaid Managed Care

Medicaid managed care providers must exhaust the complaints or grievance process with their managed care medical or dental plan before filing a complaint with HHSC. If after completing this process, the provider believes they did not receive full due process from the managed care medical or dental plan, they may file a:

You can see the complaint process by viewing this flow chart (PDF). An accessible version of the steps in the complaint process (DOC) is also available.

Providers also may mail STAR, STAR+PLUS, STAR Health or children's Medicaid dental services complaint or inquiry to:

Texas Health and Human Services Commission
Medicaid/CHIP
Health Plan Management
Mail Code H-320
P.O. Box 85200
4900 N. Lamar
Austin, Texas 78708-5200

Providers can submit appeals directly to the medical or dental plan that administers the clients' managed care benefits. Claims that originally were submitted to TMHP for routing to the appropriate medical or dental plan can be appealed to TMHP using TexMedConnect or EDI. The appeals will be routed to the appropriate entity for processing.

For additional information see Texas Administrative Code, 1 TAC 354.

CHIP

CHIP call center: 877-543-7669 or 800-647-6558

CHIP Processing Center:
Texas Health and Human Services Commission
P.O. Box 149024
Austin, TX 78714-9024