Wellness Program

The Texas Medicaid Wellness Program is a comprehensive care management program with no disease exclusions, offered to high-cost and/or high-risk Medicaid fee-for-service clients. 

Eligibility

The Wellness Program serves people with disabilities and dual eligible individuals under the age of 21 who receive Medicaid fee-for-service, are able, or have a caregiver who is able to respond actively to health information and care coordination activities, and are identified as being high-cost and/or high-risk due to chronic illness or condition.

Purpose

The goal of the Wellness Program is to promote improved health outcomes by supporting and sustaining the provider-patient relationship. 

Services

The program supports eligible Medicaid clients with a series of regional care teams consisting of:

  • Community-based primary registered nurses
  • Pharmacists
  • Social workers
  • Behavioral health specialists
  • Dieticians
  • Certified diabetes educators
  • Community health workers 

Other benefits include:

  • Diabetes self-management training
  • Weight Watchers obesity program
  • Additional support and resources available via an internet-based patient portal

Wellness Program Nurse Hotline                          

Whenever a person in the wellness program, or eligible for the program, is sick, hurt, or has a health question, they can call a wellness program nurse at 1-800-777-1178 (TTY 1-800-735-2989). Nurses can help any time of day or night. The service is free. All personal facts are kept private.

Wellness program nurses can also help people in this program with:

  • Finding a main doctor
  • Managed their health between doctor visits
  • Learning more about their health conditions
  • Knowing how to take their medicines

Providers

Wellness Program providers will receive rosters and summaries for any eligible patients linked to their practice through claims data.  Providers can also refer eligible patients into the program.  Providers can review, approve, or make recommendations for the Wellness Program care plan created for each of the individual patients in the program.

The Wellness Program also offers a variety of new benefits for providers including:          

  • A comprehensive provider portal, where providers can review patient summaries, claims data, care plans, and patient education materials.
  • Practice support facilitators, who provide practice improvement tools and training, assist with Patient Centered Medical Home certification, and familiarize provider offices with other Wellness Program components.
  • Learning collaboratives designed to allow physicians to share their clinical improvement experiences.
  • Support for practice transformation initiatives.

The Wellness Program considers the provider the leader of the patient’s care team.  The Texas Medicaid Wellness Program is an extension of that team.  Providers are encouraged to take advantage of this program to help improve the ongoing care for their patients.

If you have any questions about the Wellness Program, or if you need any additional information, please call the Wellness Program provider phone number at 1-877-530-7756.