10/31/2025
As a reminder, the Texas Health and Human Services Commission transitioned Medicaid-only acute care services provided to dually eligible members from fee-for-service to managed care on Sept. 1, 2025. This change follows the implementation of Rider 32, as required by the 2024-2025 General Appropriations Act, House Bill 1, 88th Texas Legislature, Regular Session, 2023 (Art. II, HHSC, Rider 32).
Services provided via fee-for-service for all Medicaid beneficiaries are not impacted by this transition.
Continuity of Care Contract Requirements
Blue Cross and Blue Shield of Texas is contractually required to provide continuity of care for dual-eligible members who have Medicaid-only acute care services transitioning from fee-for-service to managed care.
We must ensure our members continue to receive covered Rider 32 services for the same amount, duration and scope for the shortest period of one of the following:
- 90 days after the Rider 32 services transition to a new managed care organization
- Until the end of the current authorization period (if Texas Medicaid and Healthcare Partnership approved a prior authorization); or
- Until we have evaluated and assessed the member and issued or denied a new authorization.
We must honor prior authorizations approved by TMHP, even if the provider is not contracted with BCBSTX. We must also provide continuity of care if a Rider 32 service did not require prior authorization in fee-for-service Medicaid, but BCBSTX does require a prior authorization.
For more information, refer to our FAQs on Rider 32.
For reference, see the STARS Kids Contract 8.1.23 Continuity of Care for Out-of-Network Providers.
For questions, contact our Medicaid Provider Network Provider Team or call 855-212-1615.