07/16/2025

What’s new: Effective Sept. 1, 2025, the Texas Health and Human Services Commission will implement Rider 32, which will transition Medicaid only services for dually eligible members from a fee-for-service model to a managed care delivery system. Through Rider 32, this change affects services provided to members who are eligible for both Medicaid and Medicare. It applies only to those Medicaid services not covered by Medicare.

How does this impact providers?

• Providers will be able to bill Blue Cross and Blue Shield of Texas directly for Medicaid wrap-around services provided to dually eligible members.
• Wrap-around services include all Medicaid services not covered by Medicare. They are limited to those already covered under managed care for Medicaid-only members. 

Claims submitted in error to Texas Medicaid Health Partnership

• When TMHP receives claims submitted in error for dates of service on or after Sept. 1, 2025, they will forward those claims to BCBSTX and will no longer adjudicate them. 
• TMHP's claim response will indicate that the claim was forwarded, but they will not issue an Electronic Remittance and Status report in this instance

Stay informed: For updates on the transition of Rider 32, please continue to check our Medicaid news.

If you have questions: Call our Medicaid Provider Network Team at 1-855-212-1615 or email.