09/15/2025
The Texas Medicaid & Healthcare Partnership updated the Texas Medicaid Provider Procedures Manual to incorporate a new policy regarding provider responsibilities, effective Sept. 1, 2025.
Providers must adhere to the guidance outlined here and share this communication with their staff.
In line with House Bill 44, this update states that Medicaid providers are prohibited from refusing health care services to any Medicaid member solely based on the member's refusal or failure to obtain a vaccine or immunization for a particular infectious or communicable disease. This prohibition applies unless an exception is allowed under Texas Government Code §531.02119.
This measure aims to ensure that Medicaid recipients continue to have access to necessary health care services, regardless of their immunization status, within the bounds of the specified legal exceptions.
Where to report noncompliance for Medicaid
Allegations of provider discrimination based on vaccine status are handled by the Texas Health and Human Services Commission and not by Blue Cross and Blue Shield of Texas, as applicable.
Report allegations to the Health and Human Services Office of the Ombudsman. To contact the office:
- Call the Ombudsman Managed Care Assistance Team at 866-566-8989 (toll free). For hearing or speech assistance, call 711 or 800-735-2989 for TTY services
- Submit online
- Fax to 888-780-8099 (toll free)
- Mail to Texas Health and Human Services Commission, Office of the Ombudsman, MC H-700, PO Box 13247, Austin, Texas 78711-3247
Where to report noncompliance for CHIP:
- Allegations of provider discrimination based on vaccine status are handled by HHSC and not by Blue Cross and Blue Shield of Texas, as applicable.
- Report CHIP allegations to HHSC through the MCCO Research and Resolution Team. To contact the team:
- Email HPM Complaints
- Submit online
- Fax 512-491-1958
- Mail to Health and Human Services Commission Medicaid/CHIP, Managed Care Compliance and Operations, PO Box 149030, MC-0210, Austin, TX 78714-9030
Resources
Uniform Managed Care Contract:
- 8.2.6 (Medicaid Member Complaint and Appeal System)
- 8.4.2 (CHIP Member Complaint and Appeals)
- 8.1.29 STAR Kids (Member Complaint and Appeal System)
If you have questions or need assistance, please reach out to our Medicaid Provider Network Team at 855-212-1615 or email.