Baylor Scott & White and FirstCare stop participating in Texas Medicaid managed care after this month, and the cutoff is hard. Effective September 1 the two plans leave the program, and after August 31 their members can no longer receive Medicaid, STAR or Children’s Health Insurance Program services through them, according to a notice from the Texas Medicaid & Healthcare Partnership, the state’s claims administrator, last updated July 17.
Four plan codes end that day: FirstCare’s CHIP and STAR products in the Lubbock service area, FirstCare’s STAR product in the West Texas rural service area, and Scott & White Health Plan’s STAR product in the Central Texas rural service area. The Texas Health and Human Services Commission has put turnover plans in place to move members into new coverage; members in the affected areas were asked to choose a new plan by July 14, and those who did not choose are being assigned one by the state.
The mechanics matter to providers as well. August 31 is the last date of service for which the partnership will accept claims under either plan, and any claim with a service date on or after September 1 will be rejected. Providers have 24 months to submit claims for services delivered on or before August 31, with a federal deadline of August 31, 2028. Prior authorization processes are not affected. The commission also told providers in a July 21 notice that the exits carry consequences for electronic visit verification, the system that logs in-home attendant care.
The exit was not a surprise to the state. Baylor Scott & White Health Plan announced on April 15 that it had notified regulators of its intent to leave Medicaid managed care on August 31 and to stop offering individual marketplace coverage after December 31, 2026, attributing the decision to the state’s Medicaid procurement outcome and what it called “Individual Marketplace complexities,” KWTX reported. The plan said it serves about 3.5 percent of Texas Medicaid customers and 2.6 percent of marketplace customers, that its hospitals and clinics will continue to accept Medicaid and marketplace insurance, and that it will concentrate on employer groups and Medicare Advantage.
Losing a plan is not the same as losing coverage, and the state’s assignment process is designed to prevent a gap. But switching carriers is not free to the patient. A new plan means a new provider network, new prior authorizations for ongoing treatment, sometimes a new pharmacy benefit manager and a new formulary. For a child on a specialty drug or an adult midway through a course of therapy under STAR, the managed-care program covering most low-income children, pregnant women and families in Texas, continuity depends on whether the current treating physician contracts with the receiving plan. Rural service areas — which is exactly what MRSA West and MRSA Central are — carry the thinnest margins for that, because there are fewer alternative providers in network to begin with.
The exits also compound. The same company’s departure from the individual marketplace at the end of December lands in the same year Texas households face another round of Affordable Care Act premium increases, a squeeze this publication examined when federal officials ended a Medicare drug-premium cushion for 2027. Each withdrawal thins the number of carriers competing for the same Texans, and fewer competing bidders is not a recipe for lower prices.
Members who have not confirmed their new plan can do so through the state’s enrollment broker, and providers with claims questions can reach the partnership’s contact center at 800-925-9126. The practical deadline is four weeks out: after August 31, a Baylor Scott & White or FirstCare Medicaid card is no longer good for a visit.