MedicaidAdministrativeHigh impact
EVV Impacts: Baylor Scott & White and FirstCare MCOs End Participation in Texas Medicaid Managed Care Effective Aug. 31
Texas Medicaid·TX·General
Effective date
Sep 1, 2026
We identified it
Jul 22, 2026
Summary
Effective Sept. 1, 2026, Baylor Scott & White and FirstCare will end participation in Texas Medicaid STAR program. All members must transition to alternative MCOs (WellPoint or Superior) in their service area. Billing teams must identify each member's new MCO assignment, create new authorizations in the EVV system with updated plan codes, and bill the new payer for all dates of service on or after Sept. 1, 2026.
Action Required
Before Aug. 31, 2026: Billing team, providers, FMSAs, and PSOs must (1) identify which MCO and plan code each affected member transitioned to using the transition table provided (members in Lubbock area select plan code 53 or 52; MRSA West select W2 or W3; MRSA Central select C1 or C2); (2) verify member eligibility and new MCO assignment via EaaS/TIERS-based 270/271 inquiry or Medicaid Client Portal to check future eligibility through end of following month; (3) create new authorizations in the EVV system using the new MCO's plan code and applicable information from the old authorization expiring Aug. 31; (4) manually enter the new authorization into EVV system; (5) notify any third-party billing vendors of the plan code changes. Beginning Sept. 1, 2026: Billing team must submit all claims for affected members to the new MCO using the transitioned plan code. Continue submitting EVV-required services claims directly to TMHP for EVV claims matching. Failure to update authorizations and transition to correct MCO will result in claim denials and service interruptions for affected members.