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Update to Medicare Waiver Request Requirements and Language

Texas Medicaid·TX·General
Effective date
Jul 31, 2026
We identified it
Jul 30, 2026
Days to comply
1 days

Summary

Effective July 31, 2026, Medicare waiver request requirements and language in PEMS are being updated. Providers who obtain Medicare certification after Medicaid enrollment must now submit a new Medicaid enrollment application within 10 days listing their complete Medicare information. Additionally, providers with existing Medicare waivers who later provide billable services to Medicare clients must immediately enroll in Medicare and resubmit Medicaid enrollment within 10 days. The waiver request certification statements in PEMS have been revised to clarify these obligations and the requirement to bill all applicable non-Medicaid insurances before Medicaid.

Action Required

Before Jul 31, 2026
By July 31, 2026: Billing team must ensure all providers understand the updated Medicare waiver requirements and revised language in PEMS. (1) Audit current Medicare waivers to identify any providers who may later obtain Medicare certification—establish process to capture Medicare certification dates and trigger 10-day Medicaid re-enrollment deadline. (2) For providers currently holding Medicare waivers: implement monitoring to detect if they begin billing Medicare services; if so, immediately enroll in Medicare and resubmit Medicaid enrollment within 10 days with Medicare certification info through PEMS. (3) For new providers: ensure enrollment workflow captures Medicare certification date and automatically triggers 10-day Medicaid application deadline if Medicare certification is obtained after initial Medicaid enrollment. (4) Train front-office, credentialing, and billing staff on the new waiver language in PEMS and the conditional enrollment requirements. (5) Update provider onboarding documentation and checklists to reflect these requirements. Failure to submit timely Medicaid re-enrollment after Medicare certification may result in coverage gaps, claim denials, or compliance violations.

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