To change Medicaid plans in Texas, call the Enrollment Broker Helpline at 1-800-964-2777 or log into your account at YourTexasBenefits.com and use the “Pick Your Health Plan” tool. If you’re enrolled in STAR, STAR Kids, or STAR+PLUS, you can switch managed care organizations at any time and for any reason.1Texas Health and Human Services. Choosing a Health Plan The change takes 15 to 45 days to take effect, so timing matters if you have appointments coming up or prescriptions to refill.
When You Can Switch
Most Texas Medicaid members are not locked into a plan for the year. If you’re in STAR, STAR Kids, or STAR+PLUS, you can request a change whenever you want, with no waiting period and no need to prove a special circumstance.1Texas Health and Human Services. Choosing a Health Plan This is one of the most misunderstood parts of Texas Medicaid. It doesn’t work like employer coverage, and you don’t have to wait for an open enrollment window.
You are switching between managed care organizations (MCOs) within the same program. Your program is set by your eligibility category, so a plan change means choosing a different MCO that operates in your service area, not moving between STAR and STAR+PLUS.
CHIP Members Have Tighter Rules
The Children’s Health Insurance Program works differently. CHIP members can change plans freely during the first 90 days of enrollment, and CHIP Perinatal members have 120 days.1Texas Health and Human Services. Choosing a Health Plan There’s no cap on how many switches you can make during that initial window.2Texas Health and Human Services. Texas Works Handbook – D-1740 Health Plan Change
After that, CHIP members can change once a year at annual redetermination. Any change outside those windows requires “good cause,” which HHSC reviews case by case. Good cause includes moving to a different service area, needing a service the plan doesn’t cover, being unable to reach providers experienced with your child’s condition, the plan refusing a needed service on moral or religious grounds, needing multiple related procedures the network can’t accommodate together, or receiving poor quality of care.2Texas Health and Human Services. Texas Works Handbook – D-1740 Health Plan Change The bar is reasonable: if your child genuinely can’t get needed care through the current plan, that fits the exception.
Requesting the Change by Phone
Call the Texas Enrollment Broker Helpline at 1-800-964-2777, Monday through Friday, 8:00 a.m. to 6:00 p.m.3Texas Health and Human Services Commission. Medicaid and CHIP Services Managed Care Enrollment Overview The enrollment broker is a neutral third party, not an employee of any MCO, so they won’t steer you toward a specific plan.
Before you call, have your Medicaid ID number, current plan name, date of birth, and address in front of you. The broker will confirm you’re eligible to change, tell you which MCOs serve your ZIP code, and process the request on the call. Ask for the expected effective date before you hang up so you know when the new plan takes over.
Requesting the Change Online
Log into YourTexasBenefits.com. On your account page, click “Manage,” open “Medicaid & CHIP Services” from the Quick Links section, then click “Pick Your Health Plan.” From there you can compare available MCOs and submit your selection electronically.3Texas Health and Human Services Commission. Medicaid and CHIP Services Managed Care Enrollment Overview
The online path is faster if you already know which plan you want. If you have questions about which doctors are in-network or how covered services differ, the phone option puts you with a live person who can walk through the comparison. Either way, check each MCO’s provider directory before you commit; that’s the single most useful thing you can do to avoid problems after the switch.
How Long the Change Takes
Plan changes take 15 to 45 days to process.1Texas Health and Human Services. Choosing a Health Plan Your new MCO does not become active the day you make the request. During the processing window, you keep receiving care through your current plan.
Once the switch goes through, your new MCO will mail you ID cards. Keep your old cards until you’ve confirmed the new plan is active. Showing up at a provider’s office with only the new card before the effective date can create billing confusion. If you have prescriptions to refill during the transition, make sure the pharmacy has the updated plan information on or after the effective date, not before.
Keeping Your Providers Through the Switch
The biggest risk in changing plans is losing access to a provider mid-treatment. Before you finalize the change, pull up the new plan’s provider directory and verify your current doctors, specialists, and any hospitals or clinics you use are in-network.
Texas requires MCOs to provide continuity-of-care protections when members transition between plans. During the STAR+PLUS transition in 2024, HHSC required the new MCO to keep authorizing services in the same amount and scope for up to six months or until it completed its own assessments and issued new authorizations, and members could keep seeing current providers even if those providers were out-of-network with the new plan.4Texas Health and Human Services. Continuity of Care During the STAR+PLUS Transition Specific limits applied: up to 90 days for acute care, up to six months for long-term services and supports, and up to nine months for members with a terminal illness.
Those specific limits were set for that statewide transition, but they reflect the continuity framework Texas applies during MCO changes. If you’re in the middle of treatment for a serious condition, call your new MCO before the switch takes effect and ask about single-case agreements or out-of-network authorizations. Most MCOs would rather keep your care uninterrupted than deal with a complaint afterward.
If Something Goes Wrong After You Switch
If your new MCO denies a service, drops a provider you were told would be covered, or otherwise creates problems, start with a complaint or grievance filed directly with the MCO. Every plan has an internal grievance process and a required response timeframe.
If the MCO’s internal process doesn’t resolve it, escalate to HHSC. You can file using the online Question or Complaint Form, by emailing HPM_Complaints@hhsc.state.tx.us, or by mail to Texas Health and Human Services Commission, Health Plan Management, Mail Code H-320, P.O. Box 85200, Austin, TX 78708-5200.5Texas Health and Human Services. Medicaid and CHIP Complaints and Appeals MCO contract compliance depends on member satisfaction metrics, so complaints carry weight. Don’t treat the MCO’s first answer as final.