Act Now to Avoid Losing Your Medicaid Enrollment Status

Thanks to lobbying from TMA and organized medicine, the Centers for Medicare & Medicaid Services extended the deadline for physicians and other health professionals, including advanced practice nurses and physician assistants, to reenroll in Medicaid to Sept. 25, 2016. The initial deadline for reenrollment, driven by a provision in the Affordable Care Act, was March 24.  

According to the Texas Health and Human Services Commission (HHSC), all physicians participating in Medicaid who have not met all ACA revalidation requirements must do so through reenrollment by Sept. 24, 2016. To avoid disenrollment and possible claims payment disruption, Texas Medicaid officials urge physicians to submit a reenrollment application before June 17, 2016.  

The reenrollment requirement applies to physicians and other health professionals who participate in Medicaid managed care, traditional fee-for-service Medicaid (each active Texas Provider Identifier suffix), the Texas Vendor Drug Program, and in long-term care services administered through the Texas Department of Aging and Disability Services. 

If an application has deficiencies but is submitted by June 17, HHSC says there will not be gaps in payment after Sept. 24, if the physician makes a good faith effort to resolve application errors. Applications submitted after June 17 will be processed, but HHSC cannot guarantee those applications will be completed by Sept. 24, which could result in physician disenrollment from Texas Medicaid and denial of payment.

TMA and Texas Medicaid officials encourage Texas physicians to get ahead of the complex reenrollment process.

More Information

Acute Care Physicians Reenrolling Through Texas Medicaid and Healthcare Partnership

Ordering- and Referring-Only Physicians

Ordering- and referring-only physicians are those whose only relationship with Texas Medicaid involves ordering or referring services for Medicaid clients. They also must enroll with Texas Medicaid as participating physicians. 

Action, July 1, 2016

Last Updated On

October 11, 2016

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