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Electronic Verification Visit Impacts: Baylor Scott & White and FirstCare Managed Care Organizations End Participation in Texas Medicaid Managed Care Effective Aug. 31

Beginning Sept .1, Baylor Scott & White and FirstCare will not participate in the STAR program and will no longer be available as managed care organizations (MCOs). Due to the termination of these health plans, the plan codes in the table below will be end-dated on Aug. 31, 2026.

* Plan **Code  *



 *Organization Name* 



 *Program Name* 



 *Service Delivery Area* 



 50



 FIRSTCARE



 STAR



 Lubbock



 W4



 FIRSTCARE



 STAR



 MRSA West



 C3



 S&W HP



 STAR



 MRSA Central



Members must choose another MCO in their service area to continue their services.

 

The following table lists existing MCOs and their applicable plan code that members, who are currently with Baylor Scott & White or FirstCare, can select to continue their services.

* Plan Code *



* Organization Name *



* Program Name *



* Service Delivery Area *



 53



 WELLPOINT



 STAR



 Lubbock



 52



 SUPERIOR



 STAR



 Lubbock



 W2



 WELLPOINT



 STAR



 MRSA West



 W3



 SUPERIOR



 STAR



 MRSA West



 C1



 WELLPOINT



 STAR



 MRSA Central



 C2



 SUPERIOR



 STAR



 MRSA Central



 

*Payment of Services as of Sept. 1, 2026*

Beginning Sept. 1, program providers, financial management services agencies (FMSAs), and Proprietary System Operators (PSOs) *will* have a new MCO payer plan code for their members who were served by Baylor Scott & White or FirstCare and *must* bill the new payer with dates of service on or after Sep. 1, 2026.

Program providers, FMSAs and PSOs using a third-party vendor for billing need to notify the third-party vendor about the changes.

*Program Provider, FMSA and PSO Responsibilities*

Program providers, FMSAs and PSOs should continue to use the current authorization in the Electronic Visit Verification (EVV) system for their members through Aug. 31, 2026.

For dates of service beginning Sep. 1, 2026, and after, program providers, FMSAs and PSOs should:


* Identify the MCO and plan code that their member transitioned to.

* Create a new authorization for the member, using the new MCO’s plan code and applicable information from the authorization that ends on Aug. 31.
* Manually enter the member’s new authorization into their EVV system.

Program providers, FMSAs and PSOs can check their members’ eligibility and MCO assignment using one of the following methods:


* The *C21/SAVERR-based* TMC EV and 270/271 eligibility inquiry is limited to access only current month eligibility information.
* The *EaaS/TIERS-based* 270/271 or Medicaid Client Portal supports eligibility inquiry for future dates up to the end of the following month. Providers can use this to check eligibility.

Program providers, FMSAs and PSOs *must* continue to submit claims with EVV Required services directly to TMHP for EVV claims matching.


*Contact*

For more information about Baylor Scott & White and FirstCare ending participation with Texas Medicaid, email Managed Care Initiatives <[email protected]>.

















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