Medicaid Drug Coverage

Texas Medicaid Managed Care Organizations are pivotal in administering comprehensive prescription drug benefits to nearly all Texas Medicaid families—seamlessly coordinating high-quality medical and prescription drug care while saving taxpayer dollars.

Featured Resources

Medicaid 101

New Texas Medicaid Law Protects Families from Drug Shortages

Additional Resources

All

Policy Papers

TAHP Presentations

101s

Testimonies

Comment Letters

Legislative Briefs

News

TAHP Comments on HB 3286 Temporary Non-Preferred Revised Draft Policy

Comments on PDL Exceptions Rules as Implemented by HB 3286 October 8, 2024

Medicaid Rx 101

Medicaid Drug Coverage Works

Medicaid Drug Coverage 101

Texas Medicaid Managed Care Continues to Deliver on Savings & Outcomes

FDA Approves First State Plan to Import Drugs from Canada

New Texas Medicaid Law Protects Families from Drug Shortages

Medicaid Monday: Texas Medicaid MCOs Save Money on Prescription Drugs for Taxpayers

Testimony On SB 1113: PDL Carve-Out

One-Pager Opposing HB 1293: Mandating Fee-for-Service Pharmacy Rates in Medicaid Managed Care

Testimony Opposing SB 2402: Texas Pharmaceutical Initiative

One-Pager Supporting HB 3286: Patient Prescription Protections in Medicaid

One-Pager Opposing HB 1283: PDL not in Managed Care

Testimony Opposing HB 1283: PDL Outside of Managed care

Testimony Supporting HB 3286: PDL

Dispensing the Facts on the Medicaid Preferred Drug List

Medicaid 101

Medicaid Drug Coverage Works

Dispensing the Facts on the Medicaid Preferred Drug List

Medicaid Drug Coverage 101

Medicaid Rx 101

Medicaid 101

Testimony On SB 1113: PDL Carve-Out

Testimony Opposing SB 2402: Texas Pharmaceutical Initiative

Testimony Opposing HB 1283: PDL Outside of Managed care

Testimony Supporting HB 3286: PDL

TAHP Comments on HB 3286 Temporary Non-Preferred Revised Draft Policy

Comments on PDL Exceptions Rules as Implemented by HB 3286 October 8, 2024

One-Pager Opposing HB 1293: Mandating Fee-for-Service Pharmacy Rates in Medicaid Managed Care

One-Pager Supporting HB 3286: Patient Prescription Protections in Medicaid

One-Pager Opposing HB 1283: PDL not in Managed Care

Texas Medicaid Managed Care Continues to Deliver on Savings & Outcomes

FDA Approves First State Plan to Import Drugs from Canada

New Texas Medicaid Law Protects Families from Drug Shortages

Medicaid Monday: Texas Medicaid MCOs Save Money on Prescription Drugs for Taxpayers

Become a Member Today

Learn More

Membership with TAHP is an invaluable tool for integrating, building relationships, exchanging information and best practices, and promoting your services. You will be well-armed with the most timely and accurate information, strong relationships with key Texas leaders, and access to seasoned policy and regulatory experts.

1. How can I enroll in a health insurance plan during open enrollment?
Open enrollment for health insurance typically occurs annually from November 1 to December 15. During this period, you can enroll in or make changes to your health insurance plan through the Health Insurance Marketplace at HealthCare.gov. If you miss this window, you may qualify for a Special Enrollment Period due to certain life events, such as marriage, birth of a child, or loss of other coverage.

2. What are the health insurance options available in Texas?
Texans have several health insurance options, including:
  • Employer-Sponsored Insurance: Coverage provided by your employer.
  • Individual Plans: Purchased directly from insurance companies or through the Health Insurance Marketplace.
  • Government Programs: Such as Medicaid, the Children's Health Insurance Program (CHIP), and Medicare.
  • Short-Term Plans: Temporary coverage for specific periods.

3. Who is eligible for Medicaid and CHIP in Texas?
Medicaid: Available to low-income individuals, families, pregnant women, the elderly, and people with disabilities. Eligibility is based on income and household size.
CHIP: Provides health coverage for children in families that earn too much to qualify for Medicaid but cannot afford private insurance.
For detailed eligibility criteria, visit the Texas Health and Human Services website.

4. What is the Health Insurance Marketplace, and how does it work in Texas?
The Health Insurance Marketplace is a platform where individuals can compare and purchase health insurance plans. In Texas, the federal government operates the Marketplace through HealthCare.gov. You can compare plans, check for subsidies, and enroll during the open enrollment period.

5. Are there financial assistance options to help pay for health insurance?
Yes, depending on your income and household size, you may qualify for subsidies to lower your premiums and out-of-pocket costs. These include:
  • Premium Tax Credits: Reduce the amount you pay for insurance premiums.
  • Cost-Sharing Reductions: Lower your out-of-pocket costs for deductibles, copayments, and coinsurance.
Eligibility for these subsidies is determined through the Health Insurance Marketplace.

6. What should I consider when choosing a health insurance plan?
Consider these factors:
  • Premiums
  • Deductibles
  • Network of doctors and hospitals
  • Coverage of required medications and services
  • Out-of-Pocket Maximum
For more guidance, refer to the Texas Department of Insurance's Health Plan Shopping Guide.

7. What is a Special Enrollment Period, and how can I qualify?
A Special Enrollment Period (SEP) allows you to enroll in health insurance outside the annual open enrollment period if you experience certain life events:
  • Loss of Health Coverage
  • Household Changes (e.g. marriage, divorce, birth)
  • Residence Changes
To apply, visit HealthCare.gov.

8. How can I find out if my doctor is covered under a specific health plan?
Most insurance companies provide online directories of in-network providers. You can also contact the insurer directly or ask your doctor’s office to verify coverage.

9. Where can I get assistance with understanding and enrolling in health insurance?
Several resources are available: