Texas Medicaid can feel like a hunt in 2025, with that federal shutdown throwing wrenches into payments and appointments. Knowing how to locate Texas Medicaid providers is key.
If you’re searching for “find Medicaid doctor Texas” or “Medicaid dentist Texas,” I’m here to help.
We’ll cover the Texas Medicaid doctor list tools, networks, dental and pharmacy locators, and what to do if options are slim.
Let’s make this easy so you can get care without the runaround.
How to Search for Medicaid Providers
Texas Medicaid mostly runs through managed care plans, so your search starts with your MCO (managed care organization).
The main tool is the Texas Medicaid provider search on TMHP.com, the state’s partner site.
Go to opl.tmhp.com, pick your plan (like STAR or STAR+PLUS), enter your zip, and filter by specialty or name. It’s free, quick, and shows if they’re accepting patients.
The recent shutdown slowed updates, so double-check with your MCO app or hotline.
For basics, HHS.gov/providers has links, but TMHP is the go-to for accurate, up-to-date Texas Medicaid providers near me in Texas. Start there before calling, saves time.
Using the Texas Medicaid Provider Lookup
The Texas Medicaid provider lookup is your best friend. At opl.tmhp.com, select your program (STAR for kids/families, STAR+PLUS for seniors/disabled), then search by county, specialty (e.g., pediatrician), or provider name.
Results show contact info, hours, and if they’re in-network.
For 2025, it’s mobile-friendly; use it on your phone for “Medicaid providers near me, Texas.”
If enrolled in FFS (fee-for-service, rare now), use the same tool but select “Traditional Medicaid.”
The shutdown caused some list lags, so call to confirm. For more on your plan, see understand your plan network.
Finding Primary Care Physicians
Primary care physicians (PCPs) are your first stop for checkups, sick visits, and referrals. Use TMHP or your MCO site (e.g., UnitedHealthcare’s provider finder) with your zip and “family practice” filter.
Texas has 13 regions, Bexar (San Antonio) has options like Amerigroup; Harris (Houston) includes Texas Children’s.
Look for ratings on HHS star reports; higher stars mean better access. If rural, telehealth PCPs count in 2025. Confirm they’re taking new patients; shutdown hit some with payment delays.
For covered services, check services available from providers.
Finding Specialists
Specialists like cardiologists or therapists need PCP referrals in managed care.
Search TMHP by specialty and region, e.g., “pediatric neurology” in Travis (Austin) pulls Blue Cross Blue Shield options. MCO apps let you filter by wait times or language.
If no luck, ask your coordinator (in STAR+PLUS/STAR Kids) for help. In 2025 added more mental health specialists amid demand spikes.
Shutdown slowed approvals, so plan ahead, confirm eligibility, at confirm your coverage status.
Dental Provider Search
Medicaid dentist Texas searches use TMHP’s dental tab or MCO directories like DentaQuest (for many plans). Filter by “dentist” and zip for cleanings, fillings, or braces (if medically needed). Texas covers kids fully, adults emergencies only.
2025 networks grew in underserved spots. Search “Medicaid dentist Texas” on HHS for lists.
Call to book; shutdown delayed some claims, but services continue. For specifics, see finding dental providers.
Pharmacy Locator
For Medicaid pharmacy in Texas, use TMHP or MCO tools like Molina’s locator, enter zip for in-network spots (CVS, Walgreens common). Covers generics/brands with low copays ($0-3).
2025 formularies updated for cheaper meds, search “Texas Medicaid pharmacy locator” on HHS. Drive-through or mail-order options help rural folks. Shutdowns hit stock in some areas, but generics are prioritized.
Hospital and Facility Search
Hospitals and facilities (nursing homes, clinics) are in TMHP under “facility” filters. Search by type and region, e.g., “hospital” in Dallas pulls Parkland. Check ER ratings for emergencies.
For STAR Health (foster kids), Superior covers statewide. In 2025, added tele-facilities. The shutdown delayed elective admissions, but emergencies are full-go.
Provider Network Restrictions
In managed care, stick to your MCO network for full pay, out-of-network means bills unless approved. Restrictions: Referrals for specialists, prior auth for tests. But emergencies? No network needed.
If your doctor leaves, switch plans. 2025 rules eased auth for mental health. For basics, see Texas Medicaid coverage information.
What to Do if No Providers Nearby
Rural or low-network areas? Request an exception from your MCO for out-of-network care at in-network rates. HHS can force expansions if gaps persist. Call 800-252-8263.
Community health centers (FQHCs) take Medicaid statewide. 2025 waivers added transport vouchers. If denied, appeal, free help from the ombudsman.
Changing Your Primary Care Provider
Change PCPs anytime, no lock-in. Call your MCO or use the app; it takes 5-15 days. Good cause (e.g., move, bad fit) speeds it.
2025 made switching online easier. The shutdown slowed, so confirm by phone.
Out-of-Network Emergency Care
Emergencies? Go anywhere, Medicaid covers full, no prior auth. Call 911 or the nearest ER; MCO pays even out-of-network.
Follow up with PCP. In 2025 clarified mental health crises as emergencies. If billed wrong, dispute via grievances.
Finding Texas Medicaid providers doesn’t have to be hard; tools like TMHP make it doable. If stuck, HHS is a call away. Your health matters, get connected today.
FAQs
How do I find a Texas Medicaid doctor in 2025?
Use the Texas Medicaid Provider Lookup at opl.tmhp.com Select your plan (STAR, STAR+PLUS, etc.), enter your zip code, and filter by specialty or provider name. Always call the clinic afterward to confirm they’re accepting new Medicaid patients.
2. Why are some provider lists outdated right now?
The federal shutdown delayed system updates and slowed claim processing, which caused some provider directories to lag behind. TMHP is still the most accurate tool, but confirm by phone when possible.
3. Can I use the provider search on my phone?
Yes. The TMHP tool is mobile-friendly. Most MCOs—like Superior, Molina, Amerigroup, and UnitedHealthcare—also have apps with real-time provider lists.
4. Do I need a referral to see a specialist?
Yes, if you’re in managed care. Most plans require a PCP referral before seeing specialists. Emergencies do not require referrals.
5. What if there are no specialists or doctors available in my area?
Your MCO must either:
• Find an in-network provider for you, or
• Approve an out-of-network provider at in-network rates.
If they refuse, call the HHS help line at 800-252-8263.
6. How do I find a Medicaid dentist in Texas?
Search using TMHP or DentaQuest’s directory (used by most children’s Medicaid dental programs). Enter your zip code and pick “dentist” or “pediatric dentist.”
7. Does Medicaid cover adult dental care?
Texas Medicaid offers limited dental services for adults—mostly emergency care. Children under 21 get full dental coverage.
8. How can I find a Medicaid pharmacy near me?
Use TMHP’s pharmacy search or your MCO’s app. Major chains like CVS and Walgreens accept Texas Medicaid. Copays are between $0 and $3, depending on the medication.
9. Are hospitals required to take Medicaid for emergencies?
Yes. Any hospital must treat you in an emergency. Medicaid will cover the visit, even if the hospital is out of network.
10. How do I switch my primary care provider (PCP)?
Call your MCO or use their app. You can switch anytime, and it typically takes 5–15 days to update. Online switching is faster in 2025.
11. What should I do if I get an out-of-network medical bill?
For emergencies, Medicaid covers the full cost. If you get a bill by mistake, file a grievance with your MCO and contact the HHS Ombudsman.
12. Can I still receive care during the shutdown delays?
Yes. Clinics are still providing services. Some may have backlogs or slower approvals, but coverage and access continue statewide.
13. Are telehealth visits covered under Texas Medicaid?
Yes. Telehealth is widely covered in 2025 for PCP, mental health, and some specialist visits. It’s especially useful in rural areas.
14. Where can I confirm my Medicaid eligibility or plan status?
Check your status at YourTexasBenefits.com or on the YTB app. You can also call 2-1-1 for help.
15. What if I need transportation to appointments?
Most Texas Medicaid plans include non-emergency medical transportation. Call your MCO to schedule rides or ask for vouchers in rural regions.
