P-14. Payment

HHSC pays enrolled pharmacies for dispensed outpatient pharmaceuticals for people enrolled in:

  • Traditional Medicaid
  • Children with Special Health Care Needs (CSHCN) Services Program
  • Healthy Texas Women (HTW) program
  • Kidney Health Care (KHC) Program

Claims for clients enrolled in Medicaid managed care or the Children’s Health Insurance Program (CHIP) are billed through the managed care organization (MCO) and its contracted pharmacy benefits manager. Questions regarding remittance of these claims should be addressed to the MCO. Pharmacy providers should contact the client's specific MCO for details.