We Now Accept Traditional Medicaid

enTrust Immediate Care, your Houston, TX-area modern urgent care center and IV infusion therapy clinic, is proud to announce that it now accepts the Texas Traditional Medicaid.

Here is what you need to know about Traditional Medicaid.

What is Traditional Medicaid?

Traditional Medicaid — sometimes called Fee-for-Service (FFS) Medicaid — is the original form of the Medicaid program, jointly funded by the federal government and individual states like Texas. Under the Traditional Medicaid model, the state Medicaid agency pays doctors, clinics, emergency rooms, hospitals, and other medical providers directly for each service a patient receives. With Traditional Medicaid, beneficiaries receive coverage straight from the state, which sets the rules, determines covered services, and processes payments.

This model is called “fee for service” because providers (hospitals, doctors, clinics, etc.) are paid a fee for each appointment, test, procedure, or treatment they deliver. There is no insurance company acting as a middleman—just the patient, the provider, and the state.

Who Qualifies for Traditional Medicaid?

Eligibility varies by state, but Traditional Medicaid generally covers:

• Low-income adults
• Pregnant individuals
• Children
• Seniors
• People with disabilities

How Does Traditional Medicaid Work?

When a Medicaid beneficiary visits a doctor, gets lab work done, or is admitted to a hospital, the provider submits a claim to the state Medicaid agency, which then reimburses them for each individual service at a set rate.

1. Choose Any Medicaid Accepting Provider

One of the biggest advantages of Traditional Medicaid is flexibility. Beneficiaries can visit any doctor, specialist, emergency room, hospital, or clinic that accepts Medicaid, without being restricted to a network.

2. Receive Covered Services

Covered services under the Traditional Medicaid program vary by state, but usually include:

• Doctor visits
• Hospital care
• Prescription medications
• Preventive services
• Behavioral health care
• Long-term care services

3. Providers Bill the State

After the visit, the provider submits a claim directly to the state Medicaid agency. The state then pays the provider based on its established fee schedule. In Texas, the agency responsible for Traditional Medicaid is the Texas Medicaid & Healthcare Partnership, or TMHP.

4. Minimal Referrals or Prior Authorizations

Traditional Medicaid generally requires fewer administrative steps. Beneficiaries often do not need referrals to see specialists, and prior authorizations are less common than in managed care models.

What Does Traditional Medicaid Cover?

States must cover certain core services, including inpatient and outpatient hospital care, physician services, laboratory and X-ray tests, and home health care.

Many states also choose to cover additional services, such as prescription drugs, physical and occupational therapy, and long-term care supports. Under traditional Medicaid in Texas, for example, benefits can include clinic visits, vaccines, medicines, emergency care, and services such as nursing home care and home-based support for people with long-term needs.

Is Traditional Medicaid Different from Medicaid Managed Care Plans (MCO Plans)?

Yes. Unlike Traditional Medicaid, which is administered directly by the State of Texas, a Medicaid Managed Care Organization (MCO) is a private health insurance company that contracts with the state to deliver Medicaid benefits to enrollees. Instead of paying providers directly for each service, the state pays the MCO a fixed monthly amount — called a capitation rate — per enrollee, regardless of how much care is actually used.

The MCO then takes on the responsibility of managing and coordinating the member’s healthcare within a defined network of providers. In Texas, Medicaid beneficiaries in most counties are enrolled in MCO plans such as UnitedHealthcare Community Plan, Molina Healthcare, Texas Children’s, Ambetter/Superior, Community Health Choice, WellPoint, Amerigroup, Centene, BCBS STAR/CHIP, UnitedHealthcare Community Plan, and Aetna Better Health.

A member enrolled in Molina, for instance, would need to select a Primary Care Physician (PCP) from Molina’s network, who would then coordinate referrals to specialists.

How do I know if I have Traditional Medicaid or Medicaid MCO?

If your Medicaid card has a plan name or insurance company logo, you likely have a managed care plan, which we do not accept.

Note: enTrust Immediate Care participates in and bills for Traditional Medicaid (Fee-for-Service) only. We do not participate in Medicaid Managed Care Plans.

Please call our clinic at 713-468-7845 or complete this short contact form if you have questions about our acceptance of Traditional Medicaid.