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Medicaid No. Enter the individual’s Medicaid number.
CARE or Unique ID No. If the individual is enrolled in HCS, enter the individual’s Client Assignment and Registration (CARE) Identification number; if CARE has transitioned out of use, enter the Unique ID number assigned to the individual by Texas Medicaid & Healthcare Partnership (TMHP). Enter N/A if no CARE or Unique ID number exists.
Date of Birth Enter the individual’s date of birth using the mm/dd/yyyy format.
Service Area Enter the managed care service area the individual resides in. If the individual is not enrolled in HCBS, enter N/A. Link to service areas: https://hhs.texas.gov/sites/default/files//documents/services/health/medicaid-chip/programs/managed-care-service-areas-map.pdf
Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
Right Click for PC or
Ctrl + Click for Mac on the PDF link and click “
Save link as” from the menu.
Select the folder you want to save the file in and then click
Save.
Right Click for PC or
Ctrl + Click for Mac, then select
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC.
Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
Want to help people with special needs?
The Children with Special Health Care Needs Services Program of the Texas Health and Human Services Commission invites you to be part of our team of providers. Help us assist people with special needs 20 and younger, and people of any age with cystic fibrosis.
How to Enroll
Go to the Enrolling in the CSHCN Services Program page of the Texas Medicaid & Healthcare Partnership website. You can enroll online or print out the paper application form to complete and return to TMHP. If you have questions, call your local area TMHP provider relations representative. To find your area representative, go to the Provider Enrollment Regional Support web page or call 800-568-2413.
Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
Right Click for PC or
Ctrl + Click for Mac on the PDF link and click “
Save link as” from the menu.
Select the folder you want to save the file in and then click
Save.
Right Click for PC or
Ctrl + Click for Mac, then select
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC.
Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.