Firstcare Health Plans

What Firstcare Health Plans does

FirstCare Health Plans is a Texas-based Medicaid Managed Care Organization that provides health insurance coverage to approximately 500,000 members across 171 counties in West and Central Texas. Founded in the mid-1980s and owned by Baylor Scott & White Health Plan (part of the Baylor Scott & White Health system, the largest health system in Texas), the company administers three core products: STAR Medicaid for low-income families, children, and pregnant women; CHIP for children in families with incomes above Medicaid thresholds; and CHIP Perinatal for unborn children of women ineligible for other Medicaid programs. Revenue is generated through monthly capitation payments from the Texas Health and Human Services Commission and CHIP premium payments, with a member cost structure that is either zero (STAR) or income-based (CHIP).

The company operates a technology stack centered on a member self-service portal (my.firstcare.com, shared with the MyBSWHealth platform), a provider portal for authorizations and claims, electronic visit verification (EVV) through HHAeXchange, and pharmacy benefit management through Navitus Health Solutions. Service delivery relies on partnerships for virtual care (Teladoc Health), dental coverage (MCNA Dental, DentaQuest, Liberty Dental), non-emergency medical transportation (MTM Link, Access2Care), and prior authorization processing (Optum Rx). The company holds NCQA Health Plan Accreditation and offers value-added services including disease management programs, a maternity program (Expecting the Best), a 24-hour nurse line, and community outreach targeting farm worker families.

FirstCare has announced its intent to exit the Texas Medicaid Managed Care Program on August 31, 2026, subject to regulatory approval, signaling a planned wind-down of its core business. Marketplace and Employer Group health plan activity is directed to the parent company, Baylor Scott & White Health Plan, rather than continued under the FirstCare brand.

Name

Firstcare Health Plans

Legal name

FirstCare Health Plans

Website

https://firstcare.com

Company type

Private

Founded year

1990

Operating status

Operating

Headcount range

501–1,000 employees

Short description

FirstCare Health Plans is a Texas Medicaid Managed Care Organization owned by Baylor Scott & White Health Plan, serving ~500,000 STAR Medicaid and CHIP members across 171 West and Central Texas counties through capitation contracts with Texas HHSC. The company has announced its intent to exit the Texas Medicaid Managed Care Program on August 31, 2026.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

TANF/CHIP Managed Care Plans (HLAEAEAA)

akta.pro secondary industries

Children’s & Family Medicaid Managed Care Plans (HLAEAEAF), Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB), Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

Keywords

• Medicaid managed care
• Health insurance plans
• STAR Medicaid coverage
• CHIP children's insurance
• Texas health plans

Headquarters

HQ city

Austin

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain

Revenue model

1. Medicaid Capitation Payments: FirstCare receives monthly capitation payments from the Texas Health and Human Services Commission (HHSC) for each enrolled STAR Medicaid member. Payments are predetermined per-member-per-month rates based on actuarial calculations and member demographics.
2. CHIP Premium Payments: FirstCare receives premium payments from the state for CHIP enrolled members. Families may also pay co-payments and enrollment fees based on income levels ($50 or less annual enrollment fee, $3-$35 co-payments per visit).

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels6 records

Core offering

FirstCare Health Plans is a Texas Medicaid Managed Care Organization that administers STAR Medicaid and CHIP (Children's Health Insurance Program) health plans for low-income families, children, pregnant women, and perinatal members. The company provides comprehensive health coverage including doctor visits, prescriptions, hospital care, mental health services, dental care, and value-added services like maternity programs, disease management, virtual care, and non-emergency medical transportation across 171 Texas counties.

Product overview

FirstCare Health Plans is a Texas-based Medicaid managed care organization offering a portfolio of health insurance products including STAR Medicaid (for low-income families, children, and pregnant women), CHIP (Children's Health Insurance Program for children), and CHIP Perinatal coverage. The company provides members with integrated digital tools including a member portal (MyBSWHealth), provider finder, pharmacy benefit management through Navitus Health Solutions, virtual care via Teladoc Health, and mental health telehealth services. Supporting services include Electronic Visit Verification (EVV) for home health, nonemergency medical transportation (NEMT), the Expecting the Best maternity program, and Disease Management programs for asthma, diabetes, and musculoskeletal conditions. Value-added services include gift card incentives, dental services, wellness webinars, and Service Coordination for care management. FirstCare operates as part of Baylor Scott & White Health Plan and serves approximately 500,000 members across 171 Texas counties.

Differentiator

Problem solved

Functional benefit

Products and services

• FirstCare STAR Medicaid STAR (State of Texas Access to Rewards) is a Texas Medicaid managed care program for low-income families, children, and pregnant women, providing comprehensive health coverage including unlimited prescriptions, doctor visits, hospital care, mental health services, family planning, and Texas Health Steps medical and dental checkups.
• FirstCare CHIP (Children's Health Insurance Program) CHIP is a health insurance program for children 18 years and younger whose families earn too much for Medicaid but cannot afford other insurance, covering services such as checkups, lab tests, X-rays, hospital stays, medicines, and dental care.
• CHIP Perinatal CHIP Perinatal provides benefits for unborn children of pregnant women who do not qualify for other Medicaid programs, covering prenatal visits, postpartum care, and limited lab tests, with coverage continuing for newborns through 12 months.
• Expecting the Best Maternity Program
• Disease Management Program Free program providing specialized support from registered nurses for members with asthma, diabetes, and musculoskeletal conditions, offering care coordination and education.
• Service Coordination Voluntary care coordination program connecting members with nurses and social workers to help navigate healthcare, manage conditions, and access services, equipment, and community resources.
• Nonemergency Medical Transportation (NEMT) Free transportation service for members to medically necessary appointments including doctors, hospitals, dentists, and pharmacies, accessible via phone, web portal, or mobile app.
• Virtual Care (Teladoc Health) 24/7 virtual care access via phone or video for non-emergency conditions, including eVisits with response within one hour and 10-15 minute video consultations with Baylor Scott & White Health providers.
• Mental Health Telehealth Services Confidential therapy and psychiatry services available through Teladoc Health for members ages 13 and older, with therapists and psychiatrists accessible from 7 AM to 9 PM daily.
• 24-Hour Nurse Line
• STAR Value-Added Services
• CHIP Value-Added Services
• Pharmacy Benefit Management

Quantifiable outcome

• NCQA Accredited Status - reflecting continuous work to fulfill NCQA requirements for consumer protection and quality improvement

Named customers4 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration8 records

Feature3 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• Baylor Scott & White Health PlancoreStrategic or Co-development PartnerFirstCare Health Plans is owned by Baylor Scott & White Health Plan, which is part of Baylor Scott & White Health, the largest health system in Texas. This parent relationship provides integrated care network access, shared technology platforms, and operational synergies across both organizations.
• Navitus Health SolutionscoreTechnology or IntegrationNavitus Health Solutions serves as FirstCare's Pharmacy Benefit Manager (PBM), administering prescription drug benefits for STAR and CHIP members. They manage formulary compliance, prior authorizations, and pharmacy network access for over 40 million lives nationwide.
• MCNA DentalcoreChannel Partner/ Reseller/ DistributorMCNA Dental serves as the Medicaid and CHIP dental plan for Texas, providing dental coverage coordination for FirstCare members including preventive care, basic procedures, and major dental services.
• DentaQuestminorChannel Partner/ Reseller/ DistributorDentaQuest provides Medicaid dental coverage options for FirstCare STAR members as an alternative dental plan administrator.
• Liberty DentalminorChannel Partner/ Reseller/ DistributorLiberty Dental provides dental services specifically for Medicaid STAR pregnant women ages 21 and older as part of FirstCare's value-added dental benefits.
• MTM LinkcoreChannel Partner/ Reseller/ DistributorMTM Link provides non-emergency medical transportation (NEMT) services for FirstCare members through their free mobile app and member portal. Members can schedule rides to medical appointments, the pharmacy, WIC appointments, and other covered healthcare destinations at no cost.
• Teladoc HealthcoreTechnology or IntegrationTeladoc Health provides virtual care services including 24/7 access to board-certified doctors by phone or video for non-emergency conditions, as well as confidential mental health therapy and psychiatry services available 7AM-9PM daily for members ages 13 and older.
• MyBSWHealthcoreTechnology or IntegrationMyBSWHealth is the digital health platform (app and website) that enables FirstCare members to conduct eVisits, schedule video visits with Baylor Scott & White providers, access medical records, and manage their healthcare needs from home or anywhere in Texas.

Scale indicators4 records

Recent moves7 records

Expansion highlights3 records

Broad incumbents

• Blue Cross and Blue Shield of Texas (HCSC): Largest Texas-wide commercial health insurer that also participates in STAR Medicaid; broad incumbent with overlapping provider networks and integrated capabilities versus FirstCare's Medicaid-only footprint.

Direct peers

• Cook Children's Health Plan: Texas-pediatric-focused STAR and CHIP MCO anchored by Cook Children's Health Care System; directly comparable to FirstCare in serving low-income children and families through HHSC contracts.
• Superior HealthPlan (Centene): One of the largest Texas Medicaid managed care organizations offering STAR, CHIP, and STAR+PLUS across most Texas regions; directly competes with FirstCare for HHSC contracts and member enrollment in overlapping service areas.
• Molina Healthcare of Texas: National Medicaid-focused health plan operating STAR and CHIP programs in Texas; competes directly for Texas HHSC contracts and serves similar low-income family, children, and pregnant women populations.
• Texas Children's Health Plan: Houston-based STAR, CHIP, and STAR Kids MCO affiliated with Texas Children's Hospital; competing Texas Medicaid MCO with similar low-income children and families focus.
• Driscoll Health Plan: Texas-pediatric-anchored STAR and CHIP MCO serving South Texas; comparable regional Medicaid plan with similar provider-network and member-base characteristics as FirstCare.
• Community First Health Plans: San Antonio-based non-profit MCO offering STAR, CHIP, and Marketplace plans in Texas; comparable regional Medicaid plan with similar product mix and member demographics to FirstCare.
• Amerigroup Texas (Elevance Health): Elevance Health's Medicaid MCO in Texas providing STAR and CHIP coverage statewide; competes head-to-head with FirstCare for HHSC contracts and provider network participation.
• UnitedHealthcare Community Plan of Texas: UnitedHealth Group's Texas Medicaid MCO offering STAR, CHIP, and STAR+PLUS; one of the largest competitors for HHSC enrollment across the same counties FirstCare serves.

Regional players

• El Paso Health: Locally-focused Texas Medicaid MCO serving the El Paso region with STAR and CHIP; comparable in scale and product mix but operates in a distinct geographic area from FirstCare's West/Central Texas footprint.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/firstcare

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Firstcare Health Plans