Texas Children's Health Plan
Texas Children's Health Plan is a hospital-owned Medicaid and CHIP managed care organization founded in 1996, serving 600,000+ members across 50+ East Texas counties through STAR, CHIP, STAR Kids, and CHIP Perinatal programs via a 27,000+ provider network.
- Company typePrivate
- Founded1996
- HeadquartersHouston, United States
- Headcount5,001–10,000
- GTM typeB2C
- OfferingServices
What Texas Children's Health Plan does
Texas Children's Health Plan is a Medicaid and CHIP managed care organization (MCO) founded in 1996 by Texas Children's Hospital, operating as a wholly-owned subsidiary within the hospital's integrated delivery system. It administers STAR Medicaid, the Children's Health Insurance Program (CHIP), STAR Kids (for children and young adults under 21 with disabilities, including Long Term Services and Supports), and CHIP Perinatal programs on a capitated basis for the Texas Health and Human Services Commission (HHSC). It serves 600,000+ members — primarily low-income Texas children, pregnant women, teens, and adults with special healthcare needs — across 50+ East Texas counties (Harris, Jefferson, and Northeast service areas), with a contracted provider network exceeding 27,000 practitioners (per company scale commentary) including 4,300 primary care physicians, 6,800 specialists, and 118 hospitals.
Revenue is generated through per-member-per-month capitation payments from state and federal sources covering each Medicaid/CHIP beneficiary, with most services provided at no or low cost to eligible families. The company is government-funded (no commercial premium revenue), distinguished as the nation's first HMO created specifically for children, and holds the highest NCQA patient satisfaction rating in Texas at 3.5 stars. Member value is reinforced through wraparound benefits including the Healthy Rewards incentive program, 24/7 nurse help line (in English, Spanish, and 140 additional languages), case management, and free non-emergency medical transportation through SafeRide Health.
The technology platform consists of a member-facing MyChart portal (PCP changes, ID card requests, fitness-app data), a provider-facing Texas Children's Link / EpicCareLink portal (eligibility, prior authorization, claims, analytics), and a Telephone TouCHPoint IVR for after-hours eligibility and claims-status checks. Operational vendors include Navitus (pharmacy benefit management), Zelis (provider payments), Inovalon (provider enablement), Envolve Vision, DentaQuest/MCNA/UHC/FCL Dental, and GoPerspecta (provider directory). Distribution is exclusively through HHSC-mediated enrollment and an in-network provider ecosystem; there is no commercial line of business.
Texas Children's Health Plan firmographics
Firmographics- Name
- Texas Children's Health Plan
- Legal name
- Texas Children's Health Plan
- Website
- https://texaschildrenshealthplan.org
- Company type
- Private
- Founded year
- 1996
- Operating status
- Operating
- Headcount range
- 5,001–10,000 employees
- Short description
- Texas Children's Health Plan is a hospital-owned Medicaid and CHIP managed care organization founded in 1996, serving 600,000+ members across 50+ East Texas counties through STAR, CHIP, STAR Kids, and CHIP Perinatal programs via a 27,000+ provider network.
- Ownership category
- akta.pro rank
Texas Children's Health Plan industry classification
Industry- Product category
- Medicaid Managed Care
- NAICS
- Child and Youth Services (624110)
- SIC
- Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Children’s & Family Medicaid Managed Care Plans (HLAEAEAF)
- akta.pro secondary industries
- TANF/CHIP Managed Care Plans (HLAEAEAA), Medicaid Managed Care HMOs (HLAEAMAI)
Keywords
Where Texas Children's Health Plan is headquartered
LocationHeadquarters
- HQ city
- Houston
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Texas Children's Health Plan business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain
Revenue model
- Medicaid Managed Care Capitation (STAR): The company receives per-member-per-month capitation payments from the state of Texas and federal government to provide comprehensive healthcare coverage for STAR Medicaid members including children, some adults, and pregnant women who cannot afford health insurance.
- CHIP Managed Care Capitation: Capitation payments from state and federal sources for Children's Health Insurance Program coverage providing low-cost health coverage for children from birth through age 18 from families earning too much for Medicaid but unable to afford private coverage.
- STAR Kids Managed Care Capitation: Specialized Medicaid managed care capitation for children and young adults under 21 with disabilities, including additional Long Term Services and Supports (LTSS) services.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | STAR Medicaid - No-cost coverage for qualifying families |
| Subscription | Annual | CHIP - Low-cost coverage for children |
| Subscription | Monthly | STAR Kids - No-cost coverage for children with disabilities |
Go-to-market motion1 record
Distribution channels4 records
Marketing channels8 records
Texas Children's Health Plan product offering
Product offeringCore offering
Texas Children's Health Plan is a Medicaid and CHIP managed care organization (HMO) that provides government-funded health insurance coverage to qualifying Texas families. Core offerings include STAR Medicaid, CHIP, STAR Kids (for children with disabilities), and CHIP Perinatal plans, delivered through a network of 27,000+ contracted providers across 50+ East Texas counties. Members access care via the MyChart portal, in-network providers, 24/7 nurse help line, transportation assistance, and supplemental programs such as Healthy Rewards and case management.
Product overview
Texas Children's Health Plan is a Medicaid-managed care health insurance organization offering multiple health coverage programs including CHIP, STAR Medicaid, STAR Kids, and CHIP Perinatal. The company provides member-facing digital platforms including MyChart (member portal), Texas Children's Link (provider portal), and Telephone TouCHPoint (automated eligibility/claims system). Supporting services include 24-hour Nurse Help Line, Transportation Services via SafeRide Health, Healthy Rewards Program, Case Management, Nurse-Family Partnership, and Continuing Medical Education for providers. The plan serves pregnant women, children, teens, and adults with special health care needs across more than 50 counties in East Texas.
Differentiator
Problem solved
Functional benefit
Products and services
- STAR Medicaid
Quantifiable outcome
- 3.5-star overall satisfaction rating from NCQA, the highest patient satisfaction rating in Texas
- +2 more outcomes
Companies that use Texas Children's Health Plan
Customer profileNamed customers4 records
Segments4 records
Ideal customer profiles2 records
Texas Children's Health Plan technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration3 records
Feature3 records
Texas Children's Health Plan partnerships and signals
Strategic signalPartnerships
Eleven partnerships are on record, tiered core.
- SafeRide Health (SRH)coreSafeRide Health is the new provider for all Non-Emergency Medical Transportation (NEMT) rides to doctor appointments and pharmacy visits. Services include wheelchair-lift-equipped vehicles, stretcher vans, minivans, and ambulatory vans. Available Monday through Saturday 6:00 a.m.-8:00 p.m. CT at 888-583-0110.
- Navitus Health SolutionscoreNavitus is the pharmacy benefit manager for Texas Children's Health Plan members, providing drug store services and maintaining the Texas VDP Formulary. The network includes national chains (Walgreens, CVS, HEB, Walmart, Target, Kroger) covering over 95% of VDP providers in Texas.
- ZeliscoreZelis is Texas Children's Health Plan's new payment vendor for processing provider payments.
- InovaloncoreInovalon provides the Converged Provider Enablement platform for Texas Children's Health Plan, offering training and enablement tools for providers through the Converged Provider Enablement Training Guide.
- Envolve VisioncoreEnvolve Vision provides vision care services for Texas Children's Health Plan members. Contact: 1-844-520-3711 (CHIP), 1-844-683-2305 (STAR), 1-844-212-7269 (STAR Kids).
- DentaQuest, MCNA Dental, United Healthcare DentalcoreThree dental plan partners provide dental coverage for children: DentaQuest (1-800-508-6775), MCNA Dental (1-800-494-6262), and UHC (1-877-901-7321). Dental services include exams, cleanings, X-rays, fillings, and extractions.
- Nurse-Family PartnershipcoreNurse-Family Partnership provides free personal nurse support for first-time mothers. Nurses offer guidance during pregnancy and after baby's arrival. Members must be first-time mothers pregnant 28 weeks or less. Enrollment via 832-828-1274.
- GoPerspectacoreGoPerspecta provides the online provider search directory for Texas Children's Health Plan, enabling members to find doctors, specialists, and pharmacies in the network.
- FCL DentalcoreFCL Dental provides dental referral services for STAR members age 21+ for basic dental care including exams, cleanings, X-rays, and fillings. Contact: 1-866-548-8123.
- Texas Children's HospitalcoreTexas Children's Hospital founded Texas Children's Health Plan in 1996 as the nation's first HMO created just for children. The hospital system provides specialized pediatric care access for plan members and administrative oversight.
- Texas Health StepscoreTexas Health Steps provides well-child checkup services and immunizations for Medicaid-enrolled children. Members can access any Texas Health Steps provider without a referral for regular checkups and vaccinations.
Scale indicators8 records
Recent moves6 records
Expansion highlights5 records
Texas Children's Health Plan competitors and assessment
Company assessmentDirect peers
- Superior HealthPlan (Centene): Superior HealthPlan is Centene's Texas Medicaid/CHIP MCO and the statewide market leader by membership, including in SDAs overlapping Texas Children's Health Plan. It directly competes on STAR, CHIP, and STAR Kids contracts and represents the most significant competitive threat to TCHP's state contract retention.
- Amerigroup (Elevance Health): Amerigroup, an Elevance Health subsidiary, operates Medicaid managed care plans across Texas including STAR, CHIP, and STAR Kids products. It competes directly with TCHP on government-sponsored pediatric and family managed care contracts in overlapping SDAs.
- Molina Healthcare: Molina Healthcare is a national government-sponsored health plan offering Medicaid managed care products across Texas, including in regions overlapping TCHP's service area. It competes directly on STAR, CHIP, and STAR Kids contracts with a similar capitated, government-funded model.
- Parkland Community Health Plan: Parkland Community Health Plan is a Dallas-based, hospital-affiliated Medicaid and CHIP MCO serving North Texas children and pregnant women. It is a closely comparable hospital-system-sponsored peer competing on similar products in an adjacent Texas SDA.
- Cook Children's Health Plan: Cook Children's Health Plan is another Texas-based, hospital-sponsored Medicaid and CHIP HMO serving North Texas children. It competes head-to-head with Texas Children's Health Plan in the same government-sponsored pediatric managed care segment with overlapping product lines (STAR, CHIP, STAR Kids).
- UnitedHealthcare Community & State: UnitedHealthcare's Community & State plan operates Medicaid and CHIP across multiple Texas SDAs including overlapping East Texas regions. It is a direct competitor on government-sponsored managed care contracts with comparable STAR, CHIP, and STAR Kids offerings.
Regional players
- El Paso Health: El Paso Health is a local, hospital-affiliated Texas Medicaid and CHIP HMO serving the El Paso region. While geographically distinct from TCHP, it is a comparable hospital-system-sponsored Medicaid MCO with a similar product mix.
- Driscoll Health Plan: Driscoll Health Plan is a Corpus Christi-based, hospital-sponsored Texas Medicaid and CHIP MCO serving South Texas children. It is structurally similar to TCHP as a pediatric-focused, hospital-affiliated Medicaid plan but operates in a non-overlapping region.
Broad incumbents
- Aetna (CVS Health): Aetna Better Health operates Medicaid managed care in Texas and offers comparable STAR and CHIP products through CVS Health's broader portfolio. It is a broader-incumbent peer rather than a pediatric specialist, but competes for the same government contracts.
- Blue Cross and Blue Shield of Texas (HCSC): BCBS Texas offers CHIP and certain Medicaid products as part of a broader commercial and government health insurance portfolio. It is comparable to TCHP on government-sponsored children's coverage but operates with a much wider product and geographic footprint.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Texas Children's Health Plan social profiles
Digital presenceTexas Children's Health Plan financial estimates
Financial estimateRevenue estimate
Valuation estimate
Texas Children's Health Plan leadership team
Management profileNumber of profiles
Profiles2 records
Texas Children's Health Plan funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Texas Children's Health Plan M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Texas Children's Health Plan
What does Texas Children's Health Plan do?
Texas Children's Health Plan is a Medicaid and CHIP managed care organization (HMO) that provides government-funded health insurance coverage to qualifying Texas families. Core offerings include STAR Medicaid, CHIP, STAR Kids (for children with disabilities), and CHIP Perinatal plans, delivered through a network of 27,000+ contracted providers across 50+ East Texas counties. Members access care via the MyChart portal, in-network providers, 24/7 nurse help line, transportation assistance, and supplemental programs such as Healthy Rewards and case management.
Is Texas Children's Health Plan a public or private company?
Texas Children's Health Plan is a private company. It is classified as corporate owned and is currently operating.
When was Texas Children's Health Plan founded?
Texas Children's Health Plan was founded in 1996. It employs 5,001 to 10,000 people.
Where is Texas Children's Health Plan based?
Texas Children's Health Plan is headquartered in Houston, United States, in the North America region.
How does Texas Children's Health Plan make money?
Three revenue lines are on record. Medicaid Managed Care Capitation (STAR) is the primary driver. The others are CHIP Managed Care Capitation and STAR Kids Managed Care Capitation.
Who are Texas Children's Health Plan's main competitors?
Direct peers on record are Superior HealthPlan (Centene), Amerigroup (Elevance Health), Molina Healthcare, Parkland Community Health Plan, Cook Children's Health Plan and UnitedHealthcare Community & State. Regional players are El Paso Health and Driscoll Health Plan. Broad incumbents are Aetna (CVS Health) and Blue Cross and Blue Shield of Texas (HCSC).
Does Texas Children's Health Plan have an API?
No public API is recorded for Texas Children's Health Plan.
What industry is Texas Children's Health Plan in?
Texas Children's Health Plan's product category is Medicaid Managed Care. Its primary akta.pro industry code is HLAEAEAF, Children’s & Family Medicaid Managed Care Plans, with a secondary code of HLAEAEAA, TANF/CHIP Managed Care Plans. Its NAICS code is 624110 and its SIC code is 6321.