If you have concerns or are unhappy with your health or dental plan or the services you receive, you can submit a complaint.
How Do I Submit a Complaint?
If you have a health or dental plan, call your health or dental plan first. Often, they can help you more quickly.
Your health or dental plan's phone number is on your health or dental plan identification card.
If you don't have a health or dental plan, call the Medicaid helpline at 800-335-8957.
Learn how to submit a complaint, what you will need, and what you can expect with our easy to read flyer:
What if I Still Need Help?
If you've called your health or dental plan or the Medicaid helpline and still need help, you can submit your complaint to the Office of the Ombudsman. They can help resolve problems with your Medicaid coverage.
To submit a complaint to the HHS Ombudsman, you can:
- Fill out this online form.
- Call 866-566-8989 8 a.m. to 5 p.m. Central Time, Monday through Friday and speak to someone that day.
The Ombudsman's team will get back to you within one business day. They will follow up with you every five business days until the complaint is resolved. The team will tell you the resolution and any next steps you might need to take.
If you have an urgent medical need, the team will handle your complaint as soon as possible.
What Do I Need When I Submit a Complaint?
Be ready to give us:
- Your Medicaid ID card number.
- Your name or the name of the person you are calling about.
- Other important information, such as birthdays or home addresses.
We use this information to make sure we know who you are and the details of your case are secure.
If your complaint is about a doctor's office, pharmacy or medical equipment company, have their contact information handy. Have any documents related to your complaint, such as letters, bills or prescriptions, ready too.
If you just want information, use the resources below:
- Eligibility questions – call 2-1-1, Option 2
- Medicaid benefits questions – your health plan
- All other questions – HHS Ombudsman, 866-566-8989
Children’s Health Insurance Program (CHIP) Members
If you are not satisfied with the answer to your complaint, you also can contact to the Texas Department of Insurance by calling toll-free 800-252-3439. If you would like to make your request online or in writing, send it to the addresses listed at the Texas Department of Insurance.
To view data reports on Medicaid managed care complaint data, see the links below.
Beginning Sept. 1, 2021, HHSC included new categories for Electronic Visit Verification (EVV) and Non-Emergency Medical Transportation (NEMT) complaints, received by the Managed Care Organizations (MCO). The new categories were not included in the original complaint data; therefore, an updated report, incorporating this change, is being posted.
Please see below for more details on each program.
On Jan. 1, 2021, HHSC required Electronic Visit Verification (EVV) for all Medicaid personal care services as mandated by the federal 21st Century Cures Act. The managed care organization (MCO) is required to provide HHSC with operational data necessary to consistently evaluate the EVV system and monitor the impact of improvements made to the EVV system and EVV processes. The MCO is required to document EVV metrics on the EVV MCO Quarterly Performance Measures Report Instructions and Template (UMCM 8.7.2). UMCM 8.7.2 instructs the MCO to provide metrics including the number of complaints received, but the report does not capture provider or CDS employers’ issues in detail. Beginning Sept. 1, 2021, MCCO instructed the MCOs to begin submitting all EVV related complaints on the monthly flat file.
On June 1, 2021, MCCO, in association with contracted MCOs, implemented HB 1576, Delivery of NEMT services by MCOs. Beginning Sept. 1, 2021, MCCO instructed the MCOs to begin submitting all transportation related complaints on the monthly flat file. (All reports are in PDF format.)
- Complaint Data Report Narrative
- Managed Care Regular Complaint FY 23 Q2 Accessible Tables
- Managed Care Regular Complaint FY 23 Q2 Tableau
- Managed Care Regular Complaint FY 23 Q3 Accessible Tables
- Managed Care Regular Complaint FY 23 Q3 Tableau
- Managed Care Initial Contact Complaint FY 23 Q2 Accessible Tables
- Managed Care Initial Contact Complaint FY 23 Q2 Tableau
- Managed Care Initial Contact Complaint FY 23 Q3 Accessible Tables
- Managed Care Initial Contact Complaint FY 23 Q3 Tableau