Texas Medicaid and Superior HealthPlan: Facts About Managed Care

• Texas Medicaid is a joint federal and state program that provides health-care coverage – at no cost – to low-income individuals and families. This includes children, pregnant women, seniors, and people who have disabilities.
• The Children’s Health Insurance Program (CHIP) provides health coverage to children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage.
• In Texas, these programs are managed by the Texas Health and Human Services Commission (HHSC). They cover medical services like doctor visits, hospital care, and prescriptions.

• A Medicaid managed care organization (MCO) is a private or non-profit health plan. MCOs contract with a state government to deliver medical benefits to people who qualify for Medicaid and CHIP.
• Instead of a state paying doctors and hospitals directly for each service they provide, the state pays an MCO a set monthly fee per person. This fee helps MCOs manage and coordinate the health-care benefits and services people need.
• Superior HealthPlan is one of several MCOs serving residents in Texas.

Financial data for Superior HealthPlan and all other MCOs is available on the Texas HHSC website. MCOs that participate in Texas Medicaid or CHIP programs must abide by financial accounting and audit standards set by HHSC and the Texas Department of Insurance. These include:

• Financial reports accounting for all MCO expenses are sent to Texas HHSC each quarter. These are audited each year by external accountants hired by Texas HHSC to make sure all MCOs comply with reporting guidance.
• Financial audits every 5 years from the Texas Department of Insurance.
• Audits from the State Auditor’s Office and Office of Inspector General for areas of financial impact.
• Contractual limits to profit that Medicaid MCOs are allowed to make.
• No limit on the amount of dollars an MCO can lose if medical costs increase during a financial period. 
• Contract guidelines for what MCOs can count in their expenses. This means anything that is not defined by these rules is not paid for by Texas HHSC.
• Annual financial audits by an external accounting firm. These are conducted to provide confirmation of financial records accuracy and compliance with all standards and regulations to Superior’s Board of Directors. 

Contracts for all Medicaid and CHIP programs in Texas are awarded through a competitive Request for Proposal (RFP) process. This is managed by Texas HHSC. Here are details about the process:

• The RFP process allows Medicaid MCOs to bid for contracts in different regions and for different Medicaid programs.
• Contracts have an initial six-year term and three optional two-year extensions. History shows HHSC normally uses the extensions to the maximum extent. This can help reduce change for members, but is only done when MCOs are performing well under their contract terms.

• Superior HealthPlan is a Medicaid managed care organization (MCO) that provides health-care services to more than 1.5 million people in Texas. This includes both Medicaid and CHIP programs.
• Services through these programs include medical, dental, vision, pharmacy, and behavioral health.
• Superior began serving individuals and families in 1999 in El Paso, Texas. Superior now provides health-care coverage to Medicaid members in each of the state’s 254 counties.

• Texas Medicaid and CHIP are public health-care programs administered by the State of Texas. They are funded jointly by the state and federal governments.
• Texas HHSC oversees Texas Medicaid and contracts with MCOs such as Superior HealthPlan to administer health-care services for eligible members.
• Superior has been serving as an MCO in Texas since 1999.

Superior works with Texas HHSC to provide members with medical and mental health benefits in these programs:

• STAR (Medicaid): Health-care coverage for people in Texas from low-income backgrounds.
• STAR+PLUS (Medicaid): Health-care coverage for people in Texas from low-income backgrounds who are elderly or who have a disability.
• STAR Kids (Medicaid): Health-care coverage for children in Texas who have disabilities, special needs, or chronic conditions, and who are ages 20 or younger.
• STAR Health (Medicaid): Health-care coverage in Texas for children and youth in foster care.
• Children’s Health Insurance Program (CHIP): Health-care coverage for families in Texas that earn too much money to qualify for Medicaid, but cannot afford private insurance.
• CHIP Perinate: Prenatal and delivery services in Texas for unborn children of women from low-income backgrounds who are pregnant and do not qualify for Medicaid.

With nearly one million Medicaid and CHIP members across Texas, Superior receives state and federal funding to provide healthcare to each one of them. Overall, 91 percent of funds go to direct patient care for these members. Below is a look at how each dollar is spent across Medicaid programs in Texas:

• 34.3 cents is spent on ER & Hospital Costs (ER, Outpatient, Inpatient)
• 26.4 cents is spent on Nursing Home & Long-Term Care Services (Service Coordination)
• 13.6 cents is spent on Physician Service Costs (Primary Care, Specialists)
• 9.7 cents is spent on Prescription Drug Costs
• 7.0 cents is spent on Other Medical Services (Dental, Physical Therapy, Dialysis, Behavioral Health)
• 4.5 cents is spent on Administrative Costs
• 2.6 cents is spent on Profit (Pre-Tax)
• 1.7 cents is spent on Premium Taxes & Assessments
• 0.2 cents is spent on Profit Sharing To State (Experience Rebate)

Source: Texas Association of Health Plans (TAHP); Dollar Breakdown, HMA/Wakely Analysis of Fiscal Year (SFY) 2025 Q4 90-Day, SFY 2024 334-Day FSR Reports, May 2026

Superior HealthPlan and the State of Texas measure member satisfaction in many ways. Below are details about Superior’s member satisfaction as of September 2026:

• Since 2015, Superior has been one of the top-rated Medicaid health plans in Texas. Superior has earned a rating of 3.5 or higher on a 5.0 scale on the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings. This includes a rating of 3.5 for 2025.
• According to a 2025 patient satisfaction survey, 96% of members said they were satisfied with Superior’s customer service. Additionally, 86% of members said they were satisfied with how quickly they received care.

• Superior has a large Medicaid and CHIP provider network in Texas. This includes many doctors, specialists, and clinics.
• Superior has 130,000 providers in-network across all 254 Texas counties. This includes more than 500 hospitals.
• Members also have access to see thousands of providers from their home through telehealth.

STAR Health is a Medicaid program in Texas that provides health care to children in the Texas foster care program. STAR Health offers:

• An Integrated Medical Home where each child has access to Primary Care Providers, behavioral health clinicians, specialists, dentists, and vision services.
• Care Coordination services to help members and their caregivers understand benefits, get help with appointments, find transportation assistance, and identify community resources.
• Training programs that provide clinical expertise and program information for families, caregivers, caseworkers, and other child advocates.

• Superior HealthPlan was awarded the first STAR Health contract with a start date of April 1, 2008. This was based on participation in a competitive bid process.
• Superior also earned the contract again in 2015 and in 2022 through a competitive process.
• As of 2026, Superior is the only managed care organization in Texas that offers STAR Health coverage. This is under a contract from the Texas Health and Human Services Commission (HHSC).
• In 2017, Superior established the Foster Care Centers of Excellence (FCCOE). This helps further support children and youth in foster care. These centers specialize in caring for children in foster care and, as of 2026, there are 14 FCCOEs across Texas.

According to Medicaid/CHIP in Perspective, 11th Edition, STAR Health “is designed to better coordinate the health care of children in foster care and kinship care through one statewide MCO.” Since 2008, Superior has helped improve many facets of the STAR Health program:

• There has been a 35% reduction in psychotropic medication use since 2008. There has also been a 40% decrease in children being prescribed 5 or more of these drugs in that same timeframe.
• Superior helped launch the Turning Point program. This is a psychiatric hospital diversion program for children in STAR Health. Between 2023 – 2025, only 11% of members treated through the program had a behavioral health inpatient re-admission within 90 days.

There are many resources that can be used to learn about the role Superior and managed care have played in providing health-care coverage to some of the most vulnerable people in Texas. These include:

• Superior’s Members First Approach
• Texas Medicaid Works
• Texas Health and Human Services Commission
• Texas Association of Health Plans