How to Become a Medicaid Provider in Texas

If you’re enrolling in Medicaid for the first time as a provider in Texas, you’re in the right place! This guide will outline the step-by-step application process and all the materials you need to get a license from Texas Medicaid & Healthcare Partnership (TMHP).

What Is a Texas Medicaid License? 

A Texas Medicaid provider license or enrollment enables healthcare providers to bill Medicaid for services provided to beneficiaries. 

• Who Issues It: Texas Medicaid & Healthcare Partnership (TMHP)
• Where to Apply: Provider Enrollment and Management System (PEMS) 
• License Cost: $730 provider enrollment fee for most applicants (as of 2025) 
• Bond Requirement: Surety bond only required for some license/registration types 

Who Needs to Enroll as a Texas Medicaid Provider? 

Providers that must enroll in Texas Medicaid include, but are not limited to, the following types: 

• Traditional fee-for-service Medicaid
• Long-term care services
• Pharmacy services
• Medicaid managed care
• Ordering- and referring-only providers

How to Get a Texas Medicaid Provider License

To obtain a Medicaid provider license, you need to enroll with the Texas Health and Human Services Commission (HHSC). This involves:

• Obtaining an NPI (National Provider Identifier)
• Completing the Provider Enrollment and Management System (PEMS) application
• Ensuring compliance with all relevant requirements

Follow the process outlined below to start your Texas Medicaid enrollment today.

Step 1: Obtain an NPI number

Get a 10-digit NPI number from the National Plan and Provider Enumeration System (NPPES). 

Step 2: Get an HHSC license

All healthcare facilities in Texas must be licensed with the Health and Human Services Commission (HHSC). 

Find your specific license or licenses required to operate the facility or practice you want to enroll in. 

Step 3: Enroll in Medicare 

Most Medicaid providers but first be enrolled in Medicare. However, if you will not provide services to any Medicare-eligible patients, you may be exempt. 

Step 4: Start the application

You’ll apply online through the Provider Enrollment and Management System (PEMS). 

Select the enrollment type, Then, start by choosing your NPI type, program type and provider type. 

Step 5: Meet eligibility requirements

After making your selections, PEMS will outline the requirements for that particular provider type. 

Ensure you meet all eligibility criteria including holding the appropriate licenses and any certifications for your specific provider type.  

Step 6: Submit supporting documents 

Provide owner information and submit all required attachments and information as prompted in the PEMS application. 

If a $50,000 surety bond is required for your provider type, purchase and file a bond from a licensed provider like SuretyBonds.com. 

Step 7: Mail application fee payment

Pay any application fees via check or money order. You’ll typically mail payment along with your PEMS cover letter to the address provided on the letter. 

Step 8: Sign provider agreement

Once approved by the HHSC, enter into a written provider agreement with HHSC. 

Step 9: Fingerprinting (if required)

You’ll receive a link for fingerprinting after you apply, if required by the HHSC. All 10% or higher owners of the practice/company must submit fingerprints. 

Step 10: Enroll for specific programs 

Upon completing the Texas Medicaid provider application, you can choose to enroll in additional programs such as Texas Health Steps and the CSHCN Services Program.

Step 11: Make corrections as needed 

After you apply, a Provider Enrollment Specialist will review the application and request any corrections if necessary. The HHSC may also require a site visit or additional review. 

Once everything is approved, you’ll receive a letter to confirm your final license approval. 

If you have any questions, PEMS provides detailed instructions on how to complete each page of the online Medicaid enrollment application. See the Resources section below. 

When Do I Need to Revalidate My Medicaid Enrollment? 

Most Texas healthcare provider licenses have a five year Medicaid enrollment period. You must submit a revalidation application before your current license expires. 

TMHP recommends submitting your revalidation at least 180 days prior to the expiration date. If you don’t submit within the allotted timeframe, you’ll be disenrolled from the Medicaid program.

Do I Need a Medicaid Provider Bond?

Only some Texas Medicaid providers need a surety bond. The following provider types do need a $50,000 surety bond for enrollment: 

• Durable medical equipment
• Optician
• Orthotics and prosthetics
• Pharmacy
• Quality reporting programs
• Ambulance
• Hyperlineation provider types 

Apply for your free TX Medicaid provider bond quote today. 

More Resources

• TMHP: How to Apply for Medicaid Enrollment
• PEMS Provider Enrollment Step-by-Step Guide
• PEMS Surety Bond Requirements