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Revision 25-4; Effective Dec. 12, 2025
Complaint is defined as any dissatisfaction expressed by a complainant, verbally or in writing, to the Texas Health and Human Services Commission (HHSC).
A complainant enrolled in a STAR Kids managed care organization (MCO) should first contact the Member Services hotline when they want to file a complaint against their MCO.
The complainant may contact the HHSC Office of the Ombudsman’s Managed Care Assistance Team to investigate the complaint if they are not satisfied with the outcome after exhausting the MCO's complaint process. A complainant may contact the HHSC Office of the Ombudsman’s Managed Care Assistance Team by:
- phone at:
- 866-566-8989, 8 a.m. - 5 p.m., Monday – Friday; or
- 7-1-1 or 800-735-2989, 8 a.m. - 5 p.m., Monday – Friday, if they have a hearing or speech disability;
- submitting the Online Question or Complaint Form;
- the internet: Ombudsman Managed Care Help;
- mail at the following address: Texas Health and Human Services Commission, Ombudsman for Managed Care, P.O. Box 13247, Austin, TX 78711-3247; or
- fax at 888-780-8099.
For the Medically Dependent Children Program (MDCP), the complainant may contact the HHSC Complex Care Services (CCS) to investigate a complaint. A complainant may contact the HHSC CCS by:
- phone at 844-999-9543; or
- email at MDCP_DBMD_Escalation@hhsc.state.tx.us.
Individuals not enrolled in a MCO can call the Medicaid helpline at 800-335-8957.
7110 PSU Staff Compliant Escalation Procedures
Revision 25-4; Effective Dec. 12, 2025
Program Support Unit (PSU) management may receive an escalation of a complaint by email from:
- the Texas Health and Human Services Commission (HHSC) Office of the Ombudsman;
- HHSC Managed Care Contracts and Oversight (MCCO) Compliance;
- Complex Care Services (CCS);
- Program Enrollment and Support (PES) leadership;
- staff-legislative inquires;
- HHSC Government Relations;
- HHSC Communications; or
- other reliable sources.
PSU management or their designee determine which PSU service area (SA) the escalation originates from. They forward the email to the assigned PSU staff and their supervisor within one business day of receipt. Legislative or media inquiries and escalations are subject to immediate review and response, less than a 24-hour turnaround.
The PSU supervisor or designated PSU staff must complete the following within two business days of receipt of the escalation email from PSU management:
- search the PES Escalation Intake Tracker to determine if an open escalation record exists for this person and issue;
- create a new Escalation Intake Tracker record, as needed; and
- update the Escalation Intake Tracker report with the following information:
- Status – indicate the status of the escalation using a drop-down list of statuses.
- Open – new escalation received;
- Pending – escalation is pending completion; and
- Closed – escalation complete, no further action needed.
- Date Reported – record the date the escalation was received in MM/DD/YYYY format.
- Issue Source – enter the source of the escalation.
- Escalation Summary – provide a summary of the escalation.
- Client/Reporter - enter the first and last name of the client the escalation is about or the person reporting the escalation, if applicable.
- Medicaid ID or SSN – record the client’s Medicaid identification (ID) number or Social Security number (SSN). Always enter the Medicaid ID when it is available.
- HEART Tracking Number – enter the unique tracking number assigned to the escalation record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART).
- Assigned To – specify the name of the PSU staff the escalation has been assigned to.
- Progress Updates/Resolution – describe the steps taken to resolve the escalation. Note: Any new actions or developments must be dated and documented at least once a week.
- Associated Files – attach relevant documents.
- Issue Logged By – enter the person’s name or email address that is logging this escalation into the tracker.
- ID – this field will auto populate a unique identification number for each escalation entered into the tracker. No PSU action is required for this field.
- Status – indicate the status of the escalation using a drop-down list of statuses.
The Escalation Intake Tracker record may require more updates as the escalation is being processed.
PSU staff do not log loss of Medicaid eligibility referrals in the Escalation Intake Tracker.
The assigned PSU staff must complete the following within two business days of receipt of the escalation email from PSU management:
- create a new HEART case record using the Action Type Escalation;
- review the escalation and research all issues and concerns;
- provide a response to all parties listed on the email received from PSU management indicating detailed actions taken to resolve the escalation;
- provide weekly updates to all parties if issues or concerns cannot be immediately resolved;
- upload all applicable documents to the HEART case record; and
- document and close the HEART case record once all issues are resolved.
The PSU supervisor or designated PSU staff must review the Escalation Intake Tracker and provide an update on outstanding escalations at least once a week.