Medicaid exclusion screening requirements in Texas
What Texas Medicaid requires of the organizations that take part in it: whether the state keeps its own exclusion list, how often it expects you to check, what the penalties are, and how an action taken in another state reaches you here. Every claim on this page links to the source it came from.
Content review and source verification
- Last reviewed
- Last verified
- Content owner
- Exclia content team
- Review cadence
- Every 90 days
- Next review due
What Exclia screens for this state
Exclia does not yet screen Texas’s own Medicaid exclusion list. We screen the federal lists, and we publish every source we do and do not cover rather than leaving you to assume.
What the state requires
Texas HHSC mandates a monthly review of the state exclusions list.
Texas HHSC requires participating providers to review the state exclusions list every month for any employee or contractor who has been barred from taking part in the Medicaid program. The requirement is not limited to clinicians: it covers everyone the organization employs or contracts with, front-office staff included. Texas Medicaid does not reimburse claims from a provider currently on the list.
- Provider guidance on exclusions — Texas Medicaid & Healthcare Partnership (HHSC’s claims administrator)
- Exclusions — Texas Health and Human Services Commission, Office of Inspector General
Why monthly, and where the exposure comes from
The HHS Office of Inspector General publishes the federal exclusion list (the LEIE) monthly, and its guidance to providers is that screening staff and contractors each month is what best limits the risk of overpayment and civil monetary penalty liability. State Medicaid agencies are themselves required to check the LEIE no less frequently than monthly (42 C.F.R. § 455.436(c)(2)), which is the rhythm the lists move on.
The state’s own list
Texas HHSC OIG Exclusions Database
Texas keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
The state’s searchable database of individuals and entities barred from taking part in Texas health care programs, compiled by the HHSC Office of Inspector General. It can be searched by name or downloaded as a file.
- Published by
- Texas Health and Human Services Commission, Office of Inspector General
- Refreshed
- Updated monthly, per the publishing agency.
What happens if it is not done
Texas states the consequences as a set: the money comes back, and participation itself is on the table.
- Texas Medicaid does not reimburse claims from a provider currently on the state exclusions list.
- Submitting claims for work involving a person on the list can lead to recoupment of amounts paid, administrative penalties, termination of the provider agreement, and the provider’s own placement on the list.
- The federal exposure applies on top: repayment of what was paid, civil monetary penalties for each item or service claimed, and an assessment of up to three times the amount claimed.
- Provider guidance on exclusions — Texas Medicaid & Healthcare Partnership
- HHS Office of Inspector General, Special Advisory Bulletin on the Effect of Exclusion (May 8, 2013)
The federal exposure behind the state requirement
Where a federal health care program pays for an item or service furnished, ordered, or prescribed by a person on an exclusion list, the OIG can seek repayment of what was paid, civil monetary penalties for each item or service claimed (a statutory $10,000, adjusted annually for inflation), and an assessment of up to three times the amount claimed. The standard is what the organization knew or should have known — which is why the date of your last check is the fact that matters.
How another state’s action reaches you here
Section 6501 of the Affordable Care Act (42 U.S.C. § 1396a(a)(39), implemented at 42 C.F.R. § 455.416(c)) requires a state Medicaid agency to deny or end the enrollment of any provider that was terminated for cause on or after January 1, 2011 under Medicare, or under the Medicaid or CHIP program of any other state, and that appears in the federal termination database. In practice that means an action taken against a provider in one state reaches their participation in every other — so the list that matters to you is not only your own state's.
Common questions
Yes. The HHSC Office of Inspector General compiles and publishes a searchable exclusions database, separate from the federal OIG list, and also offers it as a downloadable file.
Monthly. HHSC mandates that providers review the state exclusions list each month for employees and contractors barred from taking part in the Medicaid program.
Yes. Texas states that the requirement reaches not only practitioners such as doctors and nurses but other staff, including front-office roles.
Claims connected to a person on the list are not reimbursed, and Texas can pursue recoupment of amounts already paid, administrative penalties, and termination of the provider agreement. The federal exposure applies as well.
Check one name against the federal lists, free
One name, no account, and the result states which sources it covered and which it did not. It is a spot check rather than monitoring — it does not satisfy a monthly requirement on its own.
Run a free checkOr do it for the whole roster, every month
Exclia screens every person and vendor on your roster each month against the sources we cover, and keeps the dated audit trail that shows you did it.
See pricingEvery published state in one printable table, with the source for each row and a publication date you can check. Get the state-by-state requirements table
This states what each state publishes and links to where it says it. It is not legal advice, and where your own obligations are unclear your counsel is the right reader of these sources.