Baylor Scott & White Health Plan credentialing for behavioral health: what's left after the Medicaid exit

Part of our credentialing guide for Texas practices and programs. Other Texas plans: Superior HealthPlan · Wellpoint Texas · Molina · every Texas Medicaid plan.

What changed in 2026

The announcement, made April 15, 2026, cited the state's Medicaid procurement decision and the complexity of the individual market, and said Baylor Scott & White's hospitals and clinics would keep accepting Medicaid and marketplace plans from other insurers (KWTX, April 15, 2026). Becker's reported about 125,000 Medicaid enrollees and about 100,000 marketplace members affected, and 321 jobs cut (Becker's Payer Issues).

If you served RightCare (Medicaid) members

RightCare from Scott and White Health Plan was BSWHP's STAR Medicaid plan in the Central Texas Medicaid Rural Service Area (MRSA Central), which takes in counties such as Bell, Brazos, Coryell and McLennan (BSWHP's 2025 RightCare provider document). HHSC's STAR comparison chart for MRSA Central dated September 1, 2026 lists two plans: Superior HealthPlan and Wellpoint (HHSC MRSA Central STAR chart). Former RightCare members in those counties are in one of them now.

1. Check every Medicaid client's plan before the next visit. A RightCare card is no longer valid coverage; run eligibility and update the payer in your EHR.
2. Get in network with Superior and Wellpoint if you aren't already. Superior takes a Network Participation Request; Wellpoint uses MultiPlan's Texas True Choice network for its rural members. Our Superior guide and Wellpoint guide walk through each.
3. Ask the new plan about continuity of care for clients mid-treatment, and get any authorization in place before you bill. Our sister site's prior authorization guide covers the request.
4. Finish RightCare claims for dates of service through August 31, 2026 within the filing limit in your BSWHP contract, and keep the remittances. Our timely filing guide has the Texas rules.

Your TMHP enrollment doesn't change: it's the state enrollment every Medicaid plan relies on, and it stays valid as long as you revalidate (our Texas Medicaid guide). Every Texas Medicaid plan uses the same credentialing verification organization, so your documents are verified once for all of them; Superior's and Wellpoint's applications, committees and contracts are still separate.

If you see BSWHP marketplace members

Individual marketplace members keep BSWHP coverage through December 31, 2026, and need a new plan for 2027. For your practice or program:

• Flag every client with a BSWHP individual plan now, and ask them in December which plan they picked.
• Verify benefits again in early January: new deductible, new network, new authorization rules. Our VOB checklist lists the questions.
• Check that you're in network with the plans they're moving to. If a client in active treatment lands in a plan you aren't contracted with, a single case agreement can bridge the gap.
• Don't steer anyone to a plan. Choosing coverage is the client's decision; tell them which networks you're in and leave it there.

Is BSWHP still worth joining?

For most behavioral health providers in Central Texas and DFW, it depends on who your clients' employers are. BSWHP sells employer group coverage and Medicare Advantage, and its site has a section for Baylor Scott & White Health's own employees' plan. It says its network includes more than 36,000 providers and 4,000 facilities in Texas (BSWHP join page).

• Yes, probably, if you're near a Baylor Scott & White hospital or clinic and your clients work for employers that offer BSWHP, or if you see Medicare clients.
• Medicare Advantage matters more than it used to for counselors: since January 1, 2024, LPCs and LMFTs can enroll in Medicare as mental health counselors and marriage and family therapists, and Medicare Advantage plans can contract with them. Enroll in Medicare first (our Medicare guide for LPCs and LMFTs).
• Probably not first if your clients are mostly Medicaid or marketplace: BSWHP no longer covers them.

Use the time saved on the plans that cover your clients; our guide to getting credentialed with insurance shows how to pick and order them.

How to apply now

BSWHP's provider process for joining the network describes two routes:

1. CAQH: BSWHP uses CAQH. List BSWHP as allowed to view your profile and make sure the attestation and data are current. Our CAQH ProView guide covers each section.
2. Aperture: Aperture Credentialing, a credentialing verification organization, collects anything missing and verifies the file. Facilities, and providers who don't use CAQH, get Aperture's instructions to apply through the Availity portal or on paper.
3. Committee: Aperture returns the verified file to BSWHP, and its credentialing committee approves or denies.
4. Ask about the criteria for your license. The same document lists hospital privileges at a BSWHP-contracted hospital as a basic network criterion; ask Provider Relations how that applies to counselors, social workers and psychologists who don't admit patients, before you build the file.
5. Confirm products and the effective date in writing, and don't see BSWHP members as in network before that date.

For IOP and PHP programs

A program goes through the same PAM portal as a facility, then Aperture's facility application on Availity. Have the HHSC license for each site, the organization NPI, accreditation, liability certificates, ownership and roster ready (our credentialing documents checklist). For a commercial plan, ask early whether BSWHP will contract with a program before accreditation, which levels of care it contracts for, and whether it pays IOP and PHP as a per diem; BSWHP's commercial provider manual sets the general rules. Our guides to insurance contracts for treatment centers and negotiating insurance rates cover what to check and ask for.

Behavioral health authorizations

• Prior authorization: BSWHP's FAQ says behavioral health services need prior authorization through its Care Coordination Department, and that non-emergency care must come from network providers (BSWHP FAQ).
• How to send it: the secure provider portal is the preferred route; a medical and behavioral health fax cover sheet and form are the alternative (BSWHP medical resources).
• What to attach: BSWHP asks for a completed request form and encourages enough documentation, such as progress notes and treatment plans, to show medical necessity. It also says prior authorization doesn't guarantee payment (BSWHP provider resources).
• Texas "gold card" changes: BSWHP says Texas House Bill 3459 changes prior authorization for certain fully insured, state-regulated plans and that its provider portal lists the services that no longer need it. Check that list, and since BSWHP describes the change as applying to fully insured, state-regulated plans, don't assume it covers a self-funded employer plan or Medicare Advantage.

For IOP and PHP, line your documentation up with ASAM criteria and request continued stays before the last approved day; our utilization review guide lays out the log, and Cima EHR for IOP and PHP programs keeps authorized units next to attendance.

How we can help

We'll tell you whether BSWHP is worth it for your caseload, file it if it is, and move your Medicaid and marketplace work to the plans that now cover those clients. Our credentialing service files each plan, follows up every two weeks and confirms each effective date in writing.

• BSWHP, or any one commercial plan, for a clinician: $175 per plan.
• A program's facility contract: $450 per plan.
• Texas Medicaid enrollment with your first managed care plan, if you aren't enrolled: $350 per clinician.

For example, a Waco-area LPC who already has Texas Medicaid and Medicare, adding Superior, Wellpoint and BSWHP: $525. Run your own list through the credentialing cost calculator.

Questions

More Texas plan guides: Superior HealthPlan · Wellpoint Texas · Molina Healthcare of Texas · Community Health Choice · Texas Medicaid plans by area

Sources

All checked October 24, 2026. BSWHP revises these pages and forms; open the current version before you rely on any detail.

1. KWTX, "Baylor Scott & White Health Plan to exit Texas Medicaid managed care in 2026, end individual marketplace plans," April 15, 2026. kwtx.com
2. Becker's Payer Issues, "Baylor Scott & White Health Plan to exit Medicaid, individual markets; cut 321 jobs." beckerspayer.com
3. Baylor Scott & White Health Plan, RightCare provider document, 2025 (MRSA Central service area). bswhealthplan.com
4. Texas HHSC, STAR comparison chart, MRSA Central, September 1, 2026. hhs.texas.gov
5. Baylor Scott & White Health Plan, Provider Process for Joining the Network (PAM portal, Join Our Network, Aperture, CAQH, committee, basic criteria). bswhealthplan.com
6. Baylor Scott & White Health Plan, Join Our Network. bswhealthplan.com
7. Baylor Scott & White Health Plan, Commercial Provider Manual. bswhealthplan.com
8. Baylor Scott & White Health Plan, Frequently Asked Questions (behavioral health prior authorization). bswhealthplan.com
9. Baylor Scott & White Health Plan, Medical Resources (prior authorization forms, portal and fax). bswhealthplan.com
10. Baylor Scott & White Health Plan, Provider Resources (prior authorization requirements, HB 3459). bswhealthplan.com

This guide is general information. Cima Consulting isn't a law firm or an accounting firm. BSWHP, HHSC and the other plans make their own decisions; we don't guarantee approvals, rates or dates. We aren't affiliated with Baylor Scott & White Health or its health plan.