Loading strategy tools...
Loading strategy tools...
How to maximize health-center economics in Texas — the fundamentals, the revenue levers, the case studies, and a simulator seeded to this state's real numbers.
Data updated: 2026-07-10
80
FQHCs
1.7M
Patients
30%
Medicaid
No
Medicaid expansion
Texas is the structural inverse of California: the largest non-expansion state, where uninsured patients — not Medicaid — are the biggest payer slice of the FQHC panel. That makes the sliding-fee scale, 330 grant base, 340B, and the federal care-management codes the core levers, and it makes the ACA premium-credit expiry the live federal threat. There is no state healthcare wage floor (federal $7.25 applies), NP practice is physician-delegated, and the legislature meets biennially — so payment policy moves slowly and the durable plays are operational.
Coverage terrain
Without expansion, uninsured patients are typically the biggest slice of the panel — the sliding-fee scale, the 330 grant base, and 340B carry more weight, and Medicaid eligibility decides less.
Payer mix (patient-weighted, UDS)
Wage floor (cost side)
follows federal $7.25/hr
Right-to-work state.
Policy signals (2026)
State budget: Non-expansion: ACA-credit expiry is the dominant cliff (~1M exposed); state FQHC Incubator $650K/center
Texas runs care coordination through STAR/STAR+PLUS managed care; CoCM became FQHC-billable in 2025 — behavioral-health integration is the clearest revenue lever.
State Medicaid programs
Collaborative Care Model (CoCM)
FQHCs/RHCs can bill CoCM since March 2025 (via 99492–99494 + G2214 as of CY2026) — a billable BH-integration line for care managers and consulting psychiatrists.
STAR+PLUS service coordination
Managed-care care coordination (every STAR+PLUS member gets a service coordinator); FQHCs participate as network providers.
CHW billing: indirect
No broad fee-for-service CHW billing — CHW revenue is limited to CPW case management and MCO quality-cost categorization.
The federal codes (apply in every state)
Chronic Care Management (CCM)
99490 (+99439) — FQHCs bill the individual codes (the G0511 bundle retired Sept 30, 2025)
FQHCs bill monthly for managing patients with two or more chronic conditions — paid for non-visit time (calls, follow-up, care plans). Since Oct 1, 2025 FQHCs bill the individual care-management codes (99490, etc.) instead of the old G0511 bundle.
Behavioral Health Integration & Collaborative Care (BHI / CoCM)
G0512 → component codes (99492–99494) in CY2026 · BHI 99484
FQHCs bill for an embedded behavioral-health care manager plus a consulting psychiatrist supporting the primary-care team — integrated mental-health care is billable. (CMS retires the G0512 bundle in CY2026; FQHCs move to component codes.)
Transitional Care Management (TCM)
99495 / 99496
Bill for managing the 30 days after a patient leaves the hospital — a nurse-driven handoff that prevents readmissions and is reimbursed.
Advanced Primary Care Management (APCM)
G0556 / G0557 / G0558 (2025)
A newer monthly per-patient care-management payment, tiered by patient complexity — team-delivered, no time-tracking required.
Community Health Integration (CHI)
G0019 / G0022
Medicare pays for CHW-delivered, SDOH-driven care navigation — your community-health work is directly billable.
Principal Illness Navigation (PIN)
G0023 / G0024 (peer support G0140 / G0146)
Bill for navigators, CHWs, or peer-support specialists who help patients with a serious, high-risk illness navigate their care.
SDOH Risk Assessment
G0136
A standardized social-determinants-of-health screening is a billable add-on when paired with a qualifying visit — your screening work helps drive revenue, not just paperwork.
Remote Patient Monitoring (RPM / RTM)
99453 / 99454 / 99457 / 99458
Bill for nurse-run remote monitoring of blood pressure, glucose, or weight between visits — managing chronic disease without an office visit.
Texas runs care coordination through STAR/STAR+PLUS managed care; CoCM became FQHC-billable in 2025 — behavioral-health integration is the clearest revenue lever.
How this role generates billable revenue
CHWs and care coordinators are how an FQHC keeps people connected to care — and now that work is billable, so doing it well literally funds more of it.
Real FQHCs that moved their economics — this state's first, then transferable lessons from similar payment terrain.
Transferable lessons
MCR Health
MCR Health is pioneering subscription-based primary care for uninsured patients — converting uncompensated care into predictable monthly revenue through NACHC's Innovation Incubator.
Read the full caseCahaba Medical Care
An Alabama FQHC deployed FDA-authorized autonomous AI for diabetic retinopathy screening — and detected previously-missed eye disease in MORE THAN 1-in-4 patients screened.
Read the full caseHighland Health
Highland Health grew pharmacy revenue 270% by switching from contract pharmacy to entity-owned operations, capturing 100% of 340B margins instead of splitting with chains.
Read the full caseCommunity Health Center (CPaMB Client)
A financially distressed FQHC with only 9 days cash on hand and 122-day AR transformed its revenue cycle — cutting AR to 34 days and doubling cash receipts from $10.7M to $22.5M.
Read the full caseA strategic revenue model seeded with this state's real numbers. Adjust volume, payer mix, and the program levers.
Starting values are planning estimates — adjust everything to your organization.
Volume & payer mix
Commercial / other: 29%
Rates
Default $202.65 = the Medicare FQHC PPS national base rate, used as a reference only. Your state Medicaid PPS rate is organization-specific — enter yours.
Revenue programs available in Texas
Visit revenue (baseline)
$9.5M
~21,875 patients
With your levers
$9.9M
+$394K from programs & 340B
Your top levers in Texas
Non-expansion scenario
Texas has not expanded Medicaid. If 10 points of your uninsured panel shifted to Medicaid coverage, visit revenue alone would change by $1.1M/yr — the scale of what coverage policy decides.
Cost-side reminder (not modeled here): the Texas wage floor is follows federal $7.25/hr.
Want the deep model — per-role staffing, costs, scheduling, and optimization pathways, seeded with Texas’s data? Continue in the Clinic Simulator →
Free educational game
Clinic Quest: America turns every state's payer mix, programs, and wage floors into an eight-quarter run. Difficulty emerges from the data — collect all 59 states.
Play Clinic Quest: America →Strategy
Healthcare Economics (fundamentals)
PPS, 340B, FMAP and more — every concept at 3 levels.
ExploreIntelligence
State Intelligence Index
News, policy, and FQHC footprint for every state.
ExploreStrategy
Case Studies
Outcome-first index of every case study on the platform.
ExploreStrategy
Clinic Simulator (California deep model)
Per-role staffing, APM, and same-day billing — the CA vertical.
Explore