Primary Care Provider (PCP)
A primary care provider (PCP) is your main doctor. It can also be a nurse or clinic. This doctor knows you well. Your main doctor will treat most of your healthcare needs. If he/she cannot, you will be sent to a provider who can. Your doctor's name and telephone number are on your ID card. To find a PCP or get help scheduling an appointment, call Member Services or visit Molina's Provider Online Directory and search for a doctor in your area.
If you also have Medicare, you will not be assigned or choose a Molina PCP. Medicare is responsible for your primary care health needs.
Molina Dual Options STAR+PLUS MMP members must get all covered services from providers within our network. When you enroll, you must choose a PCP to provide your basic medical care and coordinate your care. You may change your PCP for any reason, at any time. For some providers, you may need a referral from your PCP.
Specialist Care
Your PCP will help you if you need to see a special doctor or if you need a special service. Your PCP will make sure you get the special health care you need. When you call to make an appointment with a specialist, you will be seen within (30) days. If your medical need is urgent you will be seen within (24) hours.
If you would like a specialist to be your PCP and the doctor agrees, you can call MemberServices toll-free at (866) 449-6849 or CHIP RSA (877) 319-6826 for help.
Dental Home
Your Medicaid dental plan provides dental services, including services that help prevent tooth decay and services that fix dental problems. If you need help finding a dental provider, call Member Services.
Referrals
A "referral" is an approval for you to get certain medical services. Molina does not require referrals. But some services may require Prior Authorization (PA). PA is a request for a service from your doctor. Your PCP will help you to get PA if it is necessary.
In the case of counseling or referral service that Molina does not cover because of moral or religious objections, Molina will inform you that the services are not covered. To get information about accessing services not covered due to moral or religious objections, you can call Member Services.
What services do not need a referral?
Molina does not require referrals, but some services may require PA. Molina Healthcare’s medical staff and your doctor review the medical need of your care before services are given. This way, they can make sure it is right for your specific condition.
Talk to your doctor about covered services that do and do not require PA. You can call Member Services for more information.
Some services that do not require PA are:
- Emergency services
- Qualified Family Planning services
- OB/GYN services
- Certified Nurse Midwife services
- Certified Nurse Practitioner
- Federally Qualified Health Care (FQHC) services
- Rural Health Care (RHC) service
- Behavioral Health Service
- Routine Vision Care
If you need help finding a doctor or dentist you can call Member Services or you can find Molina providers in hospitals and clinics near you, by using the Provider Search feature.
You can also view, download and/or print your provider directories. The Provider Directory is available in hard copy without charges and provided within five (5) business days upon request.
STAR Provider Directories (
)
)- STAR - Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker
- STAR - Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton
- STAR - Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall
- STAR - El Paso and Hudspeth
- STAR - Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy and Zapata
STAR+PLUS Provider Directories ()
- STAR+PLUS - Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton
- STAR+PLUS - Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker
- STAR+PLUS - Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall
- STAR+PLUS - Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson
- STAR+PLUS - El Paso and Hudspeth
- STAR+PLUS - Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy and Zapata
- STAR+PLUS - Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Cooke, Delta, Fannin, Franklin, Grayson, Gregg, Harrison, Henderson, Hopkins, Houston, Lamar, Marion, Montague, Morris, Nacogdoches, Panola, Rains, Red River, Rusk, Sabine, San Augustine, Shelby, Smith, Titus, Trinity, Upshur, Van Zandt and Wood
- STAR+PLUS - Denton, Hood, Johnson, Parker, Tarrant and Wise
CHIP Provider Directories ()
- CHIP/CHIP Perinate - RSA South
- CHIP/CHIP Perinate - RSA North
- CHIP/CHIP Perinate - RSA East
- CHIP/CHIP Perinate - RSA Central
- CHIP/CHIP Perinate - Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton
- CHIP/CHIP Perinate - Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall
- CHIP/CHIP Perinate - Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker
