ACA Health Insurance Providers Fee


HHSC reimburses eligible MCOs for the state’s portion of the Affordable Care Act’s Health Insurance Providers Fee (HIPF) paid by the MCOs. The reimbursement is made based on a CMS-approved rate methodology. The adjusted capitation rates are applicable only to those MCOs subject to the HIPF. The adjusted capitation rates include provision for (i) the HIPF, (ii) any applicable corporate federal income tax impact resulting from receipt of the reimbursement and (iii) any applicable Texas state premium tax impact resulting from receipt of the reimbursement.

Payment Rate Information

Effective 09/01/2018 (.pdf)

Effective 09/01/2016 (.pdf)

Effective 09/01/2015 (.pdf)

Effective 09/01/2014 (.pdf)