STAR+PLUS

What is STAR+PLUS?

STAR+PLUS is a Texas Medicaid managed care program designed to provide health care, acute and long-term services and support through a managed care system.

STAR+PLUS provides a continuum of care with a range of options and flexibility to meet individual needs. The program increases the number and types of providers available to Medicaid clients.

Participants of STAR+PLUS choose a health plan (HMO) from those available in their county, and receive Medicaid services through those health plans.

Through these health plans the STAR+PLUS program combines traditional health care (such as doctor visits) and long-term services and support, such as providing help in your home with daily activities, home modifications, respite care (short-term supervision) and personal assistance.

Service coordination is the main feature of STAR+PLUS. Medicaid clients, their family members and providers work together to help clients coordinate health, long-term and other community support services.

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Why STAR+PLUS?

Texas Senate Concurrent Resolution 55 (74th Legislative Session) directed the Texas Health and Human Services Commission to create a cost-neutral model for the integrated delivery of acute and long-term services and support for Medicaid recipients over age 65 and those with disabilities.

Even though elderly clients and those with disabilities are only 23 percent of the state’s Medicaid population, they account for almost 60 percent of the expenditures. As the baby boom generation ages, the number of people needing long-term services and support will increase. While the state’s general population will increase about 50 percent by the year 2020, the elderly population will almost double from 1.9 million to 3.8 million.

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Who Qualifies for STAR+PLUS?

Enrollment in STAR+PLUS is required for Medicaid recipients who live in a STAR+PLUS service area and fit one or more of the following criteria:

• People who have a physical or mental disability and qualify for supplemental security income (SSI) benefits or for Medicaid due to low income.
• People who qualify for Community-Based Alternatives (CBA) 1915(c) waiver services.
• People age 21 or older who can receive Medicaid because they are in a Social Security Exclusion program and meet financial criteria for 1915(c) waiver services.
• People age 21 or older who are receiving SSI.

Enrollment in STAR+PLUS is voluntary for:

• Children under age 21 receiving SSI.

The following people cannot participate in the STAR+PLUS program:

• Residents of nursing facilities.
• STAR+PLUS members who have been in a nursing facility for more than 120 days.
• Clients of Medicaid 1915(c) waiver services, other than Community-Based Alternative services.
• Residents of Intermediate Care Facilities for the Mentally Retarded (ICF-MR).
• Clients not eligible for full Medicaid benefits, such as Frail Elderly program members, Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, Qualified Disabled Working Individuals and undocumented aliens.
• People not eligible for Medicaid.
• Children in state foster care.

Important notes for those in Medicare:

• Enrollment in Medicare does not affect eligibility for STAR+PLUS.
• People who qualify for both Medicare and Medicaid (also known as “dual eligibles”) and participate in STAR+PLUS will continue to receive acute care services through their Medicare doctor. STAR+PLUS does not change the way they receive Medicare services.

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Where is STAR+PLUS?

On Jan. 1, 2007, STAR+PLUS was expanded to include 29 counties in the Travis, Bexar, Nueces, and Harris Expansion Service Areas. Prior to January 2007, STAR+PLUS only served Medicaid recipients in Harris County.

Current STAR+PLUS Service Areas and counties include:

In 2011, HHSC will expand the STAR+PLUS program into the Dallas and Tarrant Medicaid Service Areas. These areas and counties will include:

Additional information on the 2011 STAR+PLUS Expansion

Map of STAR+PLUS Service Areas

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What does this mean for Dual Eligibles?

The term “dual eligible” refers to someone who is enrolled in both Medicaid and Medicare.

STAR+PLUS does not change how dual eligible members receive Medicare services.

STAR+PLUS members who are not dual eligibles (which means they only receive Medicaid services) are required to choose a health plan and a primary care provider. These members receive all of their services, including acute and long-term services, from their STAR+PLUS health plan.

Dual eligible members choose a STAR+PLUS health plan but do not choose a primary care provider because they receive acute care from their Medicare providers. The STAR+PLUS health plan only provides Medicaid long-term services and support to these dual eligible members.

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How does STAR+PLUS work?

Enrollment

Medicaid recipients who are eligible for STAR+PLUS receive an enrollment packet in the mail that contains information about the program, instructions for completing the enrollment form, and information about the health plans available in their area.

Clients can return their enrollment form by mail or by completing an enrollment form at an enrollment event or presentation.

Clients have 30 days after receiving the enrollment packet to select a STAR+PLUS health plan. If no health plan is selected, HHSC chooses a health plan and primary care provider for them.

Clients who are assigned a health plan may still choose their own health plan and primary care provider, but until they have formally made that change, they will receive their Medicaid services through the plan and provider to which they were assigned. STAR+PLUS members may change health plans as often as once a month.

Getting Services

The client’s primary care provider takes care of the client’s basic health care needs. They can also refer clients to specialists if additional health care is needed.

All members who qualify can receive long-term services and support through their STAR+PLUS health plan. Acute and long-term services and supports are coordinated through a plan of care involving the client, family members and the health care provider.

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STAR+PLUS Health Plans

The following health plans provide STAR+PLUS services in the designated areas.

HHSC is conducting a competitive procurement process to select health plans for STAR+PLUS in the Dallas and Tarrant Service Areas. The final Request For Proposals (RFP) for the Dallas/Tarrant expansion was posted in November 2009. HHSC will select at least two health plans for each service area.

Map of STAR+PLUS Health Plans by County

Statewide STAR+PLUS Service Delivery Areas

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STAR+PLUS Services

The following summarizes the services available to STAR+PLUS clients. For a complete list of covered services, see Attachment B-2.1 of the Joint Medicaid and CHIP request for proposal.

Health plans are required to assess all STAR+PLUS members within 30 days of their enrollment to determine their needs and develop appropriate care plans.

Long-term services and supports provided by the health plans include Day Activity and Health Services (DAHS), Personal Assistance Services (PAS) and home delivered meals. Additional services include adaptive aids, adult foster care home services, adult day care services, assisted living, emergency response services, medical supplies, minor home modifications, nursing services, respite care (short-term supervision), and therapies (occupational, physical and speech-language).

Service coordination is an integral STAR+PLUS service. Health plans coordinate all STAR+PLUS acute and long-term services and supports for each STAR+PLUS client who needs them.

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Value-added Services

In addition to all of the traditional Medicaid and other required services listed above, each STAR+PLUS health plan offers its own set of “value-added” services.

Health plans offer value-added services as incentives for Medicaid recipients to join their plan – they are services that are above and beyond those that are required. Some value-added services are offered by all of the HMOs, while others may vary from plan to plan.

Each health plan’s value-added services are shown in the comparison charts that are included in the enrollment kits mailed to eligible Medicaid recipients.

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Federal Waivers

Federal waivers are granted by the Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare and Medicaid programs. Waivers allow a state permission to waive certain requirements of the Social Security Act relating to Medicare or Medicaid.

HHSC received two Medicaid waivers to operate the STAR+PLUS program, a 1915(b) waiver and a 1915(c) waiver.

The 1915(b) waiver allows HHSC to limit the number of health care providers available to clients and requires that certain Medicaid clients participate in the managed care program. It also waives or eliminates the requirement that all HHSC Medicaid policies apply to all Medicaid clients in Texas, which allows HHSC to offer STAR+PLUS in selected areas of the state.

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