Texas Medicaid and CHIP
STAR+PLUS: Client Information
STAR+PLUS is a Texas Medicaid managed care program for people who have disabilities or are age 65 or older. People in STAR+PLUS get Medicaid health-care and long-term services and support through a medical plan that they choose.
Long-term services and support includes things like:
- Help in your home with basic daily activities.
- Help in making changes to your home so you can safely move around.
- Short-term care to provide a break for caregivers.
- Help with things that need to get done.
Another feature of STAR+PLUS is service coordination. A STAR+PLUS staff member works with the member, the member’s family and the member’s doctors and other providers to help the member get the medical and long-term services and support they need.
To get services through STAR+PLUS you must: (1) be approved for Medicaid, (2) live in a STAR+PLUS service area (now statewide) and (3) be one or more of the following:
- Age 21 or older, getting Supplemental Security Income (SSI) benefits, and able to get Medicaid due to low income.
- Not getting SSI and able to get STAR+PLUS Home and Community-Based Waiver Services.
- Age 21 or older, getting Medicaid through what are called “Social Security Exclusion programs” and meet program rules for income and asset levels.
- Age 21 or over residing in a nursing home and receiving Medicaid while in the nursing home.
Children age 20 and younger who have Medicaid and get SSI can be in STAR+PLUS. Or they can keep getting their Medicaid services in traditional Medicaid until November 1, 2016, when this population goes into STAR Kids.
The following people can’t be in the STAR+PLUS program:
- People over 21 who get Medicaid 1915(c) waiver services, and do not receive Medicare other than Community-Based Alternative services.
- People who are not able to get full Medicaid benefits, such as Frail Elderly program members, Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, Qualified Disabled Working Individuals and illegal immigrants.
- People who aren’t able to get Medicaid.
- Children in state foster care.
- People who receive Full Medicaid and Medicare who get Medicaid 1915(c) waiver services or who live in community homes for people with Intellectual Developmental Disabilities (IDD).
- Age 20 or younger and live in a nursing home.
Important notes for those covered by Medicare:
- You can get STAR+PLUS even if you get Medicare unless you get Medicaid 1915 (c) waiver services or live in facilities for people with Intellectual Developmental Disabilities (IDD).
- If you are covered by both Medicare and Medicaid (also known as “dual eligible”) and you join STAR+PLUS, you will keep getting regular health-care services through your Medicare doctor. STAR+PLUS does not change the way you get Medicare services.
|Service Area||Medical Plans|
|Bexar Service Area
Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson counties
|Amerigroup, Molina Healthcare of Texas, Superior HealthPlan|
|Dallas Service Area
Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties
|Molina Healthcare of Texas, Superior HealthPlan|
|El Paso Service Area
El Paso and Hudspeth counties
|Amerigroup, Molina Healthcare of Texas|
|Harris Service Area
Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, and Wharton counties
|Amerigroup, Molina Healthcare of Texas, UnitedHealthcare Community Plan|
|Hidalgo Service Area
Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, and Zapata counties
|HealthSpring, Molina Healthcare of Texas, Superior HealthPlan|
|Jefferson Service Area
Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, and Walker counties
|Amerigroup, Molina Healthcare of Texas, UnitedHealthcare Community Plan|
|Lubbock Service Area
||Amerigroup, Superior HealthPlan|
|MRSA Central Texas
Bell, Blanco, Bosque, Brazos,Burleson, Colorado, Comanche, Coryell, DeWitt, Erath, Falls, Freestone, Gillespie, Gonzales, Grimes, Hamilton, Hill, Jackson, Lampasas, Lavaca, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Somervell, Washington
|Superior HealthPlan, UnitedHealthcare|
|MRS Northeast Texas
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, Wood
|MRSA West Texas
Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Brewster, Briscoe, Brown, Callahan, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Concho, Cottle, Crane, Crockett, Culberson, Dallam, Dawson, Dickens, Dimmit, Donley, Eastland, Ector, Edwards, Fisher, Foard, Frio, Gaines, Glasscock, Gray, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Howard, Irion, Jack, Jeff Davis, Jones, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lipscomb, Loving, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Palo Pinto, Parmer, Pecos, Presidio, Reagan,
Real, Reeves, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Taylor, Terrell, Throckmorton, Tom Green, Upton, Uvalde, Val Verde, Ward, Wheeler, Wichita, Wilbarger, Winkler, Yoakum, Young, Zavala
|Amerigroup, Superior HealthPlan|
|Nueces Service Area
Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio and Victoria counties
|Superior HealthPlan, UnitedHealthcare Community Plan|
|Tarrant Service Area
Denton, Hood, Johnson, Parker, Tarrant, and Wise counties
|Travis Service Area
Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis and Williamson counties
|Amerigroup, UnitedHealthcare Community Plan|
STAR+PLUS does not change how people get their Medicare services.
They must pick a STAR+PLUS medical plan, but don’t pick a main doctor. They get regular health care from their Medicare doctor and providers. The STAR+PLUS medical plan only gives Medicaid long-term services and supports.
Picking a medical plan and main doctor
If you are approved for STAR+PLUS, you will get a packet in the mail. It will tell you about the program and the medical plans in your area.
You need to pick one of the medical plans. If you don’t get Medicare, you also will need to pick a main doctor.
You have 15 days pick a medical plan. The 15 days start once you get the packet in the mail. If you don’t pick a medical plan, HHSC will pick a medical plan and main doctor for you.
You can tell us your choices by phone, mail or by filling out a form at an enrollment event or presentation. Enrollment event calendar
Your main doctor takes care of basic health-care needs. The main doctor also can refer you to a specialist, if needed.
Regular health care and long-term services and supports are part of a plan of care put together by you, your family, and your doctor and other health-care providers.
How do I change my STAR+PLUS medical plan or main doctor?
You can change your medical plan or main doctor as often as once a month. If you ask to change your plan or doctor, you must wait until we tell you the change is made before you go to your new doctor.
The following is an overview of the services STAR+PLUS offers.
Medical plans must have a service coordinator visit with the member within 30 days of enrolling in the program. The coordinator must find out the member’s needs and develop a plan of care.
Long-term services and supports can include:
- Day Activity and Health Services (DAHS)
- Primary Home Care (PHC)
Other services under the STAR+PLUS Home and Community-Based Services Waiver include:
- Personal assistance services
- Adaptive aids
- Adult foster care home services
- Assisted living
- Emergency response services
- Home delivered meals
- Medical supplies
- Minor home modifications (making changes to your home so you can safely move around)
- Nursing services
- Respite care (short-term care to provide a break for caregivers)
- Therapies (occupational, physical, and speech-language)
- Transitional assistance services
Along with all of the traditional Medicaid and other services listed above, each STAR+PLUS medical plan offers its own set of “value-added” services. These are extra services not covered by Medicaid.
Each medical plan’s value-added services are shown in charts that are included in the packet mailed to people approved for STAR+PLUS Medicaid.