Medicaid Managed Care Changes Effective 3/1

Beginning March 1, 2012, the Texas Health and Human Services Commission (HHSC0 is implementing changes to the delivery of Medicaid and the Children’s Health Insurance Program (CHIP) services.  These changes include:

  • The expansion of the State of Texas Access Reform (STAR) and STAR+PLUS Medicaid managed care programs to new areas of the state.
  • The transition of approximately 880,000 people from the Primary Care Case Management (PCCM) program into managed care.
  • Prescription drug benefits for clients in managed care, which are currently administered through HHSC’s Vendor Drug Program, will be delivered through the Medicaid and CHIP managed care organizations (MCOs).
  • The reprocurement of STAR, STAR+PLUS, and CHIP MCOs in most existing service areas.  As a result, different MCOs may provide services in current managed care service areas.

 

STAR+PLUS Medicaid managed care expanding to El Paso, Hidalgo, and Lubbock service areas

The STAR+PLUS program integrates acute care and long-term services and supports into a Medicaid managed care delivery system for people over age 65, or who are blind or have disabilities.  STAR+PLUS expands to the Lubbock and El Paso service areas and the new Hidalgo service area in South Texas. For more information about STAR+PLUS, go to the HHSC website at www.hhsc.state.tx.us/starplus/Overview.htm.  Clients who meet the following requirements will be enrolled in the STAR+PLUS program:

  • Age 21 or older who receive Supplemental Security Income (SSI)
  • Age 21 or older and get both Medicaid and Medicare
  • Receive Community-Based Alternatives (CBA) services
  • Age 21 or older who receive Medicaid through a Social Security Exclusion program

Voluntary enrollment:

  • Children 20 years of age and younger who receive SSI

Individuals who meet the following requirements will not be included in the STAR+PLUS program:

  • Medicaid clients who live in nursing facilities-such as a nursing home, Intermediate Care Facility for Persons with Mental Retardation (ICF_MR), or a state school
  • Medicaid clients who receiver home and community-based services through a Home and Community Based Waiver other than CBA
  • State foster care
  • Medically needy
  • Foster children
  • Refugees

 

STAR Medicaid managed care expanding to 174 PCCM counties

The STAR program provides acute care services in a managed care delivery system and focuses on early intervention.  STAR expands to the newly created Hidalgo service area (which consists of 10 counties) and new Medicaid Rural Service Areas (RSAs) that consist of 164 counties.  Medicaid services currently being delivered through PCCM in these areas will be delivered instead through the STAR program beginning March 1, 2012.

 

STAR Hidalgo service area

Clients who meet the following requirements will be enrolled in the STAR program:

• Receive cash help (Temporary Assistance for Needy Families [TANF])

• Are pregnant

• Have limited income below a certain level

Individuals who meet the following requirements will not be included in the STAR program:

• SSI recipients

• Medicaid clients in institutions

• Dual-eligible Medicaid clients (clients with both Medicaid and Medicare)

• Medically needy

• Foster children

• Refugees

 

STAR Medicaid RSA service areas

Clients who meet the following requirements will be enrolled in the STAR program:

• Receive cash help (TANF)

• Are pregnant

• Have limited income below a certain level

• Age 21 or older who receive SSI and do not receive Medicare

Voluntary enrollment:

• Children age 20 and younger who receive SSI (no Medicare)

Individuals who meet the following requirements will not be included in STAR Medicaid RSA program:

• Medicaid clients who live in nursing facilities—such as a nursing home, ICF-MR, or state school

• Medically needy

• Foster children

• Refugees

• Adults and children who receive Medicaid and Medicare

 

Provider Contracting with STAR and STAR+PLUS MCOs

Medicaid providers, including pharmacies that want to contract with STAR and STAR+PLUS must contact the MCO of their choice to complete a separate contract and credentialing application. Refer to the TMHP website at  www.tmhp.com/TMHP_File_Library/PCCM/MCO Representative Contact Information_March 2012.pdf to see the MCO provider representatives contact information.

 

STAR and STAR+PLUS Service Areas Chart

Below you will find each service area, in alphabetical order, including the impacted counties and tentative awards. To see maps of the different service areas, go to the following links on the TMHP website:

• STAR Service Areas—www.hhsc.state.tx.us/medicaid/MMC/STAR-Service-Area-Map.pdf

• STAR+PLUS Service Areas—www.hhsc.state.tx.us/medicaid/MMC/STARPLUS-Service-Area-Map.pdf

• Medicaid RSA Regions—www.hhsc.state.tx.us/medicaid/MMC/MRSA-Regions-Map.pdf

You may

Bexar Service Area

• Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, and Wilson counties.

• Aetna Better Health

• Amerigroup

• Community First Health Plans

• Superior HealthPlan

• Amerigroup

• Molina Healthcare

• Superior HealthPlan

 

Dallas Service Area

• Collin, Dallas, Ellis, Hurt, Kaufman, Navarro, and Rockwall counties.

STAR STAR+PLUS

• Amerigroup

• Molina Healthcare

• Parkland HEALTH first

• Molina Healthcare*

• Superior HealthPlan*

*Current MCOs that will continue service in this area

El Paso Service Area

• El Paso and Hudspeth counties.

STAR STAR+PLUS

• El Paso First Premier

• Molina Healthcare

• Superior HealthPlan

• Amerigroup

• Molina Healthcare

 

Harris Service Area

• Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, and Wharton counties.

STAR STAR+PLUS

• Amerigroup

• Community Health Choice

• Molina Healthcare

• Texas Children’s Health Plan

• UnitedHealthcare Community Plan

• Amerigroup

• Molina Healthcare

• UnitedHealthcare Community Plan

 

Hidalgo Service Area

• Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, and Zapata counties.

STAR STAR+PLUS

• Driscoll Children’s Health Plan

• Molina Healthcare

• Superior HealthPlan

• UnitedHealthcare Community Plan

• HealthSpring

• Molina Healthcare

• Superior HealthPlan

 

Jefferson Service Area

• Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, and Walker counties.

STAR STAR+PLUS

• Amerigroup

• Texas Children’s Health Plan

• Community Health Choice

• Molina Healthcare

• UnitedHealthcare Community Plan

• Amerigroup

• Molina Healthcare

 

Lubbock Service Area

• Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher, and Terry counties.

STAR STAR+PLUS

• Amerigroup

• FirstCare STAR

• Superior HealthPlan

• Amerigroup

• Superior HealthPlan

 

Medicaid Rural Service Areas

Medicaid RSA 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, and Zavala counties.

STAR STAR+PLUS

• Amerigroup

• First Care

• Superior HealthPlan

STAR+PLUS program is not offered in this area

 

Medicaid RSA 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, and Washington counties.

STAR STAR+PLUS

• Amerigroup

• Right Care from Scott & White Health Plan

• Superior HealthPlan

STAR+PLUS program is not offered in this area

 

Medicaid RSA 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, and Wood counties.

STAR STAR+PLUS

• Amerigroup

• Superior HealthPlan

STAR+PLUS program not offered in this area

 

Nueces Service Area

• Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio, and Victoria counties.

STAR STAR+PLUS

• CHRISTUS Health Plan

• Driscoll Children’s

• Superior HealthPlan

• Superior HealthPlan

• UnitedHealthcare Community Plan

 

Tarrant Service Area

• Denton, Hood, Johnson, Parker, Tarrant, and Wise counties.

STAR STAR+PLUS

• Aetna

• Amerigroup

• Cook Children’s Health Plan

• Amerigroup*

MCOs that will continue service in this area

Travis Service Area

• Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, and Williamson counties.

STAR STAR+PLUS

• Blue Cross Blue Shield of Texas

• Sendero Health Plans

• Seton Health Plan

• Superior HealthPlan

• Amerigroup

• UnitedHealthcare Community Plan

 

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