STAR+PLUS Medicaid Managed Care Program in Texas

Introduction to STAR+PLUS

The STAR+PLUS Medicaid Managed Care program is a unique initiative in the state of Texas, designed to provide a range of health services, particularly for adults with disabilities or those who are 65 years and older. This program aims to offer comprehensive care incentives, thereby enhancing the quality of life for its beneficiaries.

  • Adults in STAR+PLUS get Medicaid healthcare through a health plan that they choose.

  • STAR+PLUS combines acute care, like doctor visits, with long-term services and supports (LTSS).

  • STAR+PLUS managed care organizations (MCOs) may also offer extra benefits (called value-added services).

Eligibility Criteria

Eligibility for the STAR+PLUS program is determined based on a combination of factors including age, disability status, and income levels. To get services through STAR+PLUS you must: (1) be approved for Medicaid, (2) 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 need the type of services in STAR+PLUS Home and Community-Based 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

  • In the Medicaid for Breast and Cervical Cancer program

Benefits of STAR+PLUS

The STAR+PLUS program offers an array of benefits that are designed to support the comprehensive health needs of its members. These benefits include, but are not limited to, medical care such as doctor visits, hospital care, and unlimited prescription drugs. In addition, the program provides essential long-term services and supports (LTSS) that can include personal care services, home modifications, respite care, and more. Mental health services and substance use disorder treatments are also covered under STAR+PLUS, ensuring holistic care for all aspects of health.

Additional Services and Supports

One of the standout features of STAR+PLUS is its focus on managed care, which coordinates all of the beneficiary's healthcare needs through a single health plan. This ensures a streamlined, efficient delivery of services with an integrated approach to managing health and wellbeing. STAR+PLUS also emphasizes preventive care, offering regular check-ups and screenings to catch health issues early, thereby reducing the need for emergency interventions and hospitalizations.

Another notable benefit is the provision of service coordination. Each member is assigned a service coordinator who assists in developing personalized care plans, ensures services are delivered as needed, and helps navigate the often complex landscape of healthcare services and supports.

Conclusion

The STAR+PLUS Medicaid Managed Care program represents a significant effort by the state of Texas to provide high-quality, coordinated care for some of its most vulnerable populations. By understanding the eligibility criteria and the wide range of benefits offered, potential beneficiaries and their families can make informed decisions about enrolling in this program, ultimately enhancing their health and quality of life.

Also read : Medicaid 101 - What is Medicaid?

Credits: https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus