Medicaid Managed Care Expands Statewide: Some Rural Recipients Can Temporarily Choose Traditional Medicaid

Health Care

Medicaid managed care expanded on March 1, 2012, including 164 more rural counties in the STAR program in west, central and northeast Texas. STAR is a managed care program that provides acute care, which is short-term medical treatment such as office visits to their doctor, prescription drugs, emergency room and inpatient hospital visits. It is not intended to replace any services provided through Medicaid waiver programs under the Department of Aging and Disability Services (DADS).

Because of concerns regarding the adequacy of the network of physicians, some Medicaid 1915(c) waiver participants’ level of understanding about how managed care works, and lack of notification regarding the change, some Texans have the opportunity to delay their participation in the STAR program. This includes individuals who may already have chosen a health plan.

HHSC will provide additional education and outreach to individuals who participate in the following Medicaid waiver programs to ensure they understand the STAR program prior to being enrolled in it:

  • Community Based Alternatives (CBA);
  • Community Living Assistance and Supports Services (CLASS);
  • Deaf Blind with Multiple Disabilities (DBMD);
  • Home and Community-based Services (HCS);
  •  Medically Dependent Children Program (MDCP); and
  • Texas Home Living (TxHmL)

The Medicaid STAR program for Rural Service Areas includes individuals who were previously covered by the Primary Care Case Management (PCCM) program who do not have Medicare, as PCCM no longer exists. Children age 20 and younger who receive SSI may choose between managed care and traditional fee-for-service Medicaid. Dual eligible clients who have both Medicaid and Medicare will still be covered by traditional Medicaid.

The Texas Health and Human Services Commission (HHSC) and DADS have not determined a new implementation schedule. DADS staff are contacting Medicaid participants in the six listed waivers who selected a managed care organization in order to confirm that they understood how the STAR program operates. Individuals who enrolled in a rural STAR program and want to return to traditional Medicaid fee-for-service for now can call (800) 964-2777 (TTY 800-267-5008) to disenroll.

See more details on the Letters to DADS Services Providers webpage on the HHS website.

A variety of other changes concerning Medicaid also took place on March 1, including:

  • Expanding STAR+PLUS to the Lubbock and El Paso service areas. STAR+PLUS combines traditional health care, such as doctor visits, with community-based long-term services and support, such as help at home with daily activities, home modifications, respite care and personal assistance for people who have disabilities or who are age 65 or older.
  • Expanding STAR and STAR+PLUS to 10 counties in South Texas. This affects about 400,000 people on Medicaid in the Hidalgo Service Area.
  • Converting dental services from to a statewide managed care model called the Children’s Medicaid Dental Services. Most children and young adults age 20 and younger in Medicaid or CHIP will get dental services through one of three dental plans. Participants have been given until April 30, 2012, to choose their primary dentist to avoid disruptions in service.
  • Adding prescription drug benefits/limits provided under the traditional fee-for-service Medicaid program to managed care benefits and capping payments to pharmacies. This includes an 80 percent reduction in the dispensing fee for pharmacies, causing many small businesses to predict that they will have to close. State lawmakers anticipate the change could save Texas about $100 million over two years.