8.1.1 OverviewThe Texas Medicaid managed care program was originally called the State of Texas Access Reform (STAR) Program and was established to explore different methods of building a framework of managed care around segments of Texas Medicaid. In 1995, the Texas Legislature adopted Senate Bill 10 and related legislation that authorized HHSC to undertake a comprehensive restructuring of Texas Medicaid to incorporate managed care delivery systems statewide. Currently, the Medicaid managed care program consists of two types of health-care delivery systems: health maintenance organizations (HMOs) and Primary Care Case Management (PCCM). STAR and STAR+PLUS provide services in Service Areas (SA) that are comprised of a selected grouping of counties. STAR is available in 9 SAs comprised of 52 metropolitan counties and STAR+PLUS is available in 5 SAs comprised of 29 metropolitan counties. PCCM provides services in the remaining rural 202 counties that consists of 11 regions. STAR Health is available statewide for children in foster care. The principle objectives of Medicaid managed care are to emphasize early intervention and to promote improved access to quality care, thereby significantly improving health outcomes for the target population, with a special focus on prenatal and well-child care. Clients enrolled in any of the Medicaid managed care programs may reside in metropolitan or rural areas. These programs include:
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• The goals of Medicaid managed care are to:
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• Additional goals for the STAR+PLUS program include:
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• Higher use of medical services by Texas Medicaid fee-for-service clients occurs when clients obtain care through ERs or access duplicate services for the same medical condition. In Medicaid managed care, clients assume a responsible role in achieving their personal health care by choosing a primary care provider, then actively participating with their primary care provider to access preventive primary care services. This collaborative approach to health-care delivery usually achieves cost savings for Texas Medicaid by reducing duplicate services and unnecessary emergency and inpatient care. Although many of the Medicaid managed care requirements are similar, each program has established specific objectives, eligibility and enrollment requirements, and claims filing processes, which are detailed in this section. |
The STAR Program. Operates under a 1915(b) waiver and provides acute care medical assistance in a Medicaid managed care environment for clients who reside in the Bexar, Dallas, El Paso, Harris, Harris Expansion, Lubbock, Nueces, Tarrant, and Travis SAs (see 
