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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 5 STAR+PLUS Program : 5.1 STAR+PLUS Program Clients

5.1
HHSC has targeted these client groups within the Texas Medicaid population for STAR+PLUS Program enrollment:
 
Note: Clients in program type 14 who are not determined eligible for the Home and Community-Based Services (HCBS) STAR+PLUS Waiver (SPW) will be excluded from participation in STAR+PLUS.
Clients who are denied SSI coverage and who receive widow/widower Social Security benefits
Clients who are eligible for Medicaid under the SSI Program and who reside in a STAR+PLUS service area can enroll in STAR+PLUS. Enrollment in STAR+PLUS is mandatory for clients who are 21 years of age and older and voluntary for clients who are 20 years of age and younger.
SSI clients who meet the following conditions are required to select a PCP from the MCO provider directory:
SSI clients who are also covered by Medicare (i.e., dual-eligible clients) must select a STAR+PLUS MCO to receive Medicaid community based long term care services.
Clients enrolled in any of the following Texas Department of Aging and Disability Services (DADS) programs can enroll in STAR+PLUS for acute care benefits, unless the client is dual eligible for Medicaid and Medicare:
Note:
Enrollment in STAR+PLUS is mandatory for clients who are 21 years of age and older and voluntary for clients who are 20 years of age and younger.
Exception:

Texas Medicaid & Healthcare Partnership
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