The Health and Human Services Commission (HHSC) contracts with managed care
organizations (MCOs) that are licensed by the Texas Department of Insurance
(TDI). HHSC pays each MCO a monthly amount to coordinate health services for
Medicaid clients who are enrolled in the MCO's health plan. The health plans
contract directly with doctors and other health care providers to create
provider networks for the MCO's members to use. The health plans provide all
Medicaid-covered medically necessary services to their members.
Medicaid managed care includes 5 programs through which Medicaid managed
clients receive benefits:
STAR – STAR is Medicaid for children, newborns,
pregnant women and some families and children.
- STAR+PLUS – STAR+PLUS is a Medicaid program
for people who have disabilities or are 65 years of age and
older. Clients in STAR+PLUS receive Medicaid basic medical
services and long-term services through a Medicaid managed care
Health – STAR Health is Medicaid for Children who get
Medicaid coverage through the Texas Department of Family and
Protective Services. One Medicaid plan provides both medical and
dental services for all children in STAR Health.
- NorthSTAR – The NorthSTAR Program is a publicly
funded managed care approach to the delivery of mental health and
chemical dependency services to the eligible residents of Dallas, Ellis,
Collin, Hunt, Navarro, Rockwall and Kaufman counties.
- Children's Medicaid Dental Services – Most children
and young adults who are 20 years of age and younger with Medicaid or
CHIP coverage receive dental services through a managed care dental
Clients are considered for coverage based on their permanent address and
the type health care they require.
Service area maps and county lists
Medicaid Managed Care Organizations (MCO’s) Participating in the STAR+PLUS Medicare-Medicaid Plan (MMP)
Texas Medicaid Provider Procedures Manual Medicaid Managed Care Handbook
Automatic Medicaid Managed Care Enrollment for Some
- Additional information for providers who received the
Information Letter No. 14-23 regarding the September 1, 2014 expansion of the
STAR+PLUS Medicaid Managed Care Program to the Medicaid Rural Service Areas
Provider transition training for STAR, STAR+PLUS, pharmacy, and children's
dental services. Click
here for recordings of webinars and