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 Medicaid Managed Care

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 plan.
  • STAR 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 plan.

Clients are considered for coverage based on their permanent address and the type health care they require.

Contact information

Service area maps and county lists

Helpful Links

Texas Medicaid Provider Procedures Manual Medicaid Managed Care Handbook

Automatic Medicaid Managed Care Enrollment for Some Individuals - 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 (MRSAs).

Provider transition training for STAR, STAR+PLUS, pharmacy, and children's dental services. Click here for recordings of webinars and training sessions.

 Related News Items

 
   
Topics: Information of interest to providers, including NDC and Alberto N. and past initiatives such as PACT transition and hurricanesFlash file
The Affordable Care Act is coming. Click here for more information on the Affordable Care Act and how it affects you.Texas Women's Health Program: Click here for information

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