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Dual Demonstration MMP Program Ending December 31, 2025, and Integrated D-SNP Model Begins on January 1, 2026

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The Centers for Medicare & Medicaid Services (CMS) Part D Final Rule requires Texas to end its Dual Demonstration Medicare-Medicaid Plan (MMP) model on December 31, 2025, and implement an Integrated Dual Eligible Special Needs Plan (Integrated D-SNP) model on January 1, 2026.

Beginning January 1, 2026, the Integrated D-SNP model will apply only to the health plan companies that operated MMPs in 2025 in the following Demonstration counties: Bexar, Dallas, El Paso, Harris, and Hidalgo.

Dual-eligible members who are enrolled in these MMPs can select another MMP in their demonstration county if a plan is available.

Overview

The new Integrated D-SNP model enables Texas to continue offering an integrated coverage option in the Demonstration counties for dual-eligible members after the Demonstration ends. However, unlike the Dual Demonstration, where a dual-eligible member was enrolled in one health plan that provided both Medicare and Medicaid benefits, the new model has dual-eligible members enrolled in two health plans:

  • An Integrated D-SNP that covers Medicare services and is responsible for certain integrated requirements.
  • The STAR+PLUS managed care organization (MCO) that covers Medicaid services and is part of the same parent company as the Integrated D-SNP.

Though the members will be enrolled in two health plans, the model includes integrated features such as one ID card to show enrollment in both plans.

Verify Benefits Before Billing

When they enroll in an Integrated D-SNP after January 1, 2026, some existing STAR+PLUS members may be required to enroll in a new STAR+PLUS MCO. Because of the different enrollment timelines for Medicare and Texas Medicaid, the Integrated D-SNP (Medicare) coverage for some of these members may start a month before their new STAR+PLUS (Medicaid) benefits begin.

Because the Medicare-Medicaid ID card is sent to members based on the Integrated D-SNP enrollment date, to avoid billing delays, providers should verify the member’s enrollment status before they submit claims for reimbursement.

Additional Resources

The Texas Health and Human Services (HHSC) hosted a provider webinar that included key details about this transition. Providers may view the recording of the webinar after registering at https://register.gotowebinar.com/recording/3856393449856109739.

For more information on all enrollment options for dual-eligible individuals throughout Texas, visit HHSC’s Options for Medicare and Medicaid Dual Coverage web page.

Contact Information

For questions regarding MCO-specific billing practices or provider contracting, call the MCO directly at the numbers below:

  • Molina Healthcare: Call Molina Texas provider services at 855-322-4080.
  • Superior HealthPlan: Call Superior provider services at 877-391-5921.
  • UnitedHealthcare: Call UnitedHealthcare provider services at 877-842-3210.

For policy questions about this transition, email Managed_Care_Initiatives@hhs.texas.gov.