Medicaid & CHIP Quality & Efficiency Improvement

Most Texas Medicaid and CHIP members receive their services through a statewide managed care organization (MCO). The 3 main Medicaid programs are: STAR, STAR+PLUS and STAR Kids.

  • STAR mainly covers pregnant women and children.
  • STAR+PLUS is for adults who have a disability or who are 65 and older. It also covers people who are enrolled in both Medicaid and Medicare.
  • STAR Kids serves youth and children who get disability-related Medicaid.

Twenty MCOs provide services to Texas Medicaid and CHIP beneficiaries, along with two dental MCOs. Texas has 13 managed care service areas – 10 of which are built around major metropolitan population centers and 3 that cover large rural regions. There also is a CHIP rural service area that combines the 3 Medicaid rural service areas and Hidalgo. A map of Texas MCO service areas shows how the state is divided up by regions and which MCOs cover them.

Texas Medicaid and CHIP are focused on improving the quality and efficiency of healthcare services and promoting value-based purchasing. Value-based purchasing means a payment system that rewards MCOs, hospitals, doctors and other providers for delivering high quality, efficient clinical care. HHSC's efforts around quality and efficiency improvement involve different projects. Senate Bill 200, 84th Legislature, Regular Session, 2015 directs HHS to develop a comprehensive plan to improve the coordination and transparency of state healthcare quality initiatives, formally called the Quality Plan (PDF). In addition, please refer to the 2017 Value-Based Purchasing Roadmap (PDF) for a detailed description of the quality improvement initiatives that HHSC is taking in relation to value-based purchasing.

Projects underway:

Other quality resources:

For questions, comments and suggestions email HHSC Quality.