3100, Ancillary Member Resources

3111 Dual-Eligible Members

Revision 18-0; Effective September 4, 2018

Members who receive both Medicaid and Medicare are called dual-eligible members. Dual eligible members choose a managed care organization (MCO), but are not required to choose a primary care provider (PCP) because dual-eligible members receive acute care from their Medicare providers. STAR+PLUS does not impact Medicare eligibility or services. The STAR+PLUS MCO only provides Medicaid long-term services and supports (LTSS) to dual-eligible members.

STAR+PLUS Medicaid-only members are required to choose an MCO and a PCP in the MCO's network. These members receive all covered services, both acute care and LTSS from the MCO.

MCOs are required to contact all members upon enrollment. If there is a need identified or a request from the member, the MCO will assess the member in developing an appropriate plan of care (POC). MCOs are expected to provide innovative, cost-effective care in order to prevent or delay unnecessary institutionalization.

3112 Medicaid Eligibility

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff must verify each applicant's current eligibility for Medicaid through the Texas Integrated Eligibility Redesign System (TIERS). PSU staff initiate the Medicaid financial eligibility determination process if there is no existing acceptable Medicaid coverage.

Refer to Section 3114, Applicants with Medicaid Eligibility, for Medicaid programs appropriate for STAR+PLUS HCBS.

Applicants who currently have Form H1200, Application for Assistance – Your Texas Benefits, on file with the Texas Health and Human Services Commission (HHSC) may not need to complete a new Form H1200. PSU staff must check with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist regarding the need for a new Form H1200.

Refer to Appendix V, Medicaid Program Actions, to determine if a program transfer by the MEPD specialist will be required. Refer to Section 3230, Financial Eligibility, for additional information regarding financial eligibility.

Note: The completion or signing of an application for an applicant or member does not automatically authorize a person to receive protected health information (PHI) from PSU staff or the managed care organization (MCO) regarding that applicant or member. Refer to Section 2240.1, Authorized Representative, for individuals who may receive or authorize the release of an applicant’s or member's personally identifiable information (PII) or PHI under Health Insurance Portability and Accountability Act (HIPPA) privacy regulations.

3113 Transmittal of Form H1200

Revision 18-0; Effective September 4, 2018

When transmitting Form H1200, Application for Assistance – Your Texas Benefits, Program Support Unit (PSU) staff fax all pages of Form H1200 along with any supporting documentation and Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist. PSU staff will upload all pages of Form H1200 and Form H1746-A to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) with the applicant's valid signature.

The original Form H1200 must be kept for three years after the HEART case record is denied or closed. PSU staff must also retain a copy of the successful fax transmittal confirmation in the HEART case record. Scanning Form H1200 and sending by electronic mail is prohibited.

3114 Applicants with Medicaid Eligibility

Revision 18-0; Effective September 4, 2018

At the time of the initial intake for the STAR+PLUS HCBS program, Program Support Unit (PSU) staff must obtain information on the applicant's Medicaid and/or financial status. PSU staff must obtain verification of the applicant's current eligibility for an appropriate type Medicaid program from the Medicaid for the Elderly and People with Disabilities (MEPD) specialist or through inquiry in the Texas Integrated Eligibility Redesign System (TIERS).

To be financially eligible for the STAR+PLUS HCBS program, refer to the mandatory population described in Section 3221, STAR+PLUS Mandatory Groups.

An applicant who receives Supplemental Security Income (SSI) is financially eligible for Medicaid and does not require a financial determination; the Social Security Administration (SSA) has already made this determination.

An applicant receiving services through Community Attendant Services (CAS) (TP14) is not automatically eligible for the STAR+PLUS HCBS program.

MEPD specialists must be consulted for these applicants. Applicants who currently have Form H1200, Application for Assistance – Your Texas Benefits, on file with the Texas Health and Human Services Commission (HHSC) may not need to complete a new Form H1200.

3115 Applicants Without Medicaid Eligibility

Revision 22-3; Effective Sept. 27, 2022

Title 42 Code of Federal Regulations (CFR) Section 431.10, specifies that Medicaid eligibility must be determined by a single state agency. The Texas state plan designates the Texas Health and Human Services Commission (HHSC) as the sole agency with the authority to make eligibility determinations for medical assistance only (MAO) Medicaid cases. The Medicaid for the Elderly and People with Disabilities (MEPD) specialist exclusively determines MAO Medicaid financial eligibility for STAR+PLUS Home and Community Based Services (HCBS) program applicants and members. An individual, applicant or member who does not receive Supplemental Security Income (SSI) may apply for MAO Medicaid.

The individual, applicant or member applies for MAO Medicaid by completing and submitting Form H1200, Application for Assistance – Your Texas Benefits, to the enrollment broker, Program Support Unit (PSU) staff or the MEPD specialist. PSU staff must fax Form H1200 and Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist within two business days of an applicant or member submitting Form H1200 to PSU staff.

3116 Monthly Income Below the SSI Standard Payment

Revision 18-0; Effective September 4, 2018

An applicant in the community (with no ineligible spouse) who has income less than the Supplemental Security Income (SSI) federal benefit rate (FBR) must apply for SSI through the Social Security Administration (SSA). The Texas Health and Human Services Commission (HHSC) cannot determine financial eligibility for these individuals except for cases in which the SSI application for disability has been pending more than 90 days and a decision is made by HHSC Disability Determination Unit (DDU) staff.

If there is a question whether the applicant should apply for SSI or medical assistance only (MAO), Program Support Unit (PSU) staff may consult the regional Medicaid for the Elderly and People with Disabilities (MEPD) specialist.

3117 Coordination with the MEPD Specialist

Revision 18-0; Effective September 4, 2018

The Program Support Unit (PSU) staff must inform the applicant or member without pre-existing Medicaid coverage and/or his or her authorized representative (AR) that the Medicaid for the Elderly and People with Disabilities (MEPD) specialist will complete a financial eligibility (Medicaid) determination. PSU staff must encourage the applicant, member or AR to cooperate with the MEPD specialist and to provide all verifications necessary in a timely fashion.

Any information, including information on third-party insurance, obtained by PSU staff must be shared with the MEPD specialist to prevent the applicant or member from having to provide the information twice.

PSU staff must inform the MEPD specialist of the request for the STAR+PLUS Home and Community Based Services (HCBS) program according to regional procedures. For those applicants or members already on an appropriate type of Medicaid program, PSU staff must fax:

• Form H1200, Application for Assistance – Your Texas Benefits; and
• Form H1746-A, MEPD Referral Cover Sheet.

An applicant for the STAR+PLUS HCBS program who has medical assistance only (MAO) coverage type Medicaid services may only receive the STAR+PLUS HCBS program after a program transfer to Medicaid waivers is completed by the MEPD specialist. When an applicant or member for the STAR+PLUS HCBS program has MAO coverage type, as indicated in the Texas Integrated Eligibility Redesign System (TIERS), a completed Form H1200 must be sent to the applicant or member. The completed application must be forwarded to the MEPD specialist for processing.

PSU staff must also send an email to MEPD at the HHSC OES MEPD IC mailbox that includes the following information:

• the applicant’s or member’s name;
• applicant’s or member’s Medicaid identification (ID) number;
• individual has MAO coverage-type Medicaid, which will require a program transfer; and
• name and telephone number of the PSU staff contact.

The MEPD specialist will make the necessary changes to allow the MAO coverage-type Medicaid individual to receive the STAR+PLUS HCBS program.

ID of MAO Coverage-Type Medicaid

PSU staff can check TIERS to determine an applicant’s or member’s coverage type. In TIERS, the coverage type on the Search/Summary screen is displayed with the preface of MAO.

Form H1200 is not required for members receiving Supplemental Security Income (SSI).

Note: If a STAR+PLUS HCBS program applicant's or member's application for SSI disability has been pending more than 90 days, the Texas Health and Human Services Commission (HHSC) Disability Determination Unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination. The SSI decision must be adopted when it is received from SSA.

3117.1 Income and Resource Verifications for MEPD

Revision 21-10; Effective October 25, 2021

Program Support Unit (PSU) staff must obtain a completed Form H1200, Application for Assistance – Your Texas Benefits, for medical assistance only (MAO) individuals or applicants. PSU staff must verify if Form H1200 is required by checking Appendix V, Medicaid Program Actions. PSU staff are not required to obtain a copy of the most recent Form H1200 for an individual or applicant already on an appropriate type of Medicaid program. PSU staff must maintain a copy of Form H1200 until PSU staff can verify Form H1200 is received in the Texas Integrated Eligibility Redesign System (TIERS). PSU staff must maintain a copy of page one of Form H1200 in the applicant’s Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record, if applicable. An individual or applicant receiving Supplemental Security Income (SSI) is not required to submit Form H1200.

PSU staff must provide Form H1200 and any additional relevant financial information obtained, including information on third-party insurance, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist, if received, to prevent the individual or applicant from having to provide the information twice. PSU staff must use Form H1746-A, MEPD Referral Cover Sheet, when communicating with the MEPD specialist. PSU staff must maintain a copy of Form H1746-A fax confirmation page in the applicant’s HEART case record, if applicable.

PSU staff must inform MAO individuals or applicants of the importance of providing all required documents to the MEPD specialist. PSU staff must explain that failure to submit the required documentation to the MEPD specialist could result in a delay or denial of their application or their current services.

PSU staff must inform the MEPD specialist of the request for the STAR+PLUS Home and Community Based Services (HCBS) program by faxing:

• Form H1746-A, noting whether the applicant is pending a Medical Necessity and Level of Care (MN/LOC) Assessment and individual service plan (ISP) or if the applicant has an approved MN/LOC and ISP;
• Form H1200, if applicable; and
• any supporting documents, if applicable.

Texas Health and Human Services Commission (HHSC) Disability Determination Unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination, if a STAR+PLUS HCBS applicant’s application for SSI disability has been pending for more than 90 days. The SSI decision must be adopted upon receipt from SSA.

PSU staff must send a second Form H1746-A noting the applicant’s start of care (SOC) for the STAR+PLUS HCBS program if the applicant’s MN/LOC and ISP were pending when the initial Form H1746-A was sent to the MEPD specialist.

3117.2 MAO Applicants Not Previously Certified in TIERS

Revision 18-0; Effective September 4, 2018

A new application is defined as an application for a Medicaid for the Elderly and People with Disabilities (MEPD) household not previously certified in the Texas Integrated Eligibility Redesign System (TIERS).

3117.3 Unsigned Applications

Revision 18-0; Effective September 4, 2018

Unsigned applications received by the Medicaid for the Elderly and People with Disabilities (MEPD) specialist are returned to the sender. Program Support Unit (PSU) staff must ensure applications are signed prior to referring to the MEPD specialist; if not, PSU staff are required to obtain signatures when unsigned applications are returned.

The application forms are:

• Form H1200, Application for Assistance – Your Texas Benefits; and
• Form H1200-A, Medical Assistance Only (MAO) Recertification.

If the MEPD specialist receives an unsigned application from HHSC with Form H1746-A, MEPD Referral Cover Sheet, the MEPD specialist returns the application to PSU staff with an annotation on the cover form (Form H1746-A) that the application is unsigned and must be signed before PSU staff can establish a file date. Once PSU staff receive an unsigned application from the MEPD specialist, it is the responsibility of PSU staff to coordinate with the applicant or member to obtain a signed application and return it to the MEPD specialist for processing.

Sending unsigned applications delays the MEPD and HHSC eligibility processes and could adversely affect service delivery to applicants or members.

3117.4 Medicaid Eligibility Decisions Pending Past the Program Due Date

Revision 18-0; Effective September 4, 2018

For most Medicaid for the Elderly and People with Disabilities (MEPD) applications, eligibility decisions are due by the 45th day. However, applications for individuals under the age of 65 may require a 90-day time frame to allow the agency to obtain a disability determination. This applies when the person's age is less than 65 and the person does not receive Retirement, Survivors and Disability Insurance (RSDI), Supplemental Security Income (SSI) or Railroad Retirement (RR). A disability determination by the Texas Health and Human Services Commission (HHSC) is required even if the person has received a Medical Necessity and Level of Care (MN/LOC) Assessment determination under the STAR+PLUS Home and Community Based Services (HCBS) program eligibility component criteria.

For other case actions (for example, program transfers) the MEPD specialist may require time to verify income and resources. This is especially true if the previous case was community-based or included an individual declaration of income or resources. Program Support Unit (PSU) staff will email MEPD at the HHSC OES MEPD IC mailbox, requesting a status update, if the case has been pending more than 45 days.

3117.5 Inquires and Complaints

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff can direct other general inquiries and complaints regarding Medicaid for the Elderly and People with Disabilities (MEPD) applications and programs to the HHSC OES MEPD IC mailbox.

3118 Address Changes for Supplemental Security Income Individuals

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff must not send address change requests for Supplemental Security Income (SSI) individuals to the Document Processing Center (DPC). PSU staff must inform the individual or authorized representative (AR) to contact the Social Security Administration (SSA) to request the residence address change. The address change will be reflected in the Texas Integrated Eligibility Redesign System (TIERS) after SSA makes the change.

PSU staff must also send an email to the Enrollment Resolution Services (ERS) mailbox to notify ERS of the request for a change in address.

3120 Other Available Services

Revision 18-0; Effective September 4, 2018

3121 Prescription Drugs

Revision 18-0; Effective September 4, 2018

Prescription drugs are not part of the managed care organization's (MCO's) array of services. STAR+PLUS Medicaid-only members continue to have prescriptions filled by any pharmacist participating in the Texas Health and Human Services Commission (HHSC) Vendor Drug Program (VDP). The member will receive unlimited medically necessary prescriptions instead of the traditional three prescriptions per month limit. Drug coverage through VDP is limited to the state's formulary and may not cover all of the prescribed medications required for the individual.

Medicare prescription drug coverage (Medicare Part D) is insurance that covers both brand name and generic prescription drugs at participating pharmacies in the member's service area. Medicare prescription drug coverage provides protection for people who have very high drug costs. Medicare members are eligible for this coverage, regardless of income and resources, health status or current prescription expenses. Members who are eligible for both Medicaid and Medicare (dual-eligible) receive the majority of their drugs through Medicare Part D.

The MCO must inform individuals requesting the STAR+PLUS program of prescription coverage available through the STAR+PLUS program and the Medicare Part D program. The following information regarding the impact of the Medicare Part D program on members must be explained to the applicant:

• If a member is considered dual-eligible (receiving both Medicare and Medicaid), the member obtains prescriptions first through Medicare Part D or, for certain prescribed drugs excluded from Medicare Part D, through the Medicaid VDP.
• Drug coverage through Medicare is limited to each drug plan's formulary and may not cover all of the prescribed medications required for the member. Prescriptions not covered by Medicare Part D may be paid by the Medicaid VDP; however, the Medicaid VDP formulary does not cover certain prescription drugs and over-the-counter medications.
• Members who participate in Medicare Part D are responsible for purchasing any medications and copayments for medications not covered through Medicare Part D or the Medicaid VDP.
• Members not participating, or those choosing private insurance over Medicare Part D, are also responsible for purchasing medications and copayments for medications not covered by Medicare Part D or the Medicaid VDP.
• Members eligible for both Medicare and Medicaid can receive assistance with prescription costs through the Low Income Subsidy program. These members pay little or no premiums and no deductibles. Drug copayment amounts could range from $1 to $5.

Federal law prohibits the use of STAR+PLUS program funds for Medicare Part D prescriptions, copayments and costs. STAR+PLUS program funds may not be authorized for prescriptions, copayments and costs if the member is eligible for Medicare Part D and chooses private insurance rather than participation in Medicare Part D. Non-covered medications cannot be billed through the STAR+PLUS program as medical supplies or adaptive aids.

Copayments for prescriptions covered by the Veterans Benefits Administration may be authorized as an adaptive aid through the STAR+PLUS program.

Members who contribute to the cost of their care may be eligible to count Medicare Part D costs as an incurred medical expense if they:

• reside in the community and have a qualified income trust (QIT); or
• receive adult foster care (AFC) or assisted living (AL) services.

For a member whose current Medicaid identification (ID) card does not include the statement "can receive more than three prescriptions," pharmacists may verify the STAR+PLUS program eligibility for more than three prescriptions by calling Pharmacy Billing at 800-435-4165.

Pharmacists must check the member's Your Texas Benefits Medicaid card monthly to ensure the member remains eligible for Medicaid.

STAR+PLUS Home and Community Based Services (HCBS) program members who contribute to the cost of their care may be eligible to count Medicare Part D costs as incurred medical expenses. Refer to Section 3123, Incurred Medical Expenses.

3122 Over-the-Counter Drugs

Revision 18-0; Effective September 4, 2018

The STAR+PLUS Home and Community Based Services (HCBS) program does not pay for over-the-counter drugs, with or without a prescription or statement from a physician or health professional. Over-the-counter drugs are generally considered medications that may be sold to a customer without a prescription and do not require the direct supervision of a physician or health professional. Common over-the-counter medications include pain relievers, decongestants, antihistamines, cough medicines, vitamins, minerals and herbal supplements. This list is not all inclusive.

Medications, including over-the-counter drugs, not covered through the Texas Health and Human Services Commission (HHSC) Vendor Drug Program (VDP), Medicare Part D or other third-party resources (TPRs), cannot be paid for by the STAR+PLUS HCBS program. Refer to Section 3121, Prescription Drugs, for additional information.

3123 Incurred Medical Expenses

Revision 18-0; Effective September 4, 2018

Incurred medical expenses (IMEs) are out-of-pocket expenses a medical assistance only (MAO) member can incur for necessary medical services. IMEs include the cost of medically necessary items not covered by Medicaid, such as Medicare Part D premiums.

STAR+PLUS Home and Community Based Services (HCBS) program members who contribute to the cost of their care may be eligible to count Medicare Part D costs (such as premiums, enhanced premiums, prescription drug copayments or deductibles, drugs not covered by Medicare Part D, the Texas Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) and non-formulary drugs) as IMEs, if the member:

• resides in the community and has a Medicaid copayment as a result of a qualified income trust (QIT); or
• resides in an adult foster care (AFC) home or assisted living facility.

Members who wish to use IMEs to pay for Medicare Part D costs should report these costs to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist so the costs can be included in the calculation of copayment for the STAR+PLUS HCBS program. The member's statement of Medicare Part D expenses is acceptable. No written documentation is required from the member to support the declaration. The arrangement for payment of the prescriptions is between the member and the pharmacist.

Some drugs are not covered by Medicare Part D, Medicaid or private drug coverage. In order for these non-formulary drugs to be considered as IMEs, a member must request an exception from the Medicare Part D plan for the drugs. The member is expected to use the procedure for requesting an exception, as required by his or her Medicare Part D plan. The member can submit the results of the requested exception directly to the MEPD specialist. If an exception is not requested, the non-formulary drugs are not allowable IMEs and the cost will be the responsibility of the member.

The MEPD specialist applies the IME policy during the certification process to all new members who meet the above criteria. The MEPD specialist also reviews Medicare costs and IMEs once every six months as part of the regular case monitoring, or whenever the member makes a request to update IME costs. The member or his or her authorized representative (AR) may identify and request IMEs by contacting the MEPD specialist.

3124 Medical Transportation Program

Revision 18-0; Effective September 4, 2018

STAR+PLUS Home and Community Based Services (HCBS) program members, as recipients of Medicaid, are eligible to use the Medical Transportation Program (MTP) for Medicaid-covered medical appointments. The MTP is accessed by calling the MTP Support Line at 1-877-633-8747. Day activity and health services (DAHS) providers, adult foster care (AFC) and assisted living facility (ALF) providers are responsible for scheduling transportation for the residents.

The local medical transportation contractors have procedures regarding service area limitations, schedules for traveling to certain areas and requirements on the amount of notice required by STAR+PLUS HCBS program members. The AFC or ALF provider must provide an escort for the member, if necessary.

There may be questions about eligibility for residents who are living in AFC or ALF. In cases of difficulties in scheduling, or questions about eligibility for transportation, residents should contact the managed care organization (MCO) to intercede on the resident’s behalf with the local Medicaid medical transportation system.

3125 STAR+PLUS HCBS Program Members Requesting Non-Managed Care Services

Revision 18-0; Effective September 4, 2018

The STAR+PLUS Home and Community Based Services (HCBS) program is required to provide all of the services (excluding hospice) needed to enable the member to live safely in the community. Therefore, Community Care Services Eligibility (CCSE) services cannot be authorized for STAR+PLUS HCBS program members. STAR+PLUS HCBS program members requesting additional services must be referred to the managed care organization's (MCO’s) service coordinator.

3126 STAR+PLUS Members Requesting Non-Managed Care Services

Revision 18-0; Effective September 4, 2018

Members receiving STAR+PLUS services are potentially eligible to receive a variety of services from the Texas Health and Human Services Commission (HHSC). For specific information, refer to Section 3126.1, Community Care Services Eligibility, below.

3126.1 Community Care Services Eligibility

Revision 18-0; Effective September 4, 2018

If STAR+PLUS members meet program requirements, they are eligible to receive the following Community Care Services Eligibility (CCSE) services:

• adult foster care (AFC);
• residential care;
• Emergency Response Services (ERS);
• home-delivered meals (HDM); or
• special services to persons with disabilities.

Members may also be eligible for family care if the managed care organization (MCO) has denied their request for personal attendant services due to the:

• lack of practitioner's statement of need for the services; or
• lack of personal care tasks.

STAR+PLUS members may never receive the following services from the Texas Health and Human Services Commission (HHSC):

• Day Activity and Health Services (DAHS);
• community attendant services (CAS);
• primary home care (PHC); or
• assisted living (AL).

An individual requesting CCSE services should be added to any applicable interest lists at the time of the request, in order to protect the date and time of the request. Prior to processing an application, the CCSE case manager must verify the service array does not include a service equivalent of the Title XX, Community Care Programs, service requested. The CCSE case manager may view the STAR+PLUS Program Health Plan Comparison Charts and value-added services (VAS) on the HHSC website at: https://hhs.texas.gov/services/health/medicaid-and-chip/programs/starplus/comparison-charts.

VAS offered by an MCO are extra services approved by HHSC. VAS will vary by MCO. HHSC staff are not required to wait for appeal decisions from MCOs to process requests for Title XX, Community Care Program services if the service requested is not a VAS on the member’s plan. Once released from the interest list, the CCSE case manager verifies the applicant’s MCO does not offer an equivalent service as a VAS and proceeds with the eligibility determination for the requested Title XX, Community Care Program service.

The member should be asked if he or she has requested the service from the MCO, if the requested service is not a VAS but is part of the MCO's service array. If the answer to that question is:

• No, the CCSE case manager refers the member to the MCO.
• Yes, and services were approved, the CCSE case manager refers the member to the MCO to initiate service delivery.
• Yes, and services were not approved or the member doesn't know if he or she was approved, the CCSE case manager contacts Program Support Unit (PSU) staff. Once PSU staff confirm services were not approved, the application can be processed.
• Unsure, the CCSE case manager refers the member to PSU staff. PSU staff will contact the MCO to inquire about the request.

Note: Once released from the interest list, CCSE case managers may proceed to determine eligibility. CCSE case managers process applications for individuals who are enrolled in STAR+PLUS services managed care only if the individuals meet the criteria outlined above. Do not authorize Title XX, Community Care Programs, services for anyone receiving the STAR+PLUS Home and Community Based Services (HCBS) program.

3127 Health Insurance Premium Payment Program

Revision 18-0; Effective September 4, 2018

The Health Insurance Premium Payment (HIPP) program is a Medicaid program that reimburses eligible individuals for their share of an employer-sponsored HIPP. The Texas Health and Human Services Commission (HHSC) pays for copayments and deductibles for Medicaid-covered services provided by Medicaid providers. HIPP individuals also can receive Medicaid benefits (provided by a Medicaid-enrolled provider) not covered by their employer-sponsored health insurance.

In order to qualify for HIPP, an employee must either be Medicaid eligible or have a family member who is Medicaid eligible. The reimbursement may pay for individuals and their family members to receive employer-sponsored health insurance benefits when it is determined the cost of insurance premiums and administration are less than the cost of projected Medicaid expenditures.

Individuals who participate in the HIPP program may participate in STAR+PLUS and remain enrolled in HIPP.