STAR+PLUS

To get services through STAR+PLUS you must: (1) be approved for Medicaid, (2) be one or more of the following:

• Age 21 or older, getting Supplemental Security Income (SSI) benefits and able to get Medicaid due to low income
• Not getting SSI and need the type of services in STAR+PLUS Home and Community-Based Services
• Age 21 or older, getting Medicaid through what are called "Social Security Exclusion programs" and meet program rules for income and asset levels
• Age 21 or over residing in a nursing home and receiving Medicaid while in the nursing home
• In the Medicaid for Breast and Cervical Cancer program

The following people can't be in the STAR+PLUS program:

• People over 21 who get Medicaid 1915(c) waiver services or who live in community homes for people with Intellectual and Developmental Disabilities (IDD) and get Medicare
• People who are not able to get full Medicaid benefits, such as Frail Elderly program members, Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, Qualified Disabled Working Individuals and illegal immigrants
• People who can’t get Medicaid
• Children in state foster care
• Age 20 or younger and not in the Medicaid for Breast and Cervical Cancer program

Important notes for those covered by Medicare:

• You can get STAR+PLUS even if you get Medicare unless you get Medicaid 1915 (c) waiver services or live in facilities for people with Intellectual and Developmental Disabilities (IDD).
• If you are covered by both Medicare and Medicaid (also known as "dual eligible") and you join STAR+PLUS, you will keep getting regular healthcare services through your Medicare doctor. STAR+PLUS does not change the way you get Medicare services.

Map of STAR+PLUS health plans by county (PDF)

Map of STAR+PLUS Health Plans by Rural Service Area (PDF)

STAR+PLUS does not change how people get their Medicare services. You can continue to get regular medical care from your Medicare doctor and providers or from a Medicare managed care health plan.

When you join STAR+PLUS, you will pick a STAR+PLUS health plan and start getting Medicaid long-term services and supports through your health plan.

STAR+PLUS is a Texas Medicaid program. To get services through STAR+PLUS, you must first be enrolled in Medicaid.

To enroll in Medicaid, visit Your Texas benefits or call 2-1-1.

Once you are approved for STAR+PLUS, you will get a packet in the mail that tells you about the program and how to choose a health plan. If you don't have Medicare, you will also need to select a primary care doctor.

After receiving the STAR+PLUS enrollment packet, you have 15 days to choose a health plan. If you don't choose a health plan and primary care doctor, HHSC will choose for you.

You can tell us your choices by phone, mail or by filling out a form at an enrollment event or presentation. Enrollment event calendar

Getting services

Your health plan will assist in setting up services.

Your primary care doctor takes care of your basic medical needs and can refer you to a specialist, if needed.

Regular health care and long-term services and supports are part of a service plan created by you, your family, your doctor, other healthcare providers, and your health plan. Other people who are important in your life can also participate in your service planning if you want to invite them.

You can change your health plan or main doctor as often as once a month. If you ask to change your plan or doctor, you must wait until we tell you the change is made before you go to your new doctor.

The following is an overview of the services STAR+PLUS offers.
Health plans must have a service coordinator visit with the member within 30 days of enrolling in the program. The service coordinator must find out the member's goals, interests, and needs, and help the member develop a service plan.

Long-term services and supports can include:

• Day Activity and Health Services (DAHS)
• Personal assistance services
• Habilitation services (learning to do activities of daily living)
• Emergency response services

Other services under the STAR+PLUS Home and Community-Based Services program include:

• Personal assistance services
• Adaptive aids
• Adult foster care home services
• Assisted living
• Emergency response services
• Home delivered meals
• Medical supplies
• Minor home modifications (making changes to your home so you can safely move around)
• Nursing services
• Respite care (short-term care to provide a break for caregivers)
• Therapies (occupational, physical and speech-language)
• Transition assistance services if someone is leaving a nursing facility to live in their home

Along with all of the traditional Medicaid and other services listed above, each STAR+PLUS health plan offers its own set of "value-added" services. These are extra services not covered by Medicaid.

Each health plan's value-added services are shown in charts that are included in the packet mailed to people approved for STAR+PLUS Medicaid.

STAR+PLUS value-added comparison charts

The STAR+PLUS Home and Community Based Services program (sometimes referred to as “STAR+PLUS Waiver”) provides services that help people live at home who would otherwise need to be in a nursing facility. HHSC assesses a person’s need for this program when they apply for Medicaid.

Email Managed Care Initiatives for more information.