Beginning April 1, 2015, the Texas Health and Human Services Commission has offered a way to serve adults who are eligible for both Medicare and Medicaid, known as dual-eligible individuals. The goal of the Dual Eligible Integrated Care Demonstration Project is to better coordinate the care its dual-eligible members receive.
The project, also known as "the Demonstration," tests an innovative payment and service delivery model to improve coordination of services for its dual-eligible members, enhance quality of care, and reduce costs for both the state and the federal governments. In the Demonstration, one Medicare-Medicaid Plan (MMP) provides the full array of Medicaid and Medicare services, integrating acute care and long-term services and supports for its members to better meet their health-care needs.
- Make it easier for clients to get care.
- Promote independence in the community.
- Eliminate cost shifting between Medicare and Medicaid.
- Achieve cost savings for the state and federal government through improvements in care and coordination.
Eligibility and Enrollment
Individuals may participate in the Demonstration if they meet all criteria listed below:
- Age 21 or older;
- Have Medicare Parts A, B and D, and receive full Medicaid benefits; and
- Have been enrolled in the STAR+PLUS program for at least 30 days.
More information about the STAR+PLUS program can be found on the STAR+PLUS website.
The Demonstration does not include dual-eligible individuals who reside in intermediate care facilities for individuals with intellectual disabilities and related conditions, and individuals with developmental disabilities who get services through one of these waivers:
- Community Living Assistance and Support Services;
- Deaf Blind with Multiple Disabilities Program;
- Home and Community-based Services; or
- Texas Home Living.
Dual-eligible individuals that meet all Demonstration criteria are automatically or "passively" enrolled into an MMP following a notification process. The notification process involves letters sent to members to explain the Demonstration and identify the MMP the member will be enrolled in if the member takes no action. They may choose to opt out of the Demonstration.
Other dual-eligible individuals who meet the eligibility criteria for the Demonstration may opt to enroll in the Demonstration including:
- Individuals in a Medicare Advantage Plan (MAP) not operated by the same parent organization that operates a STAR+PLUS MMP if they disenroll from their MAP;
- Individuals in the Program of All-Inclusive Care for the Elderly if they disenroll from PACE and enroll in the STAR+PLUS program for at least 30 days; and
- Individuals participating in the Centers for Medicare & Medicaid Services' (CMS') Independence at Home Demonstration if they switch to this Demonstration.
The Demonstration project covers six counties:
|County||Number of Enrolled Clients||Health Plans|
|Bexar||5,891||Amerigroup, Molina, Superior|
|El Paso||3,587||Amerigroup, Molina|
|Harris||9,525||Amerigroup, Molina, UnitedHealthcare|
February 2022 figures above are estimated based on incomplete data and are subject to change as data is finalized. Medicaid and CHIP managed care organization enrollment by service delivery area data is updated quarterly and published to HHSC’s Healthcare Statistics website.
Bexar Service Area
Dallas Service Area
El Paso Service Area
Harris Service Area
Hidalgo Service Area
- Molina offers two plans to choose from in the Hidalgo service area only:
Tarrant Service Area
Medicare-Medicaid Plan Comparison Charts
|Area Chart||Medicaid - Medicare Plan|
Sample Letters for Dual-eligible Individuals
- Member Chooses to Join Medicare-Medicaid Plan (PDF)
- Enrollment Letter (PDF)
- Reminder Letter (PDF)
- Enrollment Confirmation Letter (PDF)
- Denial of Enrollment Letter (PDF)
- Cancellation of Enrollment Letter (PDF)
- Member Chooses Not to Join - Confirmation Letter (PDF)
- Member Chooses Not to Join - Re-enrollment Letter (PDF)
- Member Chooses Not to Join - Remains in STAR+PLUS Medicare-Medicaid Plan Letter (PDF)
- CMS' Texas Dual Eligible Integrated Care Demonstration Project Information Website
- CMS' Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals
- Texas Dual Eligibles Demonstration into Nursing Facility Presentation (PDF)
- Provider Information Letter (PDF)
- Who Pays Medicare Cost-Sharing Comparison Chart (MS Word)
- Dual Demo FAQ’s (PDF)
- Cohort ZIP Code List (Excel)
- Enrollment Information (PDF)
- Texas Dual Eligible Demonstration Three-way Contract (PDF)
- Memorandum of Understanding (PDF)
- Texas Dual Demonstration Letter of Extension to CMS 09/01/2015 (PDF)
- Texas Dual Demonstration Letter of Extension to CMS 02/19/2020 (PDF)