Beginning April 1, 2015, the Texas Health and Human Services Commission (HHSC) has offered a way to serve adults who are eligible for both Medicare and Medicaid, known as dually eligible individuals. The goal of the Dual Eligible Integrated Care Demonstration Project, or Dual Demonstration Program, is to better coordinate the care its dually eligible members receive.
Transition of the Dual Demonstration Program
HHSC has decided to end the Dual Demonstration Program by Dec. 31, 2025, and transition Medicare-Medicaid Plans (MMPs) to integrated Dual Eligible Special Needs Plans (D-SNPs) by Jan. 1, 2026. This transition is being implemented in accordance with the Centers for Medicare & Medicaid Services (CMS) Contract Year 2023 Medicare Advantage and Part D Final Rule.
- The Superior MMP in Bexar County and all Amerigroup MMPs will continue operating the Dual Demonstration Program through Dec. 31, 2024. New enrollment into these MMPs will stop Dec. 31, 2023, but these plans will continue to serve their current members through Dec. 31, 2024. By January 2025, members in these MMPs must transition to another MMP, if available in their county, or a STAR+PLUS managed care organization (MCO) in their service area.
- The Superior MMPs in Dallas and Hidalgo counties along with all Molina MMPs and UnitedHealthcare MMPs will continue operating the Dual Demonstration Program through Dec. 31, 2025. HHSC has not yet decided when new enrollment into these MMPs will end. By January 2026, members in these MMPs must transition to a STAR+PLUS MCO in their service area.
When MMP members transition to a STAR+PLUS MCO they must choose between a Medicare Advantage Plan (MAP), D-SNP or fee-for-service Medicare. MMP members are encouraged to choose companion D-SNPs operated by the same parent organization or that are the same entity as their STAR+PLUS MCOs for better coordination of their Medicare and Medicaid services.
The Dual Demonstration Program tests an innovative payment and service delivery model to improve coordination of services for its dually eligible members, enhance quality of care and reduce costs for both the state and the federal governments. In the Dual Demonstration Program, one 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 Dual Demonstration Program 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.
Visit STAR+PLUS for more information.
The Dual Demonstration Program does not include dually 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.
Dually eligible individuals who meet all Dual Demonstration Program criteria are automatically or "passively" enrolled into an MMP following a notification process. The notification process involves letters sent to the member explaining the Dual Demonstration Program and identifying the MMP they will be enrolled in if the member takes no action. These individuals may choose to opt out of the Dual Demonstration Program.
Other dually eligible individuals who meet the eligibility criteria for the Dual Demonstration Program may opt to enroll in the Dual Demonstration Program including:
- Individuals in a 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 (PACE) if they disenroll from PACE and enroll in the STAR+PLUS program for at least 30-days; and
- Individuals participating in the CMS' Independence at Home Demonstration if they switch to this Dual Demonstration Program.
The Dual Demonstration Program covers six counties:
|Number of Enrolled Clients
|Amerigroup, Molina, Superior
|Amerigroup, Molina, UnitedHealthcare
February 2022 figures above are estimated based on incomplete data and are subject to change as the data is finalized. Medicaid and CHIP MCO enrollment by service delivery area data is updated quarterly and published to the 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
|Medicaid - Medicare Plan
Sample Letters for Dually 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)
Dual Demonstration Program Resources
- 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)