Dual Eligible Integrated Care Demonstration Project

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.

Benefit Model

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.

Objectives

  1. Make it easier for clients to get care.
  2. Promote independence in the community.
  3. Eliminate cost shifting between Medicare and Medicaid.
  4. 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.

Geographic Area

The Demonstration project covers six counties:

County Number of Enrolled Clients Health Plans
Bexar 5,891 Amerigroup, Molina, Superior
Dallas 6,054 Molina, Superior
El Paso 3,587 Amerigroup, Molina
Harris 9,525 Amerigroup, Molina, UnitedHealthcare
Hidalgo 6,664 Molina, Superior
Tarrant 3,804 Amerigroup

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.

Medicare-Medicaid Plans

Map of Dual Eligible Medicare-Medicaid Plan Service Areas (PDF)

Bexar Service Area

Dallas Service Area

El Paso Service Area

Harris Service Area

Hidalgo Service Area

Tarrant Service Area

Medicare-Medicaid Plan Comparison Charts

    Area Chart Medicaid - Medicare Plan
    Bexar English Spanish
    Dallas English Spanish
    El Paso English Spanish
    Harris English Spanish
    Hidalgo English Spanish
    Tarrant English Spanish

    Sample Letters for Dual-eligible Individuals

    Demonstration Resources