Effective January 1, 2022, Cigna will no longer participate in the Medicare-Medicaid Dual Eligibles Project and will transfer its Texas Medicaid business to Molina Healthcare. The following links have more information about this transition for providers and members:
HHSC will make further updates to this website to reflect this change.
The Texas Health and Human Services Commission offers a way to serve adults who are eligible for both Medicare and Medicaid, known as dual-eligible members. The goal of the project is to better coordinate the care those 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 dual-eligible members, enhance quality of care, and reduce costs for both the state and the federal government. By having one Medicare-Medicaid health plan, Medicare and Medicaid benefits work together to better meet the member’s health-care needs.
Beginning April 1, 2015, dual-eligible members in the six demonstration counties were passively enrolled into a Medicare-Medicaid plan, following a notification process, explained below. The notification process involves letters sent to members to explain the project and identify the Medicare-Medicaid plan the member was enrolled in if the member takes no action. The Medicare-Medicaid plan provides the full array of Medicaid and Medicare services, integrating acute care and long-term services and supports.
- 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.
The demonstration project covers six counties:
|County||Number of Enrolled Clients||Health Plans|
|Bexar||6,242||Amerigroup, Molina, Superior|
|El Paso||3,867||Amerigroup, Molina|
|Harris||10,289||Amerigroup, Molina, UnitedHealthcare|
May 2021 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.
Eligibility and Enrollment
Clients may participate in the project if they meet all criteria listed below:
- Age 21 or older.
- Get Medicare Part A, B and D, and are receiving full Medicaid benefits.
- Be enrolled in the Medicaid STAR+PLUS program for at least 30 days. More information about the STAR+PLUS program can be found on the STAR+PLUS website.
The project does not include clients 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.
Members eligible to participate in the project receive a packet with their plan selection and other information before the start date. They may choose to opt out of the project.
Other dual-eligible members may opt to enroll in the project including:
- Individuals in a Medicare Advantage plan not operated by the same parent organization that operates a STAR+PLUS MMP and who meet the eligibility criteria for the demonstration may enroll if they disenroll from their Advantage plan;
- Individuals in the Program of All-Inclusive Care for the Elderly who meet the eligibility criteria may enroll if they disenroll from PACE and enroll in the Medicaid STAR+PLUS program for at least 30 days;
- Eligible individuals participating in the Centers for Medicare & Medicaid Services (CMS) Independence at Home demonstration may switch to this demonstration project.
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
Letters for people who received Medicare and Medicaid who can choose to enroll in a STAR+PLUS Medicare-Medicaid Plan
- Introduction Letter (PDF)
- Member Chooses to Join Medicare-Medicaid Plan (PDF)
- Enrollment Letter (PDF)
- Reminder Letter (PDF)
- Enrollment Confirmation Letter (MS Word)
- Denial of Enrollment Letter (MS Word)
- Cancellation of Enrollment Letter (MS Word)
- Member Chooses Not to Join - Confirmation Letter (MS Word)
- Member Chooses Not to Join - Re-enrollment Letter (MS Word)
- Member Chooses Not to Join - Remains in STAR+PLUS Medicare-Medicaid Plan Letter (MS Word)
Medicare-Medicaid Plan Dual Demonstration Comparison Charts
|Area Chart||Medicaid - Medicare Plan|
In the demonstration, the single health plan must provide the full array of Medicaid and Medicare services, such as nursing facility services, psychosocial mental health rehabilitation and targeted case management.
Visit the CMS website for more information about the project, including the Texas proposal and memorandum of understanding.
To see how CMS monitors and evaluates the Texas demonstration project, read Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals (PDF).
- 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)