Medicaid HMO Expansion Begins Sept. 1

On Sept. 1, the Texas Health and Human Services Commission (HHSC) will begin Phase I of its Medicaid HMO expansion, converting the Medicaid Primary Care Case Management model to the Medicaid HMO model in the 28 counties contiguous to the current Medicaid HMO service delivery areas of Bexar, El Paso, Harris, Lubbock, Nueces, and Travis counties. As part of the conversion, the state also will create a new service delivery area – Jefferson -- consisting of 11 counties in Southeast Texas. 

A list of counties included in Phase I and health plans providing coverage in those counties is posted online [PDF]. 

HHSC proposed the Medicaid HMO expansion last summer to reduce Medicaid costs. The Texas Legislature recently approved the change as part of a multipronged Medicaid cost containment initiative. Officials expect Phase I to save about $35 million, and Phase II, which will convert all remaining Texas counties to the HMO model in March 2012, to save an additional $385 million.

Medicaid-enrolled children, pregnant women, and low-income parents living in one of the 28 contiguous counties must select a STAR HMO, while adult Medicaid enrollees with disabilities who reside in the community must select a STAR+PLUS HMO. STAR+PLUS plans also will provide long-term care services for patients dually eligible for Medicaid and Medicare (Medicare will continue to cover acute care services). Children with disabilities receiving Supplemental Security Income (SSI) benefits may voluntarily enroll in STAR+PLUS. (STAR Health, which provides coverage for children in foster care, is not affected by the changes.) 

In June, the state mailed enrollment packets to Medicaid patients in the 28 counties. Patients must select a health plan and primary care physician by Aug. 12. Patients who do not select a plan will be assigned one by the state.

For more information about the contiguous county expansion, including sample enrollment packets sent to patients, visit the HHSC website  


Action, July 19, 2011


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