Medicaid patients living in nursing homes will be automatically enrolled March 1 in STAR+ PLUS, the state's Medicaid managed care plan for seniors and people with disabilities. The move will affect 50,000 to 60,000 nursing home patients statewide and is intended to improve quality of care and promote care in the least restrictive, most appropriate setting.
Eligible nursing home patients covered by Medicaid will get acute and long-term care services through STAR+PLUS. Dual-eligible patients, who are covered by both Medicaid and Medicare, will continue to get their acute care services through Medicare and their long-term care services through STAR+PLUS. However, dual-eligible patients living in Bexar, Dallas, El Paso, Harris, Hidalgo, or Tarrant Counties will participate in a pilot project integrating Medicare and Medicaid services into a single plan.
The transition will be mandatory for adults aged 21 and older who are in a nursing home, who have been determined eligible for Medicaid, and who meet STAR+PLUS criteria. Children and adults younger than 21 will be excluded. State veterans home residents also will be excluded.
Each nursing home patient will be assigned a managed care service coordinator whose responsibilities will include meeting with patients every three months, authorizing add-on services and ensuring their delivery, and being involved in care plans.
Physicians and health care providers who are not part of STAR+PLUS will be given the opportunity to join the plan, according to the Texas Health and Human Services Commission, which has directed STAR+PLUS to reach out to those it calls "significant traditional providers," or STPs; physicians and providers are free, however, to contact STAR+PLUS.
For more information about the transition, go to the HHSC website, or view the plan's highlights.
Action, Feb. 17, 2015
Last Updated On
May 13, 2016