Managed care Medicaid patients who are disabled or age 65 or older may have to change plans soon

Patients in the Texas Medicaid STAR+PLUS program may need to choose a new plan in the coming weeks since the Health and Human Services agency reprocured managed care contracts last year. The new contracts are scheduled to take effect on September 1, 2024.

HHSC sent letters to beneficiaries in March informing them of new plans in their market, if any, and the need to select a new plan if their current plan will no longer be providing services. Patients who need to choose a new plan must submit their selection to HHSC by July 10 or the state will assign them to a new plan. Patients can also change their plan after receiving their assignment. If any new plans did enter the market, patients have the choice of selecting a new one even if their current plan will continue operating in STAR+PLUS.

“Many patients will consult their physicians about choosing a plan, including confirming whether their physician will be participating in a plan’s network,” says Helen Kent Davis, the newest member of TAFP’s advocacy team. “State and federal law prohibits physicians from steering patients to a particular plan, but physicians can confirm whether or not they contract with a plan.”

STAR+PLUS is the state’s managed care Medicaid program for low-income adults with disabilities or are age 65 or older. The program also provides long-term care services for patients eligible for both Medicare and Medicaid, known as “dual eligibles.” Medicare will continue to cover their acute care services, but patients must choose a STAR+PLUS plan to provide necessary long-term care services.

News outlets have recently reported about possible changes coming in the Medicaid STAR program and the Children’s Health Insurance Program, but those programs cover different populations than STAR+PLUS. The STAR Medicaid managed care program covers low-income children, pregnant women, and families, and the Children’s Health Insurance Program covers children in low-income families that earn too much to qualify for Medicaid.

As of Jan. 2024, these plans serve nearly 3.5 million pregnant women, children or parents enrolled in either Medicaid or the Children's Health Insurance Program.

“Multiple protests have been filed contesting HHSC's tentative awards, though HHSC has not indicated when it will finalize its review of the disputes,” Davis says. “Legal battles will likely ensue regardless of HHSC’s decision. Whatever the ultimate outcome, the decision will be disruptive to patients and physicians, though changes will not begin until at least 2025.”