4000, STAR+PLUS HCBS Program Services
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Revision 26-1; Effective Feb. 20, 2026
A STAR+PLUS member has access to all medically and functionally necessary services available in the Medicaid state plan. They also receive some enhanced benefits in comparison to traditional fee-for-service (FFS) Medicaid coverage:
- waiver of the three-prescription per month limit for members not covered by Medicare; and
- waiver of spell illness limitation for members admitted to a facility because of the serious and persistent mental illness (SPMI).
A STAR+PLUS member may be eligible for additional services available through the STAR+PLUS Home and Community Based Services (HCBS) program. The service array under the STAR+PLUS HCBS program is designed to offer home and community-based services as cost-effective alternatives to institutional care in a Medicaid-certified nursing facility (NF). Eligible members receive services per their specific needs, defined by an assessment process and based on informed choice and through a person-centered process.
The Texas Health and Human Services Commission (HHSC) contracts with Medicaid managed care organizations (MCOs) for the provision of STAR+PLUS and STAR+PLUS HCBS program services. These Medicaid MCOs are responsible for providing a benefit package to members that include all medically necessary services covered under the traditional, FFS Medicaid programs, except for non-capitated services provided to Medicaid members outside of the MCO capitation and listed in each managed care contract. For example, Attachment B-1, Section 8.2.2.8, of the Uniform Managed Care Contract (UMCC) (PDF_. The MCO the member is enrolled with conducts the Medical Necessity and Level of Care (MN/LOC) Assessment and identifies authorized services on the individual service plan (ISP).
A member who does not have Medicare must choose an MCO and a primary care provider (PCP) in the MCO's network. These individuals can choose a specialist to be their PCP. They receive all services, both acute care and LTSS, from the MCO.
A member who receives both Medicaid and Medicare (dual-eligible) chooses an MCO, but not a PCP. A dual-eligible member receives acute care from their Medicare providers. The STAR+PLUS program does not impact Medicare services or service delivery in any way. The STAR+PLUS MCO only provides Medicaid LTSS to dual-eligible members.
A Medicaid-only member, meaning those who do not receive Medicare, receives traditional Medicaid acute care services plus an annual check-up. The cost of acute care services is included in the capitation payment to the MCO for Medicaid-only members. For dual-eligible members, the MCO’s capitation payment does not include the cost of acute care.
4100, STAR+PLUS Acute Care Services
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Revision 26-1; Effective Feb. 20, 2026
Acute care services offered through the STAR+PLUS program include:
- ambulance services;
- audiology services, including hearing aids;
- behavioral health services, including:
- inpatient mental health services;
- outpatient mental health services;
- outpatient chemical dependency services;
- mental health rehabilitation for non-duals;
- mental health targeted case management for non-duals;
- detoxification services;
- psychiatry services; and
- counseling services;
- birthing services provided by a certified nurse midwife in a birthing center;
- chiropractic services;
- dialysis;
- durable medical equipment (DME) and supplies;
- Emergency Response Services (ERS);
- family planning services;
- home health care services for acute conditions;
- hospital services;
- laboratory;
- long-term services and supports (LTSS);
- medical checkups and Comprehensive Care Program (CCP) services for Medicaid for Breast and Cervical Cancer (MBCC) members under 21;
- oncology services;
- optometry, glasses and contact lenses, if medically necessary;
- podiatry;
- prenatal care;
- prescription drugs;
- primary care services (PCS);
- preventive services including an annual adult well check;
- radiology, imaging and X-rays;
- specialty physician services;
- therapies, including physical, occupational and speech for acute conditions;
- transplantation of organs and tissues; and
- vision services.
4200, STAR+PLUS Long-Term Services and Supports
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Revision 26-1; Effective Feb. 20, 2026
Long-term services and supports (LTSS) offered through the STAR+PLUS program include:
- Community First Choice (CFC) - Available to members who receive Supplemental Security Income (SSI) or receive SSI-related Medicaid. CFC is not available for medical assistance only (MAO) members. Members with CFC meet an institutional level of care (LOC) for a hospital, nursing facility (NF), intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or psychiatric hospital, also called an institution for mental disease. CFC services are provided in a community-based setting. Community-based settings do not include:
- hospitals;
- NFs;
- institutions for mental disease (IMD);
- ICF/IID; and
- any setting with the characteristics of an institution.
- CFC services include:
- Emergency Response Services (ERS), which are backup systems and supports, including electronic devices with a backup support plan to ensure continuity of services and supports;
- habilitation services, which provide acquisition, maintenance, and enhancement of skills necessary for the individual to accomplish activities of daily living (ADLs), instrumental activities of daily living (IADLs) and health-related tasks;
- personal assistance services (PAS), which help with ADLs, IADLs and health-related tasks through hands-on assistance, supervision or cueing, including nurse-delegated tasks; and
- support management, which is training provided to members or authorized representatives (ARs) on how to manage and dismiss their attendants.
- Day Activity and Health Services (DAHS) — All members of a STAR+PLUS managed care organization (MCO) may receive medically and functionally necessary DAHS. DAHS includes nursing and PAS, therapy extension services, nutrition services, transportation services and other supportive services. These services are provided at facilities licensed by the state.
- Nursing facilities (NFs) — Institutional care for members whose physician certified that the member has a medical condition that requires 24-hour nursing care that meets medical necessity (MN) requirements. The need for custodial care solely does not constitute MN for an NF placement. Institutional care includes coverage for the medical, social and psychological needs of each resident, including room and board (R&B) charges, social services, medications not covered by Medicare Part B or D, medical supplies and equipment, rehabilitative services and personal needs items.
- PAS, formerly known as Primary Home Care (PHC) PAS — All members may receive medically and functionally necessary PAS. PAS includes helping the member perform ADLs and household chores necessary to keep the home in a clean, sanitary and safe environment. The level of help given is determined by the member's need and the plan of care (POC). To be eligible for Medicaid state plan PAS, the MCO must assess applicants in a face-to-face visit. Members are assessed using Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, or Form H6516, Community First Choice Assessment. To be eligible for PAS through programs other than CFC or the STAR+PLUS Home and Community Based Services (HCBS) program, members must score at least 24 on Form H2060. PAS includes three service delivery options:
- Agency Option (AO);
- Consumer Directed Services Option (CDS); and
- Service Responsibility Option (SRO).
STAR+PLUS HCBS program — This is for those members who qualify for such services. The state also provides an enriched array of services to members who would otherwise qualify for NF care through the STAR+PLUS HCBS program. The MCO must also provide medically necessary services that are available to members who meet the functional and financial eligibility for the STAR+PLUS HCBS program.
4300, STAR+PLUS HCBS Program Service Array
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Revision 26-1; Effective Feb. 20, 2026
The STAR+PLUS Home and Community Based Services (HCBS) program offers the following services:
- adaptive aids and medical supplies;
- adult foster care (AFC);
- assisted living (AL) services;
- cognitive rehabilitation therapy (CRT);
- dental services;
- emergency Response Services (ERS);
- employment Assistance (EA) services;
- financial Management Services (FMS);
- home-delivered meals (HDM);
- minor home modifications (MHMs);
- nursing services;
- occupational therapy (OT) services;
- personal assistance services (PAS);
- physical therapy (PT) services;
- respite care services;
- speech therapy (ST) services;
- employment assistance (EA);
- supported Employment (SE) services; and
- transition Assistance Services (TAS).
4400, Individual Service Plan
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Revision 26-1; Effective Feb. 20, 2026
The managed care organization (MCO) must identify all authorized services on the individual service plan (ISP). The ISP consists of the following documents:
- Form H1700-1, Individual Service Plan;
- Form H1700-2, Individual Service Plan – Addendum;
- Form H1700-3, Individual Service Plan – Signature Page;
- Form H1700-A1, Certification of Completion/Delivery of STAR+PLUS HCBS Program Items/Services;
- Form H2060, Needs Assessment Questionnaire and Task/Hour Guide;
- Form H2060-A, Addendum to Form H2060;
- Form H2060-B, Needs Assessment Addendum;
- Form H6516, Community First Choice Assessment; or
- other forms and assessments related to the services provided.
The MCO must upload Form H1700-1 to the MCOHub if the MCO manually completes it. The MCO is not required to upload Form H1700-1 to the MCOHub if the MCO electronically generates this form through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP). The MCO maintains all other forms in the member case file.
4500, Adult Foster Care Home Services
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Revision 26-1; Effective Feb. 20, 2026
An adult foster care (AFC) home is a living arrangement that provides personal care services (PCS) to members who cannot continue independent functioning in their own homes due to physical or mental limitation. These residences provide a home-like environment offering services such as help with daily living, meal preparation, housekeeping, companion services, personal care, nursing tasks and transportation. The member must live with a contracted STAR+PLUS HCBS program AFC home provider.
The managed care organization (MCO) determines AFC home services to develop the individual service plan (ISP) through completion of Form H6516, Community First Choice Assessment or Form H2060, Needs Assessment Questionnaire and Task/Hour Guide.
STAR+PLUS HCBS program AFC members must pay for their own room and board (R&B) charges and copayment charges to the AFC home provider. The only time the R&B charge is not required is when the AFC home provider moves in with the member and the member's home becomes the AFC home.
4600, Assisted Living Facility Services
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Revision 26-1; Effective Feb. 20, 2026
Assisted living facility (ALF) is a living arrangement that provides personal care services (PCS) to between four and 16 unrelated residents. These facilities provide a home-like environment for individuals who cannot live independently due to physical or mental limitations. ALFs offer services such as home management, supervision, meal services, transportation and escort, housekeeping, 24-hour supervision, and medication assistance. The member must live with an ALF licensed by the Texas Health and Human Services Commission (HHSC).
The managed care organization (MCO) determines AFC home services to develop the individual service plan (ISP) through completion of Form H6516, Community First Choice Assessment or Form H2060, Needs Assessment Questionnaire and Task/Hour Guide.
STAR+PLUS HCBS program ALF members must pay for their own room and board (R&B) charges and copayment charges, if applicable, to the AFC.
4700, Hospice Services
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Revision 26-2; Effective June 1, 2026
Federal 1115 waiver requirements dictate that the STAR+PLUS Home and Community Based Service (HCBS) program provide the services needed to allow the member to live safely in the community. These services exclude hospice. Hospice services may be authorized with STAR+PLUS services or the STAR+PLUS HCBS program.
Hospice services may be delivered in a variety of settings, including nursing facilities (NFs). STAR+PLUS members must not be denied services or disenrolled due to receipt of hospice services. Hospice provides services for terminal illness that are not available under the STAR+PLUS program. For example, hospice providers can administer pain control medications that are not available to STAR+PLUS providers.
NF hospice services can be identified in the Service Authorization System Online (SASO) as service group (SG) 8, service code (SC) 31. The NF counter is activated by non-hospice NF authorizations, which appear in SASO as SG1/SC1 or SG1/SC3.