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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.