Appendix XXIX, STAR+PLUS Plan Codes
Revision 24-1; Effective Feb. 22, 2024
STAR+PLUS Plan Codes
| Service Area | Plan Name | Plan Codes | Plan Codes Dates |
|---|---|---|---|
| Bexar | Amerigroup Molina Superior | 45 46 47 | Sept. 1, 2011 Sept. 1, 2011 Sept. 1, 2011 |
| Dallas | Molina Superior | 9F 9H | March 1, 2012 March 1, 2012 |
| El Paso | Amerigroup Molina | 34 33 | March 1, 2012 March 1, 2012 |
| Harris | Amerigroup United Healthcare Molina | 7P 7R 7S | Sept. 1, 2011 Sept. 1, 2011 Sept. 1, 2011 |
| Hildago | Cigna-HealthSpring Molina Superior | H7 H6 H5 | March 1, 2012 – Dec. 31, 2021 March 1, 2012 March 1, 2012 |
| Jefferson | Amerigroup United Healthcare Molina | 8R 8S 8T | Sept. 1, 2011 Sept. 1, 2011 Sept. 1, 2011 |
| Lubbock | Amerigroup Superior | 5A 5B | March 1, 2012 March 1, 2012 |
| Medicaid Rural Service Area (RSA) West Texas | Amerigroup Superior | W5 W6 | Sept. 1, 2014 Sept. 1, 2014 |
| Medicaid RSA Northeast Texas | Cigna-HealthSpring Molina United Healthcare | N3 P2 N4 | Sept. 1, 2014 – Dec. 31, 2021 Jan 1, 2022 Sept. 1, 2014 |
| Medicaid RSA Central Texas | Superior United Healthcare | C4 C5 | Sept. 1, 2014 Sept. 1, 2014 |
| Nueces | United Healthcare Superior | 85 86 | Sept. 1, 2011 Sept. 1, 2011 |
| Tarrant | Amerigroup Cigna-HealthSpring Molina | 69 6C P1 | Sept. 1, 2011 Sept. 1, 2011 – Dec. 31, 2021 Jan. 1, 2022 |
| Travis | Amerigroup United Healthcare | 19 18 | Sept. 1, 2011 Sept. 1, 2011 |
Medicare-Medicaid Plan (MMP) Codes
| Service Area | Plan Name | Plan Codes | Plan Code Dates |
|---|---|---|---|
| Bexar | Amerigroup Molina Superior | 4F 4G 4H | Sept. 1, 2015 Sept. 1, 2015 Sept. 1, 2015 |
| Dallas | Molina Superior | 9J 9K | Sept. 1, 2015 Sept. 1, 2015 |
| El Paso | Amerigroup Molina | 3G 3H | Sept. 1, 2015 Sept. 1, 2015 |
| Harris | Amerigroup United Healthcare Molina | 7Z 7Q 7V | Sept. 1, 2015 Sept. 1, 2015 Sept. 1, 2015 |
| Hildago | Cigna-HealthSpring Molina Molina Superior | H8 H9 P3 HA | Sept. 1, 2015 – Dec. 31, 2021 Sept. 1, 2015 Jan. 1, 2022 Sept. 1, 2015 |
| Tarrant | Amerigroup Cigna-HealthSpring | 6F 6G | Sept. 1, 2015 Sept. 1, 2015 – Dec. 31, 2021 |