6300, Disenrollment from Managed Care

Revision 20-3; Effective December 1, 2020

Texas Health and Human Services Commission (HHSC) conducts member disenrollment activities. Although a STAR Kids member may request disenrollment from managed care, membership in managed care is mandatory with limited exceptions.

See Chapter 533 of the Government Code and Title 1 of the Texas Administrative Code Sections 353.1201 and 353.1203 (related to STAR Kids Medicaid managed care) and Section 353.403 (related to enrollment and disenrollment standards for Medicaid managed care).

Members who receive HHSC approval to disenroll from managed care and who maintain Medicaid eligibility may continue to receive services available through fee-for-service (FFS) Medicaid. All members who transition to FFS Medicaid lose any value-added services provided by the managed care organization (MCO). Those members who were receiving services under the STAR Kids Medically Dependent Children Program (MDCP) waiver may also lose some, if not all, of their MDCP waiver services in the transition to FFS Medicaid.

6310 Disenrollment Request by the Managed Care Organization

Revision 20-3; Effective December 1, 2020

A managed care organization (MCO) has a limited right to request a member be disenrolled from the MCO’s plan without the member’s consent pursuant to 42 C.F.R. Section 438.56. Refer to the HHSC Uniform Managed Care Manual, Chapter 11.5 (PDF), Medicaid Managed Care (MMC) Member Disenrollment Policy, for procedures to request the involuntary disenrollment of members.