The Texas Health and Human Services Commission is offering a new way to serve people who are eligible for both Medicare and Medicaid, known as dual eligibles. The goal of the project is to better coordinate the care those dual eligible members receive.
The project, also known as “the demonstration,” is testing an innovative payment and service delivery model to improve coordination of services for dual eligibles, enhance quality of care, and reduce costs for both the state and the federal government. By having one Medicare-Medicaid health plan, Medicare and Medicaid benefits work together to better meet the member’s health-care needs.
Beginning April 1, 2015, dual eligible members in the six demonstration counties will be passively enrolled into a Medicare-Medicaid plan, following a notification process, which is explained below. The letters explain the project and identify the Medicare-Medicaid plan the member will be enrolled in if the member takes no action. The plan will provide the member the full array of Medicaid and Medicare services, integrating acute care and long term services and supports.
Objectives
- Make it easier for clients to get care.
- Promote independence in the community.
- Eliminate cost shifting between Medicare and Medicaid.
- Achieve cost savings for the state and federal government through improvements in care and coordination.
Geographic Area
The demonstration project covers six counties:
| County | Number of Clients | Health Plans |
|---|---|---|
| Bexar | 26,452 | Amerigroup, Molina, Superior |
| Dallas | 27,941 | Molina, Superior |
| El Paso | 19,645 | Amerigroup, Molina |
| Harris | 47,160 | Amerigroup, Molina, UnitedHealthcare |
| Hidalgo | 27,090 | Cigna-HealthSpring, Molina, Superior |
| Tarrant | 16,986 | Amerigroup |
Eligible Clients and Enrollment
Clients will be in the project if they meet all of these criteria:
- Age 21 or older.
- Get Medicare Part A, B and D, and are receiving full Medicaid benefits.
- Be enrolled in the Medicaid STAR+PLUS program for at least 30 days, which serves members who have disabilities and those who meet a nursing facility-level of care and get STAR+PLUS home and community-based waiver services.
The project will not include clients who reside in Intermediate Care Facilities for Individuals with Intellectual Disabilities and Related Conditions and individuals with developmental disabilities who get services through one of these waivers:
- Community Living Assistance and Support Services
- Deaf Blind with Multiple Disabilities Program
- Home and Community-based Services
- Texas Home Living Program
Members eligible for the project will get a packet with their plan selection and other information before the start date. Members can choose to opt-out of the project.
Some other dual eligibles may opt to enroll in the project. Those include:
- Individuals in a Medicare Advantage plan not operated by the same parent organization that operates a STAR+PLUS MMP and who meet the eligibility criteria for the demonstration may enroll if they disenroll from their Advantage plan.
- Individuals in the Program of All-Inclusive Care for the Elderly who meet the eligibility criteria may enroll if they disenroll from PACE and enrolled in the Medicaid STAR+PLUS program for at least 30 days.
- Eligible individuals participating in the CMS Independence at Home demonstration may switch to this demonstration project.
Medicare-Medicaid Plans
Bexar Service Area
Dallas Service Area
El Paso Service Area
Harris Service Area
Hidalgo Service Area
Tarrant Service Area
Letters for people who received Medicare and Medicaid who can choose to enroll in a STAR+PLUS Medicare-Medicaid Plan
- Introduction Letter (PDF)
- Member Chooses to Join Medicare-Medicaid Plan (PDF)
- Enrollment Letter (PDF)
- Reminder Letter (PDF)
- Enrollment Confirmation Letter (MS Word)
- Denial of Enrollment Letter (MS Word)
- Cancellation of Enrollment Letter (MS Word)
- Member Chooses Not to Join - Confirmation Letter (MS Word)
- Member Chooses Not to Join - Re-enrollment Letter (MS Word)
- Member Chooses Not to Join - Remains in STAR+PLUS Medicare-Medicaid Plan Letter (MS Word)
Medicare-Medicaid Plan Dual Demonstration Comparison Charts
| Area Chart | Medicaid - Medicare Plan | |
|---|---|---|
| Bexar | English | Spanish |
| Dallas | English | Spanish |
| El Paso | English | Spanish |
| Harris | English | Spanish |
| Hidalgo | English | Spanish |
| Tarrant | English | Spanish |
Benefit Model
In the demonstration, the health plans must provide the full array of Medicaid and Medicare services. This includes any benefits that were added to the STAR+PLUS service array on March 1, 2015, such as nursing facility services, psychosocial mental health rehabilitation and targeted case management.
Visit the CMS website for more information about the project, including the Texas proposal and memorandum of understanding.
To see how CMS will be monitoring and evaluating the Texas demonstration project, read Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals (PDF).
Provider Resources
- Texas Dual Eligibles Demonstration into Nursing Facility Presentation (PDF)
- Provider Information Letter (PDF)
- Who Pays Medicare Cost-Sharing Comparison Chart (MS Word)
- Dual Demo FAQ’s (PDF)
- Cohort ZIP Code List (Excel)
- Dual Eligible Pilot Provider Training (PDF)
- Enrollment Information (PDF)
- Texas Dual Eligible Integrated Care Project contract requirements (PDF)
- Memorandum of Understanding (PDF)
- Texas Dual Demonstration Letter of Extension to CMS (PDF)