Most people covered by Medicaid who are older or who have a disability now get their basic medical services (doctor visits, hospital visits, medicines, etc.), long-term services and supports, and service coordination through a STAR+PLUS managed care health plan.

Breast and Cervical Cancer Program

A new group will be added to the expansion on Sept. 1, 2017 – women who are enrolled in the Breast and Cervical Cancer Program. (See more about this expansion here.)

Adoption Assistance and Permanency Care Assistance

  • Beginning Sept. 1, 2017, people getting Medicaid through the Texas Department of Family and Protective Services (DFPS) Adoption Assistance and Permanency Care Assistance (AAPCA) programs will get their Medicaid services through managed care.
  • Most AAPCA clients will go into the STAR managed care program. Clients who receive Supplemental Security Income (SSI) and/or Medicare will go into the STAR Kids managed care program. AAPCA clients who get services through a 1915(c) waiver are already in STAR Kids.
  • Visit the AAPCA page for more information

You can see the STAR+PLUS health plans available in your area.

Selecting or Changing Your STAR+PLUS Health Plan

Changing Your Health Plan

If you would like to change your health plan, call 1-800-964-2777 (toll-free).

Finding a Doctor

To find out if your doctor or specialist is in a health plan’s network:

  • Call the health plan. Each plan’s toll-free number is listed below. Ask if the doctor or specialist you want is in the plan’s network.
  • Go online to see the health plan’s website. Each plan’s website is listed below. Look for the plan’s provider list, then, look to see if the name of your doctor or specialist is on that list.

If the doctor you want is not in a health plan’s network, you can ask the plan to invite the doctor to become part of that plan’s network.

More Information about STAR+PLUS

Service Coordination

Your STAR+PLUS health plan provides you with a service coordinator. This is someone who will work with you, your family, and your doctors to find out what services you need and help you get them. A service coordinator can:

  • Work with Medicaid and Medicare providers.
  • Approve community-based long-term services and supports.
  • Arrange for other services like rides to your doctor visits.
  • Find help if you’re not able to pay your basic needs like rent or utilities.

Call your health plan's service coordinator at the toll-free number listed below:

MCO Name

STAR+PLUS Service Coordination Hotline

Amerigroup STAR+PLUS 1-800-315-5385 Ext. 35765
Amerigroup STAR+PLUS IDD 1-866-696-0710 Ext. 36171
Cigna-HealthSpring 1-877-725-2688
Molina Healthcare of Texas 1-866-409-0039

Superior HealthPlan

1-877-277-9772

UnitedHealthcare Community Plan

1-800-349-0550

Contact Your STAR+PLUS Health Plan

Call your STAR+PLUS health plan at one of the toll-free numbers listed below if you need help:

  • Learning more about service coordination.
  • Setting up a doctor visit.
  • Getting a prescription filled.
  • Getting any other service Medicaid covers.

These are the health plan phone numbers and websites:

Not sure what service area you live in? Look at this map.

If you have concerns about your health plan, you can call the Texas Health and Human Services Office of the Ombudsman Medicaid Managed Care Helpline at 1-866-566-8989.

Continuity of Care

Your health plan wants to be sure you keep getting the services you need as you begin getting those services through STAR+PLUS. Your plan will:

  • Honor the long-term services and support authorizations you have now. Your plan will honor those authorizations for up to 6 months, or until the health plan does a new assessment.
  • Let you keep getting services from any Medicaid provider for up to 90 days from the date your health plan coverage started.
  • After the 90 days, your plan will keep paying providers you see that are not in your health plan’s network. These non-network providers will be paid an out-of-network reimbursement rate set by the state.
  • Allow you to change your main doctor (primary care provider) at any time.
  • Invite any Medicaid provider to join the health plan's network.
  • Allow you to request a plan change at any time. Any STAR+PLUS health plan you pick will provide you all the Medicaid benefits and extra value-add benefits that are not included in Traditional Medicaid.
  • If you have an intellectual and developmental disability, a service coordinator from your STAR+PLUS health plan will contact you within 90 days of the date your coverage started with the health plan.

Sample Enrollment Packets and Letters

Sample enrollment packet for those covered by Medicaid who must enroll in STAR+PLUS
Sample enrollment packet (PDF)

STAR+PLUS Letters for people living in nursing homes:
For those covered by both Medicare and Medicaid who must enroll in STAR+PLUS

For those covered by Medicaid only who must enroll in STAR+PLUS

For those covered by both Medicare and Medicaid who can choose to enroll in STAR+PLUS

For those covered by Medicaid only who can choose to enroll in STAR+PLUS

Medicaid providers can learn more about how these changes will affect their business processes.

Questions and Answers About the STAR+PLUS

Can a member appeal a denial or a change in authorized services in STAR+PLUS?

Yes, a member may file an appeal with the health plan. Instructions on how to file an appeal can be found in the plan’s member handbook. A member may request a fair hearing from the state at the same time they file an appeal with the health plan. If members get a notice of agency action, instructions for requesting an appeal are included on the notice. If members do not get a notice, they may contact 2-1-1 or their service coordinator.

Will members’ current services continue during the appeals process?

If the appeal is filed by the effective date on the eligibility notice, services will remain at the current level until the fair hearing decision.

Who makes the final decision on fair hearings about STAR+PLUS services?

A state fair hearings officer makes the final decision in a fair hearing.

STAR+PLUS and HIPP

If you have an intellectual and or developmental disability and are enrolling in STAR+PLUS, and you also are enrolled in the Health Insurance Premium Payment (HIPP) program, here are some things you need to know:

  • HIPP will pay you back for premiums you pay for the health insurance you get through work.
  • If you get a Medicaid-covered treatment or service from a Medicaid provider and the insurance you get through work charges your cost-sharing, the STAR+PLUS health plan you pick will pay the Medicaid provider for that.
  • If you get Medicaid-covered basic health services (acute care) from a Medicaid provider that you can't get through your work insurance, your STAR+PLUS health plan will pay for those services.
  • If you live in an ICF-IID or receive CLASS, DBMD, HCS or TxHmL waiver services, you will continue to get long-term services and supports through your existing program(s).

To learn more about the HIPP program, visit www.GetHIPPTexas.com. If you have questions about HIPP and Medicaid coverage, call the HIPP helpline at 1-800-440-0493.

Resources for Providers