HHSC contracts with managed care organizations (MCO) and pays each MCO monthly to coordinate health services for people enrolled in Medicaid or Children’s Health Insurance Program (CHIP) MCOs. HHSC delivers most Medicaid and all CHIP prescription drug benefits through managed care. Each MCO contracts directly with pharmacy benefit managers (PBM) to create pharmacy provider networks people can use to fill prescriptions.
The type of Medicaid coverage a person receives depends on where the person lives and their health. The following are the Medicaid managed care programs in Texas:
STAR is a program for children, newborns, pregnant women, and some families and children. People in STAR get all their services through an MCO.
STAR+PLUS is a program for people who have disabilities or are age 65 or older. People in STAR+PLUS also receive their essential medical services and long-term services through an MCO.
STAR Health is a program for children who receive coverage through the Texas Department of Family and Protective Services. STAR Health also is for young adults who were previously in foster care.
STAR Kids is a program for children and adults 20 and younger who have disabilities.
STAR+PLUS Medicare-Medicaid Plans
HHSC and the federal Centers for Medicare and Medicaid Services (CMS) have set up combined Medicare-Medicaid plans for people in those counties with both Medicare and Medicaid coverage, known as dual eligibles. With one plan, Medicare and Medicaid benefits work together to better meet the client’s healthcare needs by offering essential health care and long-term services.