Texas Gets Approval for Waiver Expanding Medicaid Managed Care

Health Care

Texas received approval from the Centers for Medicare and Medicaid Services (CMS) on Dec. 12, 2011, for a waiver that allows the state to expand Medicaid managed care statewide. This waiver, the Texas Healthcare Transformation and Quality Improvement Program, also preserves funding for hospitals, provides incentive payments for health care improvements and directs more funding to hospitals that serve large numbers of uninsured patients.

Under this Section 1115 demonstration waiver, Medicaid managed care will expand into 174 more Texas counties on March 1, 2012. The STAR managed care program will become statewide at this time, while STAR+PLUS will only be in specific counties. STAR+PLUS serves people who have disabilities or who are age 65 or older by combining traditional health care, such as doctor visits, with community-based long-term services and support, such as help at home with daily activities, home modifications, respite care and personal assistance. Numerous events are scheduled in expansion counties to help people prepare for the switch to managed care, as listed at http://www.txmedicaidevents.com.

Individuals eligible for Supplemental Security Income (SSI) or SSI-related Medicaid and receiving Consumer Managed Personal Attendant Services (CMPAS) will be enrolled in the STAR+PLUS. However, individuals receiving CMPAS at the time of the expansion whose spouses are their paid attendants may choose to remain in CMPAS and will not be enrolled in the STAR+PLUS program. Individuals who choose this option will be enrolled in the STAR+PLUS program later if the spouse stops serving as the paid attendant.

The Health and Human Services Commission (HHSC) applied for the waiver earlier this year as directed by Gov. Rick Perry and the Texas Legislature, to identify innovative, state-based solutions to Texas’ health care needs.