Texas is an MLTSS state — meaning your clients' Medicaid benefits, including long-term care, run through managed care organizations, not fee-for-service. STAR+PLUS is the program. Seven MCOs hold contracts across 13 Service Delivery Areas as of September 2024. The authorization that enables you to be paid comes from the MCO's care coordinator, in a document called the Individual Service Plan. The claim goes to the MCO, not to TMHP directly — unless you're serving the small remaining FFS population. And the Dual Demonstration ended January 1, 2026, meaning former MMP members needed new authorizations in your EVV system. Here is the full operational picture.
STAR+PLUS is Texas's mandatory Medicaid managed care program for adults 21 and older who receive SSI benefits (disability) and adults 65 and older. It operates under a 1115 waiver administered by the Texas Health and Human Services Commission (HHSC). The program covers both acute care (medical visits, pharmacy, behavioral health) and long-term services and supports (personal attendant services, assisted living, home modifications, day care) through a single MCO.
For home care agencies, this means one critical operational reality: you bill the MCO, not the state. The MCO authorizes services through an Individual Service Plan (ISP). The ISP must be in place before services begin. The MCO pays claims on its own schedule and through its own portal or clearinghouse. Being enrolled with TMHP gives you a Medicaid provider number — it does not give you the ability to get paid for STAR+PLUS members. You must be contracted and credentialed with each MCO separately.
STAR+PLUS covers personal attendant services, assisted living facility services, adult day activity and health services, emergency response, home modifications, non-medical transportation, home-delivered meals, and more — all within a single managed care plan that also covers the member's medical care.
The ISP, developed by the MCO's service coordinator in collaboration with the member, authorizes all services. The MCO care coordinator is your primary contact for new authorizations, renewal, and changes. Prior authorization is required for STAR+PLUS HCBS services before billing.
STAR+PLUS HCBS is the 1915(c) waiver component within STAR+PLUS, providing services for members who would otherwise need nursing facility placement. It has a limited number of slots and an interest list that runs many years for new applicants.
Upgrade pathway: Members already enrolled in STAR+PLUS can request an upgrade to HCBS through their MCO — this may allow them to bypass the interest list. Medical Assistance Only individuals must reach the top of the interest list through HHSC Interest List Management. The cost of HCBS services on an ISP cannot exceed 202% of nursing facility cost.
New STAR+PLUS contracts took effect September 1, 2024. Three MCOs were new to the program. Service Delivery Area assignments changed for most SDAs. If you serve STAR+PLUS members, your contract and credentialing status with each MCO determines which members you can serve in each region.
| MCO | Service Delivery Areas (representative — verify with HHSC) | Notes |
|---|---|---|
| Anthem Blue Cross and Blue Shield (new) | Select SDAs — verify on HHSC website | New to STAR+PLUS as of September 2024 |
| Amerigroup Insurance Company | Multiple SDAs statewide | Continuing MCO from prior contract period |
| Community First Health Plans | Bexar area | Regional plan; local focus San Antonio area |
| Community Health Choice Texas | Harris area | Regional plan; local focus Houston area |
| El Paso Health | El Paso area | Regional plan; El Paso County focus |
| Molina Healthcare of Texas | Multiple SDAs including Dallas, Harris, Hidalgo | Continuing MCO; absorbed former MMP members in its SDAs Jan 2026 |
| Superior HealthPlan (Centene) | Multiple SDAs including Central, West, Travis, others | Continuing MCO; exited Bexar Sept 2024; entered Travis |
Each SDA may have 2–4 available MCOs. Members can change plans monthly. Verify current SDA assignments on the HHSC STAR+PLUS health plan profiles page before contracting efforts. Being contracted in one SDA does not automatically transfer to adjacent SDAs under the same MCO.
January 1, 2026 — Dual Demo Discontinuation: Texas ended its Medicare-Medicaid Plan (MMP) Dual Demonstration Program effective December 31, 2025. Former MMP members in Bexar, Dallas, El Paso, Harris, and Hidalgo counties moved to STAR+PLUS MCOs. Providers needed to create new authorizations in HHAeXchange using the new STAR+PLUS MCO plan codes for these members — the old MMP plan codes were deactivated. If you served Molina or Superior MMP members, verify you updated EVV authorizations to the correct STAR+PLUS plan codes for all affected members.
Becoming a billable STAR+PLUS provider requires three separate processes completed in sequence. Missing any one of them means you cannot be paid — even if you have the others in place.
| Member Type | Claim Destination | Authorization Source | Key Notes |
|---|---|---|---|
| STAR+PLUS MCO members (standard) | MCO directly | MCO ISP (Individual Service Plan) | ISP must be in place before service delivery. Authorization for HCBS services is required prior to billing. |
| STAR+PLUS HCBS waiver members | MCO directly (through waiver program within MCO) | MCO service coordinator via ISP | Bill the MCO for waiver services. Verify member is enrolled in HCBS waiver program within their MCO plan. |
| FFS Medical Assistance Only members | TMHP (via LTC Online Portal or EDI) | HHSC Program Support Unit | Small population. Verify member MCO enrollment through TMHP eligibility — most members are managed care. |
| Former MMP members (post Jan 2026) | New STAR+PLUS MCO directly | New STAR+PLUS MCO ISP | Requires new authorization in HHAeXchange with STAR+PLUS plan code. Old MMP plan codes deactivated. |
STAR+PLUS is Texas's mandatory MLTSS program for adults 21+ with disabilities (SSI) and adults 65+. It runs under a 1115 waiver. The MCO manages and pays for all acute care and long-term services and supports. For agencies, this means all authorization and billing go through the member's MCO — not through TMHP directly. The MCO develops an Individual Service Plan (ISP) that authorizes all services. No ISP means no payment. Seven MCOs hold contracts as of September 2024, operating across 13 Service Delivery Areas. Contract status varies by SDA, so check HHSC's SDA maps before targeting a market.
STAR+PLUS HCBS has a limited number of slots and an interest list that can run many years for new applicants applying through HHSC Interest List Management. The upgrade pathway is the practical alternative: members already enrolled in STAR+PLUS (receiving acute care benefits) can request an upgrade to HCBS through their MCO. The MCO evaluates the request and, if approved, may bypass the interest list entirely. As a provider, understanding the upgrade process matters because it is how most of your referrals will actually materialize — MCO care coordinators initiating upgrades, not members waiting years on the state interest list.
Texas ended its MMP Dual Demo December 31, 2025. Former MMP members in Bexar, Dallas, El Paso, Harris, and Hidalgo counties moved to STAR+PLUS MCOs effective January 1, 2026. Providers serving those members needed to identify each member's new STAR+PLUS MCO and plan code, create a new authorization in HHAeXchange using that plan code, and begin billing under the new plan. The old MMP plan codes stopped working. If you had Molina MMP members in Dallas, they transitioned to Molina's STAR+PLUS plan code. If you had Superior MMP members, they transitioned to Superior's STAR+PLUS code. Providers who did not update EVV authorizations in time created billing gaps.
CareBravo delivers scheduling, EVV compliance through HHAeXchange, authorization tracking across all seven STAR+PLUS MCO portals, and ISP-matched billing as completed operational work. The ISP-to-claim match — making sure every billed service has an active ISP authorization and a matching EVV record — is where Texas agencies lose revenue. CareBravo manages that match so your office isn't manually reconciling three systems for every visit.
Texas STAR+PLUS agencies that grow are the ones that master the MCO billing relationships first and stop losing revenue to authorization gaps. The CareDrain Diagnostic shows what your current operational gaps are costing monthly — before you decide what to fix.