Your Texas Medicaid can be managed by HHSC (Texas Health & Human Services Commission), or sold to a MCO (Managed Care Organization)… similar to an HMO.
- “Traditional Medicaid”: This is the system where all bills go to the HHSC system and are paid by Texas directly to providers enrolled with Medicaid. This is also known as “fee-for-service” since Texas would pay the bill each time you go to a doctor or hospital.
- Star, StarKids, Star Health & Star+Plus: This is the system where you are enrolled with a specific MCO company and Texas pays that MCO a lump sum per month. Then your bills are paid by the MCO. (This is NOT “fee-for-service” since Texas does NOT pay the bill each time you go to the doctor or hospital.)
- Star is the managed-care system for non-disabled children and pregnant women who received Medicaid due to low income qualifications.
- StarKids is the managed-care system for children (0-20 yrs) who have a disability. They may receive Medicaid through SSI, Medicaid waiver enrollment, or the Medicaid Buy-in for Children. (Effective 11/2016)
- Star Health is the managed-care system for children in the custody of Child Protective Services.
- Star+Plus is the managed care system for adults (21+ yrs) who have a disability. (Effective 9/2014)
- If an individual receives Medicare+Medicaid (called Dual Eligibility), they are scheduled to be enrolled in managed-care Medicaid in Fall 2018.
texasmedicaidwaivers.com 