Traditional vs Star-Plus

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 Health & Star+Plus: This is the system where you are enrolled with a specific MCO companyand 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.)
    • As of September 2014, all individuals over 21 years old receiving Medicaid are enrolled in Star+Plus Medicaid and must choose a MCO to manage their Medicaid… unless they received Medicare+Medicaid.
    • If an individual receives Medicare+Medicaid (called Dual Eligibility), they continue with traditional Medicaid.
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2 Responses to Traditional vs Star-Plus

  1. Elizabeth Garcia says:

    Does traditional medicaid pay for a home provider?

    Like

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