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 will be enrolled in managed-care Medicaid in Fall 2018.
Does traditional medicaid pay for a home provider?
Yes, any Medicaid will pay for attendant care. Look at the page on CFC: https://texasmedicaidwaivers.com/medicaid/benefits-of-medicaid/community-first-choice/
If a patient is in the hospital long term will the Medicaid plan automatically change?
I think that there is a specific type of Medicaid for nursing homes, but I have not research that at all.
Will Medicaid automatically change for my child who is in the hospital currently to another plan
No, the only people not on Star, Star Health, STARKids, or Star+Plus are dual eligible individuals (who receive Medicare & Medicaid). You do not have the option to return to traditional Medicaid unless you become dual eligible.
Eventually, dual eligible individuals will also be enrolled in Managed Care too.
If someone has Star Plus and Molina or other one like it, can they opt out and get Traditional Medicaid? Because the specialists they need to see only take Traditional.
No, Texas is gradually handing over the job to managed care, and they won’t have Traditional at all once that is complete.