Types of Medicaid

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.

9 Responses to Types of Medicaid

  1. Elizabeth Garcia says:

    Does traditional medicaid pay for a home provider?

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  2. Breanna says:

    If a patient is in the hospital long term will the Medicaid plan automatically change?

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  3. Breanna says:

    Will Medicaid automatically change for my child who is in the hospital currently to another plan

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  4. Heather says:

    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.

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  5. Sara says:

    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.

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