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.
Texas Medicaid Waivers Explained 
Does traditional medicaid pay for a home provider?
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Yes, any Medicaid will pay for attendant care. Look at the page on CFC: https://texasmedicaidwaivers.com/medicaid/benefits-of-medicaid/community-first-choice/
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If a patient is in the hospital long term will the Medicaid plan automatically change?
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I think that there is a specific type of Medicaid for nursing homes, but I have not research that at all.
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Will Medicaid automatically change for my child who is in the hospital currently to another plan
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No
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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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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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No, Texas is gradually handing over the job to managed care, and they won’t have Traditional at all once that is complete.
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