STAR+Plus
STAR+PLUS is a Texas Medicaid-managed care program for adults who have disabilities or are age 65 or older.
STAR+PLUS
STAR+PLUS is designed to meet the unique needs of adults who have disabilities or are age 65 or older.
Community First Health Plans provides Service Coordination for our STAR+PLUS Members. Service Coordination helps identify needs and connects Members to services and providers. Community First Service Coordinators review each Member’s specific needs, help the family and health plan create a unique individual service plan for each Member, and assist the member in getting medical and long-term services and support they need as they relate to health and independent living.
Program Benefits & Services
STAR+PLUS is designed to meet the unique needs of adults who have disabilities or are age 65 or older. The program will include access to benefits such as:
- Prescription drugs
- Hospital care
- Primary and specialty care
- Preventive care
- Personal care services
- Private duty nursing
- Durable medical equipment and supplies
Long-term services and supports can include:
- Day Activity and Health Services (DAHS)
- Personal assistance services
- Habilitation services (learning to do activities of daily living)
- Emergency response services
Other services under the STAR+PLUS Home and Community-Based Services program include:
- Personal assistance services
- Adaptive aids
- Adult foster care home services
- Assisted living
- Emergency response services
- Home delivered meals
- Medical supplies
- Minor home modifications (making changes to your home so you can safely move around)
- Nursing services
- Respite care (short-term care to provide a break for caregivers)
- Therapies (occupational, physical and speech-language)
- Transition assistance services if someone is leaving a nursing facility to live in their home
Patient Requirements
The STAR+PLUS Program covers adults who have disabilities or are age 65 or older. Adults in STAR+PLUS get Medicaid healthcare and long-term services and support through a health plan that they choose.
Adults with complex medical needs can choose to live and receive care in a home setting instead of a nursing facility.
To get services through STAR+PLUS patients must: (1) be approved for Medicaid, (2) be one or more of the following:
-
- Age 21 or older, getting Supplemental Security Income (SSI) benefits and able to get Medicaid due to low income
- Not getting SSI and need the type of services in STAR+PLUS Home and Community-Based Services
- Age 21 or older, getting Medicaid through what are called “Social Security Exclusion programs” and meet program rules for income and asset levels
- Age 21 or over residing in a nursing home and receiving Medicaid while in the nursing home
- In the Medicaid for Breast and Cervical Cancer program
Important notes for those covered by Medicare:
-
- Patients can get STAR+PLUS even if they get Medicare unless they have Medicaid 1915 (c) waiver services or live in facilities for people with Intellectual and Developmental Disabilities (IDD).
- If patients are covered by both Medicare and Medicaid (also known as “dual eligible”) and they join STAR+PLUS, they will keep getting regular healthcare services through their Medicare doctor. STAR+PLUS does not change the way patients get Medicare services.
Provider Training
Free online provider education is available from both Community First Health Plans and Texas Health and Human Services Commission (HHSC). Many include Continuing Education credits. Check out the online options offered by HHSC and see below for Community First-led training sessions for our Providers.
For additional information about the STAR+PLUS Program, visit Texas Health & Human Services Commission (HHSC)
Community First Provider Educational Webinars
Access our library of benefits and resources available to our members from our Resources.
Handbooks, manuals, and Community First Health Plans’ newsletters are available in print, free of charge, and mailed within 5 days by calling Provider Relations at 210-358-6294 or by making a request through the secure Provider Portal.
Referrals & Letters of Agreement
Community First Health Plans does not require a referral for a Member to see a specialist. Some specialist offices may require or prefer to have a “referral.” PCPs should confirm with the specialist if a referral is needed from the PCP’s office for a patient to be seen.
If the specialist is out-of-network, Community First Health Plans will work to complete a Letter of Agreement (LOA)/ Single Case Agreement with the non-network specialist. These LOA/Single Case Agreements can be for one or several visits and lengths of time, depending on the medical necessity as determined by Community First Health Plans.
Maintenance & Outages
Any downtime for routine scheduled maintenance for Provider-facing systems are posted to Community First Health Plans’ website and shared with Community First Health Plans staff. A toll-free number is also provided and shared.
For outages and/or unplanned downtime, information will be posted to Community First Health Plans’ website, and appropriate toll-free numbers will be posted and shared with Community First Health Plans’ staff.
If you are a Community First Provider and need to reach us after hours or on the weekend, please call 210-227-2347.