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Medicaid Managed Care Program Expands

From Staff Reports

The 82nd Legislature directed the Health and Human Services Commission (HHSC) to expand managed care statewide to achieve state budget savings and preserve hospital access to funding consistent with Upper Payment Limit funds (UPL). As a result, small urban regions and rural areas will now be transitioning to the managed care model of Medicaid with certain regions beginning the transition in September 2011 and full implementation expected in March 2012. HHSC has published an implementation timeline with service area maps.

There are two models operating in Medicaid managed care: STAR, which provides services primarily to pregnant women and children, and STAR+Plus, which provides services to persons with disabilities. However, STAR+Plus will not be implemented in rural counties; the traditional Department of Aging and Disability Services (DADS) programs will continue to serve people in those areas.

Medicaid recipients will still receive the same health benefits under the managed care program in addition to case work, care coordination, disease management, provider locating and transportation assistance.

HMO Member Benefits include:
Traditional Medicaid benefit package
Provider directories – physicians, specialists, and LTSS
PCP to coordinate health care of patient (Medicaid only)
Member services helpline (through their health plan)
Member handbooks and health education
Service coordination
Value added services – vary by health plan

Traditional Medicaid providers will now have to enroll to provide services under the managed care plans. Most providers should have received contact from those health plans, but a provider can see who is operating in their area by visiting the HHSC map. Providers who have previously accepted Medicaid may qualify as significant traditional providers and the health plans are obligated to offer to contract with those providers and offer them the opportunity to be included in the network.

More Info
Providers can receive additional information about the Medicaid program.