STAR+PLUS vs. Medicaid Nursing Home Coverage in Texas: What’s the Difference?
Texas delivers most Medicaid long-term care through STAR+PLUS managed care — not traditional fee-for-service Medicaid. Understanding how STAR+PLUS works changes how families navigate nursing home Medicaid in Texas.
When most people say “Medicaid nursing home coverage,” they picture a straightforward government payment system. In Texas, the reality is more complex: most Medicaid long-term care is delivered through STAR+PLUS, a managed care program operated by private health plans contracted with the state. Understanding how STAR+PLUS works is essential for Texas families navigating long-term nursing home Medicaid.
The Bottom Line
In Texas, for most families, STAR+PLUS is Texas Medicaid — it is the primary way Medicaid pays for nursing home and community-based long-term care in most parts of the state. When a family says their parent is “on Medicaid” at a nursing home in Texas, they are almost certainly enrolled in STAR+PLUS. The practical implication is that the MCO assigned to the member has authority to authorize, manage, and sometimes limit the specific nursing home where care is provided. Families should communicate directly with the STAR+PLUS MCO’s service coordinator when questions arise about coverage, authorization, or care planning.
Questions Families Ask About This Decision
STAR+PLUS MCOs operating in Texas include Molina Healthcare, Aetna Better Health, United Healthcare Community Plan, and others depending on the region. Quality varies by MCO and by service area. The most important factors for nursing home care are: whether the preferred nursing facility is in the MCO’s network, the quality of the MCO’s service coordination, and whether the MCO has a track record of approving needed stays rather than denying or shortening them.
The MCO must authorize nursing home admission based on a medical and functional assessment confirming nursing facility level of care need. If the MCO denies or limits a nursing home stay, the member has the right to appeal the decision. Texas HHSC and the Texas Long-Term Care Ombudsman can assist with appeals. Authorization decisions should be based on clinical criteria, not administrative cost management.
Every STAR+PLUS member in a nursing facility is assigned a service coordinator from their MCO. The service coordinator’s role is to assess needs, coordinate care between medical and LTSS providers, and help members access appropriate services. Families can contact the service coordinator directly through the MCO’s member services line. If the service coordinator is unresponsive, escalating to the MCO’s complaint and appeal department is appropriate.
Yes. STAR+PLUS provides both nursing facility care and home and community-based services (HCBS) for eligible members who prefer to remain in the community. HCBS services include personal attendant services, adult day programs, home health, and other supports. For members who prefer to remain at home or transition out of a nursing facility, the STAR+PLUS service coordinator can assess eligibility for community-based services.
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