Current through Reg. 49, No. 38; September 20, 2024
(a) Enrollment
in the STAR+PLUS program is mandatory for Medicaid recipients
who meet one or more of the following criteria:
(1) have a physical or mental disability and
qualify for Supplemental Security Income (SSI) benefits or for Medicaid due to
low income;
(2) qualify for
STAR+PLUS Home and Community-Based Waiver Services;
(3) are age 21 or older and receive Medicaid
because they are in a Social Security Exclusion program and meet financial
criteria for STAR+PLUS Home and Community-Based Services Program;
(4) are age 21 or older and reside in a
nursing facility;
(5) are over 18
and under 65 and qualify for Medicaid for Breast and Cervical Cancer as
described in Chapter 366, Subchapter D, of this title (relating to Medicaid for
Breast and Cervical Cancer); or
(6) FFCC members age 21 through the month of
his or her 26th birthday who meet the criteria in subsections (b) or (e) of
this section.
(b) In
addition to the Medicaid recipients who must enroll in the STAR+PLUS program
under subsection (a) of this section, recipients age 21 or older residing in a
community-based ICF-IID or receiving services under the following Medicaid
1915(c) waivers and not enrolled in Medicare must enroll in STAR+PLUS to
receive acute care services:
(1) Home and
Community-based Services (HCS);
(2)
Community Living Assistance and Support Services (CLASS);
(3) Texas Home Living (TxHmL); and
(4) Deaf Blind with Multiple Disabilities
(DBMD).
(c) Medicaid
recipients will have a choice among at least two MCOs.
(d) The following Medicaid recipients
cannot participate in the STAR+PLUS program:
(1) persons under age 21;
(2) residents of state supported living
centers;
(3) persons not eligible
for full Medicaid benefits; and
(4)
persons enrolled in Programs of All-Inclusive Care for Elderly
(PACE).
(e) Dual
eligible individuals.
(1) Enrollment in
Medicare does not affect eligibility for the STAR+PLUS program, except as
specified in subsection (b) of this section.
(2) Dual eligible individuals who participate
in the STAR+PLUS program receive most acute care services through their
Medicare provider, and STAR+PLUS Home and Community-Based Services Program
through the STAR+PLUS MCO. Dual eligible individuals who participate in the
STAR+PLUS program receive most acute care services through their Medicare
provider, but may receive additional services through their STAR+PLUS MCO. The
STAR+PLUS program does not change the way dual eligibles receive Medicare
services.
