Information for parents whose children receive Medicaid

[Guest guest]

Changes are coming to Medicaid. The STAR+PLUS expansion is only weeks away.

The Texas Health and Human Services Commission is expanding STAR+PLUS to four

new major service areas effective January 1st. The following information is

intended to help you decide if these changes will affect you, your family

member, or members of your organization.

STAR+PLUS is a managed care program that combines Medicaid acute medical care

with Medicaid community long term services and supports. Services are provided

by the managed care companies known as “health plans.” There will be at least

two health plans providing services in each of the new service areas. The STAR

PLUS expansion will affect most individuals in the expansion areas who receive

Medicaid and are SSI eligible.

The new service areas include the , Nueces, and Bexar areas, as well as

the counties surrounding County ( County already has STAR+PLUS).

For a complete list of all affected counties, please check the STAR+PLUS website

(www.hhsc.state.tx.us/starplus/starplus.htm).

Many individuals in these services areas will experience changes in how they

receive their health and community long term services and supports. Adults over

the age of 21 who are SSI eligible are required to enroll in STAR+PLUS to

receive services. Children under the age of 21 are considered voluntary and can

choose to enroll in STAR+PLUS or remain in traditional fee for service Medicaid.

There are a few exceptions however. Individuals residing in institutions

(nursing facilities, ICFsMR, or state schools) and individuals receiving

Medicaid waiver services other than CBA (Community Based Alternatives) are

excluded from STAR+PLUS.

Eligible individuals were mailed enrollment packets from the Health and Human

Services Commission over the past few weeks. The enrollment packets provide all

the information on how to enroll. Texas Access Alliance is the enrollment

broker for HHSC and will be contacting individuals who do not return the

enrollment forms.

Individuals currently receiving CBA Services have until mid-December to select

the health plan they want to use. If they do not voluntarily select a plan,

they will be automatically enrolled in a health plan as of January 1st, 2007.

Other eligible individuals who are not currently receiving CBA services will

have until mid-February to submit their enrollment forms. If they do not

voluntarily select a plan, they will be assigned a health plan as of March 1st,

2007. Members will be allowed to change health plans.

Services and supports will not be cut off as of the start-up date. The health

plans have up to 90 days to contact those currently receiving long term services

and supports (CBA or Primary Home Care services) to perform an assessment and

put a new plan in place if necessary. Until a new plan is in place, current

services will continue.

One of the most significant benefits of STAR+PLUS is how it will affect

individuals on the CBA waiting list. All individuals on the CBA waiver waiting

list who are SSI eligible, will be eligible to be assessed for long term

services and supports as of January 1st. If they meet CBA eligibility criteria,

they will receive the appropriate services and will come off of the CBA waiting

list. Individuals on the waiting list who are not SSI eligible (MAOs, those

between 100% and 300% of SSI), will remain on the waiting list until a waiver

slot becomes available.

There are a lot of complexities around the STAR+PLUS expansion. The Health

and Human Services Commission has contracted with the Texas Center for

Disability Studies to perform outreach and community trainings. The Center has

partnered with two local/community organizations in each expansion region to

assist with outreach efforts. The local educational meetings are intended to

help individuals, families and advocates understand the changes, provide

information on how to select a health plan, and answer questions on the

enrollment process. If you are affected and have questions, or if you have a

group of individuals (large or small) who would like to participate in one of

the STAR+PLUS community education meetings, please contact one of the local

partners in your area. A list of local partners is attached to this email.

M. Guppy

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Texas Autism Advocacy: www.TexasAutismAdvocacy.org

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compromise. We cannot negotiate the size of an institution. No one should live

in one. We cannot debate who should get an inclusive education. Everyone

should. We cannot determine who does and who does not get the right to make

their own choices and forge their own futures. All must. "