This week, our In Focus section reviews the Texas STAR+PLUS request for proposals (RFP) issued on December 4, 2017. The STAR+PLUS Medicaid managed care program covers approximately 519,000 individuals who have disabilities or are aged 65 or older. The program will integrate Acute Care services and Long-Term Services and Supports (LTSS), and cover members including those with intellectual or developmental disabilities (IDD) and dual eligibles. Managed care organizations (MCOs) will also provide access to behavioral health services, such as mental health and substance use disorder counseling and treatment. When fully implemented, Texas expects enrollment to be over 530,000 and annualized spending over $7.5 billion, based on FY 2018 data.
The Texas Health and Human Services Commission (HHSC) will award contracts to at least two MCOs for each Texas Service Area (SA). These are: Bexar, Central Texas, Dallas, El Paso, Harris, Hidalgo, Jefferson, Lubbock, Northeast Texas, Nueces, Tarrant, Travis, and West Texas.
The contracts are expected to start on January 1, 2020 and continue through August 31, 2022, with possible extension periods not to exceed a total of eight operational years.
Covered Populations and Market Size
The STAR+PLUS program will cover the following populations:
- Supplemental Security Income (SSI) eligibles age 21 and older;
- Individuals age 21 and older who are Medicaid eligible because they are in a Social Security Exclusion Program;
- Individuals who qualify for the STAR+PLUS Home and Community-Based Services (HCBS) program;
- Medicaid eligible residents of licensed nursing facilities;
- Individuals age 21 and older who are eligible for Medicare and Medicaid;
- Individuals eligible for the Medicaid for Breast and Cervical Cancer (MBCC) program, who are age 18 to 65;
- Individuals enrolled in the following § 1915(c) waiver programs receive Acute Care Covered Services from the MCO:
- Community Living Assistance and Support Services (CLASS);
- Home and Community-based Services (HCS);
- Deaf-Blind Multiple Disability waiver (DBMD); and
- Texas Home Living (TxHmL).
- Residents of community-based intermediate care facilities for individuals with intellectual disabilities or related conditions (ICF/IIDs) receive Acute Care Covered Services from the MCO. In this RFP, the Texas Health and Human Services Commission (HHSC) includes language that MCOs must be prepared under Readiness Review to demonstrate they can provide IDD LTSS services if HHSC determines that IDD LTSS is added to STAR+PLUS. A section has been added to the RFP for respondents to demonstrate their capacity to provide these services.
Texas’ federally-recognized tribes (Alabama-Coushatta Tribes of Texas, Kickapoo Traditional Tribes of Texas, and Yselta Del Sur Pueblo of Texas) may be included in the STAR+PLUS Program on a voluntary basis.
Non-emergency medical transportation; mental health rehabilitation and targeted case management for dual eligible; dual eligible participants of 1915(c) waiver programs and residents of community-based ICF/IID; and wrap-around services may be added to STAR+PLUS at any time, at the discretion of HHSC.
Proposals will be scored based on the following criteria:
Contracts will be effective January 1, 2020, through August 31, 2022. Proposals are due March 6, 2018.
Current Texas Market
Texas currently contracts with five STAR+PLUS plans: Anthem, Cigna, Centene, Molina, and UnitedHealthcare. Enrollment was over 519,000 as of February 2017.
The current program was procured through three different RFPs: STAR+PLUS Expansion for the Dallas and Tarrant Service Areas; Uniform Managed Care Contract for the Bexar, El Paso, Harris, Hidalgo, Jefferson, Lubbock, Nueces, and Travis Service Areas; and the STAR+PLUS Medicaid Rural Service Area (MRSA) for the Central Texas, Northeast Texas, and West Texas Service Areas.