STAR+PLUS Expansion

1. STAR+PLUS Expansion Heather Powell Managed Care Operations Specialist/Medicaid CHIP

2. STAR+PLUS Expansion Background • May 2009 - HHSC ceased operation of the Integrated Care Management (ICM) program in the Dallas and Tarrant service areas. • ICM served over 75,000 seniors and persons with disabilities. • 2010-11 General Appropriations Act • Requires HHSC to implement the most cost-effective, integrated managed care model for these clients in Dallas/Tarrant service areas. • After reviewing its current managed care models, HHSC determined that STAR+PLUS best meets these legislative requirements. • Early September, HHSC conducted stakeholder meetings in Dallas/Fort Worth to gather feedback on the expansion.

3. STAR+PLUS Expansion Rationale • In addition to meeting the legislative requirements for managed care in Dallas and Tarrant, STAR+PLUS: • Created specifically to serve the elderly and persons with disabilities • operation since 1998 and currently serves over 164,000 clients in 29 counties • Contains costs while maintaining quality of care for its members

4. STAR+PLUS Expansion Rationale, continued • STAR+PLUS integrates acute care and community-based long-term care services to achieve a seamless continuum of care for members. • MCOs are responsible for coordinating acute and long-term services through the use of a service coordinator. • In-patient hospital services are paid by the Texas Medicaid & Healthcare Partnership (TMHP) through fee-for-service.

5. STAR+PLUS Expansion Comparison to ICM • STAR+PLUS is significantly different from ICM in many ways: • Medicaid managed care organizations (MCOs) pay provider claims directly and can negotiate rates with providers. • MCOs set requirements for acute care prior authorization and have authority to authorize long-term care services directly. • Members have multiple MCOs from which to choose. • MCOs can offer value-added services to members at no cost. • STAR+PLUS has a proven record of success serving the elderly and disabled Medicaid population in other parts of Texas.

6. STAR+PLUS Expansion Member Characteristics • STAR+PLUS is expected to serve over 240,000 clients after expanding into the Dallas and Tarrant service areas in 2011. • 164,000 current members + 78,000 Dallas/Tarrant members • 53% of STAR+PLUS members are dual eligible clients (have both Medicare and Medicaid). • 7% (12,948) of STAR+PLUS members currently receive community-based long-term care services through the 1915 c waiver. • Expected to increase to over 16,000 post-expansion

7. STAR+PLUS Expansion Status and Next Steps • HHSC posted a draft Request for Proposals (RFP) to solicit MCOs to serve as STAR+PLUS health plans in Dallas and Tarrant service areas. • HHSC revised the RFP based on stakeholder feedback and expects to post the final RFP in mid-November. • Program implementation is expected in early 2011.