Texas Dual Eligible Demonstration

Program Location: 
Austin, TX
Payer Type: 
Health Spring

CMS approved a Memorandum of Understanding with the state of Texas on 5/23/2014. The State of Texas Health and Human Services Commission is partnering with the Centers for Medicare & Medicaid Services to implement a new program designed to better coordinate care for clients who are eligible for both Medicare and Medicaid. The initiative aims to integrate the current, fragmented model of care for Medicare-Medicaid beneficiaries by creating a single point of accountability for the delivery, coordination, and management of Medicare and Medicaid services, including primary, preventive, acute, specialty, and behavioral health services, long-term services and supports (LTSS), and pharmacy products. 


Payment Model: 

Texas signed an MOU with CMS to test a capitated financial alignment model for Medicaid-Medicare enrolees. The initiative will test the effect of an integrated care and payment model on serving both community and institutional populations. In order to accomplish these objectives, comprehensive contract requirements will specify access, quality, network, financial solvency, and oversight standards.

Under this initiative, these managed care plans, called STAR+PLUS (State of Texas Access Reform Plus) Medicare-Medicaid Plans (MMPs) in Texas, will be required to provide for, either directly or through subcontracts, Medicare and Medicaid-covered services, as well as additional items and services, under a capitated model of financing. CMS, the State, and the STAR+PLUS MMPs will ensure that beneficiaries have access to an adequate network of medical, behavioral health, and supportive services.

Last updated March 2019
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