STAR+PLUS

STAR+PLUS
CONCEPTS

STAR+PLUS

STAR+PLUS is a Texas Medicaid managed care program for adults who have disabilities or are age 65 or older.

Adults in STAR+PLUS get Medicaid health-care and long-term services and supports through a health plan that they choose.

What are the 4 kinds of services and supports STAR+PLUS offers?

STAR+PLUS
CONCEPTS

4 Kinds of Services and Supports

Daily Activities
Help in your home with basic daily activities.

Home Modifications
Help in making changes to your home so you can safely move around.

Short-term Care
Short-term care to provide a break for caregivers.

Errands
Help with things that need to get done.

STAR+PLUS
SERVICES

Individual Service Plan
STAR+PLUS
CONCEPTS
Long-term services and supports can include:
  • Day Activity and Health Services (DAHS)
  • Personal Assistance Services (PAS)
Other services under the STAR+PLUS Home and Community-Based Services Waiver include:
  • Adaptive aids
  • Adult foster care home services
  • Assisted living
  • Emergency response services
  • Home delivered meals
  • Medical supplies
  • Minor home modifications (making changes to your home so you can safely move around)
  • Nursing services
  • Respite care (short-term care to provide a break for caregivers)
  • Therapies (occupational, physical, and speech-language)
  • Transitional assistance services
Long-Term Services
and Supports

Community First Choice
(CFC)

STAR+PLUS
TERMS

COMMUNITY FIRST
CHOICE (CFC)

  • Day activity and Health Services (DAHS)
  • Personal Assistance Services (PAS)
  • Emergency Response Services (ERS)
  • Service Coordination
Long-Term Services
and Supports

Home and Community Based Services (HCBS)

STAR+PLUS
TERMS
  • Day activity and Health Services (DAHS)
  • Personal Assistance Services (PAS)
  • Emergency Response Services (ERS)
  • Nursing Facilities (NFs)
  • Adult Foster Care
  • Assisted Living (AL)
  • Minor Home Modifications (MHMs)
  • Respite Care Services
  • Employment Services
  • Home-Delivered Meals (HDM)
  • Supported Employment Services (SES)
  • Transition Assistance Services (TAS)
  • Dental Services
  • Service Coordination
Long-Term Services
and Supports

Medicare – Medicaid Plans
(MMP)

STAR+PLUS
TERMS

MEDICARE –
MEDICAID PLANS (MMP)

  • Day activity and Health Services (DAHS)
  • Personal Assistance Services (PAS)
  • Emergency Response Services (ERS)
  • Nursing Facilities (NFs)
  • Adult Foster Care
  • Assisted Living (AL)/Home Care
  • Minor Home Modifications (MHMs)
  • Respite Care Services
  • Short-Term Help for Caregivers
  • Adaptive Aids
  • Service Coordination
Long-Term Services
and Supports

Intellectual or Developmental Disability (IDD)

STAR+PLUS
TERMS
  • Day activity and Health Services (DAHS)
  • Personal Assistance Services (PAS)
  • Emergency Response Services (ERS)
  • Nursing Facilities (NFs)
  • Community Living Assistance and Support Services (CLASS)
  • Deaf Blind with Multiple Disabilities (DBMD)
  • Texas Home Living (TxHml)
  • A group home with other IDD individuals
  • Home and Community-Based Services (HCS)
  • A State Supported Living Center
  • Intermediate Care Facility
  • Service Coordination

Who is NOT
Eligible for STAR+PLUS?

STAR+PLUS
RULES

Who is NOT Eligible

  • If over 21 and receive Medicaid 1915(c) waiver services or who live in community homes for people with Intellectual Developmental Disabilities (IDD), and get Medicare.
  • People who are not able to get full Medicaid benefits,
  • People who don’t qualify for Medicaid.
  • Children in state foster care.

How many DAYS before service coordinator must visit with a new member?

STAR+PLUS
RULES

STAR+PLUS SERVICES
PLAN OF CARE

Medical plans must have a service coordinator visit with the member within 30 days of enrolling in the program.

The coordinator must find out the member's needs and develop a plan of care.

Who IS Eligible for STAR+PLUS?

STAR+PLUS
RULES

Who is Eligible

  • Must be approved for Medicaid
  • Must be one or more of the following:
  • Age 21 or older, getting Medicaid through Social Security Exclusion programs
  • Age 21 or over residing in a nursing home
  • In the Medicaid for Breast and Cervical Cancer program
  • You can get STAR+PLUS even if you get Medicare.

Home and Community Based Services Program

Sometimes referred to as STAR+PLUS Waiver 1915, HCBS
STAR+PLUS
CONCEPTS

Home and Community
Based Services Program

The STAR+PLUS Home and Community Based Services program provides services that help people live at home who would otherwise need to be in a nursing facility.

HHSC assesses a person’s need for this program when they apply for Medicaid.

Service
Coordination

Service coordination available to all members, is the main feature of the STAR+PLUS program.
STAR+PLUS
CONCEPTS
Interdisciplinary Team (IDT) - all individuals involved in planning the member's plan of care (POC). This typically includes the member, the members authorized representative, the service coordinator, the primary physician, etc.

Service coordination means that plan members, family members, and providers can work together to help members get acute care

Activity of
Daily Living

STAR+PLUS
TERMS
ACRONYM:

ADL

Definition:

Activities of Daily Living is a Medicaid benefit that helps clients with everyday tasks.

Examples of ADLs:
  • Day activity and Health Services (DAHS)
  • Personal Assistance Services (PAS)
  • Emergency Response Services (ERS)
  • Service Coordination

Day Activity and Health Services

STAR+PLUS
TERMS
ACRONYM:

DAHS

Definition:

Licensed Day Activity and Health Services facilities provide daytime services, up to 10 hours per day, Monday through Friday, to people who live in the community. Services address physical, mental, medical and social needs.

Individual Service Plan

STAR+PLUS
TERMS
ACRONYM:

ISP

Definition:

An individualized and person-centered plan in which a member enrolled in the STAR+PLUS HCBS program operated by the MCO, with assistance as needed, identifies and documents his or her preferences, strengths, and health and wellness needs in order to develop short-term objectives and action steps to ensure personal outcomes are achieved within the most integrated setting by using identified supports and services.

Local Intellectual and Development Disability Authority

STAR+PLUS
TERMS
ACRONYM:

LIDDA

Definition:

Local intellectual and developmental disability authorities (LIDDAs) serve as the point of entry for publicly funded intellectual and developmental disability (IDD) programs, whether the program is provided by a public or private entity.

Long Term Services and Supports

STAR+PLUS
TERMS
ACRONYM:

LTSS

Definition:

Services, including Primary Home Care, Day Activity and Health Services, and the STAR+PLUS HCBS program, that assist members in living in the community.

Personal
Assistance
Services

STAR+PLUS
TERMS
ACRONYM:

PAS

Definition:

Personal Assistance Services is a Medicaid benefit that helps clients with everyday tasks.
  • Bathing
  • Eating
  • Assisting with toileting
  • Dressing
  • Assisting with walking
Examples of IADLs:
  • Laundry
  • Light housework
  • Meal preparation