1. Medicaid Managed Care Expansion
Presentation to the Texas Council of Community MHMR Centers
November 2010

2. Expansion Counties Within the Year
Contract amendments with existing health plans in each service area
Replaces PCCM in those counties
Operational September 2011
Bexar Service (STAR and STAR+PLUS)
Bandera
Harris Service Area (STAR and STAR+PLUS)
Austin
Wharton
Matagorda
Jefferson Service Area (STAR and STAR+PLUS)
Chambers
Hardin
Jasper
Jefferson
Liberty
Newton
Orange
Polk
San Jacinto
Tyler
Walker
Lubbock Service Area (STAR)
Carson
Deaf Smith
Hutchison
Potter
Randall
Swisher
Nueces Service Area (STAR and STAR+PLUS)
Brooks
Goliad
Karnes
Kennedy
Live Oak
Travis Service Area (STAR and STAR+PLUS)
Fayette
El Paso Service Area (STAR)
Hudspeth

3. “Contiguous” Counties: September 2011
Service Area
County
STAR
STAR+PLUS
Bexar
Bandera X
El Paso
Hudspeth
Harris
Austin, Wharton, Matagorda
Jefferson
Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, Walker
Lubbock
Carson, Deaf Smith, Hutchinson, Potter, Randall, Swisher
Nueces
Brooks, Goliad, Karnes, Kennedy, Live Oak
Travis
Fayette
Bexar Service (STAR and STAR+PLUS)
Bandera
Harris Service Area (STAR and STAR+PLUS)
Austin
Wharton
Matagorda
Jefferson Service Area (STAR and STAR+PLUS)
Chambers
Hardin
Jasper
Jefferson
Liberty
Newton
Orange
Polk
San Jacinto
Tyler
Walker
Lubbock Service Area (STAR)
Carson
Deaf Smith
Hutchison
Potter
Randall
Swisher
Nueces Service Area (STAR and STAR+PLUS)
Brooks
Goliad
Karnes
Kennedy
Live Oak
Travis Service Area (STAR and STAR+PLUS)
Fayette
El Paso Service Area (STAR)
Hudspeth

4. November 14, 2018

5. Joint Reprocurement Standard process up for renewal
STAR, STAR+PLUS and CHIP current service areas
Plan for additional counties and benefits
The following areas have been identified as potential STAR+PLUS expansion areas due to the size of their SSI population and ability to support at least two managed care organizations: El Paso and Lubbock

6. Expansion of STAR and STAR+PLUS into South Texas
Requires legislative direction for Cameron, Hidalgo and Maverick
13 counties
350,000 new members
In the LAR for March 2012
Centers Impacted:
Coastal Plains (Brooks, Duval, Kenedy, Live Oak)
Tropical Texas (Cameron, Hidalgo, Willacy)
Border Region (Jim Hogg, Starr, Webb, Zapata)
Camino Real (Maverick, McMullen)
Projected Savings $140 million over 5 years
Prohibition against the use of health maintenance organizations in the Valley
Texas Government Code Sec DELIVERY OF SERVICES.
(e) Notwithstanding Subsection (b)(1), the commission may not provide medical assistance using a health maintenance organization in Cameron County, Hidalgo County, or Maverick County.
Brooks      South Texas     
Cameron     South Texas     
Duval       South Texas     
Hidalgo     South Texas     
Jim Hogg    South Texas     
Kenedy      South Texas     
Live Oak    South Texas     
Maverick    South Texas
McMullen    South Texas     
Starr       South Texas     
Webb        South Texas     
Willacy     South Texas     
Zapata     

7. PCCM converts to EPO Savings in the LAR
HHSC will include in joint procurement
All non-HMO counties
Implications:
No guarantee for monthly PCP fee
Providers contract and bill health plans not TMHP for covered services (not MH Rehab/CM)

8. Prescription Drug Carve-In
LAR has savings attached
for a March 2012
Implementation
Implications:
Physicians will have more PA processes and/or different PA processes for a consumer
Pharmacies will bill multiple HMOs not TMHP

9. Bottom Line
Unless the legislature acts to stop HHSC’s Medicaid Managed Care expansion plans, all centers will be contracting with HMOs for Medicaid “card” services. Operational start dates as early as September 2011 for some, and by March 2012 for everyone else.