There are mandatory groups of people that are able to get Medicaid no matter where they live. These mandatory groups include low income people with a physical or mental disability, low income families with dependent children, and women who are pregnant and have children and are below the federal poverty level.
You must join STAR+PLUS if you live in a STAR+PLUS service area and fit one of the requirements below:
- People age 21 or older who can receive Medicaid because they are in Social Security Exclusion program and meet financial criteria for waiver services.
- People age 21 or older who are receiving Supplemental Security Income (SSI).
- People who have a physical or mental disability and qualify for supplemental security income (SSI) benefits or for Medicaid due to low income.
- People who are able to get Community-Based Alternatives (CBD) waiver services.
- People who receive services in community-based Intermediate Care Facilities for people with Intellectual Disabilities or Related Conditions (ICF-IID).
- People who receive services in certain DADS 1915(c) programs:
- Home and Community-Based Services (HCS)
- Community Living Assistance and Support Services (CLASS)
- Texas Home Living (TxHml)
- Deaf Blind Multiple Disabilities (DBMD)
- Nursing Facility
- Adults age 21 and older who are in a nursing facility
- Determined able to get Medicaid, and who meet STAR+PLUS criteria will be mandatory
- Nursing Facility Dual and Nursing Facility Medicaid Only
- Members will no longer be dis-enrolled from STAR+PLUS when residing in a Nursing Facility
- Children and young adults under age 21
- Truman W. Smith Children's Care Center residents
- State veteran's home residents
*Individuals not able to get Medicaid and children in state foster; clients not able to get full Medicaid benefits, such as: 1) Qualified Medicare beneficiaries, 2) Specified low-income Medicare beneficiaries, 3) Qualified disabled working individuals and undocumented immigrants cannot participate in the STAR+PLUS program.
Enrollment in STAR+PLUS is voluntary for children under age 21 receiving (SSI) or (SSI) related benefits.
To find out if you are able to get STAR+PLUS Medicaid, call 2-1-1.
To switch to Cigna-HealthSpring STAR+PLUS, call the STAR+PLUS Help Line at 1-800-964-2777 (TTY 711), Monday to Friday, 8:00 a.m. to 8:00 p.m. Central Time.
Covered Services for Individuals in the Medicaid for Breast and Cervical Cancer (MBCC) Program
Cigna-HealthSpring covers members who qualify for the Medicaid for Breast and Cervical Cancer (MBCC) Program. Applicants must have been screened and found to need active treatment for either breast or cervical cancer. Individuals may apply for STAR+PLUS or receive information online at www.YourTexasBenefits.com or call 2-1-1. Once determined eligible for MBCC, a woman remains eligible for Medicaid through the duration of her cancer treatment or until she no longer meets the eligibility criteria, whichever is earlier. MBCC members are eligible to receive all Medicaid-covered services, not only cancer-related services.
Medicaid Rural Service Area (MRSA) / Northeast Texas Service Delivery Area:
Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Cooke, Delta, Fannin, Franklin, Grayson, Gregg, Harrison, Henderson, Hopkins, Houston, Lamar, Marion, Montague, Morris, Nacogdoches, Panola, Rains, Red River, Rusk, Sabine, San Augustine, Shelby, Smith, Titus, Trinity, Upshur, Van Zandt, Wood.
Hidalgo Service Delivery Area:
Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, and Zapata.
Tarrant Service Delivery Area:
Tarrant, Denton, Hood, Johnson, Parker, and Wise.