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Updated Guidance: STAR+PLUS Upgrade Process for Members Who Exited a Nursing Facility Due to COVID-19 Without Services in Place

Date: 09/01/23

In response to COVID-19 and to comply with the Families First Coronavirus Response Act (FFCRA, Public Law 116-127), HHSC maintained Medicaid coverage during the federal COVID-19 public health emergency (PHE). In accordance with the FFCRA, HHSC maintained the Medicaid eligibility of STAR+PLUS members who exited a NF on or after March 18, 2020, without transferring to STAR+PLUS Home and Community-Based Services (HCBS). This includes medical assistance only (MAO) members.

In this notice the term “managed care organizations” (MCOs) refers to STAR+PLUS MCOs and Medicare-Medicaid Plans (MMPs).

HHSC allowed MCOs the flexibility to utilize the existing process for requesting upgrades to STAR+PLUS HCBS for STAR+PLUS MAO members who exited a NF on or after March 18, 2020, due to concerns about COVID-19 or in accordance with local orders during the early stages of the PHE, without STAR+PLUS HCBS in place. HHSC only needed to implement this flexibility for MAO members because non-MAO members are able to access the existing upgrade process described in the STAR+PLUS Handbook, Section 3330, STAR+PLUS Members Requesting an Upgrade to the STAR+PLUS Home and Community Based Services Program.

The HCBS ARPA MOE period for Texas has been extended, and this flexibility is extended through August 31, 2024. Therefore, the COVID-19 flexibility pertaining to the ‘STAR+PLUS HCBS Upgrade Process for Members Who Exited a NF Due to COVID-19 Without Services in Place,’ will end on August 31, 2024.

After August 31, 2024, use of the upgrade process will be limited to the STAR+PLUS-enrolled members described in Section 3330 of the STAR+PLUS Handbook. MAO members who leave the NF without STAR+PLUS HCBS services in place after August 31, 2024, will lose their NF Medicaid eligibility and be disenrolled from STAR+PLUS making them ineligible to access the STAR+PLUS upgrade process.

Please note:

  • Members who used this flexibility on or before August 31, 2024, will remain in STAR+PLUS HCBS as long as they continue to meet the Medicaid eligibility redetermination and STAR+PLUS HCBS eligibility requirements.
  • HHSC will review the applications for members, including MAO members, who exited the NF due to concerns about COVID-19 but started the STAR+PLUS HCBS application process on or before August 31, 2024.  
    • By August 31, 2024, the HHSC Program Support Unit must have received the H2067 from the STAR+PLUS MCO notifying of a Money Follows the Person (MFP) request and the member leaving the NF due to COVID-19 concerns. Any request received after August 31, 2024, will not be processed for MAO members.
  • These members will be enrolled in STAR+PLUS HCBS if they meet the eligibility criteria for the program.  
  • MAO members who are not approved for STAR+PLUS HCBS will lose their NF Medicaid eligibility and be disenrolled from STAR+PLUS.