The following Medicaid clients are required to participate in STAR+PLUS:
- 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 qualify for Community-Based Alternatives (CBA) HCBS STAR+PLUS waiver services.
- People age 21 or older who can receive Medicaid because they are in a Social Security Exclusion program and meet financial criteria for HCBS STAR+PLUS waiver services.
- People age 21 or older who are receiving SSI.
- Children who are under age 21 and eligible for Medicaid through SSI can enroll in STAR+PLUS voluntarily1.
To be eligible for Nursing Facility services, a STAR+PLUS Member must meet all of the following criteria:
- A physician certifies the Member’s medical condition.
- The Member’s medical condition requires daily skilled nursing care.
- The Member’s medical condition meets medical necessity (MN) requirements.
- The Member has received a Pre-admission Screening and Resident Review (PASRR) by the local authority (LA) (see Preadmission Screening and Resident Review Referral Policy MCAID-TXSP-HS-SC-P00X).
- The Member has received a Minimum Data Set (MDS) evaluation by the NF to determine the Member’s Resource Utilization Group (RUG).
How to verify STAR+PLUS eligibility