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