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

Date: 07/17/23

Please note this article has been updated. To see updates, please reference: Updated Guidance: STAR+PLUS Upgrade Process for Members Who Exited a Nursing Facility Due to COVID-19 Without Services in Place.

In response to COVID-19, and to comply with the Families First Coronavirus Response Act (FFCRA, Public Law 116-127), the Texas Health and Human Services Commission (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 Nursing Facility 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 to utilize the existing process for requesting upgrades to STAR+PLUS HCBS for STAR+PLUS members, including MAO members, who exited a Nursing Facility 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 PHE ended on May 11, 2023. Under the federal American Rescue Plan (ARP) Act of 2021 maintenance of effort (MOE) requirements, HHSC must keep certain PHE flexibilities in place until the Texas HCBS ARP MOE period ends. With the federal PHE ending on May 11, 2023, the current ARP MOE period for Texas is scheduled to end on August 31, 2023. Therefore, the COVID-19 flexibility pertaining to the STAR+PLUS HCBS Upgrade Process for Members Who Exited a Nursing Facility Due to COVID-19 Without Services in Place, will end on August 31, 2023.

After August 31, 2023, 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 Nursing Facility without STAR+PLUS HCBS services in place after August 31, 2023, will lose their Nursing Facility 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, 2023, will remain in STAR+PLUS HCBS, if 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 Nursing Facility due to concerns about COVID-19 but started the STAR+PLUS HCBS application process on or before August 31, 2023.
    • By August 31, 2023, 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 Nursing Facility due to COVID-19 concerns. Any request received after August 31, 2023, 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 Nursing Facility Medicaid eligibility and be disenrolled from STAR+PLUS.