The STAR+PLUS program caters to adults with disabilities and those aged 65 and older. It goes beyond conventional care, offering a choice for individuals with complex medical needs to receive support within a home setting rather than residing in nursing facilities. But the program's significance extends further, advocating for the recognition and compensation of family caregivers, an integral but underpaid workforce in the US healthcare system.
The STAR+PLUS program, a Medicaid managed care initiative in Texas, is designed to provide comprehensive health care and long-term services and supports to adults with disabilities or individuals aged 65 and above. It offers a person-centered approach, allowing beneficiaries to select a health plan that best suits their needs from various options.
The primary purpose of the STAR+PLUS program is to enhance the quality of life and independence of eligible participants while ensuring they receive the necessary medical care and community-based services. By offering choices and flexibility, the program aims to empower individuals with complex medical needs to live and receive care in a home setting, fostering a sense of dignity and autonomy.
Through the STAR+PLUS program, eligible participants gain access to various services, including medical, behavioral health, and long-term care services. This comprehensive approach intends to address the unique needs of each individual, improving health outcomes and overall well-being.
Individuals must meet specific eligibility criteria to access services through the STAR+PLUS program. To be eligible, the individual must first be approved for Medicaid. Additionally, they must fall into one of the following categories:
However, specific individuals are NOT eligible for the STAR+PLUS program, including:
Individuals who are "dual eligible," meaning covered by Medicare and Medicaid, can still enroll in the STAR+PLUS program as long as they are not receiving Medicaid 1915(c) waiver services or living in facilities for those with Intellectual Developmental Disabilities (IDD). In such cases, STAR+PLUS does not affect the regular healthcare services received through Medicare.
The STAR+PLUS program offers a comprehensive array of services and supports to meet its beneficiaries' diverse needs. Upon enrolling in the program, members are visited by a service coordinator within 30 days, who assesses their specific requirements and devises a personalized care plan.
The long-term services and supports available through STAR+PLUS encompass various options, including:
Other services included under the STAR+PLUS Home and Community-Based Services Waiver are:
These services collectively promote the well-being and independence of STAR+PLUS participants, ensuring they receive the necessary care and support to lead fulfilling lives in their chosen home settings.
The STAR+PLUS program recognizes the vital role of family caregivers and has taken steps to compensate them for their dedicated services. Through the self-directed option available under this Medicaid waiver, eligible participants can hire and pay their family members, including adult children, for caregiving services. This innovative approach empowers individuals with disabilities or those aged 65 and above to choose their preferred caregivers, often family members, and offers financial compensation for their invaluable support. The self-directed option fosters a more personalized and compassionate caregiving experience while recognizing and addressing the financial burden often faced by family caregivers, making it a crucial aspect of the STAR+PLUS program's commitment to advocating for the rights and welfare of caregivers.
If you are a caregiver in Texas, find out if you're eligible for compensation by filling out this form and take the first step towards recognizing the invaluable contributions of caregivers in our society.