Texas STAR+PLUS & Medicaid Home Care: Complete Payer Guide for Agency Owners

Texas is one of the most complex Medicaid markets in the country for home care agencies. The state runs multiple distinct programs — each with different managed care organizations, different authorization processes, different EVV requirements, and different credentialing timelines. If you're billing across several of these programs, your administrative load compounds with each one you add.

For agencies in Houston, Dallas, San Antonio, Austin, Fort Worth, and other Texas metros, most clients come through two to four payer sources. A single client might receive personal attendant services through STAR+PLUS while simultaneously having a home health authorization under a different managed care pathway. Getting paid for that work means navigating two systems, two MCOs, and two sets of billing rules at the same time.

Understanding the landscape isn't academic. It determines where you build credentialing capacity, where billing errors concentrate, and which payer relationships need the most active management.

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Texas Medicaid operates through the Texas Health and Human Services Commission (HHSC). For home care agencies, the relevant programs fall into five categories:

1. STAR+PLUS — Managed care for long-term services and supports for adults with disabilities and seniors
2. STAR Kids — Managed care for children and young adults with complex medical needs
3. Community First Choice (CFC) — Personal attendant services as a Medicaid state plan benefit
4. 1915(c) Waivers (HCS, TxHmL) — Community-based services for people with intellectual and developmental disabilities
5. Primary Home Care / Community Attendant Services — Legacy fee-for-service attendant care

Each has different rules, different payers, and different administrative requirements. Most Texas home care agencies serving adult Medicaid clients participate in at least two of these programs.

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STAR+PLUS (State of Texas Access Reform Plus) is the managed care program that covers most of the long-term services and supports home care agencies provide to adults. If you're delivering personal attendant services, home health services, or community-based LTSS to adult Medicaid beneficiaries in Texas, you are almost certainly billing through STAR+PLUS managed care organizations.

What STAR+PLUS Covers

• Personal attendant services (bathing, dressing, meal preparation, housekeeping, mobility assistance)
• Home health services (skilled nursing, therapy, home health aide services)
• Community First Choice services (administered through STAR+PLUS MCOs — see below)
• Day activity and health services
• Emergency response services
• Minor home modifications

How Managed Care Works Within STAR+PLUS

HHSC contracts with managed care organizations to administer STAR+PLUS benefits across defined service delivery areas (SDAs). The MCOs — not HHSC directly — are responsible for authorizing services, credentialing providers, and processing claims.

This means your agency cannot simply obtain a Texas Medicaid provider number and bill the state. You must contract and credential separately with each MCO operating in your SDA. Agencies whose service areas span multiple SDAs may need active contracts with four to six MCOs.

Current STAR+PLUS MCOs operating in Texas include:

• Aetna Better Health of Texas
• Molina Healthcare of Texas
• Superior Health Plan (a Centene/WellCare company)
• UnitedHealthcare Community Plan of Texas
• Community Health Choice (primarily the Greater Houston area)

MCO contracts are renegotiated at each HHSC contract cycle. Always verify the current MCO list for your specific service delivery area at hhs.texas.gov before pursuing enrollment.

Service Delivery Areas

Texas divides the state into geographic SDAs. Each SDA has a defined set of MCOs offering STAR+PLUS coverage. Major metro areas — Harris County (Houston), Dallas, Tarrant (Fort Worth), Bexar (San Antonio), Travis (Austin) — each constitute their own SDA or part of one. MCO competition and available network capacity vary meaningfully by market.

For agencies operating across multiple Texas metros, this creates a patchwork credentialing challenge. You may have complete, active contracts in Dallas while a STAR+PLUS application in San Antonio is still pending because a different MCO holds that contract and has a different credentialing queue.

EVV Requirements Under STAR+PLUS

All personal attendant services and home health aide visits under STAR+PLUS require Electronic Visit Verification. Texas uses HHAeXchange as its statewide EVV aggregator — regardless of which EVV system your agency or MCO uses at the point of care, the data must ultimately flow through HHAeXchange for state reporting.

Individual MCOs may layer additional EVV requirements on top of the state standard. Some require near-real-time reporting windows; others accept batch submissions within 24 or 48 hours. These differences affect exception rates and how quickly corrections need to happen. For more detail on managing EVV compliance operations day-to-day, see EVV Compliance for Home Care Agencies.

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STAR Kids is Texas Medicaid's managed care program for children and young adults (under 21) with physical, developmental, or behavioral health conditions who require long-term services and supports. If your agency serves pediatric Medicaid clients, you're operating within STAR Kids rather than STAR+PLUS.

STAR Kids has its own credentialing process and its own authorization workflows, completely separate from STAR+PLUS even when the services look similar. MCO assignments for STAR Kids are distinct from STAR+PLUS MCO assignments, so an active STAR+PLUS contract with a given MCO does not automatically extend to STAR Kids.

EVV requirements for STAR Kids mirror STAR+PLUS: HHAeXchange aggregation is required for qualifying visits.

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Community First Choice is a Medicaid state plan benefit (Section 1915(k)) that provides personal attendant and habilitation services to people with functional limitations. In Texas, CFC services are administered through the STAR+PLUS MCOs — it is not a standalone program with separate billing pathways.

The distinction that matters operationally: CFC is federally defined, which creates specific documentation requirements that differ from standard STAR+PLUS personal attendant services. A CFC claim submitted with the wrong modifier or the wrong HCPCS code gets denied. Your billing team needs to track which members are enrolled under CFC versus standard STAR+PLUS attendant care because the documentation and claim coding differ, even when the actual care delivered looks the same.

For billing best practices across payer types, see Home Care Billing Support.

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Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) are 1915(c) Medicaid waivers specifically for people with intellectual and developmental disabilities (IDD). These programs are not managed care — they are administered directly by HHSC on a fee-for-service basis through certified Program Providers.

For home care agencies, HCS and TxHmL represent a distinct market segment from STAR+PLUS. Clients are typically younger, services are often more intensive or habilitative in nature, and the administrative requirements are different:

• A separate HHSC HCS or TxHmL Program Provider certification is required (beyond a standard Medicaid provider number)
• HHSC conducts site surveys and policy reviews as part of certification
• IDD-specific billing codes and documentation standards apply
• EVV is required for applicable services

Most general home care agencies focus on STAR+PLUS rather than HCS/TxHmL, but agencies that serve the IDD population should understand that this creates a separate, longer credentialing pathway and a separate billing environment from their Medicaid managed care work.

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Primary Home Care (PHC) and Community Attendant Services (CAS) are older Texas Medicaid programs providing personal attendant care on a fee-for-service basis, administered directly by HHSC. These programs have been substantially transitioned into managed care over time, but a population of beneficiaries — particularly in rural and semi-rural areas with limited MCO coverage — remain on PHC/CAS.

If you bill PHC or CAS, you are billing HHSC directly via the Texas Medicaid claims system (currently processed through Gainwell Technologies) rather than through an MCO. EVV requirements still apply, but the reporting pathway differs from STAR+PLUS.

The administrative overhead per claim is often lower because you're dealing with a single, standardized fee schedule rather than multiple MCO contracts. However, authorization and renewal cycles can be slower, and PHC/CAS beneficiaries are increasingly being transitioned to STAR+PLUS managed care, which means this population will shrink over time.

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Consumer Directed Services (CDS) is a self-direction option available across several Texas Medicaid programs, including STAR+PLUS and certain waivers. Under CDS, the Medicaid member — or their designated representative — acts as the employer of record for their attendant. A Financial Management Services Agency (FMSA) handles payroll and HR compliance functions.

For home care agencies, CDS means a different service model: you're not the employer of the attendant, and you may be providing support coordination or FMSA services rather than direct care staffing. MCO referrals increasingly include CDS-enrolled members, so your intake and authorization teams need to identify CDS enrollment early, because the documentation, billing, and operational pathways diverge from traditional agency-directed care.

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Programs of All-inclusive Care for the Elderly (PACE) are comprehensive managed care programs for frail older adults that integrate medical, social, and long-term care services. PACE participants are typically dual-eligible (Medicare + Medicaid). Texas has PACE programs operating in several metro areas including Dallas and San Antonio.

For home care agencies, PACE is a separate contracting relationship. PACE organizations are responsible for all participant care and contract directly with provider agencies for home care services. They are not standard MCOs — they're integrated care organizations with independent provider networks. Contracting with a PACE program in your market is a separate step from your STAR+PLUS MCO credentialing, with its own application process and its own rate structure.

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Texas home care agencies serving adult Medicaid clients in major metros typically see a client mix spanning two to four of these programs. That creates compounding administrative complexity.

Multiple credentialing timelines running simultaneously. A new agency pursuing STAR+PLUS enrollment with three MCOs plus PHC billing can have four separate credentialing applications in flight, each at a different stage, each requiring different documentation, each with a different follow-up cadence. Without dedicated tracking, one of them will fall through the cracks. For a full breakdown of what Texas credentialing involves, see Home Care Credentialing Support.

Different authorization systems per payer. Each STAR+PLUS MCO has its own prior authorization portal, its own rules for how much documentation is required, and its own reauthorization frequency. When a member changes plans mid-year — which happens regularly during the annual open enrollment period — the authorization has to be transferred or resubmitted with the new MCO.

EVV reconciliation across payer types. All Texas Medicaid programs route through HHAeXchange as the aggregator, which simplifies the data flow. But exception resolution still requires knowing which MCO or HHSC program is the billing payer for each visit, because correction documentation and attestation processes vary by payer.

Billing codes that look similar but aren't. STAR+PLUS personal attendant services and Community First Choice attendant services can look identical at the point of care but require different HCPCS codes and modifiers. Billing errors at this level don't surface until the claim comes back denied — or worse, until a retrospective payer audit.

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These timelines assume complete, accurate applications submitted on the first attempt. A single missing document can add three to six weeks to any of them. Agencies expanding into new payer relationships in Texas should plan credentialing timelines well before the anticipated start of service — not after signing a referral source agreement.

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Running credentialing across four to six active Texas payers — while managing concurrent billing submissions, EVV reconciliation, and authorization renewals across different MCO portals — is a full-time operations function. Most agencies that do this in-house either have a dedicated credentialing specialist (a hire that runs $55,000–$75,000/year in major Texas markets) or the owner is managing it directly between everything else.

The practical challenges:

• Tracking all active credentialing applications with current status and next-action dates, across MCOs that each use different portals and different timelines
• Following up with MCOs and HHSC on pending applications — some require weekly calls to get movement
• Monitoring revalidation cycles so nothing lapses without advance notice (Medicaid enrollment lapses are not caught until a claim gets denied)
• Managing EVV exception queues daily and resolving them before billing deadlines
• Submitting claims to the right billing pathway — MCO portal, HHAeXchange aggregator, or Gainwell for fee-for-service — for each payer type
• Catching CFC-vs.-STAR+PLUS coding differences before claims are submitted

Atlas handles this as part of the back-office operations model. If you're building out your Texas payer relationships or if your current multi-payer admin is leaking revenue through denied claims and delayed enrollments, we can take that work off your plate.

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Texas Medicaid is not static. MCO contract cycles, program rules, EVV requirements, and credentialing processes change regularly. This guide reflects program structures as of mid-2026 — always verify current details with HHSC directly before making enrollment decisions.

Authoritative sources:

• HHSC Medicaid for Providers: hhs.texas.gov/providers/medicaid-chip-for-providers
• STAR+PLUS program information: hhs.texas.gov/star-plus
• Texas EVV program: hhs.texas.gov/evv
• HHAeXchange Texas provider portal: hhaeXchange.com
• Texas Association for Home Care & Hospice (TAHC&H) at tahch.org — the primary industry association for Texas home care providers; an essential resource for regulatory updates, MCO relationship-building, and compliance guidance in the Texas market.