Texas HHSC to Discontinue Dual Demonstration Program Effective Jan. 1, 2026

The Texas Health and Human Services Commission (HHSC) has announced that it will discontinue the Dual Demonstration Pilot Program with Medicare-Medicaid Plans (MMPs) effective January 1, 2026. The change will impact MMP members, program providers, Financial Management Services Agencies (FMSAs), and Proprietary System Operators (PSOs) across select Texas counties.

Affected Counties and Health Plans

The discontinuation applies to the following demonstration counties and MMPs:

• Bexar County: Molina Healthcare of Texas
• Dallas County: Molina Healthcare of Texas, Superior Health Plan
• El Paso County: Molina Healthcare of Texas
• Harris County: Molina Healthcare of Texas, United Healthcare
• Hidalgo County: Molina Healthcare of Texas, Superior Health Plan

HHSC will end the existing MMP plan codes in these counties. MMP members must select a STAR+PLUS Managed Care Organization (MCO) within their service area to continue receiving services.

Transition to STAR+PLUS and Plan Code Changes

Members who choose to remain with the same health plan will be assigned a new STAR+PLUS plan code. For example, Molina’s MMP plan code 9J in Dallas will transition to the STAR+PLUS plan code 9F for members who stay with Molina.

HHSC has released detailed tables outlining:

• Ending MMP plan codes and corresponding STAR+PLUS plan codes.
• All STAR+PLUS MCO options and plan codes are available by service area.

These references are also available in HHSC Appendix XXIX: STAR+PLUS Plan Codes and Contract Numbers.

EVV and Billing Requirements Starting Jan. 1, 2026

Beginning January 1, 2026, providers must bill services using the new STAR+PLUS MCO payer plan codes for dates of service on or after that date.

Key requirements include:

• Current EVV authorizations may be used through Dec. 31, 2025.
• For services on or after Jan. 1, 2026, providers must:
  • Identify the member’s new STAR+PLUS MCO and plan code.
  • Create a new authorization using the STAR+PLUS plan code.
  • Manually enter the new authorization into the EVV system.
• Providers using third-party billing vendors must notify them of these changes.
• EVV-required claims must continue to be submitted directly to TMHP for EVV claims matching.

Eligibility Verification

Providers can verify member eligibility and MCO assignments using:

• C21/SAVERR-based TMC EV and 270/271, which provides current-month eligibility only.
• EaaS/TIERS-based 270/271 or the Medicaid Client Portal, which supports eligibility checks for future dates through the end of the following month.

Additional Resources

Providers and members are encouraged to visit the HHSC Options for Medicare and Medicaid Dual Coverage webpage for further guidance. Questions related to the Dual Demonstration transition can be directed to Managed_Care_Initiatives@hhs.texas.gov.

HHSC advises all impacted stakeholders to prepare in advance to ensure uninterrupted services and compliant billing as the transition date approaches.