STAR+PLUS in Hidalgo County: The Three Health Plans and What They Pay For

What STAR+PLUS is

STAR+PLUS is Texas Medicaid's managed care program for adults 65 and older and adults with disabilities. A member picks a health plan, and the plan pays for doctor visits and hospital care and, for members who qualify, long-term services and supports. The Home and Community Based Services part, often called HCBS, is for people who meet nursing facility level of care but live at home or in the community.

Each member gets a service coordinator who assesses needs and writes a service plan. That plan is what authorizes attendant hours, adult day attendance, respite, nursing, minor home modifications and other services.

The plans in the Hidalgo service area

HHSC publishes a table of STAR+PLUS plan codes by service area. Revision 25-5, effective December 17, 2025, lists these plans for the Hidalgo service area:

Cigna-HealthSpring served the area until the end of 2021. Plan line-ups change with state procurements, so confirm the current list with the Texas Medicaid enrollment broker at 1-800-964-2777 before choosing.

Who qualifies in 2026

To receive STAR+PLUS HCBS, a person generally must be 65 or older, or 21 or older with a disability; meet nursing facility medical necessity; have monthly income no higher than $2,982 in 2026, which is three times the $994 SSI federal benefit rate; and have countable assets of $2,000 or less. The home and one vehicle generally do not count.

Applications go through YourTexasBenefits.com or 2-1-1, option 2. A person already on Medicaid through SSI may only need the medical assessment.

Why the plan choice matters in the Valley

The plan decides the network. An adult day center, an attendant agency or a home health agency must contract with your parent's plan for Medicaid to pay it. With 130 licensed adult day centers and 257 personal-assistance-only agencies in the county, networks are large, but not every provider is in every plan.

Before choosing or switching plans, call the providers your parent already uses and ask which plans they accept. Then ask the plan's member services whether a specific provider is in network. Switching plans can mean new authorizations, so time a switch carefully.

The service coordinator is the key person

Once your parent is enrolled, the service coordinator is the person who assesses needs, writes the service plan and authorizes services. Get their name and direct number. Call them after any hospital stay, fall or change in health, because the plan should change too.

If a request is denied or hours are cut, the plan must send a written notice explaining how to appeal. Keep copies of every notice and assessment. The Area Agency on Aging's benefits counselors can help an older member understand the notice and the appeal steps.

The consumer-directed option

STAR+PLUS also offers consumer-directed services, in which the member or a representative hires and supervises their own attendant through a financial management services agency. In many cases the attendant can be a relative, which suits Valley families who already provide much of the care. Ask the service coordinator about the rules on who can be hired.

Plans and Medicare

Most older STAR+PLUS members also have Medicare, which stays their primary insurance for doctors, hospitals and prescriptions. The STAR+PLUS plan covers the long-term services. Keep both cards with you, and ask any provider which one it bills for which service.

What STAR+PLUS does not pay

STAR+PLUS can pay for the care portion of assisted living in a facility that contracts with the member's plan, but never for rent and meals. In Hidalgo County that rarely comes into play: none of the county's licensed assisted living facilities reports accepting Medicaid in its TULIP record. Long-term nursing home care for Medicaid residents is paid separately, through the nursing facility benefit.

Texas's Medicaid Estate Recovery Program can also seek repayment from the estate of a recipient who was 55 or older, including for STAR+PLUS HCBS, with exemptions for a surviving spouse and certain children. Ask an elder law attorney if a home is involved.

Finally, keep a simple folder for the plan: the member card, the service plan, the coordinator's contact, every authorization and every notice. When something goes wrong at 7 a.m. on a Monday, that folder is what gets it fixed quickly.