Medicaid Managed Care Expansion Presentation to the Texas Council of Community MHMR Centers November 2010

Expansion Counties Within the Year Contract amendments with existing health plans in each service area Replaces PCCM in those counties Operational September 2011 Bexar Service (STAR and STAR+PLUS) Bandera   Harris Service Area (STAR and STAR+PLUS) Austin Wharton Matagorda Jefferson Service Area (STAR and STAR+PLUS) Chambers Hardin Jasper Jefferson Liberty Newton Orange Polk San Jacinto Tyler Walker Lubbock Service Area (STAR) Carson Deaf Smith Hutchison Potter Randall Swisher Nueces Service Area (STAR and STAR+PLUS) Brooks Goliad Karnes Kennedy Live Oak Travis Service Area (STAR and STAR+PLUS) Fayette El Paso Service Area (STAR) Hudspeth

“Contiguous” Counties: September 2011 Service Area County STAR STAR+PLUS Bexar Bandera X El Paso Hudspeth Harris Austin, Wharton, Matagorda Jefferson Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, Walker Lubbock Carson, Deaf Smith, Hutchinson, Potter, Randall, Swisher Nueces Brooks, Goliad, Karnes, Kennedy, Live Oak Travis Fayette Bexar Service (STAR and STAR+PLUS) Bandera   Harris Service Area (STAR and STAR+PLUS) Austin Wharton Matagorda Jefferson Service Area (STAR and STAR+PLUS) Chambers Hardin Jasper Jefferson Liberty Newton Orange Polk San Jacinto Tyler Walker Lubbock Service Area (STAR) Carson Deaf Smith Hutchison Potter Randall Swisher Nueces Service Area (STAR and STAR+PLUS) Brooks Goliad Karnes Kennedy Live Oak Travis Service Area (STAR and STAR+PLUS) Fayette El Paso Service Area (STAR) Hudspeth

November 14, 2018

Joint Reprocurement Standard process up for renewal STAR, STAR+PLUS and CHIP current service areas Plan for additional counties and benefits The following areas have been identified as potential STAR+PLUS expansion areas due to the size of their SSI population and ability to support at least two managed care organizations: El Paso and Lubbock

Expansion of STAR and STAR+PLUS into South Texas Requires legislative direction for Cameron, Hidalgo and Maverick 13 counties 350,000 new members In the LAR for March 2012 Centers Impacted: Coastal Plains (Brooks, Duval, Kenedy, Live Oak) Tropical Texas (Cameron, Hidalgo, Willacy) Border Region (Jim Hogg, Starr, Webb, Zapata) Camino Real (Maverick, McMullen) Projected Savings $140 million over 5 years Prohibition against the use of health maintenance organizations in the Valley Texas Government Code Sec. 533.0025. DELIVERY OF SERVICES. (e) Notwithstanding Subsection (b)(1), the commission may not provide medical assistance using a health maintenance organization in Cameron County, Hidalgo County, or Maverick County. Brooks      South Texas      Cameron     South Texas      Duval       South Texas      Hidalgo     South Texas      Jim Hogg    South Texas      Kenedy      South Texas      Live Oak    South Texas      Maverick    South Texas McMullen    South Texas      Starr       South Texas      Webb        South Texas      Willacy     South Texas      Zapata     

PCCM converts to EPO Savings in the LAR HHSC will include in joint procurement All non-HMO counties Implications: No guarantee for monthly PCP fee Providers contract and bill health plans not TMHP for covered services (not MH Rehab/CM)

Prescription Drug Carve-In LAR has savings attached for a March 2012 Implementation Implications: Physicians will have more PA processes and/or different PA processes for a consumer Pharmacies will bill multiple HMOs not TMHP

Bottom Line Unless the legislature acts to stop HHSC’s Medicaid Managed Care expansion plans, all centers will be contracting with HMOs for Medicaid “card” services. Operational start dates as early as September 2011 for some, and by March 2012 for everyone else.