Beginning January 1, 2026, the Health and Human Services Commission (HHSC) will end the Dual Demonstration Program and transition Medicare-Medicaid Plans (MMPs) to integrated Dual Eligible Special Needs Plans (D-SNPs). Members currently enrolled in MMPs will move to a STAR+PLUS Managed Care Organization (MCO).
View the ending MMP plan codes and the STAR+PLUS MCO plan codes in the demonstration service areas: HHSC’s EVV Impacts Due to Dual Demonstration Pilot Program Discontinued.
When transitioning, members must choose between:
- Medicare Advantage Plan
- D-SNP
- Original Medicare
Members are encouraged to select companion D-SNPs that align with their STAR+PLUS MCO for better coordination of Medicare and Medicaid services.
Key Details:
Effective January 1, 2026, new payer plan codes will apply for all impacted members. Program providers, FMSAs, and PSOs must bill the new payer for any dates of service on or after January 1, 2026. They are also required to create new authorizations based on current authorizations and include the updated payer plan code.
The link below lists STAR+PLUS MCOs and MCO plan codes that the MMP members can transition to: HHSC’s Appendix XXIX, STAR+PLUS Plan Codes and Contract Numbers
To verify eligibility, Providers can use one of the following methods:
- The C21/SAVERR-based TMC EV and 270/271 eligibility inquiry is limited to access only current month eligibility information.
- The EaaS/TIERS-based 270/271 or Medicaid Client Portal supports eligibility inquiry for future dates up to end of the following month. Providers can use this to check eligibility.
Program providers, FMSAs, and PSOs should continue to use the current authorization in the Electronic Visit Verification (EVV) system for their members through December 31, 2025.
Additional Resources:
- HHAeXchnage Users: Refer to the HHAX Provider Knowledge Base for step-by-step instructions including on entering new authorizations in the HHAX system.
- For questions or technical support with the HHAX Portal review HHAX’s Enter Authorizations webpage, by contacting HHAX at TXsupport@hhaexchange.com or by phone at 1-833-430-1307.
- PSOs: Contact your proprietary system vendor directly with any questions about entering authorizations or updating payer plan codes.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter