1. (a) Except as provided in subsections (b) and (d) of this section, enrollment in the STAR+PLUS program is mandatory for Medicaid recipients who meet one or more of the following criteria:

   1. (1) have a physical or mental disability, are age 21 or older, and receive Supplemental Security Income (SSI) benefits or Medicaid due to low income;
   2. (2) qualify for the STAR+PLUS Home and Community-Based Services Program, as described in §353.1153 of this title (relating to STAR+PLUS Home and Community Based Services (HCBS) Program);
   3. (3) are age 21 or older and receive Medicaid because they are in a Social Security Exclusion program and meet financial criteria for STAR+PLUS Home and Community-Based Services Program; or
   4. (4) are age 21 or older and reside in a nursing facility.

2. (b) In addition to the Medicaid recipients who must enroll in the STAR+PLUS program under subsection (a) of this section, recipients age 21 or older residing in a community-based ICF-IID or receiving services under the following Medicaid 1915(c) waivers and not enrolled in Medicare must enroll in STAR+PLUS to receive acute care services:

   1. (1) Home and Community-based Services (HCS);
   2. (2) Community Living Assistance and Support Services (CLASS);
   3. (3) Texas Home Living (TxHmL); and
   4. (4) Deaf Blind with Multiple Disabilities (DBMD).
3. (c) Medicaid recipients have a choice among at least two MCOs.

4. (d) The following Medicaid recipients cannot participate in the STAR+PLUS program:

   1. (1) persons under age 21;
   2. (2) residents of state supported living centers;
   3. (3) persons not eligible for full Medicaid benefits; and
   4. (4) persons enrolled in Programs of All-Inclusive Care for Elderly (PACE).

5. (e) Dual eligible individuals.

   1. (1) Enrollment in Medicare does not affect eligibility for the STAR+PLUS program, except as specified in subsection (b) of this section.
   2. (2) Dual eligible individuals who participate in the STAR+PLUS program receive most acute care services through their Medicare provider, and STAR+PLUS Home and Community-Based Services Program through the STAR+PLUS MCO. Dual eligible individuals who participate in the STAR+PLUS program receive most acute care services through their Medicare provider, but may receive additional services through their STAR+PLUS MCO. The STAR+PLUS program does not change the way dual eligibles receive Medicare services.

Source Note:The provisions of this §353.603 adopted to be effective December 1, 1997, 22 TexReg 11403; amended to be effective December 1, 2000, 25 TexReg 11666; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013; amended to be effective February 1, 2011, 36 Tex Reg 231; amended to be effective March 1, 2012, 37 TexReg 1283; amended to be effective September 1, 2014, 39 TexReg 5873; amended to be effective November 1, 2016, 41 TexReg 8265.