STAR+PLUS: Making a Positive Difference in the Lives of Texans

This past week, the Senate Health and Human Services Committee explored the quality and oversight of long-term care services, one of its interim charges assigned by the Governor. TAHP CEO Jamie Dudensing testified before the committee on the positive impact the Medicaid STAR+PLUS program has had on the lives of elderly Texans and those with disabilities. A link to TAHP’s presentation can be found here.

Since its inception, the STAR+PLUS program has dramatically improved lives in Texas — improving the quality of care, enhancing access to that care, and providing more choices to beneficiaries — all while saving taxpayer dollars by making sure patients get the right care at the right time and in the right place.

STAR+PLUS first began in Texas as a pilot program in Harris County in 1998, tested as a new kind of health care delivery model for individuals age 65 or older and individuals with disabilities in Medicaid.

The success of the STAR+PLUS program is due in large part to its structure. Through STAR+PLUS, Texas was one of the first states in the country to create a Medicaid health plan that integrates and coordinates long-term care and acute care, with a focus on ensuring the least restrictive and most appropriate setting for each individual.

Previously, under the fee-for-service (FFS) model, Texans with disabilities generally had to navigate services on their own. Today, under the STAR+PLUS managed care program, these Texans have access to a service coordinator who identifies an individual’s needs, helps develop a plan of care, coordinates health care benefits, and facilitates access to community resources, whether those resources are covered by Medicaid or not. This includes coordinating efforts like securing attendant care, meals, home modifications, and participation in activities with peers within the community. These critical resources are helping members lead fuller and more independent lives.

The integration of health care and long-term care services has helped more seniors and individuals with disabilities who also have chronic conditions continue living independently and avoid hospitalization and institutionalization. When their illnesses do require hospital visits, coordinated care means more appropriate follow-up care is arranged for them at home or as needed to prevent re-admission.

STAR+PLUS began delivering immediate and significant results for beneficiaries in its initial days. As of 2003, just 5 years after its inception, STAR+PLUS had made significant strides toward reducing the highest cost drivers in Medicaid and in keeping individuals in their communities, as opposed to long-term care facilities.

Because of its success, the Legislature continued to expand STAR+PLUS, and as of September 1, 2014, the program serves elderly and disabled individuals statewide, including acute care for adults with Intellectual and Developmental Disabilities (IDD). In March of 2015, nursing home care was incorporated into STAR+PLUS, followed by the implementation of Community First Choice in June of 2015.

Today, STAR+PLUS’ positive trends continue, with a dramatic increase in the number of Texas Medicaid beneficiaries who are able to access community care. Through savings achieved from the shift to managed care, Texas was able to reinvest funding into eliminating the waiting time for services for individuals with physical disabilities. Instead of waiting years for community services, individuals now have access to the services they need when they need them. As shown below, from 2004 to 2013, more than 60,000 individuals were removed from the waiting list and provided with access to community care. This means more Texans are able to live independently in their homes and in their communities, as opposed to nursing homes and other institutions.

This expansion of the managed care approach with STAR+PLUS has been a win-win for the state and consumers. Increased quality of care and improved access to health care and community care services has reduced hospital admissions and costs and improved the lives of Medicaid consumers, including dramatic reductions in hospital stays for diabetes and pneumonia. Between 2009 and 2011, STAR+PLUS experienced double-digit reductions in hospital admissions for these common illnesses. These important efforts place a focus on wellness and prevention, keep elderly individuals out of hospitals where they can become exposed to other illnesses, and promote community-based care alternatives to much more expensive and longer hospital stays and institutional care.

Last year, Medicaid beneficiaries in Texas saw another positive impact of the STAR+PLUS program. On June 1st, 2015, the wait for long-term care community attendant and habilitative services ended for more than 12,000 individuals with IDD, as well as other persons with disabilities seeking habilitative services, when the state added the Community First Choice program to STAR+PLUS. These individuals will no longer have to wait more than 10 years for the services they need to maintain their independence in the community.

One example of the positive results Texans are seeing under STAR+PLUS is the Quality Living Program at Molina Healthcare, a TAHP operational member. On January 8th, Molina Healthcare of Texas held its “Art with the Aging” event at the Dallas Love Field Airport which featured a collection of art by Dallas area seniors living in nursing homes. The Molina Quality Living Program encourages quality within nursing homes, as well as enriching the lives of those living in nursing homes. The program provides activities such as art, music, and reminiscing therapy to help make a difference in the lives of seniors. Photos from the event are below.

While significant strides have been made, there is still room for improvement and more work to be done to ensure elderly Texans and Texans with disabilities are receiving the highest quality care, have widespread access to that care, and can achieve independence. Efforts to eliminate remaining wait lists for services and help individuals with disabilities maintain or gain their independence should be continued. The long-term care workforce should be strengthened through recruitment and retention efforts, including improving wages for community attendants who serve as the backbone for community care.

As we continue to work toward those goals, we can be pleased knowing that STAR+PLUS is already on the right path to helping aging Texans and individuals with disabilities find the tailored care they need, when they need it.

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