How to Get Your First STAR+PLUS Client: A Step-by-Step Guide for Texas Home Care Agencies

Most new Texas home care agencies expect the hardest part to be getting the HCSSA license. In practice, the license is just the beginning. Getting your first STAR+PLUS Medicaid client requires completing three separate enrollment processes after licensing — and understanding how referrals actually flow through the STAR+PLUS system once you are enrolled.

This guide walks through every step in the right order, with realistic timelines, and explains what happens once a referral reaches your agency.

All information is current as of July 2026.

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What STAR+PLUS Is and Why It Matters for Home Care Agencies

STAR+PLUS is Texas's managed Medicaid program for adults with disabilities and adults age 65 and older. It is the primary payer for personal assistance services in Texas — covering bathing, dressing, grooming, meal preparation, medication reminders, and similar personal care tasks delivered in a client's home.

STAR+PLUS has two benefit tiers:

Acute care services — standard Medicaid benefits (physician visits, hospitalization, pharmacy). All enrolled members have this tier.

Home and Community Based Services (HCBS) — the long-term services and supports tier that includes personal assistance, respite care, and adult day programs. Not all STAR+PLUS members receive HCBS; it requires a separate authorization process and a higher level of need.

As a home care agency, your clients will be STAR+PLUS members who have been authorized for HCBS personal assistance services. These are the clients you want to reach — and reaching them requires being a contracted provider with the managed care organization (MCO) that manages each member's benefits.

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The Three Prerequisites

Before you can receive STAR+PLUS referrals, three things must be in place:

1. A valid Texas HCSSA PAS license — your operating license from HHSC, which authorizes you to send caregivers into clients' homes for personal assistance services.

2. TMHP enrollment — your Medicaid provider enrollment with the Texas Medicaid & Healthcare Partnership, which is how you become a billable Medicaid provider.

3. MCO credentialing — a separate contract with each managed care organization whose members you want to serve. MCOs manage STAR+PLUS benefits; they pay you directly for services rendered to their enrolled members.

All three must be completed. Missing any one of them means you cannot be paid for STAR+PLUS services — even if the other two are in place.

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Step 1: Get Your HCSSA PAS License

Your HCSSA Personal Assistance Services license is the required foundation. It is issued by the Texas Health and Human Services Commission (HHSC) under 26 TAC Chapter 558 and typically takes 60 to 90 days from a complete application submission.

The HCSSA license is what authorizes you to operate as a home care agency and what TMHP verifies during provider enrollment. You cannot begin TMHP enrollment without it.

The license application process — including administrator requirements, required documents, and the mandatory pre-survey CBT — is covered in full in our Texas HCSSA Licensing Guide.

One timing point worth noting: you can begin private pay operations immediately after your HCSSA license is issued. You do not need to wait for TMHP enrollment or MCO credentialing to serve non-Medicaid clients. Use the STAR+PLUS enrollment window to build your team and systems.

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Step 2: Enroll with TMHP via PEMS

Texas Medicaid provider enrollment is handled by the Texas Medicaid & Healthcare Partnership (TMHP) through its Provider Enrollment and Management System (PEMS), accessible at tmhp.com.

The enrollment process

PEMS is an online system. You will create a TMHP user account, select the appropriate provider type (Personal Assistance Services), and complete the application including:

• Business entity information (must match your Texas Secretary of State registration)
• HCSSA license number and HHSC documentation
• Administrator and owner information
• Physical location and service area
• Required attestations

TMHP will verify your information, conduct screening, and route the application to the Texas Office of Inspector General (OIG) for a background check — the OIG has 10 business days to complete screening once the application is considered complete.

Timeline

The standard timeline after TMHP receives a complete application is up to 45 days. Home care agencies face moderate-risk screening, which can extend processing in some cases. If TMHP schedules an unannounced site visit as part of its screening process, add another 14 to 45 days.

In practice: submit a complete, accurate application. Incomplete applications are returned and restart the clock. Have your HCSSA license, entity documents, and administrator records ready before you begin.

TMHP contact

For enrollment assistance: TMHP Contact Center at 800-925-9126 or provider.relations@tmhp.com.

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Step 3: Set Up Your HHAeXchange EVV Connection

Once you are enrolled with TMHP and approved to begin accepting Medicaid clients, you must have Electronic Visit Verification (EVV) in place before your first STAR+PLUS visit.

Texas uses HHAeXchange as its statewide EVV aggregator — all visit data must transmit to HHAeXchange to be compliant. You have two options:

State-provided HHAeXchange system (free): HHSC provides access to the HHAeXchange EVV tool at no cost. It handles EVV only, not full scheduling or billing.

Approved EVV Proprietary System Operator (PSO): A home care software platform certified by HHSC to capture EVV data and transmit it to the HHAeXchange aggregator automatically. If you use a PSO platform, your caregivers clock in and out through the same scheduling app you use for all clients — no separate EVV tool required.

For a STAR+PLUS client, EVV is not optional — visits without valid EVV records can result in claim denials. Build your EVV system and caregiver training into your pre-launch checklist, not your post-first-visit remediation list.

For a complete breakdown of Texas EVV requirements, the alternative device phase-out timeline, and what to look for in EVV software, see Texas EVV Requirements 2026.

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Step 4: Get Credentialed with STAR+PLUS MCOs

Texas STAR+PLUS is administered by seven managed care organizations (MCOs) as of July 2026:

1. UnitedHealthcare Community Plan of Texas
2. Molina Healthcare of Texas
3. Superior HealthPlan
4. Wellpoint (formerly Amerigroup Texas)
5. Community First Health Plans (San Antonio / Bexar SDA only)
6. El Paso Health (El Paso SDA only)
7. Community Health Choice (Greater Houston area)

Texas has 13 service delivery areas (SDAs), and not all MCOs operate in all SDAs. Before you begin credentialing, identify which MCOs are active in your county or SDA. You only need contracts with the MCOs serving your geographic area.

The credentialing process

Each MCO has its own credentialing process, typically managed through its Provider Relations or Network Development department. The general steps:

1. Contact the MCO's provider relations team to request a contract application for STAR+PLUS HCBS personal assistance services.
2. Complete the application — you'll need your TMHP provider enrollment confirmation, HCSSA license, NPI (if applicable), proof of insurance, and agency documentation.
3. Submit the application for MCO review.
4. The MCO conducts its own credentialing review, which may include verifying your license, reviewing agency leadership backgrounds, and confirming compliance with their provider standards.
5. Once approved, you receive a contract and a provider number with that MCO. Only then will your agency appear in the MCO's provider directory and be eligible to receive referrals.

Timeline: MCO credentialing typically takes 30 to 90 days per MCO. Each MCO is a separate application, separate timeline, and separate contract. Some MCOs process faster than others, and the timeline can vary with application volume.

Practical note: Submit credentialing applications to all relevant MCOs simultaneously after your TMHP enrollment is confirmed. Don't wait for one to complete before starting another.

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How Referrals Actually Reach Your Agency

This is the step most guides skip — and the reason many newly-enrolled agencies wait months for their first STAR+PLUS client.

The service coordinator is your referral source

When a STAR+PLUS member qualifies for HCBS personal assistance services, the MCO assigns a service coordinator (also called a care coordinator or case manager). The service coordinator's job is to:

• Assess the member's needs and goals
• Develop the Individual Service Plan (ISP) — the authorization document that specifies which services are approved and how many hours per week or month
• Connect the member with a contracted provider in the MCO's network

The service coordinator does not search for providers the way a consumer might search online. They work from the MCO's contracted provider directory — the list of agencies credentialed to serve that MCO's members in a given geographic area. If you are not in that directory, you will not receive referrals from that service coordinator.

Understanding the upgrade path

Many STAR+PLUS HCBS referrals do not come from new Medicaid applicants. They come from members who are already enrolled in STAR+PLUS for acute care benefits and are upgrading to HCBS as their care needs increase. The MCO's care coordinator team identifies these members and initiates the upgrade — including developing the ISP and connecting them with a home care agency.

This means your referral pipeline is primarily driven by the MCO's internal care management processes, not by members calling agencies directly. Getting referrals requires being visible to MCO service coordinators — and that means being contracted, being in the directory, and proactively building relationships with each MCO's provider relations or care coordination teams.

What you can do before the first referral

Once you are credentialed with one or more MCOs:

• Request a meeting with the MCO's provider relations representative in your service area. Many MCOs have regional provider relations contacts who work with new agencies. Introducing your agency, your service area, and your capacity can accelerate referrals.
• Confirm your listing in each MCO's online provider directory. Errors in the directory (wrong address, wrong phone, missing service types) are common with new providers and will prevent referrals from reaching you.
• Be responsive. MCO service coordinators often contact multiple agencies when placing a referral. Agencies that respond quickly and can confirm start date availability get the client.

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What Happens When a Referral Comes In

When an MCO service coordinator contacts your agency with a referral, here is what to expect:

1. ISP review The coordinator will share the member's Individual Service Plan — the authorization that specifies what services are approved and the number of authorized hours. Review this carefully. You can only bill for services and hours that appear on the ISP. Hours served beyond the authorized amount are not reimbursable.

2. Confirm acceptance You'll confirm your agency's ability to provide the authorized services in the member's area, starting on the requested date.

3. Prior authorization Services cannot begin until the MCO has issued a prior authorization for your agency for that specific client. This step is often combined with the ISP coordination process, but confirm it explicitly — billing without valid prior authorization is a common reason claims are denied.

4. Scheduling and EVV Once the authorization is confirmed, schedule the first visit and ensure your EVV system is ready. The caregiver must clock in and out at the client's location for every STAR+PLUS visit. There are no exceptions that are billing-safe.

5. Start of care Conduct an initial in-home assessment and document it per your agency's care planning protocols. This is also when you collect any client signatures required by the MCO.

For a detailed walkthrough of the full billing cycle — from EVV data to MCO claim submission — see our guide: STAR+PLUS Billing for Texas Home Care Agencies.

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Timeline Reality Check

The most common error new agencies make is underestimating how long the post-licensing enrollment process takes. Here is a realistic best-case timeline:

Stage	Typical duration	Can it overlap?
HCSSA PAS license	60–90 days	Starting point — must complete first
TMHP PEMS enrollment	45+ days	Start immediately after license issued
HHAeXchange EVV setup	1–2 weeks	Start after TMHP enrollment confirmed
MCO credentialing (per MCO)	30–90 days	Submit to all relevant MCOs simultaneously, after TMHP enrollment
First referral received	Variable	Depends on MCO provider directory listing, service coordinator activity

Realistic total: 4 to 6 months from starting the process to receiving your first STAR+PLUS referral — assuming your HCSSA license is already in hand when you begin TMHP enrollment.

If your HCSSA license is also in progress, add another 60 to 90 days to that total.

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Operating While You Wait

The enrollment timeline is real, but it does not mean you have to sit idle. Once your HCSSA license is issued, you can serve private pay clients immediately — no TMHP enrollment or MCO credentialing required.

Use this period to:

• Hire and train caregivers (you'll need them when Medicaid clients arrive)
• Build your scheduling and documentation systems
• Develop and test your EVV workflow with private pay clients before your first Medicaid visit depends on it
• Generate revenue that offsets the enrollment period costs

Agencies that arrive at their first STAR+PLUS client with an experienced caregiver team, tested systems, and documented workflows have significantly fewer compliance problems than agencies scrambling to stand up operations in parallel with their first Medicaid authorization.

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STAR+PLUS Enrollment Checklist

Licensing foundation:

• HCSSA PAS license issued by HHSC
• Business entity in good standing with Secretary of State and State Comptroller
• HCSSA Pre-Survey CBT completed

TMHP enrollment:

• TMHP PEMS account created at tmhp.com
• Provider enrollment application submitted with complete documentation
• TMHP enrollment confirmed and provider ID received

EVV setup:

• EVV path selected (state-provided HHAeXchange system or certified PSO platform)
• HHAeXchange account or PSO platform configured
• Caregiver EVV training completed

MCO credentialing:

• MCOs serving your SDA/county identified (check hhs.texas.gov for current SDA map)
• Credentialing applications submitted to all relevant MCOs simultaneously
• Contracts received and signed from each MCO
• Provider directory listing confirmed with each MCO (correct address, phone, service types)

Pre-referral operations:

• MCO provider relations contacts identified in your service area
• Introduction made to MCO care coordination teams
• Private pay client operations running (build team and systems before first Medicaid visit)
• Prior authorization workflow documented
• ISP review process defined
• Start-of-care documentation templates ready

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Related Guides

• Texas HCSSA Licensing Guide — complete walkthrough of the licensing process that must precede STAR+PLUS enrollment
• Texas EVV Requirements 2026 — EVV compliance for Texas Medicaid agencies, including the HHAeXchange aggregator model
• STAR+PLUS Billing for Texas Home Care Agencies — the full billing cycle from ISP authorization through MCO claim submission
• AtlasCare vs HHAeXchange — understand HHAeXchange both as the required state EVV aggregator and as a commercial software product
• Home Care Software for Small Texas Agencies — scheduling, EVV, and billing built for agencies at exactly this stage

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Atlas Care Software — Built for Texas Home Care Agencies →