Texas's Medicaid home care market runs almost entirely through STAR+PLUS managed care — and billing STAR+PLUS is different enough from private pay, or even traditional fee-for-service Medicaid, that agencies new to the program routinely make enrollment mistakes that delay their first payment by months.

This guide covers the structure of STAR+PLUS, the enrollment sequence that gets you credentialed and billable, how the claims cycle actually works, and the 2025 changes every Texas provider needs to know. All information is current as of June 2026.

What Is STAR+PLUS

STAR+PLUS (State of Texas Access Reform Plus) is Texas's Medicaid Managed Long-Term Services and Supports (MLTSS) program. It covers adults 21 and older who:

Have a physical disability or chronic condition that requires long-term care, or
Are eligible for both Medicare and Medicaid (dual-eligible)

The defining feature of STAR+PLUS is that it consolidates all benefits — acute care, behavioral health, and long-term care — into a single managed care plan through a private Managed Care Organization (MCO). Members choose an MCO, and all services flow through that plan.

This matters for billing: you don't bill the state. You bill the MCO.

Unlike fee-for-service Medicaid programs where claims go to TMHP, STAR+PLUS billing goes directly to the member's MCO. Each MCO has its own provider portal, claim submission timelines, and credentialing requirements. There is no single state billing address.

Services Home Care Agencies Can Bill Under STAR+PLUS

STAR+PLUS covers a broad range of home and community-based services (HCBS). The services most relevant to personal care agencies are:

Personal Assistance Services (PAS) The primary service category for home care agencies. PAS — formerly called Primary Home Care (PHC) and Community Attendant Services (CAS) in older program generations — covers:

Activities of daily living: bathing, dressing, grooming, toileting, mobility, and feeding
Household chores necessary to maintain a clean, sanitary, and safe home environment
Escort services (accompanying members to medical appointments)

PAS is authorized in hourly units through each member's Individual Service Plan. The level of care and total authorized hours are determined by a functional assessment conducted by the MCO's service coordinator.

Respite Care Temporary substitute care when a family or unpaid caregiver needs a break. Respite hours are authorized separately from PAS and billed at defined rates. As of the August 2025 billing matrix update, respite care uses updated HCPCS procedure codes — verify current codes against the active LTSS billing matrix before submitting claims for respite services.

Day Activity and Health Services (DAHS) Adult day center services provided in licensed DAHS settings. Less common for home care agencies but authorized under the same HCBS framework.

Emergency Response Services Personal emergency response systems for members living alone or at high risk for falls and medical emergencies.

Supported Employment Job coaching and ongoing employment support for members seeking competitive employment.

What STAR+PLUS HCBS does not cover for home care agencies: Skilled nursing, physical therapy, occupational therapy, and home health aide services fall under separate state plan benefits, require different authorization pathways, and require an LHH or L&CHH HCSSA license rather than a PAS license.

The Seven STAR+PLUS MCOs

As of 2025, seven MCOs hold STAR+PLUS contracts across 13 Texas Service Delivery Areas (SDAs):

United Healthcare Community Plan
Molina Healthcare of Texas
Superior HealthPlan (Centene subsidiary)
Wellpoint (formerly Amerigroup)
Community First Health Plans (primarily San Antonio and surrounding areas)
El Paso Health
Community Health Choice (primarily the Houston area)

Your agency's geography determines which MCOs operate in your SDA. Most areas offer 2–3 MCO options for members to choose from. Being contracted with one MCO does not transfer to others — each requires a separate credentialing process.

To identify which MCOs serve your specific county or service delivery area, contact the HHSC Enrollment Broker at 1-800-964-2777 or reference the HHSC MCO provider relations contacts document (updated January 2026) at hhs.texas.gov.

Important 2025–2026 change: The federal Medicare-Medicaid Plan (MMP) Dual Demonstration Program ended December 31, 2025. Former MMP members in Bexar, Dallas, El Paso, Harris, and Hidalgo counties transitioned to STAR+PLUS MCOs in January 2026. If your agency served any dual-eligible clients through MMP, those members now require a new STAR+PLUS plan code, a new authorization, and a separate HHAeXchange authorization record under the new plan.

How to Become a Billable STAR+PLUS Provider: Three Required Steps

Missing any one of these three steps means you cannot be paid — even if your agency is fully licensed, fully staffed, and actively serving STAR+PLUS members. Complete them in sequence.

Step 1: Enroll in Texas Medicaid Through TMHP

Before any MCO will credential you, you need a Texas Medicaid provider number. Provider enrollment is handled through TMHP (Texas Medicaid & Healthcare Partnership).

What to do:

Visit tmhp.com → Provider Enrollment
Select your provider type (PAS agency, home health agency, or the applicable classification for your license)
Submit required documents: current HCSSA license, National Provider Identifier (NPI), tax ID, and service address
Receive your Texas Medicaid provider number (typically 2–4 weeks after a complete application)

Your TMHP provider number is a prerequisite for Steps 2 and 3. Do not begin MCO credentialing before it is in hand.

Step 2: Complete HHAeXchange EVV Onboarding

Electronic visit verification is required for all Medicaid personal care services (effective January 1, 2021) and all Medicaid home health services (effective January 1, 2024). HHAeXchange is the Texas state-funded EVV aggregator — it is free for providers, and all EVV data must flow through it regardless of which scheduling or billing software your agency uses.

What to do:

Submit the HHAeXchange Provider Onboarding Form (available through the TMHP website)
Complete required annual EVV portal training through TMHP's Learning Management System (LMS)
Confirm that every caregiver who will deliver Medicaid services knows how to clock in and out using the HHAeXchange mobile app — only the service provider can clock in at the point of care; clocking in on their behalf is a compliance violation

Alternative device policy update: Texas HHSC began phasing out alternative EVV devices (telephone-based or fixed devices used instead of the caregiver mobile app) on September 1, 2025. The phase-out runs through September 1, 2028, by which point no more than 5% of total visit transactions may use an alternative device. Agencies that currently rely heavily on phone-based clock-ins should treat the mobile app transition as an active priority. HHSC began tracking agency-level alternative device usage rates in the EVV Portal on November 1, 2025 — your usage rate is visible to payers.

For a complete breakdown of EVV requirements, the two compliance paths (state-provided HHAeXchange vs. certified Proprietary System Operator), and the full alternative device phase-out schedule, see: Texas EVV Requirements 2026.

Step 3: Credential With Each MCO in Your Service Delivery Area

Once you have a TMHP provider number, contact every STAR+PLUS MCO operating in your SDA and submit their credentialing applications simultaneously. Each MCO has its own:

Provider application and contract
Credentialing timeline (typically 30–90 days per MCO from a complete application)
Provider portal for claims submission and authorizations
Provider relations team for billing and authorization questions

Being credentialed in one SDA under an MCO does not automatically transfer to adjacent SDAs under the same plan. If your agency serves members across multiple regions, confirm your approved service scope with each MCO separately.

How the STAR+PLUS Billing Cycle Works

Understanding the full cycle — from member assignment to payment deposit — prevents the most common causes of claim denials and payment delays.

1. Verify Member Eligibility and MCO Plan Code

Before scheduling a first visit, confirm the member is actively enrolled in STAR+PLUS and identify their current MCO and plan code. The MCO name and plan code determine which provider portal you submit claims to and which care coordinator manages the member's authorizations. In HHAeXchange, each member requires a separate authorization record linked to their specific plan code. An authorization created under the wrong plan code will generate denials.

2. Obtain Prior Authorization Through the Individual Service Plan (ISP)

No STAR+PLUS claim is paid without a valid prior authorization. For HCBS members, authorization comes through the Individual Service Plan (ISP) — a document developed collaboratively by the member, any family or support network, and the MCO's service coordinator.

The ISP specifies:

Which services are authorized (PAS hours, respite units, etc.)
The authorized number of units per billing period
The authorization start and end dates
Which providers are approved to deliver each service

Your primary point of contact for all authorization questions is the member's MCO service coordinator. For new authorizations, ISP renewals, or requests to adjust authorized service hours, the MCO care manager initiates the process. When a care plan changes mid-authorization period, the change requires MCO approval before you can bill at the new level. Document every conversation with the care coordinator in the member's file.

Visits delivered before an authorization is in place — even if the member clearly needs services — are at risk for denial. Never begin services on an assumption that authorization is coming.

3. Deliver the Service With EVV Clock-In and Clock-Out

Every qualifying STAR+PLUS personal care or home health visit must be EVV-verified through HHAeXchange before it can be billed. The caregiver uses the HHAeXchange mobile app (or your PSO scheduling software, if it transmits to HHAeXchange) to:

Clock in at the start of the visit, with GPS location captured at that moment
Clock out at the end of the visit

The system must capture all six required data elements: service type, member, date, location, caregiver identity, and begin/end times. A visit with incomplete EVV records cannot be billed — and retroactive EVV entry after the fact is a compliance risk.

4. Submit the Claim to the MCO Provider Portal

After confirming the EVV record is complete and accurate, submit the claim to the member's MCO through their provider portal. Key details:

HCPCS code and modifier: Use the code in the HHSC LTSS Codes and Modifiers billing matrix that was in effect on the date of service. The matrix was updated in August 2025 — claims for respite care and certain assisted living services must use the new codes when the member's ISP renews on or after September 1, 2025. Claims submitted with pre-September 2025 codes for those service types will be denied.
Timely filing window: Each MCO sets its own timely filing deadline. Confirm the specific window with each MCO — missing it results in a permanent denial with no appeal path.
Units: Claim only units that match the authorized ISP and the EVV-verified visit record. Discrepancies between the claim, the EVV record, and the ISP authorization are audit triggers.

5. Track and Appeal Denials

STAR+PLUS claims are denied more frequently than private pay invoices — and each denial requires a specific response. Build a denial review step into your weekly billing workflow. Common denial reasons include:

Authorization not on file or expired: The ISP hasn't been set up in the MCO's system, or the date of service falls outside the authorization period
EVV not verified: The HHAeXchange visit record is incomplete, rejected, or linked to the wrong plan code
Incorrect billing code: The service was billed with a code that changed in August 2025 but was not updated in your billing records
Member enrollment gap: The member switched MCOs, has a gap in Medicaid eligibility, or was not enrolled in STAR+PLUS on the date of service
Credentialing lapse: Your agency's contract or credentialing with the MCO expired or was not renewed

Each MCO has a formal appeals process. Most require appeals within 90–120 days of the denial date — confirm the specific window per MCO. Appeals submitted after the deadline are rejected regardless of their merit.

2025 Changes Every Texas STAR+PLUS Provider Needs to Know

August 2025: Updated LTSS Billing Matrix

HHSC updated the Long-Term Services and Supports Codes and Modifiers billing matrix in August 2025. Starting when each STAR+PLUS member's Individual Service Plan renews on or after September 1, 2025, providers must use updated HCPCS procedure codes and modifiers for respite care and certain assisted living services. Claims submitted with the codes used before the update — for service dates after the member's ISP renewal — will be denied.

Action required: Download the current LTSS billing matrix from hhs.texas.gov (Appendix XVI of the STAR+PLUS Handbook) and update any billing templates or charge codes for affected service types. Confirm the ISP renewal dates for your active STAR+PLUS members so you know exactly when the new codes apply to each one.

December 2025 / January 2026: End of MMP Dual Demonstration

The federal Medicare-Medicaid Plan (MMP) Dual Demonstration Program ended December 31, 2025. Former MMP members in Bexar, Dallas, El Paso, Harris, and Hidalgo counties began enrolling in STAR+PLUS MCOs in January 2026. For agencies that served these members:

Each former MMP member now has a new STAR+PLUS plan code
A new ISP authorization is required under the new MCO
HHAeXchange authorization records must be created under the new plan code before billing
TMHP set a timely filing exception for certain affected FFS claims submitted between June 9, 2025, and December 27, 2025 — deadline to resubmit was February 28, 2026

If you have members in the five affected counties who were previously on MMP and have not yet transitioned their authorizations and billing records, address this immediately.

STAR+PLUS Provider Readiness Checklist

Use this checklist before billing your first STAR+PLUS claim — and on an ongoing basis as a compliance review.

Licensing and enrollment:

HCSSA license in effect (PAS category minimum for personal assistance services)
Texas Medicaid provider number obtained through TMHP enrollment
NPI registered and linked to TMHP enrollment record
Enrolled with HHSC as a program provider for the applicable service types

EVV compliance:

HHAeXchange Provider Onboarding Form submitted and portal access confirmed
Annual EVV training completed in TMHP Learning Management System
All caregivers delivering Medicaid services trained on HHAeXchange mobile app clock-in
Agency alternative device usage rate reviewed in EVV Portal (available since Nov 1, 2025)
Alternative device reduction plan in place if usage exceeds 5% threshold

MCO credentialing:

All STAR+PLUS MCOs operating in your service delivery area identified
Credentialing applications submitted simultaneously to all MCOs
Provider portal access confirmed for each contracted MCO
Provider relations contact saved per MCO (for authorization and claims escalations)

Billing cycle operations:

Current LTSS billing matrix (August 2025 version) on file
Billing codes and modifiers updated for respite and assisted living service types
Member eligibility and MCO plan code verified before each new member's first visit
Authorization (ISP) on file and confirmed before beginning services
EVV record verification built into weekly pre-billing workflow
Denial tracking process in place with MCO-specific appeal timelines

How STAR+PLUS Changes Your Software Requirements

A private pay home care agency can run indefinitely on private-pay-only scheduling software. The moment you take your first STAR+PLUS client, your software requirements change in three meaningful ways.

EVV integration: Your scheduling system must either be a Texas-certified Proprietary System Operator (PSO) that transmits visit data to HHAeXchange automatically, or your caregivers must use the free HHAeXchange mobile app directly for clock-in/out. A scheduling system with no HHAeXchange connection cannot support Medicaid billing compliance.

Authorization tracking: You need to track each member's ISP authorization dates and authorized unit totals — and ensure claims stay within those parameters. Most agencies billing STAR+PLUS track authorizations in a spreadsheet initially, but the error rate climbs quickly as the member census grows.

Multi-payer billing: Private pay invoicing and STAR+PLUS claim submission are two distinct workflows. If your agency serves both client types, your software should handle both without requiring separate data entry for the same visit.

Atlas Care Software currently builds for private pay agencies. Direct Texas Medicaid billing and HHAeXchange EVV aggregator integration are in active development — contact us if STAR+PLUS billing is on your roadmap and we'll share current timelines.

Atlas Care Software for Texas Agencies →

Additional Resources

STAR+PLUS Handbook: hhs.texas.gov/handbooks/starplus-handbook — the authoritative reference for program rules, eligibility, and HCBS service definitions
LTSS Codes and Modifiers Billing Matrix: STAR+PLUS Handbook, Appendix XVI — updated August 2025
TMHP Provider Enrollment: tmhp.com/topics/provider-enrollment
HHAeXchange Texas EVV Information Center: hhaexchange.com/info-hub/texas
HHSC Enrollment Broker (MCO finder): 1-800-964-2777

Related Guides

Texas HCSSA Licensing Guide 2026 — the HCSSA license you need before STAR+PLUS provider enrollment; PAS vs. LHH vs. L&CHH categories explained
Texas EVV Requirements 2026 — HHAeXchange onboarding, the two EVV compliance paths, and the full alternative device phase-out timeline
AtlasCare vs HHAeXchange — the distinction between HHAeXchange as the required Texas state EVV portal and as a commercial home care software product
AtlasCare vs Axxess — both Texas home care software companies; how STAR+PLUS and EVV support compare
Home Care Software for Small Texas Agencies — scheduling, GPS EVV, and invoicing in one platform

STAR+PLUS Billing for Texas Home Care Agencies: A Plain-English Guide