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EVV Impacts due to Dual Demonstration Pilot Program Discontinued effective January 1, 2026

Beginning January 1, 2026, HHSC will discontinue the Dual Demonstration Program with the Medicare-Medicaid Plans (MMPs) in the listed demonstration counties:


* Bexar County: Molina Healthcare of Texas.
* Dallas County: Molina Healthcare of Texas and Superior Health Plan.
* El Paso County: Molina Healthcare of Texas.
* Harris County: Molina Healthcare of Texas and United Healthcare.
* Hidalgo County: Molina Healthcare of Texas and Superior Health Plan.

HHSC will end the MMP plan codes in the demonstration counties. MMP members will choose a STAR+PLUS Managed Care Organization (MCO) in their service area to continue their services.

 

The table below shows the ending MMP plan codes and the STAR+PLUS MCO plan codes in the demonstration service areas.

"(Example: The MMP plan code for Molina in Dallas is 9J. The STAR+PLUS MCO plan code for Molina in Dallas is 9F. Due to the discontinuation of the Dual Demonstration Program, the plan code for MMP members who choose to stay with Molina as their STAR+PLUS MCO is 9F)"

*MMP Plan Code (Ending)*



*Plan Name*



*MMP Service Area*



*STAR+PLUS Plan Code*



*4G*



Molina Healthcare of Texas



Bexar



46



*9J*



Molina Healthcare of Texas



Dallas



9F



*9K*



Superior Health Plan



Dallas



9H



*3H*



Molina Healthcare of Texas



El Paso



33



*7V*



Molina Healthcare of Texas



Harris



7S



*7Q*



United Healthcare Texas



Harris



7R



*H9*



Molina Healthcare of Texas



Hidalgo



H6



*HA*



Superior Health Plan



Hidalgo



H5



 

The table below lists STAR+PLUS MCOs and the MCO plan codes that the MMP members in the MMPs ending Dec. 31, 2025, can select to transition to.

STAR+PLUS MCOs are listed in the table and in "Appendix XXIX, STAR+PLUS Plan Codes and Contract Numbers | Texas Health and Human Services" [ [link removed] ]__

"_ _"

*STAR+PLUS MCO*



*Service Area*



*STAR+PLUS Plan Code*



*Molina** Healthcare of Texas*



Bexar



46



*Community First Health Plan*



Bexar



S1



*United Healthcare Texas*



Bexar



S5



*Molina** Healthcare of Texas*



Dallas



9F



*Superior** Health Plan*



Dallas



9H



*United Healthcare Texas*



Dallas



S6



*Molina** Healthcare of Texas*



El Paso



33



*El Paso Health*



El Paso



S2



*Molina** Healthcare of Texas*



Harris



7S



*United Healthcare Texas*



Harris



7R



*Community Health Choice*



Harris



S3



*Molina** Healthcare of Texas*



Hidalgo



H6



*Superior** Health Plan*



Hidalgo



H5



*United Healthcare Texas*



Hidalgo



S7



* *

*Payment of Services as of Jan. 1, 2026*

Beginning Jan. 1, 2026, program providers, financial management services agencies (FMSAs), and Proprietary System Operators (PSOs) *will* have a new MCO payer plan code for their MMP members and *must* bill the new payer with dates of service on or after Jan. 1, 2026.

Program providers, FMSAs, and PSOs using a third-party vendor for billing need to notify the third-party vendor about the changes.

* *

* *

*Program Provider, FMSA, and PSO Responsibilities*

Program providers, FMSAs, and PSOs should continue to use the current authorization in the Electronic Visit Verification (EVV) system for their members through Dec. 31, 2025.

For dates of service beginning Jan. 1, 2026, and after, program providers, FMSAs, and PSOs should:


* Identify the STAR+PLUS MCO and plan code that their MMP member transitioned to;
* Create a new authorization for the former MMP member, using the new STAR+PLUS MCO’s plan code and applicable information from the authorization that ends on Dec. 31, 2025;
* Manually enter the former MMP member’s new STAR+PLUS authorization into their EVV system.

Program providers, FMSAs, and PSOs can check their members’ eligibility and MCO assignment using 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 the end of the following month. Providers can use this to check eligibility.

Program providers, FMSAs, and PSOs *must* continue to submit claims with EVV Required services directly to TMHP for EVV claims matching.

Resources:


* Review: Dual Eligible Integrated Care Demonstration Project | Texas Health and Human Services [ [link removed] ].

For more information about the Dual Demonstration Transition, contact [email protected]

















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