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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)

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

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.

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