When the insurance card is not enough
We Have STAR+PLUS, but We Don’t Know Who to Call About Home Help
Families may know the person has STAR+PLUS but still have no idea who handles bathing help, personal assistance, CFC, PAS, service hours, provider problems, or changes after a hospital stay. The person you are usually trying to find is the MCO service coordinator.
Planned Personal Assistance Services only; license pending.
The short answer
STAR+PLUS members receiving LTSS have service coordination
Texas STAR+PLUS service coordination is designed to connect acute care and long-term services and supports. For members receiving LTSS, the managed care organization coordinates the individual service plan, authorized services, providers, and changes in need.
Start with Member Services
If the family does not know the service coordinator’s name, call the MCO Member Services number on the health-plan card and ask for the STAR+PLUS service coordinator assigned to the member.
Ask for the current plan
Ask what PAS, PCS, CFC, HCBS, respite, or other LTSS are currently authorized and who the contracted provider is.
Ask who owns the next step
If the problem is staffing, a change in need, discharge planning, or provider performance, ask whether the service coordinator, provider, or another MCO team should act next.
Translate the acronyms
The family does not need to memorize them, but they should recognize them
MCO means Managed Care Organization. LTSS means Long-Term Services and Supports. ISP means Individual Service Plan. PAS means Personal Assistance Services. CFC means Community First Choice. HCBS means Home and Community Based Services.
Those terms help the family identify which part of the system is responsible for a particular home-support question.
Questions for the service coordinator
Use these to get past the phone-tree loop
- What LTSS are currently on the member’s service plan?
- Who is the contracted provider for each service?
- How many hours are currently authorized?
- Is the member using Agency Option, CDS, or SRO?
- How do we report a change in functional need?
- What happens if the provider cannot staff the authorized schedule?
- How do we request a provider change?
- Who should participate in discharge planning after a hospital or nursing-facility stay?
If calls are going nowhere
Document who was contacted and what happened
Keep the date, number called, person spoken with, question asked, and promised follow-up. STAR+PLUS members can use the MCO complaint process when they are dissatisfied with the plan or service handling, and HHSC has an Ombudsman/managed-care assistance pathway after the MCO process when needed.
This page provides general navigation information, not legal advice or individualized benefit advice.
The right contact can turn confusion into a plan