Texas Shifts Dual Eligible Integration to Integrated D-SNP Model in 2026

The Texas Health and Human Services Commission (HHSC) is making changes to the integration of Medicare and Medicaid benefits for dual eligible members enrolled in the state's STAR+PLUS program.

Dual eligible individuals qualify for both Medicare and Medicaid, with varying levels of benefit coverage depending on their eligibility status. Medicare is a federal program providing standardized health insurance primarily for those aged 65 and older, while Medicaid is a joint federal and state program that offers additional benefits, including services like nursing home care, which are not typically covered by Medicare. HHSC administers the state's Medicaid program, operating within federal guidelines but with state-specific management.

Currently, Texas dual eligibles in the STAR+PLUS program are served through a Medicare-Medicaid Plan (MMP) under the Dual-Eligible Integrated Care Demonstration Project. These MMPs hold contracts with both the federal government and HHSC to deliver comprehensive Medicare and Medicaid services. However, following the Centers for Medicare & Medicaid Services (CMS) Contract Year 2023 Medicare Advantage and Part D Final Rule, HHSC will phase out the Dual Demonstration Program by December 31, 2025.

Starting January 1, 2026, HHSC will implement an Integrated Dual-Eligible Special Needs Plan (Integrated D-SNP) model. This transition aims to maintain and enhance integrated care for full-benefit dual eligibles within the STAR+PLUS program. The Integrated D-SNP model offers a higher level of coordination compared to traditional D-SNP plans by combining Medicare and Medicaid benefits under a single health plan, ensuring continued, streamlined access to comprehensive services.

HHSC has already begun notifying members about these changes and their options for selecting new Medicare and Medicaid plans during the 2026 Medicare annual enrollment period. Initial implementation will focus on health plans that previously operated MMPs in 2025. The move reflects ongoing regulatory compliance with CMS directives and efforts to optimize care integration for dual eligible populations in Texas.

This update affects all counties in Texas where the STAR+PLUS program is active and is part of broader federal and state efforts to enhance care delivery models for complex patient populations, especially those who receive both Medicare and Medicaid benefits. Health plans and providers in the Texas market should prepare for these structural changes to ensure smooth transitions and continued compliance with federal CMS rules.