Texas operates one of the nation's largest Medicaid managed care systems, serving over 6.7 million enrollees through a risk-based MCO model organized by population rather than region: STAR for the general population, STAR+PLUS for LTSS-eligible adults and duals, STAR Kids for children with disabilities, and STAR Health for children in foster care.
Four population-based MCO programs cover nearly all Texas Medicaid enrollees. STAR (general population) is served by Superior HealthPlan, Texas Children's Health Plan, Community Health Choice, UnitedHealthcare, and Molina statewide, plus regional plans in specific service areas. Effective September 1, 2024, STAR+PLUS underwent a major MCO recontracting, moving to 7 MCOs (three new to the program) across 13 service delivery areas. STAR Health (foster care) is served exclusively by Superior HealthPlan statewide under a single contract.
LTSS is integrated into managed care specifically through STAR+PLUS, which combines acute care and long-term services and supports for adults with disabilities, seniors 65+, and dual eligibles. LTSS is not integrated for the general STAR population. Effective December 31, 2025, Texas ended its STAR+PLUS Medicare-Medicaid Plan (MMP) dual demonstration; the MCOs that ran those plans began offering aligned Integrated Dual Eligible Special Needs Plans (D-SNPs) starting January 1, 2026 in Bexar, Dallas, El Paso, Harris, and Hidalgo counties.
Partially integrated into managed care
Behavioral health is carved in to MCOs statewide; each MCO is responsible for mental health and substance use disorder services for its own members, with no separate BHO/MBHO layer. The legacy NorthSTAR carve-out, a Dallas-area managed behavioral health organization model, ended December 31, 2016.
Carved in
Dental services for children are carved out from the medical MCOs and delivered through three statewide prepaid ambulatory health plans (PAHPs).
Pharmacy has been carved in to MCOs since 2012, but the model is decentralized; each MCO contracts its own Pharmacy Benefit Manager rather than the state using a single statewide PBM. The state's Vendor Drug Program continues to govern pharmacy policy and provider enrollment oversight.
Non-emergency medical transportation follows the same carve-in-but-decentralized pattern as pharmacy: for managed care members, NEMT is carved in to each MCO, which contracts its own regional broker. Effective January 1, 2026, SafeRide Health became the NEMT vendor for UnitedHealthcare Community Plan of Texas, joining its existing Texas Children's Health Plan and Superior HealthPlan STAR+PLUS transportation contracts. A separate state-run Medical Transportation Program (MTP) continues to serve the smaller fee-for-service-only population (non-MCO Medicaid, CSHCN Services Program, Transportation for Indigent Cancer Patients) through regional Managed Transportation Organizations and two Full-Risk Brokers in the Dallas-Fort Worth and Houston/Beaumont areas.
Texas Medicaid & Healthcare Partnership (TMHP) serves as the statewide Medicaid claims administrator and MMIS operator, including the Provider Enrollment and Management System (PEMS). HHSC is currently mid-way through a multi-year Medicaid Enterprise System (MES) modernization effort, reprocuring several modular contracts including a new Medicaid claims administration contract and a new Medicaid claims system.
Last updated: Sep 22, 2026
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