All STAR+PLUS members can get the (2) Long-Term Care benefits if there is a functional need:
- Day Activity and Health Services (DAHS)
- Personal Attendant Services (PAS)
Day Activity and Health Services
Licensed day activity and health services (DAHS) facilities give daytime care to members who live in the community. Services are provided Monday to Friday and members can get care up to 5 days per week. They can help with physical, mental, medical and social needs. Sometimes this is called adult day care or adult day services.
What services are provided?
- Meals and snacks (depending on amount of hours attending)
- Nursing and personal care
- Physical rehabilitation
- Social, educational, and recreational activities
Personal Attendant Services
Personal attendants are caregivers that help with activities of daily living and chores needed to keep clean and safe at home (except in adult foster care homes or assisted living facilities). Services may include protective supervision and help with health-related tasks given by a registered nurse. The attendant helps with things like shopping, light cleaning and laundry. The attendant can also help with hands-on personal care items like bathing, dressing and feeding.
Service Delivery Options
What does Service Delivery Option mean?
The member has the option to self-direct services. You do not have to self-direct any of your services. Any services not chosen for self-direction will remain with the home health agency.
Services that can be self-directed
- Personal Attendant Services - PAS
- Physical Therapy (PT)
- Speech/Language Therapy (SLT)
- Occupational Therapy (OT)
You have three service delivery options:
- Service Related
- Agency model
Self-directed is a service delivery option where a member or legally authorized representative (LAR) hires and keeps providers for their personal assistance services and respite services. A financial management services agency, or FMSA, helps with money that is used for your self-directed services. This includes training about the responsibilities of being an employer and following laws for employers.
Service Related is a service delivery option that allows the member or LAR to run most day-to-day activities. This includes being in charge of the people providing personal assistance services and other services in the home. You choose how services are provided and leave the business part to the provider agency.
Agency model is where the home health agency is in charge of running the day-to-day activities of the attendant and all of the business parts.
What am I responsible for?
As a Molina Healthcare member, you must be able to be an employer and hire the caregiver, manage their time and timesheets, and finish other paperwork for them.
You will use an agency to help you with what you need to do this. This agency is called a financial management services agency or FMSA
Who do I contact for more information?
Please call your Molina Healthcare Service Coordinator or call Member Services.
STAR+PLUS Waiver Program
Eligible Molina Medicare Medicaid STAR+PLUS members can get additional long-term care services that are based on their medical need. These are called HCBS STAR+PLUS Waiver services (these services used to be called CBA). The services are provided to keep you out of a nursing facility. Your service coordinator will complete an assessment to help determine eligibility for waiver services.
The STAR+PLUS Waiver program offers long-term services and supports so you can maintain independence in a safe home or community based setting.
Your Service Coordinator will work with you, your representative or guardian to find the right types and amounts of service. Not all services will be right for you. Once you agree to these services, your case manager will work with you to arrange them.
In order to qualify for waiver services or reside in a facility, you must meet certain eligibility requirements. Molina Healthcare does not determine your eligibility into the Waiver or Nursing Facility programs. Eligibility is determined by the Texas Department of Health and Human Services (HHS). If HHS decides you are eligible, you will be asked to select a health plan or managed care organization. A health plan may be assigned for you if you did not make a choice.
Criteria for HCBS STAR+PLUS Waiver includes the following:
- Full Medicaid coverage
- A need for a minimum of one Waiver benefit, excluding PAS and/or ERS, that exceeds $0 in costs.
- Has a medical condition that is unstable or requires frequent treatment changes or intervention by a licensed nurse.
- Member must have a qualifying condition based upon the Medical Necessity Level of Care and approval by physician certifying medical necessity as well as approval from HHS.
- Costs under the established limits based on services provided in an institutional setting
If you do not meet or maintain your eligibility requirements to get waiver services according to HHS standards, you may be disenrolled. HHS will send you a notice if they find that you are no longer eligible to get waiver services. The notice will include the date that the waiver services will stop because you are no longer eligible. Molina Healthcare will also be told. Molina Healthcare will still cover your medical health care benefits as long as you are a member.