Dual Demonstration MMP Program Ending December 31, 2025, and Integrated D-SNP Model Begins on January 1, 2026
AI Summary
Texas is ending its Dual Demonstration Medicare-Medicaid Plan (MMP) program on December 31, 2025, and implementing an Integrated D-SNP model starting January 1, 2026. Members will now be enrolled in two separate health plans instead of one, and providers must verify enrollment status before billing to avoid delays due to different Medicare and Medicaid enrollment timelines.
Action Required
By January 1, 2026: Billing team must implement new verification procedures for dual-eligible members in Bexar, Dallas, El Paso, Harris, and Hidalgo counties. Verify both Medicare (Integrated D-SNP) and Medicaid (STAR+PLUS MCO) enrollment status before submitting claims, as Medicare coverage may start a month before Medicaid benefits begin. Update billing workflows to account for members having two separate health plans instead of one unified MMP. Contact MCOs directly for billing questions: Molina (855-322-4080), Superior (877-391-5921), or UnitedHealthcare (877-842-3210).
Plan Types
Medicare Advantage, Medicaid
States
TX
Specialties
all-specialties