Texas is ending its Medicare-Medicaid Plan (MMP) program on December 31, 2025. This affects 135,000 people who rely on both Medicare and Medicaid for coverage.
The program served dually eligible beneficiaries in five counties since March 2015. Now, all members must switch to a new system starting January 1, 2026.
The biggest problem: prior authorizations will not transfer.
If you have an approved prior authorization under your current MMP plan, it expires December 31. You need a new approval from your new plan. This includes home health, skilled nursing, therapy, medical equipment, and specialty medications.
Providers must submit all new prior authorizations by December 31. If they don’t, services could be denied or delayed starting January 1.
The change affects five counties: Bexar, Dallas, El Paso, Harris, and Hidalgo. These include major cities like San Antonio, Houston, and Dallas.
Members will now have two separate health plans instead of one. The new system uses an Integrated Dual Eligible Special Needs Plan (D-SNP) for Medicare and a STAR+PLUS plan for Medicaid. Both plans must come from the same parent company, but they are legally separate.
This means two ID numbers, two payer codes, and two prior authorization processes—even though members will receive one combined ID card.
Billing will change completely. Healthcare providers must update their systems with new payer plan codes by December 1, 2025. Claims submitted with old MMP codes after January 1 will be rejected.
The Texas Health and Human Services Commission (HHSC) says the change follows a federal decision. The Centers for Medicare & Medicaid Services (CMS) is ending all Medicare-Medicaid demonstration programs nationwide by the end of 2025.
Seven states are making this transition. Texas chose a two-plan model instead of keeping everything under one contract.
Electronic Visit Verification (EVV) systems must also update. Home health and personal care providers use EVV to document services. All EVV authorizations tied to the old MMP expire December 31. Providers must create new authorizations with updated payer codes.
Members enrolled in Molina Healthcare, Superior HealthPlan, or UnitedHealthcare MMP plans will be moved into new aligned plans. Members have 60 days to choose a different plan if they want.
If members don’t choose, they will be automatically enrolled in the aligned D-SNP and STAR+PLUS plan from the same company.
There is a risk of coverage gaps. Medicare D-SNP coverage may start January 1, but Medicaid STAR+PLUS coverage could start later—sometimes not until February 1. Providers must verify enrollment with both plans before billing.
The transition period from December 31 through early January is considered high-risk. Claims may be delayed. Authorizations may expire. Systems may reject billing codes.
Providers are being told to verify coverage before every service during this period. This includes checking with both the D-SNP and the STAR+PLUS plan separately.
HHSC held a provider webinar on November 20, 2025. The agency published new contact numbers effective November 30. New payer codes were released December 1.
For help, providers can contact plan-specific numbers:
Molina Healthcare: 855-322-4080
Superior HealthPlan: 1-855-445-3572
UnitedHealthcare: 877-842-3210
Members with questions should contact their current plan or the Texas Office of the Ombudsman.
The MMP program was part of the federal Financial Alignment Initiative. It was designed to integrate Medicare and Medicaid under one plan. CMS now believes D-SNPs are more scalable across all states.
The transition must be completed by January 1, 2026. There is no extension.
