Texas: Value-Based Enrollment Incentive Program

Published by Texas Health and Human Services Commission 

Meeting a statutory requirement to redesign their Medicaid managed care auto-enrollment system around quality of care, efficiency and effectiveness of service, the new Texas program phased in a value score to the auto-enrollment process for the STAR, STAR+PLUS, and STAR KIDs programs.   

The report shows that five of the participating 17 managed care organizations (MCOS) gained greater than 2.5 percent in auto enrollments to compared to the previous process. Five plans lost at least 2.5 percent, and seven plans saw changes no greater than 2.5 percent. Since research has found that the members that default into auto-enrollment typically use services at a lesser rate than those who select their plan, this program sets up a compelling incentive for plans to focus on driving value while continuing to meet beneficiary-level factors, such as maintaining existing relationships with providers.

Publication Date: January 2021

Read Study