How Medicaid STAR+PLUS managed care works in San Antonio in 2026, and how Bexar County families compare Molina, Centene's Superior HealthPlan, and other options.
By San Antonio Senior Advisor Care Team · August 11, 2026
Medicaid STAR+PLUS managed care in San Antonio is the delivery system that sits between a Bexar County senior and the long-term services their Medicaid eligibility entitles them to. Texas does not pay long-term care providers directly for this population. Instead, Texas Health and Human Services contracts with managed care organizations, or MCOs, and each eligible adult who is 65 or older or who has a disability enrolls with one of those health plans. The plan then receives a monthly payment from the state and becomes responsible for the member's acute medical care, prescription coverage, and - for members who also qualify under the Home and Community-Based Services waiver - the attendant care, adult day programs, home modifications, and assisted living services that keep them out of a nursing facility. Families in San Antonio often assume the state decides how many hours of help a parent receives. In practice, that decision is made inside the health plan, by a service coordinator employed by the MCO.
This structure matters more than it sounds. Because the plan holds the money and the network, the plan you choose determines which doctors your parent can keep, which pharmacy is in network, which home health agencies can send an attendant to a house on the South Side or in Converse, and - critically - which licensed assisted living facilities can accept your parent as a waiver resident. Two San Antonio seniors with identical diagnoses and identical Medicaid eligibility can end up with very different care simply because they enrolled with different MCOs. Enrollment is not permanent, and the rules allow changes, but the friction of switching mid-crisis is real. It is far better to choose deliberately at the outset than to fix it later from a hospital bed at Methodist Hospital or Baptist Medical Center.
The health plans that have historically served the Bexar service area include Molina Healthcare of Texas, Superior HealthPlan (a Centene company), Amerigroup, and UnitedHealthcare Community Plan. Texas periodically rebids these managed care contracts, and the roster available in San Antonio can change when the state issues new awards or when a plan's participation in a service area shifts. Never rely on a list you found online - including this one - as your final answer. Confirm the plans currently offered in Bexar County with Texas Health and Human Services at hhs.texas.gov, or by calling the state's enrollment broker, before you make a choice. The enrollment packet your parent receives in the mail will list the plans genuinely available to them in that month.
On paper the plans look interchangeable, because state contracts require every STAR+PLUS MCO to cover the same core benefit package. The waiver services are defined by the state, not by Molina or Centene, so no plan can simply refuse to cover personal attendant services or day activity and health services. Where the plans actually differ is in three places: the provider network, the value-added services each plan offers above the required floor (things like extra vision or dental allowances, over-the-counter benefits, or transportation credits), and the responsiveness of the service coordination staff. That third factor is the hardest to research and the one San Antonio families consistently report as the biggest day-to-day difference. Ask any local social worker or discharge planner which plan's coordinators return calls, and you will get a candid answer that no brochure will give you.
Here is the single most useful sequencing advice for anyone comparing Medicaid STAR+PLUS managed care options in San Antonio: identify the assisted living community or home health agency you want, and then choose the health plan that contracts with it. A licensed facility can only admit a waiver resident if it holds a contract with that resident's specific MCO. Bexar County has well over a hundred licensed assisted living facilities, but only a portion contract with STAR+PLUS plans at all, and among those, contracts are plan-by-plan. A family that enrolls with a plan first and shops for a facility second frequently discovers that the community they liked in Stone Oak, Alamo Heights, or near the Medical Center simply cannot take them.
Work the problem in this order. Build a shortlist of three to five facilities and verify each one's license type and inspection history yourself on the Texas HHSC public disclosure site at apps.hhs.texas.gov/HSPubDisclosure. Under Chapter 247, a Type A license covers residents who can evacuate without staff assistance, while Type B covers residents who need help evacuating - which includes most memory care residents. Then call each admissions director and ask two direct questions: which STAR+PLUS health plans do you contract with, and how many waiver residents do you currently serve? A facility that contracts with a plan but serves no waiver residents is telling you something. Only after you have those answers should you commit to an MCO. For families on the West Side and South Side, add a third question about whether bilingual caregivers are staffed on every shift, not only in the front office - atencion en espanol en todos los turnos is a fair thing to insist on in a city that is roughly 65 percent Hispanic.
After enrollment, the MCO assigns a service coordinator who visits the member, completes an assessment, and writes the individual service plan. That document authorizes a specific number of attendant hours per week, respite days for a family caregiver, meals, an emergency response system, minor home modifications such as grab bars or a ramp, and, for those in residential care, assisted living services in a contracted facility. Everything your family receives flows from that assessment. If the coordinator undercounts how much help your father needs with bathing, dressing, transferring, or medication management, the authorized hours will be too low, and no amount of arguing with the agency that sends the attendant will fix it - the agency can only bill for what the plan authorized.
Prepare for the assessment the way you would prepare for a medical appointment that determines a diagnosis. Keep a two-week log before the visit noting every task your parent could not complete alone and every time you had to step in overnight. Describe your parent's worst days honestly rather than their best, because seniors habitually understate their difficulties in front of a stranger with a clipboard. Ask for every authorization decision in writing, keep a dated record of every call with the coordinator, and request a reassessment in writing whenever your parent's condition changes - after a fall, a hospitalization, or a new dementia diagnosis. A free benefits counselor at AACOG, the Alamo Area Council of Governments, at (210) 362-5200, can walk a San Antonio family through what a reasonable authorization looks like before you accept one.
Members are generally not locked in. Texas allows STAR+PLUS members to change managed care plans, and there is an annual period during which any member may switch, plus circumstances that permit a change at other times. The practical caution is that switching plans mid-course can disrupt continuity: a new plan means a new service coordinator, a new assessment cycle, and the possibility that a current provider is out of network. If your reason for switching is that a specific facility only contracts with a different MCO, the move is usually worth the disruption. If your reason is frustration with one coordinator, ask the plan's member services line for a different coordinator first - that is a much smaller change and plans will often accommodate it.
When a plan denies, reduces, or terminates a service, that decision is appealable, and San Antonio families should use those rights rather than accepting a reduction quietly. The first step is an internal appeal with the MCO itself, filed within the deadline stated on the denial notice. If the internal appeal fails, the member can request a state fair hearing through Texas Health and Human Services, and in many cases can also request an external medical review. Requesting continuation of benefits during the appeal - within the short window the notice specifies - can keep services in place while the dispute is resolved. Read every notice the day it arrives, because these deadlines are short and unforgiving. AACOG's Aging and Disability Resource Center and the local long-term care ombudsman program can both help a Bexar County family navigate an appeal at no cost.
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