The Children and Youth with Medical, Behavioral and Developmental Complexity (CYC) Subcommittee focuses on improvements in the care of children and youth with medical, behavioral, or developmental complexity within Medicaid managed care. Objectives include, but are not limited to, advising HHSC on topics related to the ongoing operation and review of the STAR Kids Medicaid managed care and other managed care programs, assessing best practices for providing care for children and youth with complex needs, customization of and access to specialized care, transitions of care, and improving health outcomes and quality of services. Also collaborates with other SMMCAC subcommittees when a topic pursuant to children and youth with medical, behavioral, and/or developmental complexity within Medicaid managed care falls within another subcommittee’s charge.
In attendance. Karl Serrao, Demetria Haffort, Jacob Ulczynski, Samantha Moreno
- Call to order, introductions, and roll call. The meeting was convened by Dr. Serrao, Chair. A quorum was present.
- Consideration of May 8, 2025, draft meeting minutes. The minutes were approved as drafted.
- Update from HHSC staff on the 2023 report recommendations from the former STAR Kids Managed Care Advisory Committee. There was a handout that was not made available to the public
The STAR Kids Managed Care Advisory Committee final report was published in 2023. HHSC is still reviewing 75 recommendations for implementation and is updating committees and subcommittees as appropriate. Today there are two recommendations being presented.
“Do not implement a statewide service delivery region for STAR Kids. A statewide model would potentially prevent community-based plans and small 31 Revised: 12/2023 plans from participating and have a potential negative impact on promising practices. HHSC should continue to encourage competition among non-profit and for-profit models and the development of quality standards of care for vulnerable children.”
HHSC considers this recommendation closed since there are thirteen regions with multiple health plans in each region. There are a total of nine MCOs serving the STAR Kids Program.
“Investigate alternative models of service delivery for children in MDCP such as Primary Care Case Management, Fee for Service, or an Accountable Care Organization.”
HHSC considers this recommendation closed since an alternative model was not recommended in star-kids-alternative-model-feasibility-report-dec-2022.pdf
“Based on the findings outlined in this report, HHSC determined it would not be feasible to provide Medicaid benefits to children enrolled in the STAR Kids managed care program under an ACO or an alternative model developed by CMMI at this 1GOVERNMENT CODE CHAPTER 533. MEDICAID MANAGED CARE PROGRAM (texas.gov) 2STAR Kids Managed Care Advisory Committee | Texas Health and Human Services 1 Revised: 11/2022 time. Texas does not have a regulatory framework for licensing ACOs and there are no ACOs operating in Texas with state oversight. There are a limited number of alternative models between MCOs and providers that involve a Medicare ACO, however HHSC does not contract with ACOs in Texas Medicaid. Considering CMMI’s alternative model under the Advancing Care for Exceptional (ACE) Kids Act as required by Senate Bill (S.B.) 1648, 87th Legislature, Regular Session, 2021, HHSC implemented the Comprehensive Health Homes for Integrated Care (CHIC) Kids Pilot beginning in December 2022. The results of the CHIC Kids Pilot study may inform HHSC’s consideration of a new model of care for the most medically complex STAR Kids members. A report on the implementation of the CHIC Kids Pilot is due to the Legislature by December 31, 2024.”
Discussion.
Why was it felt that the STAR Kids would not use an APM? HHSC stated that the regulatory framework for an ACO was unworkable in Texas. One MCO for STAR Health was based on the fact that children in foster care often change locations and regions.
The recommendation against one state MCO was made at the request of HHSC who sought the Advisory Committee’s recommendation.
- Public comment. No public comment was offered.
- Review of action items and agenda items for next meeting.
Next meeting: Nov. 6, 2025
Future Agenda Items:
Community First Choice
Alternate payment models
Overall Legislative Update
- Adjourn. There being no further business, the meeting was adjourned.
***
The information contained in this publication is the property of Texas Insight and is considered confidential and may contain proprietary information. It is meant solely for the intended recipient. Access to this published information by anyone else is unauthorized unless Texas Insight grants permission. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted in reliance on this is prohibited. The views expressed in this publication are, unless otherwise stated, those of the author and not those of Texas Insight or its management.