In August of 2010, the state of Texas informed hospice providers that a family electing to receive hospice care for an individual under 21 is no longer required to waive treatment for the terminal illness. In order to understand the remainder of the letter, it is important to understand what Texas’ Star Health program is. STAR Health is a Medicaid managed care program, which services children and youth in foster care in Texas. The provider letter also informs hospice providers that STAR and STAR Health enrollees under age 21 will continue to be dis-enrolled from managed care upon the election of hospice. However, individuals under the age 21 who are enrolled in the STAR+PLUS program will receive hospice services as a carve-out benefit through fee-for-services Medicaid and will be able to retain their STAR-PLUS enrollment status and eligibility to receive services related to the treatment of their terminal illness. The announcement can be found at this link.