What is NCI-AD?

Establish in 2015, National Core Indicators—Aging and Disabilities™ (NCI-AD™) is a voluntary effort by state aging and physical disability agencies to measure and track their performance using a standardized set of nationally validated measures. The effort is coordinated by Advancing States and Human Services Research Institute (HSRI). Learn more about our history here.

In 2021-22 a total of 19 states participated in NCI-AD. Not all participating states do all surveys every year.

What is the NCI-AD
Adult Consumer Survey?

The NCI-AD Adult Consumer Survey (ACS), is standardized survey conducted with a person receiving long term services and supports (LTSS) through state aging and physical disability systems. Surveys are conducted by trained surveyors through in-person, secure video meeting, or over-the-phone conversations with service participants. The main part of the survey contains subjective questions about how well services are supporting the person; these can only be answered by the person themselves. A subset of more objective questions may be answered by a proxy respondent if needed. In addition to the questions for service participants, the survey also collects background information on the person –demographic and service-related data – mainly from service agency records. In 2021-22, the survey included two state-optional modules:

Person-Centered Planning Module. This is a series of questions that ask about the person-centered planning process, including the person’s experience developing the service plan and the service planning meeting. The following states conducted the Person-Centered Planning Module: CO, DE, GA, IN, KS, MI, MN, MO, NJ, OK, TX, WA, WI.

COVID-19 Supplement. This included a series of questions of the person’s experience with services during COVID-19 and the overall impact of the pandemic on the person’s life. The following states conducted the COVID-19 Supplement: CO, DE, GA, IN, KS, MI, MN, MO, NJ, OK, TX, WA, WI.

Sampling

There is considerable variation in how states’ long-term services and supports (LTSS) programs serving older adults and adults with physical disabilities are organized, funded, and administered. The NCI-AD program allows states to include programs funded through Medicaid, the Older Americans Act, Program of All-Inclusive Care for the Elderly (PACE), state-only funds, and/or other state- and federal-blended funds. The NCI-AD project team works closely with each participating NCI-AD state to advise and track which LTSS program populations and sub-populations are included in the state’s sampling strategy, how that sample is designed and how many surveys are targeted for completion. See detailed information on state sample frames here.

Texas Specific Sample

Total Sample Frame: 46125

Total surveys completed: 1499

Overall Margin of Error 2.49%

Program Category

Table 1. Classification of 2021-22 State programs

STATE Program Funding Source Description of Program Total Population Eligible for NCI-AD Total Usable Surveys Collected MoE (95%Confidence, 0.5 Distribution) MoE (95%Confidence, 0.7 Distribution)
TX STAR+PLUS HCBS Medicaid (waiver) Provides additional LTSS to individuals who are elderly or who have physical disabilities who meet medical necessity criteria to be in a nursing facility. Services include nursing, personal assistance services, adaptive aids, medical supplies, and minor home modifications. Must be age 21 or older, be a Medicaid recipient, or be otherwise financially eligible for waiver services (MAO). 46125 1499 2.53% 2.32%

What is included in this report?

This report presents Texas 2021-22 ACS demographics and outcomes results. Data are shown for the overall statewide average, broken out by program sampled, and include the weighted NCI-AD Average.

Please note: Extreme caution should be used when interpreting results where the number of valid responses is small. Each program’s valid number of responses (valid Ns) is shown in every chart and table in this report.

To protect people’s privacy we do not show the data when 20 or fewer people from a state or within a program responded to a question, however their data are included in the overall state average.

Presentation of Data

Data may be viewed as bar charts or in tables by clicking the appropriate tab for each outcome. Data presented in charts are “collapsed” meaning that data grouped by response options to what is considered to reflect a positive outcome and all other responses. Tables represent the un-collapsed data outcomes.

All NCI-AD data are collapsed “yes” responses only, unless otherwise noted.

All state and NCI-AD averages throughout this report are “weighted” to account for any non-proportional sampling of programs and to “rebalance” the states’ sample sizes according to their populations of survey-eligible service recipients. See more details on weighting in Part II of this report.

Results

Demographics

Table 2. Average age (reported for those under 90 years old)

Program Age N
STAR+PLUS Amerigroup 59.0 303
STAR+PLUS Cigna-HealthSpring 64.9 235
STAR+PLUS Molina 59.9 293
STAR+PLUS Superior 59.9 297
STAR+PLUS United HealthCare 58.4 294
Overall State Average 60.0 1422
NCI-AD Weighted Average 66.8 12847

Table 3. Age Category (including those 90 and older)

Program 18-44 45-64 65-89 90+ N
STAR+PLUS Amerigroup 16% 48% 33% 4% 314
STAR+PLUS Cigna-HealthSpring 8% 36% 46% 9% 259
STAR+PLUS Molina 18% 41% 36% 5% 308
STAR+PLUS Superior 18% 40% 39% 4% 308
STAR+PLUS United HealthCare 18% 42% 35% 5% 310
Overall State Average 16% 42% 37% 5% 1499
NCI-AD Weighted Average 8% 27% 58% 6% 13593

Table 4. Gender

Program Male Female Other Don’t know or unclear N
STAR+PLUS Amerigroup 36% 64% 0% 0% 314
STAR+PLUS Cigna-HealthSpring 37% 63% 0% 0% 259
STAR+PLUS Molina 34% 66% 0% 0% 308
STAR+PLUS Superior 33% 67% 0% 0% 308
STAR+PLUS United HealthCare 35% 65% 0% 0% 310
Overall State Average 35% 65% 0% 0% 1499
NCI-AD Weighted Average 32% 68% 0% 0% 13595

Table 5. Race and ethnicity

Program American Indian or Alaska Native Asian Black or African American Pacific Islander White Hispanic or Latino Other Don’t know Unclear/Refused/No Response N
STAR+PLUS Amerigroup 1% 2% 29% 1% 27% 41% 2% 2% 0% 314
STAR+PLUS Cigna-HealthSpring 1% 1% 17% 0% 31% 54% 3% 0% 0% 258
STAR+PLUS Molina 1% 1% 20% 0% 21% 59% 4% 2% 0% 308
STAR+PLUS Superior 3% 0% 10% 0% 28% 71% 2% 1% 1% 308
STAR+PLUS United HealthCare 1% 2% 24% 0% 39% 43% 1% 0% 0% 310
Overall State Average 2% 1% 19% 0% 28% 56% 2% 1% 0% 1498
NCI-AD Weighted Average 2% 5% 23% 0% 60% 9% 2% 3% 2% 13134

Table 6. Marital Status

Program Single, never married Married or in domestic partnership Separated or divorced Widowed Don’t know or unclear N
STAR+PLUS Amerigroup 44% 12% 27% 18% 0% 314
STAR+PLUS Cigna-HealthSpring 26% 21% 23% 29% 1% 258
STAR+PLUS Molina 40% 12% 28% 21% 0% 308
STAR+PLUS Superior 35% 11% 31% 23% 0% 308
STAR+PLUS United HealthCare 42% 12% 30% 17% 0% 309
Overall State Average 38% 13% 28% 21% 0% 1497
NCI-AD Weighted Average 28% 15% 27% 25% 4% 13114

Table 7. Preferred Language

Program English Spanish Other Don’t know or unclear N
STAR+PLUS Amerigroup 80% 19% 1% 0% 314
STAR+PLUS Cigna-HealthSpring 62% 36% 2% 0% 258
STAR+PLUS Molina 62% 37% 1% 0% 306
STAR+PLUS Superior 70% 29% 2% 0% 308
STAR+PLUS United HealthCare 89% 9% 2% 0% 310
Overall State Average 73% 26% 1% 0% 1496
NCI-AD Weighted Average 89% 4% 7% 0% 13409

Table 8. Residential Designation

Categories created using zip codes and corresponding RUCA codes

Program Metropolitan Micropolitan Rural Small Town N
STAR+PLUS Amerigroup 89% 8% 0% 2% 314
STAR+PLUS Cigna-HealthSpring 71% 27% 1% 2% 258
STAR+PLUS Molina 96% 1% 0% 3% 308
STAR+PLUS Superior 91% 7% 1% 1% 308
STAR+PLUS United HealthCare 95% 2% 1% 3% 310
Overall State Average 90% 7% 0% 2% 1498
NCI-AD Weighted Average 72% 14% 6% 9% 13085

Table 9. Median Income (based on zip code)

Newly reported in 2021-2022

Program $0- $9,999 $10,000- $19,999 $20,000- $29,999 $30,000- $39,999 $40,000- $49,999 $50,000- $59,999 $60,000- $69,999 $70,000- $79,999 $80,000- $89,999 $90,000- $99,999 $100,000 and over N
STAR+PLUS Amerigroup 0% 0% 15% 38% 21% 12% 5% 5% 1% 1% 0% 313
STAR+PLUS Cigna-HealthSpring 0% 0% 40% 29% 22% 4% 4% 1% 1% 0% 0% 255
STAR+PLUS Molina 0% 2% 26% 32% 13% 14% 9% 1% 1% 1% 1% 303
STAR+PLUS Superior 0% 1% 28% 41% 12% 10% 5% 3% 0% 0% 0% 297
STAR+PLUS United HealthCare 0% 2% 11% 21% 24% 10% 16% 6% 6% 2% 2% 309
Overall State Average 0% 1% 23% 34% 17% 10% 8% 3% 2% 1% 1% 1477
NCI-AD Weighted Average 0% 1% 9% 27% 27% 16% 9% 5% 3% 1% 1% 12977

Table 10. Type of Residence

Program Own or family house or apartment Senior living apartment or complex Group home, adult family home, foster home, host home Assisted living facility, residential care facility Nursing facility, nursing home Homeless or temporary shelter Other Don’t know or unclear N
STAR+PLUS Amerigroup 85% 8% 1% 5% 0% 0% 1% 0% 314
STAR+PLUS Cigna-HealthSpring 95% 4% 0% 0% 0% 0% 1% 0% 258
STAR+PLUS Molina 92% 6% 0% 2% 0% 0% 0% 0% 308
STAR+PLUS Superior 93% 6% 0% 0% 0% 0% 1% 0% 308
STAR+PLUS United HealthCare 93% 2% 0% 3% 0% 0% 1% 0% 310
Overall State Average 91% 5% 0% 2% 0% 0% 1% 0% 1498
NCI-AD Weighted Average 76% 7% 2% 7% 6% 0% 2% 1% 13448

Table 11. Who the person lives with

Program No One – Lives Alone Spouse or Partner Other Family Friend(s) Live-in PCA Others Don’t know or unclear N
STAR+PLUS Amerigroup 38% 11% 48% 1% 2% 4% 0% 314
STAR+PLUS Cigna-HealthSpring 35% 14% 51% 2% 2% 1% 0% 258
STAR+PLUS Molina 31% 7% 60% 4% 1% 2% 0% 308
STAR+PLUS Superior 37% 7% 55% 2% 3% 1% 0% 308
STAR+PLUS United HealthCare 28% 12% 58% 3% 3% 2% 0% 310
Overall State Average 34% 9% 55% 2% 2% 2% 0% 1498
NCI-AD Weighted Average 47% 13% 28% 2% 2% 9% 1% 13355

Table 12. Address Change

Program Yes No Don’t know or unclear N
STAR+PLUS Amerigroup 7% 93% 0% 314
STAR+PLUS Cigna-HealthSpring 5% 95% 0% 258
STAR+PLUS Molina 6% 94% 0% 308
STAR+PLUS Superior 5% 95% 0% 308
STAR+PLUS United HealthCare 4% 96% 0% 310
Overall State Average 5% 95% 0% 1498
NCI-AD Weighted Average 6% 92% 2% 12980
Program No Yes N
STAR+PLUS Amerigroup 93% 7% 314
STAR+PLUS Cigna-HealthSpring 95% 5% 258
STAR+PLUS Molina 94% 6% 308
STAR+PLUS Superior 95% 5% 308
STAR+PLUS United HealthCare 96% 4% 310
Overall State Average 95% 5% 1498
NCI-AD Weighted Average 94% 6% 12752

Table 13. Where people moved from (if moved in the last 6 months)

Program Own or family house or apartment Senior living apartment or complex Group home, adult family home, foster home, host home Assisted living facility, residential care facility Nursing facility, nursing home Homeless or temporary shelter Other Don’t know or unclear N
Overall State Average 88% 0% 2% 2% 1% 3% 4% 0% 81
NCI-AD Weighted Average 63% 5% 4% 5% 5% 3% 14% 1% 689
* The following programs had an N of less than 20 and were not shown: STAR+PLUS Amerigroup, STAR+PLUS Cigna-HealthSpring, STAR+PLUS Molina, STAR+PLUS Superior, STAR+PLUS United HealthCare

Table 14. Diagnoses

All categories except ‘physical disability’, ‘intellectual or other developmental disability’, and ’Alzheimer’s disease or other dementia are new in 2021-22. Categories are not mutually exclusive; therefore, N is not shown.

Program Physical Disability Traumatic brain injury or other acquired brain injury Intellectual or other developmental disability Alzheimer’s disease or dementia Heart Disease Cancer Chronic Obstructive pulmonary disease (COPD) Stroke Diabetes Hypertension (or high blood pressure
STAR+PLUS Amerigroup 80% 19% 17% 14% 31% 13% 25% 34% 46% 65%
STAR+PLUS Cigna-HealthSpring 88% 16% 12% 18% 38% 15% 25% 31% 49% 70%
STAR+PLUS Molina 77% 18% 18% 14% 32% 12% 23% 24% 43% 68%
STAR+PLUS Superior 88% 14% 18% 13% 34% 18% 27% 26% 54% 70%
STAR+PLUS United HealthCare 81% 21% 21% 18% 28% 13% 25% 29% 37% 63%
Overall State Average 83% 17% 18% 15% 32% 14% 25% 28% 46% 68%
NCI-AD Weighted Average 70% 11% 8% 11% 33% 12% 23% 20% 37% 60%

Table 15. Person has chronic psychiatric or mental health diagnosis

Program Yes No Don’t know or unclear N
STAR+PLUS Amerigroup 39% 60% 1% 314
STAR+PLUS Cigna-HealthSpring 45% 55% 0% 256
STAR+PLUS Molina 35% 65% 0% 308
STAR+PLUS Superior 45% 54% 0% 308
STAR+PLUS United HealthCare 39% 60% 1% 310
Overall State Average 41% 59% 1% 1496
NCI-AD Weighted Average 35% 61% 3% 12828

Table 16. Level of Mobility

Categories are not mutually exclusive (except ‘Don’t know or unclear or unclear’).

Program Non-Ambulatory Moves self with wheelchair Moves self with other aids Moves self without aids Don’t know or unclear N
STAR+PLUS Amerigroup 8% 37% 56% 25% 0% 314
STAR+PLUS Cigna-HealthSpring 10% 22% 74% 13% 0% 258
STAR+PLUS Molina 10% 22% 60% 30% 0% 308
STAR+PLUS Superior 7% 24% 67% 20% 0% 308
STAR+PLUS United HealthCare 11% 37% 55% 25% 0% 310
Overall State Average 9% 28% 62% 23% 0% 1498
NCI-AD Weighted Average 8% 21% 53% 27% 8% 13086

Table 17. Has history of frequent falls (more than two falls in a six-month period)

Program Yes No Don’t know or unclear N
STAR+PLUS Amerigroup 40% 60% 0% 314
STAR+PLUS Cigna-HealthSpring 34% 65% 1% 258
STAR+PLUS Molina 31% 69% 1% 308
STAR+PLUS Superior 41% 59% 0% 308
STAR+PLUS United HealthCare 33% 67% 0% 310
Overall State Average 36% 64% 0% 1498
NCI-AD Weighted Average 28% 70% 1% 12866

Table 18. Receives Medicare

Program Yes No Don’t know or unclear N
STAR+PLUS Amerigroup 63% 37% 0% 314
STAR+PLUS Cigna-HealthSpring 81% 18% 1% 258
STAR+PLUS Molina 59% 41% 0% 308
STAR+PLUS Superior 66% 34% 0% 308
STAR+PLUS United HealthCare 68% 31% 1% 310
Overall State Average 66% 34% 0% 1498
NCI-AD Weighted Average 79% 18% 3% 12473

Table 19. Length of time receiving LTSS services in current program

Program 0 - 5 months 6 months – less than 1 year 1 year – less than 3 years 3 or more years Don’t know or unclear N
STAR+PLUS Amerigroup 0% 0% 32% 68% 0% 314
STAR+PLUS Cigna-HealthSpring 0% 0% 24% 76% 0% 258
STAR+PLUS Molina 0% 0% 31% 69% 0% 308
STAR+PLUS Superior 0% 0% 27% 73% 0% 308
STAR+PLUS United HealthCare 0% 0% 29% 71% 0% 310
Overall State Average 0% 0% 29% 71% 0% 1498
NCI-AD Weighted Average 7% 6% 28% 54% 5% 11942

Outcome Tables and
Comparisons across Programs

Community Participation

Table 21. Gets to do things outside of their home as much as they want to

Bar chart

Table

Program Yes No N
STAR+PLUS Amerigroup 52% 48% 257
STAR+PLUS Cigna-HealthSpring 33% 67% 205
STAR+PLUS Molina 46% 54% 242
STAR+PLUS Superior 41% 59% 259
STAR+PLUS United HealthCare 48% 52% 222
Overall State Average 45% 55% 1185
NCI-AD Weighted Average 62% 38% 9950

Table 22. Takes part in activities with others as much as they want to (in-person or virtually)

Question changed in 2021-22

Bar chart

Table

Program Yes Sometimes No N
STAR+PLUS Amerigroup 56% 7% 36% 256
STAR+PLUS Cigna-HealthSpring 44% 4% 52% 206
STAR+PLUS Molina 52% 5% 43% 246
STAR+PLUS Superior 45% 12% 43% 262
STAR+PLUS United HealthCare 48% 32% 21% 224
Overall State Average 49% 12% 39% 1194
NCI-AD Weighted Average 58% 11% 31% 9904

Table 23. Reasons cannot always take part in activities with others as much as they want to (in-person or virtually)

Bar chart

Table

Program Cost or money Transportation Accessibility or lack of equipment Health limitations Not enough help, staffing,or personal assistance Feeling unwelcome in the community Feeling unsafe No community activities outside of home available Lack of information or doesn’t know what type of community activities are available Does not have technology or equipment Other N
STAR+PLUS Amerigroup 11% 35% 4% 61% 8% 2% 7%