Beginning November 1, 2016, STAR Kids will be the new Texas Medicaid managed care program for children and adults 20 and younger who have disabilities or participate in waiver programs. Under STAR Kids, beneficiaries will get basic medical (acute care) and long-term services and supports through their health plan’s provider network, as well as receive help with coordinating care. With few exceptions*, participation in the STAR Kids program is required for those who are 20 or younger, covered by Medicaid, and meet at least one of the following:
- Get Supplemental Security Income (SSI), or get SSI and
- Get services through the Medically Dependent Children Program (MDCP) waiver.
- Get services through the Youth Empowerment Services (YES) waiver.
- Live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility.
- Get services through a Medicaid Buy-In program.
- Get services through any of the following Department of Aging and Disability Services (DADS) intellectual and developmental disability (IDD) waiver programs:
- Community Living Assistance and Support Services (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Home and Community-based Services (HCS)
- Texas Home Living (TxHmL)
STAR Kids is designed to meet the unique needs of youth and children with disabilities. Affecting nearly 180,000 Texas children and youth with special needs, along with 5,600 MDCP children, the program will provide benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies.
How do I enroll?
Before the change takes place, beneficiaries can expect to receive the following in the mail from the Texas Health and Human Services Commission (HHSC):
- A first letter introducing the Texas STAR Kids program
- A second letter providing information on your new health plan and enrollment options
- A third letter confirming your health plan selection and alternative enrollment option
If you haven’t picked a health plan by October 12, 2016, HHSC will pick one for you. You can change health plans by calling (877) 782-6440.
What if I/my child is in an intermediate care facility?
If you or your child lives in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID), or in a nursing facility, your long term services will be provided the same way they are now.
Your long term services will also be provided the same way they are now if you or your child receives services from any of the following programs:
– Community Living Assistance and Support Services (CLASS)
– Youth Empowerment Services (YES)
– Texas Home Living (TxHmL)
– Home and Community-based Services (HCS)
– Deaf Blind with Multiple Disabilities (DBMD)
What if I/my child receives Medicare benefits?
If you or your child receives Medicare, your Medicare benefits won’t change. You will keep using Medicare for basic health services and for prescriptions ordered by your/your child’s doctor.
How do I coordinate care through my new plan?
Through STAR Kids, families will also receive help with coordinating care. Each health plan will provide service coordination, which will help identify needs and connect members to services and qualified providers. Managed Care Organizations (MCOs) contracted with STAR Kids will conduct a comprehensive assessment to evaluate each member’s service needs. This assessment will be used to help the family and the MCO create an individual service plan to provide the best level of care to meet your/your child’s unique needs.
What if my doctor or specialist is not in-network with my new plan?
To ensure seamless continuity of care for you and/or your child, your new plan will allow you to continue to receive services through your current provider during a transition period of up to six months. Your new plan will allow out-of-network authorizations for up to 180 days to ensure your/your child’s condition remains stable and that services are consistent. This can continue until: 1) your current authorized treatment plan is completed, or 2) your new health plan has performed a comprehensive screening and assessment, and they can provide comparable services and transition you to an in-network provider that meets your/your child’s complex needs.
If your specialist is not a contracted provider for your new plan, s/he can bill and be paid contracted provider rates through May 1, 2017. During this period your specialist can contact the health plan to discuss being an in-network provider.
For more information, watch this video provided by the Texas Health and Human Services Commission (HHSC):
- STAR Kids: Frequently Asked Questions
- STAR Kids: Respuestas a preguntas frecuentes
- STAR Kids Checklist
- Lista de verificación para STAR Kids