Texas Medicaid and CHIP

STAR Kids

Overview

STAR Kids Information Sessions

The Texas Health and Human Services Commission (HHSC) will hold information sessions at locations around the state in August and September of 2016 related to the transition of various Medicaid services to the STAR Kids managed care program. Find an information session near you.

STAR Kids is a new Texas Medicaid managed care program that will provide Medicaid benefits, beginning November 1, 2016, to children and adults 20 and younger who have disabilities.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).
  • Get SSI and Medicare.
  • 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)

Managed care means that you will pick health plan that will provide the health services you need through a network of doctors, specialists, and other providers. Those enrolling in the STAR Kids program will choose a health plan, as well as a primary care physician or clinic who will provide basic medical services, like check-ups, and provide referrals to a specialist when needed.

Sample draft mandatory introduction packet for those covered by Medicaid who must enroll in STAR Kids

STAR Kids Letters

Introduction Packet

Enrollment Packet

Basic medical benefits, coordination of care

STAR Kids is designed to meet the unique needs of youth and children with disabilities. 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. Children and youth who get additional services through MDCP will receive their MDCP services through STAR Kids.

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 nursing facility, your long term services will be provided the same way they are now.

If you or your child receives services from any of the following programs, they will be provided the same way they are now:

  • Community Living Assistance and Support Services (CLASS)
  • Deaf Blind with Multiple Disabilities (DBMD)
  • Home and Community-based Services (HCS)
  • Texas Home Living (TxHmL)
  • Youth Empowerment Services (YES)

If you or your child receives Medicare, your Medicare benefits won’t change. You will keep using Medicare for basic health services and medicine ordered by your doctor.

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. STAR Kids MCOs will assess each member's service needs, which will be used to help the family and the MCO create an individual service plan.

A core component of the STAR Kids program will be a standard screening and assessment process health plans will use to determine each child's needs as they relate to health and independent living. You can see a copy of this assessment, which is called the STAR Kids Screening and Assessment Instrument, here: STAR Kids Screening and Assessment Instrument (SK-SAI) (PDF)

Managed Care Organizations

Each health service area in the state will have at least two health plans, or managed care organizations (MCOs), that will provide services through the STAR Kids program.

Map of service areas for STAR, STAR Kids and STAR+PLUS - this map shows which health plans will offer services in each region of the state.

MCO Provider Relations Contacts (PDF) - list of provider relations representatives that can help with contracting.

Client Resources

STAR Kids Client Frequently Asked Questions (PDF) (Español (PDF))

STAR Kids Flyer (PDF) (Español (PDF))

Client Training – New Managed Care Program: STAR Kids Family Information Session (PDF) (Español (PDF))

STAR Kids Checklist (PDF) (Español (PDF))

Provider Resources

STAR Kids Provider Frequently Asked Questions (PDF)

Provider Tips (PDF)

Provider Training – STAR Kids Provider Information Session (PDF)

STAR Kids Billing Matrix and Crosswalk (XLS)

Service Coordination Resource Document for Providers Regarding Members

(PDF)

Stakeholder feedback

HHSC would like input regarding development of the STAR Kids program from consumers, family members, advocates, and Medicaid providers. The STAR Kids Medicaid Managed Care Advisory Committee and HHSC’s Children's Policy Council meetings provide one way to gather that input. Another way is to send questions and comments by email to Managed_Care_Initiatives@hhsc.state.tx.us.

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