What is STAR managed care?
In managed care, you choose a health plan and a primary care provider. Each health plan has a large group of providers in your area that can care for you. These providers include specialists, clinics and hospitals.

How does managed care work?

• You choose a health plan from the plans available in your area.
• You choose a primary care provider who will take care of most of your health care needs. Your primary care provider will also help you if you need other doctors, services and specialists. Your primary care provider will get to know you and your medical history. Your health plan will have a network of providers from which to choose.
• You will get a STAR ID card from your health plan. Bring your STAR ID card with your Medicaid ID form to all appointments.

Where is STAR?
STAR is in the Bexar, Dallas, El Paso, Harris, Lubbock, Nueces, Tarrant and Travis Service Areas. See the map of service areas by county.

Who must enroll in STAR?
You must enroll in the STAR program if you live in a STAR service area and you receive Medicaid because any of the following applies to you:

• You receive cash assistance (Temporary Assistance for Needy Families - TANF).
• You are pregnant.
• You or your children have limited income.

What are my Medicaid services in STAR?
The STAR program gives you all of the benefits that are included in the traditional Medicaid program.

Services available with a referral from your primary care provider:

• Office visits.
• Laboratory services.
• Vision exams.
• Mental health services.
• Unlimited prescriptions for children.

Services available without a referral from your primary care provider:

There are a few services that you can get without going to your primary care provider.  Examples of these services are:

• Eye care from a provider in your health plan network.
• OB/GYN care from a provider in your health plan network.
• Women’s health screenings and contraception.
• Mental health and substance abuse treatment from a provider in your health plan network.
• Texas Health Steps check-ups.

You will also receive other benefits from your STAR health plan:

Annual check-ups for adults (children already get check-ups through Texas Health Steps).

Unlimited prescriptions for adults.

No limit on necessary days in a hospital.

Health education classes

How do I choose a health plan?

• You will receive information in the mail about the health plans available in your area.
• Each health plan has a network of providers. You will choose your primary care provider from that network. Choosing the right health plan is very important, so be sure to read all of the information.
• If you want to stay with your current doctor, find out which of the plans your doctor works with. Or, you may want to choose a provider that is close to your home.

What health plans can I choose from?
Look for your county to see which STAR health plans are available in your area.

Can I change my health plan?
Yes, you can change your health plan at any time. To change your health plan, call the STAR program toll free at 1-800-964-2777, Monday through Friday, 8 a.m. to 8 p.m. Central Time.

Keep in mind that a health plan change can take up to 45 days to become effective. You should continue to see your current doctors until you receive information from your new health plan in the mail.

What is a primary care provider?
Your primary care provider is a doctor, nurse or clinic in the health plan that takes care of you and your family. Your primary care provider is where you will get most of your medical care. They will work with you to manage your health care and to keep you healthy. Your primary care provider can make referrals to other specialists and services you may need. Your primary care provider will get to know you and your medical history.

Your primary provider can be a:

• Family practice doctor
• Pediatrician (children’s doctor)
• Internal medicine doctor
• OB/GYN (doctor for women’s health)
• Clinic
• Specially trained nurse

Can I change my primary care provider?
Yes.  You can change your primary care provider up to four times a year.  Call your health plan to change your primary care provider. Your primary care provider change should be effective the first day of the following month.

What if I need a specialist or go to the hospital?
Your primary care provider will help you with most of your medical care. If you need other medical services, then your primary care provider will refer you. For example, if you need to see a specialist or go to the hospital, your primary care provider will arrange that for you.

You do not need to go to your primary care provider for some services, including:

• Eye care from a provider in your health plan.
• OB/GYN care from a provider in your health plan.
• Women’s health screenings and contraceptives.
• Mental health and substance abuse treatment from a provider in your health plan.
• Texas Health Steps check-ups.

What if I am pregnant?

• If you are pregnant, you must select a health plan and a primary care provider, which can be an OB/GYN.
• If you are in your third trimester, you can continue to see your current OB/GYN provider as long as your provider accepts Medicaid. You must inform your health plan that you are still seeing that provider.
• After the baby is born, the baby will be enrolled in your health plan. You must choose a primary care provider for your baby.

Will I still get my Medicaid Identification Form (Form 3087)?
Yes. It will arrive in the mail each month that you are covered by Medicaid. Carry your Medicaid Identification Form with you at all times. It helps providers know which services you can receive and how to bill Medicaid.

What do I need to bring to my doctor’s appointment?
Bring your Medicaid Identification Form (Form 3087) and your health plan identification card to all of your medical appointments.

STAR Health Plan Comparison Charts

The STAR program provides all of the services available in traditional Medicaid, as well as an annual check-up, unlimited prescriptions, and health education classes.  Each health plan also provides additional services.  The comparison charts below outline the value added services offered in each service area so that you can pick the health plan that will best meet your needs.

Bexar (effective 3/1/12)
Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, and Wilson Counties

Dallas (effective 3/1/12)
Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall Counties

El Paso (effective 3/1/12)
El Paso and Hudspeth Counties

Harris (effective 3/1/12)
Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, and Wharton Counties

Hidalgo (effective 3/1/12)
Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, and Zapata Counties

Jefferson (effective 3/1/12)
Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, and Walker Counties

Lubbock (effective 3/1/12)
Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher, and Terry Counties

MRSA Central (effective 3/1/12)
Bell, Blanco, Bosque, Brazos, Burleson, Colorado, Comanche, Coryell, DeWitt, Erath, Falls, Freestone, Gillespie, Gonzales, Grimes, Hamilton, Hill, Jackson, Lampasas, Lavaca, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Somervell, and Washington Counties

MRSA Northeast (effective 3/1/12)
Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Cooke, Delta, Fannin, Franklin, Grayson, Gregg, Harrison, Henderson, Hopkins, Houston, Lamar, Marion, Montague, Morris, Nacogdoches, Panola, Rains, Red River, Rusk, Sabine, San Augustine, Shelby, Smith, Titus, Trinity, Upshur, Van Zandt, and Wood Counties

MRSA West (effective 3/1/12)
Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Brewster, Briscoe, Brown, Callahan, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Concho, Cottle, Crane, Crockett, Culberson, Dallam, Dawson, Dickens, Dimmit, Donley, Eastland, Ector, Edwards, Fisher, Foard, Frio, Gaines, Glasscock, Gray, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Howard, Irion, Jack, Jeff Davis, Jones, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lipscomb, Loving, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Palo Pinto, Parmer, Pecos, Presidio, Reagan, Real, Reeves, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Taylor, Terrell, Throckmorton, Tom Green, Upton, Uvalde, Val Verde, Ward, Wheeler, Wichita, Wilbarger, Winkler, Yoakum, Young, and Zavala Counties

Nueces (effective 3/1/12)
Aransas, Bee, Brooks, Calhoun, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio, and Victoria Counties

Tarrant (effective 3/1/12)
Denton, Hood, Johnson, Parker, Tarrant and Wise Counties

Travis (effective 3/1/12)
Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, and Williamson Counties

Texas Children’s Medicaid Dental Services Comparison Chart

Medicaid Dental Services (effective 3/1/12)
Statewide