What is STAR Kids?
STAR Kids is a new Texas Medicaid managed care program for children and adults 20 or younger who have disabilities which began on November 1st, 2016. Under STAR Kids, individuals will receive their Medicaid services through a managed care organization (MCO). Individuals who are enrolled in the Medically Dependent Children’s Program (MDCP) will receive all of their services, including long term services and supports, through STAR Kids. Individuals receiving all other Medicaid waiver services (DBMD, HCS, CLASS and TxHmL) will continue to receive their long term services through their waiver, but will enroll with a STAR Kids MCO for their medical services like doctor visits, prescriptions or durable medical equipment.
Everyone will be assigned a service area and you will be required to choose between at least two MCOs. You can find which MCOs will provide services to your area by visiting the STAR Kids website. We encourage you to start reaching out to them now so you can make the best decision in October when you will have to choose an MCO. Most importantly, you’re going to want to make sure the providers you use (doctors, therapists, specialists, etc.) are enrolled with the MCOs in your area.
Tips & Reminders
- Find contact information, continuity of care provisions (for instance, individuals can continue to see their current providers even if they did not sign up with their health plan for at least 6 months), and referral policies for each health plan here.
- Bring a copy of your STAR Kids Health Plan Profile (or letter to doctors, if your health plan has one) to appointments until all of your providers are informed on different provisions in STAR Kids, for instance the out-of-network provisions. Each health plan profile is located here. You can also go to your health plan’s website and print out the information, such as the letters if provided. All the profiles have a phone number to contact for issues or questions.
- You should have received a member card. Check to make sure all of the information on your member card is correct.
- Meet with Your Service Coordinator: It’s important to have a relationship with your Service Coordinator. If your health plan has not appointed one, call and request one.
- Verify Single Case Agreements: Contact your provider’s billing office to verify your single case agreement and ask if there are additional requirements to schedule appointments or get prescriptions that you need to know about.
- Know Your Rights: To start, read your member handbook, get information about how to change MCOs or providers, find out about your continuity of care provisions, and learn how to get a 72 hour prescription if you run into problems at the pharmacy.
- Find some answers to frequently asked questions at HHSC’s FAQs.
Who do I contact if I have questions or complaints?
- First contact your service coordinator or member advocate at your Health Plan (complaints must be filed with your health plan before HHSC).
- If your health plan is not able to meet your needs or address your complaint, you may contact HHSC at 1-866- 566-8989 or email HPM_Complaints@hhsc.state.tx.us
- In addition, you may contact the Office of the Ombudsman – Ombudsman Managed Care Assistance Team – 1-866- 566-8989
And, of course, you can contact The Arc of Texas at 1-800-252-9729.