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STAR Kids FAQs for Members

What is managed care?

Managed care means you get Medicaid services through a select group of doctors, hospitals, and other health care providers --called a provider network -- through a health plan you pick.

What is a medical home?

A medical home is where you get your basic care. It includes your primary care provider. It helps build the relationships between the patient and family with the doctor and other care providers.

What is a Primary Care Provider (PCP)?

When you join STAR Kids, you will pick a primary care provider. This is a doctor, nurse, or clinic where you will get basic medical care and get referrals for other care. Primary care providers are a medical home to members. They get to know you and your health history. Your primary care provider can be one of the following:

  • General practice doctor
  • Family practice doctor
  • Internal medicine doctor
  • Pediatric doctor
  • Obstetrics/Gynecology doctor
  • Advanced Practice Registered Nurse (APRN)
  • Physician Assistant (PA)
  • Clinic (Federally Qualified Health Center or Rural Health Clinic)
  • Specialist physicians willing to provide a health home to selected members with special needs or conditions

If you have Medicare, you won't need to pick a primary care provider.

Can I change my Primary Care Provider (PCP)?

You may change your PCP by making a request through our secure member portal or by calling Member Services toll-free at 1-855-607-7827.

What if I need to see a specialist or go to the hospital?

Your primary care provider will help you with basic medical care. If you need other medical services, your primary care provider will give you a referral. For example, if you need to see a specialist or go to the hospital, your primary care provider will set that up for you.

You don't need a referral from your primary care provider for some services, like:

  • Mental health and drug and alcohol abuse treatment
  • Texas Health Steps checkups
  • Emergency room services

What is STAR Kids and when does it start?

STAR Kids is a new Texas Medicaid managed care program for children and adults 20 or younger who have disabilities. Under STAR Kids, you get basic medical and long-term services and supports through Community First’s provider network. Long-term services and supports include things like help in your home with basic daily activities, and help participating in community activities, if you are eligible. You also will get Medically Dependent Children Program (MDCP) waiver services through Community First’s provider network, if you are eligible. STAR Kids will begin November 1, 2016.

What services does STAR Kids offer?

Everyone will get:

  • A care plan. This will help your doctors and other providers know what kind of care you need. A Community First service coordinator will work with you and your doctor to create this plan. The service coordinator will help you find doctors, make appointments, and help with other needs you may have.
  • A primary care provider. You will get most of your preventive healthcare through your primary care provider. Your primary care provider can also refer you to specialists, if needed. If you get Medicare, you will not choose a primary care provider.
  • Basic health care services. You will get Medicaid services like you get now, such as doctor’s visits, hospital visits, therapies, specialist visits, medical equipment, prescription drugs, and medical supplies.
  • Long-Term Services and Supports (LTSS). You will get long-term services and supports in the home, like Personal Care Services, Community First Choice, or Private Duty Nursing. Long-term services and supports include things that help you in your home with basic daily activities, and help you participate in community activities.

If you get services through a Department of Aging and Disability Services (DADS) intellectual and developmental disability (IDD) waiver, the Youth Empowerment Services (YES) waiver, or live in an Intermediate Care Facility (ICF-IID), you will get your long-term services and supports through your waiver or facility, the way you do today.

If you get services through Medically Dependent Children Program (MDCP) waiver, you will get those services through Community First Health Plans.

    • To learn more about the Community First Choice, visit the HHSC CFC webpage. The page gives general information about the benefit and isn't specific to STAR Kids.

Service Coordination 

Community First Health Plans nurses and other professionals will be your service coordinators. Their services include things like:

  • Identifying physical health, mental health, and long-term services and supports needs
  • Creating service plans to address identified needs
  • Finding doctors who will take Medicaid
  • Getting access to other services and providers

Value-added services

These are the extra services offered by Community First Health Plans. They include:

    • Prescription discount card for your family for prescription medicines and certain over the counter medicines.
    • Additional eight hours of in-home respite care services for non-waiver STAR Kids members.
    • Up to $100 specialized therapies allowance.
    • Pre-vocational assistance.
    • Free cell phone with free minutes.
    • Asthma kit and asthma pillow cover.
    • Mommy mingle and advice support meetings with free toddler booster seat.
    • Smoking cessation program.
    • Youth obesity weight management program.
    • Gift programs for health-related items for disease management.
    • MP3 player with health podcast.
    • Notary services for health related items.

How will I know if my doctors and other providers are contracted with Community First Health Plans?

When you get your enrollment packet in August, check the enclosed provider directories for the providers you see today. If one of your doctors isn't listed, call Community First at 1-855-607-7827 to see if they are contracted with them. You can also talk to your doctor about joining Community First Health Plans.

What if my doctor isn't enrolled with Community First Health Plans?

You can make a list of all the providers your child sees, and contact them to encourage them to enroll with Community First Health Plans. You can also share your provider list with Community First and ask them to contract with your providers if they haven't done so already. You can do this today.

STAR Kids health plans must try to contract with all Medicaid providers who see children going into STAR Kids today. Providers don't have to contract with a health plan if they don't want to. Health plans and providers can do single-case agreements in some situations if a provider only wants to see you, but not everyone else in STAR Kids.

What if I have private health insurance?

If you have private health insurance, your private insurance will pay first, then Community First will pay the rest of any service covered by Medicaid.

What if my primary care provider (PCP) is under my private insurance and isn't a Medicaid provider?

The law requires that orders, referrals, and prescriptions for Medicaid services come from a Medicaid enrolled provider. If your private primary care provider will be ordering, referring, or prescribing Medicaid services, your doctor must complete a shortened application to continue ordering, referring, or prescribing services or medicines that will be reimbursed by Medicaid.

HHSC is working with private providers around the state to try to get them to enroll in Medicaid, but it is important for you to talk to your providers, too. Tell them how important it is to enroll with Medicaid so they can continue your care. There are no fees to complete the shortened ordering, referring, and prescribing process, and they can sign up electronically or on paper. If your private provider is ordering, referring, or prescribing Medicaid services, they should visit the following links:

Information for Ordering and Referring-Only providers

Enroll Online:https://secure.tmhp.com/ProviderEnrollment

Paper Application

After you have joined Community First, your STAR Kids service coordinator can help coordinate between private providers and Medicaid providers.

What if I have Medicare?

If you have Medicare and Medicaid, you are known as a "dual eligible," and will keep getting most of your basic health-care services through your Medicare doctors. STAR Kids will not change the way you get Medicare services.

Medicare will pay for most of your basic healthcare services, and traditional Medicaid will pay for services that are covered by Medicaid but aren't covered by Medicare. If you have Medicare, you won't pick a STAR Kids primary care provider.

After you have picked Community First as your health plan, your Community First STAR Kids service coordinator will help coordinate between Medicare providers and Medicaid providers.

If my primary care provider (PCP) is under my private insurance, do I have to choose a STAR Kids primary care provider?

If your private primary care provider isn't contracted with Community First Health Plans, you will have to pick a STAR Kids primary care provider. This means you will have two primary care providers: a private primary care provider and a STAR Kids primary care provider. After you have picked Community First as your health plan and primary care provider, your Community First service coordinator will help coordinate between private providers, Medicaid providers, and Medicare providers.

For more information about the STAR Kids program, visit the Texas Health and Human Services Commission website.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

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Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

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Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347