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STAR Kids is a new Medicaid managed care program specifically serving children and young adults getting SSI Medicaid or a Medicaid waiver. Beginning Nov. 1, 2016, those ages 20 and younger will be required to receive services through the STAR Kids program if they:
Receive SSI Medicaid
Are enrolled in one of the following Medicaid waivers:
- Medically Dependent Children Program (MDCP)
- Home and Community-based Services (HCS)
- Community Living Assistance and Support Services (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Texas Home Living (TxHmL)
- Youth Empowerment Services (YES)
Member Services (24 hours a day/7 days a week) 1-800-947-4969
For the first twelve (12) months following implementation, Children's Medical Center Heath Plan will allow members to see out-of-network Medicaid providers. This includes providers outside the service delivery area, for Medicaid covered services. Authorizations and referrals to see out-of-network Medicaid providers will not be required. Authorizations for services and treatments may still be required. Notification of visit to your Service Coordinator is advised.
A referral is not needed for STAR Kids members seeking services from an in-network specialist where there is no pre-existing relationship. During the first 12 months of enrollment, continuity of care will be upheld and an authorization will not be needed to see an in-network specialist. If an out of network specialist is requested to be seen, a referral would not be needed from the PCP; however, the health plan will need to be notified.
If a STAR Kids member is seeking emergency or urgent services from a new specialist, a referral is not needed.
If a STAR Kids member is seeking services from a current in-network specialist with whom they have an existing relationship, a referral is not needed. If their current specialist accepts Medicaid and is out of network, Children's Medical Center Heath Plan will uphold continuity of care during the first 12 months, and an authorization will not be needed to pay the claim. A referral is not needed from the PCP, but the Health Plan will need to be notified if the specialist is an out of network Medicaid provider.
If a STAR Kids member ID card is lost or stolen, call Member Services toll free number at 1-800-947-4969. We will send you a new ID card in the mail. You can request or print a new ID card by using the member web portal.
As a member of the Children's Medical Center Health Plan, we invite you to join us at events throughout the year and have an opportunity to learn about health plan and healthcare changes and updates, as well as various other topics and educational opportunities.
Join us for the next Member Advisory Group Meeting.
Effective September 1, 2017, HHSC will no longer allow a managed care organization (MCO) to provide over-the-counter (OTC) drugs without a prescription as a value-added benefit. This includes the use of gift cards that are limited to OTC drug purchases.