If you participate in Medicaid, don't forget about the implementation of the STAR Kids managed care program on Nov. 1. The legislature directed the Texas Health and Human Services Commission (HHSC) to develop the managed care program specifically designed for children aged 20 and younger who have disabilities.
According to the HHSC, participation in the STAR Kids program is required for those who are 20 or younger, covered by Medicaid, and meet at least one of these criteria:
- Receive Supplemental Security Income (SSI);
- Receive SSI and Medicare;
- Receive services through the Medically Dependent Children Program (MDCP) waiver;
- Receive 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;
- Receive services through a Medicaid Buy-In program;
- Receive services through any of the 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); or Texas Home Living (TxHmL).
STAR Kids will provide acute care services, such as physician office visits, hospitalizations, and prescription drugs, as well as long-term care services and support. Those who enroll in the STAR Kids program will choose a health plan, as well as a primary care physician or clinic that will provide basic medical services and provide referrals to a specialist when needed, HHSC says.
STAR Kids managed care organizations (MCOs) must offer contracts to any physician designated by HHSC as a significant traditional provider, a physician who cares for a substantial number of STAR Kids-eligible children. However, physicians may choose whether to contract, and if so, with which plans. For physicians who care for children across the state, MCOs may contract with them or enter into single-case agreements for particular patients.
HHSC will be conducting physician and family training sessions on the program this month and in September. For training dates and locations, visit the website.
STAR Kids Provider Frequently Asked Questions
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)
Action, Aug. 15, 2016
Last Updated On
October 10, 2016