Star Medicaid Managed Care Program
Most people who have Medicaid in Texas get their coverage through the STAR managed care program. STAR covers low-income children, pregnant women and families. STAR members get their services through health plans they choose.
If you’re new to STAR, you’ll choose a health plan from the ones available in your service area . Learn more about how to choose or change your health plan.
Why Choose Community
As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.
I always tell people to choose Community Health Choice. I tell them its the best health insurance they will ever be with. Chandolyn
How Does Star Work
Under the Medicaid Program, eligible Medicaid clients choose an HMO and a Primary Care Provider to provide all primary care services and to arrange for and coordinate referrals for all medically necessary specialty services.
For Childrens Medicaid, income levels that determine eligibility vary based on age and Medicaid program. Eligible participants for Medicaid for Pregnant Women must be at 185 percent of the Federal Poverty Level or lower. Childrens Medicaid covers a child up to his or her 21st birthday, and Medicaid for Pregnant Women covers a child-bearing woman of any age. Members must recertify every six months.
You May Like: How To Apply For Medicaid In Wisconsin
Nc Medicaid Managed Care Excluded
- Some beneficiaries will remain in NC Medicaid Direct, which is the fee-for-service program. This is how you receive health care services now. This means you cannot choose a health plan and you do not need to choose a new PCP unless you want to change to your current PCP. You will stay in NC Medicaid Direct if you:
- Receive Family Planning Medicaid, Refugee Medicaid, Foster Care/Adoption Medicaid , or must meet a deductible before getting Medicaid benefits
- Are part of the Health insurance premium payment or Program of all-inclusive care for the elderly programs, or
- Have both Medicare and Medicaid or receive long-stay nursing home services,
- Receive Innovations Waiver services, Traumatic Brain Injury Waiver services, or Community Alternatives Program for Children or Community Alternative Program for Disabled Adults services.
Health Insurance & Payment Plans
At Legacy, we believe health care is a right, not a privilege.
We believe that comprehensive health care is a human right. Thats why Legacys services and programs are open to all who need us, regardless of the ability to pay, without judgment or exception.
Legacy accepts most health insurance plans including HMO/PPOS, Medicare and the following CHIP and Medicaid plans: Amerigroup, CHIP, Community Health Choice, Medicaid, Molina Health Care, Superior Health Care, Texas Childrens Health Plan and United Healthcare. Eligibility Specialists are available at all Legacy locations to discuss sliding scale fees and potential programs to help reduce the cost of services. You may make an appointment with one of our Eligibility specialists by calling 548 5000 or asking a front desk staff member. You can learn about all of our payment and assistance options below.
If You Are Currently Uninsured, Legacy Can Help You Access Health Care
Accessing health care can be frustrating, confusing, and even intimidating. If you are currently uninsured, Legacys Eligibility specialists can help you navigate the health care landscape and help you find the right combination of grants, government assistance, and sliding fee scale to make your health care more affordable. Eligibility specialists are available to anyone who walks through our doors and are available at all of our clinic locations.
Sliding Fee Scale
Meet with a Legacy Eligibility Specialist. Its easy!
Health Insurance Plans Accepted
Recommended Reading: Physical Therapy Offices That Accepts Medicaid
Nc Medicaid Managed Care Exempt
Some beneficiaries can choose to stay in NC Medicaid Direct. This means you are not required to choose a health plan and a PCP. NCDHHS – Division of Health Benefits will send you a letter that tells you if you have the choice to enroll. You have the option to choose a health plan if you:
- Are a federally-recognized tribal member or individual eligible for services through Indian Health Service .
- Need certain services to address needs related to developmental disability, behavioral health or traumatic brain injury. BH covers MH and SUD
If you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now:
- Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received ,
To find a doctor, go to Find a provider.
Health Insurance Premium Payment
The Health Insurance Premium Payment program is a Medicaid program that helps families pay for private health insurance. This program is for families who have:
- A parent or a spouse with private health insurance
- A child or a spouse with Medicaid
Medicaid will pay the family’s private health insurance if the total cost of that insurance is less than the total cost of care with Medicaid. The total cost of the private insurance includes the premium, coinsurance and deductibles.
If approved, Medicaid may pay the private health insurance costs for the entire family and not just for the family members who get Medicaid. The family will get services through the private health insurance plan.
To learn more or to apply, visit the Get HIPP Texas website or call us toll-free at 800-440-0493. You also can ask us to send you an application. Write to:
Texas Health and Human Services CommissionTMHP-HIPP
Read Also: Check To See If You Have Medicaid
What Services Does Star Cover
Community provides its Medicaid Members with access to comprehensive medical care, including services such as hospital care, surgery, X-rays, physical/speech/occupational therapies, prescription drugs, emergency services, transplants, regular health checkups, and immunizations.
Members receive unlimited medically necessary prescriptions through the Medicaid/CHIP Vendor Drug Formulary.
Benefits Of Health Insurance In The Community
Every aspect of the Community caters to you and your family, from the benefits and programs we offer to the Member Services teams ability to help you get the most out of it. Community Health Choice benefits include:
It helps you find the best hospitals and doctors in the United States.
Their provider network is extensive, and they have the largest network of hospitals in Southeast Texas. So choosing a plan near you can be advantageous. Find a Doctor is a resource on the Community Health Choices website designed to help you find the best doctor for you.
Offers free access to telemedicine 24/7
Community Health Choice offers free 24/7 medical services with telemedicine from the best doctors and hospitals in the United States. You can consult a doctor via telemedicine from anywhere, at any time, with a phone, computer, or mobile device. This type of service allows you to contact your doctor online in an emergency or when doctors are unavailable.
Manage complex or chronic diseases.
Based in Houston, Community Health Choice Inc. helps its members provide more effective and informed care for themselves and their families, including people with chronic illnesses. Even the healthiest members can benefit from annual health checks with the companys Community Rewards program Members with chronic and life-threatening diseases are eligible for early intervention and population health management services.
Learn about health plans and benefits
You May Like: Trauma Therapist That Accept Medicaid
Children’s Health Insurance Program Health Plans
Children in CHIP get services through a medical plan in their area. Some CHIP plans also offer services to mothers who are pregnant. This is called CHIP perinatal coverage.
You can see how well some CHIP health plans perform by looking at the CHIP health plan report cards.
To learn more about CHIP, visit the CHIP and Children’s Medicaid website.
/7 Access To Telemedicine With Teladoc*
Talk to a doctor any timefor a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.
*Telemedicine isnt a replacement for your Primary Care Provider . Your PCP should always be your first choice for care .
See better with Healthfirst Vision Benefits
Also Check: Does Medicaid Pay For Alcohol Rehab
Nc Medicaid Managed Care Mandatory
To learn more about NC Medicaid Managed Care, go to the NC Medicaid Managed Care Website. Most beneficiaries receiving Medicaid or NC Health Choice will be required to transition to NC Medicaid Managed Care. This means you must choose a health plan and a Primary Care Provider . If you must choose, NCDHHS – Division of Health Benefits will send you a letter that tells you how to transition to Managed Care. You will be required to transition to NC Medicaid Managed Care if you:
- Receive full benefits through the Family and Childrens or the Aged, Blind and Disabled Medicaid programs, or through the NC Health Choice or Medicaid for Pregnant Women program.
If you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now:
- Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received ,
To find a doctor, go to Find a provider.
Your Texas Benefits Medicaid Card And Yourtexasbenefitscom
The Your Texas Benefits Medicaid card is your permanent card. Take it with you whenever you go to the doctor, dentist or drug store. Protect it the way you would your driver’s license or credit card. If you lose or damage your card, you can order a new one by visiting YourTexasBenefits.com or by calling toll-free at 800-252-8263.
You can see your available Medicaid health information through YourTexasBenefits.com‘s Medicaid Client Portal. Legally authorized representatives can see their children’s available Medicaid health information.
Recommended Reading: Does Medicaid Cover Medical Alert Devices
Who Is Eligible For Autism Benefits
Effective February 1, 2022, Autism Services, to include Applied Behavior Analysis evaluation and treatment, became a benefit of the Texas Health Steps-Comprehensive Care Program for Texas Medicaid recipients who are 20 years of age and younger and who meet the criteria outlined in the Autism Services benefit description. This benefit is not available for CHIP recipients.
Summary Of Benefits & Coverage
The Priority Partners HealthChoice plan includes coverage for the Medical Assistance For Families/Maryland Childrens Health Program , a program for pregnant women and children.
As a Priority Partners HealthChoice member, your benefits include:
- Oral exam and cleaning twice per year
Pregnant women receive all of the benefits above, plus:
Don’t Miss: Does Medicaid Pay For Walk In Tubs
State Of Texas Access Reform Managed Care Program
Community provides both Childrens Medicaid and Medicaid for Pregnant Women. These programs are at no cost to U.S. residents who cannot afford health insurance.
Childrens Medicaid Childrens Medicaid covers a child up through the month of his or her 21st birthday. Income determines eligibility. That income level is different based on age and Medicaid program. Members must recertify every year.
Medicaid for Pregnant Women Medicaid for Pregnant Women covers a childbearing woman of any age. Members must be at 185% or lower of the Federal Poverty Level . Members must recertify every year.
Chip And Children’s Medicaid Dental Services
Most children and teens with CHIP or Children’s Medicaid coverage get their dental services through a managed care dental plan. There are two dental plans to choose from.
Those with Medicaid who do not get their dental services through one of those two plans include:
- People with Medicaid age 21 and older.
- All people with Medicaid, regardless of their age, who live in facilities such as nursing homes, state supported living centers, or community-based Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions .
- Children and young adults in the state’s foster care program who get their dental services through STAR Health.
CHIP and Children’s Medicaid Dental Plans
Read Also: How Do I Know If I Have Medicaid Coverage
Health Insurance Plan Information Applies To The Following Locations:
Texas Childrens Hospital Locations
- Texas Childrens Hospital
- Texas Childrens Pavilion for Women
- Texas Childrens Hospital West Campus
- Texas Childrens Hospital The Woodlands
Texas Children’s Health Center Locations
- Texas Children’s Health Center – Sugar Land
- Texas Children’s Health Center – Cy-Fair
- Texas Children’s Health Center – Clear Lake
- Texas Children’s Specialty Care – Upper Kirby
- Texas Children’s Specialty Care – Kingwood Glen
- Texas Children’s Pavilion for Women Pearland
Community Maternal Fetal Medicine Clinic Locations
- Community Maternal Fetal Medicine Clinic – The Woodlands
- Community Maternal Fetal Medicine Clinic – Northwest Houston
- Community Maternal Fetal Medicine Clinic – West Houston
- Community Maternal Fetal Medicine Clinic – Sugar Land
- Community Maternal Fetal Medicine Clinic – Baytown
- Community Maternal Fetal Medicine Clinic The Methodist Hospital
Below is a list of payers who are contracted with Texas Childrens Hospital, Texas Childrens Physician Service Organization, and Texas Childrens Anesthesiology. Please confirm Texas Childrens participation with your health plan as some benefit plans utilize narrow networks which may exclude Texas Childrens.
Facility-based physicians bill and collect independently for their services, and may not participate in the same insurance plans as Texas Childrens Hospital. You may receive a bill from a facility-based physician for the amount unpaid by your insurance plan.
Aetna
See Better With Healthfirst Vision Benefits
Taking care of your eyes doesnt just mean having clear vision. An annual eye exam can help detect a number of health risks, such as diabetes, thyroid disease, high blood pressure, and other conditions. Healthfirst has made it easy for our members to take advantage of this often overlooked preventive service by providing access to comprehensive vision care.
Dental Care That Keeps You Smiling
Read Also: Does Kelsey Seybold Accept Medicaid
Health Choice Utah Wants You And Your Family To Live A Healthy Life By Making Smart Healthy Choices
Here are some services offered by us to make your life healthier and easier.
Health Risk Assessment
Every member of our health plan will receive and complete a Health Risk Assessment . HRAs help us coordinate and manage your health needs. You may be offered enrollment in a healthcare management program which is designed to help you stay healthy.
Case Management
Health Choice Utah has a staff of nurses and healthcare professionals that may be assigned to help you and/or a family member get the healthcare you need. Our staff works closely with your primary care physician to manage your care and keep you healthy.
Child Health Evaluation and Care Program
The Child Health Evaluation and Care Program is Utahs Medicaid Program for children from birth through age 20. Please note that well-child/CHEC services are not covered under the Non-Traditional plan.
Health Choice Utah provides all CHEC services including well-child, shots, and exams. Children may need other types of care. Some of this care may be for physical, occupational, speech therapy, medical equipment, including wheelchairs or nurses in the home. Your doctor needs to call Health Choice Utah for approval for these services before you can get them.
CHEC visits are also called well-child visits and include all screenings and services recommended for CHEC.
Adult Preventive Care
Contact your doctor and ask when you should get tests and exams, such as:
Screenings for Woman
Family Planning
Pregnancy and Maternity Services
Unitedhealthcare Connected For Mycare Ohio
UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.
Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
Don’t Miss: Who To Call For Medicaid Questions
Unitedhealthcare Connected General Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
