Texas Children’s Health Plan Star Medicaid

Date:

Unitedhealthcare Connected For Mycare Ohio

Texas Children’s Health Plan TV Commercial (2016)

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. .

We Carefully Review The Health Plans In Your Service Area

Health plan changes in service areas are usually the result of a formal business review we do every few years. This is one of the ways we ensure quality of services for members. Sometimes a health plan might decide to leave the program.

If your health plan is leaving your service area, youll have to pick a new plan. We will mail you a letter to explain the change and next steps you should take. There will be at least two plans to choose from. If you dont choose a new plan, we will choose one for you.

If theres been a change in your service area, you can find updates below.

Services Covered By Medicaid And Chip

  • Regular checkups at the doctor and dentist
  • Medicine and vaccines

Learn about Medicaid programs for children and adults with disabilities.

CHIP does not cover long-term services and supports.

If you have a child with a disability and make too much money to get Medicaid, you might be able to get coverage through the Medicaid Buy-In for Children program. MBIC allows families of children with disabilities to make a monthly payment to get Medicaid coverage.

Learn about other programs and services for people with disabilities.

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Unitedhealthcare Senior Care Options Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

American Disabilities Act Notice

STAR

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

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How Much Does It Cost

Children’s Medicaid is free.

If we find your child can get Children’s Medicaid, there is no cost to receive services.

CHIP fees vary based on your income.

If we find your child can get CHIP, your enrollment fee and co-pays will be based on your family’s income. Enrollment fees are $50 or less per family, per year.

Co-pays for doctor visits and medicine range from $3 to $5 for lower-income families and $20 to $35 for higher-income families.

Basic Medical Benefits And Coordination Of Care

STAR Kids is designed to meet the unique needs of youth and children with disabilities. The program provides benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies. Children and young adults enrolled in MDCP receive their MDCP services through STAR Kids.

The following people receive their acute care services and some of their long-term services and supports , like private duty nursing, through STAR Kids. They also receive most of their LTSS through the programs listed below.

Members who either:

  • Have intellectual and developmental disabilities and live in a community-based intermediate care facility for individuals with an intellectual disability or related conditions or
  • Receive services through one of these programs:
  • Community Living Assistance and Support Services
  • Deaf Blind with Multiple Disabilities
  • Home and Community-based Services
  • Texas Home Living
  • Community ICF/IIDs

If a person receives Medicare, they should use Medicare for basic health services and medicine.

Through STAR Kids, families receive help with coordinating care. Each health plan provides service coordination, which helps identify needs and connect members to services and qualified providers. STAR Kids health plans assess each member’s service needs, which is used to help the family, MCO and member create a yearly individual service plan.

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Income Guidelines For Children’s Medicaid

Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, your child might get Children’s Medicaid.

Family Members Monthly Family Income
For each additional person, add: $761

*A family of one might be a child who does not live with a parent or other relative.

Unitedhealthcare Connected Benefit Disclaimer

Texas HHS STAR Kids – Adoption Assistance and Permanency Care Assistance – 17V0029

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 , TTY 711, 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 , TTY 711, 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.

Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

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What Is Star Kids Screening And Assessment Instrument

The SK-SAI is the assessment tool that is used to set up a detailed Care Plan for your child. The care plan is called an Individual Service Plan . The assessment will be completed by the Service Coordinator, the Member and you. The SK-SAI will be completed in your home or at another location of your choice. We will schedule a convenient time to meet with you to complete the assessment. The SK-SAI will let both the family and the Service Coordinator have input into deciding what services and what amounts of each service are right for your child. The assessment will allow the Service Coordinator to set up the necessary authorizations to ensure that the medical care for your child is not disrupted. It may not mean that everything will be exactly the same. Our goal is to allow you and your child to have access to the providers you trust and to the services your child needs. Our promise to you is that the well-being of your child will always be a priority of our Service Coordinators.

Benefits Under Star Health

Members in the STAR Health program can get benefits like:

  • Regular checkups at the doctor and dentist.
  • Prescription drugs and vaccines.
  • Access to medical specialists and mental health care.
  • Treatment of special health needs and pre-existing conditions.
  • A 24/7 nurse hotline for caregivers and caseworkers.
  • Access to the Health Passport, a comprehensive, patient-centered and internet based electronic health record.

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Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Star Medicaid Managed Care Program

Programs

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.

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Texas Childrens Health Plan

Texas Childrens Health Plan was founded in 1996 by Texas Childrens Hospital. Texas Childrens Health Plan helps to support and maintain a community of healthy children and pregnant women by providing quality, affordable health coverage. Coverage includes a primary-care network, specialists, and a large hospital network.

We currently cover approximately 400,000 kids, teens, pregnant women, and adults through STAR Medicaid, CHIP and CHIP Perinatal. Since 2008, Texas Childrens Health Plan has held the number one total market share in member enrollment for combined CHIP and STAR.

Texas Childrens Health Plan offers STAR Medicaid, CHIP and CHIP Perinatal in more than 20 counties in the including Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton in the Harris Service Area. The Jefferson service area encompasses Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker.

We host events for the community such as:

  • Back-to-school events that provide health screenings, immunizations and backpacks
  • Local health fairs
  • Events with community-based organizations and/or government officials
  • Application assistance for families who need help applying for health coverage

Texas Childrens Health PlanAddress: 6330 West Loop South Bellaire, TXPhone: 1-800-990-8247

Clinical And Administrative Advisory Committee Behavioral Health Advisory Committee Perinatal Advisory Committee

These Provider Advisory Groups provide recommendations to Texas Childrens Health Plan in the following areas:

  • Identification and review of clinical practice guidelines and prior authorization guidelines
  • Review of general utilization patterns and assessment of Provider compliance with clinical guidelines
  • Recommendations for member engagement and quality improvement programs to improve health outcomes and keep members healthy
  • Strategies and recommendations for improving Health Plan administrative processes
  • Recommendations on how to improve care based on Member feedback and their personal experiences serving our Members and
  • Opportunities for connecting network Providers and Managed Care Organization clinical experts for purposes of peer support and sharing best practices.

There is a Clinical and Administrative Advisory Committee for each of our three Service Areas:

  • Harris

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Star Health Foster Care Plan

We Do More for STAR Health Members in Texas.Discover Superior HealthPlan.

Superior HealthPlan proudly offers STAR Health, a Medicaid managed care program serving children and youth in foster care. Superior is the only health program to include STAR Health coverage for children and youth in foster care in all 254 counties in Texas.

When children are housed within the foster care system, they are often not eligible for a traditional Medicaid plan. This is where STAR Health comes in.

Superior works very closely with the Texas Department of Family and Protective Services to make sure children in foster care in the state of Texas get the medical services they need. These STAR Health services may include:

  • Primary and specialty physician care services.
  • Prescription drugs and medical supplies.
  • Medical checkups, including Texas Health Steps.
  • Behavioral health services.
  • Family planning services.
  • Dental services.

Superior has also established Foster Care Centers of Excellence across Texas. These clinics provide many of the services listed above to STAR Health members.

Special Services For Star Medicaid Pregnant Members

Texas HHS STAR PLUS – Medicaid for Breast and Cervical Cancer – 17V0028
  • Start Smart® For Your Baby Program – If you stay for an entire baby shower, or download the Wellframe mobile app and engage for 30 days, you can get extra benefits* like: – A diaper bag and diapers when you complete the Notification of Pregnancy form – A convertible baby car seat when you complete the NOP form and go to one prenatal visit within your first trimester or 42 days of enrollment with Superior
  • Up to $100 My Health Pays® rewards each year for completing prenatal and postpartum visits. Visit My Health Pays ® for more rewards information.
  • Extra dental benefits. This includes up to $250 for pregnant women ages 21 and older.
  • Telephonic outreach, education and support services offered to reduce the health risks associated with smoking during pregnancy through Superiors Puff-Free Pregnancy program.

*Restrictions and limitations may apply.Value-added Services are extra health care services offered by Superior. Services may vary by area. These services are valid through 8/31/22.

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What Is A Referral And When Is It Needed

A referral is a request from your Primary Care doctor for you to see another doctor.

In order to see any Medicaid physician specialist you Primary Care doctor will need to follow DHPs authorization and referral rules when asking for a referral to another provider.

  • Hospital care at local hospitals
  • Shots
  • Free transportation to your doctor
  • Mental health benefits

New Name And Partnership With Amerigroup Texas Helps Parents Identify Personal Care For Children

Seton Health Plan, Inc., a subsidiary of Seton Healthcare Family, will offer its Medicaid managed care products for STAR and Childrens Health Insurance Program under the name of Dell Childrens Health Plan, effective December 1, 2016. The new name aligns Setons insurance for children of low-income families with Central Texas most trusted name in pediatric care. At the same time, Amerigroup Texas will embark on a joint venture with Dell Childrens Health Plan, providing administrative support to manage each members care.

Seton Health Plan has participated in the STAR and CHIP Medicaid managed care programs since 2012 and 2000, respectively. STAR is the State of Texas Health and Human Services Commissions no-cost Medicaid Managed Care Program. CHIP provides low-cost health coverage for children ages 0 through 18 in families who earn too much money to qualify for Medicaid, but cannot afford to buy private health coverage.

Amerigroup Texas brings a whole person approach to health plan member services, which is vital to helping our plan members many of whom are newcomers to health insurance make the most of the support they need to maintain good health, said Jess Garza, president of Seton Healthcare Family and senior vice president for the Texas Ministry Market of Ascension, the largest non-profit health system in the U.S. and the worlds largest Catholic health system.

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Healthy Texas Women Program

Have you lost your Medicaid benefits? The Healthy Texas Women Program provides family planning exams, related health screenings, and birth control to women ages 18 to 44 whose household income is at or below the programs income limits .

You must submit an application to find out if you can get services through this program. Visit this site for more information.

Why Choose Community

Seton Medicaid programs now called Dell Children

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

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What We Offer

Finding the right health plan for your children is important. Texas Children’s Health Plan is here to help. We offer coverage for children through CHIP and STAR Medicaid. Most CHIP families pay $35 per year or less to cover all of their children. Medicaid is free for children who qualify.

We also offer health coverage for pregnant women and adults. Each program is a little different. Click the links below to learn more.

What Is Star

State of Texas Access Reform is no cost health care insurance for low income families. All members must qualify based on income. The STAR plan is for children, pregnant women, newborns and adults. Members will have health care for 12 months. Members must re-enroll every 12 months for coverage to continue.

  • Hospital care at local hospitals
  • Immunization
  • Dental exams
  • Hearing exams
  • Help with transportation to your doctor
  • Prenatal care

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