Introducing STAR Kids

The right plan for kids with special needs.

STAR Kids

Texas Children’s Health Plan offers quality health coverage for children and young adults under the age of 21 with disabilities.

What is STAR Kids?

STAR Kids is a Medicaid-managed care plan. This plan helps children and young adults under the age of 21 with disabilities. Texas Children’s Health Plan offers STAR Kids in the Harris, Jefferson and Northeast Service Areas.

Benefits:

  • Prescription drugs.
  • Hospital care.
  • Primary care.
  • Specialty care.
  • Preventive care.
  • Personal care services.
  • Private duty nursing.
  • Durable medical equipment and supplies.
  • Long-term services and supports

Do I have to join STAR Kids?

You must join STAR Kids if you are under the age of 21, covered by Medicaid, and:

  • Get Supplemental Security Income (SSI).
  • Get Supplemental Security Income and Medicare.
  • Get services through the Medically Dependent Children Program (MDCP) waiver.
  • Get 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.
  • Get services through any of the following 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)
    • Texas Home Living (TxHmL)

You can choose to join STAR Kids if you are covered by Medicaid and are:

  • A member of a federally recognized tribe.

You cannot join STAR Kids if you:

  • Are in Texas foster care and get Medicaid services through traditional Medicaid or STAR Health.
  • Are 21 or older.
  • Are in adoption Medicaid.
  • Live in the Truman W. Smith Children’s Care Center.

What services are offered by STAR Kids?

Everyone will get:

  • Medicaid services like you get now.
  • A health plan that offers extra services not covered by Medicaid.
  • Help finding doctors who will take Medicaid. A STAR Kids nurse, social worker, or other professional (a service coordinator) will help you with this. They will also work with your main doctor to make sure you get the care you need.

Long-Term Services and Supports

STAR Kids offers long-term services and supports if you need them.  Long-term services and supports are things that can help in your home with daily activities. Also, we can help make changes to your home so you can safely move around.

  • 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 certain LTSS through your health plan, but you will continue to get your waiver or facility long-term services and supports through your waiver or facility, the way you do today.
  • If you do not get services through a DADS IDD waiver, YES, or ICF-IID, you will get all your LTSS services through the STAR Kids health plan you pick.
  • If you get services through the Medically Dependent Children Program (MDCP) waiver, you will get all your LTSS through the STAR Kids heath plan you pick.

If you are covered by Medicaid only, STAR Kids offers:

  • A main doctor, nurse or clinic (a primary care provider). You will get most of your healthcare through this provider. The main doctor also can refer you to specialists, if needed.
  • Medicaid services like you get now, plus:
    • Long-term services and supports provided (as described above).
    • Service coordination through the STAR Kids health plan you pick.
    • Extra services offered by the STAR Kids health plan you pick.

If you live in an ICF-IID or get services in a DADS IDD waiver program, STAR Kids offers:

  • A main doctor, nurse, or clinic (a primary care provider). You will get most of your healthcare through this provider.
  • The main doctor also can refer you to specialists, if needed.All the Medicaid services you get now.
  • Long-term services and supports, the same way you have today.

If you get Medicaid and Medicare (dual eligible Members), STAR Kids offers:

  • No changes in your Medicare benefits. You will still use Medicare for basic medical services and medicines ordered by your doctor. You will use STAR Kids for your Medicaid long-term services and supports.

What should I do now?

Use the personal worksheet that came with your letter to help you get ready to choose a health plan. You will get a packet in the mail. It will have a letter that will tell you more about STAR Kids and the health plans in your area. It will also help you choose a health plan.

Who do I call if I have questions?

1-877-782-6440 or TDD 1-800-735-2989