HHSC continues to require of Texas Children’s Health Plan to allow an extension for up to 30 days for members to request continuation of benefits after they receive an adverse benefit determination. This continuation of benefits extension time frame will end June 30, 2021.

Starting July 1, 2021, Texas Children’s Health Plan must apply the normal, regular and set timeframes for members to request continuation of benefits, which is no later than 10 days from the date they receive the adverse benefit determination notice.

Texas Children’s Health Plan is partnered with Medical Transport Management (MTM) to provide our members with transportation services at no cost to a doctor’s appointment, a dental visit and/or the pharmacy. Transportation services are also provided for qualifying classes or events sponsored by the health plan.

Schedule a Ride by Phone: 
Members must schedule a ride with Texas Children’s Transportation Line over the phone if you are requesting it for the first time or going to a new location. Call the following numbers to schedule your ride Monday through Friday from 7:00 a.m.-9:00 p.m. CT.

• 346-232-4130 (local)
• 888-401-0170 (toll-free)
• 800-735-2989 (TYY line for hearing impairment) 
• *interpreter services are available

Click here for more information about our Transportation Services!

Lost your coverage? There are a number of programs offered through Texas Health and Human Services that can help.

• The Healthy Texas Women Program - offers women’s health and family planning services. Is available to Texas women who meet the program rules.
• Healthy Texas Women Plus – gives more postpartum services for women. Available to those in the Healthy Texas Women program.
• Family Planning Program – focused on family planning and other healthcare. Available to women and men in Texas.
• Primary Health Care Program - works with clinics across Texas. It makes sure Texas residents can get the primary care they need. The program serves men, women and children.

Each program has rules for who can join. Visit the links above for more information on what they cover and how to join.

Texas Children’s Health Plan provides a Member Advocate to assist you if you have a complaint. Our team of member advocates will help you write and file a complaint or appeal on your behalf and monitor it until it is resolved. We have a member advocate dedicated for each line of business and service delivery area. We speak English and Spanish. We also have interpreters available by phone who speak 140 different languages.

To have a Member Advocate assigned to you, call 866-219-5411.

Before going to the Emergency Room, call the Nurse Help Line (unless it is an emergency). You can get advice from a nurse about health issues you may be having. You can also get tips on understanding doctor’s instructions, and more. We are available 24-hours a day, 7 days a week. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.

1-800-686-3831 or TTY 1-800-735-2989

Our Member Services Team is ready to take your call from 8 a.m. to 5 p.m., Monday through Friday. After hours, on weekends and holidays, our answering service is ready to help you and/or take your messages. A Member Service Advocate will return your call the next business day. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages. Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.

Here are some services our team can help you with, if needed:

• Oral interpretation (over the phone and face to face) and written translations assistance. Sign language available.
• Information in formats such as print, Braille, audiotapes or accessible electronic.
• Access to TTY/TDD services for hearing and speech impairment

Member Services Program Hotlines:

• CHIP: 1-866-959-6555
• STAR: 1-866-959-2555
• STAR Kids: 1-800-659-5764 (Service Coordination)
• TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1

In case of an emergency, go to your nearest in-network emergency room or call 9-1-1.

Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week. No primary care provider referral is needed. The hotline has people who speak English and Spanish. Interpreters who speak 140 different languages are also available by phone. If you have an emergency and need treatment immediately, call 9-1-1 or go to the nearest emergency room.

Behavioral Health/Substance Abuse Hotline:

• CHIP: 1-800-731-8528
• STAR: 1-800-731-8529
• STAR Kids: 1-800-731-8529 (Service Coordination)

Provider Services Hotline  

Providers can use this number for claims, inquiries, questions, and information about CHIP, STAR, or STAR Kids products and to check eligibility/benefits.  

Phone: 832-828-1004, Toll free: 1-877-213-5508

Hours 8 a.m. to 5 p.m. CT, Monday through Friday. 

After hours, on weekends and holidays, our answering service is ready to help you and/or take your messages. A Member Service Advocate will return your call the next business day.  

Telephone TouCHPoint

Texas Children’s Health Plan’s automated Telephone TouCHPoint system allows Texas Children’s Health Plan providers to check eligibility, benefits, and claims status after hours. The service is available 24 hours a day, 7 days a week. To access Telephone TouCHPoint call 832-828-1007. Enter the member’s identification number and the provider’s NPI number.

Telephone TouCHPoint: 832-828-1007

Fax: 832-825-8777

The Children’s Health Insurance Program (CHIP) offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage.

We offer CHIP in more than 20 counties in the Jefferson and Harris Service Areas.

Click here to learn more about CHIP.

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STAR is a Medicaid-managed care plan. This plan helps family members of any age. Texas Children’s Health Plan offers STAR in more than 20 counties in the Jefferson and Harris Service Areas. Learn more about STAR.

Click here to learn more about the STAR program.

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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.

Click here to learn more about the STAR Kids program.

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Texas Children’s Health Plan offers CHIP perinatal services. CHIP prenatal is no-cost health coverage for pregnant women. To get CHIP perinatal, you must:

• Meet certain income requirements.
• Not qualify for Medicaid.
• Not have any other health coverage.

Click here to learn more about CHIP Perinatal.

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How is the Texas Vendor Drug Program (VDP) used for Texas Children's Health Plan Medicaid members?

Navitus is the provider for drug store services for members. The Texas VDP maintains and publishes the Texas VDP Formulary and the associated PDL. It also maintains and publishes the clinical guidelines for drugs not on the PDL which require pre-approval, and are used by Navitus to give benefits for Texas Children's Health Plan STAR and CHIP members.

What drug stores does Navitus have contracts with?

Navitus has contracts with more than 95% of the VDP providers in Texas. The Navitus drug store network includes national chain drug stores such as Walgreen's, CVS, HEB, Wal-Mart, Target, and Kroger. And many others. Navitus' drug store network can be found here.

Contact Member Services at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR) if you need help finding a drug store.

We want you to have the best resources for your health. Here is a list of helpful websites and links to our vendors:
 

Prescriptions

Pharmacy Search

Vision Care

Envolve Vision

• 1-844-520-3711 (CHIP)
• 1-844-683-2305 (STAR)
• 1-844-212-7269 (STAR Kids)

Dental Care

Your child will have one of the following dental plans:

• DentaQuest 1-800-508-6775
• MCNA Dental 1-800-494-6262
• UHC 1-877-901-7321

If you don't know who your child's CHIP dental plans is, call CHIP toll-free at 1-866-959-6555

A State Fair Hearing is a chance for you tell the reasons why you think the services you asked for and couldn’t get should be allowed.

Can I ask for a State Fair Hearing? If you, as a member of Texas Children’s Health Plan, disagree with the health plan’s decision, you have the right to ask for a fair hearing. You may name someone to represent you by writing a letter to the health plan telling them the name of the person you want to represent you. A doctor or other medical provider may be your representative. If you want to challenge a decision made by Texas Children’s Health Plan, you or your representative must ask for the fair hearing at any time up until 90 days of the date on the health plan’s letter with the decision. If you do not ask for the fair hearing within 90 days, you may lose your right to a State Fair Hearing.

To ask for a State Fair Hearing, you or your representative should either send a letter to the health plan or call:

Texas Children’s Health Plan
Attention: Appeals Department NB8390
PO Box 300709
Houston, TX 77230

Fax: 832-825-8796
Phone: 832-828-1001 or 1-866-959-2555
TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1

Click here for more information on State Fair Hearings

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats, braille, and other formats)

Provides free language services to people whose primary language is not English, such as:

• Qualified interpreters
• Information written in other languages

If you need these services, contact Texas Children’s Health Plan Member Services Department at 866-959-2555 (STAR),
866-959-6555 (CHIP), 800-659-5764 (STAR Kids) (TTY 7-1-1)

Through the new online member portal, Texas Children’s Health Plan members can use their health data to discover the latest health care and fitness apps. Once connected, you will be able to get an accurate picture of your health and elevate your fitness progress to new heights. | Learn more