You may have a co-pay for CHIP services starting May 12, 2023.
During the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for doctor visits for Children’s Health Insurance Program (CHIP) members. This will end on May 11, 2023.
For most types of doctor visits scheduled on or after May 12, 2023, you’ll have to pay a co-pay. You won’t have to co-pay for the following types of doctor visits:
- Mental health and substance use disorder treatment services.
- COVID-19-related office visits for COVID-19 vaccines, testing, and treatment.
The amount you will need to co-pay is on your CHIP member ID card.
Your co-pay amount was based on your income when you enrolled in CHIP. You do not have to co-pay for CHIP services if you are:
- Native American
- An Alaska Native
- A CHIP Perinatal member
If you have any questions, call CHIP Toll free line 1-866-959-6555 & TTY 800-735-2989 (Texas Relay) or 7-1-1.
You can use YourTexasBenefits.com or the Your Texas Benefits mobile app to manage your benefits and update HHSC of any changes, like a new address or income.
Important Recall on Infant Powdered Plant-Based Formula
Texas Children’s Health Plan received notice of an urgent recall from The Food and Drug Administration (FDA) for certain infant powdered plant-based formulas.
The FDA is warning parents not to use the recalled products. These recalled powdered infant formulas may be contaminated with Cronobacter sakazakii, a bacterium that can cause severe illness caused by food contamination.
Which formulas are included in the recall?
The recall includes two (2) select batches of Enfamil ProSobee 12.9 oz. Simply Plant-Based Infant Formula. Check the lot number on the bottom of the formula to see if it has the following:
- Batch codes ZL2HZF and ZL2HZZ; and
- UPC Code of 300871214415; and
- “Use-By Date” of “1 Mar 2024.”
If your lot number is not in this range, your lot is safe and you can continue to use the formula.
Check to see if your product is recalled:
Enter the lot number on the bottom of the formula on the Enfamil website. If your product is included in the recall, do not use it but do not throw it away.
What do I do if my formula is part of the recall?
If your formula is part of the recall, do not use it. A contaminated formula could make your baby very sick. Click here to obtain a refund or replacement or you can also call Enfamil at 1-800-479-0551 to get a refund or replacement. Recalled infant formula can be returned to the store for an exchange. If you received formula from WIC, you can return it to WIC for an exchange. For special formulas that require a prescription, contact your baby’s doctor to get a new one. If you have questions, please contact your child’s doctor.
What if my formula is not available?
If your formula is not available, contact your child’s health care doctor to talk about new feeding options.
Need help finding a provider? Go to www.texaschildrenshealthplan.org/doctor
Is there a list of other brands I can use?
For Enfamil ProSobee 12.9 oz. Simply Plant-Based Infant Formula, WIC has temporarily added more options so parents can find a formula that meets their babies’ needs without updating their cards. For a list of brands that you can get with WIC, visit texaswic.org/about-wic/special-wic-food-updates.
Who can I reach out to for help?
If you have questions, call your child’s health care provider. If you need help in connecting with your provider or finding a provider, go to www.texaschildrenshealthplan.org/doctor or call Member Services at (CHIP) 1-866-959-6555, (STAR) 1-866-959-2555 or (STAR Kids) 1-800-659-5764.
You can also call your care coordinator for help. Interested in joining our case management program? Call us at 832-828-1430.
Facts about the Cronobacter bacteria:
Cronobacter bacteria can cause severe, life-threatening infections (sepsis) or meningitis (an inflammation of the membranes that protect the brain and spine). It may also cause bowel damage and spread through the blood to other parts of the body. Symptoms to watch for:
Poor feeding, irritability, temperature changes, jaundice (yellow skin and whites of the eyes), grunting breaths and abnormal movements.
The health of our members is our top priority. If you have used this product and are concerned about the health of your child, please contact your child’s pediatrician. If your child has any of the above symptoms, please call your child’s health care doctor and seek medical care immediately.
To learn more about Cronobacter, please visit the U.S. Centers for Disease Control and Prevention.
Find more about the recall at the Food and Drug Administration.
See how WIC is helping families get replacement formula: www.texaswic.org/health-partners
Enfamil’s recall notice and general FAQs: www.enfamil.com/prosobee-recall-2023/
ATTENTION MEMBERS: Flexible appeal policy ending soon!
HHSC Policy Flexibility for Member State Fair Hearings ends on May 11, 2023
In January 2020, the federal government declared a public health emergency (PHE) in response to COVID-19. Under the PHE, the Texas Health and Human Services Commission (HHSC) provided certain flexibilities, including allowing Medicaid members more time to request a fair hearing. Instead of 120 days to request a fair hearing after the internal MCO appeal, members were given up to 150 days to request a fair hearing with HHSC during the PHE.
HHSC will be ending this flexibility on May 11, 2023.
Starting on May 12, 2023, if you receive a “Member Notice of MCO Internal Appeal Decision” and want to appeal it, you must file your request for a fair hearing with or without an external medical review no less than 90 calendar days and no more than 120 calendar days from the date the notice is mailed. State fair hearing requests filed past this deadline may not be reviewed.
If you have any questions, please reach out to Member Services at:
- CHIP 832-828-1002 / 1-866-959-6555
- STAR 832-828-1001 / 1-866-959-2555
- STAR Kids 832-828-1003 / 1-800-659-5764
Members: Remember to take the annual CAHPS Survey!
The National Committee for Quality Assurance (NCQA) requires health plans, including Texas Children’s Health Plan, to conduct an annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey as part of the NCQA accreditation requirements.
The purpose of the CAHPS Survey is to understand more about members’ satisfaction in receiving quality healthcare.
The survey, sent out via a third party, is completely anonymous and sent at random. Please note: Surveys will be sent out via mail, and not all members will be sent the survey. Do not worry if you do not receive a survey.
If you receive, or have received, the survey, please make sure to complete it as the data collected will help us continue improving our method of care.
Welcome to your new website!
We are always looking to make it easier for you. That’s why we redesigned your member website.
This new website will make it easier for you to take care of what you need to do in just a few clicks. Among the improvements in this site:
- Simplifying website navigation to make things easier to find.
- Streamlining copy so that information is easier to understand.
- Giving you a direct connection to your secure member portal - MyChart
- Moving key information right to the home page including:
- Where to find providers and benefits information.
- How to signup/renew.
- How to get your Healthy Rewards
Thank you for the chance to serve you and we hope you enjoy the new web experience!