Texas STAR (Medicaid) Plan
What is Medicaid?
It is the State of Texas Access Reform (STAR) Managed Care Program (Medicaid). Community provides both Children’s Medicaid and Medicaid for Pregnant Women. These programs are at no cost to U.S. residents who cannot afford health insurance.
How does Medicaid work?
Members choose an HMO and a Primary Care Provider to give them all their primary care services. This includes coordinating referrals for all medically necessary specialty services.
Income determines eligibility. That income level is different based on age and Medicaid program. Children’s Medicaid covers a child up through the month of his or her 21st birthday.
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 (FPL). Members must recertify every year.
What Services Does Medicaid Cover?
Medicaid Members get medical care that includes:
- Hospital care
- Physical/speech/occupational therapies
- Prescription drugs
- Emergency services
- Regular health checkups and immunizations
Service Area Maps
Value-Added Services are effective September 1, 2019 to August 31, 2020. Limitations may apply. If you have any questions, call Member Services toll-free at 1.888.760.2600.
24-Hour Nurse Hotline
Nurse Advice Line for all Members 24 hours per day to help Members decide where to go to get the care needed. The nurses also provide health education, nurse-initiated follow-up, and network referrals.
Extra help with getting a ride to a doctor’s visit when state services are not available
Extra Vision Services
Members receive a $100 allowance towards upgraded frames, lenses, and lens options or contact lenses every two years. The benefit period is measured from the date of service. When contact lenses are chosen, the allowance is applied to the participating provider’s retail cost for the contact lenses and professional services specific to contact lens wear, e.g., fitting, assessment and follow-up. Members who elect to upgrade their eye-wear purchase with a retail value greater than the $100 allowance are financially responsible for paying the participating provider’s usual and customary (retail) cost of the difference between the cost of the eyewear selected and the $100 allowance.
Sports and School Physicals
One each year for Members age 4 through 19
Educational materials for Members who are enrolled in our Asthma and Diabetes Care Management Programs
Help for Members with Asthma
Asthma educational materials and one allergy-free pillowcase each year to Members enrolled in our Asthma Care Management Program. Member gets one pillowcase per year based on when Member received one before.
Extra Help for Pregnant Women
$25 gift card for completing a prenatal checkup within 42 days of enrollment. $25 gift card for completing a timely postpartum checkup after giving birth
Health and Wellness Services
Up to $100 allowance towards an annual Baker Ripley membership in the Harris Service Area
Healthy Play and Exercise Programs
$30 gift card each year for school-aged Member up to grade 12 who are in a school-sponsored extracurricular sports (athletic) program to pay for program fees, supplies or uniforms
Healthy Play and Exercise Programs
$40 gift card each year for Members up to grade 12 who participate in a youth sports league (apart from extra-curricular, school sponsored activities)
Gift Card Program
$10 gift card for each of up to six well-child checkups before turning 15 months old, plus a $25 bonus gift card for completing all six checkups, for a total of up to $85
Extra Dental Services for Adults (age 21 and older) and Pregnant Women
Two routine dental exams per year with teeth cleaning, x-rays, fillings, non-surgical extractions and emergency exams (limited)