Thinking about becoming a Community Health Choice Member? Here is some useful information about the Medicaid Program and Community Health Choice to get you started.
Important: The state of Texas has automatically extended CHIP and STAR Medicaid benefits since the federal government issued a public health emergency (PHE) due to the COVID-19 epidemic.
Visit our public health emergency site for more information.
Community provides both Children’s Medicaid and Medicaid for Pregnant Women. These programs are provided at no cost to U.S. residents who cannot afford health insurance.
Children’s Medicaid – Children’s Medicaid covers a child up through the month of his or her 21st birthday. Income determines eligibility. That income level is different based on age and Medicaid program. Members must recertify every year.
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.
Community Health Choice is a managed care organization that offers Texas Medicaid STAR coverage and provides services that are covered benefits of the Medicaid Program. Read the Benefits section of our Member handbook to see what is covered, what is not covered, and how to get these benefits.
Medicaid does not provide coverage if you are out of the country. Benefit coverage is limited to your service area. If you are outside of our service area, benefits are limited to emergency care.
Read about our service area coverage in our STAR Handbook.
For a list of covered services listed, view the Member Handbook.
For a list of exclusions view the Member Handbook.
After a person chooses a managed care organization, like Community Health Choice, to provide their healthcare, they then choose a Primary Care Provider to give them all their primary care services. This includes coordinating referrals for all medically necessary specialty services. Want to see if your Provider, specialist or hospital is in our network? Search our Find a Doctor directory. |
Community follows the Texas Vendor Drug Formulary for Medicaid and CHIP. Updates to the formulary are managed by the Texas Vendor Drug Program.
Here is how to search:
This search will tell you:
Drugs are listed as “preferred” and “non-preferred.” If you need a “non-preferred” drug, your doctor will need to submit a special request to get the “non-preferred” drug by calling Member Services toll-free at 1.888.760.2600.
Some benefits and services must be reviewed and approved by our Utilization Management Department. Here are some things you should know about utilization management services.
Our Notice of Privacy Practices is given to you as part of the Health Insurance Portability and Accountability Act (HIPAA). It says how we can use or share your protected health information (PHI) and sensitive personal information (SPI). We review this notice annually and update if needed.
“Protected health information” and “sensitive personal information” (PHI/SPI) is information that identifies a person or patient. These data can can be your age, address, e-mail address, and medical facts. It can be about your past, present or future physical or mental health conditions. It also can be about sensitive healthcare services and other personal facts.
It tells you who we can share it with and how we keep it safe. This includes protection of your oral, written and electronic information across the organization. It tells you how to get a copy of or edit your information. It ensures that any oral, written, and electronic information you share with us is confidential and secure.
You can allow or not allow us to share specific details unless needed by law. You have the right to approve or withdraw the use of your information.
Read our full Privacy Notice section in our Member Handbook.
Lost your Medicaid benefits? The Healthy Texas Women Program provides family planning exams, related health assessments, and birth control to women ages 18 to 44 whose family income is at or below the program’s income limits (185 percent of the Federal Poverty Level).
You must apply to find out if you can receive services through this program. Visit the Healthy Texas Women website for more information.
Autism Spectrum Disorder (ASD) is a developmental disorder that affects communication and behavior. It is characterized by restricted, repetitive patterns of behavior, interests, or activities and deficits in social communication and social interaction, with onset of symptoms occurring in early childhood.
Effective February 1, 2022, Autism Services, to include Applied Behavior Analysis (ABA) evaluation and treatment, became a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Texas Medicaid recipients who are 20 years of age and younger and who meet the criteria outlined in the Autism Services benefit description. This benefit is not available for CHIP recipients.
Medicaid Applied Behavior Analysis (ABA) Services for Children and Youth With Autism
ABA is one of many services available for Medicaid members, age 20 or younger, who have a diagnosis of autism spectrum disorder (ASD). ABA is a treatment approach provided by specialists called licensed behavior analysts (LBAs).
If your child is eligible, ABA can help:
Click here for more Applied Behavioral Analysis Services information.
Yes, prior authorization is required for evaluation and treatment. A great place to start is your child’s Primary Care Provider (PCP). They may recommend a Provider that meets your child’s needs. A signed referral must be submitted to the ABA Provider to accompany their Authorization request.
Your child can be evaluated by any of the following health care providers.
To find a provider, visit https://providersearch.communityhealthchoice.org or call Member Services at 713.295.2294 or toll free at 1.888.760.2600.
Access2Care provides transportation to non-emergency healthcare appointments for STAR (Medicaid) Members who have no other transportation options. These trips include transportation to the doctor, dentist, hospital, pharmacy, and any other place where you receive Medicaid services. These trips DO NOT include ambulance trips. Get more information about Access2Care transportation.
Need help finding and getting services? You might be able to get a case manager to help you.
Children, teens, young adults (birth through age 20) and pregnant women who get Medicaid and:
A case manager will visit with you and then:
Case managers can help you:
Contact Community Health Choice for more information Monday to Friday, 8 a.m. to 6 p.m. or call Texas Health Steps at 1-877-847-8377 (toll-free), Monday to Friday, 8 a.m. to 8 p.m.
General Information
Local: 713.295.2222
Toll-Free: 1.877.635.6736
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m
Member Services
Local: 713.295.2294 | Toll-Free: 1.888.760.2600
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m.
Provider Services Hotline
Call 713.295.2295, 8:00 a.m. - 5:00 p.m., Monday – Friday
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.
Children’s Medicaid – Children’s Medicaid covers a child up through the month of his or her 21st birthday. Income determines eligibility. That income level is different based on age and Medicaid program. Members must recertify every year.
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.
Community Health Choice is a managed care organization that offers Texas Medicaid STAR coverage and provides services that are covered benefits of the Medicaid Program. Read the Benefits section of our Member handbook to see what is covered, what is not covered, and how to get these benefits.
Medicaid does not provide coverage if you are out of the country. Benefit coverage is limited to your service area. If you are outside of our service area, benefits are limited to emergency care.
Read about our service area coverage in our STAR Handbook.
For a list of covered services listed, view the Member Handbook.
For a list of exclusions view the Member Handbook.
After a person chooses a managed care organization, like Community Health Choice, to provide their health care, they then choose a Primary Care Provider to give them all their primary care services. This includes coordinating referrals for all medically necessary specialty services. Want to see if your Provider, specialist or hospital is in our network? Search our Find a Doctor directory. |
Community follows the state Vendor Drug Formulary for Medicaid and CHIP. You can review the list at https://www.txvendordrug.com/
formulary/formulary-search
This list will tell you:
If the drug you need is non-preferred, you will need to request an exception by contacting Member Services toll-free at 1.888.760.2600.
Some benefits and services must be reviewed and approved by our Utilization Management Department. Here are some things you should know about utilization management services.
Filing an appeal – If your service is denied, you can appeal. Read the Appeals section of the Member Handbook for more information.
“Protected health information” and “sensitive personal information” (PHI/SPI) is information that identifies a person or patient. This data can be your age, address, e-mail address, and medical facts. It can be about your past, present or future physical or mental health conditions. It also can be about sensitive healthcare services and other personal facts.
Read the Privacy Notice section in our Member Handbook for more information.
Lost your Medicaid benefits? The Healthy Texas Women Program provides family planning exams, related health assessments, and birth control to women ages 18 to 44 whose family income is at or below the program’s income limits (185 percent of the federal income level). of poverty).
You must apply to find out if you can receive services through this program. Visit the Healthy Texas Women website for more information.
Autism Spectrum Disorder (ASD) is a developmental disorder that affects communication and behavior. It is characterized by restricted, repetitive patterns of behavior, interests, or activities and deficits in social communication and social interaction, with onset of symptoms occurring in early childhood.
Effective February 1, 2022, Autism Services, to include Applied Behavior Analysis (ABA) evaluation and treatment, became a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Texas Medicaid recipients who are 20 years of age and younger and who meet the criteria outlined in the Autism Services benefit description. This benefit is not available for CHIP recipients.
Medicaid Applied Behavior Analysis (ABA) Services for Children and Youth With Autism
ABA is one of many services available for Medicaid members, age 20 or younger, who have a diagnosis of autism spectrum disorder (ASD). ABA is a treatment approach provided by specialists called licensed behavior analysts (LBAs).
If your child is eligible, ABA can help:
Click here for more information.
Yes, prior authorization is required for evaluation and treatment. A great place to start is your child’s Primary Care Provider (PCP). They may recommend a Provider that meets your child’s needs. A signed referral must be submitted to the ABA Provider to accompany their Authorization request.
Your child can be evaluated by any of the following health care providers.
To find a provider, visit our provider search page or call Member Services at 713.295.2294, or toll free at 1.888.760.2600.
Access2Care provides transportation to non-emergency health care appointments for STAR (Medicaid) Members who have no other transportation options. These trips include transportation to the doctor, dentist, hospital, pharmacy, and any other place where you receive Medicaid services. These trips DO NOT include ambulance trips. Get more information about Access2Care.
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 it’s the best health insurance they will ever be with.”– Chandolyn
Member of Community Health Choice
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