Texas STAR+PLUS Plan

Community offers STAR+PLUS Medicaid in Texas in the Harris service area. We are here to help our members navigate their healthcare journey and coordinate care the way they need it.

View our service area coverage here.

Texas STAR+PLUS Plan

Community offers STAR+PLUS Medicaid in Texas in the Harris service area. We are here to help our members navigate their healthcare journey and coordinate care the way they need it.

View our service area coverage here.

STAR+PLUS Managed Care Program

STAR+PLUS is a Texas Medicaid managed care program for adults who have disabilities or are age 65 or older. Adults in STAR+PLUS get Medicaid health-care and long-term services and supports through a health plan that they choose. More information about how “Dual-Eligible” Members are affected for PCP selection here.

Benefits and Coverage

Learn more about the STAR+PLUS Medicaid benefits today. Our approach to healthcare ensures that you receive the highest quality of care and service at an affordable cost.

Read the STAR+PLUS Medicaid Benefits

Moral or Religious Objections
Community Health Choice does not exclude access to any services because of moral or religious objections.

24-Hour Nurse Advice Line

Nurse advice line available 24 hours a day, 7 days a week. Nurses provide education, nurse-initiated follow-up and network referrals.

Toll-Free: 1.800.206.9052 | TTY 7-1-1 for Hearing-Impaired

Service Area

Read about our service area coverage in our STAR+PLUS Plan Handbook.

Nursing Facility Benefits

Community Health Choice provides access to comprehensive nursing facility services in accordance with the Texas Health and Human Services Commission (HHSC) guidelines. Our network of nursing facilities offers a range of specialized care options to meet the diverse needs of our members, particularly those requiring long-term or short-term skilled nursing care.

Key Features of Nursing Facility Services

Comprehensive Care:
- Nursing facilities deliver 24-hour skilled nursing care, ensuring that residents receive continuous medical attention and support. This includes assistance with daily living activities, medication management, and rehabilitation services.
Personalized Treatment Plans:
- Each resident receives a personalized care plan tailored to their specific health needs and preferences. This plan is developed by a team of healthcare professionals, including doctors, nurses, and therapists, to provide holistic and coordinated care.
Therapeutic Services:
- Facilities offer various therapeutic services such as physical, occupational, and speech therapy. These services aim to improve residents’ mobility, independence, and overall quality of life.
Safe and Comfortable Environment:
- Nursing facilities provide a safe, comfortable, and supportive living environment. The facilities are designed to ensure the safety and well-being of residents, with amenities and activities that promote social engagement and mental health.
Specialized Care Programs:
- Specialized care programs are available for residents with specific conditions, such as Alzheimer’s disease, dementia, and other cognitive impairments. These programs include tailored activities and therapies to support cognitive function and enhance quality of life.
Support for Families:
- Facilities offer support and resources for families of residents, including educational programs and counseling services. This helps families understand the care process and stay involved in their loved ones’ care.

Value Added Services

For a list of coverage benefits view the Value Added Services

These services are valid from 9/1/24 through 8/31/25.

*Restrictions and limitations may apply. **STAR+PLUS members ages 18-64. STAR+PLUS Nursing Facility Medicaid Only members ages 21-64. Only for members in Harris service area.

Prescription Drug Services

Community follows the Texas Vendor Drug Formulary for STAR+PLUS. Updates to the formulary are managed by the Texas Vendor Drug Program.

Here is how to search:

Visit the formulary at: https://www.txvendordrug.com/formulary/formulary-search.
Enter the name of your drug.

This search will tell you:

If the drug is on the formulary
If the drug requires a prior authorization

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 1.888.435.2850.

Vision Services

Call Envolve Vision Services, Community Health Choice vision provider, at 1.844.686.4358 | TTY 7-1-1 for Hearing-Impaired.

Call Community Health Choice toll-free at 1.888.435.2850. If you need a translator. In case of an emergency, call 9-1-1 or go to the nearest hospital.

Web site: visionbenefits.envolvehealth.com

Behavior Health/Substance Abuse Services and Crisis Hotline

Local: 713.970.8215 Toll Free: 1.877.343.3108 | TTY 7-1-1 for Hearing-Impaired.

Crisis Hotline: 24 hours a day, 7 days a week. Information is available in English and Spanish.

Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital.

Dental Services

FCL Dental
Phone: 1.877.727.9570
Web site: http://www.fcldental.com/home

During normal business hours, call your Dentist to find out how to get emergency services. If you need emergency dental services after the Main Dentist’s office has closed, call us toll-free at 1.877.727.9570
or or call TTY 7-1-1.

Non-Emergency Medical Transportation – Access2Care

NEMT Services provide transportation to Non-emergency health care appointments for members who have no other transportation options. These trips include rides to the doctor, dentist, hospital, pharmacy, and any other places you get Medicaid services. These trips do NOT include ambulance trips.

Call Access2Care, Community’s NEMT & Where’s My Ride transportation provider, toll-free at 1.833.502.0131 | TTY 7-1-1 for Hearing-Impaired, available 24 hours a day, 7 days a week.

Get more information about Access2Care transportation.

How to reach a Service Coordinator

To speak with a Service Coordinator, please call the Service Coordination hotline at:

Local: 713.295.5004 Toll Free: 1.888.435.5150 | TTY 7-1-1 for Hearing-Impaired.

Service Coordination Team is available 8:00 am – 5:00 pm Monday- Friday, excluding state approved holidays.

The Service Coordinator will:

Help you choose a Primary Care Provider and organize care with your Primary Care Provider
Teach you how and when to use the 24-hour Nurse Advice Line
Give you information about illness and medication and explain and describe service and placement choices to you
Advocate and work with your healthcare team and help with any medical, behavioral health and Long-Term Services and Supports
Assist you with timely & coordinated access to an array of services and/or covered Medicaid eligible services
Partner with nursing facility to ensure best possible outcomes for the Member’s health & safety
Find ways for you to live at home or in other community settings

Provider Network

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 Provider directory.

Prior Authorization

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.

Preservice review – Some services require prior authorization before you receive the service. This is to make sure you only receive medically necessary services.
Urgent concurrent review – This is a request for services made while you are in the process of receiving care. This typically happens while you are receiving inpatient care in a hospital or are receiving ongoing outpatient care. The submission of urgent concurrent review requests will be handled by your Provider.
Post-service review – Sometimes requests have to be reviewed after services have been provided. The submission of post-service requests would be handled by your Provider.
Filing an appeal – If your service is denied, you can appeal. Read the Appeals section of the Member Handbook for more information.

Texas STAR+PLUS Plan

Care Terminology

Service Area Map

Value-Added Services

Member Resources

Access2Care Transportation

HHSC Notifications

Member Advisory Group

Member Handbook – English

Member Handbook – Spanish

Member Nursing Facility Handbook English

Member Nursing Facility Handbook Spanish

Prior Authorization Information

Provider Directory

Right for Your Patient

Member Rights and Forms

Abuse Neglect and Exploitation

Appeals Process

Complaint Process

External Medical Review Process

Fraud, Waste, and Abuse

HIPAA Release Form

Is IOP Right for Your Patient?

Language Assistance

Member Rights and Responsibilities

Notices of Privacy Practices (NOPP)

Privacy Notice

State Fair Hearing Process

STAR+PLUS Contract

General Information

Availability of Material in Alternate Formats

24 Hour Nurse Advice Line

Hotline Numbers for Providers and Members

How to replace a lost or stolen Member ID card

Helpful Phone Numbers

Member Services
Local: 713.295.2300 Toll-Free: 1.888.435.2850 | TTY 7-1-1 for Hearing-Impaired

24 hours a day, 7 days a week, Monday – Friday, excluding state-approved holidays. Access your Member account online 24 hours a day, seven days a week. Information is available in English and Spanish.

Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital. Also call for pharmacy and dental information.

Service Coordination Team
Local: 713.295.5004 Toll Free: 1.888.435.5150 | TTY 7-1-1 for Hearing-Impaired.

Service Coordination Team is available 8:00 am – 5:00 pm, Monday- Friday, excluding state approved holidays.

After business hours you can leave a message and calls will be returned within one business day or call Member Services hotline at 1.888.435.2850.

In case of an emergency, call 9-1-1 or go to the nearest hospital. If you have trouble hearing or speaking, please call the TTY/TDD line at 7-1-1

Additional Contact Numbers

STAR+PLUS Managed Care Program

Benefits and Coverage

Learn more about the STAR+PLUS Medicaid benefits today. Our approach to healthcare ensures that you receive the highest quality of care and service at an affordable cost.

Read the STAR+PLUS Medicaid Benefits

Moral or Religious Objections
Community Health Choice does not exclude access to any services because of moral or religious objections.

24-Hour Nurse Advice Line

Nurse advice line available 24 hours a day, 7 days a week. Nurses provide education, nurse-initiated follow-up and network referrals.

Toll-Free: 1.800.206.9052 | TTY 7-1-1 for Hearing-Impaired

Service Area

Read about our service area coverage in our STAR+PLUS Plan Handbook.

Nursing Facility Benefits

Key Features of Nursing Facility Services

Comprehensive Care:
- Nursing facilities deliver 24-hour skilled nursing care, ensuring that residents receive continuous medical attention and support. This includes assistance with daily living activities, medication management, and rehabilitation services.
Personalized Treatment Plans:
- Each resident receives a personalized care plan tailored to their specific health needs and preferences. This plan is developed by a team of healthcare professionals, including doctors, nurses, and therapists, to provide holistic and coordinated care.
Therapeutic Services:
- Facilities offer various therapeutic services such as physical, occupational, and speech therapy. These services aim to improve residents’ mobility, independence, and overall quality of life.
Safe and Comfortable Environment:
- Nursing facilities provide a safe, comfortable, and supportive living environment. The facilities are designed to ensure the safety and well-being of residents, with amenities and activities that promote social engagement and mental health.
Specialized Care Programs:
- Specialized care programs are available for residents with specific conditions, such as Alzheimer’s disease, dementia, and other cognitive impairments. These programs include tailored activities and therapies to support cognitive function and enhance quality of life.
Support for Families:
- Facilities offer support and resources for families of residents, including educational programs and counseling services. This helps families understand the care process and stay involved in their loved ones’ care.

Value Added Services

For a list of coverage benefits view the Value Added Services

These services are valid from 9/1/24 through 8/31/25.

*Restrictions and limitations may apply. **STAR+PLUS members ages 18-64. STAR+PLUS Nursing Facility Medicaid Only members ages 21-64. Only for members in Harris service area.

Prescription Drug Services

Community follows the Texas Vendor Drug Formulary for STAR+PLUS. Updates to the formulary are managed by the Texas Vendor Drug Program.

Here is how to search:

Visit the formulary at: https://www.txvendordrug.com/formulary/formulary-search.
Enter the name of your drug.

This search will tell you:

If the drug is on the formulary
If the drug requires a prior authorization

Vision Services

Call Envolve Vision Services, Community Health Choice vision provider, at 1.844.686.4358 | TTY 7-1-1 for Hearing-Impaired.

Call Community Health Choice toll-free at 1.888.435.2850 if you need a translator. In case of an emergency, call 9-1-1 or go to the nearest hospital.

Web site: visionbenefits.envolvehealth.com

Behavior Health/Substance Abuse Services and Crisis Hotline

Local: 713.970.8215 Toll Free: 1.877.343.3108 | TTY 7-1-1 for Hearing-Impaired.

Crisis Hotline: 24 hours a day, 7 days a week. Information is available in English and Spanish.

Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital.

Dental Services

FCL Dental
Phone: 1.877.727.9570
Web site: http://www.fcldental.com/home

Non-Emergency Medical Transportation – Access2Care

Call Access2Care, Community’s NEMT & Where’s My Ride transportation provider, toll-free at 1.833.502.0131 | TTY 7-1-1 for Hearing-Impaired, available 24 hours a day, 7 days a week.

Get more information about Access2Care transportation.

How to reach a Service Coordinator

To speak with a Service Coordinator, please call the Service Coordination hotline at:

Local: 713.295.5004 Toll Free: 1.888.435.5150 | TTY 7-1-1 for Hearing-Impaired.

Service Coordination Team is available 8:00 am – 5:00 pm Monday- Friday, excluding state approved holidays.

The Service Coordinator will:

Help you choose a Primary Care Provider and organize care with your Primary Care Provider
Teach you how and when to use the 24-hour Nurse Advice Line
Give you information about illness and medication and explain and describe service and placement choices to you
Advocate and work with your healthcare team and help with any medical, behavioral health and Long-Term Services and Supports
Assist you with timely & coordinated access to an array of services and/or covered Medicaid eligible services
Partner with nursing facility to ensure best possible outcomes for the Member’s health & safety
Find ways for you to live at home or in other community settings

Provider Network

Want to see if your Provider, specialist or hospital is in our network? Search our Find a Provider directory.

Prior Authorization

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.

Preservice review – Some services require prior authorization before you receive the service. This is to make sure you only receive medically necessary services.
Urgent concurrent review – This is a request for services made while you are in the process of receiving care. This typically happens while you are receiving inpatient care in a hospital or are receiving ongoing outpatient care. The submission of urgent concurrent review requests will be handled by your Provider.
Post-service review – Sometimes requests have to be reviewed after services have been provided. The submission of post-service requests would be handled by your Provider.
Filing an appeal – If your service is denied, you can appeal. Read the Appeals section of the Member Handbook for more information.