Texas STAR+PLUS Plan

Texas STAR+PLUS Plan

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.

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

Important: The state of Texas has automatically extended CHIP and Texas STAR+PLUS Plan 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.

Apply for Texas STAR+PLUS Plan

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.

STAR+PLUS 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.

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.

STAR+PLUS Medicaid benefits offer residential or home care options, in addition to physician services. Residents of Community can feel secure in the knowledge that we are dedicated to providing you with the most convenient care possible for your condition, and that our plans include options that honor your individual needs.

This includes benefits such as:

  • Primary and specialty physician care services.
  • Prescription drugs and medical supplies.
  • Medical checkups, including Texas Health Steps.
  • Behavioral health services.
  • Hospital care.
  • Nursing facility care services.
  • Vision services.
  • Family planning services.
  • Long Term Services and Supports (LTSS)
    • Personal attendant services.
    • Day activity and health services.
  • Home and Community Based Services (HCBS) Waiver
    • Nursing services (in home).
    • Home delivered meals.
    • Therapies (occupational, physical, speech/language, cognitive rehabilitation).
    • Home modifications.
    • Dental services.
    • Medical supplies and adaptive aids.
    • Respite services.
    • Assisted living.
    • Adult foster care.
    • Financial management services.
    • Transition assistance services.
    • Employment assistance.
    • Supported employment.             

STAR+PLUS Service Area

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

 

Nursing Facility Benefits

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Value Added Services for our STAR PLUS Members

  • List the coverage benefit year below:
    • These services are valid from 9/1/24 through 8/31/25.
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.
Extra Help with Getting a Ride Members may seek transportation assistance through Community’s Transportation Program for trips outside of the covered NEMT benefit, at no cost to STAR+PLUS Members
Dental Service Two routine dental exams per year up to $600 with teeth cleaning, x-rays, (once annually), non-surgical extractions and emergency exams (limited) for Members 21 and older
Extra Vision Services Members may opt-out of standard eyewear benefit and use $150 towards purchase of non-standard glasses or contacts, including contact fitting fee, every 24 months
Discount Pharmacy/Over-the-Counter BenefitsSouthwest Multi-Service Center Members receive $30 per quarter (up to $120 annually) for over-the-counter-medicines and other health related supplies not covered by Medicaid
Temporary Phone Help Members ages 18 and older who qualify for the federal lifeline program can get a free cell phone with talk and text and unlimited data through the federal lifeline program
Help for Members with Asthma Members must be diagnosed with Asthma or COPD and enrolled in Community’s Disease Management/Case Management program Blalock Rd. Houston, TX 77080
Extra Help for Pregnant Women Members receive a $25 gift card for completing a prenatal checkup within 42 days of enrollment and a $25 gift card for completing a timely postpartum checkup within 21- 84 days after giving birth.
Home Visits
  • Home Visits-Respite Up to 16 hours respite services for non-HCBS (STAR+PLUS Waiver) members Non-HCBS (STAR+PLUS Waiver) members.

  • Home Visits Companionship- Companionship Visits, up to 48 hours, annually, for Non-HCBS (STAR+PLUS Waiver) community-based members Non-HCBS (STAR+PLUS Waiver) members
Health and Wellness Meal Services
  • Meal Services Home delivered meals for one week after getting out of the hospital for STAR+PLUS non-HCBS Members.

  • Nutrition Services access to a nutritionist to provide personalized and culturally sensitive education for dietary needs and weight management and/or loss

  • Food/Housing/Economic/Educational Services Access to online resources, to connect with free or low-cost community resources.
  • Free pill organizer

  • Free blanket for newly enrolled. STAR+PLUS Nursing Facility Member

  • Free Digital, Large print clock for newly enrolled STAR+PLUS Nursing Facility Member

  • Free Pair of non-skid socks enrolled STAR+PLUS Nursing Facility Member

Healthy Play and Exercise
  • Healthy Play and Exercise Adult Skill-Building education (including digital skills) Access to Food and Nutrition Services Health Promotion, Health & Wellness, Exercise, and social engagement activities .

  • Healthy Play and Exercise – Exercise kit, which may include a resistance band, hand weight and pedometer for members
Gift Programs
  • $85 gift card for diabetic members who get an HbA1c blood test every 6 monthsMeal Services Home delivered meals for one week after getting out of the hospital for STAR+PLUS non-HCBS Members.

  • $30 gift card for diabetic members who get a diabetic eye exam each year

  • $30 Gift card for members with schizophrenia or bipolar disorder who are using antipsychotic medications and received a diabetes screening

  • $30 gift card each year for current female members who get a recommended mammogram.

Online Mental Health Resources
  • Online mental health resources and an online companionship tool

  • Online companionship tool

  • Online mental health intensive program

*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:

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

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: 1.866.844.4251
Web site: http://www.fcldental.com/home

During normal business hours, call your Dentist to find out how to get emergency services. If you needs emergency dental services after the Main Dentist’s office has closed, call us toll-free at  1.866.844.4251
or or call TTY 7-1-1.

Non-Emergency 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. Acces2Care is Community’s NEMT transportation service.

Get more information about Access2Care transportation.

What is Service Coordination

To speak with a Service Coordinator, please call Service Coordination Team 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
  • Assisting the Member to ensure timely & coordinated access to 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 Doctor directory.

Utilization Management

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. See our Prior Authorization Guide for more information.
  • 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.

Private Health Information

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.

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
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

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.

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.

Medicaid Benefits and Coverage

Community Health Choice is a managed care organization that offers Texas STAR+PLUS Plan 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 Service Area

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 Texas STAR+PLUS Plan Handbook.

For a list of covered services listed, view the Member Handbook.

For a list of exclusions view the Member Handbook.

Provider Network

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.

Prescription Drug Services

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 is on the formulary
  • if the drug requires a prior authorization

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.

Utilization Management

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. See our Prior Authorization Guide for more information. (Link)
  • Urgent concurrent review – If your situation is urgent, we can review your situation quickly to avoid delays in care.
  • Post-service review – Sometimes requests have to be reviewed after services have been provided.

Filing an appeal – If your service is denied, you can appeal. Read the Appeals section of the Member Handbook for more information.

Private Health 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.

Healthy Texas Women Program

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.

What is Autism?

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.

Who is eligible for Autism benefits?

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:

  • Encourage positive and adaptive behaviors.
  • Apply skills across everyday settings so they can improve their health, safety or independence.

Click here for more information.

Does this service require prior authorization?

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.

Who can evaluate my child?

Your child can be evaluated by any of the following health care providers.

  • A developmental pediatrician
  • A neurologist
  • A psychiatrist
  • A licensed psychologist
  • An interdisciplinary team composed of a physician, physician assistant or nurse practitioner in consultation with one or more providers who are qualified child specialists who have expertise in autism limited to:
    • Any provider listed above
    • Licensed clinical social worker
    • Licensed professional counselor
    • Licensed psychological associate
    • Licensed specialist in school psychology
    • Occupational therapist (OT):
    • Speech-language pathologist (SLP)

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.

Non-Emergency Transportation - Access2Care

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.

What is Case Management for Children and Pregnant Women (CPW)?

Case Management for Children and Pregnant Women

Need help finding and getting services? You might be able to get a case manager to help you.

Who can get a case manager?

Children, teens, young adults (birth through age 20) and pregnant women who get Medicaid and:
  • have health problems, or
  • are at a high risk for getting health problems.

What do case managers do?

A case manager will visit with you and then:
  • Find out what services you need.
  • Find services near where you live.
  • Teach you how to find and get other services.
  • Make sure you are getting the services you need.

What kind of help can you get?

Case managers can help you:
  • Get medical and dental services.
  • Get medical supplies or equipment.
  • Work on school or education issues.
  • Work on other problems.

How can you get a case manager?

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.

Why Choose Community?

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.

“Community Health Choice is always there to answer my questions and help me and my family with our medical needs. I truly appreciate and value their customer support and service.”

– Cecily
Member of Community Health Choice