A new Medicaid Managed Care Program


A cluster of simplified figures, one smaller than the other two.November 1st of 2016, nearly 180,000 children and youth will be served by a new Medicaid Managed Care initiative.

STAR Kids is a Medicaid Managed Care program* that will provide a mix of acute care (basic health services) and long-term services and supports to children and youth aged 20 and younger who either receive Supplemental Security Income (SSI) Medicaid services, or are enrolled in the Medically Dependent Children Program (MDCP).

This new program was legislatively mandated to improve access, care coordination, and customization, while increasing the overall quality of care. The program goal is to have better health outcomes, and cost containment. The STAR Kids model requires that providers offer a Health Home+, increased care management, and comprehensive coordination of acute care and long-term service benefits.

The STAR kids program will provide additional benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies.

There will be at least two STAR Kids health plans in each region (view a map). Families will have a choice of Managed Care Organizations (MCOs) to enroll with (like other managed care plans).

Individual providers must have a contract with an MCO in order to provide services. Families will need to be sure that their current provider is part of the MCOs provider network (or will become a member) if they want to retain the relationship with an individual provider. There is always the option to change MCOs.

*Medicaid managed care program is healthcare provided through a network of doctors, hospitals and other healthcare providers responsible for managing and delivering quality, cost-effective care.

** Other 1915(c) waver programs are:

View an overview of each program.

+ "Health Home" means a primary care provider practice or, if appropriate, a specialty care provider practice, incorporating several features, including comprehensive care coordination, family-centered care, and data management, that are focused on improving outcome-based quality of care and increasing patient and provider satisfaction under the child health plan program and Medicaid. Read more: Texas Medicaid Patient-Centered Medical Home Report, 2013, pp. 3-5.

STAR Kids Enrollment Timeline 2016

The STAR Kids program is currently on track to begin enrollment on August 1st of 2016. Other important dates are as follows:

My Provider (doctor, specialist) is not part of the managed care program! What do I do?

If your family will be served by STAR Kids, it is imperative that you take the initiative and tell your doctor(s) (and other providers) that STAR Kids will become your child’s method of payment through a Managed Care Organization (MCO).

CTD knows your relationship with a trusted provider may be very important to your family. You must let them know that they will have to become a credentialed provider with the MCO that you choose (or with all MCOs in a region), and that they must be part of the MCO network in order to continue to provide services to your child.

In addition, you can let the providers know that there is a grace period to maintain continuity of services for your child, and that a provider can negotiate an “individual provider contract” with an MCO if they do not want to serve other Medicaid patients.

Families should stress that this is a new system and that families (like yours) are advocating to increase providers' rates and to streamline credentialing systems.

More Information to Follow

The Health and Human Services Commission (HHSC) (in conjunction with advisory committees and advocates) will be developing an extensive Frequently Asked Questions (FAQ) in the near future to address common issues, concerns, and problems. Furthermore, HHSC will be sending more detailed information out this May to those who will be transitioning to STAR Kids. Be on the lookout!

CDS Option

STAR Kids allows for a Consumer Directed Services (CDS) option!

Consumer Directed Services (CDS) is an option that empowers families and people with disabilities to become the employer for personal assistants and for respite services. This alternative to traditional managed care allows you control, freedom, and flexibility in how you receive you personal assistance services.

You hire, train, and manage the people who will provide attendant services in your home; a CDS agency provides you with initial employer training and ongoing support. In addition, a CDS agency helps you with your monthly budgets and manages payroll and all applicable taxes and returns (both federal and state).

Many parents who are already using CDS with their 1915 (c) waiver services will be familiar with this option, which will not change with the implementation of STAR Kids.

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Further Reading