ELIGIBILITY REQUIREMENTS

---

If you get Medicaid or CHIP, you might be able to get extra help with your services through your health plan or your providers.

All STAR Kids members get connected with a service coordinator through their health plan. STAR+PLUS members with complex medical conditions also get a service coordinator through their health plan.

Service coordination can help ensure you get the services you need. Service coordinators are provided by your health plan to help manage your health care and long-term care needs, which can include access to community resources and help with food and housing. They work with you, your primary care provider, and your specialty and non-medical providers to develop and carry out an Individualized Service Plan.

STAR and CHIP members with special health care needs can get help from their health plans through service management. Special health care needs include serious, ongoing illnesses, chronic or complex conditions, disabilities, and conditions that require therapeutic intervention and evaluation by appropriately trained staff.

If you are a member with special health care needs, a service manager can help ensure you get the health care services you need from your health plan. They can also help you get services that might not be covered by your health plan like help with food and housing. For STAR members, this might include programs like Community First Choice or personal care services.

STAR Health provides health care and long-term care services to children and young adults in foster care with the Texas Department of Family and Protective Services. STAR Health members with a specific medical and behavioral need get service coordination or service management.

In STAR Health, service coordination helps caregivers manage information like medical records for court hearings or get services from other programs.

Service management is for members with complex medical or behavioral needs. STAR Health service manager works with the member, member's caregivers, primary care provider, and specialty care providers to create and carry out a service plan. Service managers ensure access to and use of medically needed, covered services.

These services are also available by request. If you don't already get either of these services, you can ask for them.

Case Management Services

You might also receive case management services through certain programs separate from your health plan. Examples of these programs are Early Childhood Intervention, Targeted Case Management/Mental Health Rehabilitation and the Medicaid waiver programs (STAR-PLUS-Adult Foster Care).

These services are not the same as service coordination or service management provided by your health plan.

If you are enrolled in other programs outside your health plan and have a service coordinator or service manager, they will work with any other case managers you have. Your service plan will list which services will be provided through your health plan and which will be provided by your other programs.

Important notes for those covered by Medicare:
You can get STAR+PLUS even if you get Medicare unless
you get Medicaid 1915 (c) waiver services or live-in facilities for
people with Intellectual Developmental Disabilities (IDD).
If you are covered by both Medicare and Medicaid (also known as "dual eligible") and you join STAR+PLUS, you will keep getting regular health-care services through your Medicare doctor. STAR+PLUS does not change the way you get Medicare services.

For Additional Information:
https://www.medicaid.gov/medicaid/ltss/index.html

***IMPORTANCE NOTICE***
Consideration is given to clients who are Medicaid eligible. Please contact us concerning this consideration. 

This is reviewed on a case-by-case basis.


We welcome our Veterans!!!
Inquire about additional criteria needed for Tricare participants.
We try to accommodate ALL- if not directly we do assist
with referrals to organizations who can help you locate
resources to meet your unmet needs.