STAR Kids is a Texas Medicaid program designed to provide essential healthcare benefits to children and young adults 20 years of age and younger with disabilities. For families navigating the complexities of healthcare for their children with special needs, understanding programs like STAR Kids is crucial. This program operates under a managed care model, ensuring that beneficiaries receive coordinated and comprehensive medical services through a network of providers.
Who is Eligible for STAR Kids?
Enrollment in STAR Kids is mandatory for individuals who meet specific criteria. To be eligible, a child or young adult must be 20 years old or younger, qualify for Texas Medicaid, and meet at least one of the following conditions:
- Receives Supplemental Security Income (SSI)
- Is eligible for both Medicaid and Medicare
- Resides in a community-based Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) or a nursing facility
- Receives services through the Medically Dependent Children Program (MDCP) waiver
- Participates in the Youth Empowerment Services (YES) waiver
- Is enrolled in one of the following Intellectual and Developmental Disability (IDD) waiver programs:
- Community Living Assistance and Support Services (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Home and Community-based Services (HCS)
- Texas Home Living (TxHmL)
What are Managed Care Programs?
Managed care is a healthcare delivery system organized to manage cost, utilization, and quality. In a managed care program, like STAR Kids, individuals choose a health plan, also known as a Managed Care Organization (MCO). This health plan then provides access to a network of doctors, specialists, hospitals, and other healthcare providers. Think of it as a coordinated system designed to streamline healthcare services and ensure members receive the right care at the right time. Many large insurance providers, such as Blue Cross Blue Shield (BCBS), also offer managed care programs. While STAR Kids is a Medicaid program and not directly a BCBS initiative, understanding the concept of managed care is similar across different contexts. You might find resources or quizzes online, perhaps even on platforms like Quizlet, to help further your understanding of “Which Is A Bcbs Managed Care Program Quizlet” and the general principles of managed care.
Benefits of STAR Kids
STAR Kids offers a comprehensive set of benefits tailored to the needs of its members. These benefits include:
- Prescription drugs
- Hospital care (both inpatient and outpatient)
- Primary and specialty medical care
- Preventive care services (like check-ups and vaccinations)
- Personal care services
- Private duty nursing
- Durable medical equipment and supplies
For children and young adults who are also enrolled in the Medically Dependent Children Program (MDCP), STAR Kids integrates and delivers their MDCP services.
Individuals with intellectual and developmental disabilities (IDD) living in community-based ICF/IIDs or receiving services through CLASS, DBMD, HCS, or TxHmL programs also receive their acute care and some long-term services and supports (LTSS), such as private duty nursing, through STAR Kids. Most of their LTSS continue to be provided through their existing waiver programs.
It’s important to note that if a person has Medicare in addition to Medicaid, Medicare should be used as the primary insurance for basic health services and medications. STAR Kids then coordinates with Medicare to provide supplemental and long-term care services.
Care Coordination in STAR Kids
A key aspect of STAR Kids is care coordination. Each health plan provides service coordination to help families navigate the healthcare system. Service coordinators assist in identifying member needs, connecting them to appropriate services, and finding qualified providers within the network. The health plan conducts an assessment of each member’s service needs. This assessment is then used in collaboration with the family, the MCO, and the member (when appropriate) to develop an Individual Service Plan (ISP). The ISP is a yearly plan designed to address the member’s specific healthcare requirements and goals.
The STAR Kids program utilizes a standard screening and assessment process, known as the STAR Kids Screening and Assessment Instrument (SK-SAI), to thoroughly evaluate each child’s health and independent living needs. This assessment ensures that the care plan is truly individualized and responsive to the unique circumstances of each member.
Managed Care Organizations (MCOs) in STAR Kids
In each service delivery area within Texas, STAR Kids services are provided by at least two health plans, or Managed Care Organizations (MCOs). This provides families with choices and ensures a competitive environment for service delivery.
Resources and Contact Information
For further information and resources related to STAR Kids, you can explore the following:
- STAR Kids Managed Care Advisory Committee: Provides a platform for feedback and input from members, families, advocates, and providers.
- HHSC’s Policy Council for Children and Families: Another avenue for stakeholder feedback and policy discussion related to children’s healthcare in Texas.
- Email for questions and comments: [email protected]
By understanding the intricacies of programs like STAR Kids, families can better advocate for and access the healthcare services their children need to thrive. Managed care programs are designed to create a more efficient and coordinated healthcare experience, and STAR Kids is a vital resource for eligible families in Texas.
