STAR Kids is Texas’s specialized Medicaid managed care program, expertly designed to support children and young adults up to age 20 who are living with disabilities. This essential program ensures that eligible individuals receive crucial Medicaid benefits through a coordinated health plan. If you’re navigating the landscape of managed care programs, particularly in Texas, understanding STAR Kids is vital. This guide provides a comprehensive overview of the STAR Kids program, its benefits, and who can access this important support system.
Participation in STAR Kids is mandatory for Texas residents aged 20 and younger who receive Medicaid and meet at least one of the following criteria:
- Receiving Supplemental Security Income (SSI).
- Enrolled in both Medicaid and Medicare.
- Residing in a community-based Intermediate Care Facility for Individuals with an Intellectual Disability or Related Condition (ICF/IID) or a nursing facility.
- Participants in the Medically Dependent Children Program (MDCP) waiver.
- Participants in the Youth Empowerment Services (YES) waiver.
- Enrolled in any 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)
Enrolling in a managed care program like STAR Kids means choosing a health plan. This plan then provides access to a network of healthcare professionals, including doctors and specialists, ensuring coordinated care. Upon enrollment in STAR Kids, individuals select a health plan and a primary care physician or clinic for routine medical services and specialist referrals. It’s important to note that those with Medicare will not select a primary care physician through STAR Kids, as their primary care is managed through Medicare.
View a YouTube video about STAR Kids.
Consumer Directed Services (CDS) Option within Managed Care
STAR Kids offers a valuable Consumer Directed Services (CDS) option. This empowers participants and their families to take greater control over their care by allowing them to hire and manage their chosen caregiver. This option provides flexibility and personalized care management within the broader managed care programs framework.
Basic Benefits and Coordinated Care in STAR Kids
STAR Kids is specifically structured to address the distinct healthcare needs of children and young adults with disabilities. The program encompasses a wide array of essential benefits, including:
- Prescription medications
- Hospital care services
- Primary and specialist medical care
- Preventive healthcare services
- Personal care assistance
- Private duty nursing care
- Durable medical equipment and necessary supplies
For children and young adults participating in the MDCP waiver, STAR Kids integrates and delivers their MDCP services, streamlining their care.
Individuals with intellectual and developmental disabilities (IDD) in community-based ICF/IIDs, or those receiving services through CLASS, DBMD, HCS, or TxHmL waivers, receive both acute care and specific long-term services and supports (LTSS) like private duty nursing through STAR Kids. The majority of their LTSS are provided through their respective waiver programs. For those with Medicare, basic health services and medications should be accessed through Medicare benefits.
A cornerstone of STAR Kids is its emphasis on care coordination. Each health plan offers service coordination to help families navigate the healthcare system, identify needs, and connect members with appropriate services and qualified providers. Health plans conduct assessments to understand each member’s service needs, leading to the development of a yearly Individual Service Plan in collaboration with the family, Managed Care Organization (MCO), and the member.
The STAR Kids Screening and Assessment Instrument (SK-SAI) is a crucial tool used by health plans to evaluate each child’s health and independent living needs. You can access a copy of this assessment for more detail: STAR Kids Screening and Assessment Instrument (SK-SAI) (PDF). An accessible version is also available: STAR Kids Screening and Assessment Instrument (SK-SAI) (Accessible Version PDF).
[instruction]
Managed Care Organizations (MCOs) in STAR Kids
Across Texas, each managed care service area is served by at least two health plans, known as Managed Care Organizations (MCOs). These MCOs are responsible for delivering services under the STAR Kids program, ensuring choice and access to care within the managed care programs network.
Resources and Feedback
For further information, STAR Kids provides resources for clients, providers, and MCOs. Your feedback is valuable. You can contribute to the program’s development through the STAR Kids Managed Care Advisory Committee and the HHSC’s Policy Council for Children and Families meetings, or by emailing your questions and comments to Managed Care Initiatives at [email protected].
