There are four Medicaid programs in Texas: STAR, STAR+PLUS, STAR Health and traditional Medicaid.

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Posted By: AmbulanceAuth September 11, 2017

There are four Medicaid programs in Texas: STAR, STAR+PLUS, STAR Health and traditional Medicaid. The type of Medicaid coverage a person gets depends on where the person lives and what kind of health issues the person has.

  • Traditional Medicaid —Traditional Medicaid is for those who can’t be in manage care. Traditional Medicaid is also called fee for service. Member Handbook: English(link is external) | Member Handbook: Spanish(link is external)
  • STAR — STAR is Medicaid for children, newborns, pregnant women and some families and children. People in STAR get their services through health plans, also called managed care plans. You can see how well some STAR health plans perform by looking at the STAR health plan report cards.
  • STAR Kids — STAR Kids is a new Medicaid program for children and adults 20 or younger who have disabilities. Under STAR Kids, you will get basic medical and long-term services and supports through the health plan’s provider network. You also will get Medically Dependent Children Program (MDCP) waiver services through the health plan’s provider network, if you are eligible.
  • STAR+PLUS — STAR+PLUS is a Medicaid program for people who have disabilities or are age 65 or older. People in STAR+PLUS get Medicaid basic medical services and long-term services through a health plan, also called a managed care plan. You can see how well some STAR+PLUS health plans perform by looking at the STAR+PLUS health plan report cards.
  • STAR Health(link is external) (offsite link) is Medicaid for children who get Medicaid coverage through the Texas Department of Family and Protective Services. STAR Health also is for young adults who were previously in foster care and have either: Former Foster Care Children’s Medicaid or Medicaid for Transitioning Youth. Young adults who are in the Former Foster Care in Higher Education program also get services through STAR Health.

Medicare-Medicaid Plans – In six Texas counties, HHSC and the federal Centers for Medicare and Medicaid Services (CMS) have set up combined Medicare-Medicaid health plans for people in those counties who have both Medicare and Medicaid coverage, known as dual eligibles. The six pilot counties are Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant. By having one Medicare-Medicaid Plan (MMP), Medicare and Medicaid benefits work together to better meet the member’s health-care needs by offering basic health care and long term services and supports.

CHIP is designed for families that earn too much money to qualify for Medicaid, but cannot afford to buy private health insurance. To qualify for CHIP, a child must be age 18 or younger, a Texas resident and a U.S. citizen or legal permanent resident.

CHIP enrollment fees and co-payments are based on the number of people in the family and the family’s income and assets. Enrollment fees are no more than $50 a year for all the children in the family. Some families pay no enrollment fee. Co-pays for doctor visits and prescriptions range from $3 to $5 for lower-income families and $20 to $35 for higher-income families.

Mothers-to-be also can apply for CHIP perinatal coverage(link is external).

All CHIP services are delivered through managed care medical and dental plans.

Learn more about CHIP at CHIPmedicaid.org(link is external).

Managed Care Medical and Dental Plans

Use these websites to find the health plan’s member handbook and up-to-date provider directories.

STAR

STAR Kids

STAR+PLUS

Medicare-Medicaid Plans

Children’s Health Insurance Program (CHIP) Medical Plans

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