STAR Health - A Guide to Medical Services at CPS
STAR Health is a statewide, comprehensive healthcare system that was designed to better coordinate and improve access to health care for:
- Children in DFPS conservatorship (under age 18).
- Young adults in CPS extended foster care (ages 18 through 20)
- Young adults who were previously under DFPS conservatorship and have returned to foster care through voluntary foster care agreements (ages 18 through 20.)
- Young adults eligible for Medicaid for Former Foster Care Children (FFCC) will continue coverage through the STAR Medicaid Managed Care plan of their choice from age 21 through the month of their 26th birthday.
Before STAR Health, data clearly showed children in DFPS conservatorship have increased health care needs. Physical health care for a child in conservatorship was five times the cost of care for a child receiving Medicaid but not in DFPS conservatorship. Behavioral health care costs were 40 times the cost for children not in conservatorship.
As a result, in 2005 HHSC received Legislative direction to design a comprehensive medical services delivery model to meet the healthcare needs of children in DFPS conservatorship. In April 2008, the STAR Health program was the first of its kind to be implemented.
Effective September 1, 2015 a newly enhanced STAR Health program is in place with new benefits and services! Superior HealthPlan Network (Superior) was again awarded the contract by the Texas Health and Human Services Commission (HHSC) to run the STAR Health program.
STAR Health provides a full-range of Medicaid covered medical and behavioral health services for children in DFPS conservatorship and young adults in DFPS paid placements.
The main goal of STAR Health is to quickly give children in state care the coordinated medical and behavioral health care services they need. These services are available to these children no matter where they are in the state and even when they move.
- Over the Counter Pharmacy Services that will cover $30 every 3 months for over-the-counter medications through a mail order program.
- Online Mental Health Resources, including www.mystrength.com, to improve mental health and overall well-being available for children and youth, caregivers,and caseworkers.
- Case-by-Case Services (available upon approval) include support services such as trauma-informed peer support for caregivers, practice visits for gynecology and dental appointments and services to assist when a child with primary medical needs moves.
- Mobile Health Passport access.
- Mobile Crises Outreach Teams (MCOT) in Houston, Dallas, San Antonio, Lubbock and Corpus Christi if children/ youth are placed with Pathways and Covenant Kids.
- a2A CentAccount® Rewards Program which offers rewards dollars for youth ages 18 through 21 years old who complete wellness visits, dental checkups and other health screenings.
- Boys & Girls Club Membership for children ages 6 through 18 years old.
- Sports/Camp Physicals for children ages 4 to 18 years old.
- A Medical Home for each child, meaning a doctor [or other Primary Care Provider (PCP) or PCP Team] to oversee care.
- Speedy enrollment for immediate health care benefits.
- Coordination of physical and behavioral healthcare.
- Clinical case management to address complex medical and behavioral healthcare needs.
- Preventive care through Texas Health Steps.
- Access to healthcare through a network of providers (doctors, nurses, hospitals, clinics, psychiatrists, therapists, pharmacies, etc.)
- Health Passport to makemore health history and health information available to DFPS caseworkers, medical consenters, doctors, and other healthcare providers.
- Medical advice help-line for caregivers,medical consenters and caseworkers - 24 hours a day, 7 days a week.
- Medical advisory committees to monitor healthcare provider performance.
- Recruitment of providers with a history of treating children who have been abused or neglected.
- Network of providers and specialists trained in trauma-informed services and therapy.
- Physical and behavioral healthcare
- Dental services
- Vision services
- Personal Care Services
- Service coordination
- Clinical service management and disease management
- Health Passport
- Help-lines for consumers and healthcare providers
- Physical, occupational, speech, and other health-related services
- Complex case management for children with high medical or behavioral health needs
- NurseWise 24 hour medical advice line
- Psychotropic medication review
For a child enrolled in the STAR Health program, DFPS staff, caregivers and medical consenters can get information and help with finding a provider, scheduling an appointment, or getting services by:
- Calling STAR Health Member Services at 1-866-912-6283.
- Using the STAR Health website at www.fostercaretx.com.
The medical consenter for a child in the program should present the child's STAR Health ID Card, his or her Texas Benefits Medicaid Card, or DFPS Designation of Medical consenter Form 2085-B at the time of the appointment. The Star Health provider or medical consenter may contact STAR Health Member Services if they have questions about the child's eligibility for STAR Health services.
To plan for services for a child with primary medical needs entering DFPS conservatorship or moving, the caseworker will contact the regional well-being specialist to schedule a meeting. STAR Health, the medical consenter, health care providers and other key parties are invited to participate and assist with the child's needs.
Caseworkers should let the DFPS well-being specialist know of any issues or concerns about STAR Health.
Please click on the question below to read the answer.
A: Go to the nearest emergency room in a life-threatening situation. Otherwise, contact the NurseWise Hotline by dialing (866) 912-6283 (press option "7" after hours & weekends) to talk to a nurse about health questions 24-hours/ day, 7-days/week. English and Spanish-speaking nurses are available.
A: Call STAR Health Member Services at 1-866-912-6283 and have ready both your IMPACT Person Identification (PID) number and the choice of doctor. Superior may also ask for other personal identifying information. Medical consenters should request a PCP who is a Texas Health Steps provider.
A: Medical consenters can encourage their current healthcare provider to join the network by calling one of the four numbers below and ask the representative to contact the doctor or provider in question about joining the network.
- Medical Health: 866-439-2042
- Vision Services: 866-642-9488
- Dental Services: 800-233-1468
- Behavioral Health: 866-218-8263
- Pharmacy Services: 866-912-6293
A: STAR Health providers can accept three forms of proof that the child is enrolled in the STAR Health Program:
- Your Texas Benefits Medicaid Card: If the caregiver has not received a child's Medicaid Card, the caregiver should contact MEHIS at 1-855-827-3748 to request a card but in emergency situations the caregiver should contact Star Health to request a Letter of Eligibility (LOE). If the medical provider/pharmacy does not accept the LOE the regional Eligibility Specialist can issue a temporary Medicaid card (Form 1027A).
- STAR Health ID Card: Superior sends out the ID card once it receives information that a child is in DFPS conservatorship, has changed placements, or selected a new Primary Care Provider (PCP). Request replacement cards by calling STAR Health Member Services at 1-866-912-6283.
- DFPS Form 2085-B, Designation of Medical Consenter: DFPS provides this form to caregivers when the child is placed in their care and updates it when there is a change in who can consent for the child.
If the provider has questions about the child's eligibility, the caregiver can call STAR Health Member Services at 1-866-912-6283 while still at the provider's office. A representative from STAR Health will speak with the provider to resolve the situation.
A: Call STAR Health Member Services at 1-866-912-6283. STAR Health will research the situation and provide direction. If the issue is not resolved in a timely manner, caregivers should contact their CPS caseworker. DFPS staff should contact their regional well-being specialist for assistance.
A. Immediately call Star Health Member Services at 1-866-912-6283 and provide them with the requested information.
See the STAR Health website at www.fostercaretx.com
|Superior HealthPlan Network||1-866-912-6283|
|Cenpatico (Behavioral Health)||1-866-218-8263|
|Denta Quest (Dental Services)||1-888-308-4766|
|TVHP (Vision Services)||1-866-642-8959|
|Medical Transportation Program||1-877-633-8747|
Well-being specialists are DFPS liaisons to Superior HealthPlan, the company that operates the STAR Health provider network. The DFPS caseworker for the child contacts the regional well-being specialist for help with STAR Health.
|Amarillo and Midland Regions
(Regions 1 and 9)
|El Paso and Abilene Regions
(Regions 2 and 10)
|Tyler and Beaumont Region
(Regions 4 and 5)
|San Antonio and Edinburg Regions
(Regions 8 and 11)
|Jacqueline Lerche (Jackie Lerche)|