Medical Assistance and Resources - A Guide to Medical Services at CPS
Medical Transportation is a Medicaid benefit through HHSC's Medical Transportation Program (MTP). MTPprovides free rides to and from the doctor, dentist, or other Medicaid covered services (such as to a drug store) for Medicaid clients with no other means of transportation. MTP is not a service through the STAR Health program. Caregivers may call MTP directly to arrange transportation by calling 1-877-MED-TRIP (1-877-633-8747). More information is available at www.hhsc.state.tx.us.
Personal Care Services
Personal Care Services (PCS) is a Medicaid benefit through the Texas Health Steps Comprehensive Care Program (CCP). PCS provides support to Medicaid eligible children and young adults, birth through 20 years of age, who require assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and health related functions because of a physical, cognitive, or behavioral limitation related to a disability or chronic health condition.
ADLs are activities that children and young adults do on a daily basis to perform daily self-care (such as feeding, bathing dressing, grooming, and toileting). IADLs may include: cooking, laundering, housekeeping, and the application and maintenance of prosthetics and orthotics. Assistance with health related functions may include helping a child or young adult with the use of durable medical equipment (DME) or the use of adaptive or assistive devices. PCS does not cover assistance with ADLs, IADLs, or health-related functions that a typically developing child of the same chronological age could not safely and independently perform without adult supervision.
PCS is not a service through the STAR Health program. More information about the PCS program is available at www.dshs.state.tx.us or by calling PCS at 1-888-276-0702.
Children and Pregnant Women's Program
Case Management for Children and Pregnant Women's Program (CPW) is a Medicaid benefit for Medicaid eligible children with a health condition/health risk, birth through 20 years of age and high-risk pregnant women of all ages. The CPW program will help them gain access to medical, social, educational and other health-related services. CPW is not a service through the STAR Health program. More information about the CPW program is available at www.dshs.state.tx.us or call CPW at 1-800-252-8023.
Children with Special Health Care Needs
Children with Special Health Care Needs (CSHCN) is a program that helps children with special needs and people of any age with cystic fibrosis. To be eligible for this program a person must (1) live in Texas; (2) Be under age 21 (or any age with cystic fibrosis); (3) Have a certain level of income; and (4) Have a medical problem described by a doctor that is: expected to last at least 12 months; will limit one or more major life activities; needs more health care than what children usually need; have physical symptoms. This means that the program does not cover clients with only a mental, behavioral, or emotional condition, or a delay in development. CSHCN is not a service through the STAR Health program. More information is available at: http://www.dshs.state.tx.us/cshcn or call CSHCN at 1-800-252-8023.
IMMTRAC is the Texas immunization registry developed by the Texas Department of State Health Services (DSHS). ImmTrac is a free, confidential registry designed to combine immunization records from multiple providers and store a child’s immunization information electronically in one secure central system. ImmTrac offers physicians and other healthcare providers and authorized users easy online access to a child’s immunization history. The Registry is part of a DSHS initiative to increase vaccination coverage for children across Texas. ImmTrac is not a service through the STAR Health program. More information available at: http://www.dshs.state.tx.us/immunize/immtrac/default.shtm#parents or call ImmTrac at 1-800-252-9152.
CHIP | Children's Medicaid
Call toll-free 1-877-543-7669 (that’s 1-877-KIDS-NOW) or visit www.chipmedicaid.org
Texas families with uninsured children may be able to get health insurance through Children’s Medicaid and the Children’s Health Insurance Program (CHIP). Both programs offer healthcare benefits, including regular checkups and dental care.
To qualify for CHIP or Children's Medicaid, a child must be age 18 or younger, a Texas resident and a U.S citizen or legal permanent resident. The citizenship or immigration status of the parents does not affect the children's eligibility and is not reported on the application form.
CHIP Perinatal offers health services for unborn children of women who qualify. Texas residents who are pregnant, uninsured and not able to get Medicaid may be able to get CHIP perinatal benefits. Coverage starts before the child is born and lasts 12 months from the date the unborn child is enrolled.
Children's Medicaid is health coverage provided at no cost to the children of families who qualify. Coverage begins as soon as the application is approved.
CHIP is health insurance designed for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private health insurance. CHIP enrollment fees and co-payments are based on the family’s income. Enrollment fees are $50 or less per family for each 12 month term of eligibility and most co-payments for doctor visits and prescription drugs range from $3 to $10.
Medicaid Buy-In for Children
Call 2-1-1 or 1-877-541-7905 or visit www.hhsc.state.tx.us.
Medicaid Buy-In for Children can help pay medical bills for children with disabilities. This program helps families who need health insurance, but make too much money to get traditional Medicaid. Families “buy in” to Medicaid by making a monthly payment (premium).
To be in the Medicaid Buy-In for Children program a child must be age 18 or younger, a Texas resident and a U.S citizen or legal permanent resident, and not be married. The child must meet the same rules for a disability that are used to get Supplemental Security Income (SSI).
Health Insurance Premium Payment (HIPP)
Call the HIPP Helpline at 1-800-440-0493 (toll-free) or visit www.gethipptexas.com
The Texas Health Insurance Premium Payment (HIPP) program helps families pay health insurance payments.
A family may be eligible for HIPP if anyone in the family gets Medicaid and someone in the family can get health insurance at work. With HIPP, family members with and without Medicaid might get private health insurance. Those with Medicaid can still get Medicaid services not covered by the private health insurance.
Your Texas Benefits
This website offers you easy and secure online access to Texas Health and Human Services Commission (HHSC) benefits including Medicaid, Food Stamps, Temporary Assistance for Needy Families (TANF), Children's Health Insurance (CHIP), nursing home care, and other services for people who are elderly or have disabilities.
To apply for benefits and more information go to www.yourtexasbenefits.com
MEDICAID FOR ADOPTED CHILDREN
Children in foster care who are adopted by licensed families may be eligible for Medicaid coverage when the family and child meet certain requirements. If approved an adopted child may receive Medicaid coverage up to the age 18. These benefits may last to age 21 if the child is age 16 or older when the adoption assistance agreement is signed, and the child meets certain educational vocational requirements. The child's Medicaid will transition from Foster Care Medicaid to Traditional Medicaid. This means the child will no longer be a STAR Health Member. The transition from Foster Care Medicaid to Traditional Medicaid may take a few months to complete. More information is available on these pages:
PERMANENCY CARE ASSISTANCE (PCA)
Licensed kinship families that obtain Permanent Managing Conservatorship (PMC) of a child may receive PCA benefits for that child. These benefits can include Medicaid coverage for the child up to age 18. The benefits may last until age 21 if the child is age 16 or older when the Permanency Care Assistance (PCA) Agreement is signed, and the child meets certain educational/vocational requirements. The child's Medicaid will transition from Foster Care Medicaid to Traditional Medicaid. This means the child will no longer be a STAR Health Member. The transition from Foster Care Medicaid to Traditional Medicaid may take a few months to complete. More information is available at:
CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)
CHIP is a health insurance program for children under 19 years of age whose families have low incomes and resources, but earn too much to receive Medicaid and do not have private health insurance. If Medicaid is not in place and a child is currently in the process of applying for Supplemental Security Income (SSI) benefits, they should consider applying for the Children's Health Insurance program while the SSI application is being processed.
More information is available at:
For additional resources see Medical Assistance & Resources for CPS Children & Families (above).
A brief overview of services available for youth transitioning out of foster care can be found in this PDF document. The document describes state- and federally-funded programs for individuals currently or formerly in foster care. Many more resources can be found on the Texas Youth Connection, a website to help foster youth make their way towards independent, healthy, adult living.
Medicaid for Transitioning Foster Care Youth (MTFCY)
Young adults under 21 years of age, previously in DFPS Conservatorship (custody), transfers to Medicaid for Transitioning Foster Care Youth (MTFCY) when they turn 18 years of age and leave foster care. This transition from foster Care Medicaid to MTFCY is smooth and requires no additional steps by the youth. The only exception is if the youth receives Supplemental Security Income (SSI) benefits. In that case, the Foster Care Medicaid is ended and the SSI benefits are reinstated. This process should also be smooth. If a youth changes addresses or comes across any issue concerning this benefit he or she can call: Centralized Benefit Services, at (800) 248-1078, ext. 8126 or (512)908-8126 (Region 7). [STAR Health Fact Sheet]
Former Foster Care in Higher Education (FFCHE)
Effective October 1, 2009, the Health and Human Services Commission (HHSC) began providing health care benefits to certain former foster care youth who are at least 21 years or older, but younger than 23 years of age, who are eligible to receive assistance as an independent foster youth and who are enrolled in an institution of higher learning. To request the FFCHE application individuals must call the DHS Centralized Benefits Section at 1-800-248-1078, ext. 9658 or 2-1-1. [FFCHE Fact Sheet]
Additional Programs & Resources
- Transitional Living Services: A Brief Overview
- STAR Health Fact Sheet
- FFCHE Fact Sheet
- Texas Youth Connection
- Health & Human Services Commission
- Apply for CHIP Medicaid
- Health Care for Children
For additional resources see Medical Assistance & Resources for CPS Children & Families (above).