Medical Assistance and Resources: A Guide to Medical Services at CPS
Non-emergency Medical Transportation
Non-emergency Medical Transportation is a Medicaid benefit through HHSC's Medical Transportation Program (MTP). Contracted Transportation Providers provide MTP eligible clients 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 the Transportation Provider in their region directly to arrange transportation by calling 1-855-687-4786 if they live in the Houston/Beaumont area; 1-855-687-3255 if they live in the Dallas/Ft. Worth area; or 1-877-MED-TRIP (1-877-633-8747) for all other areas of the state. More information is available at www.hhsc.state.tx.us/medicaid/mtp.
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 maintenance activities 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.
More information about the PCS program, call 1-888-276-0702.
Case Management for Children and Pregnant Women's Program
Case Management for Children and Pregnant Women's Program 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 Case Management for Children and Pregnant Women’s 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. For more information about the Case Management for Children and Pregnant Women's program or to get a case manager, call 1-877-847-837 or visit https://www.dshs.state.tx.us/caseman.
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 or the Children’s Health Insurance Program (CHIP). CHIP is a health insurance program for children whose families have low incomes, but earn too much to receive Medicaid and do not have private health insurance. 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 considered for eligibility determination.
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.
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 for their unborn child. Coverage starts before the child is born. Upon delivery, the child may qualify for an additional 12 months of Medicaid or CHIP coverage, depending on the family's income.
Medicaid Buy-In for Children
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).
For more information call 2-1-1 or 1-877-541-7905 or visit yourtexasbenefits.hhsc.texas.gov.
Health Insurance Premium Payment (HIPP)
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.
To learn more, call the HIPP Helpline toll-free at 1-800-440-0493 or visit www.gethipptexas.com.
Your Texas Benefits
The Your Texas Benefits 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
Medicaid coverage is available for children with special needs who are adopted from DFPS conservatorship, when all requirements are met. If approved, an adopted child may receive Medicaid coverage up to the age of 18. Medicaid coverage may be extended up to age 21 if the child was age 16 or older when the adoption assistance agreement was signed, and the child meets certain educational or vocational requirements. At the end of the month in which the adoption is consummated, the child's Medicaid coverage will transition from STAR Health Medicaid to Traditional Fee-for-service Medicaid. Sometimes this transition in coverage will occur one month later.
More information is available on these pages:
Permanency Care Assistance (PCA)
Medicaid coverage is available for children living with licensed kinship families that obtain Permanent Managing Conservatorship (PMC), when all requirements are met.. If approved, a child may receive Medicaid coverage up to the age of 18. Medicaid coverage may be extended up to age 21 if the child was age 16 or older when the Permanency Care Assistance (PCA) agreement was signed, and the child meets certain educational or vocational requirements. At the end of the month in which the PCA agreement is signed, the child's Medicaid coverage will transition from STAR Health Medicaid to Traditional Fee-for-service Medicaid. Sometimes this transition in coverage will occur one month later.
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.
Additional Programs and Resources
More information is available at:
For additional resources see Medical Assistance & Resources for CPS Children & Families (above).
A brief overview of state and federally funded programs and services available for youth transitioning out of foster care can be found in this document. 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.
In order to keep their Medicaid eligibility active, young adults must report all address changes and get answers to eligibility related questions via YourTexasBenefits.com, the Your Texas Benefits app, or by calling 2-1-1 or 1-877-541-7905.
Former Foster Care Children (FFCC) Program
Medicaid coverage is available for young adults age 18 up to age 26 who meet the following requirements:
- have aged out of foster care at age 18 or older;
- received federally funded Medicaid when he or she aged out of Texas foster care;
- are a U.S. Citizen or be a qualified alien; and
- are a Texas resident.
Young adults age 18 up to age 21 will continue to be enrolled in STAR Health, but may choose to switch to the STAR plan of their choice. Young adults age 21 up to age 26 must transition to the STAR program and will be given a choice of STAR plans in their area.
Medicaid for Transitioning Foster Care Youth (MTFCY)
Some young adults who are transitioning out of foster care may not qualify for the FFCC program. Young adults can still qualify for Medicaid coverage under the MTFCY program if they meet the following requirements:
- are ineligible for FFCC;
- are age 18 through 20;
- have been in foster care or voluntary agency conservatorship in Texas on their 18th birthday or have had an Interstate Compact on the Placement of Children (ICPC) agreement;
- meet Medical Programs citizenship/alien status and Social Security number requirements;
- are a Texas resident;
- do not have adequate healthcare coverage; and
- meet program rules for income.
Exception: Individuals who have an ICPC agreement are not required to meet the income limit.
Young adults age 18 up to age 21 will continue to be enrolled in STAR Health, but may choose to switch to the STAR plan of their choice.
Former Foster Care in Higher Education (FFCHE)
Young adults age 21 or 22 who are not eligible for the FFCC program may continue to receive healthcare benefits if they meet the following requirements:
- currently reside in Texas;
- have been in any state's conservatorship or voluntary agency conservatorship on their 18th birthday or have had an ICPC agreement;
- are enrolled in an institution of higher learning in Texas;
- do not have adequate healthcare coverage; and
- meet all other Medical Programs criteria such as citizenship and alien status.
These young adults will continue to be enrolled in STAR Health.Individuals apply for FFCHE using Form H1868, Application for Health Care Benefits. They may also use Form H1205, Texas Streamlined Application, or Form H1010, Texas Works Application for Assistance - Your Texas Benefits. To request an application for FFCHE healthcare benefits, individuals must call 2-1-1 or 1-877-541-7905.