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Plans & Benefits: STAR Kids

Your plan. Your team. Your life.

Amerigroup offers STAR Kids benefits to people age 20 and younger who have disabilities and are covered by Medicaid, and meet at least one of the following:

  • Get Supplemental Security Income (SSI)
  • Get SSI and Medicare
  • Get services through the Medically Dependent Children Program (MDCP) waiver
  • Get services through the Youth Empowerment Services (YES) waiver
  • Live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility
  • Get services through a Medicaid Buy-In program
  • Get services through any of the following Department of Aging and Disability Services (DADS) 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)

Supporting you and your support system

We understand your child has unique health needs, so we’re about more than doctor visits. Your child’s service coordinator will work with you and your child to create a service plan, answer questions, get your child needed care and services, and coordinate with you and your child’s doctors.

Benefits beyond what you expect

Our benefits are designed with your child and your entire family in mind. In addition to the health benefits he or she gets at no cost, we have free extra benefits to help support you and your child:

Extras for your child’s wellness and well-being
  • Real Solutions® Healthy Rewards debit card dollars for doing things that are good for your child’s health, like getting certain checkups
  • Healthy Families weight management program for members ages 7-17
  • Mobile app and online health coaching, including personalized nutrition and weight loss plans, plus help managing ongoing conditions
  • Emotional support and advice from counselors via text message — anytime, day or night, for ages 13-20
  • Inhaler sensor for members with asthma — helps prevent problems by tracking use
  • Hypoallergenic pillowcase for certain members with asthma
  • Pest control services once every three months
  • Up to $50 a year for nonslip and dexterity products
  • A first aid kit when you create your child’s emergency/disaster plan online
Extras to help your child gain independence and be a kid
  • Travel training and coaching to help your child learn to use public transportation
  • Up to $50 a year to participate in Boys & Girls Clubs, Boy Scouts, Girls Scouts, and other similar organizations
  • Yearly sports, camp, or school physical
  • Free cellphone with monthly minutes and texts for those that qualify
Extras to help caregivers
  • Rides to medical appointments for members and caregivers when other services aren’t available
  • Respite care so family and caregivers can take a break

Exclusions and limitations apply. Read your member handbook to learn more about benefit details and which ones you can get.

Your child’s health-care benefits
  • Primary and specialty care
  • Hospital care
  • Prescriptions
  • Preventive care
  • Personal care services
  • Behavioral health services
  • Private duty nursing
  • Durable medical equipment and supplies
  • Long-term services and supports including home- and community-based care
  • 24-hour Nurse HelpLine to answer your health questions
  • Dedicated Member Services phone number

To learn more about all benefits, refer to the member handbooks.

If your child has Medicare

We also help coordinate with your child’s Medicare benefits. If your child has both Medicare and Medicaid, Amerigroup will provide the long-term services and supports described in the member handbook. Medicare will provide your child’s health-care benefits, such as:

  • Doctor visits
  • Prescriptions
  • Hospital care
  • Behavioral health services

To find out about Medicare plan costs, call your child’s Medicare plan or refer to the information they sent you.

Long-term services and supports

Long-term services and supports are services and equipment to help you care for your child at home or to help your child care for him or herself. These benefits can be delivered through Amerigroup or through a waiver program. To learn more about long-term services and supports, see the member handbook or talk to your child’s service coordinator.

Texas Health Steps

Texas Health Steps is health care for people age 20 and younger who have Medicaid. Starting at birth, your child can get medical checkups at no cost. Dental checkups are also no cost starting at 6 months of age.

Call Texas Health Steps toll-free at 1-877-847-8377 (1-877-THSTEPS) or go to Texas Health Steps to learn more.

Are you a farmworker?

Your kids may be able to get services through STAR Kids. Learn more here.

Service Coordination

Service coordination helps you get the care and services your child needs. A service coordinator works closely with you and your child, gets to know you, and acts as your main contact when you have questions or need help. He or she is backed by an entire team of service coordinators with different types of expertise. This helps ensure your child gets the right care and services, tailored to his or her needs. Your service coordinator will advocate for you — working with all your child’s providers, to make sure your child’s supports and benefits align to meet his or her needs. Your service coordinator will also:

  • Work with you and your entire care team to create a service plan based on your child’s health needs and goals.
  • Make sure you and your child understand the service plan and help you learn more about your care and service options.
  • Help you make appointments with your child’s providers, arrange services, and get transportation, when needed.
  • Coordinate all of the services you get from us and other providers and community organizations.

You can have a service coordinator if you ask for one. We may also assign one after we look at your child’s health and support needs. If you think you need a service coordinator or if you’d like to speak with one, call 1-866-696-0710, ext. 31084, Monday through Friday from 8 a.m. to 5 p.m. local time.

Transition services

When your child turns 15, a transition coordinator will begin working with him or her to create a transition plan. A transition plan describes the types of services your child will need, the doctors he or she will see, and other things, like health benefits, that will change when he or she turns 21.

Eligibility & Enrollment

You may be eligible for STAR Kids if you’re age 20 or younger, covered by Medicaid, and meet one of the following:

  • Get Supplemental Security Income (SSI)
  • Get SSI and Medicare
  • Receive services through the Medically Dependent Children Program (MDCP) waiver
  • Receive services through the Youth Empowerment Services (YES) waiver
  • Receive services through any of the following Department of Aging and Disability Services (DADS)
  • 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)
  • Live in a community-based Intermediate Care Facility for Individuals with an Intellectual Disability or Related Condition (ICF/IID) or nursing facility
  • Receive services through a Medicaid Buy-In (MBI) program

STAR Kids isn’t for people:

  • Age 21 and older
  • People in foster care who have traditional Medicaid or STAR Health
  • People age 20 and younger who live at the Truman W. Smith Children’s Care Center
  • Anyone living in a State Supported Living Center (SSLC)

If you qualify, you’ll get an enrollment packet in the mail from the state’s enrollment broker. You will have 30 days to choose a health plan. Choose Amerigroup by calling the STAR Kids Help Line at 1-877-782-6440 (TTY 711 or 1-800-735-2989) Monday through Friday 8 a.m. to 6 p.m. Central time.

Pharmacy: Your prescription drug benefits

STAR Kids members do not have pharmacy copays.

We work with Express Scripts to provide pharmacy benefits. If your child has both Medicare and Medicaid, contact your child’s Medicare Part D plan to learn more about pharmacy benefits.

To learn more about your child’s pharmacy benefits, refer to the member handbook.

Getting your prescription filled is easy!

You can go to any in-network pharmacy.
Find a pharmacy close to you.

  • Give the pharmacist your written prescription or have the doctor call in the prescription
  • Show your child’s Amerigroup ID card or your Texas Benefits Medicaid card
    • If your child has Medicare, show his or her Medicare Part D card to the pharmacist

    It’s a good idea to use the same pharmacy for all your child’s prescriptions because the pharmacist will know about problems that could occur when your child takes more than one medication. If you use another pharmacy, tell them about any other medicines your child takes.

    Drug Coverage Information

    Your child’s doctor chooses drugs from the State Vendor Drug Program (VDP) list of drugs. It includes all medicines covered by Medicaid.

    View the State Vendor Drug Program list

    Prior Authorization

    Your child’s doctor may need to get approval from us for certain drugs before prescriptions are filled. This is called prior authorization.

    To ask for an exception, email us at
    wrkgp-submitmyexceptionreq@anthem.com.

    When there is a generic drug available on the VDP list, it will be covered in place of the brand-name drug. Generic drugs are equal to brand-name drugs as approved by the Food and Drug Administration (FDA).

    Search for name brand and generic drugs
    that are on your formulary:

    Searchable Formulary

    Drug Interactions and Side Effects

    Learn more about drug interactions or side effects on the ESI Drug Information website.

    Express Scripts Prescription Drug Reimbursement Form

    Manage your prescriptions online: ESI Online Registration Instructions

Pharmacy: Frequently asked questions

What pharmacies are in the Amerigroup network?

There are many chain and local pharmacies for you to choose from in our network. You can find one by:

How do I transfer my prescriptions to a network pharmacy?

If you need to transfer prescriptions:

  • Call a network pharmacy and tell the pharmacist you want to transfer a prescription
  • Bring your prescription container to the new pharmacy and they will handle the rest
  • How does my provider request prior authorization?

    Your doctor can request prior authorization by:

    • Faxing a completed prior authorization form to 1-800-601-4829
    • Calling the Amerigroup Pharmacy department at 1-855-215-4496

    What if a copay is required and I am unable to pay it?

    STAR Kids members don’t have pharmacy copays.

    How do I get my child’s medicine if I’m traveling?

    We have network pharmacies in all 50 states. Call your child’s doctor for a new prescription to take with you on vacation.

    What happens if my child’s medicines are lost or stolen?

    If your child’s medicines are lost or stolen, call the doctor and ask him or her to call your pharmacy to authorize an early refill. The pharmacy may have to contact our Prior Authorization Desk for approval. We will review lost or stolen medicines on a case-by-case basis.

    What if I paid out of pocket for a medicine and want to be reimbursed?

    If you had to pay for a medicine, you may submit a request for reimbursement form. You’ll need to mail the completed Reimbursement Request Form along with any receipts to:

    Amerigroup
    Pharmacy Department
    PO Box 62509
    Virginia Beach, VA 23466-2509

Frequently Asked Questions – STAR Kids

Here’s where you can get answers to your most frequently asked questions.

What is STAR Kids?

STAR Kids is a new state program designed to meet the unique needs of youth and children with disabilities or complex health needs. The program will provide benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies. STAR Kids is a managed care program. That means you’ll pick the health plan that will provide access to the health services you need through a network of doctors, specialists, and other providers. Managed care makes things easier for your family by adding another member to your "team" to help find and coordinate your child's services and make things work better for you. This program will make it easier for your child's doctors and other providers to work together, so he or she gets the best care possible.

Through STAR Kids, families will also get help coordinating care. Each health plan will provide service coordination, which will help identify needs and connect members to services and qualified providers. STAR Kids Managed Care Organizations (MCOs) will assess each member's service needs and work with you, your child, and providers to create an individual service plan.

Why is the state changing its Medicaid program to STAR Kids?

STAR Kids is just one Medicaid program offered by the state. It is specifically for kids and young adults, age 20 and below, who have disabilities or complex health needs.

Do I have to enroll in STAR Kids?

Yes. You must enroll if your child:

  • Gets Supplemental Security Income (SSI)
  • Gets SSI and Medicare
  • Receives services through the Medically Dependent Children Program (MDCP)
  • Receives services through the Youth Empowerment Services (YES)
  • Receives services through any of the following Department of Aging and Disability Services
  • (DADS) Intellectual and Developmental Disabilities (IDD) waiver programs:
    • Community Living Assistance and Supports Services (CLASS)
    • Deaf Blind with Multiple Disabilities (DBMD)
    • Home and Community-based Services (HCS)
    • Texas Home Living (TxHmL)
  • Lives in a community-based Intermediate Care Facility for Individuals with an Intellectual Disability or Related Condition (ICF/IID) or nursing facility
  • Receives services through a Medicaid Buy-In (MBI) Program

You will receive your enrollment package at the beginning of August. It has information about all the MCOs in your service area that offer STAR Kids.

What is service coordination?

Service coordination gives your child access to a care team who will help make sure all his or her care and services are working together. A service coordinator will work with you and your child to develop your child’s service plan. The service plan is tailored to your child and includes all of the care and services he or she will receive. Your child’s service coordination team includes service coordinators, registered nurses, social workers, and other types of clinicians who can help identify services to meet your child’s health needs and goals.

What benefits will my child get from STAR Kids?

STAR Kids will provide benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies. With STAR Kids, your child will receive:

  • An individualized care plan — This will help your doctors and other providers know what kind of care you need. A service coordinator, who works for the STAR Kids health plan you choose, will work with you and all those involved in your child’s care to create this plan. The service coordinator will also help you find doctors, make appointments, and answer any questions you might have.
  • A primary care provider — This is a doctor, nurse, or clinic that provides basic medical services, like checkups, and can provide referrals to specialists when needed. (If you get Medicare, you won’t pick a primary care provider through your STAR Kids health plan.)
  • Medicaid acute care benefits — Doctor visits, hospital visits, therapies, specialists, medical equipment, medical supplies, and more.
  • Long-term services and supports — These include nursing and personal care services in your home.
    • - If you get services through the MDCP waiver, you will also get your MDCP long-term services and supports, such as respite or home modifications, through the health plan you pick.
    • - If you already get these services through any of the following below, the program providing the services may be different. Please refer to the LTSS Benefits Overview document in the Benefits Overview Accordion:
      • The Department of Aging and Disability Services, also called DADS
      • The IDD waiver
      • The YES waiver
      • You live in a nursing facility or intermediate care facility for people with an intellectual disability or related condition
  • Value-added benefits — Extra services and benefits offered by the STAR Kids health plan you pick. Refer to the Benefits Overview Accordion for details.

When does STAR Kids start?

STAR Kids will begin statewide November 1, 2016.

Will all the services my child receives under MDCP or other waivers be provided by STAR Kids?

Your child will continue to get the waiver and acute care services he or she gets now through STAR Kids.

If I don’t enroll in STAR Kids, will my child lose his or her benefits?

You’ll receive an enrollment packet at the beginning of August with information about all of the managed care organizations (called MCOs) in your service area that offer STAR Kids. If you don’t choose an MCO, the state will choose one for you. This is to ensure your child doesn’t lose benefits. Any child receiving SSI benefits will automatically be enrolled in the STAR Kids program, as well as children who are enrolled in an MDCP, YES, or IDD waiver program and those who may receive services through the STAR or STAR+PLUS programs.

After I choose a health plan, will I be locked in?

You won’t be locked into a plan. You can change health plans at any time, but it could take up to 45 days to take effect. If you want to change your plan, call toll-free 1-877-782-6440. If you are speech or hearing impaired, call 711 or 1-800-735-2989 toll free.

My child turns 18 this summer. Will he/she age out of the program?

Your child will not age out of STAR Kids at age 18. STAR Kids is for youth and children, age 20 and younger, who receive SSI Medicaid or are enrolled in the MDCP or YES waivers, or one of the IDD waiver programs, including HCS, CLASS, DBMD, and TxHmL, lives in an ICF/IID or nursing facility, or receives services through a Medicaid Buy-In (MBI) Program.

Will my child’s dental benefits change with STAR Kids?

There will be no change to dental benefits. You will continue to get dental care in the same way you do now even after your child is enrolled in STAR Kids.

How do I choose a health plan?

Your enrollment packet has information to help you pick a health plan. Things to look for when picking a STAR Kids health plan include:

  • Which health plan works with the doctors and other providers you use the most
  • Which health plan has the extra services you like the most

What happens if I don’t choose a plan by the deadline?

If you don’t choose a health plan by October 12, 2016, the state will pick one for you. But, it’s better that you pick your own health plan by the deadline.

What if I don’t like the plan that’s chosen for me?

If you’re not happy with the plan that’s chosen for you, you can change at any time, but it could take up to 45 days to take effect.

Can I hire and manage my child’s attendants with STAR Kids?

If you use Consumer Directed Services for Personal Care Services or Community First Choice, and aren't getting services through DBMD, CLASS, HCS, or TxHmL, the CDS will be available through the STAR Kids health plan you pick.

How do I get behavioral health services for my child?

Talk to your service coordinator about behavioral health services for your child. He or she will work with you to find the right providers and services for your child’s needs. Your child won’t need a referral to get these services. If you already have a behavioral health provider who is not participating with STAR Kids, you will need to choose a provider within the network. However, a Member Services representative can assist you with that. You can also use the provider look-up tool by going to the “Find a Doctor” page.

If your child has Medicare benefits, behavioral health services are provided through your Medicare plan.

How do I use the worksheet to choose my plan?

Your enrollment packet includes detailed instructions on how to use the worksheet to choose your health plan. However, if you need help, you can call toll-free number 1-877-782-6440 Monday through Friday from 8 a.m. to 6 p.m. Central time.

I like the doctor I have now. What if he or she isn’t in the STAR Kids network?

If your child’s current provider isn’t in the STAR Kids network, you will need to select a new one from your plan’s STAR Kids network. Your enrollment package includes a provider directory from each health plan. You can also find Amerigroup STAR Kids providers online by going to the “Find a Doctor” page.

If your child has Medicare benefits, you will keep the same providers that you have selected through your Medicare plan.

What if my child needs to see a specialist?

Your child’s primary care provider will help with basic medical care. However, if your child needs other medical services provided by a specialist, your PCP will give you a referral. Some plans may not require referrals for certain services. You should check with your health plan for information about the referral process.

My child receives Medicare. Do I need STAR Kids too?

If your child gets Medicaid and Medicare, enrolling in STAR Kids won’t mean any changes in your Medicare benefits. You will still use Medicare for basic medical services and medicines ordered by your doctor. You will use STAR Kids for your Medicaid long-term services and supports.

I have private health insurance. How will my child’s benefits be coordinated?

Your private insurance will become your primary insurance and Medicaid (STAR Kids) will become your secondary insurance. The service coordinator can help to coordinate your child’s benefits.

Where are the Amerigroup service areas for STAR Kids?

Amerigroup will serve STAR Kids members in the following service areas:

  • Dallas
  • El Paso
  • Harris (Houston)
  • Lubbock
  • Medicaid Rural Service Area West

How can I get more information on STAR Kids or speak with someone in person?

Call 1-877-782-6440 (toll-free) from 8 a.m. to 6 p.m. Central time, Monday through Friday. If you are speech or hearing impaired, call 711 or 1-800-735-2989 (toll-free). You can attend an enrollment event where you can get in-person help signing up for a health plan. Check Texas Medicaid Event to find out when enrollment events will be held in your area.

More information about STAR Kids, including upcoming information sessions, can also be found on the Texas Health and Human Services Commission STAR Kids webpage.

My child gets benefits through the AAPCA program. When will he/she move into STAR Kids?

Starting September 1, 2017, children and young adults in AAPCA will move into STAR Kids if they get Supplemental Security Income (SSI) or have a disability as determined by the U.S. Social Security Administration or the State of Texas.

My child is approved for certain services or to see certain doctors. Can he or she keep getting those services or seeing those doctors if he or she moves into STAR Kids?

Before September 1, 2017, the state will send us any approvals they’ve given your child. Your child’s doctor doesn’t need to ask us to re-approve services the state has already approved.

If you have approval for care from specialists, medical supplies, and other services, we’ll honor those for:

  • 90 days OR
  • Until the authorization expires OR
  • Until we give you a new approval

We’ll honor approvals for long-term services and supports for six months or until a new assessment is completed, whichever is earlier.

What is preapproval and when does my child need it?

Some treatment, care, or services may need our approval before your child’s doctor can provide them. This is called preapproval. Your child’s doctor will work directly with us to get the approval. The following require preapproval:

  • Most surgeries, including some outpatient surgeries
  • All elective and nonurgent inpatient services and admissions
  • Chiropractic services
  • Most behavioral health and substance abuse services (except routine outpatient and emergency services)
  • Certain prescriptions
  • Certain durable medical equipment, including prosthetics and orthotics
  • Certain gastroenterology procedures
  • Digital hearing aids
  • Home health services
  • Hospice services
  • Rehabilitation therapy (physical, occupational, respiratory, and speech therapies)
  • Sleep studies
  • Out-of-area or out-of-network care except in an emergency
  • Advanced imaging (things like MRAs, MRIs, CT scans, and CTA scans)
  • Certain pain management testing and procedures
  • Long-term services and supports

This list is subject to change without notice and isn’t a complete list of covered plan benefits. Learn more about your benefits by:

  • Reading your child’s member handbook
  • Calling Member Services with questions about specific services

Does my child need a referral or preapproval to see specialists?

Your child doesn’t need a referral or preapproval from his or her primary care provider to see any type of specialist in our plan, including:

  • Specialists he or she has never seen before
  • Specialists he or she has seen before
  • Specialists for emergency or urgent care

What if my child needs services from a provider not in the Amerigroup plan?

If your child is unable to get covered services from a provider in our plan, we’ll help you get them from a provider not in our plan. Call Member Services for help arranging these services.

How do I replace my Amerigroup ID card if it is lost or stolen?

If your ID card is lost or stolen, call us right away at 1-844-756-4600 (TTY 711). We’ll send you a new one. You may also print your ID card from our website. You’ll need to register and log in to the website to access your ID card information.

Amerigroup members in the Medicaid Rural Service Area and the STAR Kids program are served by Amerigroup Insurance Company; all other Amerigroup members in Texas are served by Amerigroup Texas, Inc.