Information Letter No. 16-26 Provision of Acute Care and State Plan Services for Individuals Under 21 Years of Age
Beginning November 1, 2016, most individuals under 21 years of age who receive:
• Supplemental Security Income (SSI),
• disability-related Medicaid, or
• services in the ICF/IID Program or an ICF/IID waiver program (i.e., HCS, TxHmL, CLASS or DBMD)
will receive their acute care and most other Medicaid State Plan services through the STAR Kids managed care program. Examples of services provided under STAR Kids include: physician visits, hospital visits, prescription medication and private duty nursing.
For individuals enrolled in an ICF/IID waiver program, Community First Choice (CFC) services will continue to be provided by the individual’s current program provider or CLASS direct service agency, as applicable.
STAR Kids enrollment does not apply to:
• residents of a State Supported Living Center (SSLC) or other state-operated ICF/IID;
• foster care children with SSI or disability-related Medicaid who are enrolled in the ICF/IID Program or an ICF/IID waiver program and who receive acute care and other Medicaid State Plan benefits through STAR Health; or
• individuals who turn 21 in November 2016, December 2016, or January 2017 (first 90 days of implementation) will remain in fee-for-service Medicaid and be enrolled in STAR+PLUS if eligible.
MAXIMUS, the state’s managed care enrollment broker, will mail introductory STAR Kids letters to individuals affected by this change in July 2016, followed by enrollment packets with instructions on how to pick and enroll in a STAR Kids health plan in August 2016.
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