As our member, your child gets all the regular STAR Kids benefits, plus:
- Real Solutions® Healthy Rewards debit card dollars for doing things that are good for his or her health, like getting certain checkups
- Healthy Families weight management program for members ages 7-13 who qualify
- Mobile app and online health coaching, including personalized nutrition and weight loss plans, plus help managing ongoing conditions
- Respite care so family and caregivers can take a break
- Pest control services (once every three months) for members living at home
- Rides to medical appointments for members and caregivers when other supports are unavailable
- Travel training and coaching to help your child learn to use public transportation (when appropriate)
- Emotional support and advice from counselors via text message — anytime, day or night for ages 13-20
- Up to $50 a year to participate in Boys & Girls Clubs, Boy Scouts, Girls Scouts, and other similar organizations
- Up to $50 a year for nonslip and dexterity products for safety in the home
- Free SafeLink®* cellphone with up to 350 minutes per month and more
- Inhaler sensor for members with asthma — helps prevent problems by tracking use
- And more
*SafeLink Wireless® is a Lifeline-supported service. Lifeline is a government benefit program. Only those who qualify may enroll in Lifeline. It can’t be transferred. It is limited to one per household. You may need to show proof of income or that you take part in the program to enroll.
To learn more about your long-term services and supports (LTSS) benefits, click the appropriate link below. These charts tell you which services you can get and who will provide them. You can also refer to the member handbook.
LTSS Benefits Dual & Non-Dual Members
Are you a farmworker?
Your kids may be able to get services through STAR Kids.
Learn more here.
STAR Kids Medicaid benefits are provided at no cost to you
You don’t have to pay anything — no premiums, enrollment fees, deductibles, copays, or cost-sharing — for your benefits.
If you have both Medicare and Medicaid, call your Medicare plan or refer to the information they sent you to learn about Medicare costs.
Referrals and prior authorization
Sometimes, your primary care provider will need you to see a specialist or another provider for care or services. This is called a referral. If you need a referral to see a specialist, your primary care provider will send you to one in our network. You can get OB/GYN, family planning, and behavioral health services without a referral from your doctor. This is called self-referral. To get these services, make an appointment with a doctor in our network. You can find a list of doctors using the Find a Doctor search tool.
Your doctor may also need us to approve certain services before you get them. This is called prior authorization.
To learn more about referrals and prior authorizations, read the information in the documents below and the member handbook. If you have Medicare, your primary and specialist care is through your Medicare plan. Refer to your Medicare plan information to learn about referrals and prior authorization.
Need services from an out-of-network provider?
If you aren’t able to get covered services from a provider in our network, we’ll help you get them from an out-of-network provider. Call Member Services for help arranging these services.
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.
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.
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.
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
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:
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
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
- 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
- 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
- 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
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
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
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
- 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
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
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:
- El Paso
- Harris (Houston)
- 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.