1000, Overview and Eligibility

Revision 20-2; Effective September 1, 2020

Senate Bill 7 from the 83rd Legislature, Regular Session, 2013 required the Texas Health and Human Services Commission (HHSC) to create the State of Texas Access Reform (STAR) Kids program. STAR Kids is a Medicaid managed care program for children with disabilities in Texas, which integrates acute care and long term services and supports (LTSS) delivered by a managed care organization (MCO).

STAR Kids does not change or impact an individual's Medicaid eligibility, nor does STAR Kids impact access to Medicaid services and supports. STAR Kids does change the way in which services are delivered. Children and young adults, ages birth through 20, enrolled in a STAR Kids MCO are called members of the MCO. All STAR Kids members have access to service coordination, provided by an MCO employee or through a member's primary care provider, authorized by the MCO.

Service coordination is specialized care management performed by a service coordinator and includes but is not limited to:

  • identification of needs, including physical health, behavioral health services, and LTSS development of an individual service plan (ISP) to address those identified needs;
  • assistance to ensure timely and a coordinated access to an array of providers and services;
  • attention to addressing unique needs of members; and
  • coordination of Medicaid benefits with non-Medicaid services and supports, as necessary and appropriate.

All STAR Kids members receive a comprehensive assessment of their physical and functional needs by a service coordinator using the STAR Kids Screening and Assessment Instrument (SK-SAI), annually. Within the time frame listed in the STAR Kids Contract, Section 8.1.39, STAR Kids Initial Screening and Assessment Process, if a member has a significant change in condition, the MCO must reassess the member and update their individual service plan (ISP), as applicable, and authorize necessary services. Upon request from the member, legally authorized representative (LAR), authorized representative (AR) or health home, the MCO must update their ISP, as applicable, and authorize necessary services.

In addition to traditional Medicaid services, STAR Kids MCOs are responsible for delivering additional services to children enrolled in the Medically Dependent Children Program (MDCP). MDCP provides respite, flexible family support services, adaptive aids, minor home modifications, employment services and transition assistance to children and young adults who meet the level of care provided in a nursing facility (NF) so they can safely live in the community. The state of Texas appropriates the program a limited number of slots, so HHSC maintains an interest list for MDCP. A child, young adult, LAR or AR may ask their MCO about how to be placed on the MDCP interest list at any time.