Medicaid recipients who have renewals due during the pandemic will receive a notice from us on the next steps to take to maintain their Medicaid coverage after the pandemic ends. Please follow the instructions on the notice.
Medicaid CHIP COVID-19 Information Sessions
Beginning May 6, 2021, HHSC will post pre-recorded sessions monthly. These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic. HHSC may return to weekly sessions as needed if there are changes to the public health emergency.
Where to go for information on the novel coronavirus (COVID-19)
- Situation updates.
- Who is at higher risk.
- How the virus spreads, symptoms, prevention and treatment.
Any changes to Medicaid and CHIP services will be posted here.
Medicaid and CHIP Flexibilities
As noted in the sections below, many Medicaid and CHIP flexibilities have been extended through Oct. 31, 2021. HHSC is also extending some flexibilities related to teleservices through Dec. 31, 2021. HHSC will provide more information if there are changes.
People who are concerned that they might have COVID-19 should contact their healthcare provider via phone before going to a clinic or hospital to prevent spread in healthcare facilities. Call your healthcare provider for the following reasons:
- You feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19.
- If you live in or have recently traveled from an area with ongoing spread of COVID-19.
Testing & Vaccinations
Medicaid and CHIP will cover COVID-19 testing for Medicaid or CHIP clients. Your healthcare provider will work with local public health officials to determine if you should be tested for COVID-19.
No prior authorization will be required on the COVID-19 lab test by Medicaid and CHIP health plans or by traditional Medicaid.
Medicaid and CHIP clients age 12 and older are eligible to receive a COVID-19 vaccine. More information about vaccination is available on the Texas DSHS website.
Your health plan can cover teleservices, including in your home. HHSC has encouraged health plans to use this option when responding to COVID-19.
For people enrolled in the waiver programs, HHSC has also authorized certain services to be provided via telehealth, including some professional and specialized therapy and nursing services.
Many of the flexibilities related to teleservices have been extended through Dec. 31, 2021.
Medical office visit co-payments are waived for all CHIP members for services provided from March 13, 2020 through Oct. 31, 2021.
Co-payments are not required for covered services delivered via telemedicine or telehealth to CHIP members.
Extra Medicine or Supplies
Beginning Aug.1, 2021 pharmacies will no longer provide early refills.
In-Home Service Delivery
You or your legally authorized representative (LAR) should talk to your in-home care provider, service coordinator or case manager about what to do if your provider can’t come to work because they are sick. You or your LAR should:
- Work with your provider and your service coordinator or case manager to develop a backup plan if one is not in place.
- Update any existing backup plans.
- Keep a copy of the backup plan.
Provider agencies are required to have back-up and emergency plans in place, which include if an in-home care provider cannot work because they are sick. Your provider agency and MCO service coordinator must support you in developing those plans.
If you use the Consumer Directed Services (CDS) option, you or your LAR should work with your MCO and service coordinator or case manager to develop a backup plan if you don’t have one. Financial Management Services Agencies (FMSAs) can help you make CDS budget revisions as needed.
Temporary Change on Living in Same Home Prohibitions
HHSC temporarily lifted the prohibition on service providers of respite and CFC PAS/HAB from living in the same home as the person receiving Home and Community-based Services and Texas Home Living program services. More information about temporary changes to this policy are available in the bulletin issued on June 30, 2020. This guidance is effective through Oct. 31, 2021.
Managed Care: Face to Face Visits
Service coordination visits
Effective immediately service coordination visits may be completed in person when requested by the member receiving services. Telehealth should be the primary modality for service coordination visits if in-person is not feasible.
Beginning Sept. 1, 2021 health plans must offer service coordination visits in person when requested by the member receiving services.
Extended enrollment MDCP and STAR+PLUS HCBS
To ensure members do not experience a gap in services due to the temporary suspension of face to face service coordination visits for COVID-19, HHSC is extending enrollment for the Medically Dependent Children’s Program (MDCP) and STAR+PLUS Home and Community Based Services (HCBS) for members with an ISP expiring from April 2020 through December 2020 for 12 months from the original ISP end date.
The extension applies to the member’s Screening and Assessment Instrument (SAI), STAR+PLUS HCBS Medical Necessity Level of Care (MNLOC) and corresponding ISPs.
However, health plans may process a change in condition via telehealth if a member’s service needs change.
MDCP and STAR+PLUS HCBS reassessments
Health plans must complete level of care reassessments via telehealth at this time for members with ISPs expiring December 30 and moving forward.
Nursing facility MDS authorization extensions
HHSC extended nursing facility minimum data set (MDS) assessment authorizations by 90 days for those expiring from April 2020 to May 9, 2021. Effective May 10, 2021, MDS assessments will no longer be extended.
HHSC directed STAR, STAR Health, STAR Kids, and STAR+PLUS MCOs to allow FMSAs to suspend providing face-to-face orientations for CDS employers through Oct. 31, 2021. Employer orientations scheduled through the end of October 2021 will be virtual or by telephone. Face-to-face will be required after the suspension.
Upgrades for STAR+PLUS members who left a nursing facility without HCBS in place
HHSC is allowing STAR+PLUS health plans to use the existing process for requesting upgrades to STAR+PLUS Home and Community Based Services (HCBS) for members who exited a NF on or after March 18, 2020, due to concerns about COVID-19 or in accordance with local orders during the early stages of the public health emergency, without HCBS in place. Health plans are currently identifying and informing eligible members of the option to upgrade, and conducting the STAR+PLUS HCBS Program assessment for program eligibility.
STAR+PLUS and MMP members who were discharged from a NF on or after March 18, 2020, currently do not reside in a NF, and still have NF Medicaid should reach out to their health plan for more information about requesting an upgrade to STAR+PLUS HCBS.
IDD Waivers and Other Services: Face to Face Visits
Service coordination visits
Effective immediately health plans may allow service coordination visits to be completed in person when requested by the member receiving services for the following groups:
- Fee-for-service Medicaid 1915(c) waiver case managers and service coordinators for Community Living Assistance and Support Services (CLASS), Texas Home Living (TxHmL), Deaf-Blind with Multiple Disabilities (DBMD) and Home and Community-based Services (HCS)
- General Revenue service coordinators
- Community First Choice service coordinators
- Preadmission Screening and Resident Review (PASRR) habilitation coordinators
Telehealth should be the primary modality for service coordination visits if in-person is not feasible. Beginning Sept. 1, 2021 health plans must offer service coordination visits in person when requested by the member receiving services.
To ensure members do not experience a gap in services due to the temporary suspension of face to face service coordination visits for COVID-19, HHSC is extending Intellectual Disability/Related Condition (ID/RC) assessments and individual plans of care (IPC) through December 30, 2020. HHSC will not automatically renew IPCs and ID/RC assessments expiring on or after December 31, 2020. This guidance is for individuals who are enrolled in the following programs:
- Community Living Assistance and Support (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Home and Community-based Services Program (HCS)
- Texas Home Living (TxHmL)
FMSAs may suspend providing face-to-face orientations for CDS employers through Oct. 31, 2021. Employer orientations scheduled through the end of September 2021 will be virtual or by telephone. Face-to-face will be required after the suspension.
Appeals and Fair Hearings
In response to COVID-19, HHSC requires all health plans to extend the timeframes for the number of days members, legally authorized representatives or authorized representatives can request an appeal through Oct. 31, 2021:
- Normally 60 days to request an MCO internal appeal, now 90 days.
The timeframe to request continuation of benefits upon receipt of the adverse benefit determination was extended to 30 days through June 30, 2021. Effective July 1, 2021, health plans must enforce the normal, regular and established timeframes that members have to request for continuation of benefits, which is the later of 10 days from the date the MCO notice of adverse benefit determination is mailed or the date services will change.
HHSC also requires all health plans to accept oral requests for appeals without the member having to provide a written request through Oct. 31, 2021.
In response to COVID-19, HHSC is also extending the timeframes for the following through Oct. 31, 2021:
- Number of days members, legally authorized representatives or authorized representatives have to request a fair hearing.
- Normally 120 days to request a fair hearing after the internal MCO appeal, now 150 days.
If the timeframe for a member to request a fair hearing would have expired in Oct. 31, they will have an extra 30 days from that expiration date to request a fair hearing.
- Number of days HHSC has to make a fair hearing determination.
- Normally fair hearings determinations are made within 60 - 90 days of the date HHSC receives a request for a fair hearing, now 120 days.
If you have a prior authorization that is set to expire in December 2020 it will be extended for 90 days. Beginning on January 1, 2021 existing prior authorizations will no longer be extended.
This extension does not apply to current authorizations for one-time services, new requests for authorization or pharmacy prior authorizations. For example, a single non-emergency ambulance trip would not be extended, but a recurring non-emergency ambulance authorization for dialysis would be extended.
Texas Health Steps Comprehensive Care Program
Members who turn 21 on or after March 18, 2020 remain entitled to medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPDST) services, known in Texas as the Texas Health Steps Comprehensive Care Program.
To limit exposure to COVID-19, providers may adjust in-office medical and dental checkups. These changes may include:
- Temporarily postponing certain checkups.
- Limiting checkups to certain times of the day.
- Dedicating specific rooms for sick visits and well visits.
- Prioritizing visits for younger children, especially those due for routine vaccines.
Contact your provider to find out more information.
School Health and Related Services
School Health and Related Services (SHARS) are provided to students with a disability to ensure individuals benefit from special education programs.
During any temporary closure of schools for in-person classroom attendance, schools may continue to provide instruction using alternative methods of delivery such as telemedicine or telehealth.
If schools are unable to provide instruction using alternative methods of delivery, families can work with their primary care provider and health plan to access needed services during this time.
Past Information Sessions
For older handouts and recordings, email Medicaid CHIP.
- Reimbursement for COVID-19 testing and treatment of the uninsured
On April 22, 2020, the federal Health Resources and Services Administration (HRSA) launched a new COVID-19 uninsured program to support reimbursement to providers and facilities for testing and treatment of the uninsured.
The program includes testing and treatment provided on or after February 4, 2020 and began accepting claims May 6, 2020.
More information is available on the HRSA website.
- Texas 1135 Request (PDF)
- Texas 1135 CMS Approval Letter (PDF) [Note: Partially Approved]
- Texas 1115 Request (PDF)
- Medically Dependent Children Program (MDCP) Appendix K Submitted: Not CMS approved (PDF)
- Deaf Blind with Multiple Disabilities Program (DBMD) and Community Living Assistance and Support Services Program (CLASS) Appendix K Submitted: Not CMS approved (PDF)
- Youth Empowerment Services Waiver Program (YES) Appendix K Submitted: Not CMS approved (PDF)
- Home and Community-based Services Program (HCS) and Texas Home Living Program (TxHmL) Appendix K Submitted: Not CMS approved (PDF)