If you get Medicaid or CHIP, you might be able to get extra help with your services through your health plan or your providers.
STAR Kids and STAR+PLUS Members
All STAR Kids members get connected with a service coordinator through their health plan. STAR+PLUS members with complex medical conditions also get a service coordinator through their health plan.
Service coordination can help ensure you get the services you need. Service coordinators are provided by your health plan to help manage your health care and long-term care needs, which can include access to community resources and help with food and housing. They work with you, your primary care provider, and your specialty and non-medical providers to develop and carry out an Individualized Service Plan.
STAR and CHIP Members
STAR and CHIP members with special health care needs can get help from their health plans through service coordination. Special health care needs include serious, ongoing illnesses, chronic or complex conditions, disabilities, and conditions that require therapeutic intervention and evaluation by appropriately trained staff.
If you are a member with special health care needs, a service coordinator can help ensure you get the health care services you need from your health plan. They can also help you get services that might not be covered by your health plan like help with food and housing. For STAR members, this might include programs like Community First Choice or personal care services.
STAR Health Members
STAR Health provides health care and long-term care services to children and young adults in foster care with the Texas Department of Family and Protective Services. STAR Health members with a specific medical and behavioral need get service coordination or service management.
In STAR Health, service coordination helps caregivers manage information like medical records for court hearings or get services from other programs.
Service management is for members with complex medical or behavioral needs. A STAR Health service manager works with the member, member's caregivers, primary care provider, and specialty care providers to create and carry out a service plan. Service managers ensure access to and use of medically needed, covered services.
These services are also available by request. If you don't already get either of these services, you can ask for them.
Case Management Services
You might also receive case management services through certain programs separate from your health plan. Examples of these programs are Early Childhood Intervention, Case Management for Children and Pregnant Women, and the Medicaid waiver programs.
These services are not the same as service coordination or service management provided by your health plan.
If you are enrolled in other programs outside your health plan and have a service coordinator or service manager, they will work with any other case managers you have. Your service plan will list which services will be provided through your health plan and which will be provided by your other programs.
Contact your service coordinator, service manager, or any case managers you have any time you have questions about your services from your health plan or other programs. You should also contact them when:
- A service needs to be added to your service plan.
- The amount of a service you get needs to be adjusted.
- There's a change in your health status.
If you have questions about getting service coordination or service management through your health plan, call the help line phone number listed on the back of your health plan ID card.
If you still need help, call the Office of the HHS Ombudsman at 866-566-8989.