STAR Kids is a Texas Medicaid managed care program that provides Medicaid benefits to children and adults 20 and younger who have disabilities. Participation in the STAR Kids program is required for those who are 20 or younger, covered by Medicaid, and meet at least one of the following:
- Get Supplemental Security Income (SSI).
- Get Medicaid and Medicare.
- Live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility.
- Get services through the Medically Dependent Children Program (MDCP) waiver.
- Get services through the Youth Empowerment Services (YES) waiver.
- Get services through any of the following intellectual and developmental disability (IDD) waiver programs:
- Community Living Assistance and Support Services (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Home and Community-based Services (HCS)
- Texas Home Living (TxHmL)
Managed care means you will pick a health plan that will provide the health services you need through a network of doctors, specialists and other providers. Those enrolling in the STAR Kids program will choose a health plan and a primary care physician or clinic who will provide basic medical services like check-ups and referrals to a specialist when needed. Those with Medicare will not pick a primary care physician or clinic.
View a YouTube video about STAR Kids.
Consumer Directed Services (CDS) Option
The CDS option allows a person to hire the caregiver of their choice and manage the employee themselves.
Sample draft mandatory introduction packets for those covered by Medicaid who must enroll in STAR Kids:
- MDCP (PDF)
- Other waivers (PDF)
- Non waivers (PDF)
Basic Medical Benefits and Coordination of Care
STAR Kids is designed to meet the unique needs of youth and children with disabilities. The program provides 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. Children and young adults enrolled in MDCP receive their MDCP services through STAR Kids.
The following people receive their acute care services and some of their long-term services and supports (LTSS), like private duty nursing, through STAR Kids. They also receive most of their LTSS through the programs listed below.
Members who either:
- Have intellectual and developmental disabilities (IDD) and live in a community-based intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID); or
- Receive services through one of these programs:
- Community Living Assistance and Support Services (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Home and Community-based Services (HCS)
- Texas Home Living (TxHmL)
- Community ICF/IIDs
If a person receives Medicare, they should use Medicare for basic health services and medicine.
Through STAR Kids, families receive help with coordinating care. Each health plan provides service coordination, which helps identify needs and connect members to services and qualified providers. STAR Kids health plans assess each member's service needs, which is used to help the family, MCO and member create a yearly individual service plan.
A core component of the STAR Kids program is the standard screening and assessment process a health plan uses to determine each child's needs as they relate to health and independent living. You can see a copy of this assessment here: STAR Kids Screening and Assessment Instrument (SK-SAI) (PDF).
Managed Care Organizations
Each managed care service delivery area in the state has at least two health plans, or managed care organizations (MCOs), that provide services through the STAR Kids program.
- Map of service areas for STAR, STAR Kids and STAR+PLUS (PDF) - This map shows which health plans offer services in each region of the state.
Client Resources
- Enrollment and Re-Enrollment Process for MDCP (PDF)
- Frequently Asked Questions for MDCP Medical Necessity Determination (PDF)
- MDCP program description (PDF)
- STAR Kids Health Plan Profiles (PDF)
- STAR Kids family resources (PDF)
- STAR Kids Frequently Asked Questions for Families (PDF)
- Client Training – New Managed Care Program: STAR Kids Family Information Session (PDF)
- Coordinating Services for Children in IDD Waiver Programs and STAR Kids or STAR Health (PDF)
- What is the MDCP/DBMD Escalation Helpline (PDF)?
Provider and MCO Resources
- STAR Kids Frequently Asked Questions for Providers (PDF)
- Provider tips (PDF)
- Provider training – STAR Kids provider information session (PDF)
- STAR Kids billing matrix and crosswalk (Excel)
- Service Coordination for STAR Kids Members in 1915(c) Waivers Other Than MDCP (PDF)
Stakeholder Feedback
HHSC welcomes input about the STAR Kids program from members, family members, advocates and Medicaid providers. Provide feedback at the STAR Kids Managed Care Advisory Committee and HHSC’s Policy Council for Children and Families meetings, or emailing questions and comments to Managed Care Initiatives.
Contact Us
- For questions about the STAR Kids program, email Managed Care Initiatives.
- For questions about the CHIC Kids Pilot, email HHSC CHIC Kids.
- For provider complaints or issues, email the Ombudsman’s Office.
- For health plan (MCO) complaints or issues, email HPM Complaints.
- For the MDCP/DBMB Escalation Helpline, call 1-844-999-9543.
