TMPPM 2007 >7.2.2 Client Eligibility

HHSC has targeted these client groups within the Texas Medicaid population for STAR Program enrollment:


Base Plan	Category	Type Program	Description	Bexar, Harris, Harris Expansion, Nueces, and Travis SAs	Dallas, El Paso, Lubbock, and Tarrant SAs
	02	1	Money grant and Medicaid	M	M
	02	3	MAO RSDI increase	M	M
	02	7	12 months transitional Medicaid resulting from increase in earnings	M	M
	02	20	4 months transitional Medicaid resulting from receipt of child support	M	M
	02	29	12 through 18 months transitional Medicaid following end of state time-limited TANF	M	M
	02	37	12 months transitional Medicaid resulting from loss of 90 percent earned income disregard	M	M
	02	40	Pregnant women with income <185 percent Federal Poverty Limit (FPL)	M	M
	02	43	Children < 1 year of age at 185 percent FPL	M	M
	02	44	Children 6 through 19 years of age at 100 percent FPL	M	M
	02	45	Newborn of Medicaid eligible mother to 1 year of age	M	M
	02	47	Children ineligible for TANF due to applied income of stepparent or grandparent	M	M
	02	48	Children 1 though 5 years of age at 133 percent FPL	M	M
	02	61	TANF state plan, money grant and Medicaid	M	M
13	03 or 04	3	MAO RSDI increase, no Medicare	X	V
13	03 or 04	12	SSI manually certified adults, no Medicare	X	V
13	03 or 04	12	SSI manually certified children <21 years of age, no Medicare	X	V
13	03 or 04	13	SSI recipient, adults, no Medicare	X	V
13	03 or 04	13	SSI recipient, children <21, no Medicare	X	V
13	03 or 04	18	Disabled Adult Children denied SSI due to increase in RSDI benefits, no Medicare	X	V
13	03 or 04	19	Transitional SSI Medicaid, no Medicare	X	V
13	03 or 04	22	Early Age Widows/Widowers, no Medicare	X	V
V=Voluntary, M= Mandatory, X= Not Eligible

To ensure reimbursement, it is essential that all health-care providers verify eligibility before medical care is provided to STAR Program clients, except in cases of emergency. In situations where emergency care must be provided, the client's STAR health plan and primary care provider should be determined as soon as possible.

STAR Program clients' Medicaid Identification Forms (Form H3087) will indicate their participation in the STAR Program. Additionally, STAR health plans provide their clients an HMO identification card. Both forms of identification should be requested when determining whether or not the client is a STAR Program client.