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2012 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 3. STAR Program : 3.1 STAR Program Clients

3.1 STAR Program Clients
HHSC has targeted these client groups within the Texas Medicaid population for STAR Program enrollment:
Medicaid Base Plan
Medicaid Type Prog.
SSI Manually Certified-with Medicare living in a Title XIX facility (also Medicare skilled nursing care)
SSI Manually Certified without Medicare living in a Title XIX facility (also Medicare skilled nursing care)
SSI Recipient-with Medicare living in a Title XIX facility (also Medicare skilled nursing care)
SSI Recipient without Medicare living in a Title XIX facility (also Medicare skilled nursing care)
MAO and deemed SSI with Medicare in a Title XIX facility
MAO and deemed SSI without Medicare in a Title XIX facilty
SSI Manually Certified -without Medicare
MAO and SSI Clients in 1915 (c) waiver programs-with Medicare
MAO and SSI Clients in 1915(c) waiver programs - without Medicare
Disabled Adult / Children denied SSI due to increase in SS benefits-with Medicare
Disabled Adult/Children denued SSI due to increase in SS benefits - without Medicare
Early Age Widows/Widowers-with Medicare
SSI Manually Certified-no Medicare 21 and Over
SSI Manually Certified-Medicare Under 21
SSI Manually Certified-Medicare 21 and Over
MAO and SSI Clients in 1915 (c) waiver programs-no Medicare
MAO and SSI Clients in 1915 (c) waiver programs-Medicare
Disabled Adult / Children denied SSI due to increase in SS benefits-No Medicare
Disabled Adult / Children denied SSI due to increase in SS benefits-Medicare
Early Age Widows/Widowers-No Medicare
Early Age Widows/Widowers-Medicare
Medical Assistance Only (MAO) Foster Care
04 months post Medicaid resulting from Child Support
12 months transitional Medicaid following end of state time limited TANF
12 months transitional Medicaid coverage resulting from loss of 90% earned income disregard
Children under age 1 with income below 185% FPIL
Children age 6-19 with income below 100%FPIL
Children to age 1 born to Medicaid eligible mother
Children ineligible for TANF, TANF-SP, or the age-appropriate medical program due to stepparent or grandparents' applied income, or stepparent's income when included in the case
Children aged 1-5 with income below 133% FPIL
TANF State Program (TANF-SP)--two parent household eligible for money grant and Medicaid with income below TANF recognized needs
Money Grant and Medicaid for caretakers and deprived children with income below TANF recognizable needs
12 months transitional Medicaid resulting from increase in earnings or combined increase in earnings and child support
Medicaid Buy-in for Children with Disabilities No Medicare
Medicaid Buy-in for Children with Disabilities with Medicare
Health-care providers must 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 MCO and PCP should be determined as soon as possible.
The client's Your Texas Benefits Medicaid card will provide the client's managed care enrollment and health plan. Additionally, STAR MCOs provide their clients an MCO identification card. Both forms of identification should be required when determining whether or not the client is a STAR Program client.
Refer to:
Subsection 4.2, “Eligibility Verification” in Section 4, “Client Eligibility” (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.