Highlight on Texas: STAR Kids, the lone managed care program, aimed at serving disabled children

Texas will debut its STAR Kids program, the first Medicaid managed care program serving disabled children and youth, in Fall 2016. Children and youth aged 20 or younger will receive either all services or acute care services through the program, depending upon their enrollment in other Medicaid programs. STAR Kids aims to provide coordinated, cost-effective care, and may reduce out-of-home residential care.

Managed care organizations (MCOs) receive capitated rate payments per client, rather than per unit of service. STAR Kids, which was mandated by Senate Bill 7, 83rd Legislature, Regular Session, 2013, is unique in that it will be aimed specifically at children and youth with disabilities. Those who receive Supplemental Security Income (SSI) Medicaid or participate in the Medically Dependent Children Program (MDCP) will receive all services, including, but not limited to, prescription drugs, primary and specialty care, preventive care, hospital care, and private duty nursing, through STAR Kids. However, children in foster care who receive SSI will continue to receive services through STAR Health. Those who receive services through other home- and community-based waiver programs through section 1915(c) of the Social Security Act will receive basic acute care services through STAR Kids and continue to receive long-term services and supports (LTSS) through existing intellectual and developmental disability (IDD) waiver programs. Separate dental MCOs will cover dental services.

Health plans will conduct a standard screening and assessment process for all participants to determine needs related to both health and independent living. Assessments should take family and individual preferences into consideration, along with the need for personal care and private duty nursing services. Children, youth, and their families will be able to choose between at least two plans and will retain the option to change plans. In addition to other requirements, all plans should include a medical health home, also known as a primary care medical home; coordinate with LTSS providers outside the plan; and provide a plan for youth to transition from STAR Kids to STAR+PLUS when they turn 21. To date, 10 MCOs will participate in STAR Kids.

The Texas Health and Human Services Commission (HHSC) is accepting feedback from stakeholders at STARkids@hhsc.state.tx.us. The HHSC is also gathering input through meetings of the STAR Kids Medicaid Managed Care Advisory Committee and the Children’s Policy Council.