Medicaid 101 - What is Medicaid?
Medicaid provides free or low cost healthcare coverage to low-income families, children, seniors and people with disabilities.
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What is Medicaid?
Medicaid is a state and federal funded program, aimed at delivering healthcare coverage to qualifying individuals in need. In Texas, Medicaid program is governed by Texas Health and Human Services with the purpose of enhancing the well-being of residents who could otherwise lack access to healthcare. The mission of the program is to improve the health of Texans by:
Emphasizing prevention.
Promoting continuity of care.
Providing a medical home for Medicaid recipients.
Ensuring that each recipient can receive high quality, comprehensive health care services within the recipient's community.
Who can get Medicaid in Texas
To be eligible for Texas Medicaid, you must be a resident of the state of Texas, a U.S. national, citizen, permanent resident, or legal alien whose financial situation would be characterized as low income or very low income. You must also be one of the following:
Pregnant, or
Be responsible for a child 18 years of age or younger, or
Blind, or
Have a disability or a family member in your household with a disability.
Be 65 years of age or older.
How do I apply for Medicaid Program?
You can check eligibility and apply for Medicaid through the Health Insurance Marketplace or directly with a health plan that offers one of the Medicaid programs listed below.
Texas Medicaid Programs
STAR - Most people who have Medicaid in Texas get their coverage through the STAR managed care program. STAR covers low-income children, pregnant women and families. STAR members get their services through health plans they choose. Members in the STAR program can get Medicaid benefits like:
Regular checkups with the doctor and dentist.
Prescription drugs and vaccines.
Hospital care and services.
X-rays and lab tests.
Vision and hearing care.
Access to medical specialists and mental health care.
Treatment of special health needs and pre-existing conditions.
CHIP - covers children in families that earn too much money to qualify for Medicaid but cannot afford to buy private insurance. If you’re new to CHIP, you’ll choose a health plan for your child from the ones available in your area. Members in the CHIP program can get benefits like:
Regular checkups with the doctor and dentist.
Prescription drugs and vaccines.
Hospital care and services.
X-rays and lab tests.
Vision and hearing care.
Access to medical specialists and mental health care.
Treatment of special health needs and pre-existing conditions.
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)
STAR Health - In partnership with Texas Department of Family and Protective Services (DFPS), Medicaid provides a managed care program, STAR Health, for the following groups:
Children in DFPS conservatorship (under 18).
Children in the Adoption Assistance or Permanency Care Assistance program who are transitioning from STAR Health to STAR or STAR Kids.
Youth age 21 years and younger with voluntary extended foster care placement agreements (Extended Foster Care).
Youth age 20 and younger who are Former Foster Care Children (FFCC).
Members in the STAR Health program can get benefits like:
Regular checkups at the doctor and dentist.
Prescription drugs and vaccines.
Hospital care and services.
X-rays and lab tests.
Vision and hearing care.
Access to medical specialists and mental health care.
Treatment of special health needs and pre-existing conditions.
A 24/7 nurse hotline for caregivers and caseworkers.
Access to the Health Passport, a comprehensive, patient-centered and internet based electronic health record.
STAR+PLUS - STAR+PLUS is a Texas Medicaid managed care program for adults who have disabilities or are age 65 or older. Adults in STAR+PLUS get Medicaid health-care and long-term services and supports through a health plan that they choose. Adults with complex medical needs can choose to live and receive care in a home setting instead of a nursing facility.
Credits:
https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members