Medicaid is a joint federal-state program that provides medical coverage to low-income individuals who are eligible. The goal of Medicaid in Texas is to enhance the health of persons in Texas who would otherwise be unable to afford medical treatment for themselves and their children. There are 5 different types of Medicaid programs available in Texas: Traditional Medicaid, State of Texas Access Reform (STAR), STAR Kids, STAR Health, and STAR+PLUS. Read on to learn more about each type of Medicaid in Texas.
State of Texas Access Reform (STAR)
The STAR managed care program provides coverage to the majority of people in Texas who are eligible for Medicaid. STAR provides assistance to low-income families, pregnant women, and children.
Medicaid benefits available to members of the STAR program include:
- Medical treatment of pre-existing conditions and special health needs
- Regular checkups with the dentist and doctor
- Lab tests and X-rays
- Hospital services and care
- Vaccines and prescription medications
STAR+PLUS
STAR+PLUS is a Medicaid care program for adults 65 and above who have disabilities. Adults in STAR+PLUS are eligible for basic medical care and long-term services through a health plan of their choice. Those with complicated medical needs have the option of living and receiving care at home rather than in a nursing facility.
Long-term services include:
- Assistance with your day-to-day activities at home
- Help in implementing changes to your home to ensure you can navigate safely
- Short-term care that allows your caregiver to take a break
STAR Kids
STAR Kids is a Medicaid program for children as well as adults who are 20 or below and have disabilities. Individuals under this program can get basic healthcare and long-term services through the network of the health plan’s provider.
Benefits provided by the program include:
- Personal care
- Hospital care
- Reliable medical supplies and equipment
- Specialty care
STAR Health
When children are placed in foster care, they are frequently ineligible for traditional Medicaid coverage. This is when STAR Health enters the picture.
STAR Health provides Medicaid coverage for children through the Texas Department of Family and Protective Services. Services under STAR Health may include:
- Hospital care
- Dental services
- Specialty and primary physician care services
- Medical supplies and prescription drugs
- Medical checkups
Traditional Medicaid
Traditional Medicaid, also known as Fee-for-Service (FFS), is for individuals who are enrolled in managed care. Under this system, bills are sent to the Texas Health & Human Services Commission (HHSC) and paid directly by Texas to providers enrolled with Medicaid.
Medicaid pays for services such as clinic visits, vaccines and medicines, hospital care, emergency services, and more. For those with chronic health conditions or long-term disabilities, Medicaid also covers:
- Occupational therapy
- Home care and personal care
- Speech therapy
- Physical therapy
- Nursing home care
If you’re considering making the move into an assisted living community in Texas but aren’t quite sure if Medicaid can cover your expenses, our friendly care professionals can help. Schedule a consultation with us and let us help you assess your available financial options.
