Plans For All: A Guide To Finding Health Coverage For Every Age & Ability
Understanding health insurance, including the different plans and who qualifies for each, shouldn't feel overwhelming. Community First Health Plans has created a simple breakdown of some of the no-cost and low-cost health plans offered by the state of Texas to help you learn more about each plan, who may be eligible, and how to apply.
1. LEARN ABOUT HEALTH CARE PROGRAMS
Learn about different health plans offered through the Texas Health and Human Services Commission (HHSC).
· STAR is a Medicaid program for children, newborns, pregnant women, and some families. STAR Medicaid costs nothing.
· STAR Kids is a Medicaid program for children and adults up to age 20 with a disability. STAR Kids costs nothing.
· CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but still cannot afford private insurance. CHIP fees and copays vary and depend on the family's income.
· CHIP Perinatal provides care to pregnant women who are not eligible for Medicaid and do not have any other health coverage. CHIP Perinatal costs nothing.
Now, let’s take a closer look at STAR Kids:
STAR Kids is designed to meet the unique needs of people with disabilities. The program provides benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies.
Through STAR Kids, families receive help with coordinating care. Each health plan provides service coordination, which helps identify specific needs and connect Members to services and qualified providers. STAR Kids assesses each Member’s service needs.
A main part of the STAR Kids program is the STAR Kids Screening and Assessment Instrument (SK-SAI). Health plans use the SK-SAI to determine each child's needs as they relate to health and independent living. You can see a copy of the SK-SAI here.
2. DETERMINE WHO QUALIFIES
The following individuals may qualify for Medicaid (STAR/STAR Kids) or CHIP:
• A child age 18 or younger*
• A pregnant woman of any age
• A Texas resident
• A U.S. citizen or legal permanent resident**
You'll also need to meet family income guidelines set by HHSC. You can review the current income guidelines here.
3. APPLY FOR COVERAGE
If you qualify, the quickest and easiest way to apply is online at YourTexasBenefits.com. When filling out your application, you'll need documents like pay stubs, your driver's license, your child's birth certificate or passport, and proof of residency. If you cannot or do not want to apply online, you can call 2-1-1 and select option 2.
4. CHOOSE A HEALTH PLAN
After you’re approved, you will receive a packet from HHSC confirming your approval. You can also check your application status at YourTexasBenefits.com.
To complete your enrollment, you must choose a health plan to deliver your health benefits. The health plan you choose makes all the difference.
As the only local health plan in our area, Community First Health Plans is here to help you on your health care journey. Community First offers Value-Added Services (extra benefits) and excellent customer service to support you and your family’s well-being.
Here are a few of the Value-Added Services we offer our STAR Kids Members.*** Click here for a complete list.
• Up to $100 in specialized therapy or camp allowance
• Up to 8 hours of in-home respite care services for non-waiver STAR Kids Members
• $10 gift card for completion of Adolescent Well Child exam (ages 12-21)
• Up to $25 in gift cards for completing Health Assessment and receiving Adolescent Immunizations (ages 9-13)
• Toddler booster seat for children who are up to date with their Texas Health Steps checkup (ages 4-10)
• $10 gift card for new Members who complete the General Health Assessment
• Extra vision benefits, including $125 for frames or $75 for contact lenses
• Smartphone with two plan options
We understand you might still have some questions. This Step-by-Step Guide goes into more detail about each step listed above.
If you’d like more information about STAR Kids or any of the health plans we offer, please call our Member Services Department at (210) 227-2347. If you need assistance with your application, you can visit our bilingual team at our Avenida Guadalupe Community Office located at1410 Guadalupe St. Ste. 222, San Antonio, TX 78207. You may also make an appointment by filling out this form.
*Children up to age 20 may qualify for Medicaid in some cases.
**Only the child must be a U.S. citizen or legal permanent resident. The citizenship or immigration status of the parent will not be asked.
***Effective 9/1/2022. Limits and restrictions may apply.