Long-Term Services and Supports for STAR Kids

As a part of the Blue Cross and Shield of Texas STAR Kids Plan, we cover Long-Term Services and Supports (LTSS). LTSS are for members with special needs. This includes chronic physical and mental illness and disabilities. LTSS helps when you need ongoing support to care for them. Also, LTSS can help your child live in at home or in a community setting.

LTSS are managed by the BCBSTX Service Coordination team. They will assist you in getting care. They can help you choose providers that your child needs. If you would like to go to a Medicaid doctor who is not part of our network, you will need to get approval. Work with your service coordinator to do this. They will help you figure out care needs, create a care plan and more. Learn about Service Coordination.

What is Covered?

Here is a list of services for which your child may qualify.

• Personal Care Services (PCS)
• Respite Care (in-home or out-of-home)
• Flexible Family Supports
• Adaptive Aids
• Minor Home Modifications
• Transition Assistance Services (TAS)
• Financial Management Services (CDS only)
• Employment Assistance
• Supported Employment
• Community First Choice – Attendant care, habilitation, emergency response services (ERS), support management
• Private duty nursing (PDN)
• Home health skilled nursing
• Home health aide services
• Physical therapy (PT)
• Occupational therapy (OT)
• Speech therapy (ST)
• Mental health rehabilitation
• Mental health targeted case management
• Medical supplies
• Durable medical equipment (DME)

Not everyone will qualify for the above services. For those who qualify, it means the care is medically necessary. You will work with your service coordinator to:

• Complete a health assessment. This will help you know what care is needed.
• Create a care plan.
• Get services set up.
• Monitor progress toward health care goals.

Check your Member Handbook to learn more about LTSS.

Medicaid Wrap-around Services

BCBSTX covers wrap-around services for STAR Kids dual eligible members. These are members who are on Medicaid, but who also qualify for Medicare.

These services include:

• Outpatient drugs and products.
• LTSS.
• Other services that are covered by Medicaid but are not covered by Medicare.

Medicaid will cover these services when:

• The member’s cost for care has gone above the amount covered by the Medicare; or
• The services needed by the member are not covered by Medicare.

Your provider will not be required to submit a Medicare denial or explanation of benefits with:

• A prior authorization request; or
• With a claim for a Medicaid Wrap-Around Service that is a covered service but not covered by Medicare.

Do you have questions about these services? Call Service Coordination at 1-877-301-4394. Or you can call the Customer Advocate Department at 1-877-688-1811 (TTY: 711).

Waivers

Some STAR Kids members qualify for more services through waivers. Waiver programs are handled by different state agencies. These programs help members with special needs. Those who qualify can get waivers for certain types of health care. This allows members to get care that helps them stay at home. Or it can allow members to live in a community setting.

BCBSTX service coordinators will assist in setting up care for members with waivers. These waivers include:

• Medically Dependent Children's Program (MDCP) Waiver. To learn more, check the MDCP brochure.
• Youth Empowerment Services (YES) Waiver
• Community Living Assistance and Support Services (CLASS) Waiver
• Deaf Blind with Multiple Disabilities (DBMD) Waiver
• Texas Home Living (TxHmL) Waiver
• Home and Community-based Services (HCS) Waiver

Some of the waiver services are delivered through the Department of State Health Services or the Department of Aging and Disability Services. The MDCP Waiver will be delivered through the STAR Kids plan. 

Need find out more about LTSS and waivers? Refer to your Member Handbook.

Do you need help to access these services? Call your BCBSTX service coordinator at 1-877-301-4394.