STAR Kids Medical Benefits

Ambulance Services

No

• Only covered when ambulance is used for emergency transport.
• A licensed ambulance company

Community First Choice (CFC) Services

Yes

The state provides an array of services to STAR Kids members who would otherwise qualify for care in:

• A nursing facility,
• An Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities (ICF/IDD), or
• An Institution for Mental Diseases (IMD).

Members with special needs may be able to get help to live at home or in a community setting. This can allow them to be more independent. All qualified members may get the services below under CFC.

• Personal Care Services. These can assist members with:
  • Activities of Daily Living (ADLs). These include basic self-care tasks such as eating, bathing, dressing, and getting in/out of bed;
  • Instrumental Activities of Daily Living (IADLs). These are more complex self-care tasks. IADLs include paying bills, taking medicines, driving, shopping, cooking or cleaning; and
• Emergency Response Services. This is emergency call button service.
• Support Management. Members can be trained on how to select, manage and dismiss attendants.

Diagnostic and Therapeutic Radiology

Some radiology services need an “okay” from us before you get the service. These include CT, MRI, MRA, PET and SPECT.

• Testing and X-rays that are:
  • not invasive
  • done to find out what is wrong
  • ordered and done by (or under the guidance of) your provider

Doctor Services

No

• Visits to in-network primary care providers (PCPs), specialists or other health care providers
• Well exams

Durable Medical Equipment (DME) and Disposable Supplies

Yes

• Medical equipment that is used in the home
• Must be within the limits of what is covered by Medicaid

Emergency Services

No

• Treatment in an emergency room (ER)
• Ambulance services

Family Planning Services

No

• Medical visits for birth control
• Marriage and family planning, education and counseling services
• Birth control medicines, including long-acting reproductive contraception (LARC)

Home Health Care

Yes

• Nursing services
• Personal care services
• Home health aid services
• Speech therapy
• Physical therapy visits
• Occupational therapy visits
• DME
• Medical supplies that are thrown away after use

Hospital Services (inpatient)

Yes

• Hospital room with two or more beds
• Nursing care
• Operating room
• Surgery
• Anesthesia

Hospital Services (outpatient)

Yes

• Dialysis
• Giving you someone else’s blood

Lab Services

Yes

• All authorized lab services such as blood and urine testing

Medically Dependent Children Program (MDCP) STAR Kids

BCBSTX must provide needed services to members who qualify for MDCP STAR Kids. These can include:

• Respite Care;
• Supported Employment;
• Financial Management Services;
• Adaptive Aids;
• Employment Assistance;
• Flexible Family Support Services;
• Minor home modifications; and
• Transition Assistance Services.

Pregnancy and Maternity Care

No

• Pregnancy care
• After-delivery care when medically necessary
• Newborn exams

Texas Health Steps Medical Checkups

No

• Routine shots
• Lab tests
• Comprehensive Care Program services for members 20 years and under

Urgent Care

No

• Treatment at an in-network urgent care clinic for an illness or injury that is not an emergency, but should be treated within 24 hours