Provider Alert! Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19tcph
Attention: All Providers
Effective Date: July 31, 2020 – January 21, 2021
The content in this message will remain in effect through the public health emergency period, extended to January 21, 2021, as announced by the U.S. Health and Human Services Department. TCHP COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Health and Human Services Commission (HHSC) is taking action to maintain Medicaid eligibility including STAR KIDS types of assistance (TOA) during the duration of the emergency period regardless of eligibility rules, such as age or income limits. This action is in response to H.R. 6201, Families First Coronavirus Response Act. TOA details are available here. Children’s Health Insurance Program (CHIP) and CHIP Perinatal coverage for newborns has been extended in response to COVID-19. HHSC will communicate the processes that will be followed to resume eligibility renewal activities at the close of the emergency period.
How this impacts providers: Providers should follow the Medicaid and CHIP eligibility communication and continue care while HHSC is updating our members continuing coverage.
Medicaid STAR and STAR Kids program eligibility:
HHSC is maintaining Medicaid eligibility for members with eligibility initially scheduled to end by re-opening the end date of the existing eligibility segment and extending the TOA according to the federal requirements. HHSC has instructed MCOs not to override member’s eligibility end dates or the TOA. Instead, HHSC will provide TCHP with updated eligibility records, as needed, in the daily and monthly eligibility files and we will update our systems accordingly.
STAR Kids members who are scheduled to age out of the program:
On April 1, 2020, members who aged-out of STAR Kids in March 2020 transitioned to STAR+PLUS. These members transitioned to a STAR PLUS Plan according to the procedures and guidelines in the HHSC STAR Kids Handbook and receive the same attendant care and nursing services at the same amount, duration and scope as permitted in the member’s current individual service plan (ISP). The individual continues to be eligible for all services available as if they were still covered under Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Comprehensive Care Program.
To comply with House Resolution (H.R.) 6201, STAR PLUS MCOs are required to ensure that these members may receive services as permitted in STAR Kids for the duration of the public health emergency.
TCHP will outreach to Medically Dependent Children Program (MDCP) members and inform them they will continue to receive MDCP and state plan services as they had previously, for the duration of the public health emergency according to their individual service plans and service authorizations.
Children’s Health Insurance Program and CHIP Perinatal coverage for newborns
Actions Taken in October and November 2020:
Individuals with CHIP certification periods ending in:
- October 2020 were extended until January 2021
- November 2020 were extended until February 2021
CHIP Perinatal coverage for the mother will still end on the last day of the month the pregnancy ends. CHIP Perinatal newborns whose mothers received emergency Medicaid coverage for labor and delivery will still be enrolled in Medicaid. CHIP Perinatal coverage for newborns living in families with income above the Medicaid income limit, has been extended as follows:
- October 2020 was extended until January 2021
- November 2020 was extended until February 2021
These CHIP and CHIP Perinatal extensions shall apply only when there is no information presented to HHSC during that period indicating that the individual is no longer eligible.
HHSC will assess the need for further CHIP and CHIP Perinatal eligibility extensions as appropriate.
References: COVID-19 FAQ April 23
Next steps for providers: COVID-19 related updates for people receiving Medicaid services are available here: https://hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-covid-19-information-people-receiving-services
HHSC STAR Kids Member handbook: https://hhs.texas.gov/laws-regulations/handbooks/skh/appendices/appendix-vi-star-kids-transition-activitie
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.