Provider Alert! Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19tcph
Date: July 23, 2021
Attention: All providers
Subject: Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19
Effective Date: July 22, 2021 For STAR Kids Age Outs that complete their transitions August 1, 2021.
The content in this message on STAR Kids Age-Outs that transitioned on April 1, 2020 will remain in effect through July 31, 2021. Individuals ageing out starting May 1, 2021 are following normal timelines and processes, as announced by the Health and Human Services Commission.
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. Current Medicaid clients cannot be transferred to CHIP during the public health emergency period. CHIP is not considered a Medicaid program under the requirements for H.R. 6201.
CHIP and CHIP Perinate update received June 14, 2021: HHSC will begin reviewing eligibility for CHIP and CHIP Perinatal and notifying members when they need to renew their benefits to continue coverage after the end of their current certification period. Members with CHIP certification periods originally ending between April 30, 2020 and May 31, 2021 were extended through June 2021. These members with a CHIP coverage end date of June 30, 2021 were then extended to October, November, or December 2021. In June 2021, HHSC sent these members a special notice informing them of their new renewal date (October, November, or December 2021) and the date when HHSC will send members a new renewal packet. CHIP members whose coverage ends on July 31, 2021, or later will go through the regular eligibility renewal process.
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.
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-activities
If you have any questions, please email Provider Network Management at: email@example.com.