STAR is the program through which most people in Texas get their Medicaid coverage. People in STAR Medicaid get their services through medical plans, also known as managed care plans, which they choose.
STAR is in the Bexar, Dallas, El Paso, Harris, Lubbock, Nueces, Tarrant and Travis Service Areas.
- Map of STAR health plans (PDF)
- Uniformed Managed Care Contract (PDF) and Manual
- Provider Enrollment Contact Information (PDF)
What is STAR Medicaid?
STAR is managed care Medicaid. You pick a medical plan that provides your Medicaid services and a main doctor that is your point of contact for Medicaid services. In addition to your main doctor, each plan has a large group of specialists, therapists, clinics, and hospitals that can provide you with Medicaid services.
How does managed care work?
- You pick a medical plan from the plans available in your area (PDF).
- You pick a main doctor who will take care of most of your health-care needs. Your main doctor will also help you if you need other doctors, services, and specialists. Your main doctor will get to know you and your medical history. Your medical plan will have a list of providers from which to choose.
- You will get a STAR ID card from your medical plan. Bring your STAR ID card and the Your Texas Benefits Medicaid card to all your health-care appointments.
Where is STAR?
STAR is statewide. See the map of service areas by county (PDF).
Who must enroll in STAR?
You must enroll in the STAR program if you are approved for Medicaid and any of the following applies to you:
- You get cash assistance (Temporary Assistance for Needy Families - TANF).
- You are pregnant.
- You or your children have limited income.
- You are a newborn baby.
What kinds of services are offered by STAR?
The STAR program gives you all of the benefits Medicaid has to offer. You also get:
- No limit on the number of days you can stay in a hospital for needed care.
- No limit on the number of medicines.
- Health education classes.
- Medical plans that offer extra services not covered by Medicaid. These are called value-added services.
How do I pick a medical plan?
- After you are approved for Medicaid, we will send you a packet in the mail with facts about the Medical plans in your area you can choose from.
- Each medical plan has a list of providers. You will pick your main doctor from that list. Picking the right medical plan is very important, so be sure to read all of the information we send you.
- If you want to stay with the doctor you have now, find out which of the plans your doctor works with. Or, you may want to choose a main doctor that is close to your home.
Questions to ask yourself when picking a medical plan:
- Which medical plan works best with the doctors I use?
- Which medical plan has extra services I like the most?
- Which medical plan works best with my health needs?
What medical plans can I pick from?
Look for your county (PDF) to see which STAR medical plans are available in your area.
Can I change my medical plan?
Yes. To change your medical plan, call STAR toll free at 1-800-964-2777.
Keep in mind that when you change a medical plan, it can take up to 45 days before the change takes effect.
What is a main doctor?
When you join STAR, you will pick a main doctor. This is a doctor, nurse, or clinic where you will get most of your health care. They will get to know you and your health history. They can make referrals to other specialists and services you might need.
Your main doctor can be one of the following:
- Family practice doctor
- Pediatrician (children’s doctor)
- Internal medicine doctor
- OB/GYN (doctor for women’s health)
- Specialty trained nurse
Yes. Call your medical plan to change your main doctor.
What if I need to see a specialist or go to the hospital?
Your main doctor, nurse, or clinic will help you with most of your medical care. If you need other medical services, your doctor will give you a referral.
For example, if you need to see a specialist or go to the hospital, then your main doctor will set that up for you.
You do not need a referral from your main doctor for some services in your medical plan, including:
- Eye care.
- Family planning services and supplies, such as birth control.
- Mental health and drug and alcohol abuse treatment.
- Texas Health Steps checkups (for children age 20 and younger).
- Emergency room services.
What if I am pregnant? Does this matter when I pick a medical plan?
- If you are pregnant and new to Medicaid, you’ll pick a medical plan and a main doctor, which can be an OB/GYN.
- If you are in your third trimester, you can keep going to the OB/GYN you’re seeing now as long as that doctor accepts Medicaid. You must call your medical plan and tell them that you are still seeing that OB/GYN.
- After the baby is born, the baby will be covered by your medical plan. At that time, you must pick a main doctor for your baby.
Extra services (Value-Added Services) offered by STAR medical plans
STAR medical plans provide all of the Medicaid services as well as unlimited prescriptions, unlimited number of hospital days and health education classes. Each plan also offers extra services (value-added services). Look at these charts to see the plan that will best meet your needs.
Extra services offered by Medicaid dental plans
Medicaid dental services are only available to children, teens, and young adults age 20 or younger.