Texas Children's Health Plan |
Your Health Newsletter

Stay up to date on your health plan benefits, rewards and helpful resources for you and your family’s well-being.

Good Health Starts Here!

New exclusive benefits for the whole family to enjoy.

COVID-19 Vaccine

What you need to know

Online health care visits anytime, anywhere

Texas Children’s Anywhere Care provides reliable and convenient care with 24/7 access to providers.

Need a ride to the doctor or pharmacy?

Texas Children's Health Plan is your one-stop to secure transportation for you!

Stay insured, renew now!

Our renewal assistance team can help you renew and stay insured.

Need care now?

Skip the wait at the ER and learn about options such as urgent care, virtual care, nurse helpline and more.

A plan for the expected and the unexpected

Get them covered with a quality health care plan from Texas Children's Health Plan. Our application assistance team can help you apply.

Be Prepared. Have a plan now.

First-time mom? Join the Nurse-Family Partnership for extra support during your pregnancy.

Everything you need in one place.

We put your family at the center of care. The Center for Children and Women.

 

Who We Are

Texas Children’s Health Plan was founded in 1996 by Texas Children’s Hospital. We cover kids, teens, pregnant women, and adults. If you qualify for Medicaid or CHIP, we have a large network of doctors and resources to care for your needs.

  • More than 4,300 doctors
  • 6,800 specialists
  • 118 hospitals

Helpful Information

HHSC continues to require of Texas Children’s Health Plan to allow an extension for up to 30 days for members to request continuation of benefits after they receive an adverse benefit determination. This continuation of benefits extension time frame will end June 30, 2021.

Starting July 1, 2021, Texas Children’s Health Plan must apply the normal, regular and set timeframes for members to request continuation of benefits, which is no later than 10 days from the date they receive the adverse benefit determination notice.

Veyo Member Transportation Line:

  • 1-888-401-0170 (toll free)
  • 1-346-232-4130 (local)
  • For TTY/TDD call 1-800-735-2989
  • Trip scheduling available Monday- Friday, 8am-5pm CT.
  • “Where’s My Ride” trip updates will available 5am-7pm, Monday- Saturday. For updates, call the Member Transportation Line above.
  • We speak English and Spanish. We also have interpreters available by phone who speak 140 different languages.

For more information about Veyo "Where's my ride" benefit click here.

Lost your coverage? There are a number of programs offered through Texas Health and Human Services that can help.

  • The Healthy Texas Women Program - offers women’s health and family planning services. Is available to Texas women who meet the program rules.
  • Healthy Texas Women Plus – gives more postpartum services for women. Available to those in the Healthy Texas Women program.
  • Family Planning Program – focused on family planning and other healthcare. Available to women and men in Texas.
  • Primary Health Care Program - works with clinics across Texas. It makes sure Texas residents can get the primary care they need. The program serves men, women and children.

Each program has rules for who can join. Visit the links above for more information on what they cover and how to join.

Texas Children’s Health Plan provides a Member Advocate to assist you if you have a complaint. Our team of member advocates will help you write and file a complaint or appeal on your behalf and monitor it until it is resolved. We have a member advocate dedicated for each line of business and service delivery area. We speak English and Spanish. We also have interpreters available by phone who speak 140 different languages.

To have a Member Advocate assigned to you, call 866-219-5411.

Can a Member ask for an External Medical Review?
 
If a Member, as a member of the health plan, disagrees with the health plan’s internal appeal decision, the Member has the right to ask for an External Medical Review. An External Medical Review is an optional, extra step the Member can take to get the case reviewed before the State Fair Hearing occurs. The Member may name someone to represent them by contacting the health plan and giving the name of the person the Member wants to represent him or her. A provider may be the Member’s representative. The Member or the Member’s representative must ask for the External Medical Review within 120 days of the date the health plan mails the letter with the internal appeal decision. If the Member does not ask for the External Medical Review within 120 days, the Member may lose his or her right to an External Medical Review. To ask for an External Medical Review, the Member or the Member’s representative may either:
 
Fill out the ‘State Fair Hearing and External Medical Review Request Form’ provided as an attachment to the Member Notice of MCO Internal Appeal Decision letter and mail or fax it to Texas Children’s Health Plan by using the address or fax number at the top of the form.
 
Texas Children's Health Plan
Attn: UM Department
P.O. Box 301011, WLS 8390
Houston, TX 77230-1011
Fax: 832-825-8796
 
Call Texas Children’s Health Plan at 866-959-2555 (STAR) or 800-659-5764 (STAR KIDS) or email us at TCHPUM@texaschildrens.org 
 
If the Member asks for an External Medical Review within 10 days from the time the Member gets the appeal decision from the health plan, the Member has the right to keep getting any service the health plan denied, based on previously authorized services, at least until the final State Fair Hearing decision is made. If the Member does not request an External Medical Review within 10 days from the time the Member gets the appeal decision from the health plan, the service the health plan denied will be stopped.
 
The Member may withdraw the Member’s request for an External Medical Review before it is assigned to an Independent Review Organization or while the Independent Review Organization is reviewing the Member’s External Medical Review request. An Independent Review Organization is a third-party organization contracted by HHSC that conducts an External Medical Review during Member appeal processes related to Adverse Benefit Determinations based on functional necessity or medical necessity. An External Medical Review cannot be withdrawn if an Independent Review Organization has already completed the review and made a decision. Once the External Medical Review decision is received, the Member has the right to withdraw the State Fair Hearing request. If the Member continues with the State Fair Hearing, the Member can also request the Independent Review Organization be present at the State Fair Hearing. The Member can make both of these requests by contacting Texas Children’s Health Plan at 866-959-2555 (STAR) or 800-659-5764 (STAR KIDS) or the HHSC Intake Team at EMR_Intake_Team@hhsc.state.tx.us If the Member continues with a State Fair Hearing and the State Fair Hearing decision is different from the Independent Review Organization decision, it is the State Fair Hearing decision that is final. The State Fair Hearing decision can only uphold or increase Member benefits from the Independent Review Organization decision.
 
Can I ask for an emergency External Medical Review?
 
If you believe that waiting for a standard External Medical Review will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you, your parent or your legally authorized representative may ask for an emergency External Medical Review and emergency State Fair Hearing by writing or calling Texas Children’s Health Plan. To qualify for an emergency External Medical Review and emergency State Fair Hearing review through HHSC, you must first complete Texas Children’s Health Plan internal appeals process.

In response to the recent high school shooting in Santa Fe Texas, the National Child Traumatic Stress Network has developed resources to help families and communities. 

Learn More

24-Hour Nurse Help Line

Before going to the Emergency Room, call the Nurse Help Line (unless it is an emergency). We are available 24-hours a day, 7 days a week. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.

1-800-686-3831 or TDD 1-800-735-2989

Our Member Services Team is ready to take your call from 8 a.m. to 5 p.m., Monday through Friday. After hours, on weekends and holidays, our answering service is ready to help you and/or take your messages. A Member Service Advocate will return your call the next business day. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages. Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.
 
Here are some services our team can help you with, if needed.
 
  • Oral interpretation (over the phone and face to face) and written translations assistance. Sign language available.
  • Information in formats such as print, Braille, audiotapes or accessible electronic.
  • Access to TTY/TDD services for hearing and speech impairment
  • To join, you can call: 1-877-782-6440 (STAR Kids) or 1-800-964-2777 (CHIP and STAR). For TTY/TDD call 1-800-735-2989.

Member Services Program Hotlines:

  • CHIP: 1-866-959-6555
  • STAR: 1-866-959-2555
  • STAR Kids: 1-800-659-5764 (Service Coordination)
  • TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1
In case of an emergency, go to your nearest in-network emergency room or call 9-1-1.

Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.

Behavioral Health/Substance Abuse Hotline:

(no provider referral needed)

Customer Service

Providers can use this number for claims, inquiry, questions and information about CHIP, STAR, or STAR Kids products and to check eligibility/benefits.

Phone: 832-828-1004
Toll free: 1-877-213-5508



Telephone TouCHPoint

Texas Children’s Health Plan’s automated Telephone TouCHPoint system allows Texas Children’s Health Plan providers to check eligibility, benefits, and claims status after hours. The service is available 24 hours a day, 7 days a week. To access Telephone TouCHPoint call 832-828-1007. Enter the member’s identification number and the provider’s NPI number.

Telephone TouCHPoint: 832-828-1007
Fax: 832-825-8777

 

What is CHIP?

The Children’s Health Insurance Program (CHIP) offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage.

We offer CHIP in more than 20 counties in the Jefferson and Harris Service Areas.

Click here to learn more about CHIP.



What is STAR?

STAR is a Medicaid-managed care plan. This plan helps family members of any age. Texas Children’s Health Plan offers STAR in more than 20 counties in the Jefferson and Harris Service Areas. Learn more about STAR.

Click here to learn more about the STAR program.



What is STAR Kids?

STAR Kids is a Medicaid-managed care plan. This plan helps children and young adults under the age of 21 with disabilities. Texas Children’s Health Plan offers STAR Kids in the Harris, Jefferson and Northeast Service Areas.

Click here to learn more about the STAR Kids program.



CHIP Perinatal

Texas Children’s Health Plan offers CHIP perinatal services. CHIP prenatal is no-cost health coverage for pregnant women. To get CHIP perinatal, you must:

  • Meet certain income requirements.
  • Not qualify for Medicaid.
  • Not have any other health coverage.

Click here to learn more about CHIP Perinatal.

 

How is the Texas Vendor Drug Program (VDP) used for Texas Children's Health Plan Medicaid members?

Navitus is the provider for drug store services for members. The Texas VDP maintains and publishes the Texas VDP Formulary and the associated PDL. It also maintains and publishes the clinical guidelines for drugs not on the PDL which require pre-approval, and are used by Navitus to give benefits for Texas Children's Health Plan STAR and CHIP members.

What drug stores does Navitus have contracts with?

Navitus has contracts with more than 95% of the VDP providers in Texas. The Navitus drug store network includes national chain drug stores such as Walgreen's, CVS, HEB, Wal-Mart, Target, and Kroger. And many others. Navitus' drug store network can be found here.

Contact Member Services at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR) if you need help finding a drug store.

We want you to have the best resources for your health. Here is a list of helpful websites and links to our vendors:



Prescriptions


Pharmacy Search



Vision Care


Envolve Vision

  • 1-844-520-3711 (CHIP)

  • 1-844-683-2305 (STAR)

  • 1-844-212-7269 (STAR Kids)

Dental Care

Your child will have one of the following dental plans:

If you don't know who your child's CHIP dental plans is, call CHIP toll-free at 1-866-959-6555

A State Fair Hearing is a chance for you tell the reasons why you think the services you asked for and couldn’t get should be allowed.

Can I ask for a State Fair Hearing? If you, as a member of Texas Children’s Health Plan, disagree with the health plan’s decision, you have the right to ask for a fair hearing. You may name someone to represent you by writing a letter to the health plan telling them the name of the person you want to represent you. A doctor or other medical provider may be your representative. If you want to challenge a decision made by Texas Children’s Health Plan, you or your representative must ask for the fair hearing at any time up until 90 days of the date on the health plan’s letter with the decision. If you do not ask for the fair hearing within 90 days, you may lose your right to a State Fair Hearing.

To ask for a State Fair Hearing, you or your representative should either send a letter to the health plan or call:

Texas Children’s Health Plan
Attention: Appeals Department NB8390
PO Box 300709
Houston, TX 77230
Fax: 832-825-8796
Phone: 832-828-1001 or 1-866-959-2555
TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1

Click here for more information on State Fair Hearings