Medicaid managed care assistance in Texas: STARLink Main Page

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	Success Stories

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A 12-year-old boy was hospitalized in an inpatient psychiatric hospital for serious mental health issues in Dallas. His mother called STARLink because she was told that her son would need to be moved to an in-network facility, in the Tarrant area. The family had just moved from Ft. Worth to Dallas but since the child's case information had not been updated yet the child was still assigned to the health plan and behavioral health organization in the Tarrant service delivery area.

STARLink contacted the Behavioral Health Organization (BHO) to explain the circumstances and emphasize the importance of allowing the child to continue treatment at the facility he was admitted to, in the town he currently lived in. STARLink's advocate assisted the family in working with the hospital and the BHO to ensure that the treatment at the out-of-network facility was authorized. STARLink's work on behalf of the family alleviated much of the concern and pressure the mother was facing during an already difficult and overwhelming time with her son.

A woman was refused a visit with her PCP due to two previous unpaid claims. The doctor's office told her the claims were not paid because she had other insurance.

STARLink contacted the doctor's office and the Third Party Resources hotline who verified that she did not have any other health insurance. STARLink then contacted the Medicaid hotline and with their assistance found out that the woman's case mistakenly had an open Worker's Compensation case review that should have been closed. STARLink worked with the TPR hotline, the Worker's Compensation Commission and the doctor's office to get the necessary information to close the case. After over 10 contacts and four days STARLink got the information corrected and the woman was able to make an appointment with her PCP.

A father called regarding his son's Medicaid case. He had not received the Medicaid ID form for August and was told that his son would be on CHIP. STARLink verified that the child's Medicaid had ended on the last day of July and referred the father to the CHIP hotline to find out when his CHIP coverage would begin. The father called back stating that the CHIP coverage would not begin until September 1st, however the son needed medical attention and would not have any coverage for August.

STARLink contacted the Children's Medicaid specialist with the Department of Human Services to request an extension of the child's Medicaid until the CHIP coverage became effective. Within four days DHS had certified the one-month of extended coverage to prevent the gap in health coverage. STARLink advised the father to pick up a temporary Medicaid ID form for his son for the month of August. As a result there was no gap in coverage and the child was able to continue to access health care.

A woman who was 5 months pregnant moved from Ft. Worth to El Paso. She had contacted her plan and her local DHS office to inform them that she had moved. The OBGYN she located in her new area contacted her health plan in Ft. Worth (she was still assigned to the plan) for authorization to see the patient but were denied authorization. The OBGYN was told that the plan only covers emergencies when members move out-of-network.

STARLink called the health plan and informed them that the member is entitled to accessing care out-of-network and needed authorization for services until her case was transferred to El Paso. The health plan contacted the member and the OBGYN's office and provided authorization for all necessary prenatal care visits. The member was able to access prenatal care and the provider's office obtained the authorization they needed.

An individual receiving Supplemental Security Income (SSI) contacted STARLink after finding out she was not enrolled in the STAR program anymore and was therefore unable to fill all of the 21 prescriptions she needed for the month. She did not know what happened to cause the sudden disenrollment.

STARLink checked her eligibility information and found a county code error that mistakenly disenrolled her from the STAR program. The consumer explained that 17 of the prescriptions she took were for life threatening conditions. The other four were psychotropic medications for mental health issues. STARLink contacted the state immediately and requested that the consumer get reenrolled into the STAR program effective immediately. Within three days the state reenrolled her and the consumer was able to fill her prescriptions.

A mother called STARLink after finding out her baby was no longer covered by Medicaid. Her local DHS office informed her that the child's Medicaid was good from May through June although the child should have been certified for 6 months according to the new Children's Medicaid policy. The baby had an appointment with a gastroenterologist scheduled for the end of the week and the mother had already paid out-of-pocket for an $85 prescription for her baby.

STARLink contacted the Regional DHS office who stated incorrectly that the new Children's Medicaid rules did not apply to this child because the policies did not go into effect until April 1st. STARLink contacted the DHS state office to request assistance. They confirmed that the child's eligibility was incorrectly processed and worked with the local office to ensure the baby's Medicaid was extended for the full 6 months. In the meantime STARLink worked with the doctor's office and the local DHS office to ensure that the baby would be able to keep the scheduled appointment. The Medicaid was recertified and the mother was able to pick up a temporary Medicaid form to provide to the doctor's office and the child was able to receive the health care he needed.