Medicaid managed care assistance in Texas: STARLink Main Page

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	Success Stories

If you need any of the following information in alternative formats or languages please contact us at 1-866-566-8989.

A baby with special health care needs, living in the Travis SDA, was going to lose his home health care nurse. The child had been brought home after being hospitalized since birth and needed in-home health care to monitor his condition. The home health provider could not get the in-home care authorized because the Social Security Administration was coding the child as being hospitalized. The SSA would not update his case until the father went in to the SSA office, but the office would not make an appointment for him earlier than two weeks away.

STARLink contacted his SSA office and emphasized the importance of getting the child's code changed. The office agreed to see the father right away. Meanwhile, the advocate stayed in constant contact with the home health provider to ensure that the nurse was not removed from the child's home. The advocate continued to check the child's case and follow-up with the SSA. Within four days the code was changed, the nurse remained in the home and the provider was pleased that they could now submit authorization to get paid for the services provided.

A newborn was suffering from serious complications including sleep apnea. The hospitals covered under his health plan did not have the proper accommodations for a baby in his condition. The child's family requested to change the health plan however; Medicaid dictates that plan changes may not occur until a child reaches 3 months of age.

STARLink contacted the enrollment broker to explain the necessity for a change of plan to one that could accommodate the baby's needs. The enrollment broker contacted the Bureau of Managed Care to request a health plan change for the child. The Bureau approved the plan change, which became effective immediately. The child was able to access the necessary treatment for his condition.

A 27-year old man with leukemia contacted STARLink because he was having difficulty accessing dental services. He received SSI and is enrolled in the STAR program in the Dallas area. While Medicaid does not provide routine dental care to adults, the consumer got a letter from his Primary Care Physician stating that he was at risk of a "life-threatening infection" if he did not receive dental care. The consumer contacted his health plan and had been trying to locate a dentist for a month before calling STARLink.

STARLink began assisting the consumer in finding a dentist who would evaluate his condition. After making over 25 contacts, STARLink finally located a dentist. The consumer received confirmation from the dentist that the dental work he needed would be extensive (removal of two teeth and two root canals). Obtaining the evaluation cleared the way for final authorization of the needed dental treatment.

A child on Medicaid was denied surgery because the surgeon that was to perform the operation and the hospital that it was to be performed in were not providers in the child's health plan. The health plan had denied an out-of-network referral.

Because the child's health plan was only willing to cover their own providers, all of which were too far away for the family to travel, STARLink contacted the Bureau of Managed Care. Since the child had been seen and evaluated for the surgical procedure by several doctors that were members of another health plan in that area, they decided to retroact his enrollment into that plan for the current month. This way he wouldn't have to wait until the following month (when his plan was due to change) for his surgery.