Guest guest Posted January 1, 2002 Report Share Posted January 1, 2002 The following is from a booklet I picked up at a workshop. It's written by the Texas Department of Health, dated August 2001, and describes the available services. This booklet targeted the Panhandle and South Plains areas, but similar programs should be available state-wide. Look before you print, it was 14 pages long on my word processor. Tonya This informational booklet was designed to assist individuals and organizations who provide services to children and families. It has been developed to offer a better understanding of government funded programs in Public Health Region 1 (PHR 1) which are related to children’s health. This does not include every resource that may be available through other organizations in the region. ******************** Essential Telephone Numbers THSteps Client HelpLine 1-877-THSTEPS (847-8377) Medical Transportation 1-877-MEDTRIP (633-8747) Medicaid Client Services Hotline 1- Texas Health Steps Outreach Lubbock (Maximus) Amarillo (Coalition of Health Services Texas STAR Program Enrollment HelpLine 1- Maximus (Lubbock) TexCare Partnership (Medicaid and Children’s Health Insurance Program) Hotline 1- Coalition of Health Services 1- West Texas CHIP Coalition Texas Department of Health, Region 1 THSteps Program Manager THSteps Provider Relations Health and Human Services Commission Medicaid Managed Care Children’s Health Insurance Program (CHIP) Title V Program Nurse Consultant (Lubbock) Nurse Consultant (Amarillo) Statewide Title V Director ext. 3054 Children with Special Health Care Needs Client intake (Amarillo) ext. 228 Client intake (Lubbock) Other Important Numbers Early Childhood Intervention (ECI) 1- Amarillo State Center ECI Program Region 16 Education Service Center (Amarillo) Region 17 Education Service Center (Lubbock) Eleanor ECI (Plainview) Developmental Education Birth through Two (DEBT) (Lubbock) Texas Department of Health (TDH) Region 1 Texas Department of Human Services (TDHS) Region 1 Texas Department of Mental Health and Mental Retardation (TDMHMR) Lubbock MHMR Texas Panhandle Mental Health Authority Texas Department of Protective and Regulatory Services (TDPRS) Region 1 ******************** TexCare Partnership http://www.texcarepartnership.com 1/ TexCare Partnership is a children’s health insurance campaign developed for Texas families. Its purpose is to provide health insurance for children at a price that fits the budgets of Texas families. Two separate health insurance programs are involved in this partnership: Medicaid and Children’s Health Insurance program (CHIP). The main eligibility factor for these programs is family income in accordance with the Federal Poverty Levels (FPL). Various deductions are applied in determining net income and income limits are as follows: Under Age 1, up to 185% FPL uses Medicaid, 185-200% used CHIP Age 1-5, up to 133% FPL uses Medicaid, 134-200% uses CHIP Age 6-18, up to 100% FPL uses Medicaid, 100-200% uses CHIP ******************** Texas Medicaid Medicaid is a jointly funded state/federal program administered in Texas by the Health and Human Services Commission. Medicaid only makes payments to providers for medical or dental care; it cannot repay a client for any money paid to a provider. Services must be received from medical or dental providers who are enrolled in the Medicaid Program. Medicaid serves primarily the poor, Temporary Assistance to Needy Families (TANF) recipients, the elderly and people on Social Supplemental Income (SSI). Eligibility for children: Texas resident U S citizen or a legal permanent resident Under Age 18 Income levels vary according to age Medicaid Identification Form The Medicaid ID form (Form 3087) is mailed to each eligible client monthly. The post office will not forward the Medicaid ID to a new address. The Department of Human Services (DHS) will automatically deny Medicaid services on all form 3087’s returned by the post office. To prevent this, the client must contact DHS to notify them of an address change. ******************** Texas Health Steps Program Texas Health Steps (THSteps) is the Texas name given to the federally mandated programs known as EPSDT (Early Periodic Screening Detection Treatment). It is part of the Texas Medicaid Program. THSteps provides preventive health care services at regular and periodic intervals to Medicaid clients who are from birth through 20 years of age. It includes: Medical screenings Dental services Immunizations Vision exams and services Hearing exams and aids Comprehensive Care Services Case Management Laboratory services The THSteps toll-free lines allow individuals to obtain information on Medicaid services and how to access them. By calling the toll-free number (1-), a client can receive: a list of THSteps providers assistance with scheduling appointments transportation to THSteps exams and medical or dental appointments case management referrals other needs as requested THSteps Medical Periodicity Schedule Children need health check-ups at: Birth 1-2 weeks 2 months 4 months 6 months 9 months 12 months 15 months 18 months 24 months 3 years 4 years 5 years 6 years 8 years 10 years 11 years 12 years 12 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years Medical Check-ups include: Health history (family and neonatal included) Physical examination Measurements (height and weight) Developmental assessment Mental Health assessment Immunizations TB screening Laboratory Screening (lead, STD, Hgb or Hct) Sensory screening (vision and hearing) Health education Dental referrals ******************** Basic Medicaid Services Ambulance services Prescriptions Dental care (under age 21) Orthodontics (under age 21 - with some exceptions) Psychiatric services Eye Exams and Eyeglasses Chiropractic Family planning Laboratory Hearing aids (one every six years) Physician services Physical therapy Hospital services (inpatient and outpatient) Radiology Respiratory care ********************** Comprehensive Care Program THSteps-CCP is an expansion of the Texas Medicaid Program. CCP covers services for children under age 21 that are not usually allowed under the Texas Medicaid Plan. CCP provides for: Durable Medical Equipment Nutritional Counseling Occupational Therapy Orthotic and Prosthetic Supplies Private Duty Nursing Speech Therapy Home Health Services Diabetic Supplies Diapers (over age 4) Nebulizer Supplies ******************** Dental Services Texas Health Steps provides free dental services to Medicaid eligible children under the age of 21. The first dental checkup is provided at age one and every six months after that. The THSteps dental program provides: Preventive services - oral exam, e-rays, cleaning, sealants, education Treatment - fillings, crowns, gum disease, extractions Orthodontic services, referred by a regular dentist - cleft palate, severe occlusions, crossbite therapy (cosmetic orthodontia is not covered) Emergency care - control bleeding, relieve pain, eliminate acute infection *********************** Hearing and Vision Services Medicaid will pay for one eye exam per year and one pair of eyeglasses every two years. Another pair of eyeglasses can be obtained before the end of the two-year period if: Eyeglasses have been broken and cannot be repaired Eyeglasses have been lost The child’s vision has changed significantly Medicaid will not pay for contact lenses unless medically necessary as determined by the provider. Hearing screening is a mandatory part of each THSteps checkup. Only audiologists who have contracts with the Program for the Amplification of Children in Texas (PACT) may provide services under Medicaid. Hearing exams and services including hearing aids are available when medically necessary. ******************** Medical Case Management THSteps Medical case Management provides services to eligible children enrolled in Medicaid. Case Managers assist children and their families in gaining access to necessary medical, social, educational, nutritional, transportation, vocational and any other needed services. Examples of children, ages 1-21, who are eligible for this Medical Case Management include the following: Failure to Thrive Asthma or breathing problems Chronic ear infections Diabetes Anemia Hearing or visual problems Cerebral palsy Behavior problems Cancer Chaotic home environment Symptoms of an undiagnosed disorder, such as ADD, ADHD, or depression Hiv/AIDS To make a referral to this program contact THSteps Hotline at 1- ******************** Targeted Case Management for High Risk Pregnant Women and Infants Targeted Case Management for High Risk Pregnant Women and Infants provides services to pregnant women who are medically and/or socially high risk and infants up to the age of one and are receiving or are eligible to receive Medicaid or Title V benefits. Case managers assist these families in gaining access to necessary medical, social, educational, nutritional, transportation, vocational and any other needed services. Examples of pregnant women and infants who are eligible for this program include the following: Homeless Pregnant teenager Pregnancy over the age of 35 Alcohol/drug/tobacco use or abuse Family violence Non-compliance with medical treatment Developmental delays Low birth weight Third trimester entry into prenatal care Birth defects Medically complicated circumstances Premature labor To make a referral for targeted case management, call 1- ******************** Medical Transportation The Medical Transportation Program (MTP) ensures that children and adults get to Medicaid medical or dental care. Transportation to medical or dental care is available to Medicaid clients of any age, when they have no other means of travel. Types of travel services available: Rural public transit services (car or sedan service) Mass transit service (Amarillo & Lubbock) Car or van rides (Amarillo & Lubbock) Mileage reimbursement for driving your own car or for a friend who drives his/her car Airfare Meals, lodging services, and up-front travel funds (recipients through age 20) Other information to know: Two days notice required; urgent requests arranged when and where it is available Children through age 14 require adult escorts 15 and 16 year olds may ride alone with written parental permission To arrange trips, call 8 a.m. to 5 p.m. Spanish speaking staff are available Trips are prior authorized through call center staff at the Texas Department of Health and most arrangements are made while callers are on the line. Information to have when requesting services: Name, home address Medicaid Number, Social Security Number or birth date Pick-up address, medical address Name of medical service and appointment time NOTE” Transportation arrangements are made based on medical necessity. Medical providers may be contacted by MTP to validate medical necessity for long distance travel, necessary attendants or in determining a specific mode of travel in town. Travel arrangements for Children with Special Health Care Needs (formerly CIDC) are also made by MTP. Call 1-877-MED-TRIP (1-) for questions or to arrange services. ******************** Outreach and Informing The Medicaid ID informs clients when a medical or dental checkup is due. The THSteps outreach and informing activities include letters to clients who are: 1. new or re-certified for Medicaid 2. periodically due for medical and/or dental checkup 3. sixty days overdue for a check-up 4. ten months old and due for the first dental checkup at age one year 5. pregnant women receiving Medicaid The Texas Department of Health contacts new and re-certified Medicaid clients by telephone or home visit in order to offer assistance in scheduling THSteps appointments for their children and to inform them about the availability of Medicaid services such as case management and medical transportation. Outreach staff help families remove barriers to obtaining the needed checkups for their children. Note: Participation in the THSteps program is voluntary. Acceptance or refusal of THSteps services does not affect eligibility for, or benefits of, and other Medicaid services. ******************** Extra Effort Referral The Extra Effort Referral Form enables recipients to request additional information or outreach services. These forms are available by calling the Texas Department of Health (Lubbock area ). Clients are contacted within 10 calendar days of receipt. ******************** Medicaid ID (3087) Once an individual becomes eligible for Medicaid they will receive a Medicaid ID form at the beginning of each month. The Medicaid ID will show the client: The most recent renewal date that Medicaid coverage began under the heading “Eligibility Date” Reminders for when the client is due for their THSteps medical or dental checkup The ID form for managed care clients will also contain health plan information. ********************* Texas Star Program The Texas STAR (State of Texas Access Reform) Program is the Medicaid managed care program in Texas. Medicaid recipients on the STAR Program must coordinate health care through their selected health plan. Individuals on Temporary Assistance to Needy Families (TANF) and TANF-related programs must participate in managed care, and SSI recipients can voluntarily enroll. Currently, the Medicaid managed care counties (in Region 1) are Lubbock, Hale, Lamb, Hockley, Terry, Lynn, Garza, Crosby and Floyd. Enrollment in the STAR Program requires that the family choose a health plan and a Primary Care Provider (PCP). The PCP provides a medical home for Medicaid clients who previously were left to find health care on their own. Maximus is contracted by Texas Department of Health to assist clients with enrolling into health plans and choosing a PCP. STAR clients must obtain a referral from their PCP to obtain any kind of specialty care other than routine vision care, behavioral health care, and freedom of choice services. ******************** Children’s Health Insurance Program (CHIP) To qualify for CHIP coverage a child must be: A Texas resident A U. S. citizen or a legal permanent resident (the citizenship status of the parents is not questioned) Under age 19 Uninsured for at least 90 days, with some exceptions Able to meet income requirements. Most types of income are counted. Deductions for work-related expenses and dependent care are allowed against earned income. There is no assets test. Benefits CHIP will cover sick child visits and regular check-ups, immunizations, x-rays, hearing and vision tests. CHIP also pays for mental health services and limited dental care. Emergency care, hospital stays, surgery, and services for children with disabilities and special health needs are also covered. CO-Payments CHIP-eligible families pay some portion of their health care. Families at or below 150% of the FPL pay an annual $15 enrollment fee and very low co-payments for medical services. Families between 150% and 200% of the FPL pay either $15 or $18 per month per family for their children’s health insurance, and the co-payments for medical services are similar to those charged by commercial health plans. Most children who enroll in CHIP receive 12 months of continuous coverage, usually beginning on the first day of the month following enrollment in a health plan. How to apply: 1. Call the hotline, 1-, and give information to a hotline customer service representative, who will enter the information into the system. This information will be printed out and mailed to the family for review, completion of any missing items, signature, and submission of any necessary verification. 2. Get an application booklet from a community-based organization, complete and sign the application, and mail it with any necessary verification. 3. Download an application from the TexCare Partnership website http://www.texcarepartnership.com , complete and sign, then mail with any necessary verifications. ********************* Co-Payments for the CHIPS Native American families are exempt. Families at or below 100% of the FPL are exempt for cost-sharing. All enrollment fees and monthly premiums are assessed on a per-family basis, regardless of the number of children. Families pay no co-payment for preventive services such as well-child or well-baby visits or immunizations. Co-pays and Caps: FPL 100%-150%, office visit $2, Emergency visit $5, Generic Meds $1, Brand Name Meds $2, Maximum: an annual self declared co-payment cap of $90 per family. FPL 151%-185%, office visit $5, Emergency visit $25, Generic Meds $5, Brand Name Meds $10, Maximum: 4.5% cap of gross income in an calendar year. FPL 186%-200%, office visit $10, Emergency visit $35, Generic Meds $5, Brand Name Meds $10, Maximum: 4.5% cap of gross income in an calendar year. ********************* Children with Special Health Care Needs (CSHCN) Children with Special Health Care Needs Program (CSHCN) provides comprehensive medical services for a person younger than 21 years of age and who has a chronic physical or developmental condition; or has Cystic Fibrosis, regardless of the person’s age; and may have a behavior or emotional condition that accompanies they person’s physical or developmental condition. A chronic physical condition is defined as a disease or disabling condition of the body, or a bodily tissue or of an organ which will last or is expected to last at least 12 months; results, or without treatment, may result in limits to one or more major life activities; and that requires health and related services of a type or amount beyond those required by children generally. Such a condition may exist with accompanying developmental, mental, behavioral or emotional conditions but is not solely a delay in intellectual developmental or solely a mental, behavioral and/or emotional condition. Eligibility: Younger than 21 years of age, except those with Cystic Fibrosis Certified by a physician / dentist as a child with special health care needs Income at or below 200% of Federal Poverty Level Resident of Texas (does not have to be a citizen) Once a child is determined eligible for CSHCN services, the child will have continuous eligibility for 12 months. Eligibility of the child must be re-established annually (age, residency, financial and medical). CSHCN will pay for such things as: doctor’s visits, inpatient hospitalization, Orthotic and prosthetic devices, medications, nutrition services and products, durable medical equipment, medical supplies, vision services, audiological testing, Occupational Therapy, Speech Therapy, Physical Therapy, home health nursing, hospice care, Family Support Services, case management and travel expenses including mileage, meals and lodging. Family Support Services (FSS) include disability-related support, resources or other assistance and may be provided to the family of a child with special health care needs. FSS may provide such things as van-lifts and modifications, special equipment and supplies, training, specialized childcare and medical food products. Referrals for the CSHCN program may be made to the TDH-Social Work Services office. in Lubbock in Canyon ext. 228 ******************** Title V Maternal and Child Health (MCH) Services Authorized under Title V of the Social Security Act, the MCH program remains the only federal program solely devoted to improving the health of mothers and children. It complements related non-Medicaid programs by providing for uncovered services, such as preventive, primary health, and case management services. Eligibility: 1. Child age 0 through 21, female age 12 to 45; 2. Family income less than 185% of the FPL; 3. Texas resident (not necessarily a citizen) 4. Uninsured for the service provided; 5. Not eligible for Medicaid Individual client eligibility will be determined on an annual basis and at other times, as necessary, based upon change in pregnancy status or income. The eligibility process is based upon client self-declaration. Title V services include: Prenatal care Family planning Genetics Program for Amplification for Children in Texas Well Child Checks (limited sick-care) Dysplasia ******************** WIC The Special Supplemental Program for Women, Infants, and Children (WIC) program is a health and nutrition program focused on improving the diets of infants, children, and pregnant, postpartum and breastfeeding women who are at risk for nutrition-related illnesses. The benefits of the WIC program include the provision of supplemental foods, nutrition education, health screens, immunizations, and medical/professional referrals. Eligibility Income at or below 185% of the Federal Poverty Level Be at nutritional risk Texas resident (not necessarily a US citizen) To become a WIC client, individuals can set an appointment with a local WIC agency by calling 1-800-WIC-FORU (1-) ********** Health Insurance Premium Payment Reimbursement Program (HIPP) HIPP is a Medicaid program that pays for the cost of insurance premiums, coinsurance, deductibles, and other cost sharing when it is determined to be cost effective. Individuals in this program must be Medicaid eligible and have health insurance available through and employer. Information can be obtained by calling 1-. ********************* Medically Need Program This program assists with the payment of medical bills for individuals who meet specific income and resource requirements. It is generally designed to help a family whose income is above the normal Medicaid limits and pays for medical expenses that exceed the family’s income. To inquire, families should contact the local Texas Department of Human Services office. ********************* Medically Dependent Children’s Program (MDCP) MDCP is available for medically involved children under the age of 21 who meet the medical criteria for admission into a nursing home. It provides a variety of services to qualified children that allow them to live at home. Services can include respite services, home modifications, adaptive aids, and support to enable participation in child care. For information or referral to a caseworker, contact the Texas Department of Health Regional Office. ********************* Community Living Assistance and Support Services (CLASS) The CLASS Program is for individuals with a disability (other than mental retardation) that originated before age 22, It provides home-based and community-based services such as respite care, nursing services, adaptive aids/supplies, home modifications, and case management and other related services. For more information, contact the local Texas Department of Human Services office. ********************* In-Home and Family Support This program provides assistance to individuals with physical disabilities, age 4 and over. Help is provided to purchase or lease services and/pr equipment that allow individuals to remain in the home. Income requirements begin at 105% of the state median income for household size. For more information, contact the local Texas Department of Human Services office. ********************* Primary Home Care and Family Care This is a non-technical, medically related personal care service prescribed by a physician as part of a client’s plan of care. It is available to eligible clients who are functionally limited due to health problems/conditions. Services are provided by an attendant and do not require the supervision of a registered nurse. There is no age limit for Primary Home Care/Family Care services; however, specific income and resource limits may apply. To inquire, families can contact the local Texas Department of Human Services office. ********************* Home-Based and Community-Based Services (HCS) HCS is available for individuals with mental retardation. It helps individuals remain in their family’s home by providing respite services, homemaker services, nursing, case management, occupational or physical therapy, speech/language pathology, audiology services, psychology, and social work services. Information can be obtained by contacting the Texas Department of Mental Health and Mental Retardation. ********************* Deaf-Blind Multiple Disabilities Program This program is for individuals whoa re both deaf and blind, 18 years or older, and have a need for 24-hour support. Options for residential support range from 24-hour care in a six-bed group home to support for individuals who live with their families. Services include assistance with skills of daily living, assistance with home maintenance, case management, respite care for those individuals who live with their families, equipment to increase interaction with the environment, and modifications to the home or apartment. Family training is also available. A weeklong summer camp is provided for children ages 7 and older. For more information, contact the local Texas Department of Human Services office. ********************* Early Childhood Intervention Program (ECI) The Texas Interagency Council on Early Childhood Intervention (ECI) is the state agency that funds and oversees local programs statewide that serve Texas families who have children birth to age 2, with disabilities or delays. ECI teaches families to help their children reach their potential through education and therapy services. Services are provided at no cost to the family, regardless of income. Services are provided in every Texas county in home and community settings. For referral to the appropriate ECI program by county, call 1-. ********************* Glossary Case Management - A Medicaid service provided by a case manager to help families gain access to necessary medical, social, educational, nutritional, transportation, vocational and any other services. Case Manager - A licensed nurse or social worker, who has been approved and trained and is given technical assistance by the Texas Department of Health. Client - A person who has applied for or is enrolled in the Medicaid program and is eligible to receive Medicaid services. Durable Medical Equipment (DME) - Equipment that is primarily and customarily used to serve a medical purpose, generally it is not useful to a person in the absence of illness or injury, and is appropriate for use at home. Example of durable medical equipment include hospital beds, wheelchairs, and oxygen equipment. EPSDT - (Early Periodic Screening, Diagnosis and Treatment) This is the federal program know in Texas as Texas Health Steps (THSteps). Enrollment Broker - state contractor that assists Medicaid clients enrolling in Medicaid managed care. Maximus is the enrollment broker for Texas. Federal Poverty Levels (FPL) - Income guidelines established annually by the federal government. Public assistance programs usually define eligibility in terms of FPL limits. Managed Care - a system in which the primary care of a patient is overseen by a single provider or organization. Managed Care Organization (MCO) - An entity that provides or contracts for managed care. MCOs include entities such as HMOs and Primary Care Case Management (PCCM). Maximus - A private corporation that has been awarded contracts through the Texas Department of Health to provide the Texas Medicaid Enrollment Broker Services (EBS) and to provide outreach, informing, and support services for the Texas Health Steps program in Public Health Regions 1, 2/3, 6/5 South, 7, 8, and 9. Medicaid - A joint federal0stae entitlement program that pays for medical care on behalf of certain groups of low-income persons. Medicaid Eligible - This term is used to reference persons who, after going through a certification process, become eligible to receive services and other assistance under the auspices of the Medicaid program. This term does not include persons who could be eligible for Medicaid that are not enrolled in the program. PACT - Program for the Amplification for Children in Texas serves Texas children from birth through 20 years of age who have hearing losses. PACT provides diagnostic and remedial services needed by children who are Medicaid eligible or whose family income qualifies according to the federal poverty guidelines. STAR - State of Texas Access Reform Program that is the Texas Medicaid managed care program. TANF - Temporary Assistance for Needy Families. A government funded cash assistance program formerly known as Aid for Families with Dependent Children (AFDC). Quote Link to comment Share on other sites More sharing options...
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