Medicaid FAQs

To qualify for STAR+PLUS, you must be approved for Medicaid, and meet at least one of these requirements:

• Age 21 or older, getting Supplemental Security Income (SSI) benefits, and able to get Medicaid due to low income.
• Not getting SSI and need the type of services in STAR+PLUS Home and Community Based Services (HCBS).
• Age 21 or older, getting Medicaid through what are called “Social Security Exclusion programs” and meet program rules for income and asset levels.
• Age 21 or over residing in a nursing home and receiving Medicaid while in the nursing home.
• In the Medicaid for Breast and Cervical Cancer program.

Community First Health Plans serves STAR+PLUS Members who live in our service area.

Once you are approved, you will get a packet in the mail that tells you about the program and how to choose a health plan. After receiving the STAR+PLUS enrollment packet, you have 15 days to choose a health plan. If you don’t choose a health plan and primary care doctor, HHSC will choose for you.

Dual eligible means you have health coverage through both Medicare and Medicaid. When you join STAR+PLUS, you will pick a STAR+PLUS health plan and start getting Medicaid long-term services and support and service coordination through your health plan. STAR+PLUS does not change how you get your Medicare services. You can continue to get regular medical care from your Medicare doctor and providers or from a Medicare Advantage Plan.

Long-term services and supports (LTSS) are benefits that help you stay safe and independent in your home or community. LTSS help you with everyday needs like bathing, dressing, taking medicine, or preparing meals.

Community First STAR+PLUS Members are eligible to receive:

• Personal Attendant Services (PAS)

• Day Activity and Health Services (DAHS)

Long-term services and supports are part of a service plan created by you, your family, your doctor, other health care providers, and your health plan. Other people who are important in your life can also participate in your service planning if you want to invite them.

Every STAR+PLUS Member has their own Service Coordinator assigned to them. Service Coordination is a special service that helps Members manage their long-term service and supports and their physical, behavioral, and social care needs. Service Coordinators work with Members, work with Members, their caregivers, families, Legally Authorized Representatives (LAR), health care providers, plus social care and community organizations to build an individual service plan (ISP) to address those needs.

Service Coordinators work to ensure that STAR+PLUS Members receive all the health care and social services they need to live as comfortably as possible through their ISP. They provide personalized services to help our Members, including:

• Identifying unique health and social needs of Members.
• Ensuring timely and coordinated access to providers and services.
• Coordinating Medicaid benefits with non-Medicaid services and supports as needed.

Medicaid home and community-based services (HCBS) are types of person-centered care delivered in the home and community, rather than in an institution or facility. Learn more about HCBS by reading our Community First STAR+PLUS Member Handbook.

• Service Coordination
• Non-emergency medical transportation to doctor’s appointments, the pharmacy, or anywhere you get Medicaid services
• Vision and dental care
• 24/7 Nurse Advice Line
• Value-Added Services (extra health benefits), including:
  • Up to 8 hours of in-home respite care services per year
  • Gift card programs
  • Access to rapid response services
  • Transportation assistance to non-medical appointments
  • Seat attachment that fits on a walker
  •  Adult activity books
  • Exercise kit
  • Insulated insulin cooler bag and foot insoles

You can view a full list of STAR+PLUS Community First Value-Added Services here.

*Limitations and restrictions apply. For more information about Value-Added Services, please email healthyhelp@cfhp.com or call 210-358-6055.

If you go into a nursing facility, you will continue to receive your STAR+PLUS Medicaid benefits through Community First. To find a nursing facility close to you, view our STAR+PLUS Provider Directory. You can learn more about STAR+PLUS Nursing Facility benefits in our Nursing Facility Member Handbook.

If you’re enrolled in a STAR+PLUS Medicaid plan, you can choose to change your health plan at any time. Changes take between 15 to 45 days. If you would like to change your plan, you can call the Texas Enrollment Broker Helpline at 800-964-2777 or log into your Your Texas Benefits account.

If your current health plan is leaving your service area, you will have to pick a new plan to continue receiving your STAR+PLUS benefits. Health and Human Services (HHSC) will let you know if and when you need to choose a new plan and will send you a packet in the mail when it’s time to choose. The packet will include facts about each health plan available to you.

• If you don’t choose a health plan by July 1, 2024, HHSC will choose one for you. Check your mail for information from HHSC and respond accordingly.
• Visit YourTexasBenefits.com or call 211 to report any changes to your contact information, like your address or phone number.

For more information, visit CommunityFirstSTARPLUS.com or read the Community First STAR+PLUS Member Handbook.

Our Avenida Guadalupe Community Office located at 1410 Guadalupe Street, Ste 222 provides in-person assistance in both English and Spanish.  Walk-ins are welcome or you can make an appointment online. We can also help you in person at Morgan’s Multi-Assistance Center (MAC) by appointment only, or you can call STAR+PLUS Member Services toll free at
1-844-382-2347 (TTY 711).

Children from ages 0-18,* pregnant women, and some families in low-income households may be eligible for STAR. Eligibility depends on household (family) size, income, and citizenship status. Non-U.S. citizens who meet certain criteria can qualify for STAR coverage. Factors like immigration status, residency, and other circumstances help determine eligibility.

*Youth up to age 20 may be eligible in some cases.

There are no out-of-pocket costs for STAR coverage and health care. Children/families covered by STAR do not pay for eligible medical care or prescription benefits.

Community First STAR Medicaid Members are eligible for benefits including:

• Regular checkups and office visits.
• Prescription drugs and medical supplies.
• Dental and vision services.
• Vaccines.
• Mental health care.
• Hospital stays.

See the Community First STAR Member Handbook for more information.

Community First offers the value-added services for our STAR Members, including:*

• Gift cards for completing Texas Health Steps and our Community First health assessment.
• 24/7 Nurse Advice Line.
• Pregnancy support including labor, delivery, and postpartum education classes, gifts and gift cards for moms and babies, and breastfeeding support.
• No-cost sports and school physicals.
• Non-Emergency Medical Transportation.
• Health and Wellness programs for pregnant women and for Members with/at risk of diabetes, asthma, high blood pressure, mental health conditions, and weight loss.
• No-cost YMCA membership for Members who participate in YMCA programs.
• And much more!

You can view a full list of Community First STAR Value-Added Services.

*Limitations or restrictions may apply. Please call 210-358-6055 or email healthyhelp@cfhp.com to see if you qualify for specific value-added services.

Regular checkups and shots keep your children healthy. You can go to any Texas Health Steps doctor without a referral. To find a Texas Health Steps doctor near you, call us at 1-800-434-2347 or use our Find a Provider tool.

For more information, visit Texas Health Steps.

For family planning services, you can go to any Provider that accepts Medicaid. You do not need a referral from your primary care provider (PCP). You should also talk to your PCP about family planning. You can also call Member Services at 1-800-434-2347.

You can also find family planning providers near you online at HealthyTexasWomen.org/Healthcare-Programs/Family-Planning-Program

Call Member Services at 1-800-434-2347 or use our Find a Provider tool to find a behavioral or mental health provider or support for alcohol or substance use disorders. You do not need a referral.

For urgent problems, call the Community First Behavioral Health Hotline at 1-877-221-2226 for help 24 hours a day, seven days a week.

For a suicidal, substance use, and/or mental health crisis, call or text the 988 Suicide & Crisis Lifeline or go to the nearest emergency room.

Medicaid pays for most medicine that your doctor says you or your child will need. Your doctor will write a prescription for you to take to the pharmacy or send it for you. If you need help finding a pharmacy, please call Member Services at 1-800-434-2347 or use the Pharmacy Locator.

For more information, visit CommunityFirstSTARMedicaid.com or read the Community First STAR Member Handbook.

Our Avenida Guadalupe Community Office located at 1410 Guadalupe Street, Ste 222 provides in-person assistance in both English and Spanish. Walk-ins are welcome. You can also make an appointment online or call STAR Member Services toll free at 1-800-434-2347.

Individuals who are 20 or younger, covered by Medicaid, and meet at least one of the following can apply for STAR Kids:

• Receive Supplemental Security Income (SSI).

• Receive Medicaid and Medicare.

• Live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility.

• Receive services through the Medically Dependent Children Program (MDCP) waiver.

• Receive services through the Youth Empowerment Services (YES) waiver.

• Receive services through any of the following intellectual and developmental disability (IDD) waiver programs:

• Community Living Assistance and Support Services (CLASS)

• Deaf Blind with Multiple Disabilities (DBMD)

• Home and Community-based Services (HCS)

• Texas Home Living (TxHmL)

Dual eligible means you have health coverage through both Medicare and Medicaid. When you join STAR+PLUS, you will pick a STAR+PLUS health plan and start getting Medicaid long-term services and support and service coordination through your health plan. STAR+PLUS does not change how you get your Medicare services. You can continue to get regular medical care from your Medicare doctor and providers or from a Medicare Advantage Plan.

Long-term services and supports (LTSS) are benefits that help you stay safe and independent in your home or community. LTSS help you with everyday needs like bathing, dressing, taking medicine, or preparing meals.

STAR Kids Members with an assessed need for LTSS may receive:

• Day Activity Health Services (DAHS)

• Personal Care Services (PCS)

• Prescribed Pediatric Extended Care Center (PECC)

• Private Duty Nursing (PDN)

STAR Kids Members with an assessed need for institutional level of care (LOC) may receive:

• Personal Assistant Services (PAS)

• Habilitation

• Emergency Response Services (ERS)

• Support Management

Every STAR Kids Member has their own Service Coordinator assigned to them. Service Coordination is a special service that helps Members manage their long-term service and supports and their physical, behavioral, and social care needs. Service Coordinators work with Members, their caregivers, families, Legally Authorized Representatives (LAR), health care providers, plus social care and community organizations to build an individual service plan (ISP) to address those needs.

Service Coordinators work to ensure that STAR Kids Members receive all the health care and social services they need to live as comfortably as possible through their ISP. They provide personalized services to help our Members, including:

• Identifying unique health and social needs of Members.
• Ensuring timely and coordinated access to providers and services.
• Coordinating Medicaid benefits with non-Medicaid services and supports as needed.

The SK-SAI is a tool used to create a detailed care plan for your child, including what level of care (LOC) they need and which LTSS they are eligible for. This care plan is called an Individual Service Plan (ISP).

A Community First STAR Kids Service Coordinator will schedule a good time to meet with you and complete the assessment. The assessment can be done in your home or at another location of your choice. Then, together with your Service Coordinator, you will determine which services are right for your child.

STAR Kids Members in the MDCP are eligible for additional services as an alternative to living in a nursing facility. Even if your child receives some of the additional services from MDCP, they are still eligible for other LTSS that are part of the STAR Kids program.

Here are some of the additional services STAR Kids Members in the MDCP can receive:

• Adaptive aids.
• Employment assistance.
• Financial management.
• Flexible family support.
• Minor home modifications.
• Respite care.
• Transition assistance.
• Supported employment.

There are no out-of-pocket costs for STAR Kids coverage and health care. Children/young adults covered by STAR Kids do not pay for eligible medical care or prescription benefits.

Community First STAR Kids Medicaid Members are eligible for benefits including:

• Regular checkups and office visits.

• Prescription drugs and medical supplies.

• Dental and vision services.

• Vaccines.

• Mental health care.

• Hospital stays.

• Case Management.

• Long Term Services and Supports.

• Transportation to doctors appointments.

See the Community First STAR Kids Member Handbook for more information.

Community First offers the value-added services for our STAR Kids Members, including:*

• In-home respite care.
• An allowance for camp or specialized therapy.
• Gift cards for completing Texas Health Steps and our Community First health assessment.
• 24/7 Nurse Advice Line.
• Pregnancy support including labor, delivery, and postpartum education classes, gifts and gift cards for moms and babies, and breastfeeding support.
• No-cost sports and school physicals.
• Non-Emergency Medical Transportation.
• Health and Wellness programs for pregnant women and for Members with/at risk of diabetes, asthma, high blood pressure, mental health conditions, and weight loss.
• No-cost YMCA membership for Members who participate in YMCA programs.
• And much more!

You can view a full list of STAR Kids Value-Added Services here.

*Limitations or restrictions may apply. Please call 210-358-6055 or email healthyhelp@cfhp.com to see if you qualify for specific value-added services.

Regular checkups and shots keep your children healthy. You can go to any Texas Health Steps doctor without a referral. To find a Texas Health Steps doctor near you, call us at 1-855-607-7827 or use our Find a Provider tool.

For more information about Texas Health Steps, see the Community First STAR Kids Member Handbook.

Medicaid pays for most medicine that your doctor says you or your child will need. Your doctor will write a prescription for you to take to the pharmacy or send it for you. If you need help finding a pharmacy, please call Member Services at 1-855-607-7827 or visit CommunityFirstMedicaid.com to use the Pharmacy Locator.

For family planning services, you can go to any Provider that accepts Medicaid. You do not need a referral from your primary care provider (PCP). You should also talk to your PCP about family planning. You can also call Member Services at 1-855-607-7827 (TTY 711).

You can also find family planning providers near you online at HealthyTexasWomen.org/Healthcare-Programs/Family-Planning-Program

Call Member Services at 1-855-607-7827 or use our Find a Provider tool to find a behavioral or mental health provider or support for alcohol or substance use disorders. You do not need a referral.

For urgent problems, call the Community First Behavioral Health Hotline at 1-844-541-2347 for help 24 hours a day, seven days a week.

For a suicidal, substance use, and/or mental health crisis, call or text the 988 Suicide & Crisis Lifeline or go to the nearest emergency room.

For more information, visit CommunityFirstSTARKids.com or read the Community First STAR Kids Member Handbook.

Our Avenida Guadalupe Community Office located at 1410 Guadalupe Street, Ste 222 provides in-person assistance in both English and Spanish.  Walk-ins are welcome or you can make an appointment online. We can also help you in person at Morgan’s Multi-Assistance Center (MAC) by appointment only, or you can call STAR Kids Member Services toll free at
1-855-607-7827.

CHIP Perinatal covers qualifying pregnant women during their pregnancy and their unborn baby. CHIP Perinatal also covers two postpartum checkups within the first 60 days after the baby is born. Most women who have CHIP Perinatal change to a Medicaid plan after they have their baby.

Babies who are born to pregnant women covered by CHIP Perinatal are automatically eligible for Medicaid or CHIP, without an application or further determination of eligibility. This CHIP Perinatal Newborn coverage will remain active for the infants until they turn one year old.

If your child is eligible for CHIP or if you are pregnant and qualify, your enrollment fee and copays will be based on your family income. For more information about copays, see the Community First CHIP/CHIP Perinatal Member Handbook. There are no copayments required for CHIP Perinatal Members.

Children in the CHIP program can get benefits like:

• Regular checkups with the doctor and dentist.
• Prescription drugs and vaccines.
• Hospital care and services.
• X-rays and lab tests.
• Vision and hearing care.
• Access to medical specialists and mental health care.
• Treatment of special health needs and pre-existing conditions.

Pregnant women in the CHIP Perinatal program can get benefits like:

• Prenatal doctor visits.
• Prescription drug coverage, including prescription prenatal vitamins.
• Labor and delivery.
• Two postpartum visits.
• Checkups and other benefits for the baby after leaving the hospital.

You can get well-child checkup services from your main doctor. You can find their name and phone number on your Community First Member ID card. It’s important to take your child to get their checkup every year.

CHIP pays for most medicine that your doctor says you need or your child needs. Your doctor will write a prescription for you to take to the pharmacy or send it in for you. You may have to pay a copay for some medicines. 

If you need help finding a pharmacy, please call Member Services at 1-800-434-2347 or visit CommunityFirstMedicaid.com to use the Pharmacy Locator.

Community First offers the value-added services for our CHIP Members, including:*

• Gift cards and a toddler booster seat for children current with their CHIP Well-Child Checkups.
• Gift cards for children who get specific recommended immunizations.
• Gift cards for Members with asthma and diabetes who complete required education and screenings.
• 24/7 Nurse Advice Line.
• Low-cost dental and vision benefits.
• Transportation help.
• Health and Wellness programs for Members with/at risk of diabetes, asthma, high blood pressure, mental health conditions, and weight loss.
• No-cost YMCA membership for Members who participate in YMCA health and wellness programs.
• And much more!

You can view a full list of CHIP Value-Added Services here.

*Limitations or restrictions may apply. Please call 210-358-6055 or email healthyhelp@cfhp.com to see if you qualify for specific value-added services.

Community First offers the following value-added services (extra benefits) for our CHIP Perinatal Members, including:*

• Gift cards for completing prenatal visits.
• Mommy & Me Baby Shower with gifts, including a pack & play, infant car seat, diaper bag filled with baby items, and more.
• Opportunity to join our Maternal Community Health Club with gifts, including baby and self-care items.
• 24/7 Nurse Advice Line.
• Transportation help.
• Health and Wellness programs for Members with/at risk of diabetes, asthma, high blood pressure, mental health conditions, and weight loss.
• And much more!

You can view a full list of CHIP Perintal Value-Added Services here.

*Limitations or restrictions may apply. Please call 210-358-6055 or email healthyhelp@cfhp.com to see if you qualify for specific value-added services.

For more information, visit CommunityFirstCHIP.com or read the Community First CHIP/CHIP Perinatal Member Handbook.

Our Avenida Guadalupe Community Office located at 1410 Guadalupe Street, Ste 222 provides in-person assistance in both English and Spanish. Walk-ins are welcome. You can also make an appointment online or call CHIP Member Services toll free at 1-800-434-2347.

To apply for Medicaid (STAR, STAR Kids, STAR+PLUS, or CHIP), go to YourTexasBenefits.com or call 211. You can also refer to this helpful Step-by-Step Guide.

Community First can also help you with your application. Our staff speaks English and Spanish, and we offer free interpreter services for other languages. We can help over the phone or in person. Schedule an appointment here.

The Community First Member Advisory Group is made up of STAR and CHIP Members and their parents/guardians who live and work throughout our service area. They provide valuable insight and help us best meet our Members’ needs. Member Advisory Group meetings give you the opportunity to learn about the benefits and services you receive from Community First and a safe space to share your thoughts and ideas about your health plan. If you are interested in learning about how you can participate, call 1-800-434-2347.

Community First is currently seeking STAR Kids Members and/or their parents, guardians, or representatives to participate on our STAR Kids Member Advisory Committee (SK MAC). This committee is dedicated to providing an opportunity for STAR Kids families to share how they feel about and what they expect from their health plan. If you would like to participate, please call 1-855-607-7827.

If you would like to change your plan, call the Texas Enrollment Broker Helpline at 1-800-964-2777 or log into your Your Texas Benefits account.

All new Community First Medicaid Members will receive a New Member Guide, your Community First Member ID card, and a Member Handbook in the mail. Read your Member Handbook to find out more about your health plan and benefits. As soon as you receive your Member ID card, you can also create a Community First Member Portal account.

As a Member of our plan, you will choose a main doctor, called a primary care provider (PCP).* If you don’t choose one, one will be assigned to you. You can use our Find a Provider tool to find a PCP. Your PCP will provide regular checkups and vaccines and monitor any health conditions or risks. They can also refer you or your child for specialty care as needed. If you need help choosing one, call Community First Member Services at the number on the back of your ID card.

*Dual eligible Members (Members who have both Medicaid and Medicare) will not be assigned a PCP.

A Member Services Representative can help you choose a new primary care provider (PCP). Call Member Services toll-free at the number on the back of your Member ID card. You can also submit a request to change your PCP through our secure Community First Member Portal.

Your PCP can refer you or your child to a specialist for specialty care. 

You do not need a referral for the services listed below.

• Behavioral (mental) health services

• Women’s health services (OB/GYN care)

• Pregnancy and delivery services

• Eye exams for all Members

• Texas Health Steps checkups from any Medicaid provider

• Family planning services from any Medicaid provider

Community First partners with Envolve to provide routine eye care services to our Members. You can call Member Services for help finding an Envolve provider near you or go to VisionBenefits.EnvolveHealth.com.

Routine dental services, including services that help prevent tooth decay and services that fix dental problems, are provided by DentaQuest, MCNA Dental, or United Healthcare Dental. You may pick the Dental Maintenance Organization (DMO) of your choice.

DentaQuest: 1-800-516-0165
MCNA Dental: 1-855-691-6262
United Healthcare Dental: 1-877-901-7321

You can also call Member Services for help making a routine dental appointment or for more information.

We want to help. If you have a complaint, please call us toll-free at 1-800-434-2347 to tell us about your problem. A Community First Member Services Representative can help you file a complaint. You can also submit a complaint by sending a message through our secure Member Portal. Most of the time, we can help you right away or within a few days.

Once you have gone through the Community First complaint process, you can file a complaint to the Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989. If you would like to make your complaint in writing, please send it to this address:

Texas Health and Human Services Commission
Ombudsman Managed Care Assistance Team
P.O. Box 13247
Austin, TX 78711-3247

If you can get on the Internet, you can submit your complaint at HHS.Texas.gov/Managed-Care-Help.