UPDATED 9/3/2025: This news post has been edited to reflect updated guidance from HHSC. The information below applies to all Texas Medicaid clients impacted by the 2025 Texas flooding regardless of whether the clients are permanent residents of a declared disaster county. This guidance is effective from July 2, 2025, through Sept. 29, 2025.
The Texas Health and Human Services Commission (HHSC) is giving Members more time to act on certain health plan requests if you or your family were affected by the 2025 Texas flooding. This includes extra time to ask for an appeal or to keep getting services that were denied or set to stop.
What has changed?
Normally, if Community First Health Plans says it will stop or deny a service (called an “adverse benefit determination”), you have 60 days to ask for an appeal and 10 days to ask to keep getting services during your appeal (this is called continuation of benefits).
Due to the floods, Members now have:
- 90 days to ask for an appeal after receiving an adverse benefit determination from Community First Health Plans.
- 30 days to request continuation of benefits after receiving an adverse benefit determination (denial) from Community First Health Plans.
These changes apply to requests received between July 2, 2025, and September 29, 2025.
Who qualifies?
These new timelines apply to Community First STAR, STAR Kids, STAR+PLUS, and CHIP Members.
Members must include in the appeal and continuation of benefits request that the need for extra time is a result of the 2025 Texas flooding.
Need help?
If you need help or have questions about this notice, please call Community First Health Plans Member Services at:
- STAR/CHIP: 1-800-434-2347
- STAR Kids/STAR+PLUS: 1-855-607-7827