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.

To apply, go to YourTexasBenefits.com or call 2-1-1. 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.

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.

Dually eligible people have health coverage through both Medicare and Medicaid. Community First will coordinate the care you receive. 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.

When you join STAR+PLUS, you will pick a STAR+PLUS health plan and start getting Medicaid long-term services and support through your health 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.

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 CommunityFirst 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

Limitations and restrictions apply. For more information about Value-Added Services, please call 210-358-6055. You can view a full list of Community First Value-Added Services here.

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 or, 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 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 2-1-1 to report any changes to your contact information, like your address or phone number

For more information, visit CommunityFirstSTARPLUS.com.

Our Avenida Guadalupe Community Office also provides in-person assistance in both English and Spanish. Walk-ins are welcome. We can also help you in person at Morgan’s Multi-Assistance Center (MAC) by appointment only or in the comfort of your own home. Please fill out this form or call 210-358-6105. You can also call Community First STAR+PLUS Member Services 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.

To apply, 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.

Once you are approved, you will receive a packet in the mail that tells you about the program and how to choose a health plan. After receiving the STAR enrollment packet, you will choose a health plan in your service area. Our service area includes Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, and Wilson counties.

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!

Limitations and restrictions apply. For more information about Value-Added Services, please call 210-358-6055. See a full list of Community First Value-Added Services for STAR here.

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 1-800-434-2347.

A Member Services Representative can help you choose a new primary care provider. Call Member Services toll-free at 1-800-434-2347. You can also submit a request to change your PCP at CommunityFirstSTARMedicaid.com through our secure Member Portal.

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 TXHealthSteps.com.

For family planning services, you can go to any Provider that accepts Medicaid. You do not need a referral from your primary care provider. 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 a mental health crisis, call or text the 988 Suicide & Crisis Lifeline or go to the nearest emergency room.

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

These specialists do not need a referral:

• Behavioral health services

• Pregnancy and delivery services

• Eye exams for all Members

• Glasses for Members under 21 years of age

• 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 at 1-800-434-2347 for help finding an Envolve provider near you or go to VisionBenefits.EnvolveHealth.com.

Medicaid pays for most medicine that your doctor says you or your child 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.

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.

For more information, visit CommunityFirstSTARMedicaid.com.

Our Avenida Guadalupe Community Office also provides in-person assistance in both English and Spanish. Walk-ins are welcome. We can also help you in person in the comfort of your own home. Please fill out this form or call 210-358-6105. You can also call Community First STAR Member Services at 1-800-434-2347.

You can get well-child checkup services from your main doctor, also called your primary care provider (PCP). You can find your PCP’s information on your Community First Member ID card. It’s important to take your child to get their checkup every year.

As a valued Community First Member, we want to hear from you. 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.

The Community First Member Advisory Group is made up of STAR and CHIP Members and their parents/guardians. They work in social services, schools, and community agencies and live throughout our service area. The Member Advisory Group provides valuable insight and helps Community First best meet the needs of our membership. If you are interested in learning about how you can participate, call 1-800-434-2347 (STAR/CHIP).

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 (STAR Kids).

We have different helplines, depending on your plan. Visit our Contact Us page for phone numbers and hours. 

You can also log in to your Member Portal an time to view or request a new Member ID card, update your contact information, change your primary care provider, and more.