FirstCare STAR Program
Welcome to FirstCare STAR
Our goal is to give you quality care and a great network of doctors, specialists and hospitals. STAR members receive Medicaid health care benefits, including Texas Health Steps (THSteps) medical and dental checkups.For more details, call THSteps toll-free at 877-847-8377 or visit the THSteps website.
If you are not a member and you have questions about Medicaid, visit yourtexasbenefits.com to learn more. For help with choosing a Medicaid plan, call the STAR helpline at 800-964-2777, 8 a.m. to 6 p.m. weekdays. TTY users call 800-735-2989.
What is STAR?
STAR is a Medicaid program for low-income families, children and pregnant women. When you join STAR, you pick a primary care provider (PCP) to manage your health care and treatment. You can pick any PCP in FirstCare’s STAR network. Your PCP can be a family doctor, general practitioner, obstetrician/gynecologist, internist, pediatrician or a clinic.
Star Income Guidelines
Family Members (Adults & Children) |
Monthly Family Income |
1 |
$1,354 |
2 |
$2,034 |
3 |
$2,559 |
4 |
$3,083 |
5 |
$3,607 |
6 |
$4,132 |
7 |
$4,656 |
8 |
$5,180 |
For each additional person, add: |
$525 |
How to Choose a Primary Care Provider
Your Primary Care Provider (PCP) must be a FirstCare STAR provider. To find a participating provider, you can do one of the following:
- Search our Online Provider Directory.
- Search the FirstCare STAR Provider Directory:
- Call FirstCare STAR Customer Service at 800-431-7798.
When you fill out your Enrollment Form, list the PCP you have chosen. There is a space on the form for the name and provider number. Your PCP will be the doctor in charge of your health care. Visiting the same doctor for checkups and when you are sick can help your doctor keep an eye on your health. You can go to a family planning, OB/GYN, behavioral health, and/or other health care provider. You do not need a referral by a PCP.
For additional assistance with scheduling an appointment or finding a Provider, call FirstCare STAR Customer Service at 800-431-7798. Members with hearing loss can call the Relay Texas number 711. Relay Texas is a free telephone interpreting service to help people with hearing or speech disabilities.
Did you know you can change your primary care doctor on our member portal?
You can choose a new doctor or OB/Gyn in the portal anytime with a few easy clicks. To get started:
- Log into the portal
- Click View/Edit My Info
- Click My Providers
- Choose your new doctor and effective date
STAR Benefits
Below is a list of some of the health benefits you get with STAR:
- Unlimited prescriptions
- Doctor and clinic visits
- X-rays and lab tests
- Emergency and hospital care
- Eye exams and glasses
- Medical supplies and equipment
- Care for mental health, drug, or alcohol problems
- Family planning counseling and education
- Pregnancy and childbirth care
- Speech therapy
- Occupational therapy
How do I access covered services?
What should I do if I have an emergency?
To access covered services, call FirstCare STAR Customer Service at 800-431-7798.If you are having an emergency and need immediate medical care, go to the nearest Emergency Room (ER) or call 911. If you do not have life threatening injuries or symptoms or do not need immediate medical care, call your PCP first. Your doctor can help you and give you advice.
Nonemergency Medical Transportation (NEMT)
- We can help you or your child get a ride, at no cost, to the doctor, hospital, dentist, and drugstore.
- Call us 48 hours before at 833-779-3105 (TTY 711) or download the Access2Care (A2C) app.
How do I replace my ID card if it is lost or stolen?
If you need to replace your ID cards, call FirstCare Customer Service toll-free at 800-431-7798 and we can assist you.
Member Portal
FirstCare members have access to our online Member Portal.Here, you can look up your claims, view your benefits and find important plandocuments.
Member Portal
Frequently Asked Questions about Medicaid Transition
I received a letter that my Medicaid changed (or may change), what does this mean?
- Starting February 2021, the Texas Health and Human Services Commission (HHSC) will transition Medicaid clients to the appropriate type of Medicaid coverage on an ongoing basis when there is an identified change in circumstance.
- If HHSC receives information that your household has a change in circumstances (such as income, expenses, people in the household, etc.) they will move you to the appropriate type of Medicaid coverage based on the eligibility criteria your household meets.
- This does not necessarily mean you will have a reduction in coverage.
- Review the notice for any requests to take action. If the letter is asking for you to take any action, please comply with this request as soon as possible.
I received a letter that I need to select a new health plan, what does this mean?
Ask you received an actual enrollment form or alert via text/E-mail to select a new plan HHSC will send you either a separate enrollment form if it is determined that you need to pick a new health plan. If this is necessary, you should receive this request within 15 calendar days of the date on the TF0001 Notice about your case.
You received notice to select a new health plan.
- HHSC has determined that your new Medicaid program requires you to pick a health plan.
- If you know what plan you want to pick, go ahead and do so and return the form.
- If you need further assistance, HHSC Managed Care can assist. Managed Care hours of operations are 8 a.m. to 6 p.m. CT weekdays.
What might make HHSC change my type of Medicaid?
- HHSC looks at the following information to determine what the appropriate type of Medicaid is for the client:
- Renewal applications.
- Reported changes.
- Information received from other agencies, such as the Social Security Administration.
Will I continue to keep my Medicaid during COVID?
- Yes, Medicaid coverage will continue for anyone who has coverage during the federal declared public health emergency. The only exceptions could be:
- Clients who move out of Texas.
- Clients who voluntarily leave/withdraw from Medicaid.
- Deceased clients.
- However, if you have received a notice that you are no longer eligible for Medicaid, your coverage may end at the end of the public health emergency.
- Clients may receive notice on their TF0001 that their Medicaid eligibility/coverage will end with the public health emergency ends.
- This will happen for one of the following reasons:
- The household failed to respond to a request from HHSC like a renewal packet or H1020 Request for Missing Information, or
- HHSC received information via a renewal packet, reported change, or from another agency that indicates the household no longer meets the eligibility requirements.
Could my Medicaid or Health Plan change during COVID?
- Yes, If HHSC receives information that a client no longer meets the criteria for their current type of Medicaid coverage, but
- DOES meet the criteria for a different type of Medicaid coverage, they will be moved to that type of Medicaid coverage, if it provides the same (or a better) level of coverage.
- DOES NOT meet the criteria for any other type of Medicaid coverage, they will continue in their same type of Medicaid coverage until the federally-declared public health emergency ends or federal guidance changes.
- The only exceptions are Healthy Texas Women (HTW), Community Attendant Services (CAS), and CHIP.
- Medicaid clients will not be transitioned to any of these programs from another health care program during the public health emergency.
Prior Authorization
Prior authorization is sometimes called pre-certification or pre-notification. Prior authorization verifies whether medical treatment that is not an emergency is medically necessary. It also determines if the treatment matches the diagnosis and that the requested services will be provided in an appropriate setting. During prior authorization, Baylor will also verify if the Member has benefits.
Prior authorization DOES NOT guarantee payment. Even if a Provider obtained the required prior authorization, Baylor must still process a Providers claim to determine if payment will be made. The claim is processed according to:
- Eligibility
- Contract limitations
- Benefit coverage guidelines
- Applicable State or Federal requirements
- National Correct Coding Initiative (NCCI) edits
- Texas Medicaid Provider Procedures Manual (TMPPM)
- Other program requirements, as applicable
Prior Authorization Requests: Essential Information & Supporting Clinical Documentation
Providers must submit the Prior Authorization Request Form. The form must include the following information to initiate the prior authorization review process:
- Member name
- Member date of birth
- Member number
- Requesting provider name
- Requesting providers National Provider Identifier (NPI)
- Rendering providers name
- Service requested:
- Current Procedural Terminology (CPT)
- Healthcare Common Procedure Coding System (HCPCS)
- Current Dental Terminology (CDT)
- Service requested start and end date(s)
- Quantity of service units requested based on the CPT, HCPCS, or CDT requested
- Requesting Providers Dated Signature
Please note any prior authorization requests missing essential information will not be processed and a new request will need to be submitted. To avoid delays in authorization or administrative denials, Providers are encouraged to submit sufficient documentation to validate the medical necessity for the services being requested. This may include, current progress notes, history and physical, radiology or laboratory results, consult notes/reports, treatment plans showing progress to goals (e.g. therapy requests), or similar medical record documentation to illustrate medical necessity.
Supporting Clinical Documentation
Lack of Information
When BSWH receives a request for prior authorization and the request does not contain complete clinical documentation and/or information:
- BSWH will notify the Member by letter that an authorization request was received but cannot be acted upon until BSWH receives the missing documentation/information from the requesting Provider. The letter will include the following information:
- A statement that BSHW has reviewed the PA request and is unable to make a decision about the requested services without the submission of additional information.
- A clear and specific list and description of missing/incomplete/incorrect information or documentation that must be submitted in order to consider the request complete.
- Timeline for the provider to submit the missing information.
- Contact information and modes of communication for provider inquiry if necessary.
- BSWH will contact Provider via fax or phone and request documentation for completion of the medical necessity review within three business days of BSWH receipt of request (where applicable).
- If BSWH does not receive the documentation/information by the end of the third business day of our request to the requesting Provider, the request will be submitted to the Medical Director no later than the seventh business day after receipt of request (where applicable).
- BSWH will render a decision no later than the tenth business day after the request received date.
Filing a Complaint
If you receive benefits through Medicaid’s STAR, STAR+PLUS, STAR Health or STAR Kids Program, call your medical or dental plan first. If you don’t get the help you need there, you should do one of the following:
- Call the Medicaid Managed Care Helpline at 866-566-8989 (toll free).
- Online: hhs.texas.gov/about-hhs/your-rights/hhs-office-ombudsman
- Mail:Texas Health and Human Services Commission
Office of the Ombudsman, MC H-700
P.O. Box 13247
Austin, TX 78711-3247
- Fax: 888-780-8099 (toll-free)
Mindoula
Behavioral Health Tool
Who qualifies?
Active FirstCare STAR members qualify based on certain conditions. Mindoula will reach out to you if you qualify.
How can Mindoula help?
Mindoula is a behavioral health management vendor that provides tech-enabled (digital) 24/7 case/care management and psychiatric support to members with behavioral health challenges and multiple medical needs.
Programs provided via Mindoula:
- Interpersonal Violence Reduction Program (IVRP)
- Suicide Prevention Program (SPP)
- SUD (Substance Use Disorder) Exposed Pregnancy (SEPP)
- Substance Exposed Living Program (SELP)