Frequently asked questions

Medicaid is a program that provides health care for millions of Americans. In Texas, it’s called STAR. It covers low-income adults, children, pregnant women and people with disabilities. If you qualify, you can get coverage for things like:

• Preventive care 

• Vision care

• Dental care

• Medications 

• Disease management

• Behavioral health services 

What is STAR?

STAR is Medicaid coverage for kids, newborns, pregnant women and some families.

What is STAR Kids?

STAR Kids is Medicaid coverage for kids and adults ages 20 or younger who have disabilities.  

More questions and answers about STAR Kids English (PDF) | Spanish (PDF)

What are CHIP and CHIP Perinatal?

CHIP offers coverage for families that earn too much money to use Medicaid, but can’t afford to buy private health insurance. CHIP Perinatal offers coverage for mothers-to-be.  

Find out if you qualify

Before you can get coverage, be sure you qualify for Medicaid or CHIP.

If you qualify, you can choose Aetna Better Health as your health plan in your Medicaid application.

You can also read the answers to 10 common questions about qualifying for Medicaid.

Learn more about how to enroll

Yes. To keep your coverage, you must renew every year.

Learn more about how to renew your coverage

We want you to be happy with the care you get. So if you’re ever unhappy with your health plan or a provider, you can file a complaint. Or you can file an appeal if we deny, delay or change a service. If you don’t agree with the decision on your appeal, you can ask for an external medical review or state fair hearing.

Learn more about filing a complaint or an appeal

Tell us. You have the right to report anyone you believe is committing fraud or abusing the Medicaid system. You can use this form to report fraud or abuse. Your identity and contact info will be kept private to the extent the law allows. 

Learn more about fraud or abuse

You’ll find your health plan summary and benefits info in your member handbook or on your Member Portal. 

Log in to the Member Portal

You can also check your specific plan online:

STAR

STAR is Medicaid coverage for kids, newborns, pregnant women and some families. 

STAR Kids 

STAR Kids is Medicaid coverage for kids and adults ages 20 or younger who have disabilities.  

More questions and answers about STAR Kids English (PDF) | Spanish (PDF)

CHIP and CHIP Perinatal 

CHIP offers coverage for families that earn too much money to use Medicaid, but can’t afford to buy private health insurance. CHIP Perinatal offers coverage for mothers-to-be.  

We have different helplines, depending on your plan and where you live. Just visit our contact us page for hours, services and service areas. 

You can also log in to your Member Portal.

Just log in to your Member Portal to ask for a new ID card. Or contact us.

Your PCP is a medical provider who will manage your health care. They’re the doctor, nurse or clinic that provides your main health care. They’ll help you get all the covered services you need.

You can change your PCP through your Member Portal. Or just contact us.

You can also learn more about choosing a PCP.

Log in to the Member Portal

Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal.

Log in to the Member Portal

Specialists are providers who treat specific conditions. Your PCP might refer you to a specialist in our network or recommend you see one. You don’t need a referral to see a specialist.

Need help finding a specialist? Just contact us.

Find a specialist near you

You can find providers for the health care services you need. 

Find a provider

Whether it’s day or night, your PCP or on-call provider can tell you what to do. If they’re not in the office, leave a message. They’ll return your call. Your provider must see you within 24 hours if you need urgent care.

If you're having an emergency, call 911 or go to the closest hospital.

You’ll only need emergency care if you think your health is in serious danger. Emergencies may include:

• Severe pain
• Serious injury
• Sudden illness
• Illness that is quickly getting much worse
• Heavy bleeding that doesn’t stop, especially if you’re pregnant

If it’s not an emergency, but you need medical advice, try calling your PCP. You can leave a message with the answering service. A provider on call will return your call.

Still not sure what to do? You can also contact us. When prompted on the phone, say, “nurse line.” A nurse can help you decide if you need to go to the ER or urgent care.

STAR

• 1-800-248-7767 (TTY: 711) for Bexar service area
• 1-800-306-8612 (TTY: 711) for Tarrant service area

STAR Kids

• 1-844-STRKIDS (1-844-787-5437) (TTY: 711) for Tarrant and Dallas service areas

CHIP and CHIP Perinatal

• 1-866-818-0959 (TTY: 711) for Bexar service area
• 1-800-245-5380 (TTY: 711) for Tarrant service area

Find the closest hospital

Check out some of these articles to learn more about getting the right care at the right time:

• Is it an emergency?
• Where to go for quick medical care

If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency for all members. 

Need a ride to your normal doctor visits? You can get help with rides to medical services we cover. We work with Access2Care to provide rides for your nonemergency medical needs. You can get a ride for visits to your:

• Provider 
• Dental provider
• Pharmacy
• Behavioral health care provider 

Learn more about covered rides

If you’re out of the area and have an emergency, go to the closest hospital or call 911. The hospital doesn’t have to be in our network for you to get care.

We work with many hospitals. You can use the provider search tool to find a hospital. Or you can contact us for help.

Pregnant women need special care. You should see a provider within three weeks of a positive pregnancy test (home or lab). We can help with pregnancy care. Just contact us as soon as you can.

You can also visit our health and wellness library to learn more about pregnancy, women’s health and other topics to help keep you healthy.

Learn about Healthy Texas Women

Learn about women’s health from the Centers for Disease Control

You’ll want to make sure your baby has medical coverage. If you don’t have insurance when your baby is born, you’ll want to enroll them in Texas Medicaid. Just contact the Department of State Health Services (DSHS) as soon as possible. Call 1-888-963-7111 (TTY: 711) Monday to Friday, 8 AM to 5 PM. Then, your baby can get an ID number and be eligible for benefits. 

If you have questions or need help, just contact us.

Learn about rewards for pregnancy and birth care

If you are breastfeeding or would like to, we can help. Visit https://book.nestcollaborative.com/2?partner=abh

WIC phone lines may be busy. WIC has made changes to how you can use your WIC card. You can also check their website for new formula types and can sizes to meet your baby's needs. Visit https://texaswic.org/about-wic/special-wic-food-updates

Do not mix formula differently to make it last longer. Follow the directions on the can or bottle. Talk to a doctor before you change how you make your baby's formula

Some formula was stopped by the formula maker (recalled). Some names are Similac, Alimentum, and EleCare. You should check to see if the formula you have is safe to use. If you have questions you can contact the formula make (Similacrecall.com)

You may get your formula delivered by a company. If you having problems, please contact them or let us know. We have changed our rules to make it easier for you to get a different formula. 

Referrrals

A referral is an approval from your PCP for you to get covered specialty care and follow-up treatment. You don’t need a referral to see in-network providers for routine and preventive health care services. You don’t need a referral to see a specialist, either.

PA

You do need PA for some health care services, supplies and medications before you get them. We use nationally recognized guidelines to make PA decisions about care your provider suggests.

Your provider must check to see if your service requires PA before they provide it. To ask for the current PA list, just contact us.

Learn more about PA

PA timelines

We review pharmacy requests and make a decision within:

• 24 hours for STAR and STAR Kids members
• 3 business days for CHIP and CHIP Perinatal members

You can learn more about PA timelines.

A PDL is a state-run list of medications that a health plan covers. These medications treat a variety of conditions.

Learn more on our pharmacy benefits page

You can ask your provider:

• To give you a similar medication that is preferred on the list
• To get prior authorization (PA) to cover this medication if they think it’s necessary to treat your medical condition

First, your provider will contact us. Then, our pharmacy staff will review the info your provider gave us. Finally, we’ll make a decision. 

Some health care services and supplies need approval before you can get them. We follow nationally recognized guidelines to make these decisions. Not sure if a service needs PA? Just contact us for the most current PA list. Before providing a service, your provider should check the list. It may change from time to time. 

We work with the state to set quantity limits for different reasons. Some medications have a maximum limit or dose for safety reasons. Our clinical staff sets the limits based on proven standards of care, such as the Food and Drug Administration (FDA) guidelines. In some cases, we make exceptions. Have your provider contact us if you need an exception. We’ll review the info from your provider and make a decision.

These types of medications aren’t covered on the PDL:

• Cosmetic 

• Hair growth

• Infertility or erectile dysfunction 

• Experimental or investigational 

We know you have lots of questions about COVID-19. We’re here to support you with answers. Just check these resources to learn more:

COVID-19 FAQ page for Medicaid and Medicare members

Member COVID-19 vaccine key messages (PDF)

Medicaid COVID-19 FAQs (PDF)

COVID-19 vaccine info from the Texas Department of State Health Services

COVID-19 Testing Location Resources

Staying active is one of the best things you can do for your health. It can:

• Give you more energy
• Help you feel better
• Prevent some health problems that go along with aging

Some physical activity is better than none at all. But check with your doctor before you start — just to be sure it’s safe. Want to learn more about staying active? 

Learn more about exercise from the Centers for Disease Control and Prevention

Want to hear more about health goals, info and coaching? Just visit your Member Portal to learn about MyActiveHealth.

You’re not alone. During the COVID-19 pandemic, many people have felt more stress and anxiety than ever. They need more help than usual coping with everyday pressures. Things like job loss, childcare issues and other challenges are very real.

Did you know that stress can affect your health? It’s common during times of stress to pick up some unhealthy habits. Don’t be too hard on yourself. It can be hard to eat healthy, exercise and follow all the other habits that are part of good self-care.

Learn more about healthy habits:

• Healthy living resources
• 4 ways to take care of physical and mental well-being during unsettled times
• Staying mentally healthy in tough times

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. Or you can find this info on your Member Portal.

It may not be easy, but you can stop using nicotine — whether it’s smoking, vaping or chewing. Let’s quit together.

Stop smoking program

The program for CHIP members includes:

• Tools and support to help members stop smoking and be healthier
• Stop-smoking counseling for non-pregnant members 12 and older
• Stop-smoking products for members 18 and older (up to $200 each year after they use up the CHIP benefit)

Questions on how to get started? Just contact us.

Find more support

You can also learn more about quitting from the:

• American Cancer Society’s guide to quitting smoking
• Great American Smokeout® event
• Centers for Disease Control and Prevention at 1-800-QUIT-NOW (1-800-784-8669)

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal.