In response to COVID-19, Texas Children’s Health Plan is following the new recommendations from the Health and Human Services Commissions (HHSC). The changes below are in effect through December 31, 2020.
- Members may now request an appeal verbally. They no longer have to do it in writing.
- Texas Children’s Health Plan now has sixty (60) days to decide a standard appeal. Before, it was thirty (30) days.
- Members now have ninety (90) days to request an internal appeal with Texas Children’s Health Plan. Before, it was sixty-(60) days. Members may now have thirty (30) days to request to continue their benefits after receiving an unfavorable benefit decision. Before, it was ten (10) days.
- Individuals now have one hundred and fifty (150) days to request a fair hearing after a Texas Children’s Health Plan internal appeal. Before, it was one hundred and twenty (120) days. If before the changes, the timeframe for an individual to request a fair hearing would have expired in April 2020, now the individual will have extra 30 days from that expiration date to request a fair review.
24-Hour Nurse Help Line
Before going to the Emergency Room, call the Nurse Help Line (unless it is an emergency). We are available 24-hours a day, 7 days a week. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.
1-800-686-3831 or TDD 1-800-735-2989
Our Member Services team is ready to take your call from 8 a.m. to 5 p.m., Monday through Friday. After hours, on weekends and holidays, our answering service is ready to help you and/or take your messages. A Member Service Advocate will return your call the next business day. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages. Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.
- CHIP: 1-866-959-6555
- STAR: 1-866-959-2555
- STAR Kids: 1-800-659-5764 (Service Coordination)
- TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1
To join, you can call: 1-877-782-6440 (STAR Kids) or 1-800-964-2777 (CHIP and STAR). For TTY/TDD call 1-800-735-2989.
Not a member? Call our Marketing Hotline at 1-800-990-8247 from 8 a.m. to 5 p.m., Monday through Friday. One of our representatives will be happy to assist you. You can also call the enrollment broker at 1-800-964-2777 from 8 a.m. to 6 p.m., Monday through Friday.
In case of an emergency, go to your nearest in-network emergency room or call 9-1-1.
Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.
Behavioral Health/Substance Abuse Hotline:
- CHIP: 1-800-731-8528
- STAR: 1-800-731-8529
- STAR Kids: 1-800-731-8529 (Service Coordination)
(no provider referral needed)
Providers can use this number for claims, inquiry, questions and information about CHIP, STAR, or STAR Kids products and to check eligibility/benefits.
Toll free: 1-877-213-5508
Texas Children’s Health Plan’s automated Telephone TouCHPoint system allows Texas Children’s Health Plan providers to check eligibility, benefits, and claims status after hours. The service is available 24 hours a day, 7 days a week. To access Telephone TouCHPoint call 832-828-1007. Enter the member’s identification number and the provider’s NPI number.
Telephone TouCHPoint: 832-828-1007
What is CHIP?
The Children’s Health Insurance Program (CHIP) offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage.
We offer CHIP in more than 20 counties in the Jefferson and Harris Service Areas.
What is STAR?
STAR is a Medicaid-managed care plan. This plan helps family members of any age. Texas Children’s Health Plan offers STAR in more than 20 counties in the Jefferson and Harris Service Areas. Learn more about STAR.
What is STAR Kids?
STAR Kids is a Medicaid-managed care plan. This plan helps children and young adults under the age of 21 with disabilities. Texas Children’s Health Plan offers STAR Kids in the Harris, Jefferson and Northeast Service Areas.
Texas Children’s Health Plan offers CHIP perinatal services. CHIP prenatal is no-cost health coverage for pregnant women. To get CHIP perinatal, you must:
- Meet certain income requirements.
- Not qualify for Medicaid.
- Not have any other health coverage.
How is the Texas Vendor Drug Program (VDP) used for Texas Children's Health Plan Medicaid members?
Navitus is the provider for drug store services for members. The Texas VDP maintains and publishes the Texas VDP Formulary and the associated PDL. It also maintains and publishes the clinical guidelines for drugs not on the PDL which require pre-approval, and are used by Navitus to give benefits for Texas Children's Health Plan STAR and CHIP members.
What drug stores does Navitus have contracts with?
Navitus has contracts with more than 95% of the VDP providers in Texas. The Navitus drug store network includes national chain drug stores such as Walgreen's, CVS, HEB, Wal-Mart, Target, and Kroger. And many others. Navitus' drug store network can be found here.
Contact Member Services at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR) if you need help finding a drug store.
We want you to have the best resources for your health. Here is a list of helpful websites and links to our vendors:
1-844-212-7269 (STAR Kids)
Your child will have one of the following dental plans:
If you don't know who your child's CHIP dental plans is, call CHIP toll-free at 1-866-959-6555
A State Fair Hearing is a chance for you tell the reasons why you think the services you asked for and couldn’t get should be allowed.
Can I ask for a State Fair Hearing? If you, as a member of Texas Children’s Health Plan, disagree with the health plan’s decision, you have the right to ask for a fair hearing. You may name someone to represent you by writing a letter to the health plan telling them the name of the person you want to represent you. A doctor or other medical provider may be your representative. If you want to challenge a decision made by Texas Children’s Health Plan, you or your representative must ask for the fair hearing at any time up until 90 days of the date on the health plan’s letter with the decision. If you do not ask for the fair hearing within 90 days, you may lose your right to a State Fair Hearing.
To ask for a State Fair Hearing, you or your representative should either send a letter to the health plan or call:
Texas Children’s Health Plan
Attention: Appeals Department NB8390
PO Box 300709
Houston, TX 77230
Phone: 832-828-1001 or 1-866-959-2555
TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1