SECTION 353.1203. Member Participation

(a) Except as provided in subsection (b) of this section, enrollment in the STAR Kids program is mandatory for a Medicaid client who is younger than 21 years of age and meets one or both of the following criteria:

(1) has a physical or mental disability and qualifies for Supplemental Security Income (SSI) or SSI-related Medicaid; or

(2) is enrolled in the Medically Dependent Children Program (MDCP) waiver.

(b) Clients younger than 21 years of age residing in a community-based ICF-IID or nursing facility or receiving services under the following Medicaid 1915(c) waivers must enroll in STAR Kids to receive acute care services and non-facility based state plan services:

(1) Home and Community-based Services (HCS);

(2) Community Living Assistance and Support Services (CLASS);

(3) Texas Home Living (TxHmL); or

(4) Deaf Blind with Multiple Disabilities (DBMD).

(c) Clients younger than 21 years of age receiving services under the Youth Empowerment Services (YES) Medicaid 1915(c) waiver must enroll in STAR Kids to receive acute care services and non-facility based state plan services other than Community First Choice state plan services.

(d) The following Medicaid clients cannot participate in the STAR Kids program:

(1) clients residing in the Truman W. Smith Children's Care Center;

(2) residents of state supported living centers;

(3) residents of state veterans' homes;

(4) persons not eligible for full Medicaid benefits; and

(5) children in the conservatorship of DFPS.

(e) Dual eligible clients.

(1) Enrollment in Medicare does not affect eligibility for the STAR Kids program.

(2) Dual eligible clients who participate in the STAR Kids program receive most acute care services through their Medicare provider, and long term services and supports through the STAR Kids MCO. Participation in the STAR Kids program does not change the way dual eligible clients receive Medicare services.

(f) Individuals younger than 21 years of age who participate in the Medicaid Buy-In for Children Program or the Medicaid Buy-In Program must enroll in STAR Kids.

(g) FFCC members at least 18 years of age but younger than 21 years of age may choose to transfer from STAR Health to STAR Kids if they meet the criteria in subsections (b), (c), (e), or (f) of this section.

(h) A STAR Kids member has a choice among at least two MCOs.

(i) Except as provided in subsection (d) of this section, a child or young adult, from birth through the month of his or her 21st birthday, who is enrolled in the Adoption Assistance Program or the Permanency Care Assistance Program and who meets one or more of the following criteria is eligible to participate in the STAR Kids program:

(1) receives SSI;

(2) received SSI before becoming eligible for the Adoption Assistance Program or the Permanency Care Assistance Program;

(3) is enrolled in a Medicaid 1915(c) waiver; or

(4) is enrolled in Medicare.

Source Note: The provisions of this §353.1203 adopted to be effective November 1, 2016, 41 TexReg 8265; amended to be effective September 1, 2017, 42 TexReg 4273; amended to be effective August 12, 2021, 46 TexReg 4843