Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
Welcome to [choose one] today’s/tonight’s introduction to Medicaid health
care. My name is __________________________________, and I work with
________________________.
I will [choose one] today/tonight provide you with some information to make the
Medicaid program work well for your baby, child, or teenager. It is the Medicaid
program’s job to provide your child with access to quality health care.
We may have some teenagers who are here today to find out information about
Medicaid for themselves. Although I will be referring to “your child” all the way
through this presentation, for our teenage attendees, the information you hear today
will apply to you as well—not just your child.
Thank you for coming to this meeting. We appreciate your taking the time to be
here. The purpose of this meeting is to answer some of your questions about
Medicaid, so you can help your child stay as healthy as possible. You have each
received a handout with important phone numbers on it. I will point out these
numbers to you as we go through the presentation.
What is Medicaid?
Medicaid can help pay for some of your child’s medical services, but Medicaid may
not cover all services. Medicaid has certain limits and restrictions.
• Medicaid only makes payments to providers. You cannot file a claim with
Medicaid yourself. (A provider is anyone who gives you medical services,
such as your doctor, hospital, pharmacy, clinic, dentist or lab.) If you pay a bill
yourself, Medicaid will not pay you back.
• You should not get a bill from a provider. However, if you do get a bill that you
think Medicaid should have paid, please call the Medicaid Help Line for help
at 1-800-252-8263. [Point out number on handout.]
• You must make sure you receive services from a provider who accepts
Medicaid, if you want Medicaid to pay your bills.
• You must show your child’s Medicaid ID form to his or her medical provider
each time your child is seen.
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
Medicaid is meant to provide health care benefits to your child whether he or she is
sick or not. Make sure you keep your child’s Medicaid coverage active—even if
your child is not sick. Follow up on any letters you get from the Department of
Human Services or the Texas Department of Health. We call the Department of
Human Services DHS for short and the Department of Health TDH for short Make
sure you complete all of the paperwork DHS and TDH mail to you. That way your
child will be covered by Medicaid without interruption.
What will Medicaid cover for your child?
Some of the things that Medicaid will generally pay for are:
• Treatment for illnesses
• Hospital stays
• Specialists
• Immunizations
• Transportation to medical appointments
• Unlimited prescriptions, and
• Medical and dental checkups through Texas Health Steps
You will receive or may already have received—a Medicaid Users Guide. This
Guide has a complete list of Medicaid covered services on page ____ [Hold up
guide].
[Managed Care Areas Only—Use the following portion of the script]
What is the STAR program?
STAR is the Texas Medicaid managed care program. You will soon receive in the
mail, or may already have received, a packet of information about the STAR
program. When you get the packet, please read through it carefully.
The materials in that packet will ask you to make two choices: first, you will choose
a health plan and then you will choose your child’s Primary Care Provider, called a
PCP. Your child’s PCP can be a doctor, nurse, clinic, or health center that has
agreed to work for your child’s health plan and to provide your child with medical
services.
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
After you choose a health plan and PCP, mark your choices on the forms, and mail
them in. Or, you can call the STAR Help Line at 1-800-964-2777 [point to number on
handout], and choose a plan and PCP right over the phone. The plan you pick will
will be printed on your child’s Medicaid ID form that will be mailed to you. If you
ever want to change your child’s plan, call the STAR Help Line to make that change.
Your health plan and PCP will coordinate your child’s health care. The PCP will get
to know your child and help with all your child’s health care services. Your child’s
PCP will be the one you call first with any health problems or questions. Your PCP
can also send your child to specialists, if the child needs additional health care
services.
Once you enroll in a health plan, you may change your child’s PCP up to four times
a year by calling your plan and requesting a change. All the health plans’ numbers
are on the handout [point out the HP phone numbers on the handout.] Unless you
request a change, you must continue to take your child to the same PCP. You
cannot take your child to other doctors—unless you have a referral from the PCP.
However, there are a few exceptions to that rule. You will not need a referral to take
your child for the following services: behavioral health, family planning, OB/GYN .
or to the emergency room.
When you receive your packet of information, you will have a limited amount of time
to choose a plan and PCP. If you do not mail back the forms or call to make a
choice within 30 days, a plan and PCP will be chosen for your child. You can make
a plan or PCP change later, but there will be a delay—as long as two months. So,
make sure you mail the forms back or call the toll-free number as soon as possible.
[End of Managed Care only section of script]
What is Texas Health Steps, and what can it do for your child?
Texas Health Steps is the preventive care and treatment program for people under
21 in the Texas Medicaid program. Texas Health Steps provides medical and dental
checkups to you, your child, or your family. The checkups are part of your child’s
Medicaid coverage. Medicaid pays for many kinds of treatment and health care
services that may be needed to follow up on any problems found in Texas Health
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
Steps medical and dental checkups. The Texas Medicaid program pays for Texas
Health Steps checkups. You will not have to pay for your child to get a Health Steps
checkup, and there are no co-payments or hidden charges. Transportation is
covered by the Medicaid program, too.
Medicaid and Texas Health Steps offer your child something that everyone wants in
this country today: access to quality health care. Texas Health Steps checkups help
find and solve any health problems your child may have, before they get out of
hand. Medicaid pays for lots of other helpful services, too, including transportation to
health care appointments and case management—that is, working with a case
manager who helps you find the services your child needs. Depending on where
you live in Texas, you may be able to get your child’s health care from any doctor,
dentist, clinic, etc., who takes Medicaid. Or, you may need to sign up for a health
care plan that is part of the Texas STAR program. The health care plan will work
with you to determine where your child can go for services.
Parents may say, “Why should I take my child to the doctor when he is not sick? My
child is fine—he doesn’t even have a runny nose. Why should I take him to the
doctor for a checkup?" or “There’s no need to take my child to the dentist. She
doesn't have a toothache, and her teeth are fine!" These are reasonable comments.
It’s not easy to get your child to the doctor or dentist even when there is a problem,
and it may not seem to make sense to go if your child seems healthy.
But medical and dental checkups are important for your child’s good health. A timely
visit to the doctor or dentist for a checkup can really help in the long run. Health
Steps checkups are a chance for a doctor or dentist to find medical and dental
problems that you may not be able to see. A child or young person may look healthy
but still have a health problem. Texas Health Steps checkups are the chance to
catch those invisible problems early, before they get out of control and cause more
pain and trouble for you and your child. The visit to the PCP also presents the
opportunity for the family to receive health education, which can help your child or
youth make healthy choices in the future.
Texas Health Steps doctors, nurses, and other health care workers offer sound
advice on health care. Shots, lab tests, and other features of Texas Health Steps
checkups help prevent problems and keep children healthy. Medicaid covers followup care and treatment for problems, so you can be sure something will be done
about any problems the doctor or dentist finds during your child’s checkup.
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
If your child needs follow-up care for a health problem, Medicaid will pay for your
child to see one or more special doctors, called “specialists”, as needed. Medicaid
covers necessary care from specialists, too, as long as they are Medicaid providers.
Regular check-ups with the doctor and dentist can help a healthy child stay healthy.
New babies need a series of shots to protect them from illnesses that can be painful
or even deadly, and they need the doctor to make sure they are growing normally.
Pre-school children also need shots, and they need to have their eyes and ears
checked, too, because problems with hearing or vision can prevent them from
learning and slow their progress in school. A checkup can catch any problem with
sight or hearing and take care of it before a child has fallen behind, and Medicaid
will pay for glasses or a hearing aid if your child needs them.
Texas Health Steps checkups make sure elementary school kids are growing up
healthy and strong, and Health Steps checkups are also useful for teens. Teens
face lots of problems today, and they do better in school, at work, and in
relationships if they are healthy and can get extra help with their problems. Help for
teens is available at Texas Health Steps checkups, and additional treatment for both
physical and mental problems is very often covered by Medicaid. If your child or
teen misses school to go to a Health Steps checkup, it will be counted as an
excused absence.
[If in a STAR area, say the following] Each health plan may handle Texas Health
Steps a little differently. Please call your child’s health plan for information on
Texas Health Steps. Or you can read about Texas Health Steps in the member
handbook that will be sent to you by the plan. The provider directories in the
STAR information packet may show which providers do Texas Health Steps
checkups.
Medical checkups offered by Texas Health Steps providers include:
A health history and physical exam
Immunizations or shots that are due
Vision and hearing screening
Height and weight measurement
Developmental assessments, both physical and mental
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
Screening for elevated blood-lead level, if your child is between 6 months to
6 years of age
TB screening
Health and safety information and counseling.
Texas Health Steps dental checkups include:
A full dental exam
X-rays, if needed
Cleaning, and
Dental sealants at recommended ages.
When is it time for a Texas Health Steps checkup?
Medical check-ups are due at various times, depending on your child’s age. You
will receive in the mail, or may already have received, one of these wallet-sized
cards. [Hold up wallet card.] The wallet card will tell you at what ages medical
checkups are due. Also, your child’s Medicaid ID form will tell you when a checkup
is due. When you get your child’s Medicaid ID form in the mail each month, a Health
Steps reminder message may be printed under your child’s name. If it’s time for a
checkup, it will say “THSteps Medical Due” or “THSteps Dental Due.” You’ll also get
a letter from Health Steps to remind you that it’s time for your child’s checkup.
Texas Health Steps offers dental check-ups to your child free of charge every six
months, starting when your child is a year old. Starting checkups early can help
avoid serious dental problems like baby-bottle tooth decay. Dentists say little
children as young as one year old need regular check-ups, and toddlers do too. At a
check-up, the dentist can catch tooth decay before it becomes severe. When tooth
decay gets really serious, a child may need treatment in a hospital. Regular checkups can help prevent that from happening.
Good dental care is important for toddlers and bigger kids, too. The first teeth, or
“baby” teeth, need to be protected from decay. At Health Steps dental check-ups,
children can have a special coating called a “sealant” put onto their teeth to help
prevent cavities. Teenagers and young adults also benefit from dental check-ups.
Teens tend to do better in school and in life when they feel better about their looks,
and a healthy mouth and healthy teeth are a big part of looking good.
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
How can you get free transportation to your child’s health care appointments?
You may have no problem getting your child to and from medical and dental
appointments. But if you would like assistance, Medicaid can provide free
transportation. The Medicaid program is required to pay for transportation for you
and your child to any health care service that is part of your child’s Medicaid
coverage, including Texas Health Steps checkups. This service is called the Medical
Transportation Program, or MTP.
This handout [hold up]shows a toll-free number to call for more information about
MTP. MTP may provide a ride in a van, or pay for you and your child to take the bus
to a health care appointment, or help get you there some other way. Or, Medicaid
can pay back a parent, friend, or volunteer for taking you and your child to a
Medicaid appointment. This type of transportation must be approved ahead of time.
The driver will be paid back for gas money at the official state mileage rate, which is
now 34.5 cents a mile.
To get transportation from MTP, or to get permission for a volunteer driver to be
paid back, please call at least two days before your child’s appointment. Here is the
number to call. [Point to number on handout.] It’s important to make sure before
your child’s appointment that you and your child have a way to get there and you
can both are able to go on that day at that time. If you can’t show up for an
appointment, please be sure to call and tell the provider you can’t make it. Your
child’s Medicaid coverage depends on having good doctors and dentists who want
to work with Medicaid. Doctors and dentists tend to quit the Medicaid program if too
many patients don’t show up for appointments and don’t call ahead to cancel.
What is your child’s Medicaid ID form, and why is it important?
The Medicaid program covers your child’s health care. However, if you want
Medicaid to pay, you will need to show proof that your child has Medicaid whenever
your child receives health care services, including Texas Health Steps checkups.
Your proof that your child has health care paid for by Medicaid is the Medicaid ID, or
“identification” form. The Medicaid program sends a new ID form to your child every
month as long as your child has Medicaid. The ID form is sometimes called the
“Medicaid ID card,” but it’s really a letter-size sheet of paper that looks like this.
[Hold up “Jane Doe” sample of Medicaid ID form].
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
[NOTE: Use this paragraph only in Managed Care areas]: After you choose a
health care plan for your child, you will get a member card from your child’s plan.
You will need to take both this small card and the letter-size Medicaid ID form to
your child’s appointments.
Do you have any questions so far?
[Answer any questions that arise.]
I’ll stay after this meeting to answer any other questions you may have. Now let’s
cover the rest of [choose one] today’s/tonight’s information.
What is medical case management, and how can it help your child?
Another service that Medicaid pays for is medical case management, provided by a
person known as a “case manager.” Their job is to help you get the services your
child needs. If you would like a case manager to assist you, please call this toll-free
phone number listed on the handout [show number.]
Where can you get more information about Medicaid and Texas Health Steps?
You can get more information by calling either the Medicaid Help Line or the Texas
Health Steps Help Line. These are both listed on your handout.
What if your child is sick or in pain?
Even if your child is sick or in pain, it’s important to go to the emergency room only
in an emergency.
Emergencies include severe accidents and injuries; severe bleeding; extreme
shortness of breath; sudden severe pain or pressure in some part of the body; and
blackouts or fainting. If your child has an emergency, please call 911 or go to the
nearest emergency room immediately. Otherwise, it is important to call your child’s
Medicaid doctor or clinic, not take him or her to the emergency room. Your child’s
doctor or clinic will know you and your child and will have your child’s complete
medical records on file. That means much better care for your child. Even if it is after
hours or on a weekend, you can call your child’s Medicaid doctor. Someone should
answer the phone. [NOTE: the following section is for managed care areas
only:
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
You may also call your plan’s Nurses Hotline 24 hours a day.
[End of managed care only section]
Now that you know more about Medicaid, let’s go on to the next step. As a parent,
you have a key role in helping your child get the quality health care that Medicaid
will pay for. You will need to take action to make your child’s health care happen.
You have just received a lot of information about your child’s Medicaid coverage in
my presentation. The next step is to make sure you have a Medicaid doctor and
dentist for your child.
How do you find the right Medicaid dentist for your child?
You may already have a dentist for your child. If so, you will need to be sure that
dentist does Texas Health Steps checkups. If you do not have a dentist for your
child who you are sure will do Health Steps dental checkups please call the Texas
Health Steps Hot line at 1-877-847-8377.
[Note: the following section of the script is for non-managed care areas only.]
How do you find the right Medicaid doctor (or clinic)?
Texas Health Steps doctors and nurses do medical checkups in clinics, private
offices, and other places. You may need to take your child to other Medicaid
providers, too, to follow up on any problems discovered in the checkup. Health care
services for your child are offered statewide by enrolled Medicaid and Texas Health
Steps providers. If you want Medicaid to pay for your child’s care, you cannot go to
just any doctor, nurse, or clinic. You must go to one who is part of the Medicaid
program. And for Texas Health Steps checkups, you must go to Health Steps
providers.
[NOTE: If the parent or caretaker stays after the meeting or calls you later and
requests name(s) of provider or provider(s), you may go ahead and help them
choose a provider based on their criteria. Also give or send the appropriate list of
providers to the parent.]
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
To be sure your child’s health care is covered by Medicaid, you will need to find the
right Medicaid doctor for your child.
Does your child already have a doctor? If so, make sure that doctor accepts
Medicaid before your take your child in for an appointment. Also, find out if your
child’s doctor does Texas Health Steps medical checkups. Not all Medicaid doctors
who provide sick care provide Health Steps checkups. If your child’s doctor does
not do Texas Health Steps checkups, you will have to take your child to a different
doctor for those checkups. Or you may decide to choose a new doctor for your
child—one who accepts Medicaid and does Texas Health Steps checkups. Or you
could decide to keep your child’s current doctor, as long as he or she accepts
Medicaid, and only go to the other doctor for the Texas Health Steps checkups. The
choice is yours. If you would like help finding doctors (including specialists) who
accept Medicaid in your area, please call the Texas Health Steps Hotline.
[NOTE: If the parent or caretaker stays after the meeting or calls you later and
requests name(s) of provider or provider(s), you may go ahead and help them
choose a provider based on their criteria. Also, remind the parent that the
appropriate list of providers has been given to them, or send one to the parent
if he or she has called later.]
[End of non-managed care-only section.]
Before we end this meeting, I’d also like to tell you about two other programs that
your family may want to look into. The first of these is the WIC program. You may
already be enrolled in WIC. If so, you already know that WIC provides healthy food
and education about nutrition for women who are pregnant or nursing, infants, and
children under five years of age. The number to call for more information, to find out
if you can get WIC services, or to find a WIC clinic near you is on your handout.
Another program you may want to know about is called CHIP—the Children’s Health
Insurance Program. If you know of any uninsured children under age 19 who are not
eligible for Medicaid, they may be eligible for CHIP. The most any family would have
to pay to cover all their children on CHIP is $18 per month. And some families pay
as little as $15 per year. To find out more, call the toll-free TexCare Partnership
number shown on your handout.
[Note: this section is for the Dallas Area only:]
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Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
What is the NorthSTAR program?
NorthSTAR provides behavioral health services (such as services for mental health
or substance abuse) for people on Medicaid in the Dallas area. Enrollment in
NorthSTAR is required. A special organization called a Behavioral Health
Organization, or BHO, offers these services. When you call to choose a health plan
and PCP for your child or when you complete the necessary forms and mail them in,
your child will also be enrolled with the BHO. Even if your child loses Medicaid
eligibility, but still needs behavioral health services, his or her enrollment in
NorthSTAR can continue.
Some of the services offered by North STAR include:
• Psychiatric services
• Crisis stabilization
• Inpatient hospital stays
• Day treatment
• Residential services, and
• Community support services
For more information about North STAR, please call 1-877-735-2989 toll- free. This
number is also listed on your handout.
[This is the end of the Dallas Area-only section.]
Do you have any other questions?
[Answer questions or give the client the appropriate phone numbers to
call for more information. ]
Once again, many thanks for attending this meeting. If you would like to stay and
see me individually, I will be here for the next _________minutes, and you are
welcome to stay, too. Thank you again.
11
Medicaid/Texas Health Steps
Health Care Orientation
English Language Version for Group Setting
DRAFT ~ 11_5_01
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