Bridging the gap
Texas Children’s Health Plan helps children with complex medical needs, expands reach throughout the state of Texas
Three years ago, Jessica Coker of Willis, Texas, gave birth to her son, Christopher. Unbeknownst to Coker during her pregnancy, Christopher would be born with various medical issues. Christopher has apert (a cranio facial syndrome) and a heart murmur. He also relies on a trach and has, at times, needed a feeding tube.
After delivering her baby, Coker was suddenly faced with needing to learn how to care for a child with very complex needs, as well as how to manage the comprehensive care he would need from more than two dozen specialists. Just in his first week of life, Christopher had 17 doctor’s appointments. As a newborn, Christopher was transferred to Texas Children’s and had a team of doctors taking care of him, successfully treating some of his issues and managing others.
Today, the toddler still sees about 24 doctors at Texas Children’s and other medical facilities near his family’s home in Willis. He’s doing well, because he is receiving excellent care – and because his mother has created a system to manage and coordinate his complex care.
“We currently have great access to care,” Coker said. “I can call doctors directly, and they do a fantastic job when I need them the most. It’s a team approach that we’ve worked hard to establish.”
Coker’s fortunate to have figured out a system to manage her son’s care. Learning to advocate for and manage the care of children with complex medical needs is often critical to their ability to thrive and have a good quality of life. On November 1, 2016, STAR Kids debuted in Texas to provide the support families like the Cokers need, and Texas Children’s Health Plan played a prominent role in the launch. The Health Plan was selected by the Texas Health and Human Services Commission as one of three managed care organizations offering the STAR Kids plan in Texas’ Harris and Jefferson counties and in the northeast service area.
“The STAR Kids contract allows Texas Children’s Health Plan to increase its reach to about 40,000 new children and teens in 54 counties,” said Texas Children’s President and CEO Mark Wallace. “These children see multiple specialists and therapists, and many receive home care services. They typically see at least one physician every week.
“Coordination and management of care is essential for these children. It helps prevent children with significant intellectual development disabilities or complex medical problems from falling through the gaps and provides a structure where their progress can be followed throughout the system.”
Texas Children’s Health Plan provides children in the STAR Kids program benefits such as prescription drug coverage, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing and durable medical equipment and supplies. Also, in preparation for last fall’s launch of STAR Kids, Texas Children’s Health Plan hired nearly 300 care coordinators to help families manage, navigate and coordinate care and services.
“These care coordinators are registered nurses and certified social workers who bring much needed support to families who are managing care for their children in what can sometimes be an incredibly complex system,” said Texas Children’s Vice President Diane Scardino. “They visit with families at home to assess children’s needs and develop care plans to address those needs. Texas Children’s comprehensive network allows us to provide the resources around care coordination and home based services, creating a much more robust system of care for them.”
Children age 20 or younger who receive Supplemental Security Income Medicaid, are enrolled in the Medically Dependent Children Program or receive services through 1915(c) waiver programs are eligible to receive a variety of services through the STAR Kids program. Children, youth and their families choose among the three STAR Kids health plans based on the plan that best suits the child’s needs.
While many of the children who transitioned into STAR Kids were already Texas Children’s patients, thousands more are becoming part of and receiving care in Texas Children’s system through enrollment in STAR Kids. STAR Kids’ new care model is a huge step in supporting the unique needs of patients and their families, and improving their access to health care services, while also reducing preventable events or unnecessary visits to the hospital or care provider. There are about 180,000 children across Texas eligible for the STAR Kids program.
“Texas Children’s is proud to be a part of this program that means so much and can help so many families throughout Texas,” Wallace said. “This program and the work we are doing to help ensure these families’ needs are met and that their children receive the best possible care speaks to our mission. This is what Texas Children’s has always done.”
To read a blog post by Texas Children’s President and CEO Mark Wallace about STAR Kids, click here.
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