Making the switch to StarPlus: Here’s our experience!

Authors: Debbie Wiederhold, Parent

Keywords: StarPlus, Medicaid waiver, Individual Service Plan

Reprinted with permission from Texas Parent to Parent 2016 Fall Newsletter. If you have not had the pleasure of connecting with Texas Parent to Parent before, we invite you to do so by visiting their website.

Our son has extensive medical expenses that have, until he turned 21, been covered by private insurance, traditional Medicaid through the Comprehensive Care Program (CCP) and the CLASS Medicaid waiver. (He did have MDCP previously, until his name came up on the CLASS waiting list and we switched to the CLASS waiver.) Daniel requires private duty nursing care and quite a bit of medical equipment for him to be able to live in the community and in his own (our) home. Services end with the Medicaid Comprehensive Care Program (CCP) when your child turns 21.

I knew changes were coming with the introduction of StarPlus, and had many days of angst about “giving up” CLASS – since it took us 7 years “waiting” to finally get the waiver. I weighed the options over and over, talking with the CLASS Case Manager and the StarPlus intake coordinators. I also thought at the time that he would no longer have an option when StarPlus was rolling out for all of Texas this year, so I thought we would just go ahead and do it when he transitioned from pediatric to adult care. Things have changed since that initial thought and individuals are able to keep their current waiver without switching. However, each individual’s needs vary and staying with the current waiver may be the best option for some, and not for others. We had several meetings with both case managers from CLASS and StarPlus, even preparing a “mock” budget, but in the end StarPlus was the one that would provide the best care for our son. I think we made the right decision to go ahead and switch, given the CLASS restraints (For instance, our son uses a lot of private duty nursing care. I still don’t know of a nursing agency willing to sign up with CLASS as a provider; however, there are several nursing agencies that do take StarPlus). Check with your insurance provider if your child or young adult family member requires nursing care for options.

Since services end with the Medicaid Comprehensive Care Program (CCP) when your child turns 21, and we were already looking at having to change some of Daniel’s physicians due to “aging out”, we just added switching from CLASS to StarPlus in the mix. Luckily our son’s pediatrician helped with this transition as well, recommending an adult physician to transition to; he called and spoke with the physician prior to even meeting Daniel, to make sure it would be a good fit, and it has been! We did not see a lapse in his coverage or care during the switch, which was a huge relief seeing that his nursing care would continue uninterrupted. We’ve already had 2 budget meetings since then with Daniel’s StarPlus Case Manager (you still have to have annual budget meetings and set up an ISP –Individual Service Plan–for each year, just like the other waivers). The case managers are also required to check in with you several times a year, on the phone and in person, to make sure your child’s needs are being met.

Our relationship with the StarPlus insurance provider has been a very good fit for us. They “go to bat” for items and services for Daniel and help to insure the best quality of care for him. If you are facing similar decisions ahead, don’t be afraid to ask questions! We are always in transition and this is just another one to add to the list of many!