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About RightCare

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Here’s your go-to guide for RightCare

Filled with useful information, your member handbook helps you get the care you need. Read through to learn all about your benefits. It’s pretty handy to have, especially if you don’t always have Internet access. Inside you’ll find:

Download RightCare Member Handbook

RightCare Member Handbook Table of Contents

About Notifications and Prior Authorizations

STAR Medicaid Terms and Definitions

If you need this book in a different format such as audio, large print, braille, or in a language other than English and Spanish, call RightCare Member Services.

Call RightCare at 1-855-897-4448 to get paper copies of helpful information:

  • • Member Handbook
  • • Provider Directory
  • • Privacy Practices
  • • Members Rights & Responsibilities
  • • Anything on our website
This information will be sent at no cost to you within five (5) business days.

Texas Health and Human Service - Texas STAR

Member Information

Scott and White Health Plan for RightCare — RightCare from Scott and White Health Plan is part of Baylor Scott & White Health, a healthcare system in West, Central and North Texas. In 2022, many members of Scott and White Health Plan will have a new brand on their plan materials: Baylor Scott & White Health Plan. RightCare members, like you, will not see a new brand on your materials in 2022. Your plan will continue under the Scott and White Health Plan name. Questions? Call us at 1.855.TX.RIGHT (1.855.897.4448) TTY: 711, Monday through Friday from 7 AM to 7 PM.

NEW Chat with Customer Service

Need a Ride? Nonemergency Medical Transportation (NEMT) — Starting June 1, 2021, we can help you or your child get a ride, at no cost, to the doctor, hospital, dentist, and drugstore.

Nondiscrimination Notice

Replacement ID Card — If you lose your RightCare STAR Medicaid ID Card, call us right away at 1-855-897-4448 to get a new one. If you don’t have the card, you can still go to the doctor, clinic, or hospital. You might have to wait for services while your RightCare membership is checked.

Member Rights and Responsibilities

Texas Medicaid for Children — 1-877-847-8377 (1-877-THSteps)

Notice of Privacy Practices — For information on how medical information about you may be used and disclosed and how you can get access to this information use the Notice of Privacy Practices.

New website for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) at texaswic.org

The website includes features such as online nutrition classes, recipes, and a newsletter feature that provides parents with customized information based on the child's current age for children ages 1-5. Parents can subscribe to the newsletter here for information in English and here for information in Spanish.

Join Texas WIC

Frequently Asked Questions about Medicaid Transition

I received a letter that my Medicaid changed (or may change), what does this mean?

  • Starting February 2021, the Texas Health and Human Services Commission (HHSC) will transition Medicaid clients to the appropriate type of Medicaid coverage on an ongoing basis when there is an identified change in circumstance.
  • If HHSC receives information that your household has a change in circumstances (such as income, expenses, people in the household, etc.) they will move you to the appropriate type of Medicaid coverage based on the eligibility criteria your household meets.
  • This does not necessarily mean you will have a reduction in coverage.
  • Review the notice for any requests to take action. If the letter is asking for you to take any action, please comply with this request as soon as possible.

I received a letter that I need to select a new health plan, what does this mean?

If you received an actual enrollment form or alert via text/E-mail to select a new plan HHSC will send you either a separate enrollment form if it is determined that you need to pick a new health plan. If this is necessary, you should receive this request within 15 calendar days of the date on the TF0001 Notice about your case.

You received notice to select a new health plan.

  • HHSC has determined that your new Medicaid program requires you to pick a health plan.
  • If you know what plan you want to pick, go ahead and do so and return the form.
  • If you need further assistance, HHSC Managed Care can assist. Managed Care hours of operations are 8 a.m. - 6 p.m. Central Time, Monday through Friday.

What might make HHSC change my type of Medicaid?

  • HHSC looks at the following information to determine what the appropriate type of Medicaid is for the client:
  • Renewal applications.
  • Reported changes.
  • Information received from other agencies, such as the Social Security Administration.

Will I continue to keep my Medicaid during COVID?

  • Yes, Medicaid coverage will continue for anyone who has coverage during the federal declared public health emergency.
  • The only exceptions could be:
  • Clients who move out of Texas.
  • Clients who voluntarily leave/withdraw from Medicaid.
  • Deceased clients.

However, if you have received a notice that you are no longer eligible for Medicaid, your coverage may end at the end of the public health emergency.

  • Clients may receive notice on their TF0001 that their Medicaid eligibility/coverage will end with the public health emergency ends.
  • This will happen for one of the following reasons:
  • The household failed to respond to a request from HHSC like a renewal packet or H1020 Request for Missing Information, or
  • HHSC received information via a renewal packet, reported change, or from another agency that indicates the household no longer meets the eligibility requirements.

Could my Medicaid or Health Plan change during COVID?

  • Yes, If HHSC receives information that a client no longer meets the criteria for their current type of Medicaid coverage, but
  • DOES meet the criteria for a different type of Medicaid coverage, they will be moved to that type of Medicaid coverage, if it provides the same (or a better) level of coverage.
  • DOES NOT meet the criteria for any other type of Medicaid coverage, they will continue in their same type of Medicaid coverage until the federally-declared public health emergency ends or federal guidance changes.
  • The only exceptions are Healthy Texas Women (HTW), Community Attendant Services (CAS), and CHIP.
  • Medicaid clients will not be transitioned to any of these programs from another health care program during the public health emergency.

HHSC Notification Area

  • Healthy Texas Women Plus — Beginning Sept. 1, 2020, Texas HHSC is implementing Healthy Texas Women Plus (HTW Plus), an enhanced, cost-effective and limited postpartum services package for women in the HTW program. HTW Plus will be provided in the postpartum period for not more than 12 months after the start date. Women in HTW Plus will have access to both HTW and HTW Plus benefits. Learn more.
  • Member Fraud Notice

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Provider Directory

  • Members can choose a PCP by calling Member Services at 1-855-897-4448. RightCare’s Provider Directory lists all in-network PCPs. You may ask for one to be mailed to you by calling Member Services at 1-855-897-4448. You may also view the Provider Directory by viewing this link.
  • Specialty Providers Referrals — Referrals are needed to see most RightCare specialty provider. A referral is an approval from your PCP for you to get specialty care and follow up treatment. If you receive services from a specialist without your PCP’s referral, or if the specialist is not a RightCare provider, you might be responsible for the bill. You can get some services without going to your PCP first. These include:
  • 24-hour Emergency Care (if you feel you have a true medical emergency)
  • Routine Vision Care
  • Dental Services (for children)
  • OB/GYN Care
  • Family Planning Services and Supplies
  • Behavioral (Mental) Health and Substance Abuse Services
  • Texas Health Steps

Medicaid Appeals Process

You can appeal a decision if Medicaid covered services are denied based on lack of medical need.

Complaints Process

If you have a complaint, please call us toll-free at 1-855-897-4448 to tell us about your problem.

File a Complaint

Ckick here.

 

Grow WellTM

Grow Well App

Mindoula - Behavioral Health Support

Who qualifies?

Active Scott and White Health Plan STAR members qualify based on certain conditions. Mindoula will reach out to you if you qualify.

How can Mindoula help?

Mindoula is a behavioral health management vendor that provides tech-enabled (digital) 24/7 case/care management and psychiatric support to members with behavioral health challenges and multiple medical needs.

Programs provided by Mindoula and their StrongWell Program:

    • Interpersonal Violence Reduction Program (IVRP)
    • Suicide Prevention Program (SPP)
    • SUD (Substance Use Disorder) Exposed Pregnancy (SEPP)
    • Substance Exposed Living Program (SELP)

    Papa Pals - Extra Support for New Moms

    Who qualifies?

    Papa Pals is for active Scott and White Health Plan STAR members from birth to one year of age and pregnant STAR members. You can receive up to 120 hours of service per year.

    How can Papa Pals help?

    • Social support
    • Home visits
    • child care assistance
    • Meal preparation
    • Laundry and light cleaning
    • Grocery and prescription delivery
    • Short-distance travel for errands and appointments
    • And more

    How can I get Papa Pals?

    1. You may receive a phone call from Papa Pals. They can sign you up during the phone call.
    2. You can call Papa Pals to sign up. Phone number: 1-888-345-2619; TTY users, please call 711. Business hours are 7 a.m. – 10 p.m. from Monday – Friday and 7 a.m. – 7 p.m. on Saturday and Sunday. (Tell them you are a member of Scott and White Health Plan.)

    • The National Committee for Quality Assurance (NCQA) awarded Scott and White Health Plan an Accredited Status (Medicaid certified 03/2021) - reflecting our continuous work to fulfill NCQA requirements for consumer protection & quality improvement.