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.

Member Information

Changes to RightCare's Extra Member Benefits — Starting Sept. 1, 2020, RightCare has new and updated benefits for members.

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

Make Your Voice Heard at the RightCare's Member Advisory Group

You can help RightCare with the way our health plan works. We have a Member Advisory Group that gives members like you a chance to share your thoughts and ideas with RightCare. At the meetings, you will have a chance to talk about the way services are delivered. The Member Advisory Group will meet four (4) times a year. We ask members, community representatives, advocates and member of RightCare’s staff to join in the meeting. This gives you a chance to talk about your concerns with a variety of people. You also have a chance to tell us how we are doing. You may ask questions or share any concerns that you have about the delivery of services. Call RightCare Member Services at 1-855-897-4448 if you would like to be on this team.

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.
• Mosquito Repellent is Available as a Statewide Benefit — Texas covers certain mosquito repellent products for the prevention of Zika virus as a benefit in Medicaid and other state programs. Learn more.
• Member Fraud Notice