Medicaid/Texas Health Steps Health Care Orientation English Language Version for Group Setting DRAFT ~ 11_5_01

Transcription

1 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 [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. 1

2 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. 2

3 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 [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 3

4 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. 4

5 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 5

6 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. 6

7 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]. 7

8 [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: 8

9 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 [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.] 9

10 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:] 10

11 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 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

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