The Texas STAR Health program for foster children is the state’s Medicaid managed care plan built specifically for kids and young adults in the foster care system. It is run by the Texas Health and Human Services Commission with the Department of Family and Protective Services, and every member uses the same insurer, Superior HealthPlan.1Texas Health and Human Services. STAR Health Coverage includes medical, dental, behavioral health, vision, and prescriptions, with no copays or premiums. Because one plan covers the whole state, a child who moves counties or changes placements keeps the same insurance, the same provider network, and the same medical record.
Who Is Automatically Enrolled
Enrollment in STAR Health is automatic and mandatory for any child or youth in the temporary or permanent managing conservatorship of DFPS.1Texas Health and Human Services. STAR Health Foster parents, kinship caregivers, and relatives do not file a separate application. Once DFPS places the child, Superior HealthPlan coverage follows.
Young adults who stay in Extended Foster Care past age 18 remain on STAR Health. They have to sign a Voluntary Extended Foster Care Agreement and keep up at least one qualifying activity: high school, college, a workforce program, 80 hours of work per month, or a documented medical condition that prevents those activities.2Cornell Law Institute. 40 Texas Admin Code 700.346 – Extended Foster Care Extended care generally runs to 21, or to 22 if the young adult is still finishing high school.
If a youth ages out of care at 18 or older while enrolled in Medicaid, STAR Health itself ends, but a different program, Medicaid for Former Foster Care Children, picks up and runs until age 26 with no income test. More on that below.
What STAR Health Covers
Superior HealthPlan’s STAR Health benefit package includes primary and specialty physician visits, hospital care, prescription drugs and medical supplies, behavioral health services, vision care, dental services, and family planning.3Superior HealthPlan. STAR Health Insurance for Foster Care Foster children on Medicaid pay nothing out of pocket for covered services.
Behavioral health matters a lot in this population. The plan covers outpatient counseling, psychiatric evaluations, and substance use treatment. Dental covers cleanings every six months, X-rays, and restorative work like fillings. Vision covers annual exams and corrective lenses. Pharmacy benefits let caregivers fill prescriptions at participating pharmacies at no cost.
Required Checkups and When They Are Due
Federal Medicaid rules require Early and Periodic Screening, Diagnostic, and Treatment services for every child enrolled. Texas calls its version Texas Health Steps, and it applies to every child in DFPS conservatorship.4Texas DFPS. Texas Health Steps – A Guide to Medical Services at CPS
The first medical checkup has to happen within 30 days of a child entering DFPS conservatorship, no matter the age. After that, the schedule by age is:
- Under age 1: seven checkups, starting within the first five days, then at two weeks, two months, four months, six months, nine months, and twelve months.
- Ages 1 and 2: visits at 15 months, 18 months, 24 months, and 30 months.
- Ages 3 through 20: one checkup each year.
Dental runs on its own clock. For children six months and older, the first dental visit must happen within 60 days of entering DFPS conservatorship. After that, dental checkups happen every six months, and children under three who are flagged as moderate-to-high risk for cavities may be seen every three months.4Texas DFPS. Texas Health Steps – A Guide to Medical Services at CPS Medical checkups are considered overdue 31 days after placement; dental, 61 days. Caseworkers follow up on misses.
Who Can Consent to a Foster Child’s Medical Care
A foster parent cannot assume they have authority to consent to treatment the way a biological parent would. Under Texas law, a court order must name who holds that authority for a specific child.5State of Texas. Texas Family Code 266.004 – Consent for Medical Care
The court can name an individual (such as the foster parent, a relative, or the biological parent if rights have not been terminated) or DFPS. When DFPS holds the authority, the agency designates up to four medical consenters, usually the live-in caregivers or a caseworker. If that designation changes, DFPS has five business days to notify the court.6Texas DFPS. Medical Consent – A Guide to Medical Services at CPS
Youth who are 16 or 17 can ask the court to let them consent to their own care, in whole or in part. Both the attorney ad litem and DFPS are required to inform older foster youth about that right.6Texas DFPS. Medical Consent – A Guide to Medical Services at CPS Keeping a copy of the court order with you at appointments avoids delays at check-in.
Psychotropic Medication Reviews
Foster children are prescribed psychotropic medications at much higher rates than other children, and STAR Health has specific oversight built in. Superior HealthPlan runs automated pharmacy claim reviews on every foster child receiving psychotropic drugs, checking whether the prescription falls inside established clinical parameters.7Texas Children’s Commission. Agency Oversight – Texas Child Welfare Law Bench Book
Several patterns trigger closer review:
- Prescriptions for very young children (under age three or four, depending on the drug class).
- Two or more medications from the same drug class, with narrow exceptions for certain stimulant combinations.
- Four or more psychotropic medications prescribed at the same time.
- Any psychotropic prescription without a documented mental health diagnosis.
When a flagged prescription comes up, a STAR Health child psychiatrist conducts a Psychotropic Medication Utilization Review and contacts the prescribing doctor directly. The review may confirm the treatment is appropriate or recommend reducing medications. A foster parent, caseworker, judge, or anyone else involved with the child can also request a review if they have concerns about the regimen.7Texas Children’s Commission. Agency Oversight – Texas Child Welfare Law Bench Book
The Health Passport
DFPS is required to maintain an electronic Health Passport for every foster child. The passport pulls together immunizations, known conditions and allergies, current medications, surgical and hospital records, dental history, vision and hearing screening results, and mental health diagnoses and treatments.8State of Texas. Texas Family Code 266.006 – Health Passport
The passport travels with the child across moves and placement changes, so a new caregiver or doctor is not rebuilding the medical history from scratch. DFPS has to keep it current and share it with foster parents and, when age-appropriate, with the child.8State of Texas. Texas Family Code 266.006 – Health Passport Ask for access when a child is placed with you.
Getting Care Started
You will need the child’s Medicaid ID number and STAR Health ID card to access services. If you do not have the card when the child arrives, contact Superior HealthPlan or your caseworker to get one issued.
To pick a primary care doctor, use the Find a Provider tool on Superior HealthPlan’s website. Choosing a doctor close to home who already works with STAR Health shortens the wait for a first appointment. Once you set up portal access, you can track claims and prior authorization requests online.
STAR Health also runs a 24-hour nurse advice line. When something seems off but may not warrant the emergency room, the nurse line can help you decide where to take the child.
Transportation is covered too. Federal rules require every state Medicaid program to make sure enrollees can get to and from medical appointments.9Medicaid.gov. Assurance of Transportation If you cannot get a child to therapy, dental, or a specialist, call Superior HealthPlan to arrange a non-emergency ride, usually with advance notice. For true emergencies, call 911.
If a Service Is Denied
When Superior HealthPlan denies, reduces, or ends a covered service, it has to send a written notice with the reason and your appeal rights. You have 60 calendar days from the denial notice to file an internal appeal. You can appeal by phone, fax, or mail, and you do not need a lawyer; a relative, friend, or the caseworker can file for you. Superior HealthPlan acknowledges the appeal within five business days and decides within 30 calendar days.10Superior HealthPlan. Complaints and Appeals If waiting 30 days could seriously harm the child, request an expedited appeal, which must be decided within 72 hours.
Here is the part caregivers often miss. If Superior HealthPlan is reducing or ending a service the child was already approved for, you can ask that the service keep running at its current level while the appeal is pending. The request has to be made within 10 calendar days of the denial notice, or before the service actually stops, whichever is later.10Superior HealthPlan. Complaints and Appeals Families who do not know about that window lose services during the fight.
If the internal appeal does not go your way, you have 120 calendar days to request a Medicaid State Fair Hearing through Texas Health and Human Services, or an External Medical Review by an independent organization.10Superior HealthPlan. Complaints and Appeals The same continuation-of-services rule applies if the hearing is requested within 10 days of the appeal decision.
Coverage After Age 18
Turning 18 does not have to mean losing coverage. Two pathways continue Medicaid for former foster youth in Texas.
Extended Foster Care Keeps STAR Health Going
A young adult who was in DFPS conservatorship at 18 can stay in care voluntarily until 21 by signing an Extended Foster Care Agreement. They have to keep up monthly caseworker visits, attend court review hearings, and stay engaged in a qualifying activity such as school, work, or a job-readiness program.2Cornell Law Institute. 40 Texas Admin Code 700.346 – Extended Foster Care Transitions between activities are allowed for up to 30 days; longer gaps end eligibility. STAR Health, the same plan and the same provider network, continues the whole time.
Former Foster Care Children Medicaid Through Age 25
Under the Affordable Care Act, states must cover former foster youth with Medicaid until age 26, with no income or asset test.11Medicaid.gov. Medicaid and CHIP FAQs – Coverage of Former Foster Care Children Texas does this through Medicaid for Former Foster Care Children. To qualify, the person must be between 18 and 25, have aged out of foster care at 18 or older, and have been enrolled in Medicaid when they aged out.12Texas Health and Human Services. E-110 Medicaid for Former Foster Care Children
Enrollment often happens automatically through a DFPS interface with Centralized Benefit Services. If it does not, the young adult can submit a Medicaid application and answer “Yes” to the question about having been in foster care at age 18 or older. No income verification, no asset documentation.