Thinking about becoming a Community Health Choice Member? Here is some useful information about the Medicaid Program and Community Health Choice to get you started.
CHIP and Medicaid automatic benefit renewal has ended.
Visit our public health emergency site for more information.
Community provides both Children’s Medicaid and Medicaid for Pregnant Women. These programs are provided at no cost to U.S. residents who cannot afford health insurance.
Children’s Medicaid – Children’s Medicaid covers a child up through the month of his or her 21st birthday. Income determines eligibility. That income level is different based on age and Medicaid program. Members must recertify every year.
Medicaid for Pregnant Women – Medicaid for Pregnant Women covers a childbearing woman of any age. Members must be at 185% or lower of the Federal Poverty Level (FPL). Members must recertify every year.
Community Health Choice is a managed care organization that offers Texas Medicaid STAR coverage and provides services that are covered benefits of the Medicaid Program. Read the Benefits section of our Member handbook to see what is covered, what is not covered, and how to get these benefits.
Medicaid does not provide coverage if you are out of the country. Benefit coverage is limited to your service area. If you are outside of our service area, benefits are limited to emergency care.
Read about our service area coverage in our STAR Handbook .
After a person chooses a managed care organization, like Community Health Choice, to provide their healthcare, they then choose a Primary Care Provider to give them all their primary care services. This includes coordinating referrals for all medically necessary specialty services.
Want to see if your Provider, specialist or hospital is in our network? Search our Find a Provider .
Community follows the Texas Vendor Drug Formulary for Medicaid and CHIP. Updates to the formulary are managed by the Texas Vendor Drug Program.
Here is how to search:
This search will tell you:
Drugs are listed as “preferred” and “non-preferred.” If you need a “non-preferred” drug, your doctor will need to submit a special request to get the “non-preferred” drug by calling Member Services toll-free at 1.888.760.2600.
Some benefits and services must be reviewed and approved by our Utilization Management Department. Here are some things you should know about utilization management services.
Our Notice of Privacy Practices is given to you as part of the Health Insurance Portability and Accountability Act (HIPAA). It says how we can use or share your protected health information (PHI) and sensitive personal information (SPI). We review this notice annually and update if needed.
“Protected health information” and “sensitive personal information” (PHI/SPI) is information that identifies a person or patient. These data can can be your age, address, e-mail address, and medical facts. It can be about your past, present or future physical or mental health conditions. It also can be about sensitive healthcare services and other personal facts.
It tells you who we can share it with and how we keep it safe. This includes protection of your oral, written and electronic information across the organization. It tells you how to get a copy of or edit your information. It ensures that any oral, written, and electronic information you share with us is confidential and secure.
You can allow or not allow us to share specific details unless needed by law. You have the right to approve or withdraw the use of your information.
Read our full Privacy Notice section in our Member Handbook.
