1. (a) Except as provided in subsection (b) of this section, enrollment in the STAR Kids program is mandatory for a Medicaid client who is under the age of 21 and meets one or both of the following criteria:

   1. (1) has a physical or mental disability and qualifies for Supplemental Security Income (SSI) or SSI-related Medicaid; or
   2. (2) is enrolled in the Medically Dependent Children Program (MDCP) waiver.

2. (b) Clients birth through age 20 residing in a community-based ICF-IID or nursing facility or receiving services under the following Medicaid 1915(c) waivers must enroll in STAR Kids to receive acute care services and non-facility based state plan services:

   1. (1) Home and Community-based Services (HCS);
   2. (2) Community Living Assistance and Support Services (CLASS);
   3. (3) Texas Home Living (TxHmL); or
   4. (4) Deaf Blind with Multiple Disabilities (DBMD).
3. (c) Clients birth through age 20 receiving services under the Youth Empowerment Services (YES) Medicaid 1915(c) waiver must enroll in STAR Kids to receive acute care services and non-facility based state plan services other than Community First Choice state plan services.

4. (d) The following Medicaid clients cannot participate in the STAR Kids program:

   1. (1) clients residing in the Truman W. Smith Children's Care Center;
   2. (2) residents of state supported living centers;
   3. (3) residents of state veterans' homes;
   4. (4) persons not eligible for full Medicaid benefits; and
   5. (5) children in the conservatorship of the Texas Department of Family and Protective Services.

5. (e) Dual eligible clients.

   1. (1) Enrollment in Medicare does not affect eligibility for the STAR Kids program.
   2. (2) Dual eligible clients who participate in the STAR Kids program receive most acute care services through their Medicare provider, and long term services and supports through the STAR Kids MCO. Participation in the STAR Kids program does not change the way dual eligible clients receive Medicare services.
6. (f) Individuals birth through 20 who participate in the Medicaid Buy-In for Children Program or the Medicaid Buy-In Program must enroll in STAR Kids.
7. (g) STAR Kids Medicaid clients have a choice among at least two MCOs.

Source Note:The provisions of this §353.1203 adopted to be effective November 1, 2016, 41 TexReg 8265.