Coronavirus Information for Medicaid and CHIP Members

• Testing and testing-related visits for COVID-19 are covered by BCBSTX
• COVID-19 treatment and costs associated to COVID-19 are covered as well
• As with all BCBSTX services, there is no copay or deductible

Free At-Home COVID-19 Test Kits:

• Every home in the U.S. is eligible to order 8 free at-home COVID-19 tests. The tests are completely free and will be shipped at no cost through the United States Postal Service.
  Place your order today

Now Is the Time – Protect Yourself and Others

Vaccines are at no cost to BCBSTX Medicaid members. If you are on Children's Health Insurance Program (CHIP), you will have to pay a copay for the COVID-19 vaccine starting on October 1, 2024.

Don’t wait, get your vaccine:

• Build protection in your body to fight COVID-19
• Slow the spread of the virus
• Return to our pre-COVID-19 lives 

To learn how to get a ride, go to your plan's website and you will find Transportation Services in the Plan Details. 

• We have temporarily lifted restrictions for early drug refills. In some situations, you may get an early refill. Pharmacists can provide an early fill on most medications. Contact your pharmacy to ask for an early fill. 
• You can use your 90-day supply benefit. A 90-day supply is for members that need maintenance medications. You can also get at home delivery through our Mail-Order Program.

To find a network pharmacy check the Pharmacy Directory. Customer Advocates can also help you find a pharmacy or set up a Mail-Order service.

• Telehealth benefits have expanded to include more types of providers and more telehealth options in which a provider can deliver you services. This includes, but is not limited to, dieticians, therapists, and physicians. 
• BCBSTX now covers medically necessary telehealth, virtual visits and digital video consultations. For participating health care providers, there is no copay nor a deductible.

Telehealth is when a medical provider gives care by phone or digital video. Please call your doctor to see if they offer telehealth services.

Our Service Coordinators for STAR Kids and Service Managers for STAR and CHIP are here to help manage your care and get the services you need! If you need help with meals, in-home services, or other specialized needs, STAR Kids members can reach their Service Coordinator at 1-877-214-5630 (TTY: 711), and STAR and CHIP members can call the Service Management line at 1-877-214-5630 (TTY: 711).

• There are IV medications and oral pills that can be used to treat COVID-19. Learn more about those medications.
  
• You can also find a Test to Treat site and get treatment where you get tested. You must take oral COVID-19 medication within 5 days of your first COVID-19 symptoms. Use this tool to find a location that is right for you. 
  Test to Treat T2T locator
• COVID-19 medications are available through your doctor, local pharmacies, and health clinics. If you have COVID-19 symptoms and test positive, do not wait to get treated.

In January 2020, the federal government declared a public health emergency (PHE) in response to COVID-19. Under the PHE, the Texas Health and Human Services Commission (HHSC) has provided certain flexibilities, including allowing Medicaid members more time to request Fair Hearing. Instead of 120 days to request a fair hearing after the internal Blue Cross and Blue Shield of Texas (BCBSTX) appeal is finished, members were given 150 days to request a fair hearing with HHSC during the PHE.  

HHSC ended this flexibility on May 11, 2023.

Starting May 12, 2023, if you receive an “Adverse Benefit Determination” notice and want to appeal it, you must file your request for a fair hearing with or without and external medical review no less than 90 calendar days and no more than 120 calendar days from the date the notice is mailed. State Fair hearing requests filed past this deadline may not be reviewed.

If you have any questions, please call our Member Outreach team toll-free 1-877-375-9097 (TTY: 711) from 8:00 a.m. to 5:00 p.m., Central Time, Monday through Friday. 

Copays for Children’s Health Insurance Program (CHIP) will begin on October 1, 2024.

During the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived copays for doctor visits for CHIP members and COVID-19 vaccines. This will end on September 30, 2024.

You won’t have to copay for the following types of doctor visits:

• Mental health and substance use disorder treatment services

The copay amount you’ll need to pay is listed on your CHIP member ID card.
Your copay amount was determined based on your income when you enrolled in CHIP. You don’t have to copay for CHIP services if you are:

• Native American
• An Alaska Native
• A CHIP Perinatal member

If you have any questions, call the Customer Advocate Department at 1-888-657-6061 (TTY: 711). You can use YourTexasBenefits.com or the Your Texas Benefits mobile app to manage your benefits and update HHSC of any changes, like a new address or income.