Page 10

Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 10 also processes through the Third Party Reimbursement (TPR) system to seek premium reimbursement for cases where medical coverage is provided.

Local Mental Health Authorities (LMHAs) - Under the authority of the Department of State Health Services (DSHS), LMHAs are required to do outreach to identify clients with serious mental illness and mental retardation. The LMHAs vary in the amount and types of outreach conducted. Outreach activities may include: public announcements; distribution of brochures in targeted areas, such as doctors' offices, schools, and juvenile courts; public forums; or public festivals.

At intake, information, which may indicate Medicaid eligibility, is gathered by the LMHA. Individuals who appear to be Medicaid eligible are then referred for Medicaid eligibility determination. If the individual needs assistance with this referral, the LMHA will assist.

LMHAs may have out-stationed HHSC Medicaid eligibility workers on staff that do the Medicaid eligibility determinations on site.

Texas Health Steps - Texas Health Steps outreach efforts are aimed at encouraging the use of services (program participation) by enrolled THSteps clients. Texas Health Steps communicates with Medicaid eligible families on the state level as well as on the regional and local level through a statewide system of DSHS staff and contractors using the following tools:

• over 435,000 informing letters per month;

• a variety of brochures and other handouts in English and Spanish for recipient and provider use;

• home visits, telephone calls outreach at places where clients may be found, and efforts targeting specific groups such as migrant workers and newly enrolled Medicaid recipients;

• a single statewide toll-free number (1-877-THSTEPS) that is routed to the appropriate regional outreach location.

• regional provider newsletters which help to keep Health Steps providers informed of developments in the program;

• regional provider relations staff who help recruit and maintain Health Steps and Medicaid providers, supplementing the provider relations activities for which DSHS contracts with the Texas Medicaid and Healthcare Partnership (TMHP);