Profile of Texas HEART and "STARLink"
November 2002
Texas HEART (Texas Health Education Assistance Resources and Training), with a helpline called "STARLink," is a fairly new Medicaid health assistance program. Texas Heart is located in a nonprofit organization. In 1995, when Texas first began to transition from a Medicaid fee-for-service to a managed care delivery system, the Texas legislature required creation of an independent consumer helpline (included in Senate Bill 601) staffed by advocates to help managed care enrollees facing barriers to needed care. The helpline became operational in January 2001 through a contract between the Texas Department of Health (now the Health and Human Services Commission) and Texas HEART. It serves the Medicaid managed care population throughout Texas―approximately 800,000 people currently, most of whom live in metropolitan areas. (In nonmetropolitan areas, the Medicaid population mostly remains in a fee-for-service delivery system.)
Four full-time advocates staff STARLink. They educate people about how to navigate managed care through general outreach presentations, educational resources posted on their Web site, and one-on-one telephone counseling. When people call with an inquiry or problem, advocates provide advice and information to help callers resolve problems on their own. In more complex cases, advocates intervene on the consumer's behalf, sometimes making conference calls with the consumer to providers, health plans, and state agencies. They advise consumers on their rights to file grievances, appeals, and hearing requests and, when needed, guide consumers through these processes. (They do not actually represent consumers in hearings but can refer consumers to legal services programs.) STARLink staff assists consumers with issues that span the Medicaid managed care system, regardless of the parties involved. STARLink advocates spend a lot of time following up with all parties to make sure each consumer's problem is fully resolved. As a result of this intensive work, advocates complete a large volume of outgoing calls. As of Spring 2002, STARLink received about 400 calls per month, a number that has steadily grown since the program's inception. For a volume of 400 incoming calls STARLink makes approximately 1200 outgoing calls.
Besides counseling individuals, Texas HEART advocates for improvements in the Medicaid managed care system. Its authorizing legislation requires the program to track and identify trends in consumer problems, publish quarterly reports, and assist the state in identifying and correcting problems. Though the program has no authority to enforce or change laws or regulations, it can assure through its reports that the public and the state have information about problems consumers encounter and the program can recommend solutions to the state, and it builds alliances with plans and the state to assist Medicaid beneficiaries.
Examples of Texas HEART's quarterly reports are on the Web at www.txheart.org (click "STARLink" and "Reports"). Through its database, Texas HEART can track the prevalence of various types of problems, the piece of the health system involved (e.g., a health plan, provider, the state agency, or another contractor), and the area of the state in which a problem occurred. The database also tracks how much time was spent on calls and how problems were resolved.
One issue that Texas HEART has brought to the state this year is the difficulty consumers face in obtaining care after a move within the state. When consumers move out of a managed care area, they frequently need assistance in obtaining routine health care while their cases get transferred to traditional fee-for-service Medicaid. A statewide managed care advisory committee is now working to resolve such problems with access to care.
Outreach is among Texas HEART's biggest challenges. Though the program was authorized by legislation when Medicaid managed care began in Texas, it was not funded or implemented until five years later. While some states publicize health assistance programs on Medicaid enrollment materials or require contracting health plans to publish a health assistance program's phone number, Texas does not. Thus, Texas HEART must rely on its own outreach efforts to inform consumers of its services. Eventually, when word gets out about the program, STARLink expects to handle 1400 calls per month.
