Star Kids Basics
This program provides Medicaid managed care services for children with disabilities or special healthcare needs under age 21.
What is STAR Kids?
This service helps with ADLs such as bathing, dressing, and feeding.
What is Personal Care Services (PCS)?
Member requires total assist with toileting and feeding—this supports approval for this service.
What is PCS?
This must be clearly documented to justify PCS hours.
What are functional limitations?
These must be consistent across all documentation?
What is documentation between SAI, ISP, and notes.
This document outlines the member’s assessed needs, services, and goals.
What is the Individual Service Plan (ISP)?
Members must have this to qualify for STAR Kids.
What is Medicaid?
Caregiver reports exhaustion and inability to provide 24/7 care—this service should be explored.
What is respite?
PCS tasks must not replace this person's responsibility.
Who is the parent/legally responsible adult (LAR)?
This phrase strengthens justification for increased hours.
What is “increased assistance required due to change in condition”?
This required annual assessment determines service needs and level of care.
What is the STAR Kids Screening and Assessment Instrument (SAI)?
These include PCS, PDN, and therapies.
What are long-term services and supports (LTSS)?
Member’s condition worsens and requires more assistance—this must be completed.
What is Change in condition assessment/SAI update?
Documentation must match this across SAI, ISP, and progress notes.
What is consistency?
This phrase indicates the member needs hands-on assistance.
What is “requires physical assistance”?
This person is responsible for coordinating services, monitoring needs, and ensuring care plan implementation.
Who is the Service Coordinator?
These extra benefits go beyond standard Medicaid coverage.
What are Value-Added Services (VAS)?
This is a common denial risk when documentation is missing or weak.
What is lack of medical necessity?
This must explain why the member cannot perform ADLs independently.
What are detailed limitations/needs narratives?
“Requires assistance.” (What’s missing?)
What is specific task, frequency, and level of assistance?
Does STAR Kids replace all Medicaid services?
What is No!!—some are non-capitated*** Bonus points to name some non-capitated services***
STAR Kids is mandatory for members who meet eligibility criteria within this group.
Who are Medicaid members under age 21 with disabilities?
This must be individualized and not copied when documenting PCS needs.
What is member-specific care documentation?
PCS hours must reflect this—no more, no less.
What are assessed needs?
“Member needs help with bathing.” (What’s missing?)
What is frequency, level of assistance, and reason (why)?