Adult Day Care

Companionship is important. Adult day care provides care and companionship for members who qualify for extra help during the day. Caregivers also benefit, knowing their loved one is well cared for and safe during the day.

If your need for long‑term care has been determined by Texas Medicaid, Adult Day Care can provide:

• Social connections and friendship.
  
• Bathing and personal care. 
  
• Meals.

Asthma and COPD Support

Individual care to help you control asthma or COPD symptoms.

Do you have trouble managing asthma or COPD symptoms? A nurse who specializes in breathing issues could help. You’ll get a customized treatment plan and medicine to help:

• Manage flare-ups.
• Reduce symptoms.
• Stay active.

Certain members can also get an allergy-free mattress cover and pillow cases each year.

Choice of Doctor

From regular checkups to preventive health screenings, we want to make sure you get access to the right care at the right time.

You get a primary care physician (PCP) who is your main doctor. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured
• Referrals to specialists for certain conditions.
• Denture and denture repair 

Dental Care

Checkups, routine and emergency care are covered.

Exams and cleanings once every 12 months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well.

Adult Dental Services (non-waiver Members) $1,000 benefit to cover routine exam and cleaning once per year, full mouth x-ray, scaling and root planning if medically necessary.

Equipment and Supplies

The health and safety of our members at home are important.

Our plan covers some medical equipment ordered by a member's doctor or case manager. This can include:

• Walkers
• Wheelchairs
• Hospital beds

Foot Care

We provide the exams and treatments needed to help keep your feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.

Our podiatry coverage includes:

• Routine foot exams.
• Tips about foot care and choosing the right shoes.
• Therapeutic shoes and inserts for members with diabetes.

Hearing Care

Trouble hearing can affect a person’s everyday life in many ways.  Our plan includes services and support to help protect hearing.

We cover:

Hospitalization

This plan pays for most expenses related to a hospital stay. This way you can rest and heal.

Our plan covers these services and more:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after leaving the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

In-Home Care

Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help with:

• Dressing
• Bathing
• Feeding

Language and Interpretation

You and your doctor need to understand one another. We can explain information in English or in your native language. If you are visually or hearing impaired, special help can be provided.

Medicines

Our plan includes prescription drugs and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

You pay only a co-pay amount, if needed, and you can get your prescription drugs at any in-network pharmacy.

Member Services

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call 24/7. We’ll answer your questions simply and completely.

We can also help you find:

• Home care providers.
• Dentists and vision providers.
• Adult Day Health Centers.

Mental Health

Get help with personal problems that may affect your mental or physical health. These may include depression, anxiety or drugs and alcohol abuse. Our services also include: 

• Therapy
• Counseling
• Medications

Online mental health resources: Access to LiveandWorkWell.com, which provides access to article resources, and provider searches.

No Copays

While you pay nothing for covered services, you get:  

• Treatments at hospitals and clinics.
• Prescription drugs and over-the-counter medicines.

Nurse Advice

Medical questions and situations come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.

Our nurses will: 

• Listen to symptoms.
• Help with self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

Quitting Tobacco

You know the bad health effects of smoking. You know you need to quit. We will support you while you quit with coaches and supplies. The only thing you won't get from us is a lecture.

Respite Care

Do you have family members or friends who care for you at home? If so, we want to support their hard work too. That's why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.

Service Coordinator

Our members' safety is our focus. For members who need extra care, like after a major illness, we'll visit them at home to make sure they're doing okay.

During this visit we:

• See if the residence needs minor modifications, such as ramps and bathroom safety devices.
• Set up emergency monitoring.
• Arrange for a personal care attendant, if needed.

Therapy Services

Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.

Our plan covers visits for:

• Occupational therapy
• Physical therapy
• Speech therapy
• In-home therapy

Transportation

Whether you live in the city or in the country, rides are available. Our plan provides round trips to and from plan locations. This includes trips to and from the pharmacy to fill your prescriptions.

We pay for 8 one-way, or 4 round-trips per year to support services or support needed.

Vision Care

You'll get the care, eyeglasses and treatment that let you see life more clearly. Coverage includes:

• One routine eye exam every two (2) years.
  
• $105 for frames, lenses, or contact services not covered by Medicaid, but cannot be used for a 2nd pair lenses every two (2) years.

This benefit is offered by certain stores and retailers.

Weight Control

Get 10 vouchers toward local Weight Watchers programs.

Weight Watchers encourages a healthy approach for eating and living. The program helps you change your eating habits and become more active. Weekly meetings give you advice and support. So you can stay on track and meet your goal.

• $50 gift card for workout clothes for Members who complete Weight Watchers.
  
• Enhanced Disease Management (prior authorization and referral required) providing specific observation and comprehensive educational activities.
  
• Specific counseling services for comprehensive individual or group treatment sessions (prior authorization and referral required)