Mental Health and Substance Use Services for Adult Members
Driscoll Health Plan Member Advocates are here to help you with writing complaints and will help you through the complaint process. If you need help with an appeal, a Member Advocate can help you file an appeal and walk you through the process. If you have a question about the covered services or preventative services of Driscoll Health Plan, call Member Services toll-free at 1-877-324-7543.
Our staff speaks English or Spanish and can help you with questions. We also have special services for members who have trouble reading, hearing, seeing, or speaking a language other than English or Spanish. Members or their legally authorized representatives can ask for the handbook in audio, larger print, Braille, and other languages. To get help, call Member Services toll-free or the TTY line listed on your member ID card.
As soon as you have your new address, give it to HHSC benefits office by dialing 2-1-1 and call Driscoll Health Plan Member Services Department toll-free, for Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247. Before you get Medicaid services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you get a bill, call Member Services and we can help you. We can call the provider’s office for you. You are not responsible for co-pays, deductibles, and services that are not covered by Medicaid.
Your Primary Care Provider can help you decide if you need to see a specialist. In general, you cannot go to another doctor or get a special service unless your Primary Care Provider agrees to make a referral. Refer to your member handbook for additional information.
You should ask for Non-Emergency Medical Transportation (NEMT) services as early as possible and at least two business days before you need the NEMT service. In certain circumstances, you may ask for the NEMT service with less notice.
Driscoll Health Plan will provide you with information on how to schedule a ride through SafeRide Health. Call SafeRide Health to schedule and pick up at: 1-833-694-5881. To learn more about transportation, click here https://driscollhealthplan.com/services/transportation/
If you need medical care when traveling, call us toll-free, for Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247 and we will help you find a doctor.
If you need emergency services while traveling, go to a nearby hospital, then call us toll-free, for Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247.
Your Primary Care Provider or another doctor is available by phone 24 hours a day, 7 days a week. If you get sick at night or on the weekend, you can call your Primary Care Provider’s office number for help. The office will have an answering service or message on how to contact your Primary Care Provider. Your Primary Care Provider should return your call within 30 minutes.
You may also visit an in-network after-hours clinic or urgent care center for sudden illness. You should contact your Primary Care Provider’s office if you are unsure about going to an after-hours clinic or urgent care center.
Emergency Behavioral Health Condition means:
Any condition, without regard to the nature or cause of the condition, which in the opinion of a prudent layperson, possessing an average knowledge of medicine and health:
Emergency care is available 24 hours a day, 7 days a week.
Emergency medical condition means a medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:
Emergency care is available 24 hours a day, 7 days a week.
When to seek EMERGENCY medical care:
You may choose a clinic as your Primary Care Provider. This can be a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC).
There is no limit on how many times you can change your or your child’s Primary Care Provider. You can change primary care providers by calling us toll-free, for Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247
You may change your PCP at any time. If you have seen your PCP within the current month, the change will become effective on the first day of the following month. If you have NOT seen your PCP within the current month, the change will become effective on the first day of the month in which the change is made. The PCP change may be expedited if DHP decides it is in the best interest of the Member and the current PCP.
Driscoll Health Plan wants you to be happy with your Primary Care Provider. You can change your Primary Care Provider if:
You can change your Primary Care Provider by calling Member Services. The Driscoll Health Plan Provider Directory lists all Primary Care Providers.
A Primary Care Provider is your main doctor, nurse practitioner, or physician assistant who takes care of your medical needs. Your PCP will make sure you get regular checkups. They will write prescriptions for medicines and supplies you need. Your PCP may also refer you to other providers if needed.
If your Medicaid ID card is lost or stolen, you can get a new one by calling toll-free at 1-800-252-8263, or by going online to order or print a temporary card at yourtexasbenfits.com
Driscoll Health Plan Member Advocates are here to help you with writing complaints and will help you through the complaint process. If you need help with an appeal, a Member Advocate can help you file an appeal and walk you through the process. If you have a question about the covered services or preventative services of Driscoll Health Plan, call Member Services toll-free at 1-877-324-7543.
Contact your Service Coordinator if your child needs to see a doctor or provider that is out of the area. We want to make sure your child keeps getting the care and services needed during the transition into STAR Kids. Driscoll Health Plan will authorize services that are out of the area when it is the best interest of your child.
Your primary care provider or another doctor is available by phone 24 hours a day, 7 days a week. If you get sick at night or on the weekend you can call your primary cares provider’s office number for help. The office will have an answering service or message on how to contact your primary care provider. Your primary care provider should return your call within 30 minutes.
You may also visit an in-network after-hours clinic or urgent care center for sudden illness. You should contact your primary care provider’s office if you are unsure about going to an after-hours clinic or urgent care.
As soon as you have your new address, give it to the HHSC benefits office by dialing 2-1-1 and call Member Services toll-free, for Nueces SA: 1-844-508-4672 or Hidalgo SA: 1-844-508-4674. Before you get Medicaid services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will keep getting care through Driscoll Health Plan until HHSC changes your address.
If you get a bill, call Member Services and we can help you. We can call the provider’s office for you. You are not responsible for co-pays, deductibles, and services that are not covered by Medicaid.
These services will continue until your DHP Service Coordinator assesses your needs and determines the number of hours you will require. Call your Service Coordinator or the Service Coordination Line toll-free at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
Yes, you can see the same doctor as your child if the doctor takes care of adults. You can call your child’s doctor and ask them or you can call Member Services. Member Service can help you in finding out if the doctor takes care of adults.
If your child’s doctor does take care of adults and you want to change your doctor you will need to call Member Services to change your doctor of record. Service Coordination can also help you with scheduling an appointment for your child. Call the Service Coordination Line toll-free at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
Medicaid covers some durable medical equipment and products normally found in a pharmacy. For all Members, Driscoll Health Plan pays for nebulizers, ostomy supplies, and other covered supplies and equipment if they are medically necessary. For children (birth through age 20), Driscoll Health Plan also pays for medically necessary prescribed over-the-counter drugs, diapers, formula, and some vitamins and minerals.
To learn more, please call Members Services.
Community First Choice provides home and community-based basic attendant services and supports. The services you can get in CFC are:
To learn more, call Service Coordination toll-free at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
Personal Care Services helps with everyday tasks like bathing, eating, dressing, and walking. PCS can also help you to fix meals and do light housework. Your Service Coordinator will assess your need for this service at each home visit. To learn more, call your Service Coordinator toll-free at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
In STAR Kids, you may select how you would like some LTSS delivered.
CDS option gives you more choices and control over how some of your LTSS services are delivered.
If you choose the CDS option, you will be able to:
Services that can be managed by CDS will depend on your Waiver. Some of these services may include; attendant care, speech, physical and occupational therapy, respite care, employment assistance, flexible family support, etc.
If you choose to be in CDS, you will contract with a Financial Management Services Agency (FMSA). FMSA will:
Call the Service Coordination Line toll-free at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
To choose an OB/GYN, call Member Services. You can also have the OB/GYN doctor be your Primary Care Provider. If you want to have the OB/GYN doctor be your Primary Care Provider, call Member Services.
You have the right to pick an OB/GYN without a referral from your Primary Care Provider.
A network pharmacy can be found on the Pharmacy Network List at driscollhealthplan.com or contact Member Services for help finding a network pharmacy.
Family planning services (such as birth control and counseling) are very private. You can have a once a year visit, counseling, and tests. You can also have drugs and supplies that prevent pregnancy. Ask your primary care provider if he or she offers family planning services such as birth control. If you do not feel comfortable talking with your primary care provider, call Member Services or your Service Coordinator. You can go to any family planning clinic that will take Medicaid.
To get eye exams or glasses, call Envolve, for Nueces 1-844-305-8300 or Hidalgo 1-844-725-6410. You do not need a referral from your Primary Care Provider for routine eye checkups from ophthalmologists or optometrists in Envolve’s provider network.
If your doctor cannot be reached to approve a prescription, you may be able to get a three-day emergency supply of your medication.
You should ask for NEMT services as early as possible and at least two business days before you need the NEMT service. In certain circumstances, you may ask for the NEMT service with less notice.
Driscoll Health Plan will provide you with information on how to schedule a ride through SafeRide Health. Call Saferide Health to schedule and pick up at: 1-833-694-5881
In addition to your regular health benefits, Driscoll Health Plan offers extra services to our Members at no cost. Driscoll Health Plan wants you and your family to stay healthy and enjoy life. Therefore, we offer a Value-Added Service for everyone in the family.
Respite care is temporary help for caregivers from the responsibilities of caring for a person with special needs. Services might be delivered in the home or out of the home. Respite care can be a few hours provided:
Minor Home Modifications must be needed to ensure health, welfare and safety or to support independence in the home. Some STAR Kids members might be able to get Minor Home Modifications, such as MDCP members.
Driscoll Health Plan will cover changes to existing bathrooms and doorways, as well as ramps.
For more information about Minor Home Modifications, contact your Service Coordinator or the Service Coordination Line toll-free at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
There might be times when the DHP’s Medical Director denies these services. When this happens, you can ask for an appeal for the denial of payment for services in whole or in part. For help with how to fill out the appeal form, call Member Services.
We want to help you. If you have questions about how to file a complaint, please call us toll-free, for Nueces SA: 1-844-508-4672 or Hidalgo SA: 1-844-508-4674 to tell us about your problem. A Driscoll Health Plan Member Advocate can help you file a complaint.
Once you have gone through the Driscoll Health Plan complaint process, and you are not pleased with our response, you may file your complaint directly to the Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989. If you would like to make your complaint in writing, please send it to the following address:
Texas Health and Human Services Commission
Ombudsman Managed Care Assistance Team
P.O. Box 13247
Austin, TX 78711-3247
If you can get on the Internet, you can submit your complaint at: hhs.texas.gov/managed-care-help
For help on choosing a specialist in our network call Service Coordination toll-free at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
Your Primary Care Provider can help you decide if your child needs to see a specialist. Your child’s doctor will make a referral for services, if needed. There are some exceptions to referral requirements, especially for MDCP Members. You may also share your referral questions with your Service Coordinator.
Driscoll Health Plan has a program for Members who have asthma or diabetes. The program helps you and your family to understand and take care of your disease. Our goal is for you to have better health. Your Service Coordinator will call to explain the program and will assess your asthma or diabetes during a scheduled visit. The Service Coordinator will work with you and your doctor to create a plan.
To learn more, call Driscoll Health Plan Disease Management at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
Driscoll Health Plan wants you to be happy with your Primary Care Provider. You can change your Primary Care Provider if:
You can change Primary Care Providers by calling Member Services. The Driscoll Health Plan Provider Directory lists all Primary Care Providers.
A Primary Care Provider is your main doctor, nurse practitioner, or physician assistant who takes care of your medical needs. Your PCP will make sure you get regular checkups. They will write prescriptions for medicines and supplies you need. Your PCP may also refer you to other providers if needed.
If you would like to speak to a Service Coordinator, call the Driscoll Health Plan Service Coordination line at:
Nueces: 1-844-508-4673
Hidalgo: 1-844-508-4675
A Service Coordinator will assess your health care needs. Once a care plan is in place, the Service Coordinator will monitor your progress towards your health care goals. They will help with:
Service coordination helps you with getting the covered services you need. This service costs you nothing. Your Service Coordinator will work with you, your family, and provider to create an Individual Service Plan.
If you lose your ID card, call us right away, for Nueces SA: 1-844-508-4672 or Hidalgo SA: 1-844-508-4674 to get a new one. We can mail you one right away. If you move or change phone numbers, call us so we can send you another ID card. We always need to have your correct address and phone number.
Driscoll Health Plan Member Advocates are here to help you with writing complaints and will help you through the complaint process. If you need help with an appeal, a Member Advocate can help you file an appeal and walk you through the process. If you have a question about the covered services or preventative services of Driscoll Health Plan, call Member Services toll-free at 1-877-324-7543.
Driscoll Health Plan will provide you with information on how to schedule a ride through SafeRide Health. Call SafeRide Health to schedule and pick up at: 1-833-694-5881. To learn more about transportation, click here https://driscollhealthplan.com/services/transportation/
Our staff speaks English or Spanish and can help you with questions. We also have special services for people who have trouble reading, hearing, seeing, or speaking a language other than English or Spanish. You can ask for member materials in audio, larger print, Braille, and other languages. To get help, call our Member Services toll-free number on your ID card.
You must report your new address before getting any services in your new area unless it is an emergency. If you have moved out of the DHP service area you will be reassigned to a new health plan. You will continue to get care through DHP until the address is changed.
If you are a CHIP member: As soon as you have your new address, give it to HHSC by calling 2-1-1 or updating your account on yourtexasbenefits.com and call the Driscoll Health Plan Member Services Department at 1-877-451-5598. Before you get CHIP services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you are a CHIP Perinate member: As soon as you have your new address, give it to the HHSC by calling 2-1-1, or updating your account on yourtexasbenefits.com and calling Driscoll Health Plan Member Services at 1-877-451-5598. Before you get CHIP services in your new area, you must call Driscoll Health Plan Member Services, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you get a bill from your Primary Care Provider or other Doctor, call Member Services at 1-877-451-5598 and someone will call the Doctor’s office. We will help to explain your benefits and copayments.
If you get a bill, call Member Services at the numbers shown to the right, and someone will help you. When you call, please have your ID card and doctor’s bill. Member Services will need this information to help you.
Your PCP will tell you when you and/or your child need to see a specialist. Your PCP will make sure that you and/or your child get the special care needed. Most of the time, you cannot go to another doctor or get a special service if your PCP does not agree to make a referral. A referral is when your PCP sends you to another doctor. You should expect the specialist to give you an appointment within 30 days for non-urgent care or within 24 hours for urgent care.
If you are a CHIP member and need a ride to the doctor’s office, SafeRide Health offers transportation services to medical appointments.
Phone Reservations: 1-833-694-5881
We can help you with a ride to the doctor.
If you and/or your child get sick while you are out of town or out of state, call your PCP. Your PCP’s phone number is listed on the front of your DHP ID card. You may also call Member Services at the number on the back of your ID card. If you and/or your child have an emergency while you are out of town or out of state, go to the nearest ER.
Driscoll Health Plan does not cover any care outside of the United States.
If you and/or your child gets sick at night or on the weekend and cannot wait to get medical care, call your PCP for advice. If you and/or your child have a fever or a sore throat and you are not sure what to do, call your PCP’s office. Your PCP or another doctor are available by phone 24 hours a day, 7 days a week.
Emergency medical condition means a medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:
Emergency care is available 24 hours a day, 7 days a week.
You and/or your child have an EMERGENCY medical need if:
There is no limit on how many times you can change your or your child’s primary care provider. You can change primary care providers by calling us toll-free at 1-877-451-5598.
You and/or your child may choose a clinic as your PCP. This can be a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC). A hospital-based clinic such as the Spohn Family Health Clinics can also be your PCP. To choose a clinic as your PCP or if you have questions, call Member Services at 1-877-451-5598.
You can change your PCP at any time. If you have seen your PCP within the current month, the change will become effective on the first day of the following month. If you have NOT seen your PCP within the current month, the change will become effective on the first day of the month in which the change is made. The PCP change may be expedited if DHP decides it is in the best interest of both the Member and the current PCP. You need to continue to see your current PCP until the change is effective.
Having a medical home is very important. It makes sure that you and/or your child have a doctor that you know and trust for all your medical needs. If for any reason you need to change your PCP, call Member Services at 1-877-451-5598.
You must take your DHP ID Card. Bring a list of medicines you and/or your child are taking. If you take your child, also remember to take your child’s shot records.
If you lose your DHPID card, call us right away at 1-877-451-5598 to get a new one. We can mail you one right away. If you move or change phone numbers, call us so we can send you another ID card. We always need to have your correct address and phone number.
If you lose your DHPID card, call us right away at 1-877-451-5598 to get a new one. We can mail you one right away. If you move or change phone numbers, call us so we can send you another ID card. We always need to have your correct address and phone number.
Our staff speaks English or Spanish and can help you with questions. We also have special services for people who have trouble reading, hearing, seeing, or speaking a language other than English or Spanish. You can ask for member materials in audio, larger print, Braille, and other languages. To get help, call our Member Services toll-free number on your ID card.
As soon as you have your new address, give it to the HHSC by calling 2-1-1, or updating your account on yourtexasbenefits.com and calling Driscoll Health Plan Member Services at 1-877-451-5598. Before you get CHIP services in your new area, you must call Driscoll Health Plan Member Services, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you get a bill from your provider, call Member Services at 1-877-451-5598. We will contact the provider’s office and explain your benefits.
You do not need a referral to go see your CHIP Perinatal Provider.
If you are a CHIP Perinate member and need a ride to the doctor’s office, SafeRide Health offers transportation services to medical appointments.
Phone Reservations: 1-833-694-5881
If you and/or your child get sick while you are out of town or out of state, call us toll-free at 1-877-451-5598, and we will help you find a doctor. If you and/or your child have an emergency while you are out of town or out of state, go to the nearest ER and then call us toll-free at 1-877-451-5598.
Driscoll Health Plan does not cover any care outside of the United States.
Your Primary Care Provider or another doctor is available by phone 24 hours a day, 7 days a week. If you get sick at night or on the weekend, you can call your Primary Care Provider’s office number for help. The office will have an answering service or message on how to contact your Primary Care Provider. Your Primary Care Provider should return your call within 30 minutes.
A CHIP Perinate Member is defined as an unborn child. Emergency care is a covered service if it directly relates to the delivery of the unborn child until birth. Emergency care is provided for the following Emergency Medical Conditions:
Benefit limits: Post-delivery services or complications resulting in the need for emergency services for the mother of the CHIP Perinate are not a covered benefit.
You will need to pick a Primary Care Provider for your newborn baby. The Primary Care Provider is the doctor who takes care of your baby’s medical needs. This includes all checkups and vaccines (immunizations). You can pick your child’s Primary Care Provider before he or she is born if you would like. If needed, you can change your baby’s Primary Care Provider later. If you do not pick a Primary Care Provider for your baby, DHP will pick one for you.
Your Perinatal Provider can be a doctor, a health clinic, a Federally Qualified Health Center (FQHC), or a Rural Health Clinic (RHC) that is contracted with DHP to provide pregnancy services.
If you have 16 weeks or less remaining before the expected delivery date of your baby, you can stay with your current doctor until after your postpartum checkup, even if the doctor is, or becomes, out of network. Otherwise, you will need to pick a Perinatal Provider that is in DHP’s network.
You should be able to get an appointment for routine care within two weeks. If you have had problems with previous pregnancies, or if you are more than seven months pregnant, you should be given an appointment within five days of the request.
You can change your Perinatal Provider by calling Member Services at 1-877-451-5598.
You may choose a Perinatal Provider from the DHP Provider Directory or you can get help picking a Perinatal Provider by calling Driscoll Health Plan Member Services at 1-877-451-5598.
If you go to a Provider that is not in DHP's network, you might have to pay the bill.
You must take your DHP ID Card. Bring a list of medicines you are taking, including any herbal supplements. A list of health concerns. Medical records if you are a new patient.
