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Medicaid Inpatient Hospital Spell of Illness Policy Extension for COVID-19 PHE Ending

Date: 03/23/23

The COVID-19 public health emergency (PHE) is ending on May 11, 2023.

The federal government declared a public health emergency (PHE) in January 2020 in response to COVID-19. Due to the PHE, the Texas Health and Human Services Commission (HHSC) allowed certain temporary flexibilities in Medicaid.

The federal PHE ends on May 11, 2023.

You may be impacted by the end of the inpatient hospital spell of illness policy extension.

This extension allows certain Medicaid members to receive inpatient hospital care for COVID-19 or a related diagnosis for up to 30 additional days beyond the existing limit of 30 days. This flexibility has been for Medicaid members who are:

  • A STAR Health member age 21 or older; or
  • A STAR+PLUS member.

HHSC will also be ending the flexibility waiving the $200,000 benefit limitation for COVID-19-related inpatient hospital stays, which applies to some members who remain in STAR Health after their twenty-first birthday.

These flexibilities will no longer be effective for COVID-19-related inpatient hospital stays with an admission date on or after May 12, 2023.

Need help?

If you have questions or need help, call Superior Member Services at the number on the back of your ID card. Hours of operation are 8 a.m. - 5 p.m., Monday-Friday.