Revision 18-0; Effective September 4, 2018

All children and young adults enrolled with a STAR Kids managed care organization (MCO) receive an assessment, at least annually, using the STAR Kids Screening and Assessment Instrument (SK-SAI).

The MCO must assess each member using the SK-SAI at least annually, or when the member experiences a change in condition. The assessment contains screening questions and modules that assess for medical, behavioral and functional services.

Once an MCO has completed the SK-SAI and Community First Choice (CFC), Personal Care Services (PCS) and/or Medically Dependent Children Program (MDCP) services have been determined, it is the responsibility of the MCO to communicate to the existing provider the approved service amount, duration and scope. If a new service is approved the member, legally authorized representative (LAR) or authorized representative (AR) should notify the MCO of the intended provider of services and the MCO will reach out to the provider.

Revision 25-4; Effective Dec. 12, 2025

All STAR Kids members are reassessed using the STAR Kids Screening and Assessment Instrument (SK-SAI) at least annually. The managed care organization (MCO) is responsible for tracking the renewal dates to ensure all member reassessment activities are completed timely. The MCO must initiate a reassessment to determine and validate continued need for services for each member before the end date of the annual SK-SAI.

The MCO uses the SK-SAI to create and submit a Medically Dependent Children Program (MDCP) member’s STAR Kids individual service plan (SK-ISP) to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP). The SK-ISP lists the member’s services and preferences for care and is valid for one year. The MCO does not submit an SK-ISP in the TMHP LTCOP for a service change or a change in condition. The MCO maintains amended SK-ISPs resulting from a service change or a change in condition SK-SAI in the member file.

The MCO must:

• Complete all member reassessment activities within 30 days before the SK-ISP expiration date.
• Not conduct the SK-SAI earlier than 90 days before the one-year anniversary of the previous SK-SAI.
• Submit the SK-SAI in the TMHP LTCOP no earlier than 90 days before or no later than 30 days before the expiration of the member’s current SK-ISP on file.
• Upload Form H2067-MC, Managed Care Programs Communication, to the MCOHub documenting any reason for a delay.

Program Support Unit (PSU) staff must:

• Ensure the member’s SK-ISP is authorized annually.
• Verify the member continues to meet the eligibility criteria for MDCP stated in 1200, MDCP Eligibility.
• Issue Form H2065-D, Notification of Managed Care Program Services, as notification MDCP services were approved or terminated at reassessment.

Failure to complete and submit timely reassessments may result in the member losing MDCP or Medicaid eligibility.

The assigned PSU staff must notify the Program Support Operations Review Team (PSORT) of late MCO reassessment activity by sending the Individual Service Plan (ISP) Expiring Report to the PSORT mailbox monthly. The ISP Expiring Report details members with SK-ISPs that expire within the next 90 days. The ISP Expiring Report must be in an Excel spreadsheet format. The assigned PSU staff must edit the ISP Expiring Report so that it only identifies SK-ISPs reported as an MCO non-compliance. The subject line for the email must read: MDCP Reassessment Delinquencies for [Month].

PSU staff do not have to send a follow-up email to PSORT when the MCO submits the following documents for reassessment delinquencies:

• Form H2067-MC;
• the SK-SAI; or
• the SK-ISP.

PSU staff must upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and document the HEART case record.

PSU staff must refer to 3327, Individual Service Plan Expiring Report, for more information about the ISP Expiring Report.

3210 Reassessment of Medical Necessity Determination

Revision 25-4; Effective Dec. 12, 2025

A Medically Dependent Children Program (MDCP) member must have a valid medical necessity (MN) determination for a nursing facility (NF) level of care (LOC) before Program Support Unit (PSU) staff recertifies the member for MDCP. The MN determination is based on a completed STAR Kids Screening and Assessment Instrument (SK-SAI).

PSU staff must refer to 1200, MDCP Eligibility, for more information on the eligibility criteria for MDCP including an MN determination.

The MCO completes and submits a reassessment SK-SAI to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) annually. The TMHP LTCOP automatically processes the SK-SAI and redetermines the member’s Patient-Driven Payment Model (PDPM) Long-Term Care (LTC) level and MN. The TMHP LTCOP sends the SK-SAI to the Office of the Medical Director (OMD) staff for manual review if the SK-SAI fails automatic MN approval.

PSU staff must monitor the TMHP LTCOP every five business days from the MN denial date in the TMHP LTCOP, until the MN status updates to one of the final statuses below:

• MN Approved: The status may change to MN Approved if the OMD physician overturns the denial because more information is received; or
• Overturn Doctor Review Expired: The status may change to Overturn Doctor Review Expired when the 14-business day period for the OMD physician to overturn the denied MN has expired, and no more or inadequate information was submitted for the doctor review. The denied MN remains in this status unless the member or legally authorized representative (LAR) requests a state fair hearing.

The MCO must notify PSU staff of a member’s MN denial and request Form H2065-D, Notification of Managed Care Program Services, by uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub.

PSU staff must complete actions in the following sections when notified a member is denied MN or requests an appeal of an MN denial:

• 6300, Denials and Terminations.
• 7200, State Fair Hearing Procedures for Medically Dependent Children Program.

Revision 25-1; Effective May 16, 2025

The managed care organization (MCO) must collaborate with the member and legally authorized representative (LAR) to create and update Form 2604, STAR Kids Individual Service Plan – Service Tracking Tool (SK-ISP). The MCO develops the SK-ISP using a person-centered process with the support of a group of people chosen by the member or LAR.

The SK-ISP articulates assessment findings from the STAR Kids Screening and Assessment Instrument (SK-SAI). It includes short and long-term goals, service needs and member preferences.

The MCO uses the SK-ISP to:

• document findings from the SK-SAI;
• develop a plan for services received through the MCO;
• document services received through third-party sources;
• identify a member's strengths, preferences, support needs and desired outcomes;
• identify what is important to the member;
• identify natural supports available to the member and needed service system supports;
• document the member's preferences for when and how to receive services;
• identify special needs, requests, or considerations the MCO or providers should know when supporting the member; and
• document the member's unmet needs.

The MCO must:

• write the SK-ISP in plain language that is clear to the member or LAR and, if requested, must be furnished in Spanish or another language;
• submit the electronic SK-ISP to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP), as applicable;
• create and update the SK-ISP at least annually, as applicable;
• ensure that all assessments are timed to prevent any lapse in service authorization or program eligibility;
• provide a printed or electronic copy of the SK-ISP to the member or LAR following any significant update;
• provide the Texas Health and Human Services Commission (HHSC) staff with the SK-ISP upon request;
• keep any amended SK-ISP in an MCO member's case file;
• not provide significant change SK-ISPs to Program Support Unit (PSU) staff;
• not submit any significant change SK-ISPs to the TMHP LTCOP; and
• authorize all services identified on the SK-ISP.

The SK-ISP must be within the member's cost limit. PSU staff do not calculate the SK-ISP cost limit. It is automatically calculated in the TMHP SK-ISP Annual Cost Limit field.

PSU staff must refer to 1 Texas Administrative Code (TAC) Section 353.1155, and the STAR Kids Handbook (SKH) for more information about the MDCP cost limit.

3310 Service Planning

Revision 23-3; Effective May 22, 2023

Form 2603, STAR Kids Individual Service Plan (SK-ISP) Narrative, is designed to complement the STAR Kids Screening and Assessment Instrument (SK-SAI) and to develop the SK-ISP. The managed care organization (MCO) is responsible for completing Form 2603. The MCO maintains Form 2603 in the MCO's case file.

At a minimum, Form 2603 must account for the following information:

• a summary document describing the recommended service needs identified through the SK-SAI;
• covered services currently received;
• covered services not currently received but the member may benefit from;
• a description of non-covered services that could benefit the member;
• member and family goals and service preferences;
• natural strengths and supports of the member, including helpful family members, community supports or special capabilities;
• a description of roles and responsibilities for the member, legally authorized representative (LAR), others in the member's support network, key service providers, the member's health home, the MCO and the member's school with respect to maintaining and maximizing the health and well-being of the member;
• a plan for coordinating and integrating care between providers and covered and non-covered services;
• short and long-term goals for the member's health and well-being;
• services provided to the member through other third-party resources (TPR) and the sources or providers of those services;
• plans specifically related to transitioning to adulthood for members 15 and older;
• a list of Medicaid state plan services the member is receiving or is approved to receive, including service type, provider, hours per week, begin and end date, and if the member has chosen the Consumer Directed Services (CDS) option or Service Responsibility Option (SRO), if applicable;
• a brief rationale for the services; and
• any other information to describe strategies to meet service objectives and member goals.

The MCO must include the items listed above in the SK-ISP.

3320 Service Planning for Medically Dependent Children Program Services

Revision 24-4; Effective Dec. 1, 2024

The STAR Kids individual service plan (SK-ISP) contains a list of all the member's services including Medically Dependent Children Program (MDCP) services. The managed care organization (MCO) lists MDCP services on Form 2603, STAR Kids Individual Service Plan Narrative. The list of MDCP services on Form 2603 must match the services listed on the electronic Form 2604, STAR Kids Individual Service Plan - Service Tracking Tool.

The MCO must submit Form 2604 to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) before the start date of the member's SK-ISP.

The MCO must collaborate with the member or legally authorized representative (LAR) to create the SK-ISP to ensure MDCP services do not exceed the member's cost limit. Only MDCP services count toward the cost limit. Program Support Unit (PSU) staff will not calculate the SK-ISP cost limit. It is automatically calculated in the TMHP LTCOP SK-ISP Annual Cost Limit field.

The MCO must initiate a reassessment for MDCP to determine and validate the need for continued services listed on the SK-ISP for each member before the end date of the annual STAR Kids Screening and Assessment Instrument (SK-SAI). The MCO must ensure all member reassessment activities, including submitting the SK-ISP to the TMHP LTCOP, are completed no earlier than 90 days and by 30 days before the expiration of the member's current SK-ISP on file. Failure to complete and submit timely reassessments may result in the member losing MDCP or Medicaid eligibility.

Program Support Unit (PSU) staff must refer to Section 3327, Individual Service Plan Expiring Report, for information on reporting delinquent MCO reassessments.

3321 Medically Dependent Children Program Individual Service Plan Revision

Revision 24-4; Effective Dec. 1, 2024

It may be necessary for the managed care organization (MCO) to revise the STAR Kids individual service plan (SK-ISP) within the SK-ISP period due to situations outlined in the STAR Kids Contract, Section 8.1.39.1 (PDF).

The MCO must retain the amended SK-ISP in the MCO's member case file.

The MCO must not submit the revised SK-ISP in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) or upload it to the MCOHub.

3322 Reserved for Future Use

Revision 23-3; Effective May 22, 2023

3323 Reserved for Future Use

Revision 23-3; Effective May 22, 2023

3324 Reserved For Future Use

Revision 22-3; Effective Sept. 9, 2022

3325 Reserved For Future Use

Revision 23-4; Effective Aug. 21, 2023

3326 Suspension of Medically Dependent Children Program Services

Revision 18-0; Effective September 4, 2018

To remain eligible for Medically Dependent Children Program (MDCP) services, a member must receive one MDCP service monthly. In the event that the member travels out of state, is admitted to a hospital or nursing facility (NF), or is unable to receive a waiver service in a particular month, the STAR Kids managed care organization (MCO) must document the suspension of waiver services in the member’s case file. The MCO must document the:

• dates during which services are suspended; and
• reason for suspension.

A member may not have services suspended longer than 90 days. If a member’s services are suspended 91 days or more, the MCO must notify the Program Support Unit using Form H2067-MC, Managed Care Programs Communication, and request closure of MDCP enrollment, following procedures in Section 2000, Medically Dependent Children Program Intake and Initial Application. Closure of MDCP enrollment may result in disenrollment from STAR Kids, loss of Medicaid eligibility, or both.

3327 Individual Service Plan Expiring Report

Revision 25-3; Effective Oct. 20, 2025

The assigned Program Support Unit (PSU) staff review the Individual Service Plan (ISP) Expiring Report for the Medically Dependent Children Program (MDCP) monthly to ensure reassessments are done on time. The ISP Expiring Report details members with STAR Kids individual service plan (SK-ISPs) that expire in the next 90 days.

The MCOs must provide a status update for all members with SK-ISPs expiring in the next 45 days. Only SK-ISPs expiring in 45 days require a status update from the MCO.

The process to manage the ISP Expiring Report follows:

• The MCO must:
  • research and provide a written status for each member whose SK-ISP expires in 45 days; and
  • return a completed report to PSU staff within two business days of the monthly call.
• PSU staff review the MCO responses to determine if the MCO needs to provide clarification about any member’s SK-ISP status. Only SK-ISP statuses that PSU staff have questions on are reviewed during the monthly call. There is no need to review each member for the status of the SK-ISP if the MCO response is sufficient.

Note: The monthly call may also be held if PSU staff or the MCO need to discuss items unrelated to the ISP Expiring Report.

The assigned PSU staff must check the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) to determine if the MCO has submitted the member’s SK-ISP before the SK-ISP end date. The assigned PSU staff must email PSORT the ISP Expiring Report each month as notification of late MCO reassessment activity. The ISP Expiring Report must be in an Excel spreadsheet format and edited so that it only identifies SK-ISPs being reported as delinquent. The subject line for the email must read: MDCP Reassessment Delinquencies for [Month].

The assigned PSU staff is not required to send a follow up email to PSORT when the MCO submits the following documents for reassessment delinquencies:

• Form H2067-MC, Managed Care Programs Communication;
• the STAR Kids Screening and Assessment Instrument (SK-SAI); or
• the SK-ISP. 

3327.1 Reassessment Procedures

Revision 24-4; Effective Dec. 1, 2024

The managed care organization (MCO) must complete annual assessment activities within 45 days of the individual service plan (ISP) expiration date. Assessment activities include:

• conducting an annual STAR Kids Screening and Assessment Instrument (SK-SAI) assessment;
• developing the STAR Kids individual service plan (SK-ISP); and
• submitting the SK-SAI and SK-ISP to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).

Designated Program Support Unit (PSU) staff must:

• search the TMHP LTCOP for SK-ISPs submitted daily; and
• create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and assign it to a designated PSU staff person.

PSU staff must complete the following activities within five business days of receipt of the reassessment HEART case record:

• ensure the member’s SK-ISP is authorized annually;
• check the Texas Integrated Eligibility Redesign System (TIERS) to verify the member:
  • is under 21;
  • has ongoing Medicaid financial eligibility and is actively enrolled in managed care;
• check the TMHP LTCOP to verify the member has:
  • an approved medical necessity (MN) and SK-SAI;
  • a SK-ISP that is within the cost limit that contains at least one Medically Dependent Children Program (MDCP) service;
• electronically generate Form H2065-D, Notification of Managed Care Program Services, in the TMHP LTCOP if the member continues to meet all MDCP requirements;
• mail Form H2065-D to the member or legally authorized representative (LAR);
• upload applicable documents to the HEART case record; and
• document the HEART case record.

PSU staff must refer to:

• Section 6300, Denials and Terminations, if the member does not meet MDCP requirements at reassessment.
• Section 7000, Applicant or Member Appeal Requests and State Fair Hearings, if the member or LAR files a state fair hearing within the adverse action notification period.

3410 Transfer from One MCO to Another

Revision 24-3; Effective Aug. 26, 2024

A member or legally authorized representative (LAR) can request to change managed care organizations (MCOs) at any time. However, a member can only be enrolled with one MCO for a given month. 

A member or LAR who wants to change from one MCO to another MCO must contact the state-contracted enrollment broker by:

• phone: 800-964-2777;
• fax: 855-671-6038; or
• mail: 
  HHSC 
  P.O. Box 149023 
  Austin TX 78714-9023

Note: Adoption Assistance or Permanency Care Assistance (AAPCA) members must contact the state’s enrollment broker to request transfer.

MCO enrollment changes become effective based on the date the MCO change is requested and processed in relation to state cutoff. The MCO selected before the state cutoff date will be the MCO of record on the first day of the next month. Any MCO change made after the state cutoff date is reflected in the following month.

Examples:

State cutoff date – Nov. 14

• A member requests an MCO change on Nov. 1, 2024. The enrollment effective date for the receiving MCO is Dec. 1, 2024.
• A member requests an MCO change on Nov. 18, 2024. The enrollment effective date for the receiving MCO is Jan. 1, 2025.

Program Support Unit (PSU) staff must refer to Appendix XIV, State Cutoff Charts, for more information on current cutoff dates.

Monthly Plan Changes Report

Enrollment Operations Management (EOM) Unit staff prepares and sends the Monthly Plan Changes report to PSU staff. The report gives a full list of all Medically Dependent Children Program (MDCP) members who have changed MCOs from the previous month. PSU staff are not required to provide the Plan Change Report to the MCOs. MCOs receive the plan change report for their members only through an automated process in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Portal (LTCOP).

The losing MCO and the gaining MCO must coordinate and share applicable member information to prevent a gap in services during the transfer. The gaining MCO must notify the Managed Care Contracts and Oversight (MCCO) Unit staff if they encounter issues getting the transfer packet from the losing MCO. MCCO Unit staff may contact PSU staff for help transferring member information to the gaining MCO.

The gaining MCO will have access to current and historical STAR Kids Screening and Assessment Instruments (SK-SAIs) and STAR Kids - Individual Service Plans (SK-ISPs) in the TMHP LTCOP once the member is enrolled with them.

The gaining MCO is responsible for service delivery from the first day of enrollment. The gaining MCO must provide services and honor authorizations included in the prior SK-ISP until the member receives a new SK-SAI. 

3420 Transfer from Another Medicaid Waiver Program to MDCP

Revision Notice 25-2; Effective July 11, 2025

Title 1 Texas Administrative Code (TAC) Section 353.1155(a)(1)(F) states that Medically Dependent Children Program (MDCP) members cannot be enrolled in more than one Medicaid waiver program at the same time. Program Support Unit (PSU) staff must refer to Appendix XIX, Mutually Exclusive Services, to determine if two services may be received at the same time by a member.

Individuals in the following Intellectual and Developmental Disabilities (IDD) waiver programs may be on the interest list for MDCP:

• Community Living Assistance and Support Services (CLASS);
• Deaf Blind with Multiple Disabilities (DBMD);
• Home and Community-based Services (HCS);
• Texas Home Living (TxHmL); or
• Youth Empowerment Services (YES) waiver program.

Individuals enrolled in the IDD waiver programs noted above are enrolled with a STAR Kids or STAR Health managed care organization (MCO).

PSU staff receive an MDCP interest list release (ILR) case record from the Interest List Management (ILM) unit in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART). The case record is assigned when an individual in another IDD waiver program comes to the top of the MDCP interest list (IL) and requests MDCP.

PSU staff must complete the following activities within ten business days of receiving the MDCP ILR case record in HEART:

• assign the HEART case record to the appropriate PSU staff; and
• document in the HEART case record the individual is enrolled in STAR Kids or STAR Health and does not require an enrollment packet.

PSU staff must complete the following activities within five business days of receiving the MDCP ILR case record in HEART:

• check the Texas Integrated Eligibility Redesign System (TIERS) to verify:
  • Medicaid financial eligibility in the Medicaid/CHIP/CHIP perinatal History screen;
  • STAR Kids or STAR Health managed care enrollment in the Managed Care screen;
• confirm the individual’s enrollment with another IDD waiver program by reviewing the:
  • Service Authorization System Online (SASO) Enrollment and Service Authorization records for:
    • CLASS (Service Group (SG) 2);
    • DBMD (SG 16);
    • HCS (SG 21);
    • TxHmL (SG 22); or
  • TIERS Long Term Services and Supports (LTSS) Eligibility Periods Details screen for the YES waiver;
• upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to the existing STAR Kids or STAR Health MCO in the MCOHub;
• upload all applicable documents to the HEART case record; and
• document the HEART case record.

PSU staff do not have to complete a 14-day contact for individuals enrolled in STAR Kids or STAR Health.

MCO Coordination

The MCO must submit the following required documents within 60 days from the date PSU staff uploaded Form H3676, Section A, to the MCOHub:

• the STAR Kids Screening and Assessment Instrument (SK-SAI) and STAR Kids Individual Service Plan (SK-ISP) to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP); and
• Form H3676, Section B, to the MCOHub.

Note: PSU staff must document Form H2067-MC, Managed Care Programs Communication, was received in lieu of Form H3676, Section B, in the HEART case record, if applicable.

PSU staff must email the Program Support Operations Review Team (PSORT) within two business days of an MCO failing to submit initial assessment information within the 60-day time frame. The email to PSORT must include:

• an email subject line that reads: MDCP Initial 60-Day XX [plan code] MCO Non-Compliance for XX [first letter of the applicant’s first and last name];
• the following items in the body of the email:
  • applicant’s name;
  • Social Security number (SSN) or Medicaid identification (ID) number;
  • date of birth (DOB);
  • name of the MCO and plan code;
  • date information was due from the MCO;
  • a brief description of the delay and any MCO information received; and
• attachments of any pertinent documents received from the MCO such as Form H2067-MC.

PSU staff must continue to monitor the TMHP LTCOP and the MCOHub for receipt of the above information. PSU staff must email any case information received from the MCO to the PSORT mailbox within two business days from its receipt. The follow-up email must include the same email identifier elements listed above.

PSU staff must continue to email the Managed Care Contracts and Oversight (MCCO) unit for MCO non-compliance issues unrelated to late initial assessment information. The email to MCCO must include:

• an email subject line that reads: MDCP MCO Non-Compliance for XX [first letter of the applicant’s first and last name];
• the following items in the body of the email:
  • applicant’s name;
  • SSN or Medicaid ID number;
  • DOB;
  • name of the MCO and plan code;
  • date information was due from the MCO;
  • a brief description of the MCO non-compliance and any MCO information received; and
• attachments of any pertinent documents received from the MCO, if applicable.

PSU staff must ensure the medical necessity (MN) determination on the SK-SAI in the TMHP LTCOP is valid by verifying the approval date does not exceed 120 days. PSU staff must complete the following activities within two business days from the MN expiration of 120 days:

• upload Form H2067-MC to the MCOHub advising the MCO:
  • the approved MN determination is past 120 days; and
  • a new initial SK-SAI is required for PSU staff to determine MDCP eligibility;
• upload Form H2067-MC to the HEART case record; and
• document the HEART case record.

The MCO must submit a new initial SK-SAI to the TMHP LTCOP before PSU staff can determine MDCP eligibility if the most recent assessment exceeds 120 days.

PSU Staff Coordination

PSU staff must contact and coordinate with IDD waiver program staff, the applicant, legally authorized representative (LAR) and MCO, as appropriate, to ensure the applicant’s current IDD waiver program services end one day before enrollment in MDCP.

PSU staff must determine if the applicant meets the eligibility criteria for MDCP within two business days of receiving all required documentation from the MCO.

PSU staff must complete the following activities on the same day they confirm all eligibility criteria for MDCP are met:

• in the TMHP LTCOP:
  • review and adjust the SK-ISP record start of care (SOC) and end dates, as needed;
  • update the MDCP Enrollment Form and save the form;
  • generate Form H2065-D, Notification of Managed Care Program Services;
• mail Form H2065-D to the member or LAR;
• fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist noting the:
  • MDCP program SOC date; and
  • termination date for the other IDD waiver program;
• email the Department of Family and Protective Services (DFPS) Developmental Disability Specialist (DDS) Manager the following information, if the member is enrolled in STAR Health:
  • an email subject line that reads: MDCP Determination for STAR Health Member XX [first letter of the member’s first and last name];
  • the following items in the body of the email:
    • member’s name;
    • Medicaid ID number;
    • DOB;
    • name of the MCO and plan code;
    • notice of the MDCP approval with the member’s SK-ISP dates;
  • Form H2065-D as an attachment.

Note: The DFPS DDS Manager does not have to respond to PSU staff’s notice MCDP services were approved. 

• email the Enrollment Resolution Services (ERS) unit the following information:
  • an email subject line that reads: Waiver Transfer for XX [first letter of the member’s first and last name];
  • the following items in the body of the email:
    • member’s name;
    • Medicaid ID number;
    • type of request: waiver transfer;
    • SK-ISP begin date;
    • SK-ISP end date;
    • MCO selection;
    • effective date of MDCP enrollment; and
  • Form H2065-D as an attachment;
• close the MDCP ILR case record in the Community Services Interest List (CSIL) database documenting the closure reason and date, if applicable;
• upload all applicable documents to the HEART case record;
• document all contacts with the IDD waiver program staff, member, LAR or MCO and any delays; and
• close the HEART record.

PSU staff must refer to 6300, Denials and Terminations, for more information on processing MDCP applicant denials.

3430 Transfer from MDCP to Another Medicaid Waiver Program

Revision 25-3; Effective Oct. 20, 2025

Title 1 Texas Administrative Code (TAC) Section 353.1155(b)(1)(F) states Medically Dependent Children Program (MDCP) members cannot be enrolled in more than one Medicaid waiver program at the same time. Program Support Unit (PSU) staff must refer to Appendix XIX, Mutually Exclusive Services, to determine if a member may receive two services simultaneously.

MDCP members may be on an interest list for an Intellectual and Developmental Disabilities (IDD) waiver program, such as:

• Community Living Assistance and Support Services (CLASS);
• Deaf Blind with Multiple Disabilities (DBMD);
• Home and Community-based Services (HCS);
• Texas Home Living (TxHmL); or
• Youth Empowerment Services (YES) waiver program.

PSU staff may receive notification from IDD waiver program staff or the MDCP member’s managed care organization (MCO) that the MDCP member:

• has come to the top of an IDD waiver program interest list;
• chooses to transfer to the IDD wavier program; or
• is already enrolled with an IDD waiver program.

PSU staff must complete the following activities within two business days from notification:

• create a case record in the Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART), if applicable;
• contact and coordinate with IDD waiver program staff by email to determine the:
  • MDCP termination date; and
  • start of care (SOC) date for the IDD waiver program with the MDCP termination date being the last day of the month before the IDD waiver SOC date;
• terminate the STAR Kids Individual Service Plan (SK-ISP) record and the MCDP Enrollment Form in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) the last day of the month before the IDD waiver SOC date;
• manually generate Form H2065-D, Notification of Managed Care Program Services;
• upload Form H2065-D to the MCOHub;
• mail Form H2065-D to the member or legally authorized representative (LAR);
• fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the MDCP termination date and the enrollment effective date for the new Medicaid waiver program;
• upload all applicable documents to the HEART case record;
• document all contacts with the IDD waiver program staff, member, LAR or MCO and any delays; and
• close the HEART case record.

Adverse Action is not required when an MDCP member transfers to an IDD waiver program.

3440 Transfer from Community Care Services Eligibility to STAR Kids

Revision 24-4; Effective Dec. 1, 2024

PSU staff must coordinate the termination of Community Care Services Eligibility (CCSE) with the CCSE case worker for individuals entering STAR Kids through the Medically Dependent Children Program (MDCP). This ensures the individual does not experience a break in services and does not receive concurrent services through CCSE services.

CCSE services are terminated by the CCSE case worker in the Service Authorization System Online (SASO) by the day before MDCP enrollment. This is crucial since no MDCP member may receive CCSE and MDCP services on the same day.

PSU staff are not required to provide Form H2065-D, Notification of Managed Care Program Services, as notification of MDCP certification to the CCSE case manager when requesting CCSE termination in SASO.

Revision 24-4; Effective Dec. 1, 2024

All STAR Kids members begin transition activities at 15 and periodically meet with a transition specialist to plan their transition to an adult program.

A person receiving Medically Dependent Children Program (MDCP), private duty nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC):

• is no longer eligible for these services at 21 years old;
• must transition to an adult program; and
• may choose to transition to the STAR+PLUS Home and Community Based Services (HCBS) program.

The Texas Health and Human Services Commission (HHSC) Utilization Review (UR) provides a copy of the MDCP-PDN Transition Report each month to:

• Program Support Unit (PSU) supervisors and managers; and
• UR unit for the Intellectual and Developmental Disability (IDD) 1915(c) waivers.

The report lists members enrolled in STAR Kids:

• receiving MDCP, PDN or PPECC services; and
• who may transition to STAR+PLUS or the STAR+PLUS HCBS program in the next 12 months.

3510 Twelve Months Before the Member's 21st Birthday

Revision 25-1; Effective May 16, 2024

The STAR Kids managed care organization (MCO) identifies all members turning 21 within the 12 months before the member’s 21st birthday. The STAR Kids MCO schedules a face-to-face visit with the member and the member’s available supports to initiate the transition process to:

• provide an overview of the STAR+PLUS program, including the STAR+PLUS Home and Community Based Services (HCBS) program; and
• discuss the changes that will occur in the first month following the member's 21^st birthday.

The STAR Kids MCO follows up with the member or legally authorized representative (LAR) every 90 days during the year before the member turns 21 to ensure all transition activities specified in Appendix VI, STAR Kids Transition Activities, are completed.

The enrollment broker (EB) contacts members who meet the STAR+PLUS enrollment criteria 30 days before their 21st birthday and mails the STAR+PLUS enrollment packet. The EB selects an MCO for the member if no selection was made within 15 days, as outlined in Title 1 Texas Administrative Code (TAC) Section 353.403(3).  

Members who receive MDCP, private duty nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) may apply for the STAR+PLUS HCBS program to continue receiving medically necessary nursing services that are unavailable at 21. These services may not be the same level of nursing services they receive through STAR Kids.

Members receiving MDCP, PDN or PPEC are referred to the STAR+PLUS HCBS program through the MDCP-PDN Transition Report. Program Support Unit (PSU) staff for the STAR+PLUS HCBS program begin the enrollment process for these members by 12 months before their 21st birthday. PSU staff must refer to 3420, Individuals Transitioning Services for Adults, of the STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH) for detailed information on the STAR+PLUS HCBS enrollment process.

Members who meet the STAR+PLUS HCBS program enrollment criteria transition to the STAR+PLUS HCBS program on the first of the month following their 21st birthday. MDCP eligibility terminates on the last day of the member's 21st birth month.

PSU staff must refer to 6300.9, No Longer Meets the Age Requirement for MDCP, for PSU staff denial procedures for MDCP members transitioning out of MDCP due to turning 21.

3520 Transition Policy for Non-Waiver Individuals and Applicants Receiving PCS or CFC Only

Revision 25-1; Effective May 16, 2025

STAR Kids and STAR Health eligibility terminates the last day of the month that the non-waiver program individual or applicant turns 21. The non-waiver program individual or applicant with STAR Kids or STAR Health must receive services through programs serving adults beginning the first day of the month following the non-waiver program individual or applicant’s 21st birthday.

Individuals or applicants with STAR Kids and STAR Health must transition their Personal Care Services (PCS) and Community First Choice (CFC) services to an adult program. Some individuals or applicants with STAR Kids and STAR Health may continue to receive PCS or CFC through STAR Health until 22 depending on eligibility requirements.

The Texas Health and Human Services Commission’s (HHSC’s) state contracted enrollment broker will reach out to the individual or applicant 30 days before the individual or applicant turns 21 and provide the individual or applicant with a STAR+PLUS enrollment packet. The individual or applicant is allowed 15 days to make a managed care organization (MCO) selection. HHSC’s contracted enrollment broker selects an MCO for the individual or applicant if the individual or applicant has not made an MCO selection after 15 days, as outlined in Title 1 Texas Administrative Code (TAC) Section 353.403(3).