Revision 26-1; Effective March 16, 2026

First position is an interest list (IL) option. It is available to members under 21 who are denied the medical necessity (MN) determination for a nursing facility (NF) level of care (LOC) at reassessment. Members who request first position can move to the top of the Medically Dependent Children Program (MDCP) IL to be reassessed when an MDCP IL slot becomes available. 

First position can be requested verbally or in writing, either alone or with a request for: 

• a state fair hearing; and 
• advanced placement.

Note: Written notification is required if:

• first position is requested; and 
• the member or legally authorized representative (LAR) decline a state fair hearing.

First position may be requested only once, on or before the 120^th day from the Date of Notice on Form H2065-D, Notification of Managed Care Program Services. Requests for first position received after 120 days from the Date of Notice on Form H2065-D require PSU supervisor approval before processing.

A state fair hearing decision sustaining the MN denial must be received before a member is eligible for first position. If a state fair hearing is also requested, PSU staff may accept Appendix XXIV, MDCP Medical Necessity Denial Attachment - Members, as written notification the member or LAR want to forgo a state fair hearing. PSU staff must advise the member or LAR that MDCP services and Medicaid eligibility, if applicable, will not continue if the member declines a state fair hearing.

First position is not available to applicants denied MN or members who aged out of MDCP. Members who aged out of MDCP can only request the advancement placement IL option. 

PSU staff must complete the actions in:

• 6300.5, Medical Necessity and Level of Care, when a member is denied MN at reassessment. 
• 7221.1, Medical Necessity Denial by Texas Medicaid & Healthcare Partnership, upon receipt of a state fair hearing request. 

Revision 26-1; Effective March 16, 2026

Advanced placement is an interest list (IL) option available to members terminated from the Medically Dependent Children Program (MDCP) due to:

• no longer meeting the medical necessity (MN) determination for a nursing facility (NF) level of care (LOC); or
• aging out of the program.

Members who choose advanced placement may be eligible to move up on the IL for one of the following 1915(c) Medicaid waiver programs: 

• Community Living Assistance and Support Services (CLASS) 
• Home and Community-based Services (HCS) 
• Texas Home Living (TxHmL)
• Deaf Blind with Multiple Disabilities (DBMD)

The original MDCP IL request date is used to move an eligible member up on the selected 1915(c) Medicaid waiver program IL. A member must have been previously or currently on the IL, to be eligible to move up the list. This includes members who were previously on the 1915(c) Medicaid waiver program IL, but the IL record was closed. A member is placed at the bottom of the requested 1915(c) Medicaid waiver program IL if the member was never on the IL. 

A member or legally authorized representative (LAR) can request advanced placement verbally or in writing, either alone or with a request for:

• a state fair hearing; and 
• first position, if the member was denied MN at reassessment.

A member or LAR must request advanced placement on or before the 120^th day from the Date of Notice on Form H2065-D, Notification of Managed Care Program Services. Requests for advanced placement received after 120 days from the Date of Notice on Form H2065-D require supervisor approval.

Written notification selecting advanced placement is not required. However, PSU staff may accept Appendix XXIV, MDCP Medical Necessity Denial Attachment - Members or Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP, as written notification the member or LAR wants to pursue advanced placement. 

Members who aged out of MDCP will only receive the advancement placement IL option to move up on another 1915(c) Medicaid waiver program’s IL. These members do not qualify for first position. 

PSU staff must complete the actions in:

• 6300.5, Medical Necessity and Level of Care, when a member is denied MN at reassessment.
• 6300.9, No Longer Meets the Age Requirement for MDCP, when notified a member is aging out of MDCP. 
• 7200, State Fair Hearing Procedures for Medically Dependent Children Program, upon receipt of a state fair hearing request.

Revision 26-1; Effective March 16, 2026

A member or legally authorized representative (LAR) may request the first position and advanced placement interest list (IL) options any time on or before the 120^th day from the Date of Notice on Form H2065-D, Notification of Managed Care Services.

A member or LAR can request the following options in writing or verbally, unless otherwise noted, for members denied medical necessity (MN) for the Medically Dependent Children Program (MDCP) at reassessment:

• state fair hearing;
• first position:
  • written notification is required, if the member declines a state fair hearing; 
  • will not be processed until a sustained state fair hearing decision is issued, if a state fair hearing is also requested; and
• advanced placement.

A member or LAR can request the following options in writing or verbally for members who aged out of MDCP:

• state fair hearing; and
• advanced placement.

The table below lists options available for the member based on their denial reason. It provides the Fair Hearing and Interest List Option Attachment mailed with Form H2065-D. The option is available for the member:

• if an X appears in the square; or 
• with more requirements noted below the table, if a number appears in the square. 

Notes:

1. A written request to decline a state fair hearing must be received before the option can be processed, if the member or LAR opt out of a state fair hearing and request the first position option.
2. A sustained state fair hearing decision must be issued before the option is processed, if a state fair hearing is requested along with the first position option.

Program Support Unit (PSU) staff may refer to Appendix XXXIII, Scenario Guide for MDCP State Fair Hearing, First Position and Advanced Placement Requests, for guidance on handling different request scenarios for a state fair hearing, first position and advanced placement.

Revision 26-1; Effective March 16, 2026

Program Support Unit (PSU) staff must create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record for all first position and advanced placement interest list (IL) requests received on or before the 120^th day from the Date of Notice on Form H2065-D, Notification of Managed Care Program Services. The HEART case record is assigned to Interest List Management (ILM) unit staff for processing.

PSU staff must refer to 5400.3, First Position and Advanced Placement Assignments Beyond 120 Days, on receipt of a first position or advanced placement request received after 120 days from the Date of Notice on Form H2065-D. 

5400.1 Advanced Placement Assignments and First Position Assignments Without a State Fair Hearing 

Revision 26-1; Effective March 16, 2026

Program Support Unit (PSU) staff must create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record within two business days from request receipt for:

• advanced placement; and
• first position, if the member or legally authorized representative (LAR) decline a state fair hearing.

Note: The request for first position must be received with written notification declining a state fair hearing before PSU staff can process the request.  

PSU staff must complete the following activities on the same day the HEART case record is created:

• in HEART:
  • select the following for the:
    • Action Type: SB1207;
    • Issue Type, as applicable:
      • MDCP First Position/Advanced Placement/New IL when creating a HEART case record for first position and advanced placement at the same time;
      • MDCP First Position;or
      • Advanced Placement;
• inform the member or LAR who declined a state fair hearing to pursue first position that: 
  • Medically Dependent Children Program (MDCP) services and Medicaid eligibility, if applicable, will not continue if the member or LAR decline a state fair hearing; 
  • the request to decline the state fair hearing and pursue first position will not be processed unless a written request is received on or before the 120^th day from the Date of Notice on Form H2065-D, Notification of Managed Care Program Services, if applicable; and
  • the member may request the following, if this information was not received:
    • a new MCO or to remain with their previous or current MCO upon interest list release; and
    • a different service coordinator if they choose to remain with their previous or current MCO;
• document the: 
  • outcome of the contact with a member or LAR who declined a state fair hearing and requested first position verbally instead of in writing, if applicable;
  • date first position or advanced placement were requested;
  • Medically Dependent Children Program (MDCP) termination effective date; 
  • member’s request for:
    • first position and advanced placement; and
    • the following, if first position is selected:
      • a new managed care organization (MCO) or to remain with their previous or current MCO upon interest list; and
      • a different service coordinator with the previous or current MCO, if applicable; 
• upload the following documents to the HEART case record:
  • the written request:
    • declining a state fair hearing to pursue first position; and
    • to pursue advanced placement, if received; and
  • Form H2065-D; and
• assign the HEART case record to the Interest List Management (ILM) unit manager.

ILM unit staff place the member on the correct interest list, as applicable.   

PSU staff may need to create two HEART case records, if written notification declining a state fair hearing and requesting first position is received after an advanced placement request. PSU staff must follow the steps above to create a new first position HEART case record within two business days from receipt of the written notification and:

• relate the first position HEART case record to the advanced placement HEART case record as follows:
  • find the Tracking Number of the advanced placement HEART case record and copy this number;
  • select the Relationships tab in the first position HEART case record;
  • paste the copied Tracking Number for the advanced placement HEART case record in the Associated Assignment field of the Relationships tab in the first position HEART case record;
  • select Refer To in the Relationships dropdown;
  • enter Refer to assignment for request of Advanced Placement, in the Brief Summary field; and
  • ensure Save Relation was selected to complete the relationship.

PSU staff must close a first position HEART case record created due to a verbal request to decline a state fair hearing and pursue first position, if:

• written notification is not received within 120 days from the Date of Notice on Form H2065-D; and
• the member or LAR did not also request advanced placement.

5400.2 First Position and Advanced Placement Assignments Following a Sustained MN Denial

Revision 26-1; Effective March 16, 2026

Program Support Unit (PSU) staff must complete the following activities within two business days from receiving notification that the hearings officer sustained a member’s medical necessity (MN) denial:

• create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record for the first position and advanced placement requests;
• select the following in the HEART case record for the:
  • Action Type: SB1207;
  • Issue Type, as applicable:
    • MDCP First Position/Advanced Placement/New IL, when creating a HEART case record for first position and advanced placement at the same time;
    • MDCP First Position; or 
    • Advanced Placement;
• document the following in the HEART case record:
  • sustained MDCP denial after a state fair hearing;
  • date of first position and advanced placement request; 
  • effective date of MDCP termination; 
  • the member’s request for:
    • first position and advanced placement; 
    • the following, if first position is selected:
      • a new managed care organization (MCO) or to stay with their previous or current MCO upon interest list; and
      • a different service coordinator with the previous or current MCO, if applicable;
• upload the following documents to the HEART case record:
  • the written request to pursue first position and advanced placement, if received; and
  • Form H2065-D, Notification of Managed Care Program Services; and
• assign the HEART case record to the Interest List Management (ILM) unit manager. 

ILM unit staff place the member on the correct interest list, as applicable.

5400.3 First Position and Advanced Placement Assignments Beyond 120 Days

 Revision 26-1; Effective March 16, 2026

Program Support Unit (PSU) staff must receive PSU supervisor approval before assigning a first position or advanced placement request to the Interest List Management (ILM) unit manager, if the request is received after 120 days from the Date of Notice on Form H2065-D, Notification of Managed Care Program Services. 

PSU staff must complete the following activities within two business days of receiving a request for first position and advanced placement beyond the 120^th day:

• create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record for the first position and advanced placement requests;
• document the member or legally authorized representative’s (LAR’s) request for first position and advanced placement in the HEART case record. 
  • if the request is verbal, advise the member or LAR: 
    • the request is past 120 days from the Date of Notice on Form H2065-D and requires supervisor approval; and 
    • they may call ILM unit staff to be added to the bottom of any interest list; 
• email the PSU supervisor an email with:
  • this email subject line: 120 Day Request for First Position or Advanced Placement XX [first letter of the member's first and last name];
  • the following items in the body of the email:
    • member’s name;
    • Medicaid identification (ID) number;
    • date member or LAR requested first position or advanced placement; 
    • reason the member or LAR could not provide their request within 120 days from the Date of Notice on Form H2065-D; and 
  • Form H2065-D as an attachment;
• upload all applicable documents, including the written request for first position and advanced placement, if received, to the HEART case record; and
• document the HEART case record. 

PSU staff must complete the following activities within two business days of receiving the PSU supervisor’s decision that the request was approved:

• document the outcome of the member’s 120-day request in the HEART case record;
• upload the 120-day approval email and all applicable documents to the HEART case record; 
• close the HEART case record; 
• create a new HEART case record selecting the following for the:
  • Action Type: SB1207;
  • Issue Type, as applicable:
    • MDCP First Position/Advanced Placement/New IL, when a request for first position and advanced placement are received at the same time;
    • MDCP First Position; or
    • Advanced Placement;
• document the following in the new HEART case record:
  • the member’s request for:
    • first position and advanced placement noting the dates these options were requested;
    • the following, if first position is selected:
      • a new managed care organization (MCO) or to remain with their previous or current MCO upon interest list; and
      • a different service coordinator with the previous or current MCO, if applicable; 
  • member’s request was past 120 days;
  • outcome of the member’s 120-day request; 
  • Medically Dependent Children Program (MDCP) effective termination date; 
  • Date of Notice on Form H2065-D; and
  • the statement: Please see relationship case for request of First Position or Advanced Placement, if a first position or advanced placement HEART case record was already created on or before 120 days from the Date of Notice on Form H2065-D;
• upload the following documents to the new HEART case record:
  • the written request for first position or advanced placement, if received;
  • the 120-day approval email; and 
  • Form H2065-D; 
• relate the new HEART case record to the older first position or advanced placement case record created on or before 120 days from the Date of Notice on Form H2065-D, if applicable, by:
  • finding the Tracking Number of the older first position or advanced placement case record and copying this number;
  • selecting the Relationships tab in the new HEART case record;
  • pasting the copied Tracking Number for the older first position or advanced placement HEART case record in the Associated Assignment field of the Relationships tab in the new HEART case record;
  • selecting Refer To in the Relationships dropdown;
  • entering Refer to assignment for request of First Position or Advanced Placement, in the Brief Summary field; and
  • ensuring Save Relation has been selected to complete the relationship; and
• assign the new HEART case record to the ILM unit manager.

Interest List Management (ILM) unit staff place the member on the correct interest list, as applicable.   

PSU staff must complete the following activities within two business days of receiving the PSU supervisor’s decision the request was denied:

• document the outcome of the member’s 120-day request in the HEART case record;
• mail Form 2128, 120 Day Notice, to the member or LAR;
• upload Form 2128 and the email denying the 120-day request to the HEART case record; and 
• close the HEART case record.