2200, Enrollment Procedures Following an MDCP Interest List Release

Body

Revision 25-1; Effective May 16, 2025

2210 Individuals Enrolled in STAR and Individuals Receiving Other Types of Medicaid 

Revision 26-1; Effective March 16, 2026

The following individuals must select a STAR Kids MCO to begin the enrollment process:

  • individuals:
    • receiving Medicaid but not enrolled in a managed care organization (MCO); 
    • enrolled in a STAR MCO that does not operate a STAR Kids companion plan; or
    • who have a STAR Kids companion plan but requested first position and a new STAR Kids MCO.

Program Support Unit (PSU) staff must complete the following activities within two business days of getting a STAR Kids MCO selection for the individuals noted above:

  • confirm the individual continues to receive Medicaid in the Texas Integrated Redesign System (TIERS);
  • check the Texas Health and Human Services (HHS) Benefits Portal to verify Form H1746-A, MEPD Referral Cover Sheet, was received, if applicable;
  • upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to the selected STAR Kids MCO in the MCOHub indicating:
    • all zeros in Item No. 3, Social Security Number (SSN), if the applicant does not have an established SSN for Medicaid type of assistance (TOA) code 45, MA-Newborn Children, children up to 1; and 
    • the following in the Comments section, if the applicant qualifies for first position: 
      • applicant or legally authorized representative (LAR) requested first position, and the applicant needs to be reassessed for MDCP; and
      • a different service coordinator must conduct the new assessment, if applicable; 
  • upload all applicable documents to the Texas HHS Enterprise Administrative Record Tracking System (HEART) case record; and
  • document the HEART case record.

The Medicaid for the Elderly and People with Disabilities (MEPD) specialist will notify PSU staff of the financial eligibility determination, if applicable. PSU staff must upload the MEPD specialist’s notification to the HEART case record.

PSU staff must check TIERS to verify Medicaid financial eligibility if the MEPD specialist has not notified PSU staff by the 45th day after Form H1746-A was faxed to the MEPD specialist.

PSU staff must refer to 2010.2, MCO Selection or Default, within two business days after the 30th day an enrollment packet is mailed, if an individual did not select a STAR Kids MCO and the individual:

  • receives Medicaid but is not enrolled in an MCO; 
  • is enrolled in a STAR MCO that does not operate a STAR Kids companion plan; or
  • has a STAR Kids companion plan but requested first position and a new STAR Kids MCO.

2210.1 Individuals Not Receiving Medicaid or Individuals Enrolled in CHIP 

Revision 26-1; Effective  March 16, 2026

Individuals must return Form H1200, Application for Assistance – Your Texas Benefits, to start the enrollment process if the are:

  • not receiving Medicaid; or 
  • enrolled in the Children’s Health Insurance Program (CHIP).

Program Support Unit (PSU) staff must complete the following activities. They must do this within two business days of locating Form H1200 in the Texas Health and Human Services (HHS) Benefits Portal or receiving the signed form from the applicant or legally authorized representative (LAR):

  • check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid eligibility;
  • upload a copy of Form H1200 to the Texas HHS Enterprise Administrative Report and Tracking System (HEART) case record;
  • fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for Elderly and People with Disabilities (MEPD) specialist:
    • if Form H1200 is found in the HHS Benefits Portal; or
    • with Form H1200 and any other verification documents provided by the applicant or LAR, if received from the applicant or LAR;
  • upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to the selected STAR Kids MCO in the MCOHub including the following in the Comments section, if the applicant qualifies for first position: 
    • applicant or LAR requested first position and the applicant needs to be reassessed for MDCP;
    • a different service coordinator must conduct the new assessment, if applicable;
  • upload all applicable documents to the HEART case record;
  • document the HEART case record

The MEPD specialist notifies PSU staff of the financial eligibility determination. PSU staff must upload the MEPD specialist’s notification in the HEART case record.

PSU staff must check TIERS to verify Medicaid financial eligibility if the MEPD specialist has not notified PSU staff by the 45th day after Form H1746-A was faxed to the MEPD specialist.

PSU staff must refer to 2010.2, MCO Selection or Default, if a STAR Kids managed care organization (MCO) selection was not obtained for an applicant not receiving Medicaid or enrolled in the Children’s Health Insurance Plan (CHIP) upon:

  • locating Form H1200 in the HHS Benefits Portal; or
  • receipt of a signed Form H1200 from the applicant or LAR.

2220 MCO Coordination 

Revision 25-3; Effective Oct. 20, 2025

The managed care organization (MCO) has 60 days from receipt of  Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A to complete all initial assessment activities for an applicant to the Medically Dependent Children Program (MDCP). This includes:

  • verifying the individual meets all other eligibility criteria referenced in the STAR Kids Handbook (SKH), 1000, Overview and Eligibility;
  • completing Form H3676, Section B, and uploading it to the MCOHub;
  • conducting and submitting the STAR Kids Screening and Assessment Instrument (SK-SAI), including Section R, MDCP Related Items, to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP); and
  • completing and submitting Form 2604, STAR Kids Individual Service Plan – Service Tracking Tool, to the TMHP LTCOP.

Note: PSU staff must document Form H2067-MC, Managed Care Programs Communication, was received instead of Form H3676, Section B, in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (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:

  • this email subject line: 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;
    • the 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; and
  • 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 staff for MCO non-compliance issues unrelated to late initial assessment information. PSU staff must include the following components when emailing MCCO Unit staff:

  • this email subject line: 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;
    • the 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. 

2230 MDCP ILR: PSU Staff Coordination 

Revision 26-3; Effective Aug. 14, 2026

Program Support Unit (PSU) staff must determine if the applicant meets the eligibility criteria for the Medically Dependent Children Program (MDCP). PSU staff must do this within two business days of receiving the following documentation from the managed care organization (MCO):

Note: PSU staff must document Form H2067-MC, Managed Care Programs Communication, was received instead of Form H3676, Section B. This is done in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record, if applicable.

The start of care (SOC) date for MDCP services is the first day of the month after the applicant meets all the eligibility criteria.

Example: 

  • If an MCO submits all eligibility criteria on March 1; and
  • PSU staff verify the applicant meets all eligibility criteria on March 3; then
  • the SOC date is April 1. 

The SOC is April 1 because services begin the first day of the month after the applicant meets all eligibility criteria. The eligibility date on Form H2065-D, Notification of Managed Care Program Services, is April 1.

Example: 

  • If an MCO submits all eligibility criteria on March 31; and
  • PSU staff verify the applicant meets all eligibility criteria on April 2; then
  • the SOC date is April 1. 

The SOC is April 1 because services begin the first day of the month after the applicant meets all eligibility criteria. The eligibility date on Form H2065-D is April 1. The individual met the eligibility criteria on March 31. Do not delay services due to PSU staff processing times.

Applicant with Approved Financial Eligibility

PSU staff must complete the following activities on the same day they confirm all eligibility criteria for MDCP are met. This is if the applicant has approved financial eligibility for MDCP:

  • in the TMHP LTCOP:
    • review and adjust the SK-ISP record SOC and end dates, as needed;
    • update the MDCP Enrollment Form and save the form;
    • generate Form H2065-D;
  • mail Form H2065-D to the member or legally authorized representative (LAR);
  • 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:
    • this email subject line: 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 identification (ID) number;
      • date of birth (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:
    • this email subject line: MDCP ILR Enrollment Request 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: interest list release enrollment;
      • SK-ISP begin date;
      • SK-ISP end date;
      • MCO selection;
      • effective date of MDCP enrollment; and
    • Form H2065-D as an attachment;
  • close the interest list release (ILR) case record in the Community Services Interest List (CSIL) database documenting the closure reason and date;
  • upload all applicable documents to the HEART case record; and
  • close the HEART case record.

Applicant Pending Financial Eligibility

PSU staff must complete the following activity on the same day they confirm all other eligibility criteria for MDCP are met, if the applicant requires a financial eligibility determination:

  • fax Form H1746-A to Medicaid for Elderly and People with Disabilities (MEPD) noting:
    • the applicant has approved medical necessity (MN) and a SK-ISP for MDCP;
    • the proposed SOC date; and
    • the case requires a Medicaid financial eligibility decision.

MEPD notifies PSU staff of the financial eligibility determination. PSU staff must upload MEPD’s determination in the HEART case record once received.

PSU staff must complete the following activities within two business days from receipt of MEPD’s notification the applicant meets Medicaid financial eligibility. This is if the applicant continues to meet all other MDCP eligibility criteria:

  • in the TMHP LTCOP:
    • review and adjust the SK-ISP record SOC and end dates, as needed;
    • update the MDCP Enrollment Form and save the form;
    • generate Form H2065-D;
  • mail Form H2065-D to the member or LAR;
  • email the ERS unit the following information:
    • this email subject line: MDCP ILR Enrollment Request for XX [first letter of the member’s first and last name]
    • the following items in the body of the email:
      • the member’s name;
      • Medicaid ID number;
      • type of request: interest list release enrollment;
      • SK-ISP begin date;
      • SK-ISP end date;
      • MCO selection;
      • effective date of MDCP enrollment; and
    • Form H2065-D as an attachment;
  • close the ILR case record in the CSIL database documenting the closure reason and date;
  • upload all applicable documents to the HEART case record; and
  • close the HEART case record.

The MCO must monitor the TMHP LTCOP for the status of the member’s SK-ISP and to retrieve Form H2065-D.

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

2240 Reserved For Future Use

Revision 22-3; Effective Sept. 9, 2022