2400, Money Follows the Person

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2410 Traditional Money Follows the Person

Revision 24-4; Effective Dec. 1, 2024

The Money Follows the Person (MFP) procedure allows Medicaid-eligible nursing facility (NF) residents to receive services in the community by transitioning to long-term services and supports (LTSS). The managed care organization (MCO) performs the functional assessment and service planning for residents who need the Medically Dependent Children Program (MDCP) services upon discharge from the NF.

Individuals in a NF are assigned permanency planners. The permanency planner coordinates permanency planning through the traditional MFP process into MDCP. The state-contracted permanency planner is EveryChild Inc.

Permanency planning is:

  • the placement process for a child in a NF; and
  • A philosophy and planning process that focuses on the outcome of family support by facilitating a permanent living arrangement with the primary feature of an enduring and nurturing parental relationship. (Title 4 Texas Government Code Section 531.151).

An individual receiving NF Medicaid must request MDCP while living in a NF and remain in the NF until Program Support Unit (PSU) staff make a final eligibility determination for MDCP.

An individual without Medicaid must:

  • request MDCP while living in a NF;
  • live in a NF for no less than 30 days or until Medicaid eligibility is approved; and
  • remain in the NF until PSU staff make a final eligibility determination for MDCP.

An individual is denied if the individual discharges from the NF before being determined eligible for MDCP.

PSU staff must refer to Section 1200, Medically Dependent Children Program Eligibility, for more information about MDCP eligibility requirements.

Individuals who meet the medically fragile criteria and are not able to live in a NF for a minimum of 30 days or until Medicaid is approved may be able to enter MDCP through the MFP Limited NF stay process.

PSU staff must refer to Section 2420, Money Follows the Person Limited Nursing Facility Stay Option for a Medically Fragile Individual, for more information about the MFP limited NF stay process.

2411 Reserved for Future Use

Revision 24-4; Effective Dec. 1, 2024

2412 Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents 

Revision 26-2; Effective June 1, 2026

The individual’s permanency planner, Every Child, Inc., contacts the Interest List Management (ILM) unit. This is done within two business days from the individual’s Medically Dependent Children Program (MDCP) selection date to:

  • notify the Texas Health and Human Services Commission (HHSC) that the individual selected MDCP through the traditional Money Follows the Person (MFP) process; and
  • update the individual’s address on file, if needed.

Note: Other entities may contact the ILM unit to provide notification of an individual’s request to pursue MDCP through the traditional MFP process. These entities may include the:

  • legally authorized representative (LAR);
  • individual; or 
  • nursing facility (NF).  

2412.1 Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Interest List Management Responsibilities 

Revision 22-3; Effective Sept. 9, 2022 

Interest List Management (ILM) Unit staff complete the following activities for a non-STAR Kids nursing facility (NF) individual who requests to pursue the Medically Dependent Children Program (MDCP) through the traditional Money Follows the Person (MFP) process:

  • create an MDCP case record assignment in Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART);
  • verify the individual is on the interest list for MDCP in the Community Services Interest List (CSIL) database; or
  • add the individual to the interest list if they are not on the interest list;
  • immediately release the individual from the interest list using the bypass code “Residing in a Nursing Facility”; and
  • assign the MDCP case record in HEART to Program Support Unit (PSU) staff. 

2412.2 Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Program Support Unit Responsibilities

Revision 22-3; Effective Sept. 9, 2022

 

2412.2.1 Enrollment Following Interest List Release Bypass 

Revision 22-3; Effective Sept. 9, 2022 

Program Support Unit (PSU) staff must complete the following activities within two business days of the receipt of a traditional Money Follows the Person (MFP) Medically Dependent Children Program (MDCP) case record assignment in Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

  • check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility and document the Medicaid type;
  • determine if Form H1200, Application for Assistance – Your Texas Benefits, is required in the enrollment packet;
  • contact or attempt to contact the individual or legally authorized representative (LAR) by phone to explain the:
    • Medicaid application process, if applicable;
    • importance of selecting a STAR Kids managed care organization (MCO); and
    • the importance of promptly returning the enrollment packet, if applicable;
  • mail the following enrollment packet to the individual or LAR:
  • •upload the applicable documents to the HEART case record, following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
  • document the HEART case record.

PSU staff must contact the individual or LAR within 14 days after mailing the enrollment packet to:

  • verify receipt of the enrollment packet;
  • explain the Medicaid application process, if applicable;
  • give a general description of MDCP services;
  • explain the need to select a STAR Kids MCO within 30 days from the mail date of the above enrollment packet;
  • inform the individual or LAR that a delay in selecting a STAR Kids MCO could result in a delay in an eligibility determination for MDCP;
  • encourage the individual or LAR to complete the enrollment packet and mail it back to HHSC as quickly as possible, if the individual:
    • has not selected a STAR Kids MCO; or
    • has not provided Form H1200, if applicable; and
  • advise the individual, LAR or nursing facility (NF) to immediately submit Form H1200 if:
    • the individual requires Form H1200 to determine Medicaid financial eligibility; and
    • TIERS does not have a record of submission; and
  • document all contact attempts and any delays in the HEART case record. 

PSU staff must check TIERS to verify Form H1200 has been submitted if the applicant, LAR or NF states Form H1200 has already been submitted during the 14-day follow-up contact.

PSU staff must fax Form 1746-A, MEPD Referral Cover Sheet, and Form H1200 to the Medicaid for Elderly and Persons with Disabilities (MEPD) specialist within two business days from locating Form H1200 in TIERS without Form H1746-A, if applicable. PSU staff must notate the following on Form H1746-A:

  • Form H1200 is in TIERS; and
  • the applicant is requesting to pursue the MFP process.

PSU staff must review the enrollment packet upon receipt to ensure all documents are completed. PSU staff must complete the following activities within two business days from the date Form H1200 is received:

  • fax Form H1746-A and Form H1200 to the MEPD specialist;
  • notate the applicant is requesting to pursue the MFP process on From H1746-A;
  • record the date Form H1200 was received from the applicant and the date PSU staff faxed Form H1200 to the MEPD specialist in the HEART case record;
  • maintain a copy of Form H1200 until PSU staff can verify Form H1200 is received in TIERS;
  • check TIERS to determine if Form H1200 is received;
  • maintain a copy of page one of Form H1200 in the applicant’s HEART case record;
  • upload applicable documents to the HEART case record, following the instructions in Appendix XVIII; and
  • document the HEART case record.

PSU staff must ensure Form H1200 is signed prior to faxing Form H1200 to the MEPD specialist, if applicable. The MEPD specialist will return the unsigned Form H1200 to PSU staff requesting the applicant or LAR’s signature before processing the application. 

PSU staff must complete the following activities within two business days from notification by the MEPD specialist that Form H1200 is unsigned:

  • contact the applicant or LAR;
  • advise that the application cannot be processed unless Form H1200 is signed; and
  • document the HEART case record.

PSU staff may complete the following activities within two business days from the date PSU staff received an unsigned Form H1200: 

  • generate Form 2606, Managed Care Enrollment Processing Delay, and Form 2606-S;
  • mail Form 2606 with the original unsigned Form H1200 to the applicant; and
  • document the HEART case record.
  • PSU staff must complete the following activities if Form 2606 was mailed:
  • upload all applicable documents to the HEART case record, following the instructions in Appendix XVIII; and
  • document the HEART case record.

PSU staff must check TIERS to verify if Form H1200 and Form H1746-A is received, as applicable. 

PSU staff must document all contact attempts and any delays in the HEART case record. 

The MEPD specialist has 45 days (or up to 90 days if it is necessary to obtain a disability determination) to complete the application process.  

2412.2.2 Managed Care Organization Selection or Default

Revision 25-1; Effective May 16, 2025

Non-STAR Kids nursing facility (NF) residents pursing the Medically Dependent Children Program (MDCP) though the traditional Money Follows the Person (MFP) process must select a STAR Kids managed care organization (MCO). Program Support Unit (PSU) staff may accept an individual, applicant or legally authorized representative’s (LAR’s) verbal or written STAR Kids MCO selection. The individual, applicant or LAR may provide their written STAR Kids MCO selection on Form H2053-B, Health Plan Selection.

PSU staff must refer to 2010.2, MCO Selection or Default, for more information on the MCO selection and default processes.   

2412.2.3 Receipt of Enrollment Packet 

Revision 22-3; Effective Sept. 9, 2022 

Program Support Unit (PSU) staff must complete the following activities within two business days from:

PSU staff must contact the individual or legally authorized representative (LAR) within two business days from the receipt of an enrollment packet that is incomplete, incorrect, or missing information to:

  • obtain a STAR Kids MCO selection if PSU staff have not received the STAR Kids MCO selection;
  • obtain missing or corrected information required to process the case if information is missing or incorrect;
  • encourage the individual or LAR to complete the enrollment packet and mail it back to the Texas Health and Human Services Commission (HHSC) as quickly as possible, if the individual:
  • advise the individual or LAR to immediately submit Form H1200 if:
    • the individual requires Form H1200 to determine Medicaid financial eligibility; and
    • PSU staff do not see Form H1200 in the Texas Integrated Redesign System (TIERS).

PSU must document all contact attempts in the HEART case record.

PSU staff may complete the following activities within two business days from the 30th day of the enrollment packet mail date if the applicant has not returned Form H1200:

  • generate Form 2606, Managed Care Enrollment Processing Delay, and Form 2606-S;
  • mail Form 2606 with the original unsigned Form H1200 to the applicant; and
  • document the HEART case record.
  • PSU staff must complete the following activities if Form 2606 was mailed:
  • upload all applicable documents to the HEART case record, following the instructions in Appendix XVIII; and
  • document the HEART case record. 

2412.3 Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Managed Care Organization Coordination

Revision 22-3; Effective Sept. 9, 2022 

The managed care organization (MCO) initiates contact with the individual, applicant, or legally authorized representative (LAR) to begin the assessment process within 10 business days of receipt of Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A.

The MCO must complete the STAR Kids Individual Assessment Instrument (SK-SAI) within 30 days from the date Program Support Unit (PSU) staff uploaded Form H3676, Section A, to TxMedCentral. The SK-SAI is considered complete upon MCO’s receipt of the Form 2601, Physician Certification. The MCO must submit the SK-SAI to the Texas Health and Human Services (HHSC) Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) within 72 hours of the assessment’s completion.

TMHP staff process the SK-SAI to determine medical necessity (MN) and calculate a Resource Utilization Group (RUG) value. A RUG value is a measure of nursing facility (NF) staffing intensity and is used to establish the STAR Kids individual service plan (SK-ISP) cost limit.

The MCO must correct the information on the SK-SAI within 14 days of submitting an SK-SAI with an error. The MCO must inactivate the SK-SAI and resubmit the assessment with correct information to the TMHP LTCOP if the MCO fails to submit the correction within 14 days.

The MCO has an additional 30 days to submit all required documentation to PSU staff. The MCO must complete the following activities within 60 days from the receipt of Form H3676, Section A:

  • complete Form H3676, Section B and upload it to TxMedCentral;
  • complete the SK-SAI in the TMHP LTCOP;
  • obtain the applicant’s physician's signature on Form 2601;
  • complete the SK-ISP; and
  • submit the SK-ISP electronically through the TMHP LTCOP.

PSU staff must monitor TxMedCentral and the TMHP LTCOP, as applicable, for receipt of the completed:

  • Form H3676, Section B;
  • SK-ISP; and
  • SK-SAI.

The MCO must complete and submit the SK-SAI and SK-ISP before the NF discharge.

PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and Persons with Disabilities (MEPD) specialist to notify the MEPD specialist within two business days of the receipt of:

  • a valid SK-ISP; and
  • the SK-SAI if Medicaid is still pending. 

PSU staff must notate the following on Form H1746-A:

  • The applicant has an approved MN; and
  • The applicant has a valid SK-ISP.

PSU staff must check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid eligibility, if applicable.

PSU staff must email the Program Support Operations Review Team (PSORT) mailbox within two business days from the date the MCO fails to submit the initial assessment information within the 60-day timeframe. The email must include: 

  • an email subject line that reads: “MDCP Initial 60-Day XX [plan code] MCO Non-Compliance for XX [first letter of the individual’s or applicant’s first and last name].” For example, the email subject line for Ann Smith would read “MDCP Initial 60-Day 9B MCO Non-Compliance for AS.”
  • the following items in the body of the email:
    • individual or 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 (e.g., Form H2067-MC, Managed Care Programs Communication).

PSU staff must continue to monitor TxMedCentral and the TMHP LTCOP 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 Texas Health and Human Services Commission (HHSC) Managed Care Contracts and Oversight (MCCO) Unit staff for MCO non-compliance issues that are unrelated to late initial assessment information. PSU staff must include the following components when emailing MCCO Unit staff:

  • an email subject line that reads: “MDCP MCO Non-Compliance for XX [first letter of the member’s first and last name].” For example, the email subject line for an MDCP MCO non-compliance for Ann Smith would read “MDCP MCO Non-Compliance for AS”;
  • the following items in the body of the email:
    • applicant or member’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:
  • collaborate, as needed, with all involved parties throughout the MDCP eligibility determination process to assist with problem resolution and to document delays;
  • track all actions and communications in the Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART) case record;
  • upload applicable documents to the HEART case record, following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
  • document the HEART case record. 

2412.4 Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Program Support Unit Staff Coordination 

Revision 23-3; Effective May 22, 2023

Program Support Unit (PSU) staff must complete the following activities in one business day following the receipt of all documentation required for the Medically Dependent Children Program (MDCP) eligibility, as well as the Medicaid financial eligibility determination, as applicable:

  • confirm MDCP eligibility by verifying the applicant:
    • is under 21 years old in the Texas Integrated Eligibility Redesign System (TIERS);
    • is a Texas resident in TIERS;
    • has the appropriate Medicaid type of assistance (TOA) for MDCP in TIERS;
    • has an approved medical necessity (MN) in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP);
    • has a STAR Kids individual service plan (SK-ISP):
      • with a least one MDCP service; and
      • within the applicant's cost limit;
  • manually generate the initial Form H2065-D, Notification of Managed Care Program Services, following the instructions in Appendix II, Form H2065-D MDCP Reason for Denial and Comments Language;
  • PSU staff must refer to Form H2065-D instructions for more information on field entries;
  • mail the initial Form H2065-D to the applicant or legally authorized representative (LAR);
  • upload Form H2065-D to TxMedCentral, following the instructions in Appendix IX, STAR Kids TxMedCentral Naming Conventions;
  • upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
  • document the HEART case record.

The managed care organization (MCO) collaborates with the applicant, LAR, and PSU staff to identify a proposed discharge date. The MCO must upload Form H2067-MC, Managed Care Programs Communication, to TxMedCentral within two business days from determining the discharge date.

PSU staff must upload Form H2067-MC to TxMedCentral following the instructions in Appendix IX within two business days from notification by another entity of a different nursing facility (NF) discharge date. PSU staff must request the MCO confirm which discharge date is acceptable. The MCO must respond within two business days by uploading Form H2067-MC to TxMedCentral advising of the correct scheduled discharge date.

The MCO must upload Form H2067-MC to TxMedCentral within two business days before the applicant’s planned NF discharge date to confirm the applicant’s planned discharge date remains the same. The MCO will provide PSU staff with the new NF discharge date if the planned NF discharge date has changed.

PSU staff must complete the following activities within one business day after the NF discharge notification date:

  • approve the SK-ISP in the TMHP LTCOP;
  • electronically generate the final Form H2065-D following the instructions in Appendix II;
    • PSU staff must refer to Form H2065-D instructions for more information on field entries.
    • The start of care (SOC) date is the first of the month in which the discharge occurred.
  • mail the final Form H2065-D to the member or LAR;
  • upload the final Form H2065-D to TxMedCentral, following the instructions in Appendix IX, if generated manually;
  • fax Form H1746-A, MEPD Referral Cover Sheet, and Form H2065-D to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist, if applicable;
  • email Enrollment Resolution Services (ERS) requesting MDCP enrollment. The email must include the following information:
    • an email subject line that reads, “MDCP MFP Enrollment Request for XX [first letter of the member's first and last name].” For example, the email subject line for a traditional MDCP Money Follows the Person (MFP) enrollment request for Ann Smith would be “MDCP MFP Enrollment Request for AS;”
    • the member's name;
    • Medicaid identification (ID) number;
    • the type of request (i.e., MFP NF discharge);
    • SK-ISP receipt date;
    • SK-ISP begin date;
    • SK-ISP end date;
    • effective date of enrollment;
    • MN approval date;
    • MCO selection; and
    • Form H2065-D;
  • close the Community Services Interest List (CSIL)
  • database record using the appropriate closure code;
  • upload all applicable documents to the HEART case record following the instructions in Appendix XVIII; and
  • document and close the HEART case record.

2412.5 Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Denials 

Revision 23-3; Effective May 22, 2023

An individual without Medicaid must:

  • request the Medically Dependent Children Program (MDCP) while living in a nursing facility (NF);
  • live in an NF for no less than 30 days or until Medicaid eligibility is approved; and
  • remain in the NF until Program Support Unit (PSU) staff make a final eligibility determination for MDCP.

The managed care organization (MCO) must upload Form H3676, Care Pre-Enrollment Assessment Authorization, Section B, to TxMedCentral, within two business days from determining the applicant has failed to meet any MDCP eligibility criteria.

PSU staff must deny the MDCP Money Follows the Person (MFP) applicant by manually generating Form H2065-D, Notification of Managed Care Program Services, within two business days from MCO notification if the MDCP MFP applicant has not: 

  • met MDCP eligibility; or
  • completed the MFP process.

PSU staff must follow the instructions in Appendix II, Form H2065-D MD CP Reason for Denial and Comments Language, when manually generating Form H2065-D.

PSU staff must refer the Uniform Managed Care Manual (UMCM) Section 16.2 for specific requirements about the denial of MDCP for STAR Health applicants.

PSU staff must refer to Section 6000, Denials and Terminations, for more information about processing MDCP applicant denials.

PSU staff must notify the Interest List Management (ILM) Unit staff by email at MDCP_Interest_List@hhsc.state.tx.us for all MDCP MFP individuals or applicants who do not meet the MDCP MFP eligibility requirements. The email must include the following information:

  • an email subject line that reads: "MDCP MFP Denial for XX [first letter of the individual’s or applicant’s first and last name]." For example, the email subject line for an MFP denial for Ann Smith would be "MDCP MFP Denial for AS;"
  • the individual or applicant’s name;
  • Medicaid identification (ID) number or Social Security number (SSN);
  • contact name and phone number;
  • the reason for the denial; and
  • the request to return the individual or applicant to the MDCP interest using their original MDCP request date.

PSU staff must not close the Community Services Interest List (CSIL) record for an MDCP MFP applicant.

PSU staff must not:

PSU staff must refer to Section 6300.9, No Longer Meets the Age Requirement for MDCP, for more information about scenarios where an individual, applicant or member transitions out of MDCP for not meeting the MDCP age requirement.

2413 Traditional Money Follows the Person STAR Kids Nursing Facility Residents

Revision 22-3; Effective Sept. 9, 2022

An individual’s permanency planner, Every Child, Inc., contacts the Interest List Management (ILM) Unit within two business days from the individual’s Medically Dependent Children Program (MDCP) selection date to:

  • notify the Texas Health and Human Services Commission (HHSC) that the individual has selected MDCP under the traditional Money Follows the Person (MFP) process; and
  • update the individual’s address on file, if needed.

Note: Other entities may contact the ILM Unit to provide notification of an individual’s request to pursue MDCP through the traditional MFP process. These entities may include:

  • legally authorized representative (LAR);
  • individual; or
  • nursing facility (NF). 

2413.1 Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Interest List Management Responsibilities

Revision 22-3; Effective Sept. 9, 2022 

Interest List Management (ILM) Unit staff complete the following activities for a STAR Kids nursing facility (NF) individual who requests to pursue the Medically Dependent Children Program (MDCP) through the traditional Money Follows the Person (MFP) process:

  • create an MDCP case record assignment in Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART);
  • verify the individual is on the interest list for MDCP in the Community Services Interest List (CSIL) database; or
  • add the individual to the interest list if they are not on the interest list;
  • immediately release the individual from the interest list using the bypass code “Residing in a Nursing Facility”; and
  • assign the MDCP case record in HEART to Program Support Unit (PSU) staff. 

2413.2 Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Program Support Unit Responsibilities

Revision 22-3; Effective Sept. 9, 2022

 

2413.2.1 Enrollment Following Interest List Release Bypass

Revision 22-3; Effective Sept. 9, 2022 

Program Support Unit (PSU) staff must complete the following activities within two business days of the receipt of a traditional Money Follows the Person (MFP) Medically Dependent Children Program (MDCP) case record assignment in Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

PSU staff must contact the individual or LAR within 14 days after mailing the enrollment packet to: 

  • verify receipt of the enrollment packet; and
  • provide a general description of MDCP services.

2413.3 Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Managed Care Coordination

Revision 22-3; Effective Sept. 9, 2022 

The managed care organization (MCO) initiates contact with the individual, applicant, or legally authorized representative (LAR) to begin the assessment process within 10 business days of receipt of Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A.

The MCO must complete the STAR Kids Individual Assessment Instrument (SK-SAI) within 30 days from the date Program Support Unit (PSU) staff uploaded Form H3676, Section A, to TxMedCentral. The SK-SAI is considered complete upon MCO’s receipt of the Form 2601, Physician Certification. The MCO must submit the SK-SAI to the Texas Health and Human Services Commission (HHSC) Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) within 72 hours of the assessment’s completion.

TMHP staff process the SK-SAI to determine medical necessity (MN) and calculate a Resource Utilization Group (RUG) value. A RUG value is a measure of nursing facility (NF) staffing intensity and is used to establish the STAR Kids individual service plan (SK-ISP) cost limit.

The MCO must correct the information on the SK-SAI within 14 days of submitting an SK-SAI with an error. The MCO must inactivate the SK-SAI and resubmit the assessment with correct information to the TMHP LTCOP if the MCO fails to submit the correction within 14 days.

The MCO has an additional 30 days to submit all required documentation to PSU staff. The MCO must complete the following activities within 60 days from the receipt of Form H3676, Section A:

  • Form H3676, Section B and upload it to TxMedCentral;
  • the SK-SAI in the TMHP LTCOP;
  • the SK-ISP;
  • obtain the applicant’s physician's signature on Form 2601; and
  • submit the SK-ISP electronically through the TMHP LTCOP.

PSU staff must monitor TxMedCentral and the TMHP LTCOP, as applicable, for receipt of the completed:

  • Form H3676, Section B;
  • SK-ISP; and
  • SK-SAI.

The MCO must complete and submit the SK-SAI and SK-ISP before the NF discharge.

PSU staff must email the Program Support Operations Review Team (PSORT) mailbox within two business days from the date the MCO fails to submit the initial assessment information within the 60-day timeframe. The email must include: 

  • an email subject line that reads: “MDCP Initial 60-Day XX [plan code] MCO Non-Compliance for XX [first letter of the individual’s or applicant’s first and last name].” For example, the email subject line for Ann Smith would read “MDCP Initial 60-Day 9B MCO Non-Compliance for AS.”
  • the following items in the body of the email:
    • individual’s or 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 (e.g., Form H2067-MC, Managed Care Programs Communication)

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

PSU staff must continue to email the Texas Health and Human Services Commission (HHSC) Managed Care Contracts and Oversight (MCCO) Unit staff for MCO non-compliance issues that are unrelated to late initial assessment information.

PSU staff must include the following components when emailing MCCO Unit staff:

  • an email subject line that reads: “MDCP MCO Non-Compliance for XX [first letter of the member’s first and last name].” For example, the email subject line for an MDCP MCO non-compliance for Ann Smith would read “MDCP MCO Non-Compliance for AS”;
  • the following items in the body of the email:
    • applicant or member’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: 

  • collaborate, as needed, with all involved parties throughout the Medically Dependent Children Program (MDCP) eligibility determination process to assist with problem resolution and to document delays;
  • track all actions and communications in the Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART) case record;
  • upload applicable documents to the HEART case record, following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
  • document the HEART case record. 

2413.4 Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Program Support Unit Staff Coordination

Revision 23-3; Effective May 22, 2023

Program Support Unit (PSU) staff must complete the following activities within one business day following the receipt of all documentation required for Medically Dependent Children Program (MDCP) eligibility:

  • confirm MDCP eligibility by verifying the applicant:

The managed care organization (MCO) collaborates with the applicant, LAR, and PSU staff to identify a proposed discharge date. The MCO must upload Form H2067-MC, Managed Care Programs Communication, to TxMedCentral within two business days from determining the discharge date.

PSU staff must upload Form H2067-MC to TxMedCentral, following the instructions in Appendix IX, within two business days from notification by another entity of a different nursing facility (NF) discharge date. PSU staff must request the MCO confirm which discharge date is acceptable. The MCO must respond within two business days by uploading Form H2067-MC to TxMedCentral advising of the correct scheduled discharge date.

The MCO must upload Form H2067-MC to TxMedCentral within two business days before the applicant’s planned NF discharge date to confirm the applicant’s planned discharge date remains the same. The MCO must provide PSU staff with the new NF discharge date if the planned NF discharge date has changed.

PSU staff must complete the following activities within one business day following the NF discharge notification date: 

  • approve the SK-ISP in the TMHP LTCOP;
  • electronically generate the final Form H2065-D; following the instructions in Appendix II;
    • PSU staff must refer to Form H2065-D instructions for more information on field entries.
    • The start of care (SOC) date is the first of the month in which the discharge occurred.
  • mail the final Form H2065-D to the member or LAR;
  • upload the final Form H2065-D to TxMedCentral, following the instructions in Appendix IX, if generated manually;
  • email Enrollment Resolution Services (ERS), requesting MDCP enrollment. The email must include the following information:
    • an email subject line that reads, “MDCP MFP Enrollment Request for XX [first letter of the member's first and last name].” For example, the email subject line for a traditional MDCP Money Follows the Person (MFP) enrollment request for Ann Smith would be “MDCP MFP Enrollment Request for AS;”
    • the member’s name;
    • Medicaid identification (ID) number;
    • type of request (i.e., MFP NF discharge);
    • SK-ISP receipt date;
    • SK-ISP begin date;
    • SK-ISP end date;
    • effective date of enrollment;
    • MN approval date;
    • MCO; and
    • Form H2065-D;
  • close the Community Services Interest List (CSIL) database record using the appropriate closure code;
  • upload all applicable documents to the HEART case record, following the instructions in Appendix XVIII; and
  • document and close the HEART case record.

2413.5 Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Denials

Revision 23-3; Effective May 22, 2023

An individual receiving nursing facility (NF) Medicaid must request the Medically Dependent Children Program (MDCP) while residing in an NF and remain in the NF until Program Support Unit (PSU) staff make a final eligibility determination for MDCP.

The managed care organization (MCO) must upload Form H3676, Care Pre- Enrollment Assessment Authorization, Section B, to TxMedCentral, within two business days from determining the applicant has failed to meet any MDCP eligibility criteria.

PSU staff must deny the MDCP Money Follows the Person (MFP) applicant by manually generating Form H2065-D, Notification of Managed Care Program Services, within two business days from MCO notification if the MDCP MFP applicant has not: 

  • met MDCP eligibility; or
  • completed the MFP process.

PSU staff must follow the instructions in Appendix II, Form H2065-D MD CP Reason for Denial and Comments Language, when manually generating Form H2065-D.

PSU staff must refer to the Uniform Managed Care Manual (UMCM) Section 16.2 for specific requirements about the denial of MDCP for STAR Health applicants.

PSU staff must refer to Section 6000, Denials and Terminations, for more information about processing MDCP applicant denials.

PSU staff must notify the Interest List Management (ILM) Unit staff by email at MDCP_Interest_List@hhsc.state.tx.us for all MDCP MFP individuals or applicants who do not meet the MDCP MFP eligibility requirements. The email must include the following information:

  • an email subject line reads: “MDCP MFP Denial for XX [first letter of the individual’s or applicant’s first and last name].” For example, the email subject line for an MFP denial for Ann Smith would be “MDCP MFP Denial for AS;”
  • the individual or applicant's name;
  • Medicaid identification (ID) number or Social Security number (SSN);
  • contact name and phone number;
  • the reason for the denial; and
  • the request to return the individual or applicant to the MDCP interest list using their original MDCP request date.

PSU staff must not close the Community Services Interest List (CSIL) record for an MDCP MFP applicant.

PSU staff must not:

PSU staff must refer to Section 6300.9, No Longer Meets the Age Requirement for MDCP, for more information about scenarios where an individual, applicant or member transitions out of MDCP for not meeting the MDCP age requirement.

2414 MDCP Money Follows the Person Delays in NF Discharge

Revision 23-3; Effective May 22, 2023

Program Support Unit (PSU) staff and the managed care organization (MCO) must use their judgment and work with a Medically Dependent Children Program (MDCP) traditional Money Follows the Person (MFP) applicant who has community living arrangements pending but not finalized. 

PSU staff must keep the request for services open if the applicant has an estimated discharge date beyond a four-calendar month period.

PSU staff must refer traditional MFP cases pending beyond four calendar months to the PSU supervisor when an applicant: 

  • has not established living arrangements to return to the community;
  • cannot decide when to return to the community; or
  • has no viable plan or support system in the community.

2415 Money Follows the Person Demonstration (MFPD) References in STAR Kids

Revision 22-3; Effective Sept. 9, 2022 

Money Follows the Person Demonstration (MFPD) does not apply to the Medically Dependent Children Program (MDCP). Children transition to the least restrictive setting under the traditional Money Follows the Person (MFP) program. For this reason, managed care organizations (MCOs) are not required to track an individual or applicant’s enrollment period or seek informed consent from an individual, applicant, or legally authorized representative (LAR). Program Support Unit (PSU) staff must disregard the "MFPD" check box on Form 2604, STAR Kids Individual Service Plan - Service Tracking Tool. 

2420 Money Follows the Person Limited NF Stay Option for a Medically Fragile Individual

Revision 18-0; Effective September 4, 2018

The limited nursing facility (NF) stay process applies to an individual who requests Medically Dependent Children Program (MDCP) services through the Money Follows the Person (MFP) option, but is too medically fragile to reside in an NF for an extended period of time. Medically fragile is defined as a chronic physical condition that results in a prolonged dependency on medical care. The individual is either already enrolled in STAR Kids or new to the program.

Typically, an individual must meet two or more of the following criteria to be considered medically fragile:

  • ventilator dependent with tracheostomy (not bi-level positive airway pressure (BiPap));
  • renal dialysis;
  • 24 hour/day supplemental oxygen dependence;
  • total nutrition through enteral tube feeding;
  • total parenteral nutrition (TPN);
  • seizures requiring medical intervention (e.g., medication administration, oxygen) during the seizure, every day for the past six months;
  • documented immune deficiency confirmed by lab findings (i.e., immunoglobulin A (IgA) or immunoglobulin G (IgG) deficiency) or on immunosuppressive drug therapy;
  • congestive heart failure requiring hospitalization and routine medication within the past six months; or
  • in hospice care.

An individual determined to be medically fragile and is approved for a limited NF stay, must stay at least part of two consecutive days in the NF. MDCP services must be authorized within 24 hours of discharge to allow for continuity of services and to establish Medicaid in an NF setting. Managed care organization (MCO) service coordinators must stress to the individual, legally authorized representative (LAR) or authorized representative (AR), in order to ensure compliance with MFP limited NF stay policy for continuity of services, an applicant may not discharge from an NF on a Friday, Saturday, Sunday, or any day preceding a state holiday as services must be authorized within 24 hours of discharge. If MDCP services cannot be authorized within 24 hours after the NF discharge date, the NF stay will not be accepted as meeting MFP limited NF stay policy. 

2421 Money Follows the Person Procedures for Requesting a Limited Nursing Facility Stay

Revision 18-0; Effective September 4, 2018

An individual requesting Medically Dependent Children Program (MDCP) services through the Money Follows the Person (MFP) limited nursing facility (NF) stay option may contact the Interest List Management (ILM) Unit or his or her managed care organization (MCO) service coordinator. If an individual contacts a Texas Health and Human Services Commission (HHSC) regional office, or his or her MCO service coordinator, the individual must be referred to ILM Unit staff to add the individual’s name to the interest list. This request will not be considered a release from the interest list, but instead as a referral of an individual interested in bypassing the interest list through the MFP limited NF stay option.

ILM Unit staff must explain the following to the individual requesting to bypass the MDCP interest list:

  • STAR Kids program, if not enrolled;
  • an overview of MDCP services;
  • the limited NF stay enrollment process, including that the individual must first be approved for the limited NF stay;
  • the NF may charge the individual a fee for the NF stay, which Medicaid will not reimburse;
  • Form 2406, Physician Recommendation for Length of Stay in a Nursing Facility, must be completed in its entirety by a physician licensed in the state of Texas by the Texas Medical Board and signed within 90 days of receipt by ILM Unit staff;
  • required medical documentation from the individual’s clinical record at the physician’s office, hospital or clinic (not from a patient portal) must be within 12 months of the date the documentation is submitted to ILM Unit staff; and
  • admission and discharge documentation from the NF will be required.

ILM Unit staff will mail Form 2406 to the individual, parent, guardian, legally authorized representative (LAR) or authorized representative (AR) within one business day of the contact, along with a self-addressed stamped envelope to return Form 2406 and required documentation to the ILM Unit staff.

If the individual, parent, guardian, LAR or AR is reapplying after being denied the limited NF stay, ILM Unit staff must inform the individual, parent, guardian, LAR or AR a new Form 2406 must be submitted if the physician signature is older than 90 days. In addition, medical records not previously submitted must also be obtained or the request will not be considered. 

2422 Money Follows the Person Limited Nursing Facility Stay Procedures

Revision 18-0; Effective September 4, 2018 

 

2422.1 Processing Form 2406 and Medical Documents

Revision 18-0; Effective September 4, 2018

Form 2406, Physician Recommendation for Length of Stay in a Nursing Facility, must be completed by the individual’s physician, licensed to practice in the state of Texas through the Texas Medical Board, and signed by the physician within 90 days of receipt by Interest List Management (ILM) Unit staff, to be considered for the Money Follows the Person (MFP) limited nursing facility (NF) stay option. The Texas physician must attach to Form 2406 documentation (such as a visit note or hospital discharge summary) of chronic conditions. The medical documentation provided must include:

  • documentation of the individual’s chronic conditions and the current health status of the individual  that will substantiate the boxes checked on Form 2406; and
  • medical records from within 12 months of the date the documentation is being submitted. Medical records must be physician-originated (not from a patient portal).

Upon receipt of Form 2406 and medical documentation, ILM Unit staff will identify the physician’s recommendation.

If the individual’s physician attests the individual does meet the medically fragile criteria and is too medically fragile to reside in an NF setting for an extended period of time on Form 2406, ILM Unit staff will verify the following within two business days:

  • the individual’s name and date of birth are present and legible on Form 2406;
  • the individual is under age 21;
  • the physician’s name, address, license number, signature and date are on Form 2406;
  • physician that signed Form 2406 is licensed in the state of Texas by conducting a license search on the Texas Medical Board’s website; and
  • physician signature on Form 2406 is within 90 days of receipt.

If Form 2406 contains all required information and medical documentation appears to be from an appropriate source and dated within the allowable date range, ILM Unit staff will email all documents to the Texas Health and Human Services Commission (HHSC) nurse to determine if the individual meets the medically fragile criteria. ILM Unit staff must submit each request in a separate email to the HHSC nurse. The email’s subject line must read: Medically Dependent Children Program Form 2406 for XX. The “XX” in the title represents the initials of the individual; therefore, the subject line of an email on behalf of Ann Smith would read "Medically Dependent Children Program Form 2406 for AS."

ILM Unit staff must place the individual in a “Release” status in the Community Services Interest List (CSIL) database using the bypass code “Residing in a Nursing Facility.” ILM Unit staff will also create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and upload Form 2406. ILM Unit staff must not upload medical records to the HEART case record.

If the individual’s physician attests the individual does not meet the medically fragile criteria for a limited NF stay, ILM Unit staff must contact the individual within two business days, to inform him or her of the physician’s recommendation. The individual can remain on the interest list until his or her name reaches the top, or follow the traditional MFP option as described in Section 2410, Traditional Money Follows the Person.

If Form 2406 does not contain the required information, ILM Unit staff must contact the individual, parent, guardian, legally authorized representative (LAR) or authorized representative (AR) within two business days of receipt to discuss the elements of the form that are incomplete, and that Form 2406 and associated documents will be returned.

This includes medical documentation that is over 12 months old or not from an appropriate source (such as a patient portal). The individual, parent, guardian, LAR or AR, may submit additional records to satisfy the medical record requirement. If additional records are not submitted before the physician signature on Form 2406 expires (90 days from the physician signature date), the Medically Dependent Children Program (MDCP) MFP limited NF stay interest list request will remain in an “Open” status until the individual reaches the top of the interest list and no additional action is taken. 

2423 HHSC Nurse or Physician Review of Medical Fragility

Revision 18-0; Effective September 4, 2018

A Texas Health and Human Services Commission (HHSC) nurse will review Form 2406, Physician Recommendation for Length of Stay in a Nursing Facility, and medical documentation within two business days to determine if an individual meets the limited nursing facility (NF) stay criteria.

If the individual’s physician attests the individual meets the medically fragile criteria and the physician’s documentation clearly substantiates the individual meets two or more criteria on Form 2406, the HHSC nurse may approve the limited NF stay request. Within two business days of the decision, the HHSC nurse will document his or her decision that the individual “meets criteria” in the referral email sent by the Interest List Management (ILM) Unit staff and reply all to notify ILM Unit staff of the decision.

If the documentation does not substantiate the individual meets two or more criteria on Form 2406, the HHSC nurse will forward Form 2406 and associated medical records to the HHSC physician for a decision. ILM Unit staff are also included in the email. 

2424 Physician Determination of Medical Fragility

Revision 18-0; Effective September 4, 2018

The Texas Health and Human Services Commission (HHSC) physician will review Form 2406, Physician Recommendation for Length of Stay in a Nursing Facility, and associated medical records to determine if the individual meets the medically fragile criteria. The HHSC physician will respond by email within seven days to the HHSC nurse with his or her decision. The response will indicate if the individual “meets criteria” or “does not meet criteria.” Within two business days of the decision, the HHSC nurse will document the physician’s decision in the referral email sent by the ILM Unit staff and reply all to notify ILM Unit staff of the decision. 

2425 Individual Not Meeting the Medically Fragile Criteria

Revision 18-0; Effective September 4, 2018

If the Texas Health and Human Services Commission (HHSC) physician determines the individual does not meet the medically fragile criteria, Interest List Management (ILM) Unit staff will contact the individual, parent, guardian, legally authorized representative (LAR) or authorized representative (AR) by telephone within two business days of receipt of the HHSC physician’s decision email. If the HHSC physician has a comment regarding the information submitted, this will be noted in the HHSC physician response to ILM Unit staff. ILM Unit staff must include this comment when advising the individual of the outcome of the limited nursing facility (NF) stay request. ILM Unit staff will inform the individual that a limited NF stay is not approved and the individual has the option to transition from an NF stay, as described in 2410, Traditional Money Follows the Person, to access Medically Dependent Children Program (MDCP) through the Money Follows the Person (MFP) traditional option.

If the individual does not choose to complete an NF stay as described in 2410, his or her name will return to an “Open” status in the Community Services Interest List (CSIL) database and the “Residing in a Nursing Facility” bypass code removed. The individual will remain on the interest list until his or her name comes to the top of the list. If the individual, parent, guardian, LAR or AR requests to reapply for the limited NF stay process, ILM Unit staff must inform the individual, parent, guardian, LAR or AR that a new Form 2406 must be submitted if the physician signature is older than 90 days. In addition, medical records not previously submitted must also be obtained or the request will not be considered. 

2426 Individual Approved for an MFP Limited NF Stay: ILM Unit Procedures

Revision 25-4; Effective Dec. 12, 2025

Interest List Management (ILM) unit staff complete the following activities for individuals who request to pursue the Money Follows the Person (MFP) limited nursing facility (NF) stay process:

  • check if the individual is on the Medically Dependent Children Program (MDCP) interest list (IL) in the Community Services Interest List (CSIL) database;
  • add the individual to the MDCP IL, if applicable;
  • immediately release the individual from the MDCP IL using the bypass code Residing in a Nursing Facility; and
  • create an MFP limited stay case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART).

ILM unit staff must assign the MFP limited stay HEART case record to the appropriate Program Support Unit (PSU) staff within two business days of an individual being approved for an MFP limited NF stay.

No more action is required for ILM unit staff.

2427 MFP Limited NF Stay: Individuals Enrolled in STAR Kids

Revision 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff must complete the following activities for individuals enrolled in STAR Kids. This is done within five business days from receiving the Money Follows the Person (MFP) limited stay case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

  • check the Texas Integrated Eligibility Redesign System (TIERS) to verify: 
    • Medicaid financial eligibility in the Medicaid/CHIP/CHIP perinatal History screen; and
    • STAR Kids managed care enrollment in the Managed Care screen;
  • make sure the individual does not have an open enrollment with another Medicaid waiver program by reviewing the:
    • Service Authorization System Online (SASO) Enrollment and Service Authorization records for one of the following:
      • Community Living Assistance and Support Services (CLASS) Program (Service Group (SG) 2);
      • Deaf Blind with Multiple Disabilities (DBMD) Program (SG 16);
      • Home and Community-based Services (HCS) Program (SG 21); or
      • Texas Home Living (TxHmL) Program (SG 22); and
    • TIERS Long Term Services and Supports (LTSS) Eligibility Periods Details screen for the Youth Empowerment Services (YES) waiver record;
  • upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to the current STAR Kids managed care organization (MCO) in the MCOHub and note the applicant:
    • lives at home; and 
    • is enrolled in STAR Kids and was approved for an MFP limited nursing facility (NF) stay;
  • upload all applicable documents to the HEART case record; and
  • document the HEART case record.

PSU staff are not required to complete a 14-day contact for individuals enrolled in STAR Kids. PSU staff must refer to 2428, MFP Limited NF Stay: MCO Coordination, for information on the MCO’s responsibilities after receipt of Form H3676, Section A.

2427.1 MFP Limited NF Stay: Individuals Enrolled in STAR Health

Revision 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff must complete the following activities for individuals enrolled in STAR Health. This is done within five business days from receiving the Money Follows the Person (MFP) limited stay case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

  • Check the Texas Integrated Eligibility Redesign System (TIERS) to verify both: 
    • Medicaid financial eligibility in the Medicaid/CHIP/CHIP perinatal History screen.  
    • STAR Health managed care enrollment in the Managed Care screen.
  • Make sure the individual does not have an open enrollment with another Medicaid waiver program by reviewing the:
    • Service Authorization System Online (SASO) Enrollment and Service Authorization records for one of the following:
      • Community Living Assistance and Support Services (CLASS) Program (Service Group (SG) 2).
      • Deaf Blind with Multiple Disabilities (DBMD) Program (SG 16).
      • Home and Community-based Services (HCS) Program (SG 21). 
      • Texas Home Living (TxHmL) Program (SG 22).
    • TIERS Long Term Services and Supports (LTSS) Eligibility Periods Details screen for the Youth Empowerment Services (YES) waiver record.
  • Upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to the STAR Health managed care organization (MCO) in the MCOHub. Note: PSU staff must not update Form H3676 with the primary or secondary medical consenter’s contact information unless it has been documented in the HEART case record. Form H3676 should:
    • Note the applicant lives at home.
    • State the applicant is enrolled in STAR Health and was approved for an MFP limited nursing facility (NF) stay.
    • Request the STAR Health MCO complete the following:
      • Contact the primary medical consenter, or secondary if the primary medical consenter is unavailable, to complete the Medically Dependent Children Program (MDCP) assessment. 
      • Provide the name and mailing address of the primary or secondary medical consenter when communicating the outcome of the assessment to PSU staff.
  • Email the Department of Family and Protective Services (DFPS) Developmental Disability Specialist (DDS) Manager the following information:
    • This email subject line: Referral for MDCP Assessment for STAR Health Member XX [first letter of the applicant’s first and last name].
    • The following items in the body of the email:
      • Applicant’s name
      • Medicaid identification (ID) number
      • Date of birth (DOB)
      • Notice a referral for an MDCP assessment was submitted to the STAR Health MCO on MM/DD/YYYY, and PSU staff will send a follow up email when an MDCP eligibility determination is made.
  • Upload all applicable documents to the HEART case record.
  • Document the HEART case record.

Note: The DFPS DDS Manager is not required to respond to PSU staff’s notification that a referral for an MCDP MFP limited NF stay assessment was submitted.

PSU staff are not required to complete a 14-day contact for individuals enrolled in STAR Health. PSU staff must refer to 2428, MFP Limited NF Stay: MCO Coordination, for information on the MCO’s responsibilities after receipt of Form H3676, Section A.

2427.2 MFP Limited NF Stay: Individuals Enrolled in STAR or Individuals Receiving Other Types of Medicaid

Revision 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff must complete the following activities for individuals:

  • enrolled in a STAR managed care organization (MCO); or
  • receiving other types of Medicaid not related to Supplemental Security Income (SSI).

This is done within five business days from receiving the Money Follows the Person (MFP) limited stay case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

  • Check the Texas Integrated Eligibility Redesign System (TIERS) to verify both: 
    • Medicaid financial eligibility in the Medicaid/CHIP/CHIP perinatal History screen.  
    • Managed care enrollment in the Managed Care screen.
  • Make sure the individual does not have an open enrollment with another Medicaid waiver program by reviewing the:
    • Service Authorization System Online (SASO) Enrollment and Service Authorization records for one of the following:
      • Community Living Assistance and Support Services (CLASS) Program (Service Group (SG) 2).
      • Deaf Blind with Multiple Disabilities (DBMD) Program (SG 16).
      • Home and Community-based Services (HCS) Program (SG 21). 
      • Texas Home Living (TxHmL) Program (SG 22). 
    • TIERS Long Term Services and Supports (LTSS) Eligibility Periods Details screen for the Youth Empowerment Services (YES) waiver record.
  • Refer to Appendix XVI, MEPD Referral Crosswalk, to determine if Form H1746-A, MEPD Referral Cover Sheet, must be faxed to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist for a financial eligibility determination.
  • Fax Form H1746-A to the MEPD specialist, if applicable. Note the request is for an MFP limited nursing facility (NF) stay applicant and eligibility must be expedited and assigned immediately. Note: the MEPD specialist notifies PSU staff of the financial eligibility determination within 45 days. Can be up to 90 days if it is necessary to get a disability determination.
  • Email HHSC OES MEPD IC. Cc: HHSC OES CCC IC, if Form H1746-A was faxed to the MEPD specialist. The email must include:
    • This email subject line: MDCP Request for Expedited Processing 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.
      • Type of service: Medically Dependent Children Program (MDCP) MFP limited NF stay.
      • Form 1746-A was faxed to MEPD on MM/DD/YYYY requesting MEPD expedite the program transfer since this case is an MFP limited NF stay case. Note: These assignments will be special assigned by an MEPD complaint resolution specialist.
  • For individuals enrolled in a STAR MCO:
    • Refer to Appendix XXXII, STAR Kids Companion Plans, to check if the individual’s STAR MCO operates a STAR Kids companion plan. Note: A companion plan is defined as an MCO that is operated by the same parent organization as the individual’s current MCO.
    • Upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to the STAR Kids companion plan in the MCOHub, if applicable. Note the applicant lives at home and:
      • All zeros for the SSN, if the applicant does not have an established SSN.
      • The applicant is approved for an MFP limited NF stay.
  • Mail the following enrollment packet to the individual or legally authorized representative (LAR), if the individual either:
  • Upload all applicable documents to the HEART case record.
  • Document the HEART case record.

PSU staff do not complete a 14-day contact for individuals approved for an MFP limited NF stay who were defaulted to a STAR Kids companion plan. PSU staff must refer to 2428, MFP Limited NF Stay: MCO Coordination, for information on the MCO’s responsibilities after receipt of Form H3676, Section A, if the form was uploaded to the STAR Kids companion plan.

14th Day Contact

PSU staff must contact the individual or LAR within 14 days of the enrollment packet mail date, if the individual:

  • receives Medicaid but is not enrolled in an MCO; or
  • is enrolled in a STAR MCO that does not operate a STAR Kids companion plan.

PSU staff must complete the following activities when contacting the individual or LAR:

  • verify receipt of the enrollment packet;
  • confirm interest in MDCP and give a general description of MDCP services;
  • explain the need to select a STAR Kids MCO as quickly as possible or one will be defaulted to them, if applicable;
  • inform the individual or LAR of the following, if applicable:
    • any delay in selecting a STAR Kids MCO could result in a delay in the MDCP eligibility determination;
    • the STAR Kids MCO selection can be changed at any time but will not go into effect until after one full calendar month of MDCP service provision;
  • document the individual or LAR’s STAR Kids MCO choice in the HEART case record if obtained during the 14-day contact;
  • make sure the individual or LAR understands the MFP limited NF stay process by advising the individual that the MFP limited NF stay:
    • must be coordinated with the MCO service coordinator;
    • cannot be completed until notified by the MCO service coordinator;
    • must not occur on a Friday, Saturday, Sunday or any other day preceding a state holiday; and
    • process requires that MDCP be authorized by PSU staff within 24 hours of the nursing facility discharge; and
  • document all contact attempts and any delays in the HEART case record.

PSU staff must refer to 2120, Inability to Contact the Individual, when unable to contact the individual or LAR within 14 days of the enrollment packet mail date.

The following individuals must select or be defaulted to a STAR Kids MCO so the MCO can perform the STAR Kids Screening and Assessment Instrument (SK-SAI):

  • an individual:
    • who receives Medicaid but is not enrolled in an MCO; or
    • enrolled in a STAR MCO that does not operate a STAR Kids companion plan. 

PSU staff cannot process the MFP limited NF stay without an SK-SAI with an approved MN determination. PSU staff must complete the activities in 2010.2, MCO Selection or Default, within two business days after the 30th day an enrollment packet is mailed, if an MCO has not been selected.

PSU staff must complete the activities in 6300, Denials and Terminations, when:

  • notification is received about the individual’s death; or
  • the individual or LAR decline MDCP services.

Receipt of STAR Kids MCO Selection

PSU staff must complete the following activities within two business days from obtaining a STAR Kids MCO selection:

  • confirm the individual continues to receive Medicaid in TIERS;
  • check the HHS Benefits Portal to verify Form H1746-A, was received, if applicable;
  • upload Form H3676, Section A, to the selected STAR Kids MCO in the MCOHub noting the applicant lives at home and:
    • all zeros for the Social Security Number (SSN), if the applicant does not have an established SSN; and
    • the applicant is approved for an MFP limited NF stay, in the Comments section;
  • upload applicable documents to the HEART case record; and
  • document the HEART case record.

PSU staff must refer to 2428 for information on the MCO’s responsibilities after receipt of Form H3676, Section A.

2427.3 MFP Limited NF Stay: Individuals Not Receiving Medicaid or Individuals Enrolled in CHIP

Revision 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff must complete the following activities for individuals:

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

This is done within five business days of receiving the Money Follows the Person (MFP) limited stay case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

14th Day Contact

PSU staff must contact the individual or LAR within 14 days of the enrollment packet mail date to:

  • verify receipt of the enrollment packet;
  • confirm interest in Medically Dependent Children Program (MDCP) and give a general description of MDCP services;
  • explain the following as applicable:
    • the Medicaid application process and the need to return Form H1200 within 30 days from the enrollment packet mail date;
    • the need to select a STAR Kids MCO as quickly as possible or one may be defaulted to them;
  • inform the individual or LAR that:
    • any delay in returning the Medicaid application could result in a delay in an eligibility determination for MDCP, if applicable;
    • the STAR Kids MCO selection can be changed at any time, but the change will not go into effect until after one full calendar month of MDCP service provision;
  • document the individual or LAR’s STAR Kids MCO choice in the HEART case record if obtained during the 14-day contact;
  • make sure the individual or LAR understands the MFP limited nursing facility (NF) stay process by advising the individual that the MFP limited NF stay:
    • must be coordinated with the MCO service coordinator;
    • cannot be completed until notified by the MCO service coordinator;
    • must not occur on a Friday, Saturday, Sunday or any other day preceding a state holiday; and
    • process requires that MDCP be authorized by PSU staff within 24 hours of the nursing facility discharge; and
  • document all contact attempts and any delays in the HEART case record.

PSU staff must refer to 2120, Inability to Contact the Individual, when they cannot contact the individual or LAR within 14 days of the enrollment packet mail date.

PSU staff must check the HHS Benefits Portal to verify Form H1200 was received. This is if the individual or LAR states Form H1200 was submitted during the 14-day contact.

An individual or LAR must select or be defaulted to a STAR Kids MCO so the MCO can perform the STAR Kids Screening and Assessment Instrument (SK-SAI). PSU staff cannot process the MFP limited NF stay without an SK-SAI with an approved MN determination. PSU staff must complete the activities in 2010.2, MCO Selection or Default, if a MCO selection has not been obtained upon:

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

PSU staff must complete the activities in:

  • 2010.1, Incomplete Enrollment Packet, upon receipt of an enrollment packet with an unsigned Form H1200.
  • 6300, Denials and Terminations, when:
    • notification is received about the individual’s death; or
    • the individual or LAR:
      • decline MDCP services; or
      • failed to return Form H1200 within 30 days from the date an enrollment packet is mailed.

Receipt of Form H1200

PSU staff must complete the following activities within two business days of locating Form H1200 in the HHS Benefits Portal or receiving the signed form from the applicant or LAR:

  • check TIERS to verify Medicaid eligibility;
  • upload a copy of Form H1200 to the HEART case record;
  • fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for Elderly and People with Disabilities (MEPD) specialist identifying the application is for an MFP limited NF stay applicant and eligibility must be expedited and assigned immediately:
    • if Form H1200 was in the HHS Benefits Portal; or
    • with Form H1200 and any other verification documents received from the applicant or LAR, if applicable;  
  • email HHSC OES MEPD IC and Cc: HHSC OES CCC IC an email that includes:
    • this subject line: MDCP Request for Expedited Processing 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;
      • type of service: MDCP MFP limited NF stay; and
      • notice that Form H1200 and Form H1746-A were faxed to MEPD on MM/DD/YYYY and requesting MEPD expedite the applicant’s eligibility process since this case is an MFP limited NF stay case;
      • Note: These assignments are special assigned by an MEPD complaint resolution specialist;
  • upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to the STAR Kids MCO in the MCOHub noting the applicant lives at home and is approved for the MFP limited NF stay option, in the Comments section;
  • upload all applicable documents to the HEART case record; and
  • document the HEART case record.

PSU staff must refer to 2428, MFP Limited NF Stay: MCO Coordination, for information on the MCO’s responsibilities after receipt of Form H3676, Section A.

2428 MFP Limited NF Stay: MCO Coordination

Revision 25-4; Effective Dec. 12, 2025

The managed care organization (MCO) service coordinator must contact an applicant or legally authorized representative (LAR) to begin the assessment process for the Money Follows the Person (MFP) limited nursing facility (NF) stay within 14 days from receiving Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A.

The MCO informs the applicant or LAR of the Medically Dependent Children Program (MDCP) eligibility process and explains the MFP limited NF stay during the contact. The MCO must explain that the:

  • applicant must not proceed with the limited NF stay until authorized to do so by the MCO; and
  • NF may charge a fee for the limited NF stay that will not be reimbursed by Medicaid or the MCO.

The MCO has 60 days after receipt of Form H3676, Section A, to complete all initial assessment activities and submit required forms to Program Support Unit (PSU) staff. The MCO must:

  • complete Form H3676, Section B, and upload it to the MCOHub;
  • conduct and submit 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
  • complete and submit the electronic Form 2604, Individual Service Plan - Service Tracking Tool, to the TMHP LTCOP.

Note: The MCO must use + in the Medicaid identification (ID) number field when uploading Form 2604 to the TMHP LTCOP. This is if the applicant is medical assistance only (MAO) and does not have a Medicaid ID number. A Medicaid ID number is assigned to the individual in the Texas Integrated Eligibility Redesign System (TIERS) and TIERS will interface with the TMHP LTCOP to update the applicant’s Medicaid ID number, once the applicant has been authorized for MDCP services for 30 days.

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 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. 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 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 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. The MCO must submit a new initial SK-SAI to the TMHP LTCOP before PSU staff can determine MDCP eligibility if the SK-SAI has expired.

2428.1 MFP Limited NF Stay: PSU Staff Coordination

Revision 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff must determine if the applicant meets the eligibility criteria for the Medically Dependent Children Program (MDCP) within two business days of receiving the following 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.

PSU staff must upload Form H2067-MC to the MCOHub notifying the MCO to proceed with the Money Follows the Person (MFP) limited nursing facility (NF) stay on the same day they confirm all MDCP eligibility criteria is met except for the NF stay, if the:

  • applicant is financially eligible for MDCP; or
  • Medicaid for Elderly and People with Disabilities (MEPD) specialist has confirmed the individual is eligible for Medicaid except for the limited NF stay and 30 days of MDCP authorization.

The MCO service coordinator must notify PSU staff within five business days of the planned NF discharge date by uploading Form H2067-MC to the MCOHub.

The MDCP start of care (SOC) date will be the first of the month that the MFP individual discharged from the NF. Example: A member leaves the NF Dec. 12, 2025, and begins MDCP services Dec. 12, 2025. The eligibility date on Form H2065-D is Dec. 1, 2025.

The following activities must occur within 24 hours after the limited NF stay discharge:

  • the MCO must notify PSU staff that the limited NF stay was completed by uploading Form H2067-MC to the MCOHub.  Form H2067-MC must:
    • document the admission and discharge dates of the limited NF stay; and
    • request PSU staff approve MDCP services;
  • PSU staff must:
    • confirm the applicant continues to meet the eligibility criteria for MDCP; 
    • complete the following in the TMHP LTCOP, if the applicant meets the eligibility criteria for MDCP:
    • mail Form H2065-D to the member or legally authorized representative (LAR);
    • upload all applicable documents to the HEART case record; and
    • document the HEART case record.

PSU staff must complete the following activities. This is done within two business days from receiving notification from the MCO that the applicant is authorized to receive MDCP services:

  • fax Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist noting the member has transferred from a NF to MDCP, if applicable;
  • email the: 
    • Interest List Management (ILM) unit the following information for the Community Services Interest List (CSIL) database record closure:
      • this email subject line: MFP Limited NF Stay Closure 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; and
        • CSIL closure reason: Certified to Enter Program;
    • 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; and
      • Form H2065-D as an attachment; 
      • Note: The DFPS DDS Manager does not have to respond to PSU staff’s notice that MCDP services were approved;
    • Enrollment Resolution Services (ERS) unit the following information:
      • this email subject line: MDCP MFP Limit NF Stay 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: MFP limited NF stay;
        • date of MFP limited NF stay;
        • MN approval date;
        • ISP receipt date;
        • ISP begin date;
        • ISP end date;
        • MCO selection; 
        • effective date of MDCP enrollment; and
      • Form H2065-D as an attachment; 
  • upload all applicable documents in HEART case record; and
  • close the HEART case record.

Note: ERS updates the member’s Texas Integrated Eligibility Redesign System (TIERS) record to show managed care enrollment after the member was determined eligible for MDCP, if applicable.

MCOs must monitor the TMHP LTCOP and the MCOHub for: 

  • the status of their member’s ISP; and 
  • to retrieve Form H2065-D.

PSU staff must complete activities in 6300, Denials and Terminations, upon notification an applicant:

  • fails to meet any of the eligibility criteria for MDCP; or
  • Medicaid is denied by the MEPD specialist for financial eligibility.

2429 Delays in Limited NF

Revision 25-3; Effective Oct. 20, 2025

The managed care organization (MCO) must notify Program Support Unit (PSU) staff of any delays with completion of the Money Follows the Person (MFP) limited nursing facility (NF) stay by the applicant. They do this by uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub.

Applicants Pending Medicaid

PSU staff must request the Medicaid for the Elderly and People with Disabilities (MEPD) specialist delay Medicaid certification, if the applicant:

  • cannot complete the limited NF stay within 40 days after the MEPD specialist communicated that the applicant is eligible for Medicaid except for:
    • completing the limited NF stay; and
    • 30 days of Medically Dependent Children Program (MDCP) authorization.

PSU staff must complete the following activities within two business days after the 40th day, if the limited NF stay was not completed:

  • fax Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist requesting a delay to Medicaid certification;
  • include the statement “Request for delay in certification due to delay in NF stay; start date of MDCP services is pending” in the comments section;
  • upload Form H1746-A to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
  • document the HEART case record.

The MEPD specialist may extend the financial eligibility time frame to the following, if the request for delay in certification is approved:

  • 135 days from the original file date; or
  • 180 days from the original file date if a disability determination is required

The MEPD specialist will deny the application if there is a continued delay in completion of the limited NF stay beyond:

  • 135 days from the file date; or
  • 180 days from the file date for an applicant requiring a disability determination.

PSU staff must refer to 6300.4, Financial Eligibility, to process the MDCP eligibility denial on the same day they confirm the Medicaid denial.

MCOs must monitor the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) and the MCOHub for:

The MFP limited NF stay application process must start over if the individual, parent, guardian or legally authorized representative (LAR) continues to pursue the MFP limited NF stay option after MDCP eligibility was denied. The individual, parent, guardian or LAR must contact the Interest List Management (ILM) unit, described in 2421, Money Follows the Person Procedures for Requesting a Limited Nursing Facility Stay, to restart the process.

The MCO must complete a new STAR Kids Screening and Assessment Instrument (SK-SAI) if the applicant’s medical necessity (MN) expired due to the delay in the limited NF stay.

PSU staff must request the MEPD specialist reopen the Medicaid application within two business days from receipt of the new SK-SAI, if the new SK-SAI is received within 90 days of the MEPD specialist’s denial. PSU staff must complete the following for the Medicaid application reopen request:

  • fax Form H1746-A to the MEPD specialist:
    • selecting Application as the Action Type;
    • noting:
      • the previously submitted Medicaid application needs to be reopened and re-evaluated for an MDCP MFP limited NF stay applicant; and
      • eligibility must be expedited and assigned immediately;
  • email OESMEPDIC@hhsc.state.tx.us and cc: OESCCCIC@hhsc.state.tx.us an email that includes:
    • this subject line: MDCP Request for Expedited Processing 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;
      • type of service: MDCP MFP limited NF stay;
      • notating that Form H1746-A was faxed to MEPD on MM/DD/YYYY and requesting the last MEPD application be reopened, re-evaluated, and the eligibility process expedited since this case is an MFP limited NF stay case.

Note: These assignments are special assigned by an MEPD complaint resolution specialist.

The MEPD specialist’s time frame for certification starts over once the Medicaid application is reopened. PSU staff must request the MEPD specialist delay certification, as noted above, if the NF stay cannot be completed within 40 days after the date the request to reopen the Medicaid application was submitted to the MEPD specialist. However, the MEPD specialist may not approve more requests for delay in certification based on the amount of time that passed since the original application file date.

PSU staff must notify the MCO to proceed with coordination of the NF stay and enrollment procedures. They do this by posting Form H2067-MC to the MCOHub, if the MEPD specialist approves the request for delay in certification. PSU staff must inform the individual, parent, guardian or LAR that a new Form H1200, Application for Assistance – Your Texas Benefits, must be completed if the MEPD specialist denies the request to delay certification due to the age of the application.

Limited NF Stay More than One Year

PSU staff must request the ILM unit decide if an MFP limited NF stay case can be transitioned to an interest list release (ILR) if the limited NF stay was not completed within one year of receiving the HEART assignment.

The ILM unit reviews the MFP limited NF stay case to check if the case can be processed as an ILR if the MDCP request date in the Community Services Interest List (CSIL) is on or before the current MDCP release through date.

PSU staff must email their supervisor within two business days from the 365th day of the HEART assignment, to notify an MFP limited NF stay case was pending for a year. The email must include:

  • this email subject line: MFP Limited NF Stay Pending Over One Year for XX [first letter of the applicant’s first and last name];
  • the following items in the body of the email:
    • the applicant’s name;
    • Medicaid ID number;
    • the date the MFP limited NF stay case was assigned in HEART; and
    • request for the case to be processed as an ILR.

The PSU supervisor forwards the email request to the ILM unit manager to decide if the MFP limited NF stay applicant can be processed as an ILR, within two business days from the PSU staff request to transition the case. The ILM unit manager responds to the PSU supervisor within two business days with an approval or denial of the request.

PSU staff must complete the following activities within two business days of receiving approval to transition the MFP limited NF stay case to an ILR: 

  • upload Form H2067-MC to the MCO noting the following:
    • case is pending since MM/DD/YYYY [date of the HEART case record assignment];
    • case can be processed as an ILR instead of an MFP limited NF stay case; and
    • applicant is not required to complete the NF stay.
  • refer to 2100, Activities Following an MDCP Interest List Release, to process the case as an ILR;
  • upload the applicable documents to the HEART case record; and
  • document the HEART case record.

PSU staff must continue to process the case following MFP limited NF stay policy within two business days of receiving notice the request to transition the MFP limited NF stay case to an ILR was denied.