3400, Member Transfers

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3410 Transfer from One MCO to Another

Revision 24-3; Effective Aug. 26, 2024

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

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

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

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

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

Examples:

State cutoff date – Nov. 14

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

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

Monthly Plan Changes Report

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

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

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

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

3420 Transfer from Another Medicaid Waiver Program to MDCP

Revision Notice 25-2; Effective July 11, 2025

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

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

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

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

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

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

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

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

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

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

MCO Coordination

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

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

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

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

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

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

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

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

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

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

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

PSU Staff Coordination

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

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

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

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

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

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

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

3430 Transfer from MDCP to Another Medicaid Waiver Program

Revision 25-3; Effective Oct. 20, 2025

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

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

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

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

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

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

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

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

3440 Transfer from Community Care Services Eligibility to STAR Kids

Revision 24-4; Effective Dec. 1, 2024

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

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

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

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