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Revision 26-1; Effective March 16, 2026
First position is an interest list (IL) option. It is available to members under 21 who are denied the medical necessity (MN) determination for a nursing facility (NF) level of care (LOC) at reassessment. Members who request first position can move to the top of the Medically Dependent Children Program (MDCP) IL to be reassessed when an MDCP IL slot becomes available.
First position can be requested verbally or in writing, either alone or with a request for:
- a state fair hearing; and
- advanced placement.
Note: Written notification is required if:
- first position is requested; and
- the member or legally authorized representative (LAR) decline a state fair hearing.
First position may be requested only once, on or before the 120th day from the Date of Notice on Form H2065-D, Notification of Managed Care Program Services. Requests for first position received after 120 days from the Date of Notice on Form H2065-D require PSU supervisor approval before processing.
A state fair hearing decision sustaining the MN denial must be received before a member is eligible for first position. If a state fair hearing is also requested, PSU staff may accept Appendix XXIV, MDCP Medical Necessity Denial Attachment - Members, as written notification the member or LAR want to forgo a state fair hearing. PSU staff must advise the member or LAR that MDCP services and Medicaid eligibility, if applicable, will not continue if the member declines a state fair hearing.
First position is not available to applicants denied MN or members who aged out of MDCP. Members who aged out of MDCP can only request the advancement placement IL option.
PSU staff must complete the actions in:
- 6300.5, Medical Necessity and Level of Care, when a member is denied MN at reassessment.
- 7221.1, Medical Necessity Denial by Texas Medicaid & Healthcare Partnership, upon receipt of a state fair hearing request.