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Revision 26-1; Effective March 16, 2026
A member or legally authorized representative (LAR) may request the first position and advanced placement interest list (IL) options any time on or before the 120th day from the Date of Notice on Form H2065-D, Notification of Managed Care Services.
A member or LAR can request the following options in writing or verbally, unless otherwise noted, for members denied medical necessity (MN) for the Medically Dependent Children Program (MDCP) at reassessment:
- state fair hearing;
- first position:
- written notification is required, if the member declines a state fair hearing;
- will not be processed until a sustained state fair hearing decision is issued, if a state fair hearing is also requested; and
- advanced placement.
A member or LAR can request the following options in writing or verbally for members who aged out of MDCP:
- state fair hearing; and
- advanced placement.
The table below lists options available for the member based on their denial reason. It provides the Fair Hearing and Interest List Option Attachment mailed with Form H2065-D. The option is available for the member:
- if an X appears in the square; or
- with more requirements noted below the table, if a number appears in the square.
| Denial Reason | Fair Hearing and Interest List Option Attachment | State Fair Hearing | Advanced Placement | First Position |
|---|---|---|---|---|
| Member Denied MN for MDCP at Reassessment | Appendix XXIV, MDCP Medical Necessity Denial Attachment - Members | X | X | 1, 2 |
| Member Denied MDCP Due to Aging Out of the Program | Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP | X | X | Not Applicable |
Notes:
- A written request to decline a state fair hearing must be received before the option can be processed, if the member or LAR opt out of a state fair hearing and request the first position option.
- A sustained state fair hearing decision must be issued before the option is processed, if a state fair hearing is requested along with the first position option.
Program Support Unit (PSU) staff may refer to Appendix XXXIII, Scenario Guide for MDCP State Fair Hearing, First Position and Advanced Placement Requests, for guidance on handling different request scenarios for a state fair hearing, first position and advanced placement.