3400, Transferring Into STAR+PLUS

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Revision 25-1; Effective Feb. 19, 2025

Mandatory STAR+PLUS program members may continue to receive their current non-Medicaid services from the Texas Health and Human Services Commission (HHSC) until the managed care organization (MCO) is able to authorize Medicaid services. For example, a member would be able to continue to receive Family Care until the MCO authorizes personal attendant services (PAS). STAR+PLUS members are also entitled to be placed on an interest list for non-Medicaid services following policy specified in the Case Manager Community Care for Aged and Disabled (CM-CCAD) Handbook, 2230, Interest List Procedures.

Any application for new long-term services and supports (LTSS) from HHSC requires the mandatory member to be sent to his or her MCO first. This must be coordinated through Program Support Unit (PSU) staff. Refer to 3315, STAR+PLUS HCBS Program Individuals Requesting Non-Managed Care Services.

Some STAR+PLUS Home and Community Based Services (HCBS) program applicants or members transferring in and out of STAR+PLUS will have an individual service plan (ISP) that is over the cost limit and is approved for the Medically Fragile group or general revenue (GR) funds process. For these applicants or members, the losing service area (SA) MCO must inform the gaining SA MCO of the Medically Fragile group or GR funds status. The gaining SA MCO must follow the Medically Fragile group or GR funds process.

3410 MCO Transfer Scenarios

Revision Notice 25-2; Effective June 6, 2025

The applicant, member, or authorized representative (AR) must contact the enrollment broker by phone at 800-964-2777 to change from one managed care organization (MCO) to another MCO. The MCO transfer may occur within the same service area (SA) or in another SA.

An applicant, member, or AR may request to change MCOs at any time, for any reason, and regardless of their living arrangement. However, for an applicant requesting an MCO change, the transfer will not go into effect until after one full calendar month of STAR+PLUS Home and Community Based Services (HCBS) program service provision. All MCO enrollment changes become effective based on the date the MCO change is requested and processed, in relation to the state cutoff. Refer to Appendix XVII, State Cutoff Dates, for more information.

3411 Transferring from One MCO to Another Within the Same Service Area

Revision 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff may become aware of an applicant or member transferring from one managed care organization (MCO) to another within the same service area (SA):

PSU staff must make sure the contract number in the Service Authorization System Online (SASO) is updated to reflect the new managed care organization’s (MCO’s) contract number.

PSU staff must complete the following manual actions in the Service Authorization System Online (SASO), within three business days from notification, if applicable: 

  • close service authorization record using the MCO transfer date; and
  • create a new service authorization record using the new MCO’s contract number.

The old MCO must transfer all relevant information to the new MCO using a secure file transfer protocol (SFTP) or secure email. Relevant information includes: 

The new MCO is responsible for service delivery beginning the first day of enrollment. The new MCO must honor authorizations included in the prior ISP until the member requires a new MN/LOC Assessment.

The new MCO must notify Managed Care Contracts and Oversight (MCCO) unit staff if they encounter issues getting the transfer packet from the old MCO. MCCO unit staff may contact PSU staff for help transferring member information to the gaining MCO.

3412 Transferring from One MCO to Another in a Different Service Area

Revision Notice 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff may become aware of an applicant or member transferring from one managed care organization (MCO) to another in a different service area (SA):

Program Support Unit (PSU) staff must complete the following activities. This must be done within five business days of being aware of the transfer of an applicant or member to another MCO in a different SA:

  • create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record;
  • verify the applicant or member’s address and managed care enrollment is updated in Texas Integrated Eligibility Redesign System (TIERS);
  • manually close the Service Authorization System Online (SASO) Service Authorization record using the MCO transfer date, if applicable; and
  • manually create a new SASO Service Authorization record using the new MCO’s contract number, if applicable.

PSU staff must complete the following activities. This must be done within two business days of determining an applicant or member does not have an updated address or managed care enrollment in TIERS:

  • advise the MCO to help the Supplemental Security Income (SSI) applicant or member contact the Social Security Administration (SSA) to update their address; or
  • fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist noting the address change for medical assistance only (MAO) applicants and members.

TIERS tries to assign an applicant or member to a companion plan automatically when their address is updated in TIERS and reflects an SA change. A companion plan is defined as an MCO that operates the same managed care line in multiple SAs. TIERS systematically refers the applicant or member to the enrollment broker if a companion plan is unavailable.

The enrollment broker tries to get a new MCO selection from the member. The enrollment broker defaults the member to an MCO if a selection is not provided within 15 days. The defaulted MCO selection is made using the Texas Health and Human Services Commission (HHSC) approved default logic and is processed at the next state cutoff. The HHSC-approved default logic considers the member’s medical history, including prior enrollments, primary care providers (PCPs), claims data, and any family plans about the program type and SA.

PSU staff must make sure the MCO submits the Medical Necessity and Level of Care (MN/LOC) Assessment and ISP for applicants. The MCO must do this within 45 days from the date PSU staff upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub.

For members, PSU staff must confirm all STAR+PLUS Home and Community Based Services (HCBS) program eligibility within five business days of receipt of Form H1700-1. The process is abbreviated since the member already has the following:

  • an MN/LOC Assessment;
  • a Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) level; and
  • financial eligibility determination by the MEPD specialist, if applicable.

PSU staff coordinates all appropriate activities between the MCOs, applicant, member or authorized representative (AR), Enrollment Resolution Services (ERS) unit staff and other key parties. This helps make sure there is a successful transition.

PSU staff must complete the following activities within five business days from notification of the transfer:

  • confirm the applicant or member’s address and managed care enrollment is updated in TIERS;
  • make sure the contract number in SASO is updated to reflect the new MCO’s contract number;
  • for MAO members, email ERS unit staff the following information:
    • this subject line: STAR+PLUS HCBS MCO Transfer Enrollment Request for XX [member’s first and last name initials]”;
    • the member’s name;
    • Medicaid identification (ID) number;
    • type of request: MCO change;
    • medical necessity (MN) approval date;
    • ISP receipt date;
    • ISP begin date;
    • ISP end date;
    • MCO selection;
    • effective date of enrollment;
  • upload all applicable documents to the HEART case record; and
  • document and close the HEART case record.

PSU staff must complete the following activities within two business days of determining an applicant or member does not have an updated address or managed care enrollment in TIERS:

Refer to Appendix XXXI, STAR +PLUS Members Transitioning from an NF in one Service Area to the Community in Another Service Area, for more information, and for SA changes occurring for a Money Follows the Person (MFP) case.

3420 Individuals Transitioning Services for Adults

Revision 18-0; Effective September 4, 2018

STAR Kids and STAR Health eligibility will terminate the last day of the month in which the member's 21st birthday occurs and the member must receive services through programs serving adults beginning the first day of the first month following the individuals 21st birthday. The following services end at the end of the month following the member's 21st birthday.

  • Medically Dependent Children Program (MDCP) operated by STAR Kids or STAR Health managed care organizations (MCOs); and
  • Texas Health Steps (THSteps) Comprehensive Care Program (CCP), private duty nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) services.

Note: Depending on eligibility requirements, some members may continue to receive services except MDCP, through STAR Health until age 22.

In addition to the programs and services above, individuals for Community First Choice (CFC) services and personal care services (PCS) must transition to an adult program.

Members who receive MDCP, PDN, PPECC, CFC or PCS and transition to adult programs may apply for services through STAR+PLUS or the STAR+PLUS Home and Community Based Services (HCBS) program to continue to receive community services and avoid institutionalization beginning the 1st of the month following their 21st birthday.

3421 Procedures for Children Transitioning from STAR Kids/STAR Health Receiving MDCP or THSteps-CCP, PDN or PPECC

Revision 18-0; Effective September 4, 2018

Members may receive a combination of the following services:

  • Medically Dependent Children Program (MDCP);
  • private duty nursing (PDN); or
  • prescribed pediatric extended care center (PPECC) services.

3421.1 Twelve Months Prior to the Member's 21st Birthday

Revision 26-2; Effective June 1, 2026

The Texas Health and Human Services Commission (HHSC) Utilization Review (UR) unit provides a copy of the Medically Dependent Children Program (MDCP)-Private Duty Nursing (PDN) Transition Report, to the following each quarter:

  • Program Support Unit (PSU) staff; and
  • UR Unit for Intellectual or Developmental Disabilities (IDD) Waiver/Community Services/Hospice staff.

The MDCP-PDN Transition Report lists STAR Kids or STAR Health members who may transition to STAR+PLUS or the STAR+PLUS Home and Community Based Services (HCBS) program in the next 18 months and are receiving:

  • MDCP,
  • PDN;
  • Comprehensive Care Program (CCP) services; or 
  • Prescribed Pediatric Extended Care Center (PPECC) services. 

The STAR Kids and STAR Health managed care organizations (MCOs) identify all members turning 21 within the next 12 months and schedule a face-to-face home visit with the member and the member's support person, including the authorized representative (AR), if applicable, to initiate the transition process.

The MCO must present an overview of the STAR+PLUS HCBS program, and the changes that will take place when the member transitions to the adult program during the home visit.  The MCO must make a referral to the Utilization Review (UR) unit mailbox if they believe the member meets high needs criteria. 

Designated PSU staff must:

  • monitor the MDCP-PDN Transition Report and identify all members receiving MDCP, PDN or PPECC services turning 21 in 12 months and not enrolled in one of the following IDD 1915(c) Medicaid waivers:
    • CLASS;
    • DBMD;
    • HCS; or
    • TxHmL;
  • create a case record in HEART noting:
    • if the MCO determines the member is high needs; 
    • the program type the member is transitioning from; and
    • the due date for the nine-month contact; and
  • assign the HEART case record to regional PSU staff.

PSU staff must not upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub earlier than five months before the member's 21st birthday.

3421.2 Nine Months Before the Member's 21st Birthday

Revision 23-4; Effective Dec. 7, 2023

Nine months before the 21st birthday of a member receiving the Medically Dependent Children Program (MDCP), Texas Health Steps (THSteps) Comprehensive Care Program (CCP), Private Duty Nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) service, the following process begins.

The STAR Kids and STAR Health managed care organization (MCO) must:

  • monitor transition activities with the member and the member's available supports, including his or her authorized representative (AR), every 90 days during the year before the member turns 21; and
  • notify Program Support Unit (PSU) staff of any issues or concerns by uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub.

PSU staff must:

PSU staff must update the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record by:

  • documenting the date Form 2114 was sent out to the member or AR;
  • documenting the due date for the phone contact 30 days from the date the STAR+PLUS Home and Community Based Services (HCBS) program enrollment packet is mailed; and
  • upload all applicable documents to the HEART case record.

Note: PSU staff must upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub no earlier than five months before the member's 21st birthday.

PSU staff must contact the member or AR within 30 days from the date the enrollment packet was mailed to discuss:

  • The transition process and review the enrollment packet.
  • STAR Kids eligibility, MDCP, PDN and PPECC services will terminate on the last day of the month that the member's 21st birthday occurs.
  • The STAR+PLUS HCBS program is an option available to eligible members at 21. PSU staff must also present an overview of the array of services available within the STAR+PLUS HCBS program.
  • The STAR+PLUS HCBS program enrollment packet sent to the member is reviewed. The enrollment packet contains a list of the STAR+PLUS MCOs in the SA and a comparison chart to help the member in making an MCO selection. The member will choose a STAR+PLUS MCO in their SA to conduct the Medical Necessity and Level of Care (MN/LOC) Assessment for services and oversee the delivery of services.
  • The importance of choosing an MCO six months before the 21st birthday to avoid having a gap in services.
  • The member can change MCOs any time after the first month of enrollment.
  • The STAR+PLUS HCBS program has a cost limit based on a medical assessment, the MN/LOC Assessment. The assessment determines the cost limit for the individual service plan (ISP).
  • To be eligible for the STAR+PLUS HCBS program, an ISP must be developed within the cost limit, meet the member's needs and ensure health and safety.
  • The STAR+PLUS HCBS program will be denied if an ISP cannot be developed within the cost limit that ensures member's health and safety in the community.
  • The ISP considers all resources available to meet the member's needs, including community supports, other programs, and what the member's informal support system can provide to meet the member's needs.
  • The STAR+PLUS HCBS program assessment process will begin six months before the member's 21st birthday. PSU staff will contact the member to begin the application process and find out which MCO has been selected. The member has 30 days to select an MCO. An MCO will be selected for the member after 30 days if one has not been selected.
  • The MCO service coordinator will contact the member to begin the MN/LOC Assessment for services and assist the member or AR identify and develop additional resources and community supports to help meet the member's needs.
  • The MCO service coordinator will help the member determine the services needed within this service array to meet his or her needs and ensure health and safety. Example: A member who primarily requires nursing services can have an ISP developed with the maximum number of nursing hours within the cost limit while the member's other needs are met through other resources.
  • Reassure the member or AR every effort will be made to ensure a successful transition to the STAR+PLUS HCBS program.
  • The member may potentially receive an enrollment packet from the Texas Health and Human Services Commission (HHSC) enrollment broker and the importance of selecting the same MCO.

PSU staff must update the HEART case record by noting the due date for the six-month contact.

The following chart outlines the responsibilities to monitor the MDCP-PDN Transition Report and contact members transitioning from STAR Kids or STAR Health and receiving MDCP and PDN or PPECC nine months before the member's 21st birthday:

Nine-Month Transition Chart

Under 21 MDCPUnder 21 Other Services ReceivedMonitors MDCP-PDN Transition Report:Nine-Month Contact:
MDCPPDN-CCP or PPECC-CCPPSU StaffPSU Staff
MDCPNonePSU StaffPSU Staff
NonePDN-CCPPSU StaffPSU Staff
NonePPECC-CCPPSU StaffPSU Staff

3421.3 Six Months Prior to the Member's 21st Birthday

Revision 18-0; Effective September 4, 2018

Six months prior to the 21st birthday of a member receiving the Medically Dependent Children Program (MDCP) or Texas Health Steps (THSteps) Comprehensive Care Program (CCP), Private Duty Nursing (PDN) or Prescribed Pediatric Extended Care (PPECC) services, the following process begins.
The Utilization Review (UR) Unit must:

  • monitor the MDCP-PDN Transition Report and identify all members turning age 21 in six months receiving CCP/PDN through fee-for-service (FFS) or STAR Health and not enrolled in one of the following Intellectual or Developmental Disability (IDD) 1915(c) Medicaid waivers:
    • Community Living Assistance and Support Services (CLASS);
    • Deaf Blind with Multiple Disabilities (DBMD);
    • Home and Community-based Services (HCS); or
    • Texas Home Living (TxHmL).
  • coordinate with Program Support Unit (PSU) staff if it is determined the member is high needs and/or will need to be assessed for the STAR+PLUS Home and Community Based Services (HCBS) program.

The IDD Waiver/Community Services/Hospice UR Unit staff will:

  • monitor the MDCP-PDN Transition Report for members enrolled in one of the following 1915(c) Medicaid waivers for IDD and who are turning age 21 in the next six months:
    • CLASS;
    • DBMD;
    • HCS; or
    • TxHmL; or
  • make a STAR+PLUS HCBS program referral to PSU staff by email using Form H2067-MC, Managed Care Programs Communication, for members requesting a STAR+PLUS HCBS program assessment, or whose proposed waiver plan exceeds the member cost limit for the IDD 1915(c) Medicaid waiver listed above.

PSU staff must:

  • monitor the MDCP-PDN Transition Report and identify all members referenced in 3421, Children Transitioning from STAR Kids or STAR Health Receiving MDCP or THSteps-CCP, PDN or PPECC, turning age 21 in six months and not enrolled in one of the IDD 1915(c) Medicaid waivers listed above;
  • not reach out to members in CLASS, DBMD, HCS or TxHmL, unless the IDD Waiver/Community Services/Hospice UR Unit submits a referral, as documented above;
  • send Form H2116, Age-Out MDCP and PDN Contact Letter, to the member if the MCO choice has not been obtained;
  • contact the member or authorized representative (AR) if the MCO choice has not been obtained by telephone to:
    • review the STAR+PLUS enrollment packet discussed at the 12-month or the nine-month contact;
    • inform the member or AR of a 30-day time frame to choose a managed care organization (MCO) and a primary care physician (PCP);
    • explain if the member or AR does not timely choose an MCO, the Texas Health and Human Services Commission (HHSC) will assign an MCO for the member; and
    • explain that the member can change MCOs any time after the first month of enrollment.
  • email the UR Unit at the HHSC UR High Needs CCR mailbox regarding all possible high needs situations; and
  • update the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record, documenting the:
    • contact or contact attempt date;
    • MCO selection; and
    • due date for the five-month contact.

Note: PSU staff must not upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to TxMedCentral in the MCO's SPW folder earlier than five months prior to the member's 21st birthday.

The following chart outlines the responsibilities for agency referrals and PSU staff action for members enrolled in STAR Kids or STAR Health and receiving MDCP, PDN or PPECC transitioning six months prior to the member's 21st birthday.

Six-Month Transition Chart

Under Age 21 Current ProgramUnder Age 21 Other Services ReceivedPSU Staff Action
MDCPPDN-CCP or PPECC-CCPMonitors the MDCP-PDN Transition Report and contacts the member.
MDCPNot ApplicableMonitors the MDCP-PDN Transition Report and contacts the member.
Not ApplicablePDN-CCPMonitors the MDCP-PDN Transition Report and contacts the member.
Not ApplicablePPECC-CCPMonitors the MDCP-PDN Transition Report and contacts the member.
CLASS, DBMD, HCS or TxHmLNot Applicable, CCP/PDN or PPECCContacts the member when the referral is received.

3421.4 Five Months Prior to the Member's 21st Birthday

Revision 18-0; Effective September 4, 2018

Five months prior to the 21st birthday of a member receiving Medically Dependent Children Program (MDCP) or Texas Health Steps (THSteps) Comprehensive Care Program (CCP), private duty nursing (PDN), or Prescribed Pediatric Extended Care Centers (PPECC) services, and within 30 days of the previous contact, Program Support Unit (PSU) staff contact the member or authorized representative (AR) by telephone.

If the member or AR receiving MDCP or CCP/PDN or PPECC has made a managed care organization (MCO) and primary care provider (PCP) choice:

  • the member or AR receiving MDCP-PDN or PPECC informs PSU staff of the MCO choice; and
  • PSU staff inform the:

If the member or AR has not made an MCO and PCP choice:

  • PSU staff inform the member or AR that if an MCO is not selected within seven days from the PSU staff contact, one will be assigned; and
  • if the selection is not made within seven days from the PSU staff contact, PSU staff:
    • select an MCO for the member;
    • inform the member that:
      • an MCO has been selected; and
      • he or she must remain with this MCO through the first month of STAR+PLUS enrollment to ensure a smooth transition and service continuity; and
  • inform the MCO of the choice by uploading Form H3676 to TxMedCentral in the MCO's SPW folder, following the instructions in Appendix XXXIV.

Note: Within 14 days of the PSU staff uploading date of Form H3676, the MCO must schedule the initial home visit with the MDCP or CCP or PDN member or AR.

3421.5 MCO Actions After Receiving Form H3676 Referral

Revision 23-2; Effective May 15, 2023

The managed care organization (MCO) must complete the following activities within 45 days of receiving Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, from Program Support Unit (PSU) staff:

3421.6 Confirm STAR+PLUS HCBS Program Eligibility

Revision 25-4; Effective Oct. 6, 2025

Program Support Unit (PSU) staff must confirm ongoing Medicaid eligibility in the Texas Integrated Eligibility Redesign System (TIERS) within two business days of receipt of Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section B, from the managed care organization (MCO).

PSU staff must coordinate with Medicaid waiver program staff by email, if the member is enrolled in an Intellectual or Developmental Disability (IDD) waiver program, within five business days of receipt of the following from the MCO:

  • Form H3676, Section B;
  • an approved and valid Medical Necessity and Level of Care (MN/LOC) assessment; and
  • the STAR+PLUS Home and Community Based Services (HCBS) program individual service plan (ISP).

The email to the Medicaid waiver program staff must include:

  • a subject line that reads: [IDD waiver program acronym] Transition to STAR+PLUS HCBS for XX [first letter of the member's first and last name];
  • member’s name;
  • Medicaid identification (ID) number;
  • the Medicaid waiver program termination date; and
  • the STAR+PLUS HCBS program start of care (SOC) date.

PSU staff must confirm STAR+PLUS HCBS program eligibility:

  • no earlier than 45 days before the transition to an adult program; and
  • by verifying the following eligibility criteria:
    • an approved and valid MN/LOC Assessment submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) and updated in the Service Authorization System Online (SASO);
    • an ISP within the cost limit that includes at least one STAR+PLUS HCBS program service; and
    • continued Medicaid financial eligibility in the Texas Integrated Eligibility Redesign System (TIERS).

Note: A valid medical necessity (MN) does not exceed 150 days from the date of TMHP approval for applicants transitioning to an adult program. PSU staff must upload Form H2067-MC, Managed Care Programs Communication, to the MCOHub requesting the MCO submit a new initial MN/LOC Assessment in the TMHP LTCOP if the MN exceeds 150 days from the date of TMHP approval.

PSU staff must complete the following activities within five business days of confirming approval of STAR+PLUS HCBS program eligibility:

  • establish the SOC date which is the first of the month following the member's 21st birthday;
    • SOC Date Examples:
      • A member receiving Medically Dependent Children Program (MDCP) or Comprehensive Care Program (CCP), private duty nursing (PDN) or Prescribed Pediatric Extended Care Centers (PPECC) services has their 21st birthday on March 3, 2019. STAR+PLUS enrollment is effective April 1, 2019.
      • A member receiving MDCP or CCP, PDN or PPECC services has their 21st birthday on April 1, 2019. STAR+PLUS enrollment is effective May 1, 2019.
  • manually or electronically generate Form H2065-D, Notification of Managed Care Program Services;
  • upload Form H2065-D to the MCOHub, if manually generated;
  • mail Form H2065-D to the member;
  • email Enrollment Resolution Services (ERS) unit staff the following information:
    • an email subject line that reads: [MDCP or Medicaid waiver program] Transition to STAR+PLUS HCBS for XX [first letter of the member's first and last name];
    • the member's name;
    • Medicaid ID number;
    • ISP begin and end date for the STAR+PLUS HCBS program;
    • MCO selection and plan code; and
    • Form H2065-D as an attachment;
  • fax Form H1746-A, MEPD Referral Cover Sheet to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist as notification of the program change from MDCP or an Medicaid waiver program to the STAR+PLUS HCBS program;
  • verify Medicaid waiver program staff have closed IDD records in SASO, if applicable;
  • verify SASO records are aligned with TMHP LTCOP records;
  • upload applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
  • document and close the HEART case record.

Refer to 6000, Denials and Terminations, for more information on denying an applicant trying to transition to an adult program.

3421.7 ISP Cost Exceeds 202% of the Cost Limit

Revision 25-1; Effective Feb. 19, 2025

The managed care organization (MCO) must provide documentation to the Texas Health and Human Services Commission (HHSC) Utilization Review (UR) Transition/High Needs coordinator if the individual service plan (ISP) cost exceeds 202 percent of the cost limit.

The UR Unit may request a clinical review of the case to consider the use of the Medically Fragile group or General Revenue (GR) funds process to cover costs more than 202 percent of the cost limit. The UR Unit provides the final determination letter to the MCO and Program Support Unit (PSU) staff if a clinical review is conducted.

Note: HHSC UR staff coordinates with the member, authorized representative (AR) and the MCO to discuss the process for HHSC to request the use of the Medically Fragile group GR funds process for services above the cost limit.

Refer to 5000, Medically Fragile Group and General Revenue Process, for more information on processing cases submitted for Medically Fragile group and GR funds process consideration.

3422 Transition Policy for Non-Waiver Individuals and Applicants Receiving PCS or CFC Only

Revision 25-2; Effective June 6, 2025

STAR Kids and STAR Health eligibility terminates the last day of the month that the non-waiver program individual's or applicant's 21st birthday occurs. The individual or applicant must receive services through programs serving adults beginning the first day of the month after the individual's or applicant's 21st birthday.

Individuals and applicants with STAR+PLUS must transition their personal care services (PCS) and Community First Choice (CFC) services to an adult program. Some individuals or applicants may continue to receive PCS or CFC through STAR Health until 22, depending on eligibility requirements.

The Texas Health and Human Services Commission (HHSC) enrollment broker will reach out to the individual or applicant 30 days before the individual's or applicant's 21st birthday and provide the individual or applicant with a STAR+PLUS enrollment packet. The individual or applicant is allowed 15 days to make a managed care organization (MCO) selection. The HHSC enrollment broker selects an MCO for the individual or applicant if the individual or applicant has not made a selection after 15 days, as outlined in Title 1 Texas Administrative Code (TAC) Chapter 353.403(d)(3), Enrollment and Disenrollment.

3423 Intrapulmonary Percussive Ventilator

Revision 18-0; Effective September 4, 2018

Members who were approved for, and are using, an intrapulmonary percussive ventilator (IPV) are permitted to continue using the IPV if it is deemed to have a beneficial impact on the health of the member. The member must not be subjected to abrupt removal of the equipment. The member continues to receive ongoing IPV treatment until a final decision is made by the STAR+PLUS managed care organization (MCO), on a case-by-case basis, including thorough review and documentation by the MCO and explicit approval by the Texas Health and Human Services Commission (HHSC) Office of the Medical Director (OMD).