7200, State Fair Hearing Procedures for MDCP

Revision 25-4; Effective Dec. 12, 2025

Title 1 Texas Administrative Code (TAC) Section 357.1, Definitions, states an appeal is a request for a review of an agency action or failure to act that may result in a fair hearing. A Medically Dependent Children Program (MDCP) applicant, member or  legally authorized representative has the right to request an appeal within 90 days from the effective date of a Texas Health and Human Services Commission (HHSC) action as shown in Title 1 TAC Section 357.3, Authority and Right to Appeal. The appeal request may be verbal or in writing.

A state fair hearing is an informal proceeding held before an impartial HHSC hearings officer where an applicant, member or LAR appeals an agency action, as shown in Title 1 TAC Section 357.1. 

7201 Timely or Non-timely State Fair Hearing Request

Revision 25-4; Effective Dec. 12, 2025

An applicant, member or legally authorized representative (LAR) may request a state fair hearing verbally or in writing.

A timely state fair hearing request for a Medically Dependent Children Program (MDCP) eligibility denial is received by Program Support Unit (PSU) staff no later than 90 days from the date listed on Form H2065-D, Notification of Managed Care Program Services. A non-timely state fair hearing request for an MDCP eligibility denial is received by PSU staff later than 90 days from the date listed on Form H2065-D.

PSU staff must create the appeal in the Texas Integrated Eligibility Redesign System (TIERS) for all state fair hearing requests that are received, except for Medicaid for the Elderly and People with Disabilities (MEPD) or Texas Works (TW) financial denials. PSU staff must notify Appeals and Mitigation (A&M) staff by creating an appeal task in the Texas Health and Human Services Commission (HHSC) Benefits Portal if a fair hearing request is received for a MEPD or TW financial denial. PSU staff must refer to Appendix XXI, Creating an Appeal in TIERS and Appendix XII, Create an Appeal Task in the HHSC Benefits Portal, when creating records.

The hearing officer will determine if there is good cause for a non-timely state fair hearing request. The applicant or member is not eligible for a state fair hearing if the hearing officer determines if there is no good cause.

7210 Entering a State Fair Hearing In TIERS

Revision 24-4; Effective Dec. 1, 2024

Program Support Unit (PSU) staff may receive a verbal or written appeal request related to a Medically Dependent Children Program (MDCP) eligibility denial or termination from:

• an applicant;
• a member;
• the legally authorized representative (LAR); or
• the medical consenter.

PSU staff must complete the following activities within two business days of receipt of all appeal requests, except appeal requests resulting from a Medicaid for the Elderly and People with Disabilities (MEPD) or Texas Works (TW) financial eligibility denial:

• create a new appeal case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), if necessary; and
• enter a state fair hearing in the Texas Integrated Eligibility Redesign System (TIERS).

PSU staff must refer to Appendix XXI, Creating an Appeal in TIERS, for detailed instructions on entering a state fair hearing in TIERS.

TIERS will assign an appeal identification (ID) number when PSU staff complete and submit the fair hearing in TIERS. PSU staff must document the appeal ID number in the HEART case record.

PSU staff must refer to:

• Section 7213, State Fair Hearing Evidence Packet, for additional activities PSU staff must complete on the same day as creating the fair hearing in TIERS.
• Section 7221.2, Financial Denial by Medicaid for the Elderly and People with Disabilities or Texas Works, for PSU staff responsibilities for appeal requests related to an MEPD or TW financial eligibility denial.

7211 Reserved for Future Use

Revision 23-4; Effective Aug. 21, 2023

7212 Generation of the State Fair Hearing Packet

Revision 24-3; Effective Aug. 26, 2024

The Texas Integrated Eligibility Redesign System (TIERS) generates a partial state fair hearing packet. The packet is available to state fair hearing participants other than the applicant, member or legally authorized representative (LAR), such as Texas Health and Human Services Commission (HHSC), the Office of the Medical Director (OMD), Texas Medicaid & Healthcare Partnership (TMHP), and managed care organization (MCO) staff. A partial state fair hearing packet includes:

• Form H4800, Fair Hearing Request Summary; and
• Form H4803, Notice of Hearing.

Program Support Unit (PSU) staff and the PSU supervisor receive an alert in TIERS that a state fair hearing is scheduled. The alert in TIERS identifies the hearings officer assigned to the state fair hearing and the date and time of the state fair hearing. PSU staff use this information to monitor for the decision of the state fair hearing. PSU staff do not attend state fair hearings unless it is related to a Supplemental Security Income (SSI) financial denial.

Once a state fair hearing has been scheduled, TIERS generates a full state fair hearing packet.  The hearings officer mails the packet to the applicant, member or LAR. A full state fair hearing packet includes:

• Form H4800;
• Form H4803;
• Fair Hearing Procedures (PDF); and
• Form H4806, Request for Another Appointment - Request to Withdraw.

7213 State Fair Hearing Evidence Packet

Revision 25-3; Effective Oct. 20, 2025

Program Support Unit (PSU) staff must complete the following activities on the same day PSU staff enter the state fair hearing in the Texas Integrated Eligibility Redesign System (TIERS):

• prepare the state fair hearing evidence packet, as applicable;
• mail the state fair hearing evidence packet to the applicant, member or legally authorized representative (LAR);
• upload the state fair hearing evidence packet to the Texas Health and Human Services Commission (HHSC) Benefits Portal;
• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document the HEART case record.

PSU staff must not enter state fair hearing requests for Medicaid for the Elderly and People with Disabilities (MEPD) or Texas Works (TW) Medicaid financial denials. Appeals and Mitigation (A&M) staff are responsible for creating all fair hearings related to MEPD and TW financial denials.

PSU staff must:

• refer to 7221.2, Financial Denial by Medicaid for the Elderly and People with Disabilities or Texas Works, for PSU staff responsibilities for MEPD or TW financial denials; and
• ensure documentation clearly states the state fair hearing is for the Medically Dependent Children Program (MDCP).

The PSU state fair hearing evidence packet includes the following:

• Form 4801, State Fair Hearing Evidence Packet Cover Page;
• Form H2065-D,  Notification of Managed Care Services;
• the appropriate handbook section, notated on Form H2065-D;
• Appendix XVII, MDCP Eligibility TAC;
• Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP, as applicable, for members transitioning from MDCP due to turning 21;
• the following documents, as applicable, for medical necessity (MN) denials or terminations:
  • Appendix XXVII, Fair Hearing Options for MDCP Denials – Applicants; or
  • Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials – Members; and
  • any written requests for a state fair hearing, first position or advanced placement.

PSU staff must ensure all state fair hearing evidence packets are complete, organized and all pages are numbered to support the agency’s action on appeal.

Other agencies that may be involved in a state fair hearing, such as the managed care organization (MCO), the Office of the Medical Director (OMD), A&M or the Texas Medicaid & Healthcare Partnership (TMHP) will:

• generate their own state fair hearing evidence packet;
• upload their state fair hearing evidence packet to the HHSC Benefits Portal; and
• mail their state fair hearing evidence packet to the applicant, member or LAR.

The hearings officer mails Form 4803, Notice of Fair Hearing, to the applicant, member, or LAR when the state fair hearings is first requested. The applicant, member, or LAR may fax or mail evidence to the hearings officer. The applicant, member or LAR gets the hearings officer’s contact information from Form H4803. The hearings officer shares any evidence submitted by the applicant, member, or LAR with HHSC.

7214 Changes to the State Fair Hearing Request Summary

Revision 23-4; Effective Aug. 21, 2023

Program Support Unit (PSU) staff may learn of changes to an applicant or member’s information after entering the fair hearing into Texas Integrated Eligibility Redesign System (TIERS).

PSU staff must complete the following activities as soon as possible but no later than 10 days from notification of the change:

• verify that a hearings officer has been assigned to the case by checking TIERS;
• complete Form H4800-A,  Fair Hearing Request Summary (Addendum), with the updated information;
• upload Form H4800-A to the Texas Health and Human Services Commission (HHSC) Benefits Portal;
• notify the hearings officer by email. The email to the hearings officer must include the following:
  • an email subject line that reads: Form H4800-A for XX [first letter of the applicant’s or member’s first and last name]
  • applicant or member’s name;
  • Social Security number (SSN) or Medicaid identification (ID) number, as applicable;
  • HHSC State Benefits appeal ID number;
  • the type of request (i.e., notification of a change); and
  • Form H4800-A;
• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document the HEART case record.

PSU staff must include the following on Form H4800-A:

• a clear statement indicating that this is a state fair hearing for Medically Dependent Children Program (MDCP); and
• the appeal ID number assigned by TIERS in the designated field on Form H4800-A.

PSU staff may also email Form H4800-A to the hearings officer if they encounter issues with uploading Form H4800-A to the HHSC Benefits Portal.

Refer to Section 7221.2, Financial Denial by Medicaid for the Elderly and People with Disabilities or Texas Works, for PSU staff responsibilities for appeal requests related to Medicaid for Elderly and People with Disabilities (MEPD) or Texas Works (TW) financial eligibility denials. 

Delays in uploading documentation may delay the fair hearing or require the fair hearing to be rescheduled.

7220 Processing a State Fair Hearing Request

Revision 18-0; Effective September 4, 2018

7221 Type of Denials

Revision 25-3; Effective Oct. 20, 2025

Program Support Unit (PSU) staff procedures to process a fair hearing vary based on the denial reason. For example, PSU staff notify Appeals and Mitigation (A&M) staff using the Texas Health and Human Services Commission (HHSC) Benefits Portal if the appeal request is a result of a Medicaid for the Elderly and People with Disabilities (MEPD) or Texas Works (TW) financial eligibility denial. PSU staff create a fair hearing in the Texas Integrated Eligibility Redesign System (TIERS) for all other denial reasons when the applicant or member requests a fair hearing.

Refer to the following sections for more information about processing an appeal request for the following denial reasons:

• 7221.1, Medical Necessity Denial by the Office of the Medical Director , for a medical necessity (MN) denial reason;
• 7221.2, Financial Denial by Medicaid for the Elderly and People with Disabilities or Texas Works, for a MEPD or TW financial eligibility denial reason;
• 7221.3, Supplemental Security Income Denial by the Social Security Administration, for a supplemental security income (SSI) denial reason; or
• 7221.4, Other Denial Reasons, for any other denial reason.
   

7221.1 Medical Necessity Denial by the Office of the Medical Director 

Revision 26-1; Effective March 16, 2026

Program Support Unit (PSU) staff must complete the following activities for an appeal request for a medical necessity (MN) denial or termination:

• Create the following within two business days from receiving the appeal request:
  • A new fair hearing Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record. Note: The HEART case record must remain open until the fair hearing decision is rendered.
  • A fair hearing in the Texas Integrated Eligibility Redesign System (TIERS) following the instructions in Appendix XXI, Creating an Appeal in TIERS.
• Prepare, mail and upload the state fair hearing evidence packet, as noted in 7213, State Fair Hearing Evidence Packet. Do this on the same date PSU staff create the fair hearing in the HHS Benefits Portal.
• Complete Form H4800-A, Fair Hearing Request Summary (Addendum) if PSU staff learn of changes to the applicant or member’s information after entering the fair hearing in TIERS.
• Maintain the applicant on the Community Services Interest List (CSIL) during the fair hearing, if the CSIL record is open when the applicant requested the fair hearing.
• Monitor the fair hearing case for the receipt of the TIERS alert showing the hearings officer rendered their decision.
• Upload all applicable documents to the HEART case record.
• Document the HEART case record.

PSU staff do not attend the fair hearing for MN denials or terminations.

Refer to 7222.1, Continuation of Medically Dependent Children Program During a State Fair Hearing, for more information about continuing MDCP benefits during the fair hearing. 
 

7221.2 Financial Denial by MEPD or Texas Works

Revision 25-3; Effective Oct. 20, 2025

Program Support Unit (PSU) staff must forward the request for a state fair hearing to Appeals and Mitigation (A&M) staff. This is if the denial involves an applicant or member not receiving Supplemental Security Income (SSI) who does not meet financial criteria through the Medicaid for the Elderly and People with Disabilities (MEPD) or Texas Works (TW) programs. A&M staff must attend the state fair hearing to represent Medically Dependent Children Program (MDCP) financial denials.

Within one business day of receipt of the request, PSU staff must create:

• An appeal task in the Texas Health and Human Services (HHS) Benefits Portal in the Appeals/RFR tab for A&M staff about a financial denial for an non-SSI applicant or member. Refer to Appendix XII, Create an Appeal Task in the HHSC Benefits Portal.
• An email to A&M staff at the HHSC Access and Eligibility Services (AES) Fair Hearing mailbox that includes:
  • this subject line: MDCP Appeal Request - XX [first letter of the applicant or member’s first and last name] #### [last 4-digits of the case number];
  • the following items in the body of the email:
    • applicant or member’s name;
    • Social Security number (SSN) or Medicaid identification (ID) number;
    • Texas Integrated Eligibility Redesign System (TIERS) Case Number;
    • type of service: MDCP;
    • timeliness of receipt of the appeal;
    • specific information requesting the MEPD or TW financial case remain open during the state fair hearing, if the state fair hearing request is filed by the effective date of the action pending the state fair hearing;
    • observers contact information noted as the PSU staff and PSU supervisor;
  • a copy of Form H2065-D, Notification of Managed Care Program Services, signed, if available.
• A case record in the HHS Enterprise Administrative Report and Tracking System (HEART) documenting:
  • the receipt date of the state fair hearing request; and
  • notification to A&M staff for completion of Form H4800, Fair Hearing Request Summary.

PSU staff must refer to 7222.1, Continuation of Medically Dependent Children Program During a State Fair Hearing, for more information.

A&M will send the PSU staff and supervisor listed as observers an email with the appeal ID number within five days of receipt of a state fair hearing request as notice Form H4800  was completed. PSU staff must upload the notification in the HEART case record and monitor the appeal until the state fair hearing decision is rendered.

PSU staff must:

• not put an applicant or member name back on the MDCP interest list while an MEPD or TW financial denial are in the state fair hearing process; and
• take appropriate action to certify or deny the case or resume services once the MEPD or TW financial denial state fair hearing decision is rendered.

The applicant or member may choose to be added back to the MDCP interest list if the denial is sustained.

PSU staff and the PSU supervisor entered as observers are notified by an email alert from TIERS of the hearing officers rendered decision when the decision is rendered.

PSU staff must refer to 7500, State Fair Hearing Decision Actions, for more information about required actions after the decision of a state fair hearing.

7221.3 Supplemental Security Income Denial by the Social Security Administration

Revision 23-4; Effective Aug. 21, 2023

Program Support Unit (PSU) staff must complete the following activities for an appeal request for a supplemental security income (SSI) financial eligibility denial:

• create the following within two business days from the receipt of the appeal request:
  • a new fair hearing Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record. Note: The HEART case record must remain open until the fair hearing decision is rendered; and
  • a fair hearing in Texas Integrated Eligibility Redesign System (TIERS);
• prepare, mail and upload the state fair hearing evidence on the same day PSU staff create the fair hearing in TIERS;
• complete Form H4800-A, Fair Hearing Request Summary (Addendum), if PSU staff learn of changes to the applicant or member’s information after entering the fair hearing in TIERS;
• maintain the applicant or member on the Community Services Interest List (CSIL) during the fair hearing, if the CSIL record is open when the applicant or member requested the fair hearing;
• attend and present the state fair hearing evidence packet during the fair hearing;
• monitor the fair hearing case for the receipt of the TIERS alert indicating the hearings officer rendered their decision;
• upload all applicable documents to the HEART case record; and
• document the HEART case record.

PSU staff attend the fair hearing for SSI denials and terminations. Refer to Section 7232, Presentation of the State Fair Hearing Evidence Packet, for more information about PSU procedures during the fair hearing.

Continuation of Medically Dependent Children Program (MDCP) benefits during a state fair hearing does not apply for SSI terminations. 

7221.4 Other Denial Reasons

Revision 25-3; Effective Oct. 20, 2025

Program Support Unit (PSU) staff may receive a state fair hearing request for other denial and termination reasons. Other denial reasons include:

• living arrangement is not an allowable setting;
• voluntarily declined services;
• unable to locate the applicant or member;
• failure to get physician signature; or
• exceeding the STAR Kids individual service plan (SK-ISP) cost limit.

Managed care organization (MCO) staff must prepare the evidence packet and attend the state fair hearing if the action relates to other denial reasons. PSU staff do not attend state fair hearings related to other denial reasons.

PSU staff must complete the following activities for an appeal request not related to a denial reason listed in 7221.1 through 7221.3:

• create the following within two business days from receipt of the appeal request:
  • a new appeal case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), if necessary; and
  • a state fair hearing in the Texas Integrated Eligibility Redesign System (TIERS);
• refer to 7214, Changes to the State Fair Hearing Request Summary, as soon as possible but no later than 10 days from notification of changes to the applicant or member’s information after entering the state fair hearing in TIERS;
• monitor the state fair hearing case for the receipt of the TIERS alert showing the hearings officer rendered their decision;
• upload all applicable documents to the HEART case record; and
• document and close the HEART case record.

PSU staff must refer to 7222.1, Continuation of Medically Dependent Children Program During a State Fair Hearing, for more information about continuing Medically Dependent Children (MDCP) benefits during the state fair hearing.

7222 Continuation or Termination of Services

Revision 18-0; Effective September 4, 2018

7222.1 Continuation of MDCP Benefits During a State Fair Hearing

Revision 25-3; Effective Oct. 20, 2025

Medically Dependent Children Program (MDCP) benefits must continue until the hearings officer issues a decision if the member or legally authorized representative (LAR) files a state fair hearing requesting continued benefits:

• within the adverse action notification period of the MDCP termination; or
• by the effective date of the action pending the state fair hearing.

The deadline is the date that is later.

Continuation of MDCP benefits during a state fair hearing do not apply for Supplemental Security Income (SSI) denials.

PSU must refer to 6200, Adverse Action Notification Period, for more information about the adverse action notification period.

PSU staff must complete the following activities within one business day of entering a state fair hearing in the Texas Integrated Eligibility Redesign System (TIERS), if the member appeals within the adverse action notification period or by the effective date of the action:

• Extend the current STAR Kids individual service plan (SK-ISP) record and MDCP Enrollment Form in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) in four calendar month intervals. Example: The member’s four-month period would end on April 30, 2023, if the SK-ISP expiration date is Dec. 31, 2022.
• Upload Form H2067-MC, Managed Care Programs Communication, to the MCOHub notifying the managed care organization (MCO) to continue providing MDCP benefits until the hearings officer renders a decision.
• For members not receiving SSI, email Appeals and Mitigation (A&M) staff at the Texas HHSC Access and Eligibility Services (AES) Fair Hearings email the following:
  • this email subject line: MDCP Request for Continued Benefits – XX [first letter of the member’s first and last name] #### [last four digits of the case number];
  • the following items in the body of the email:
    • member's name;
    • Medicaid identification (ID) number;
    • HHS Benefits Portal Appeal ID number, if available;
    • TIERS case number;
    • type of service: MDCP;
    • reason for termination such as a medical necessity (MN) denial;
    • specific information requesting the Medicaid for the Elderly and People with Disabilities (MEPD), or Texas Works (TW) financial termination case remain open during the state fair hearing such as;
      • the MEPD or TW financial denial case may need to remain open pending a state fair hearing decision about MN; and
      • the witnesses’ contact information, such as the MCO representative and the designated MCO back-up.
• Upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.
• Document the HEART case record.
• Monitor the case for the receipt of the TIERS alert showing the hearings officer’s decision.

Note: PSU staff must mail the member or LAR the following forms to be tested for medical assistance only (MAO) Medicaid, if the member loses Texas Works or Foster Care Medicaid during the state fair hearing:

• Form H1200, Application for Assistance – Your Texas Benefits; and
• Form 2606, Managed Care Enrollment Processing Delay.

PSU staff must not mail Form H2065-D, Notification of Managed Care Program Services, to the member or LAR notifying of continued MDCP benefits.

HHSC continues MDCP benefits pending the hearings officer’s decision if:

• the state fair hearing is initially dismissed;
• then reopened later; and
• the member or LAR requests continued benefits.

The hearings officer voids the past fair hearing decision if they set a date for a new state fair hearing. The member must continue to receive MDCP benefits until the hearings officer renders a new state fair hearing decision.

7222.2 Discontinuation of Medically Dependent Children Program Services During a State Fair Hearing

Revision 24-4; Effective Dec. 1, 2024

A member’s Medically Dependent Children Program (MDCP) services must continue until the effective date of denial noted on Form H2065-D, Notification of Managed Care Program Services. The MDCP denial date is the last day of the month of the current STAR Kids individual service plan (SK-ISP) or the last day of the month that the adverse action notification period ends, whichever is later. Program Support Unit (PSU) staff must refer to section 6200, Adverse Action Notification Period, for more information.

A member who does not request a state fair hearing with continued benefits before the effective date of the denial will not receive continued MDCP services during the state fair hearing. PSU staff must monitor the case for the receipt of the Texas Integrated Eligibility Redesign System (TIERS) alert indicating the hearings officer’s decision.

Supplemental Security Income (SSI) members will remain enrolled in STAR Kids after MDCP termination. SSI members remain eligible for Medicaid state plan services, which include acute care and long-term services and supports (LTSS), such as Community First Choice (CFC) and Personal Care Services (PCS).

7230 State Fair Hearing Actions

Revision 18-0; Effective September 4, 2018

7231 Uploading the State Fair Hearing Evidence Packet to the HHSC Benefits Portal

Revision 23-3; Effective May 22, 2023

Program Support Unit (PSU) staff must upload the state fair hearing evidence packet to the Texas Health and Human Services Commission (HHSC) Benefits Portal on the same day PSU staff enter the state fair hearing.

PSU staff must:

• select the Appeals/RFR tab and ensure the appeal was entered in the Texas Integrated Eligibility Redesign System (TIERS);
• select Hearing Evidence Packets Upload and enter the appeal identification (ID) number;
• select Document Type: Agency Evidence Packet (items entered in any other selection will not be included in the evidence packet);
• select Validate;
• check the details to ensure the right person has been selected;
• browse for the document (e.g., Form H2065-D, Notification of Managed Care Program Services);  
• select Upload;
• 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.

PSU staff must refer to Section 7213, State Fair Hearing Packet, for documentation PSU staff must submit as evidence.

PSU staff must correct errors found in the state fair hearing task in TIERS.

PSU staff must correct errors made on: 

• the "Agency Representative" screen in TIERS using the "Maintain Appeals" screen in TIERS; and
• any other screen in TIERS by completing and uploading Form H4800-A, Fair Hearing Request Summary (Addendum), to the HHSC Benefits Portal. 

The "Agency Action Date" cannot be changed.

PSU staff must refer to Section 7221.2, Financial Denial by Medicaid for the Elderly and People with Disabilities or Texas Works, for PSU staff responsibilities for Medicaid for Elderly and Persons with Disabilities (MEPD) or Texas Works (TW) financial denials.

7232 Presentation of the State Fair Hearing Evidence Packet

Revision 22-1; Effective January 31, 2022

The hearings officer will not consider documentation in the evidence packet in the state fair hearing decision unless the packet is offered and admitted into evidence. The “Agency Representative” listed on Form H4800, Fair Hearing Request Summary, must present the packet, ask that the documents be admitted as evidence and summarize what the packet contains. Program Support Unit (PSU) staff do not attend state fair hearings unless the hearing is related to a Supplemental Security Income (SSI) denial. Refer to Section 7221.3, Supplemental Security Income Denial by the Social Security Administration, for PSU staff state fair hearing responsibilities. The hearings officer is a neutral party and is restricted by law from presenting the agency’s case.

MCO Example: "I want to offer the following packet as evidence in the state fair hearing filed on behalf of Ned Flanders.

• Pages 1-10 contain information relating to the completion of Form 2603, STAR Kids Individual Service Plan (ISP) Narrative.
• Pages 11-15 contain policy from the STAR Kids Handbook (SKH) that relates directly to the issue in question.
• Pages 16-20 contain documents signed by the applicant, member or legally authorized representative (LAR) related to individual rights.
• Page 21 contains Form H2065-D, Notification of Managed Care Program Services, which was mailed to the applicant, member or LAR on March 2."

PSU Example: "I want to offer the following packet as evidence in the state fair hearing filed on behalf of Ned Flanders.

• Page 1 contains a copy of Form H4803, Notice of Fair Hearing.
• Page 2 contains a copy of Appendix XVII, MDCP Eligibility TAC that states the STAR Kids Program Support Unit Operational Procedures Handbook (SKOPH) includes policies and procedures to be used by all Texas Health and Human Services (HHS) agencies and their contractors and providers in the delivery of STAR Kids Medically Dependent Children Program (MDCP) services to eligible applicants or members.
• Page 3 contains a copy of the Section 6300.4, Financial Eligibility, which states an applicant’s or member’s receipt of STAR Kids MDCP services depends on financial eligibility determined by SSI or Medicaid for Elderly and People with Disabilities (MEPD) program requirements.
• Page 4 contains Form H2065-D, which was mailed to the applicant, member or LAR on March 2nd."

The hearings officer then asks for objections and admits the documents into evidence. The hearings officer explains the reasons for excluding the material if the hearings officer is not able to admit any documents. The hearings officer considers any documents admitted when rendering a decision.