Appendix II, Form H2065-D MDCP Reason for Denial and Comments Language

Revision 23-2; Effective May 22, 2023

Program Support Unit (PSU) staff must use Appendix II, Form H2065-D MDCP Reason for Denial and Comments Language, to enter approved language in the Reason for Denial and Comments fields on Form H2065-D, Notification of Managed Care Program Services, and Form H2065-DS. PSU staff must not enter additional language in the Reason for Denial or Comments fields of Form H2065-D or Form H2065-DS. PSU staff must consult with their supervisor if they encounter a denial reason or comment not covered in Appendix II.

Reason for Denial and Comments language is illustrated in both English and Spanish in the tables below.

PSU staff must enter the denial reason in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) associated with the denial reason on Form H2065-D and Form H2065-DS. The denial reason in the TMHP LTCOP associated with the denial reason on Form H2065-D and Form H2065-DS is listed in the TMHP Denial Reason column in the table below.

Denial and Termination Reason Language

The table below contains language PSU staff must enter in the Reason for Denial and Comments field on Form H2065-D and Form H2065-DS for denials and terminations.

PSU staff must enter the associated STAR Kids Program Support Unit Operational Procedures Handbook (SKOPH) section supporting the denial reason on Form H2065-D and Form H2065-DS, listed in the SKOPH Section column.

Purpose of Form H2065-DReason for Denial in Plain LanguageComments in Plain LanguageSKOPH SectionTMHP Denial Reason
Unable to Locate

You are not eligible for MDCP because HHSC staff or your health plan cannot locate you to complete the assessment required for the program.

Usted no puede recibir servicios del MDCP porque la HHSC o su plan médico no lo han podido localizar para que se someta a la valoración que requiere el programa.

PSU staff must not enter comments language.6300.6Applicant/Member whereabouts are unknown
Voluntarily Declined Services

You are not eligible for MDCP because you voluntarily withdrew from the program.

Usted no puede recibir servicios del MDCP porque abandonó voluntariamente el programa.

PSU staff must not enter comments language.6300.3

Applicant: Applicant requested application for services be closed

Member: Member requests service termination

Enrolled in Another 1915(c) Medicaid Waiver

You are not eligible for MDCP. This is because you are enrolled in another Medicaid waiver program. You can only be enrolled in one Medicaid waiver program at a time.

Usted no reúne los requisitos para el programa MDCP. Esto se debe a que usted está inscrito en otro programa con exenciones de Medicaid. Solo puede estar inscrito en uno de los programas con exenciones de Medicaid a la vez.

You are not eligible for MDCP. This is because you are currently enrolled in [Select one: Community Living Assistance and Support Services (CLASS); Deaf Blind with Multiple Disabilities (DBMD); Home and Community-based Services (HCS); Texas Home Living (TxHmL)]. MDCP cannot be authorized. You can only be enrolled in one Medicaid waiver program at a time.

Usted no reúne los requisitos para el programa MDCP. Esto se debe a que usted está inscrito actualmente en [Select one: Programa de Servicios de Apoyo y Asistencia para Vivir en la Comunidad (CLASS); Programa para Personas Sordociegas con Discapacidades Múltiples (DBMD); Programa de Servicios en el Hogar y en la Comunidad (HCS); Programa de Texas para Vivir en Casa (TxHmL)]. No se puede autorizar el programa MDCP. Solo puede estar inscrito en uno de los programas con exenciones de Medicaid a la vez.

6110Applicant/Member can only be enrolled in one 1915(c) waiver program at a time
Financial Eligibility

You are not eligible for MDCP because you do not meet the financial criteria necessary for the program.

Usted no puede recibir servicios del MDCP porque no cumple los criterios financieros necesarios para participar en el programa.

Call 2-1-1 if you have questions about the Medicaid application process.

Llame al 2-1-1 si tiene preguntas sobre el proceso de solicitud de Medicaid.

6300.4Applicant/Member denied Medicaid eligibility
Declined Assessment

You are not eligible for MDCP because you did not let your health plan complete the assessment required for the program.

Usted no puede recibir servicios del MDCP porque no permitió que el plan médico realizara la valoración que requiere el programa.

PSU staff must not enter comments language.6110Applicant/Member failure to provide information
Living Arrangement is Not an Allowable Setting

You are not eligible for MDCP because where you live is not an allowable setting to receive services. Code of Federal Regulations at Title 42 CFR Section 441.301(c)(5) describes these settings.

Usted no puede recibir beneficios de MDCP porque donde vive no es un entorno adecuado para recibir servicios. Estos servicios están descritos en la sección 441.301(c)(5) del título 42 del Código de Reglamentos Federales (CFR).

PSU staff must not enter comments language.6300.2Applicant/Member does not reside in an allowable living arrangement
Does Not Have an Unmet Need

You are not eligible for MDCP because you do not need services offered through the program.

Usted no puede recibir los servicios del MDCP porque no los necesita.

PSU staff must not enter comments language.6110Applicant and Member: Need for at least one waiver service per individual service plan year
Failure to Obtain Physician's Signature

You aren't eligible for MDCP because your doctor didn't tell us you need the level of care provided in a nursing home.

Usted no puede recibir los servicios del MDCP porque su médico no nos informó que usted necesita el nivel de atención que se ofrece en una casa de reposo.

PSU staff must not enter comments language.6300.8Applicant/Member failure to provide information
Medical Necessity and Level of CareReason for denial language must be populated through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTOCP).

You are not eligible for MDCP. See the Reason for Denial text box on page 1 of this form and the MDCP Medical Necessity Denial Attachment for more information.

Usted no puede recibir servicios del MDCP. Para más información, vea el cuadro “Motivo de la denegación”, en la página 3 de este formulario, y el anexo “Medical Necessity Denial” (denegación por no existir una necesidad médica) del MDCP.

6300.5Applicant and Member: Denied Medical necessity/level of care
Exceeding the ISP Cost Limit

You are not eligible for MDCP because the cost of your individual service plan exceeds the maximum amount allowed.

Usted no puede recibir servicios del MDCP porque el costo de su plan individual de servicios excede la cantidad máxima permitida.

PSU staff must not enter comments language.6300.7Applicant and Member: Exceeds cost limit
MFP Services Not Authorized Within 24 Hours

You are not eligible for MDCP because services were not authorized within 24 hours of the nursing facility stay.

Usted no puede recibir servicios del MDCP porque los servicios no se autorizaron en las 24 horas siguientes a su estancia en el centro de reposo.

PSU staff must not enter comments language.2428Applicant: PSU staff must contact their supervisor for the appropriate TMHP denial reason.
MFP NF Discharge Prior to Eligibility Determination

You are not eligible for the MDCP because you left the nursing facility before HHSC could determine program eligibility.

Usted no reúne los requisitos para recibir servicios del MDCP porque abandonó el centro de reposo antes de que la HHSC pudiera determinar si reunía los requisitos del programa.

PSU staff must not enter comments language.2001Applicant: Failure to Follow Service Plan
Institutional Stay Over 90 Days

You are not eligible for MDCP because you have entered an institution for a long-term stay, as described in the Code of Federal Regulations (CFR) at Title 42 CFR Section 441.301(b)(1).

Usted no puede recibir servicios del MDCP porque ha ingresado en una institución donde tendrá una estancia a largo plazo, como se describe en la sección 441.301(b)(1) del título 42 del Código de Reglamentos Federales (CFR).

You are not eligible for MDCP services while an in-patient of a [Select one: hospital; nursing facility; intermediate care facility for persons with intellectual disability].

Usted no puede recibir servicios del MDCP mientras sea un paciente interno de [Select one: un hospital; un centro de reposo; un centro de atención intermedia para personas con discapacidad intelectual].

6300.2Applicant and Member: Institutional stay
Moved Out of State

You are not eligible for MDCP because you are not a Texas resident.

Usted no puede recibir servicios del MDCP porque no reside en Texas.

PSU staff must not enter comments language.6110Applicant/ Member: Member moved out of state

Over Age 20 and:

  • Member declines another Medicaid waiver; or 
  • Ages out before eligibility is established for another Medicaid waiver 

You are not eligible for MDCP because you are 21 or older.

Usted no puede recibir servicios del MDCP porque es mayor de 21 años.

PSU staff must not enter comments language.6300.9Applicant/Member must be age 20 years or younger to be eligible for MDCP services
Over Age 20 and Member Transitions to Another Medicaid Waiver

You are not eligible for MDCP because you are 21 or older.

Usted no puede recibir servicios del MDCP porque es mayor de 21 años.

PSU staff must not enter comments language.6300.9Member: Transition to an adult Program
OtherPSU staff must contact supervisor.PSU staff must contact supervisor.PSU staff must contact supervisor.Applicant/Member: PSU staff must contact their supervisor for the appropriate TMHP denial reason.

Approval Language

The table below contains language PSU staff must enter in the Comments field on Form H2065-D and Form H2065-DS for approvals. 

Purpose of Form H2065-DReason for Denial in Plain LanguageComments in Plain LanguageSKOPH SectionTMHP Denial Reason
Medicaid Eligibility Reinstated within Six MonthsNo reason for denial language should be added.

Your Medicaid was reinstated on [DATE]. Your MDCP services will continue without interruption.

Su participación en el programa Medicaid fue restablecida el [DATE]. Usted seguirá recibiendo servicios del MDCP sin interrupción.

N/AN/A
Initial Form H2065-D for MFP to CommunityN/A

You’re eligible for MDCP. Your services won’t start until you and your health plan agree on a date for you to leave your nursing home. Please stay in the nursing home until you have agreed with your medical plan on a date to leave. This will make sure services are in place when you leave the nursing home. You will receive a second Form H2065-D telling you when your services will begin.

Ud. cumple los requisitos del MDCP. Sus servicios no empezarán hasta que usted y su plan médico acuerden una fecha para su salida de la casa de reposo. Permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén vigentes cuando salga de la casa de reposo. Usted recibirá un segundo Formulario H2065-D en el que se le informará cuándo comenzarán sus servicios.

N/AN/A
Initial Form H2065-D for MFP to AFCN/A

You’re eligible for MDCP. Your services won’t start until you and your health plan agree on a date for you to leave your nursing home. Please stay in the nursing home until you have agreed with your medical plan on a date to leave. This will make sure services are in place when you leave the nursing home. You will receive another notice telling you when your MDCP services will begin. We will also send you a notice telling you how much your room and board and copayment will be.

Usted cumple los requisitos del programa MDCP. Usted no empezará a recibir los servicios hasta que haya acordado con el personal de su plan médico la fecha en que usted saldrá de la casa de reposo. Le pedimos que permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén disponibles cuando usted salga de la casa de reposo. Usted recibirá otra notificación informándole cuándo comenzará a recibir los servicios del programa MDCP. Además, le enviaremos una notificación informándole del costo de su alojamiento, comida y copago.

N/AN/A
Room and Board and CopaymentN/A

You must pay room and board and any copayment. You will pay them every month to your foster care home or assisted living facility.

Ud. tiene que cubrir los gastos de alojamiento y comida y de cualquier copago. Deberá pagarlos cada mes al hogar de acogida o centro de vida asistida en el que se encuentre.

N/AN/A

Note: PSU staff must enter “Pending” and “Calculando” in the Copayment fields on the English and Spanish versions of Form H2065-D, if the Medicaid for the Elderly and People with Disabilities (MEPD) specialist has not provided copayment amounts at the time Form H2065-D is generated. This applies to cases where an applicant or member has or will have a copayment.

Appendix III, LTSS Billing Matrix and Crosswalk

Appendix IV, MDCP Frequently Asked Questions

Appendix V, Time Calculation

Appendix VI, STAR Kids Transition Activities

Appendix VII, SASO Service Group, Service Code and Termination Code

Appendix VIII, RUG IPC Cost Limits

Appendix IX, STAR Kids TxMedCentral Naming Conventions

Appendix X, Income and Resource Limits

Appendix XI, HHSC Benefits Portal and TIERS Reference Guides

Appendix XII, Create an Appeal Task in the HHSC Benefits Portal

Appendix XIII, Long Term Services and Supports

Appendix XIV, State Cutoff Dates

Appendix XV, Guidelines for Completing Form H1746-A, MEPD Referral Cover Sheet

Appendix XVI, Medicaid Program Actions

Appendix XVII, MDCP Eligibility TAC

Appendix XVIII, STAR Kids HEART Naming Conventions

Revision 23-3; Effective May 22, 2023

This appendix outlines the screenshots Program Support Unit (PSU) staff must upload to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must use the HEART Naming Conventions below when uploading documents to the HEART case record. Refer to Appendix IX, STAR Kids TxMedCentral Naming Conventions, for TxMedCentral naming convention instructions.

PSU staff must add a sequence number after the naming convention when more than one of the same form or screenshot is uploaded. For example, PSU staff must name the first Form H1746-A sent or received as 1746_1, the second form sent or received as 1746_2 and the third form sent or received as 1746_3, etc.

PSU staff must upload all screenshots, forms, documents and emails marked as “Yes,” in the “Required” column in the HEART case record. PSU staff must include screenshots, forms, documents and emails marked with an “*” in the “Required” column in the HEART case record if used by PSU staff while completing the case.

Interest List Release (ILR)

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
SASO Enrollment ScreenshotSASO ENYes
SASO Service Authorization ScreenshotSASO SAYes
CSIL Closure ScreenshotCSIL CLOSUREYes
Form 2442 (English)2442*
Form 2442-S (Spanish)2442-S*
Form 2442 Screenshot of Upload to TxMedCentralUse TxMedCentral Naming Convention*
Form 26022602*
Form 2604 (if received through TMHP LTCOP)LTCOP ISPYes
Form 2604 (if received through TxMedCentral)Use TxMedCentral Naming ConventionYes
Form 26062606*
Form 2606-S2606-S*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)1200*
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
Form H1826H1826*
Form H2053-B2053B*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065*
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming Convention*
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMED*
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Form H3676-AUse TxMedCentral Naming ConventionYes
Form H3676-A Upload to TxMedCentral3676A TXMEDYes
Form H3676-BUse TxMedCentral Naming ConventionYes
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CCSECCSE EMAIL*
Emails to and from CRUCRU EMAIL*
Emails to and from ERSERS EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSORTPSORT EMAIL*
MEPD Communication ToolMEPD EMAIL*

Note: PSU staff must upload Form 2442 or Form H2065-D in the HEART case record, as appropriate.

Money Follows the Person (MFP)

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual- Managed Care ScreenshotTIERS MCYes
SASO Enrollment ScreenshotSASO ENYes
SASO Service Authorization ScreenshotSASO SAYes
CSIL Closure ScreenshotCSIL CLOSUREYes
Form 2604 (if received through TMHP LTCOP)LTCOP ISPYes
Form 2604 (if received through TxMedCentral)Use TxMedCentral Naming ConventionYes
Form 26062606*
Form 2606-S2606-S*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)1200*
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
H1826, Case Information ReleaseH1826*
Form H2053-B2053B*
Form H2065-D Generated in TMHP LTC Online Portal (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CCSECCSE EMAIL*
Emails to and from CRUCRU EMAIL*
Emails to and from ERSERS EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSORTPSORT EMAIL*
MEPD Communication ToolMEPD EMAIL*

Annual Reassessment

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
Form 2604 (if received through TMHP LTCOP)LTCOP ISPYes
Form 2604 (if received through TxMedCentral)Use TxMedCentral Naming ConventionYes
Form 26062606*
Form 2606-S2606-S*
H1826, Case Information ReleaseH1826*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming Convention*
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMED*
Emails for PSU QA ProcessQA EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSORTPSORT EMAIL*

Transition to Adult Programs (MDCP Age-Out)

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
Form 26062606*
Form 2606-S2606-S*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)1200*
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
H1826, Case Information ReleaseH1826*
Form H2053-B2053B*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming Convention*
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMED*
Form H21162116*
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CCSECCSE EMAIL*
Emails to and from ERSERS EMAIL*
Emails to and from Higher Needs CoordinatorHN EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from STAR+PLUS PSUPSU EMAIL*
Emails to and from URUR EMAIL*
MEPD Communication ToolMEPD EMAIL*

Denials and Terminations

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
CSIL Closure ScreenshotCSIL CLOSURE*
Form 2128120 Day NTCE*
Form 26062606*
Form 2606-S2606-S*
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
H1826, Case Information ReleaseH1826*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065*
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming Convention*
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMED*
Form H2067-MCUse TxMedCentral Naming Convention*
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMED*
Appendix XXVII, Fair Hearing Options for MDCP Denials – ApplicantsMN DENIAL ATCH*
Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials – MembersMN DENIAL ATCH*
Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP ATCH D*
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CRUCRU*
Emails to and from ERSERS EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSU supervisor for 120-day exception requestEXCEPTION REQ EMAIL*
MEPD Communication ToolMEPD EMAIL*

Note: PSU staff uploads Form H2067-MC or Form H2065-D in the HEART case record, as appropriate.

Fair Hearings

ItemHEART Naming ConventionRequired
Form 26062606*
Form 2606-S2606-S*
Form 4801FH COVER LTRYes
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
H1826H1826*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Form H48004800*
Form H4800-A4800A*
Form H48034803Yes
Form H48064806*
Form H48074807*
Copy of Handbook Section Referenced on Form H2065-DSKOPH [####]Yes
Appendix XVII, MDCP Eligibility TACELIGIBILITY TACYes
Appendix XXVII, Fair Hearing Options for MDCP Denials – Applicants MN DENIAL ATCH*
Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials – MembersMN DENIAL ATCH*
Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP (English)ATCH D*
Notice of Hearing Officer’s DecisionAPPEAL DECISION LTRYes
HHSC Benefits Portal Screenshot of Hearing Officer's DecisionTIERS APPEAL DECISIONYes
Emails to and from CRUCRU EMAIL*
Emails to and from ERSERS EMAIL*
MEPD Communication ToolMEPD EMAIL*

Disenrollment

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
TMHP LTCOP ISP Termination ScreenshotDISENISP*
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Medicaid Managed Care Member Disenrollment FormDISENFORMYes
Emails for PSU QA ProcessQA EMAIL*
Emails to and from MCCOMCCO EMAILYes
MEPD Communication ToolMEPD EMAIL*

Appendix XIX, Mutually Exclusive Services

Appendix XX, MDCP Program Description

Revision 19-6; Effective March 25, 2019
 

English PDF: The Medically Dependent Children Program
Spanish PDF: El Programa para Niños Médicamente Dependientes

Appendix XXI, Creating an Appeal in TIERS

Appendix XXII, Instructions and Access to CARE

Appendix XXIII, Community First Choice Support Management

Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials - Members

Appendix XXV, Acronyms

Appendix XXVI, STAR Kids Plan Codes

Appendix XXVII, Fair Hearing Options for MDCP Denials - Applicants

Appendix XXVIII, PSU TMHP LTC Online Portal MDCP Enrollment Form User Guide

Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP

Appendix XXX, County Codes and City and County List