Revision 22-2; Effective September 1, 2022

Program Support Unit (PSU) staff determine the Medically Dependent Children Program (MDCP) waiver start of care (SOC) date for individuals coming off the MDCP interest list, and for STAR Kids members completing the Money Follows the Person (MFP) limited nursing facility stay process. PSU staff will notify managed care organizations (MCOs) of the MDCP SOC date and individual service plan (ISP) effective date on Form H2065-D, Notification of Managed Care Program Services

2210 Medical Necessity Expiration

Revision 25-1; Effective March 3, 2025

A medical necessity (MN) approval is valid for 120 days from the date of the Texas Medicaid & Healthcare Partnership (TMHP) determination for an individual seeking the Medically Dependent Children Program (MDCP) before approval. After 120 days from the date of TMHP determination, Program Support Unit (PSU) staff notify the managed care organization (MCO) by uploading Form H2067-MC, Managed Care Programs Communication (PDF), to MCOHub in the MCO’s STAR Kids folder. The MCO must submit an:

  • initial STAR Kids Screening and Assessment (SK-SAI) in TMHP Long Term Care (LTC) Online Portal for initial eligibility determination; or
  • annual SK-SAI in the TMHP LTC Online Portal for reassessment.

MFP Limited Nursing Facility Stay Example

An individual seeking MDCP through the Money Follows the Person (MFP) limited stay option receives an approved MN in TMHP on Aug. 2, 2021. The individual wants to complete the MFP limited stay by entering the nursing facility (NF) on Aug. 11, 2021, and discharging on Aug. 12, 2021. On Aug. 10, 2021, the individual notifies the MCO they cannot enter the NF on Aug. 11, 2021, and would like to reschedule admission to Jan. 16, 2022. The current MN approved Aug. 2, 2021, expires Nov. 30, 2021. The MCO must complete a new SK-SAI and obtain an MN approval from TMHP before the PSU can approve the NF limited stay of Jan. 16, 2022.

Interest List Release Example

An individual released from the interest list receives an approved MN from TMHP on Aug. 2, 2021. The current MN expires Nov. 30, 2021. The individual met all other MDCP eligibility criteria on Dec, 15, 2021. The MCO must complete a new SK-SAI to get an MN approval from TMHP before the PSU can approve the applicant.

2220 MDCP Start of Care Date for Interest List Releases

Revision 23-3; Effective July 21, 2023

The Medically Dependent Children Program (MDCP) waiver start of care (SOC) date for individuals being released from the interest list is based on the following criteria: 

  • Medicaid eligibility effective date, if applicable;
    • the date the medical necessity (MN) was approved from a STAR Kids Screening and Assessment Instrument (SK-SAI) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal; and
  • The date Form 2604, STAR Kids Individual Service Plan – Service Tracking Tool, is uploaded to MCOHub or the TMHP LTC Online Portal.  

Program Support Unit (PSU) staff determine the MDCP SOC date. If the date falls on the first day of the month, the eligibility and ISP effective date on Form H2065-D, Notification of Managed Care Program Services, is the first day of that month. If the date falls between the second and the last day of the month, the eligibility and ISP effective date is the first date of the following month. 

2230 MDCP Start of Care Date for STAR Kids Members Completing the MFP Limited NF Stay

Revision 23-3; Effective July 21, 2023

The Medically Dependent Children Program (MDCP) waiver start of care (SOC) date for STAR Kids members being assessed through the Money Follows the Person (MFP) limited nursing facility (NF) stay process is based on the following criteria: 

  • The date the medical necessity (MN) was approved from a STAR Kids Screening and Assessment Instrument (SK-SAI) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal;
  • The date the individual was discharged from a nursing facility; and
  • The date Form 2604, STAR Kids Individual Service Plan – Service Tracking Tool, is uploaded to MCOHub or the TMHP LTC Online Portal.  

Program Support Unit (PSU) staff determine the MDCP SOC date. The MDCP effective date will be the first of the month in which the member met all MFP limited stay eligibility criteria and was discharged from the NF. Example: A member who has met all eligibility criteria for the MFP limited stay leaves the NF December 12, 2021, and begins MDCP services December 12, 2021. The eligibility date on Form H2065-D will be December 1, 2021.