4600, Medically Dependent Children Program Services

Revision 22-3; Effective Dec. 1, 2022

The Medically Dependent Children Program (MDCP) provides respite, flexible family support services, minor home modifications, adaptive aids, transition assistance services, supported employment, and employment assistance. This is to prevent placement of individuals in long-term care facilities who are medically dependent and under 21 years old and support deinstitutionalization of nursing facility residents under 21 years old.

Only members who are assessed as meeting medical necessity (MN) and who have a slot in the MDCP waiver are eligible for MDCP services. Federal guidelines require that members must need and use one or more waiver services to qualify and maintain eligibility for MDCP. The minimum utilization of MDCP service required to maintain MDCP eligibility is dependent upon the member’s Medicaid eligibility and whether they utilize Community First Choice (CFC), as described in Section 1530, Unmet Need for at Least One Waiver Service.

The managed care organization (MCO) service coordinator must inform all members receiving MDCP services of the requirements outlined in Section 1530 and the following:

  • If the member’s eligibility is Medical Assistance Only (MAO) and:
    • CFC has been authorized, at a minimum, one MDCP service must be used at least once a month to qualify and maintain enrollment in MDCP.
    • CFC has not been authorized, at a minimum, one MDCP service must be used at least once during the member’s ISP year to qualify and maintain enrollment in MDCP.
  • If the member’s eligibility is not MAO and CFC has been authorized, at a minimum, at least one MDCP service must be used during the member’s ISP year. The member must receive monthly monitoring by the MCO if services are furnished on a less than monthly basis to qualify and maintain enrollment in MDCP.

If the member is not meeting the minimum required service utilization, the MCO must notify the Program Support Unit (PSU) following requirements in Section 6270, Denial/Termination Due to Failure to Meet Other Program Requirements. If a member is offered enrollment in MDCP or at an MDCP member's reassessment, during the STAR Kids assessment, using the STAR Kids Screening and Assessment Instrument (SK-SAI), the service coordinator must discuss the member's needs relating to the available MDCP services. The service coordinator must develop a recommended individual service plan (ISP) if the member's Resource Utilization Group (RUG) is not known, as the RUG determines the member's budget.

Example: The service coordinator could ask;

  • the member or their caregiver if they would like respite or have a desire for employment services. 
  • if the member requires adaptive aids, minor home modifications, or could benefit from flexible family support services
  • which services the member or caregiver would like more of, should the member's budget be unknown during the assessment.

Based on the discussion, the service coordinator could develop a recommended ISP for that member and work with the member or caregiver in person or by phone to develop a final service plan once the member's budget is known.