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Revision 22-3; Effective Dec. 1, 2022
If the State Fair Hearing is pending, and the member has timely requested continuation of benefits, the benefits must be continued until:
- the member withdraws the request for State Fair Hearing; or
- a State Fair Hearing officer issues a hearing decision adverse to the member.
See Section 7400, Post Hearing Actions, for information on how to proceed following receipt of the State Fair Hearing decision.
7510 Continuation of Medically Dependent Children Program Waiver Services During a State Fair Hearing
Revision 23-3; Effective July 21, 2023
Medically Dependent Children Program (MDCP) waiver services must continue until the hearings officer issues a decision about the State Fair Hearing of an active MDCP waiver member, if the request is for a continuation of benefits was timely filed. Program Support Unit (PSU) staff must notify the managed care organization (MCO) of the request for a continuation of benefits within three business days by posting Form H2067-MC, Managed Care Programs Communication, to the MCO via MCOHub.
If the member has timely requested continued benefits, MDCP waiver services must continue to be provided until the hearings officer renders a decision. The PSU includes this information on Form H2067-MC posted on MCOHub.
If the hearings officer's decision will not be made until after the individual service plan (ISP) expiration date, the current ISP will be extended for four calendar months or until the outcome of the state appeal is determined. PSU staff do not mail Form H2065-D, Notification of Managed Care Program Services, to the member notifying them of continued eligibility related to the reassessment action taken to continue services until the hearings officer renders a State Fair Hearing decision.
If a State Fair Hearing is initially dismissed and then re-opened, the PSU staff continues or restarts services pending the decision outcome, if the member has timely requested continued services. When the hearings officer sets a date for a new State Fair Hearing this voids the prior State Fair Hearing decision.
7520 Discontinuation of Medically Dependent Children Program Waiver Services During a State Fair Hearing
Revision 23-3; Effective July 21, 2023
If the member does not timely request continuation of benefits, Medically Dependent Children Program (MDCP) waiver services continue until the effective date of denial notated on Form H2065-D, Notification of Managed Care Program Services, which is usually the expiration date of the current individual service plan (ISP). Program Support Unit (PSU) staff must process according to the following:
- For Medical Assistance Only (MAO)-eligible members, Form H2065-D is posted to MCOHub to inform the managed care organization (MCO) that MDCP waiver services will be terminated effective the day after the date noted on Form H2065-D. For Supplemental Security Income (SSI)-eligible members, Form H2067-MC is posted by PSU staff to MCOHub to inform the MCO MDCP waiver services will be terminated effective the day after the date noted on Form H2065-D.
Even if a member loses eligibility for MDCP, SSI-eligible members are still enrolled in a STAR Kids MCO and are still eligible for state plan services, which include acute care and long-term services and supports, such as personal care services, day activity and health services, and Community First Choice Services.