2001 Initial Requests for MDCP 

Revision 25-1; Effective May 16, 2025

An individual requesting services through the Medically Dependent Children Program (MDCP) must be placed on the MDCP interest list (IL) per the date and time of the request. Individuals are released from the MDCP IL in the order of their request date. An individual is placed on the MDCP IL by calling the Interest List Management (ILM) unit’s toll-free number at 877-438-5658.

A Texas Health and Human Services Commission (HHSC) regional office or managed care organization (MCO) service coordinator must inform the individual about the MDCP IL. The regional office must refer them directly to the ILM unit for placement on the IL, if a request for MDCP services is received.

The individual’s name may only be added to the MDCP IL if the individual is younger than 21 and resides in Texas.

2002 ILM Unit Responsibilities

Revision 25-1; Effective May 16, 2025

The Interest List Management (ILM) unit are Texas Health and Human Services Commission (HHSC) staff responsible for maintaining and releasing individuals from the Medically Dependent Children Program (MDCP) interest list (IL). ILM unit staff must use the Community Services Interest List (CSIL) database to track Texas residents who request MDCP services. ILM unit staff must release individuals from the MDCP IL as slots become available.

ILM unit staff perform the following activities for individuals who request MDCP services:

  • place individuals on the MDCP IL in chronological order;
  • maintain annual contact requirements;
  • release individuals from the MDCP IL when funding is available; and
  • confirm individuals on the MDCP IL are viable MDCP candidates before release by:
    • verifying all contact information is correct;
    • checking the Texas Integrated Eligibility Redesign System (TIERS) to determine the Medicaid eligibility status; and
    • confirming the individual is still interested in MDCP services.

ILM unit staff must complete annual contacts for individuals on the MDCP IL to verify the current address and phone number and confirm continued interest in the program. The interest list status automatically updates to an inactive status if no response is received from the individual within 120 days of the annual contact. The individual remains in an inactive status until the individual notifies ILM unit staff of continued interest in MDCP.

Program Support Unit (PSU) staff must refer the individual to the ILM unit at 877-438-5658 to add the individual to the MDCP IL for the first time.

ILM unit staff perform the following, once an individual is released from the MDCP IL:

  • verify the individual’s Medicaid type of assistance (TOA) in TIERS, if applicable;
  • contact the individual by phone to notify them they reached the top of the interest list;
  • confirm continued interest in MDCP;
  • provide a general description of MDCP services;
  • encourage the individual to contact the managed care organization (MCO) for more information and available services, if applicable;
  • create an MDCP interest list release (ILR) case record assignment in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART);
  • assign each MDCP ILR HEART case record to PSU staff for individuals who confirm interest in MDCP; and
  • update the CSIL database record’s status to assigned.

If the individual does not wish to pursue MDCP:

  • the individual can be added back to the bottom of the MDCP IL for an offer in the future, at the individual’s request; or
  • the ILR will be closed with the appropriate closure code in the CSIL database.

PSU staff must refer to sections:

An individual requesting MDCP through the Money Follows the Person (MFP) limited nursing facility (NF) stay option must contact the ILM unit. This request will not be considered a release from the MDCP IL, but instead as a referral of an individual interested in bypassing the MDCP IL through the MFP limited stay option.

PSU staff must refer to 2400, Money Follows the Person, for ILM procedures about the MFP processes. 

2010 PSU Staff Responsibilities  

Revision 25-1; Effective May 16, 2025

The Program Support Unit (PSU) staff are regional Texas Health and Human Services Commission (HHSC) staff. They are responsible for facilitating the required components of the Medically Dependent Children Program (MDCP) eligibility process by coordinating between HHSC, managed care organizations (MCOs) and MDCP individuals. Coordination activities completed by PSU staff include, but are not limited to:

  • verifying Medicaid financial eligibility;
  • ensuring the individual does not have an open enrollment with another Medicaid waiver program;
  • mailing enrollment packets, if applicable;
  • submitting a referral to the:
    • Medicaid for the Elderly and People with Disabilities (MEPD) specialist for a financial eligibility determination, if applicable; and
    • selected MCO for an assessment of the individual’s needs and medical necessity; and
  • providing notification on MDCP eligibility determinations.

PSU staff must document all coordination efforts in the individual’s Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must refer to 1200, Medically Dependent Children Program Eligibility, for more information about MDCP eligibility requirements.

2010.1 Incomplete Enrollment Packet 

Revision 25-1; Effective May 16, 2025

An individual has 30 days from the date an enrollment packet is mailed to complete and return:

Program Support Unit  (PSU) staff must complete the following activities within two business days of receipt of the documents noted above that are incomplete or missing information: 

  • contact the individual or legally authorized representative (LAR) to:
    • advise the Medically Dependent Children Program (MDCP) application cannot be processed unless complete information is received;
    • encourage the individual or LAR to complete and mail incomplete or missing information back to the PSU as quickly as possible;
    • obtain a STAR Kids managed care organization (MCO) selection if a STAR Kids MCO selection has not been previously received;

Note: PSU staff may accept the individual or LAR’s verbal statement of a STAR Kids MCO selection.

  • mail Form 2606, Managed Care Enrollment Processing Delay, with the original unsigned Form H1200 to the individual or LAR, if applicable;
  • upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART) case record; and
  • document all contact attempts in the HEART case record.

PSU staff must refer to sections:

  • 2010.2, MCO Selection or Default, if the individual or LAR does not provide an MCO selection:
    • upon receipt of Form H1200; or
    • within two business days after the 30th day an enrollment packet is mailed, if the individual:
      • receives Medicaid but is not enrolled in an MCO; or
      • is enrolled in a STAR MCO that does not operate a STAR Kids companion plan; or
  • 6300, Denials and Terminations, for information on MDCP case closure when the individual or LAR:
    • decline MDCP services; or
    • fail to return Form H1200 within 30 days from the date an enrollment packet is mailed.

2010.2 MCO Selection or Default

Revision 25-1; Effective May 16, 2025

An individual, applicant or legally authorized representative (LAR) must select or be defaulted to a STAR Kids managed care organization (MCO) to complete a STAR Kids Screening and Assessment Instrument (SK-SAI).

Program Support Unit (PSU) staff may accept an individual, applicant or LAR’s verbal or written STAR Kids MCO selection within 30 days from the date an enrollment packet is mailed. The individual, applicant or LAR may provide their written STAR Kids MCO selection on Form H2053-B, Health Plan Selection.

Individuals Enrolled in a STAR MCO

PSU staff must default an individual enrolled in a STAR MCO to the STAR Kids companion plan, if applicable. A companion plan is an MCO operated by the same parent organization as an individual’s current MCO.

PSU staff must refer to Appendix XXXII, STAR Kids Companion Plans, to find a list of STAR MCOs that operate STAR Kids companion plans.

PSU staff must default an individual to the STAR Kids companion plan within five business days of receipt of a:

  • Medically Dependent Children Program (MDCP) interest list release (ILR) case record in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART); or
  • Money Follows the Person (MFP) limited nursing facility (NF) stay option case record in HEART.

MDCP ILR Example:

PSU staff verify in the Texas Integrated Eligibility Redesign System (TIERS) Medicaid/CHIP/CHIP perinatal History screen an MDCP ILR is receiving MA-Children Medicaid. The individual is enrolled in STAR with Wellpoint Texas, Inc. PSU staff confirm Wellpoint Texas, Inc. operates a STAR Kids companion plan in the individual’s service area (SA). PSU staff must select Wellpoint Texas Inc. as the STAR Kids MCO within five business days of the receipt of the MDCP ILR case record in HEART.

MFP Limited NF Stay Example:

PSU staff verify in the TIERS Medicaid/CHIP/CHIP perinatal History screen an MFP limited NF stay individual is receiving MA-Children Medicaid. The individual is enrolled in STAR with Driscoll Children’s Health Plan. PSU staff confirm Driscoll Children's Health Plan operates a STAR Kids companion plan in the individual’s SA. PSU staff must select Driscoll Children's Health Plan as the STAR Kids MCO within five business days of the receipt of the MFP limited NF stay case record in HEART.

Individuals Who Receive an Enrollment Packet

PSU staff must mail an enrollment packet to individuals released from the MDCP interest list who:

  • do not receive Medicaid and are not enrolled in an MCO;
  • are enrolled in the Children’s Health Insurance Program (CHIP);
  • receive Medicaid but are not enrolled in an MCO; or
  • are enrolled in a STAR MCO that does not operate a STAR Kids companion plan.

PSU staff must default a STAR Kids MCO to an individual or applicant who received an enrollment packet, but has not selected an MCO:

  • upon receipt of Form H1200, Application for Assistance – Your Texas Benefits; or
  • within two business days after the 30th day an enrollment packet is mailed, if the individual:
    • has Medicaid but no MCO enrollment; or
    • is enrolled in a STAR MCO that does not operate a STAR Kids companion plan.

PSU staff must default a STAR Kids MCO to the individuals or applicants as noted above using a rotation log. The log must contain an equal distribution of every STAR Kids MCO in each SA. PSU staff must enter the following information into the rotation log:

  • the individual or applicant’s name;
  • the individual or applicant’s Social Security number (SSN) or Medicaid identification (ID) number;
  • the date the STAR Kids MCO default selection is made; and
  • the type of case action the STAR Kids MCO default selection is for:
    • ILR; or
    • MFP.

MDCP ILR Example:

An enrollment packet is mailed to an MDCP ILR. The applicant returns Form H1200 with no MCO selection before the 30th day from the date the enrollment packet was mailed. The applicant did not previously select an MCO in the 14-day contact. PSU staff must select a STAR Kids MCO using a rotation log, upon receipt of Form H1200.

MFP Limited NF Stay Example:

PSU staff verify in the TIERS Medicaid/CHIP/CHIP perinatal History screen an MFP limited NF stay individual is receiving MA – Children Medicaid. The individual is enrolled in STAR with Parkland Community Health Plan. PSU staff confirm Parkland Community Health Plan does not operate a STAR Kids companion plan in the individual’s SA. An enrollment packet is mailed to the individual requesting an MCO selection.

PSU staff did not obtain a verbal MCO selection at the 14-day contact nor did PSU staff receive the MCO selection by the 30th day from the date the enrollment packet was mailed. PSU staff must select a STAR Kids MCO using a rotation log, within two business days after the 30th day the enrollment packet is mailed.

Traditional MFP Example:

PSU staff verify in TIERS a traditional MFP individual is residing at Truman Smith NF and is receiving ME–Nursing Facility Medicaid. The individual is not enrolled in an MCO. An enrollment packet is mailed to the individual requesting an MCO selection.

PSU staff did not obtain a verbal MCO selection at the 14-day contact nor did PSU staff receive the MCO selection by the 30th day from the date the enrollment packet was mailed. PSU staff must select a STAR Kids MCO using a rotation log, within two business days after the 30th day the enrollment packet is mailed.

PSU staff must contact the applicant or LAR within two business days of defaulting a STAR Kids MCO to the applicant, if a STAR Kids MCO was selected using a rotation log. PSU staff must inform the individual or LAR:

  • which STAR Kids MCO they are assigned to; and
  • the STAR Kids MCO in which they are assigned can be changed at any time but will not go into effect until after one full calendar month of MDCP service provision.

PSU staff must document all contact attempts and case actions in the HEART case record.

PSU staff must refer to 6300.10, Other Reasons, for information on MDCP case closure when the individual or LAR fails to return Form H1200 within 30 days from the date an enrollment packet is mailed.