2100, Enrollment Following Release from the Interest List

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Revision 21-10; Effective October 25, 2021

Interest List Management (ILM) Unit staff must use the Community Services Interest List (CSIL) database to track individuals who request the Medically Dependent Children Program (MDCP). ILM Unit staff must release individuals from the MDCP interest list as slots become available in the program.

ILM Unit staff contact all individuals by phone to notify them of their names reaching the top of the list and to confirm interest in applying for MDCP. ILM Unit staff will create an interest list release (ILR) case record assignment in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) and assign it to Program Support Unit (PSU) staff when the individual confirms their interest to pursue MDCP.

2100.1 Individual Not Enrolled in Medicaid, Including an Individual Enrolled in the Children’s Health Insurance Program

Revision 21-10; October 25, 2021

An individual who does not receive Medicaid and is not enrolled in a managed care organization (MCO) must go through the process of MCO selection, medical necessity (MN) assessment, and financial eligibility determination including individuals enrolled in the Children’s Health Insurance Program (CHIP).

Program Support Unit (PSU) staff must complete the following activities within three business days of the receipt of the Medically Dependent Children Program (MDCP) interest list release (ILR) case record assignment in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

Check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility;
Ensure that the individual does not have an open enrollment with another Medicaid waiver program according to the procedures below:
- for either the Texas Home Living (TxHmL) or Home and Community-based Services (HCS) waiver programs, check the Client Assignment and Registration (CARE) System, Screen 397 series, Client ID Information Screens, to verify whether the individual is enrolled in one of these programs. The screen specific to "waiver consumer assignment history" identifies enrollment, when applicable;
- for the Community Living Assistance and Support Services (CLASS) (Service Group 2) and Deaf Blind with Multiple Disabilities (DBMD) (Service Group 16) waiver programs, check the Service Authorization System Online (SASO) to verify the service authorization record for these waivers programs; and
- review the TIERS Long Term Services and Supports (LTSS) screen; and
Mail the following enrollment packet to the individual or legally authorized representative (LAR):
- Form 2600-A, MDCP Waiver Release Letter - Medical Assistance Only;
- Form 2602, Application Acknowledgement;
- Form H2053-B, Health Plan Selection;
- Form H1200, Application for Assistance – Your Texas Benefits;
- STAR Kids Comparison Charts;
- STAR Kids Report Cards;
- Appendix IV, MDCP Frequently Asked Questions;
- Appendix XX, MDCP Program Description; and
- a postage-paid envelope.

PSU staff are responsible for completing the below activities within 14 days of mailing the enrollment packet. PSU staff must document all attempted contacts with the individual or LAR, and any delays in the HEART case record. PSU staff must contact the individual or LAR to:

Verify receipt of the enrollment packet;
Confirm interest in MDCP;
Explain the Medicaid application process;
Give a general description of MDCP services;
Explain the need to select an MCO as quickly as possible within 14 days from the mail date of the above enrollment packet;
Inform the individual or LAR that any delay in selecting an MCO could result in a delay in an eligibility determination for MDCP;
Inform the individual or LAR a request to change their MCO can be made at any time but the effective date for the change may be the next month or the following month depending on when the change request is received;
Encourage the individual or LAR to complete the enrollment packet and mail it back to the Texas Health and Human Services Commission (HHSC) as quickly as possible;
Advise the individual or LAR to immediately submit Form H1200 if PSU staff do not see Form H1200 in TIERS; and
Confirm Form H1200 appears in TIERS if the individual or LAR informs PSU staff that they have completed and submitted Form H1200.

PSU staff must refer to Section 2120, Inability to Contact the Individual, when unable to contact the individual or LAR within 14 days of the enrollment packet mail date.

PSU staff must refer to Section 2130, Declining Medically Dependent Children Program Services, for notification requirements when an individual or LAR does not have an interest in pursuing MDCP.

PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet, and Form H1200 to the Medicaid for Elderly and People with Disabilities (MEPD) specialist within two business days of the receipt of a completed Form H1200 for medical assistance only (MAO) applicants.

PSU staff must indicate on Form H1746-A that this is a financial eligibility request for an MDCP applicant.

PSU staff must complete the following activities if Form H1200 is not received within 45 days of the date PSU staff sent Form H1200 to the individual:

Manually generate Form 2442, Notification of Interest List Release Closure;
Mail Form 2442 and Appendix XX, MDCP Program Description, to the individual or LAR;
Upload Form H2067-MC, Managed Care Programs Communication, to TxMedCentral, following the instructions in Appendix IX, STAR Kids TxMedCentral Naming Conventions, notifying the MCO of the ILR closure;
Close the ILR in the Community Services Interest List (CSIL) database using the appropriate closure reason and date;
Document the closure date, the reason for closure and that Form H1200 was not received within 45 days in the HEART case record;
Upload all applicable documents to the HEART case record following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
Document and close the HEART case record.

PSU staff must complete the following activities if Form H1200 is not received within 45 days of the date PSU staff sent Form H1200 to the applicant:

Manually generate Form H2065-D, Notification of Managed Care Program Services;
Mail Form H2065-D to the applicant or LAR;
Upload Form H2065-D to TxMedCentral, following the instructions in Appendix IX;
Close the ILR in the CSIL database using the appropriate closure reason and date;
Document the closure date, the reason for closure and that Form H1200 was not received within 45 days in the HEART case record;
Upload all applicable documents to the HEART case record following the instructions in Appendix XVIII; and
Document and close the HEART case record.

PSU staff must contact the individual or LAR within two business days of the receipt of an enrollment packet that is incomplete, incorrect or missing information to:

Obtain an MCO selection if PSU staff have not received the MCO selection;
Obtain confirmed interest in MDCP if PSU staff have not received confirmation of interest in MDCP;
Obtain missing or corrected information required to process the case, if information is missing or incorrect;
Encourage the individual or LAR to complete the enrollment packet and mail it back to HHSC as quickly as possible, if the individual:
- does not select an MCO;
- does not express interest in MDCP; or
- has not provided Form H1200; and
Advise the individual or LAR to immediately submit Form H1200, if PSU staff do not see Form H1200 in TIERS.

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

The individual, applicant or LAR must select an MCO in order for the MCO to perform the STAR Kids Screening and Assessment Instrument (SK-SAI). PSU staff can accept the individual’s, applicant’s or LAR’s verbal statement of an MCO selection or interest in MDCP.

PSU staff must assign an MCO based on criteria developed by HHSC from the list of available MCOs in the individual’s or applicant’s service area (SA) if the individual, applicant or LAR:

Has expressed an interest in applying for MDCP; and
Has not selected an MCO within 30 days from the enrollment packet mail date.

PSU staff must refer to Section 2210.1, Non-Medicaid Individual or Individual Enrolled in the Children’s Health Insurance Program, when PSU staff receive:

Confirmed interest in MDCP; and
An MCO selection.

2100.2 Individual Who Receives Supplemental Security Income or SSI-Related Medicaid

Revision 21-10; Effective October 25, 2021

An individual with Supplemental Security Income (SSI) or SSI-related Medicaid is already enrolled with a STAR Kids managed care organization (MCO) and does not need to go through the process of selecting a STAR Kids MCO or financial eligibility determination. The individual must receive a medical necessity (MN) assessment.

Check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility;
Ensure that the individual does not have an open enrollment with another Medicaid waiver program according to the procedures below:
- for either the Texas Home Living (TxHmL) or the Home and Community-based Services (HCS) waiver programs, check the Client Assignment and Registration (CARE) System, Screen 397 series, Client ID Information Screens, to verify whether the individual is enrolled in one of these programs. The screen specific to "waiver consumer assignment history" identifies enrollment, when applicable;
- for the Community Living Assistance and Support Services (CLASS) (Service Group 2) and Deaf Blind and Multiple Disabilities (DBMD) (Service Group 16) waiver programs, check the Service Authorization System Online (SASO) to verify the service authorization record for these waiver programs; and
- review the TIERS Long Term Services and Supports (LTSS) screen; and
Mail the following enrollment packet to the individual or legally authorized representative (LAR):
- Form 2600-B, MDCP Waiver Release Letter - Supplemental Security Income;
- Form 2602, Application Acknowledgement;
- Appendix IV, MDCP Frequently Asked Questions;
- Appendix XX, MDCP Program Description; and
- a postage-paid envelope.

PSU staff are responsible for completing the below activities within 14 days of mailing the enrollment packet. PSU staff must document all attempted contacts with the individual or LAR and any delays in the HEART case record. PSU staff must contact the individual or LAR:

Verify receipt of the enrollment packet;
Confirm interest in MDCP;
Give a general description of MDCP services; and
Encourage the individual or LAR to complete the enrollment packet and mail it back to the Texas Health and Human Services Commission (HHSC) as quickly as possible, if the individual or LAR has not expressed interest in MDCP.

PSU staff must refer to Section 2120, Inability to Contact the Individual, when unable to contact the individual or LAR within 14 days of the enrollment packet mail date.

PSU staff must refer to Section 2130, Declining Medically Dependent Children Program Services, for notification requirements when an individual or LAR does not have an interest in pursuing MDCP.

PSU staff must contact the individual or LAR within two business days of the receipt of an enrollment packet that is incomplete, incorrect or missing information to:

Obtain confirmed interest in MDCP, if PSU staff have not received confirmation of interest in MDCP;
Obtain missing or corrected information required to process the case, if information is missing or incorrect; and
Encourage the individual or LAR to complete the enrollment packet and mail it back to HHSC as quickly as possible, if the individual does not express interest in MDCP.

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

The individual or LAR is not required to select an MCO since the individual is already enrolled with a STAR Kids MCO. PSU staff can accept the individual or LAR’s verbal statement of interest in MDCP.

2100.3 Individual Who Receives STAR Health

Revision 18-0; Effective September 4, 2018

See the Uniform Managed Care Manual (UMCM) for STAR Health members.

The medical consenter appointed by Texas Child Protective Services (CPS) is the only individual who can accept or decline to pursue Medically Dependent Children Program (MDCP) services on behalf of the individual.

An individual enrolled with a STAR Health managed care organization (MCO) must remain enrolled with the STAR Health MCO.

If the medical consenter chooses to decline MDCP services, refer to Section 2130, Declining Medically Dependent Children Program Services, for notification requirements.

2100.4 Individual Who Receives Other Types of Medicaid

Revision 21-10; Effective October 25, 2021

An individual who receives other types of Medicaid, i.e., non-Supplemental Security Income (SSI) or is enrolled with a STAR managed care organization (MCO), must go through the process of selecting a STAR Kids MCO, medical necessity (MN) assessment and a financial eligibility determination, if applicable.

Program Support Unit (PSU) staff must refer to Appendix XVI, Medicaid Program Actions, to determine if the individual requires Form H1200, Application for Assistance – Your Texas Benefits, and Form H1746-A, MEPD Referral Cover Sheet, to determine financial eligibility for Medically Dependent Children Program (MDCP).

PSU staff must complete the following activities within three business days of the receipt of the MDCP interest list release (ILR) case record assignment in Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

Check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility and determine if Form H1200 and Form H1746-A are required;
Ensure that the individual does not have an open enrollment with another Medicaid waiver program according to the procedures below:
- for either the Texas Home Living (TxHmL) or Home and Community-based Services (HCS) waiver programs, check the Client Assignment and Registration (CARE) System, Screen 397 series, Client ID Information Screens, to verify whether the individual is enrolled in one of these programs. The screen specific to "waiver consumer assignment history" identifies enrollment, when applicable;
- for the Community Living Assistance and Support Services (CLASS) (Service Group 2) and Deaf Blind and Multiple Disabilities (DBMD) (Service Group 16) waiver programs, check the Service Authorization System Online (SASO) to verify the service authorization record for these waivers programs and
- review the TIERS Long Term Services and Supports (LTSS) screen; and
Mail the following enrollment packet to individuals who do not require Form H1200:
- Form 2600-B, MDCP Waiver Release Letter - Supplemental Security Income;
- Form 2602, Application Acknowledgement;
- Form H2053-B, Health Plan Selection;
- STAR Kids Comparison Charts;
- STAR Kids Report Cards;
- Appendix IV, MDCP Frequently Asked Questions;
- Appendix XX, MDCP Program Description; and
- a postage-paid envelope; and
Mail the following enrollment packet to individuals who require Form H1200:
- Form 2600-A, MDCP Waiver Release Letter – Medicaid Assistance Only;
- Form 2602;
- Form H2053-B;
- Form H1200;
- STAR Kids Comparison Charts;
- STAR Kids Report Cards;
- Appendix IV;
- Appendix XX; and
- a postage-paid envelope.

PSU staff are responsible for completing the below activities within 14 days of mailing the enrollment packet. PSU staff must document all attempted contacts with the individual or legally authorized representative (LAR) and any delays in the HEART case record. PSU staff must contact the individual or LAR to:

Verify receipt of the enrollment packet;
Confirm interest in MDCP;
Explain the Medicaid application process, if applicable;
Give a general description of MDCP services;
Explain the need to select a STAR Kids MCO as quickly as possible within 14 days from the mail date of the above enrollment packet;
Inform the individual or LAR that any delay in selecting a STAR Kids MCO could result in a delay in an eligibility determination for MDCP;
Inform the individual or LAR a request to change their MCO can be made at any time but the effective date for the change may be the next month or the following month depending on when the change request is received;
Encourage the individual or LAR to complete the enrollment packet and mail it back to the Texas Health and Human Services Commission (HHSC) as quickly as possible, if the individual:
- has not expressed interest in MDCP;
- has not selected a STAR Kids MCO; or
- has not provided Form H1200, if applicable; and
Advise the individual or LAR to immediately submit Form H1200, if:
- the individual requires Form H1200 to determine Medicaid financial eligibility; and
- PSU staff do not see Form H1200 in TIERS; and
Confirm Form H1200 appears in TIERS if the individual or LAR informs PSU staff that they have completed and submitted Form H1200, if applicable.

PSU staff must refer to Section 2120, Inability to Contact the Individual, when unable to contact the individual or LAR within 14 days of the enrollment packet mail date.

PSU staff must refer to Section 2130, Declining Medically Dependent Children Program Services, for notification requirements when an individual or LAR not have an interest in pursuing MDCP.

PSU staff must fax Form H1746-A and Form H1200 to the Medicaid for Elderly and People with Disabilities (MEPD) specialist within two business days of the receipt of a completed Form H1200, if appropriate. PSU staff must indicate on Form H1746-A that this is a financial eligibility request for an MDCP applicant.

PSU staff must complete the following activities if Form H1200 is not received within 45 days of the date PSU staff sent Form H1200 to the individual, if appropriate:

Manually generate Form 2442, Notification of Interest List Release Closure;
Mail Form 2442 and Appendix XX to the individual or LAR;
Upload Form H2067-MC, Managed Care Programs Communication, to TxMedCentral, following the instructions in Appendix IX, STAR Kids TxMedCentral Naming Conventions, notifying the MCO of the ILR closure;
Close the ILR in the Community Services Interest List (CSIL) database using the appropriate closure reason and date;
Document the closure date, the reason for closure and that Form H1200 was not received within 45 days in the HEART case record;
Upload all applicable documents to the HEART case record following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
Document and close the HEART case record.

PSU staff must complete the following activities if Form H1200 is not received within 45 days of the date PSU staff sent Form H1200 to the applicant, if appropriate:

Manually generate Form H2065-D, Notification of Managed Care Program Services;
Mail Form H2065-D to the applicant or LAR;
Upload Form H2065-D to TxMedCentral, following the instructions in Appendix IX;
Close the ILR in the CSIL database using the appropriate closure reason and date;
Document the closure date, the reason for closure and that Form H1200 was not received within 45 days in the HEART case record;
Upload all applicable documents to the HEART case record following the instructions in Appendix XVIII; and
Document and close the HEART case record.

PSU staff must contact the individual or LAR within two business days of the receipt of an enrollment packet that is incomplete, incorrect or missing information to:

Obtain a STAR Kids MCO selection if PSU staff have not received the STAR Kids MCO selection;
Obtain confirmed interest in MDCP, if PSU staff have not received confirmation of interest in MDCP;
Obtain missing or corrected information required to process the case, if information is missing or incorrect;
Encourage the individual or LAR to complete the enrollment packet and mail it back to the Texas Health and Human Services Commission (HHSC) as quickly as possible, if the individual:
- has not selected a STAR Kids MCO;
- has not expressed interest in MDCP; and
- has not provided Form H1200, if applicable; and
Advise the individual or LAR to immediately submit Form H1200 if:
- the individual requires Form H1200 to determine Medicaid financial eligibility; and
- PSU staff do not see Form H1200 in TIERS.

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

The individual, applicant or LAR must select a STAR Kids MCO in order for the MCO to perform the STAR Kids Screening and Assessment Instrument (SK-SAI). PSU staff can accept the individual’s, applicant’s or LAR’s verbal statement of a STAR Kids MCO selection or interest in MDCP. PSU staff must assign a STAR Kids MCO based on criteria developed by HHSC from the list of available STAR Kids MCOs in the individual or applicant’s service area (SA) if the individual, applicant or LAR:

Has expressed an interest in applying for MDCP; and
Has not selected an MCO within 30 days from the enrollment packet mail date.

PSU staff must refer to Section 2210.4, Individual Receiving Other Types of Medicaid, when PSU staff receive:

Confirmed interest in MDCP; and
A STAR Kids MCO selection from the individual or LAR.

2110 Managed Care Organization Selection

Revision 18-0; Effective September 4, 2018

The individual has 30 days from the date the enrollment packet is mailed to complete and return the enrollment packet to Program Support Unit (PSU) staff. If the individual has expressed interest in pursuing Medically Dependent Children Program (MDCP) services, verbally or in writing, but has not selected a managed care organization (MCO) within 30 days from the date the enrollment packet was mailed, an MCO is assigned based on criteria developed by Texas Health and Human Services Commission (HHSC) from the list of available MCOs in the individual’s service area (SA).

PSU staff must contact the individual within three business days of an MCO assignment to inform the individual:

which MCO he or she is assigned to; and
the MCO in which he or she is enrolled can be changed at any time, but will not go into effect until after one full calendar month of MDCP service provision.

2120 Inability to Contact the Individual

Revision 21-10; Effective October 25, 2021

Program Support Unit (PSU) staff must make one additional attempt to contact the individual by the 30th day from the date the enrollment packet was mailed if:

PSU staff are unable to contact the individual by telephone within 14 days from the enrollment packet mail date; and
The individual has not returned the enrollment packet or expressed interest in the Medically Dependent Children Program (MDCP).

PSU staff must complete the following activities within two business days from the 30th day of the enrollment packet mail date if PSU staff have not:

Made contact with the individual by the 30th day from the enrollment packet mail date;
Received the enrollment packet; or
Received notification from the individual of their interest in MDCP:
- Manually generate Form 2442, Notification of Interest List Release Closure;
- Mail Form 2442 and Appendix XX, MDCP Program Description to the individual or legally authorized representative (LAR);
- Close the MDCP interest list release in the Community Services Interest List (CSIL) database using the closure reason ‘Released From List/No Response to Letter’;
- Document the closure date, reason for closure and contact attempts in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record;
- Upload all applicable documents to the HEART case record, following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
- Document and close the HEART case record using the appropriate closure reason.

The interest list closure date is the 31st day after the issuance date on Form 2600-A, MDCP Waiver Release Letter - Medical Assistance Only, or Form 2600-B, MDCP Waiver Release Letter - Supplemental Security Income.

PSU staff must mail a request to reopen the interest list release to the Interest List Management (ILM) Unit manager at StarPlusWaiverInterestList@hhsc.state.tx.us if the individual contacts PSU or ILM Unit staff after the interest list release closure requesting to pursue MDCP.

PSU staff must refer to Section 2310, Contacting the Interest List Management Unit to Reopen a Closed Interest List Release, for additional information about processing reopen requests.

PSU staff should not attempt to contact an individual if the Texas Health and Human Services Commission (HHSC) receives information about the individual’s death. PSU staff must not mail Form 2442 or Appendix XX to the responsible party if the interest list release was closed due to the death of the individual. The effective date of the interest list release closure is the date staff received notification of the individual’s death.

2130 Declining Medically Dependent Children Program Services

Revision 21-10; Effective October 25, 2021

Program Support Unit (PSU) staff must complete the following activities within two business days from the receipt of an individual’s completed Form 2602, Application Acknowledgement, indicating no interest in applying for Medically Dependent Children Program (MDCP) or if the individual verbally declines MDCP:

Manually generate Form 2442, Notification of Interest List Release Closure;
Mail Form 2442 and Appendix XX, MDCP Program Description, to the individual or LAR;
Close the MDCP interest list release in the Community Services Interest List (CSIL) database using the appropriate closure reason;
Document the closure date, reason for requesting closure and how PSU staff received the individual’s request for closure (e.g., if by telephone, then document the date, caller’s name and caller’s contact information) in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record;
Upload all applicable documents to the HEART case record, following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
Document and close the HEART case record using the appropriate closure reason.

See the Uniform Managed Care Manual (UMCM) §16.2 for specific requirements regarding the denial of MDCP for STAR Health members.