3400, Member Transfers

3410 Transfer from One MCO to Another

Revision 22-3; Effective Sept. 9, 2022

A member or legally authorized representative (LAR) can request to change managed care organization (MCO) plans as often as they want, but the change cannot be made more than once per month. A member can only be enrolled with one MCO for a given month.  
A member or LAR who wants to change from one MCO to another MCO must contact the state-contracted enrollment broker by: 

  • phone: 800-964-2777;
  • fax: 855-671-6038; or
  • mail: 
    HHSC 
    P.O. Box 149023 
    Austin TX 78714-9023

Note: Adoption Assistance or Permanency Care Assistance (AAPCA) members must contact the state’s enrollment broker to request transfer.

MCO enrollment changes become effective based on the date the MCO change is requested and processed in relation to state cutoff. 

Refer to Appendix XIV, State Cutoff Charts, for more information on for additional information on current cutoff dates.

Monthly Plan Changes Report

Enrollment Operations Management (EOM) Unit staff prepares and sends the Monthly Plan Changes report to Program Support Unit (PSU) staff. The report gives a full list of all Medically Dependent Children Program (MDCP) members who have changed MCOs from the previous month. PSU staff are not required to provide the Plan Change Report to the MCOs. MCOs receive the plan change report for their members only through an automated process in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Portal (LTCOP).

The losing MCO and the gaining MCO must coordinate and share applicable member information in order to prevent a gap in services during the transfer. In cases where this does not occur, the HHSC Managed Care Contracts and Oversight (MCCO) Unit staff must request PSU staff intervention. Within two business days of notification from MCCO Unit staff, PSU staff must assist with the transfer of information from the losing MCO to the gaining MCO.

The gaining MCO will have access to current and historical STAR Kids Screening and Assessment Instruments (SK-SAIs) and STAR Kids - Individual Service Plans (SK-ISPs) in the TMHP LTCOP once the member is enrolled with them. 
The gaining MCO is responsible for service delivery from the first day of enrollment. The gaining MCO must provide services and honor authorizations included in the prior SK-ISP until the member receives a new SK-SAI. 

3420 Transfer from Another Medicaid Waiver Program to Medically Dependent Children Program

Revision 21-10; Effective October 25, 2021

Title 1 Texas Administrative Code (TAC) §353.1155(b)(1)(F) states that Medically Dependent Children Program (MDCP) members cannot be enrolled in more than one Medicaid waiver program at the same time. Refer to Appendix XIX, Mutually Exclusive Services, to determine if two services may be received simultaneously by a member.

Individuals in the following Intellectual and Developmental Disabilities (IDD) waiver programs may be on the interest list for MDCP:

  • Community Living Assistance and Support Services (CLASS);
  • Home and Community-based Services (HCS);
  • Deaf Blind with Multiple Disabilities (DBMD); or
  • Texas Home Living (TxHmL).

Program Support Unit (PSU) staff will receive a Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) interest list release (ILR) case record assignment from Interest List Management (ILM) Unit staff when an individual in another IDD waiver program comes to the top of the MDCP interest list and requests MDCP. PSU staff may also receive notification from IDD waiver program staff.

PSU staff must complete the following activities within three business days of the receipt of the MDCP ILR case record assignment in HEART or notification from IDD waiver program staff:

  • Create a case record in HEART, if applicable;
  • Check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid eligibility;
  • Verify that individual has an open enrollment with another Medicaid waiver program according to the procedures below:
    • for either the TxHmL or 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 CLASS (Service Group 2) and 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 must contact the individual or LAR within 14 days from the mail date of the above enrollment packet to:

  • 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 HHSC as quickly as possible, if the individual or LAR did not express interest in MDCP.

PSU staff can accept the individual’s or LAR’s verbal statement of interest in MDCP. PSU staff must document all attempted contacts with the individual, LAR and IDD waiver program staff and any delays in the HEART case record.

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 services.

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 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 or LAR 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 a managed care organization (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.

PSU staff must complete the following activities within two business days from the date the individual or LAR expressed interest in MDCP:

  • Complete Form H3676 , Managed Care Pre-Enrollment Assessment Authorization, Section A;
  • Upload Form H3676, Section A to TxMedCentral, following the instructions in Appendix IX, STAR Kids TxMedCentral Naming Conventions;
  • Upload applicable documents to the HEART case record, following the instructions in Appendix XVIII, STAR Kids HEART Naming Conventions; and
  • Document the HEART case record.

The MCO must complete the STAR Kids Screening and Assessment Instrument (SK-SAI) within a total of 30 days from the date PSU staff uploaded Form H3676, Section A to TxMedCentral. The SK-SAI is considered “complete” when the MCO has obtained a physician’s signature on Form 2601, Physician’s Certification.

The MCO must submit the complete SK-SAI to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) within a total of 60 days from the date PSU staff uploaded Form H3676, Section A, to TxMedCentral. PSU staff must monitor the TMHP LTCOP for receipt of the completed SK-SAI.

The MCO must submit the following documents within a total of 60 days from the date PSU staff uploaded Form H3676, Section A, to TxMedCentral:

  • The STAR Kids Individual Service Plan (SK-ISP) to the TMHP LTCOP; and
  • Form H3676, Section B to TxMedCentral.

PSU staff must monitor TxMedCentral for receipt of Form H3676, Section B. PSU staff must monitor the TMHP LTCOP for receipt of the SK-ISP.

PSU staff must email Managed Care Compliance & Operations (MCCO) Unit staff at PSU_Past_Due_Assessments@hhsc.state.tx.us to advise if the MCO has not completed and submitted the following items within 60 days of the date of PSU staff uploaded Form H3676, Section A, to TxMedCentral:

  • The completed SK-SAI;
  • The completed SK-ISP or
  • Form H3676, Section B.

PSU staff must contact and coordinate with IDD waiver program staff, the applicant, LAR and MCO as appropriate, ensuring the applicant’s current Medicaid waiver program services end one day before enrollment in MDCP.

PSU staff must complete the following activities within two business days of receipt of all required MDCP eligibility documentation:

  • Confirm MDCP eligibility by verifying the applicant:
    • is under age 21 in TIERS;
    • is a Texas resident in TIERS;
    • has a compatible Medicaid eligibility for MDCP in TIERS;
    • has an approved medical necessity (MN) in the TMHP LTCOP;
    • has an SK-ISP with a least one MDCP service; and
    • has an SK-ISP within the applicant’s cost limit.

PSU staff must approve the applicant’s enrollment in MDCP the first day of the following month after verifying all MDCP eligibility criteria are met. PSU staff must complete the following activities within two business days of determining the start of care (SOC) date for MDCP:

  • Generate Form H2065-D, Notification of Managed Care Program Services, following the instructions Appendix II, Form H2065-D MDCP Reason for Denial and Comments Language, in the TMHP LTCOP;
  • Mail Form H2065-D to the member or LAR;
  • Email Enrollment Resolution Services (ERS) Unit at ManagedCareEligibilityEnrollment@hhsc.state.tx.us. The email to the ERS Unit must include the following information:
    • an email subject line that reads: “Waiver Transfer for XXX.XXX [first three letters of the member’s first and last name].” For example, the email subject line for a waiver transfer for Ann Smith would be “Waiver Transfer for ANN.SMI”;
    • member’s name;
    • Medicaid identification (ID) number;
    • type of request (i.e., waiver transfer);
    • MN approval date;
    • SK-ISP receipt date;
    • SK-ISP begin date;
    • SK-ISP end date;
    • MCO;
    • effective date of enrollment; and
    • Form H2065-D; and
  • Upload all applicable documents to the HEART case record following the instructions in Appendix XVIII;
  • Document all contacts with the IDD waiver program staff, member, LAR or MCO and any delays; and
  • Close the HEART record.

PSU staff must complete the following activities for an individual whose MDCP eligibility is denied or who declined MDCP:

  • 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 Communication, to TxMedCentral following the instructions in Appendix IX, notifying the MCO that the individual is not eligible for MDCP;
  • Upload all applicable documents to the HEART case record. following the instructions in Appendix XVIII; and
  • Document and close the HEART record.

The MCO must upload Form H3676, Section B, to TxMedCentral within two business days if the applicant fails to meet any MDCP eligibility criteria other than Medicaid financial eligibility. PSU staff must complete the following activities for an applicant whose MDCP eligibility is denied or who declined MDCP:

  • Electronically generate Form H2065-D if the applicant is denied due to not meeting MN;
  • Manually generate Form H2065-D if the applicant is denied for reasons other than MN;
  • Mail Form H2065-D to the applicant or LAR;
  • Upload Form H2065-D to TxMedCentral if manually generated;
  • Fax Form H2065-D and Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for Elderly and Persons with Disabilities (MEPD) specialist for medical assistance only (MAO) members;
  • Upload all applicable documents to the HEART case record following the instructions in Appendix XVIII; and
  • Document and close the HEART case record. 

3430 Transfer from MDCP to Another Medicaid Waiver Program

Revision 23-4; Effective Aug. 21, 2023

Title 1 Texas Administrative Code (TAC) Section 353.1155(b)(1)(F) states Medically Dependent Children Program (MDCP) members cannot be enrolled in more than one Medicaid waiver program at the same time. Refer to Appendix XIX, Mutually Exclusive Services, to determine if a member may receive two services simultaneously.
MDCP members may be on an interest list for an Intellectual and Developmental Disabilities (IDD) waiver program, such as:

  • Community Living Assistance and Support Services (CLASS);
  • Home and Community-based Services (HCS);
  • Deaf Blind with Multiple Disabilities (DBMD); or
  • Texas Home Living (TxHmL).

Program Support Unit (PSU) may receive notification from IDD waiver program staff or the MDCP member’s managed care organization (MCO) that the MDCP member:

  • has come to the top of an IDD waiver program interest list;
  • chooses to transfer to the IDD wavier program; or
  • is already enrolled with an IDD waiver program.

PSU staff must complete the following activities within three business days from notification:

  • create a case record in the Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART), if applicable;
  • contact and coordinate with IDD waiver program staff by email to determine an MDCP termination date and a start of care (SOC) date for the IDD waiver program;
    • The MDCP termination date must be the last day of the month before the IDD waiver SOC date.
  • terminate the STAR Kids Individual Service Plan (SK-ISP) and the Enrollment Form in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) to the last day of the month before the IDD waiver SOC date. 
  • manually generate Form H2065-D, Notification of Managed Care Program Services;
  • upload Form H2065-D to TxMedCentral;
  • mail Form H2065-D to the member, legally authorized representative (LAR) or medical consenter;
  • for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet, and Form H2065-D to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the MDCP termination date and the enrollment effective date for the new Medicaid waiver program; 
  • upload all applicable documents to the HEART case record;
  • document all contacts with the IDD waiver program staff, member, LAR, medical consenter or MCO and any delays; and
  • close the HEART case record. 

3440 Transfer from Community Care for Aged and Disabled Services to STAR Kids

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff must coordinate the termination of Community Care for Aged and Disabled (CCAD) services with the CCAD case worker so the individual does not experience a break in services and does not receive concurrent services through another §1915(c) Medicaid waiver or CCAD.

For individuals entering STAR Kids through the Medically Dependent Children Program (MDCP), PSU staff coordinate the termination of CCAD services with the §1915(c) Medicaid waiver or CCAD case worker. This ensures the individual does not experience a break in services and does not receive concurrent services through CCAD services.

CCAD services are terminated by the CCAD case worker no later than the day prior to MDCP enrollment. This is crucial since no MDCP member may receive CCAD and MDCP services on the same day.