Revision 24-4; Effective Dec. 1, 2024

All STAR Kids members begin transition activities at 15 and periodically meet with a transition specialist to plan their transition to an adult program.

A person receiving Medically Dependent Children Program (MDCP), private duty nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC):

  • is no longer eligible for these services at 21 years old;
  • must transition to an adult program; and
  • may choose to transition to the STAR+PLUS Home and Community Based Services (HCBS) program.

The Texas Health and Human Services Commission (HHSC) Utilization Review (UR) provides a copy of the MDCP-PDN Transition Report each month to:

  • Program Support Unit (PSU) supervisors and managers; and
  • UR unit for the Intellectual and Developmental Disability (IDD) 1915(c) waivers.

The report lists members enrolled in STAR Kids:

  • receiving MDCP, PDN or PPECC services; and
  • who may transition to STAR+PLUS or the STAR+PLUS HCBS program in the next 12 months.

3510 Twelve Months Before the Member's 21st Birthday

Revision 25-1; Effective May 16, 2024

The STAR Kids managed care organization (MCO) identifies all members turning 21 within the 12 months before the member’s 21st birthday. The STAR Kids MCO schedules a face-to-face visit with the member and the member’s available supports to initiate the transition process to:

  • provide an overview of the STAR+PLUS program, including the STAR+PLUS Home and Community Based Services (HCBS) program; and
  • discuss the changes that will occur in the first month following the member's 21st birthday.

The STAR Kids MCO follows up with the member or legally authorized representative (LAR) every 90 days during the year before the member turns 21 to ensure all transition activities specified in Appendix VI, STAR Kids Transition Activities, are completed.

The enrollment broker (EB) contacts members who meet the STAR+PLUS enrollment criteria 30 days before their 21st birthday and mails the STAR+PLUS enrollment packet. The EB selects an MCO for the member if no selection was made within 15 days, as outlined in Title 1 Texas Administrative Code (TAC) Section 353.403(3).  

Members who receive MDCP, private duty nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) may apply for the STAR+PLUS HCBS program to continue receiving medically necessary nursing services that are unavailable at 21. These services may not be the same level of nursing services they receive through STAR Kids.

Members receiving MDCP, PDN or PPEC are referred to the STAR+PLUS HCBS program through the MDCP-PDN Transition Report. Program Support Unit (PSU) staff for the STAR+PLUS HCBS program begin the enrollment process for these members by 12 months before their 21st birthday. PSU staff must refer to 3420, Individuals Transitioning Services for Adults, of the STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH) for detailed information on the STAR+PLUS HCBS enrollment process.

Members who meet the STAR+PLUS HCBS program enrollment criteria transition to the STAR+PLUS HCBS program on the first of the month following their 21st birthday. MDCP eligibility terminates on the last day of the member's 21st birth month.

PSU staff must refer to 6300.9, No Longer Meets the Age Requirement for MDCP, for PSU staff denial procedures for MDCP members transitioning out of MDCP due to turning 21.

3520 Transition Policy for Non-Waiver Individuals and Applicants Receiving PCS or CFC Only

Revision 25-1; Effective May 16, 2025

STAR Kids and STAR Health eligibility terminates the last day of the month that the non-waiver program individual or applicant turns 21. The non-waiver program individual or applicant with STAR Kids or STAR Health must receive services through programs serving adults beginning the first day of the month following the non-waiver program individual or applicant’s 21st birthday.

Individuals or applicants with STAR Kids and STAR Health must transition their Personal Care Services (PCS) and Community First Choice (CFC) services to an adult program. Some individuals or applicants with STAR Kids and STAR Health may continue to receive PCS or CFC through STAR Health until 22 depending on eligibility requirements.

The Texas Health and Human Services Commission’s (HHSC’s) state contracted enrollment broker will reach out to the individual or applicant 30 days before the individual or applicant turns 21 and provide the individual or applicant with a STAR+PLUS enrollment packet. The individual or applicant is allowed 15 days to make a managed care organization (MCO) selection. HHSC’s contracted enrollment broker selects an MCO for the individual or applicant if the individual or applicant has not made an MCO selection after 15 days, as outlined in Title 1 Texas Administrative Code (TAC) Section 353.403(3).