An official State of Texas website.
Revision 23-3; Effective May 22, 2023
All STAR Kids members begin transition activities at age 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.
Each quarter, Texas Health and Human Services Commission (HHSC) Utilization Review (UR) provides a copy of the MDCP PDN Transition Report 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.
PSU staff must refer to Appendix VI, STAR Kids Transition Activities, for more information about managing this report, including time frames.
3510 Twelve Months Before the Member's 21st Birthday
Revision 23-3; Effective May 22, 2023
The member’s STAR Kids managed care organization (MCO) identifies all members turning age 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 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. This is to ensure the MCO completes all transition activities.
The enrollment broker (EB) will contact the member 30 days before the member’s 21st birthday and mail the STAR+PLUS HCBS enrollment packet. EB will select an MCO for the member if no selection has been made within 15 days, as outlined in Title 1 Texas Administrative Code (TAC) Section 353.403(3).
The member’s selected or defaulted STAR+PLUS MCO conducts the Medical Necessity and Level of Care (MN/LOC) Assessment for those receiving the Medically Dependent Children Program (MDCP), private duty nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) to determine eligibility for the STAR+PLUS HCBS program before 21.
Members who meet the STAR+PLUS HCBS program enrollment criteria will 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 month when the member's 21st birthday occurs.
Program Support Unit (PSU) staff must refer to Section 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.
PSU staff must refer to the following resources for more detailed information about STAR Kids transition activities, as applicable:
- Appendix VI, STAR Kids Transition Activities;
- the STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH); and
- the STAR+PLUS Handbook (SPH).
3520 Transition Policy for Non-Waiver Individuals and Applicants Receiving PCS or CFC Only
Revision 21-10; Effective October 25, 2021
STAR Kids and STAR Health eligibility will terminate the last day of the month in which the non-waiver program individual’s or applicant’s 21st birthday occurs. 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’s 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 age 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 prior to the individual’s or applicant’s 21st birthday 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 will select 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) §353.403(3).