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Educational Series: MDCP Eligibility Denials

On November 1, 2016, HHSC rolled out the new STAR Kids managed care program across Texas, which has brought significant changes and challenges to our provider partners and families. The CareStarter team has been very involved in the process of disseminating information to our network in the last year both before and during this rollout.

In May, we began to get a steady stream of families reaching out to us saying they had been denied eligibility for the MDCP program after completing the new assessment process using the SK-SAI with their managed care organization.

So what is a family supposed to do if this happens? We turned to Hannah Corbin Mehta with Protect Texas Fragile Kids (PTFK) to create this 15-minute video that walks families through a 7-step process if and when they receive a denial of eligibility from TMHP.

MDCP Denials: What you need to know

Need more information? Want to know more? The short video we are asking all of our partners to share just scratches the surface of this complex process. Watch the extended interview with our founder, Lamarque Polvado, and Hannah Corbin Mehta, the Executive Director of Protect Texas Fragile Kids.

In this hour long interview, Hannah discusses in detail the SK-SAI tool, legislative efforts, and what the most recent denial data from HHSC means for families and providers.

Have you seen the new SK-SAI tool being used by the MCO’s for assessment of services? Last week, we asked over 40 provider partners to raise their hand if they knew what the SK-SAI was. Not one person raised their hand. Our provider partners need to take time to get familiar with this complicated tool being used to assess the families they serve. Click the link below to download the SK-SAI tool provided to us by Hannah with PTFK.

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