What is MDCP?
MDCP is a Medicaid waiver program that provides in-home services and supports for families who are caring for children and young adults in their homes as an alternative to receiving services in a nursing facility.
MDCP members receive all of the services provided to every Star Kids member PLUS extra waiver benefits.
Some of these include:
- Minor Home Modifications, like wheelchair ramps, roll-in shower installation, and door widening.
- Adaptive aids, such as a portable generator, communication devices, and specialized seating.
- Respite services.
3%
Statewide about 162,000 children are enrolled in Star Kids. Of these, only 5,500 are MDCP — that’s roughly 3%.
UnitedHealthcare serves 12% of these MDCP members.
In order to be eligible for MDCP, individuals must:
- Be younger than age 21.
- Meet the medical necessity and level of care requirements for nursing home admission.
- Be eligible for Medicaid in the community, including being able to receive Supplemental Security Income (SSI), being able to receive a Medical Assistance Only (MAO)*
- Have income and assets that do not exceed the specified limit. This refers to the child’s income, not the family income.
- Not be enrolled in another waiver program.
*MAO refers to someone who is able to receive Medicaid benefits, but does not receive Social Security income.
UnitedHealthcare MDCP Statistics:
- 84% of participants use their respite benefits.
- 46% of participants have primary insurance through a commercial plan.
- 11% of participants receive MAO protected status.
History of MDCP, prior to STAR Kids
The program was run by the Texas Department of Aging and Disability and MDCP Case Management was focused on waiver benefits. As a result, there was not holistic support for families needing long term services and support, support for behavioral health, and acute care for their child. Families needing assistance with state plan benefits had a separate case manager to support their needs. Support for the family was fragmented with no single point of contact for all Medicaid services. Case managers were spread throughout the state.
Present Day MDCP STAR Kids
Beginning in 2016, when Medicaid for children with disabilities was carved into Managed Care, MDCP members have had a Registered Nurse assigned to them as a Service Coordinator. The Service Coordinator acts as the first point of contact for any needs a member has from finding a provider to arranging medically necessary services or medical equipment. Members are able to call their Service Coordinator directly at any time.
MDCP Service Coordinators outreach to members monthly to assess for and assist with any needs identified. In addition to responding to any requests initiated by the member, Service Coordinators ask about recent provider visits and whether there were any new orders that resulted. The Service Coordinator will call the provider office if needed and request information to ensure that proper referrals are made. The Service Coordinator will then follow up until the needed item is in the member’s home or services are started. Many members report that having an assigned Service Coordinator has increased the ease in which they access services and decreased the amount of time spent and amount of stress they experience related to getting the services they need.
Member survey results
In August 2022, UnitedHealthcare conducted a MDCP member survey.
- 25% of UnitedHealthcare MDCP members/caregivers responded.
- 81% of respondents received Medicaid benefits prior to the rollout of STAR Kids in 2016.
- 75% indicated STAR Kids has improved their quality of life and ease of receiving medically necessary services.
- STAR Kids’ service coordination was rated the most valuable program feature.
"Prior to UnitedHealthcare MCO, she had no consistent contact and had difficulty reaching anyone for questions or concerns. The communication with UnitedHealthcare has been amazing.” — Survey respondent
Success in service coordination
Member story
The unprecedented winter storm of February 2021 was scary for the many parents and caregivers of individuals who depend on a tracheotomy and ventilator to breathe. One parent reached out to her UnitedHealthcare Community Plan service coordinator when the family started running out of money to buy gas to fuel the generator powering her child’s ventilator. Her service coordinator referred the mom to Helping Hands Ministry in Belton, Texas, who provided the family with $100 to purchase gas. Helping Hands Ministry also kept in touch with the family to ensure that they had water, since they were on a ‘boil’ notice and had no running water.
For medically vulnerable children who rely on MDCP to live at home, something as simple as air to breathe can be a major challenge when the power goes out. Thanks to the benefit of having a service coordinator, the family was able to be connected to resources and was provided comfort knowing that their daughter would have air to breathe during the weather crisis.
Recommendations to Improve the Medically Dependent Children’s Program
- Addressing workforce shortages within MDCP for Private Duty Nursing and Attendant Care
- Update policies for Coordination of Benefits to address member access
- Improve eligibility for the MDCP Program
- Improve benefits in the MDCP Program
- Develop alternative medical models within the STAR Kids program to provide comprehensive medical homes
