Molina Healthcare of Texas Clinical Policies

Molina has established Molina Clinical Policies (MCP) that function as one of the sets of guidelines for coverage decisions or determinations. includes the Molina-wide Clinical Policies (MCPs), which are used by providers as well as Molina’s Medical Directors and internal reviewers to make Medical Necessity determinations.

Note:These MCPs do not constitute plan authorization, nor are they an explanation of benefits. The MCPs located on are applicable to all lines of business including Medicaid, Marketplace, and Medicare unless superseded by National Coverage Determination (Medicare) or one of the state Medicaid Plans.

In addition to the Molina Clinical Policies listed on, please be sure to review the Texas specific policies below.

Molina Healthcare of Texas Clinical Policies

  • Hospital Readmission Review Policy
  • Appropriate Professionals Making UM Decisions Policy
  • Clinical Criteria for UM Decision Making Policy
  • Non-Participating Provider PA (Prior Auth) Requests Policy
  • Continuity of Care (COC) and Access to Care for New and Existing Members Policy

Additional Resources