Revision Notice 22-3; Effective Oct.17, 2022

15100 Research Preventing Dual Enrollment

Revision Notice 22-3; Effective Oct.17, 2022

A person cannot be simultaneously enrolled in more than one 1915c waiver. See Appendix II, Mutually Exclusive Services.

If a person accepts a Home and Community-based Services (HCS) or Texas Home Living (TxHmL) enrollment offer, the local intellectual and developmental disability authority (LIDDA) determines if the person is currently enrolled in a mutually exclusive waiver program before the HCS or TxHmL begin date can be determined. The LIDDA  asks the person or legally authorized representative (LAR) if they currently receive any Medicaid services and checks the following systems to verify if the person is currently enrolled in a mutually exclusive waiver program or service:

HHS applications: 

• Client Assignment and Registration (CARE) – C63, Medicaid Eligibility Search
• Service Authorization System Online (SASO) (see instructions below)

Texas Medicaid & Healthcare Partnership (TMHP) applications:

• TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV)
• Long-Term Care (LTC) Online Portal

Enrollment information for the Medically Dependent Children Program (MDCP) is only available on the LTC Online Portal.

SASO instructions:

• In the “Client ID” field, enter the person’s Medicaid number, or enter their Social Security number in the “SSN” field.
• Verify the search results are for the correct person.
• Click on the hyperlink for the person’s Medicaid number.
• Scroll down on the left navigation list to “Program and Service” and click on “Enrollment.”
• In the search results, look at the columns labeled “Service Group,” “Begin Date” and “End Date.”
• If a service group code is indicated with a begin date but no end date, the person is receiving services for that service group.
• Use the chart below to determine which service the person receives or program the person is enrolled in. 

If the person receives other Medicaid Services, the LIDDA uses Appendix I, Mutually Exclusive Services, to determine if the services being received are mutually exclusive to enrollment in HCS or TxHmL. When using the table, if an “x” appears in the square where two services intersect, the two may not be received at the same time. However, if the square is blank, the two services may be received at the same time. Some services may be received simultaneously if certain conditions apply—if the square shows a number, refer to the explanation for that number below the table.

If the LIDDA determines that the person is enrolled in a mutually exclusive waiver program or service, the LIDDA must:

• inform the person or LAR of the requirement to choose between the two programs;
• discuss and compare the services with the person and LAR, using the Long Term Services & Supports document to ensure that the person or LAR makes an informed decision; and
• if the person accepts the offer for HCS or TxHmL, coordinate with the service coordinator or case manager of the other program to determine the HCS or TxHmL begin date and the end date of the other program or service to:
  • ensure there is no service interruption; and
  • prevent dual enrollment in mutually exclusive waiver programs.

Note: People receiving Community First Choice (CFC) non-waiver services must transition over to HCS or TxHmL waiver services once enrolled. The LIDDA must instruct the person or LAR to work with the Managed Care Organization (MCO) to end current CFC non-waiver services before transitioning to HCS or TxHmL waiver services.

15200 Persons Enrolled in STAR+PLUS Waiver or Medically Dependent Children Program

Revision 22-2; Effective July 22, 2022

The State of Texas Access Reform Plus (STAR+PLUS) Waiver and the Medically Dependent Children Program (MDCP) STAR Kids programs operate through a managed care organization (MCO), which receives a monthly capitation payment. Therefore, a person must be not be discharged from STAR+PLUS or MDCP before the last day of the month that the MCO has already been paid to provide services to the person. Home and Community-based Services (HCS) and Texas Home Living (TxHmL) can begin on the first day of the month after the STAR+PLUS or MDCP discharge date.

If a person is enrolled in STAR+PLUS Waiver or MDCP and chooses to enroll in HCS or TxHmL, the local intellectual and developmental disability authority (LIDDA) must:

• inform the person and legally authorized representative (LAR) that disenrollment from SPW or MDCP must occur on the last day of a month;
• ensure the person's HCS or TxHmL Individual Plan of Care (IPC) begin date is on the first day of the month immediately following the SPW or MDCP end date; and
• submit in the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal before the 20th day of the month before the enrollment begin date for HCS or TxHmL:
  • HCS or TxHmL Pre-enrollment Form;
  • 8578 ID/RC Assessment; and
  • 3608 Individual Plan of Care or 8582 Individual Plan of Care on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal before the 20th day of the month before the enrollment begin date for HCS or TxHmL.

If forms are submitted on the TMHP LTC Online Portal before the 20th day of the month before the HCS or TxHmL begin date, PES will notify HHSC Health Plan Operations of the person’s pending enrollment into HCS or TxHmL and request the person’s disenrollment from STAR+PLUS Wavier or MDCP.

However, if forms are not submitted on the LTC Online Portal before the 20th day of the month before the HCS or TxHmL begin date, the LIDDA must coordinate with the case manager or service coordinator of the other program again to change the STAR+PLUS Waiver or MDCP end date to the last day of the next month and change the HCS or TxHmL begin date to the first day of the following month.

15300 Determine if the Person is a Medicare Beneficiary

Revision 19-4; Effective September 9, 2019

The US Government site for Medicare is Medicare.gov.

The local intellectual and developmental disability authority (LIDDA) will:

• check to see if a person is a Medicare recipient and:
  • verify that the person is enrolled in a Medicare-sponsored prescription drug plan; and
  • assist the person in applying for extra help using the SSA-1020 form.
    Note: The person must enroll in a Medicare drug plan to receive prescription medications.
• inform the person that upon enrollment in a waiver or an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) program, he or she will be auto-enrolled into a Medicaid drug plan, which may or may not be the drug plan that is most beneficial. Medicaid will pay for a limited list of drugs that Medicare will not.
• inform the person that if they are enrolling in Home and Community-based Services (HCS), the program provider can assist them with changing drug plans and filing an exception, appeal or grievance with the drug plan.
• inform the person that if they are enrolling in Texas Home Living (TxHmL), the LIDDA service coordinator can assist them with changing drug plans and filing an exception, appeal or grievance with the drug plan.

15400 Financial Eligibility

Revision 19-4; Effective September 9, 2019

Texas Health and Human Services Commission (HHSC) requires all persons to meet financial eligibility for enrollment in the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver program. After enrollment, financial eligibility must be maintained for the person to continue participation in the program. Persons eligible for certain types of Medicaid coverage are financially eligible for the program; however, not all types of Medicaid coverage ensure eligibility.

15410 Financial Eligibility at Pre-Enrollment

Revision 22-2; Effective July 22, 2022

The local intellectual and developmental disability authority (LIDDA) checks the Client Assignment and Registration System screen C63, Medicaid Eligibility Search or the Texas Medicaid & Healthcare Partnership (TMHP) TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV) system.

15411 No Medicaid

Revision 20-4; Effective October 15, 2020

If a person is not currently receiving Medicaid benefits or receives Medicaid benefits under a Medicaid program type that is not accepted for enrollment in the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) programs, the person/legally authorized representative (LAR) must apply for Supplemental Security Income (SSI) benefits through the Social Security Administration (SSA) or apply for Medicaid through Texas Health and Human Services Commission (HHSC). The LIDDA must offer to assist the person/LAR with submitting the application and explain the time frame for enrollment again. To determine which application the person/LAR should submit, the LIDDA must know the person’s monthly income.

Note: There are monthly income limits that can affect Medicaid eligibility.

If the person’s monthly income does not exceed the monthly federal payment standard for SSI benefits by more than $20, the LIDDA must inform the person of the process for applying for SSI benefits and assist the person/LAR to apply. If the person’s SSI benefits are approved, SSI Medicaid is automatically approved, which is accepted for enrollment in the HCS or TxHmL program.

If the person’s monthly income exceeds the monthly federal payment standard for SSI benefits by more than $20, the LIDDA must assist the person/LAR with submitting Form H1200, Application for Assistance – Your Texas Benefits. The LIDDA can assist the person/LAR with creating an account and applying online at www.yourtexasbenefits.com. If the person/LAR applies online, the status of the application is available while under review. Also, if additional documentation is needed to complete the application process, the person/LAR will be informed of the needed documents through their online account. The LIDDA can assist the person/LAR with submitting documents through their online account. The online process is recommended; however, if preferred, the person/LAR or LIDDA may submit the application by fax.

When the application is submitted either online or by fax, the LIDDA must download Form H1746-A, MEPD Referral Cover Sheet, follow the form instructions to complete the form and fax it to the HHS Document Processing Center at 877-236-4123.

Note: Form H1746-A is a fillable “smart form” that must be downloaded each time and completed using Adobe Acrobat Reader DC. Each form has a unique bar code that captures the person’s information as the form is completed. This ensures the form is matched to the correct application upon submission. Form H1746-A is not to be photocopied.

If completed and when faxing Form H1746-A, the LIDDA should include a copy of the person’s Determination of Intellectual Disability (DID), Form 8578, Intellectual Disability/Related Condition Assessment, and Form 3608, Individual Plan of Care (IPC) – HCS/CFC, (for HCS), or Form 8582, Individual Plan of Care – TxHmL/CFC, (for TxHmL). Submission of these forms is encouraged before completion of Form H1200 and Form H1746-A.

Apply for SSI benefits if the person’s monthly income does not exceed the monthly federal payment standard for SSI benefits by more than $20. Medicaid should only be applied for if the person’s monthly income exceeds the monthly federal payment standard for SSI benefits by more than $20. The Medicaid application cannot be approved if the person may be eligible for SSI benefits.

A Medicaid application cannot be processed while the person has a pending application for SSI benefits or is appealing an SSI denial. If the person is denied SSI benefits and does not want to appeal, or the person appeals and is still denied, follow the process described above for submitting a Medicaid application.

15412 Qualified Medicare Beneficiary or Specified Low-Income Medicare Beneficiary

Revision 22-2; Effective July 22, 2022

Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) are not “full” Medicaid benefit programs. QMB only pays for a person’s Medicare premiums, deductibles, and co-pays, while SLMB is an extension of QMB that only pays for Medicare Part B premiums. People receiving QMB or SLMB may also receive full Medicaid benefits. However, if the person’s Medicaid information in Client Assignment and Registration System screen C63, Medicaid Eligibility Search or the Texas Medicaid & Healthcare Partnership (TMHP) TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV) system, indicates the person only receives QMB (Q24) or SLMB (B23), the local intellectual and developmental disability authority (LIDDA) must follow the process described in Section 15411 No Medicaid.

The LIDDA can refer to the Medicaid for the Elderly and People with Disabilities Handbook for detailed information about Medicaid programs, timelines, procedures and forms.

15420 Persons Leaving an ICF/IID, State Hospital or SSLC to Enroll in HCS or TxHmL

Revision 22-2; Effective July 22, 2022

A person residing in an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), state hospital or state supported living center (SSLC) is certified for full Medicaid benefits under the institutional Medicaid program. 

• If a person is leaving the facility and enrolling in the Home and Community-based Services (HCS) and is currently receiving Supplemental Security Income (SSI) Medicaid (D13 or I13) or ME Institutional Medicaid (D14 or I14), when the LIDDA  has submitted the HCS or TxHmL Pre-enrollment Form; Form 8578, Intellectual Disability/Related Condition (ID/RC); and Form 3608, Individual Plan of Care on the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal (see Section 13241, Form Submission for Enrollment), Program Eligibility and Support (PES) will submit Form 1746A, MEPD Referral Coversheet to Medicaid for the Elderly and People with Disabilities (MEPD) to request a Medicaid program transfer to “ME Waivers Medicaid,” which pays for HCS. However, if the person loses full Medicaid benefits before the LIDDA enters the enrollment  forms, the LIDDA must follow the process described above for submitting a new Medicaid application.
• If a person is leaving the facility and enrolling in the Texas Home Living (TxHmL) program, and is currently receiving SSI Medicaid (D13 or I13) when the LIDDA  has submitted the HCS or TxHmL Pre-enrollment Form; Form 8578, Intellectual Disability/Related Condition (ID/RC); and Form 8582, Individual Plan of Care on the LTC Online Portal (see Section 13339, Form Submission for Enrollment), PES submits a request to HHSC Texas Integrated Eligibility System (TIERS) Disposition to transfer the person’s Medicaid program to “SSI Waivers Medicaid,” which pays for services. However, if the person loses full Medicaid benefits before the LIDDA enters the enrollment forms, the LIDDA must follow the process described above for submitting a new Medicaid application.

Note: PES cannot submit a request for the Medicaid program change until the person is discharged from the facility and the LIDDA has submitted the required forms on the LTC Online Portal. See Section 13241, Form Submission for Enrollment and Section 13339, Form Submission for Enrollment. 

A person receiving Supplemental Security Income (SSI) benefits is automatically certified for SSI Medicaid. Client Assignment and Registration (CARE) screen 193, Medicaid Eligibility Information, displays a Medicaid coverage code and program type of “D13” or “I13” for people who reside in a facility and receive SSI Medicaid. Before PES can request a Medicaid program change for HCS or TxHmL to “R13,” the person’s representative payee must contact the Social Security Administration (SSA) to update the person’s address and inform the SSA of the person’s facility discharge date. The facility must submit a discharge form to the SSA. If the SSA receives the discharge form from the facility before the representative payee notifies the SSA of the change, SSI benefits may be suspended, which will result in suspension of SSI Medicaid. When the representative payee contacts the SSA to update the information, SSI will be unsuspended, which will automatically reinstate SSI Medicaid. When SSI Medicaid is reinstated, PES can request the Medicaid program change.

For people being discharged from an ICF/IID, state hospital, or SSLC who have lost SSI benefits or full Medicaid benefits before the HCS or TxHmL begin date, the LIDDA must follow the process described in Section 15411, No Medicaid.

15500 Chart of Acceptable Types of Medicaid for HCS and TxHmL

Revision 20-4; Effective October 15, 2020

The following chart indicates the acceptable Medicaid coverage codes and program types for enrollment in Home and Community-based Services (HCS) and Texas Home Living (TxHmL). If a person does not an acceptable Medicaid coverage/program, the local intellectual and developmental disability authority (LIDDA) must follow the process described in Section 15411, No Medicaid.

Required Medicaid Codes and Type Program

15600 Appointment of an Authorized Representative

Revision 20-4; Effective October 15, 2020

A person may allow designate another person to act on his or her behalf as a Medicaid authorized representative by completing Form H1003, Appointment of an Authorized Representative. Only one authorized representative may be appointed. To change or end a designated authorized representative, the person can log in to his/her Your Texas Benefits account or call 2-1-1.

An authorized representative must be familiar with the person and knowledgeable of their finances; therefore, a person should only designate a LIDDA staff person as a last resort. However, the person or their designated authorized representative may submit Form H1826, Case Information Release, to authorize HHSC to release information regarding the person’s Medicaid case to the LIDDA. To end this authorization, the person can log in to his/her Your Texas Benefits account or call 2-1-1. The LIDDA may also call 2-1-1 to end the authorization.

Form H1003 is submitted to HHSC with Form H1746-A, MEPD Referral Cover Sheet, and when submitting the required application and supporting documentation.

15700 Medicaid Forms

Revision 20-4; Effective October 15, 2020

Medicaid forms are found in the Medicaid for the Elderly and People with Disabilities Handbook.

15710 Form H1746-A, MEPD Referral Cover Sheet

Revision 22-2; Effective July 22, 2022

Form H1746-A, MEPD Referral Cover Sheet, is completed by the local intellectual and developmental disability authority (LIDDA) to share case information and provide supporting documentation with Access and Eligibility Services (AES) eligibility staff for applicants and recipients of Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver services.

Form H1746-A is a fillable “smart form” that must be downloaded each time and completed using Adobe Acrobat Reader DC. Each form has a unique bar code that captures the person’s information as the form is completed. This ensures the form is matched to the correct application upon submission. 

Important: Form H1746-A should not be photocopied.

Form H1746-A must be included with all applications and documents submitted for an HCS or TxHmL applicant.

Form H1746-A must be the first document in the packet when mailing or faxing documents. Two-sided faxing must be used when possible. By faxing and mailing documents, duplication in the system occurs and delays the process. If sending more than one application, fax each application individually with one Form H1746-A per application, or mail applications in a batch using Form H1746-B, Batch Cover Sheet.

Not submitting Form H1746-A may result in a Medicaid denial for HCS/TxHmL services.

15720 Completing Sections on Form H1746-A, MEPD Referral Cover Sheet

Revision 22-2; Effective July 22, 2022

Applicant/ Consumer Information

• If known, fill in the Texas Integrated Eligibility System (TIERS) number. If the TIERS number is unknown, do not enter any other number and leave the field blank.
• If known, enter the Medicaid number in the Individual Number field. If the Medicaid number is unknown, do not enter any other number.
• The local intellectual and developmental disability authority (LIDDA) must enter the correct ZIP code, county, Social Security number, person’s last and first name, and date of birth. LIDDAs must not submit Form H1746-A without this information.

Action

• For pending enrollments, the LIDDA must mark “Application.”
• The LIDDA must review the instructions for Form H1746-A for details on using the other action statuses.

Program

• The LIDDA must select either Home and Community-based Services (HCS) or Texas Home Living (TxHmL). 

Information for MEPD Worker

• The LIDDA must leave this section blank.

Sender

The LIDDA must:

• select “MRA”; and
• enter the Date, From, Phone, City, County/Service Area and Fax information for the LIDDA staff helping with the Medicaid application process. 

Note: LIDDAs must not submit the form without this information.

Additional Comments

• If the person or legally authorized representative (LAR) submitted the application to Texas Health and Human Services Commission (HHSC) separately, the LIDDA should indicate “application submitted separately.” HHSC will link Form H1200, Application for Assistance – Your Texas Benefits, with Form H1746-A.  
• For HCS, LIDDAs must enter this statement:  
  • “Please test for Medicaid Waivers. Level of Care Authorized. Medical Necessity and Individual Service Plan questions below are not applicable for the HCS program.”  
• For TxHmL, LIDDAs must enter this statement:  
  • “Enrolling in TxHmL. Please test the applications for all Retirement Survivor and Disability Insurance (RSDI) Exclusion Programs. Level of Care Authorized. Medical Necessity and Individual Service Plan questions below are not applicable for the TxHmL program.” 

Note: LIDDAs must not complete the Medical Necessity (MN) section of Form H1746-A. 

Follow-up

• Generally, the Medicaid application process is completed within 45 days. However, some situations may prolong the process, such as requests for more documentation and disability determination reviews.
• The LIDDA must document in the person’s record the date the application was submitted to Health and Human Services Commission (HHSC).
• If assistance from HHSC is needed while the application is being processed, the LIDDA, person or legally authorized representative can call: 
  • 2-1-1; 
  • Medicaid Hotline at 800-252-8263; or 
  • HHSC Ombudsman Office at 800-252-8154.
• If all enrollment forms have been submitted, Medicaid eligibility has been pending for longer than 45 days, and the LIDDA has been unsuccessful using the contact information above, the LIDDA can contact Program Eligibility and Support (PES) at 512-438-2484 or email EnrollmentTransferDischargeInfo@hhs.texas.gov.

15800 Financial Eligibility After Enrollment - HCS and TxHmL

Revision 20-4; Effective October 15, 2020

Persons must maintain financial eligibility to remain eligible for the waiver program.

Supplemental Security Income (SSI) Medicaid

If a person loses SSI benefits, the person also loses SSI Medicaid. It is the person’s representative payee’s responsibility to contact the Social Security Administration (SSA) for assistance. If SSI benefits are reinstated, SSI Medicaid will be automatically reinstated. If the program provider is the representative payee, the provider is responsible for taking action to reestablish SSI benefits and SSI Medicaid.

Medical Assistance Only (MAO)

If a person loses MAO, the person or their authorized representative must call 2-1-1 for assistance. However, the local intellectual and developmental disability authority (LIDDA) must assist if requested by the person or authorized representative.

15810 Medicaid Redetermination

Revision 22-2; Effective July 22, 2022

For Medical Assistance Only (MAO) recipients (i.e., not applicable for Supplemental Security Income (SSI) recipients), Texas Health and Human Services Commission (HHSC) requires people to submit a Medicaid redetermination packet to HHSC at least annually. HHSC mails the redetermination packet to the person’s mailing address on file in the Texas Integrated Eligibility Redesign System (TIERS) 90 days in advance of the redetermination due date. It is important that the packet be completed and returned to HHSC before the due date; otherwise, Medicaid eligibility will be denied.

• Local intellectual and developmental disability authorities (LIDDAs) can review the Client Assignment and Registration (CARE) System screen C63, Medicaid Eligibility Search, to determine a person’s review date. This information is displayed in the “ME Annual Renewal Date” field in this screen. LIDDAs can also use “Due” and “Past Due” Dashboard tiles on the Texas Medicaid & Healthcare Partnership  Long-Term Care  Online Portal. 

Note: People who receive SSI Medicaid are not required to submit a redetermination packet because their eligibility is based on their SSI eligibility. The Social Security Administration (SSA) reports SSI recipient information directly to TIERS for these persons.

15820 Reestablishing Medicaid

Revision 20-4; Effective October 15, 2020

15821 Loss of Supplemental Security Income (SSI) Medicaid

Revision 20-4; Effective October 15, 2020

If a person loses SSI benefits, the person will also lose SSI Medicaid. It is the responsibility of the person or their representative payee to contact the Social Security Administration (SSA) to determine the necessary action to reinstate SSI benefits. Adults who lose SSI benefits because they became eligible for Retirement, Survivors and Disability Insurance (RSDI) benefits, and their income is now over the income limit for SSI benefits, may be eligible for Disabled Adult Children’s Medicaid. Therefore, if SSI benefits will not be reinstated due to receiving RSDI benefits, the person must submit a Medicaid application to Texas Health and Human Services Commission (HHSC).

If the provider is the representative payee, the provider is responsible for ensuring immediate action is taken to reestablish financial eligibility. If they are not the authorized representative, the provider is responsible for working with the person or authorized representative in assisting to maintain and reestablish the person’s financial eligibility. The local intellectual and developmental disability authority (LIDDA) must assist if requested by the person or authorized representative. If the LIDDA is assisting with the submission of the Medicaid application, they must include a completed Form H1746-A, MEPD Referral Cover Sheet.

15822 Loss of Medical Assistance Only (MAO) Medicaid

Revision 20-4; Effective October 15, 2020

If a person loses financial eligibility, it is the responsibility of the person, legally authorized representative (LAR) or authorized representative to reestablish financial eligibility as soon as possible. If the provider is the authorized representative, it is the provider’s responsibility to maintain and reestablish the person’s financial eligibility to prevent an interruption in services and payment. If they are not the authorized representative, the provider is responsible for working with the person or authorized representative in assisting to maintain and reestablish the person’s financial eligibility. The local intellectual and developmental disability authority (LIDDA) must assist if requested by the person or authorized representative.

15823 Loss of Department of Family and Protective Services (DFPS) Medicaid

Revision 20-4; Effective October 15, 2020

When a person “ages out” of DFPS conservatorship, the person may lose DFPS Medicaid. Typically, as the person reaches the age out date, DFPS submits a Supplemental Security Income (SSI) application to the Social Security Administration (SSA) on the person’s behalf. However, should a person lose DFPS Medicaid due to aging out of DFPS conservatorship, the person’s representative payee must submit an SSI application to the SSA.