Revision 21-1; Effective March 1, 2021

In addition to the MEPD denial codes for all programs, there are eleven denial reasons specific to the MBI program. The correct reason for denial must be manually entered in the case comments section of Form TF0001, Notice of Case Action, before the system generates and sends out the notice. Use the following denial reasons for MBI as appropriate.

  1. You failed to pay your MBI premium by the due date.
  2. Your Independence Account is a countable resource from <mmddyy> through <mmddyy> for one or more of the following reasons:
    • Money was used for non-health care or non-work related expenses.
    • Deposits exceed 50% of your earnings for the Social Security Administration qualifying quarter.
    • Deposits are from sources other than earnings or interest earned on this account.
    • Deposits include income from another individual.
  3. Your countable income increased because you did not pay a designated impairment-related work expense (IRWE) with your income.
  4. Your countable income increased because you did not pay a designated blind work-related expense (BWE) with your income.
  5. The resources excluded as part of your Plan to Achieve Self-Support (PASS) are now countable because you have not met the goal dates in your PASS.
  6. The resources excluded as part of your PASS are now countable because funds have not been set aside as agreed.
  7. The resources excluded as part of your PASS are now countable because funds have not been spent as agreed.
  8. The income excluded as part of your PASS is now countable because you have not met the goal dates in your PASS.
  9. The income excluded as part of your PASS is now countable because funds have not been set aside as agreed.
  10. The income excluded as part of your PASS is now countable because funds have not been spent as agreed.
  11. You did not meet the requirements of completing a Social Security Administration Qualifying Quarter.

M-8510 Redeterminations

Revision 11-4; Effective December 1, 2011

Redeterminations for MBI follow regular MEPD policy for redeterminations.

Streamlining methods and passive reviews are not allowed for an MBI redetermination.

M-8520 Appeals

Revision 13-1; Effective March 1, 2013

HHSC is responsible for all appeals including those concerning premiums.

If an individual is dissatisfied with HHSC's decision concerning his eligibility for medical assistance, he has the right to appeal through the appeal process established by HHSC. In certain circumstances, the individual is entitled to receive continued benefits or services until a hearing decision is issued. Whether an individual is entitled to continued assistance is based on requirements set forth in appropriate state or federal law or regulation of the affected program. See the Fair and Fraud Hearings Handbook.