11000, Maintaining Medicaid Eligibility

11100, Financial Eligibility Guidelines for Texas Home Living and Home and Community-based Services

Revision 22-2; Effective May 1, 2022

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

There are several ways to meet the financial eligibility requirement for the TxHmL or HCS program through Medicaid certification.

Individuals receiving Supplemental Security Income (SSI) from the Social Security Administration (SSA) are categorically eligible for SSI Medicaid.
Individuals in certain adoption or foster care cases through the Department of Family and Protective Services (DFPS) are eligible for DFPS Medicaid.
Individuals certified for Medicaid for the Elderly and People with Disabilities (MEPD), Texas Works Temporary Assistance for Needy Families (TANF) and certain other Medicaid programs HHSC are eligible.

Every individual certified for Medicaid benefits has a "coverage code" and a "type program" assigned to the individual's Medicaid record. The appropriate coverage code for participation in the TxHmL or HCS waiver program is "R" (regular Medicaid) or "P" (three months prior coverage); there are no other acceptable coverage codes. The only acceptable base plan is 13, except for individuals who receive Medicaid through DFPS, which does not have a base plan. There are several appropriate type programs for the waivers (see chart below). CARE Screen C63 (DHS Medicaid Eligibility Search) can be used to verify an individual's current and past Medicaid records.

Required Medicaid Codes and Type Program

Coverage Code	Type Program	HCS	TxHmL	Coverage Code	Type Program	HCS	TxHmL
R or P	01	√	√	R or P	18	√	√
R or P	02	√	√	R or P	19	√	√
R or P	03	√	√	R or P	21	√	√
R or P	07	√		R or P	22	√	√
R or P	08	√	√	R or P	29	√	√
R or P	09	√	√	R or P	37	√
R or P	10	√	√	R or P	44	√	√
R or P	12	√	√	R or P	47	√	√
R or P	13	√	√	R or P	48	√	√
R or P	14	√		R or P	51	√
R or P	15	√	√	R or P	61	√	√

For specific questions regarding SSI, contact your local SSA office, call 1-800-772-1213 or visit the SSA website at www.ssa.gov.

For specific questions regarding MEPD or Texas Works, contact your local HHSC office, call 211 or visit the HHSC website at hhs.texas.gov.

For specific questions regarding DFPS, call 512-438-4800 or visit its website at www.dfps.state.tx.us.

11200, Responsibility to Reestablish Medicaid Eligibility

Revision 11-2; Effective March 1, 2011

If an individual loses Medicaid eligibility, it is the responsibility of the representative payee to contact the appropriate entity to determine necessary action to reinstate benefits.

If the HCS Program provider is the representative payee, the provider is responsible for ensuring action is taken to reestablish Medicaid eligibility.

If the individual or family is the representative payee, the service coordinator will assist, if requested.