Appendix XXXII, Medicaid Program Actions
3-2017
When a Medicaid for the Elderly and People with Disabilities (MEPD) Texas Integrated Eligibility Redesign System (TIERS) action is needed, complete Form H1746-A, MEPD Referral Cover Sheet.
Use the following chart to determine whether or not a new Form H1200, Application for Assistance – Your Texas Benefits, must be attached to the coversheet. If a type program does not appear in this table, submit Form H1746-A and the application, if needed.
Supplemental Security Income (SSI) Adding Any HHSC Program
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA08 | ME – SSI State Group Home | No worker intervention | No application needed No Form H1746-A needed |
TP12 | ME – Temp Manual SSI | No worker intervention | No application needed No Form H1746-A needed |
TP13 | ME – SSI | No worker intervention | No application needed No Form H1746-A needed |
TP38 | ME – SSI Nursing Facility | No worker intervention | No application needed No Form H1746-A needed |
TP39 | ME – SSI State Hospital | No worker intervention | No application needed No Form H1746-A needed |
TA02 | ME – SSI Waivers | No worker intervention | No application needed No Form H1746-A needed |
SSI Denial to Medicaid Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA02 | ME – SSI Waivers | Add MEPD Eligibility Determination Group (EDG) | Submit Form H1200 Submit Form H1746-A |
SSI Denials to Community Attendant Services (CAS)
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA08 | ME – SSI State Group Home | Add ME – Community Attendant EDG | Submit Form H1200 Submit Form H1746-A |
TP12 | ME – Temp Manual SSI | Add ME – Community Attendant EDG | Submit Form H1200 Submit Form H1746-A |
TP13 | ME – SSI | Add ME – Community Attendant EDG | Submit Form H1200 Submit Form H1746-A |
TP38 | ME – SSI Nursing Facility | Add ME – Community Attendant EDG | Submit Form H1200 Submit Form H1746-A |
TP39 | ME – SSI State Hospital | Add ME – Community Attendant EDG | Submit Form H1200 Submit Form H1746-A |
TP46 | ME – SSI State Supported Living Center | Add ME – Community Attendant EDG | Submit Form H1200 Submit Form H1746-A |
TA02 | ME – SSI Waivers | Add ME – Community Attendant EDG | Submit Form H1200 Submit Form H1746-A |
SSI Denials to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA08 | ME – SSI State Group Home | Add ME – State Supported Living Center EDG | Submit Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement Submit Form H1746-A and Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution |
TP12 | ME – Temporary Manual SSI | Add ME – State Supported Living Center EDG | Submit Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement Submit Form H1746-A and Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution |
TP13 | ME – SSI | Add ME – State Supported Living Center EDG | Submit Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement Submit Form H1746-A and Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution |
TP38 | ME – SSI Nursing Facility | Add ME – State Supported Living Center EDG | Submit Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement Submit Form H1746-A and Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution |
TP39 | ME – SSI State Hospital | Add ME – State Supported Living Center EDG | Submit Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement Submit Form H1746-A and Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution |
TA02 | ME – SSI Waivers | Add ME – State Supported Living Center EDG | Submit Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement Submit Form H1746-A and Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution |
Qualified Medicare Beneficiaries (QMB)/Specified Low-Income Medicare Beneficiaries (SLMB) to CAS
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP23 | MC – SLMB | Add MEPD – Community Attendant EDG | No application needed Submit Form H1746-A |
TP24 | MC – QMB | Add MEPD – Community Attendant EDG | No application needed Submit Form H1746-A |
QMB/SLMB to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP23 | MC – SLMB | Add MEPD EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200 Submit Form H1746-A |
TP24 | MC – QMB | Add MEPD EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200 Submit Form H1746-A |
QMB/SLMB to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP23 | MC – SLMB | Add MEPD – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP24 | MC – QMB | Add MEPD – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
Qualifying Individuals (QI-1) to CAS
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP26 | MC – QI-1 | Add MEPD – Community Attendant EDG and end MC- QI-1 EDG | No application needed Submit Form H1746-A Include a statement that the individual is willing to give up QI-1 to obtain CAS |
QI-1 to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP26 | MC – QI-1 | Add MEPD EDG and end MC-QI-1 EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200 Submit Form H1746-A Include a statement that the individual is willing to give up QI-1 to obtain waiver |
CAS to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP14 | ME – Community Attendant | Add MEPD EDG and end MEPD – Community Attendant EDG Determine the impact of any transfer of assets and impact of home equity and spousal impoverishment on waiver eligibility | Submit Form H1200 Submit Form H1746-A |
Nursing Facility to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP17 | ME – Nursing Facility | End MEPD – Nursing Facility EDG and add MEPD EDG Determine the impact of any transfer of assets and impact of home equity on waiver eligibility | No application needed Submit Form H1746-A |
TP41 | ME – Skilled Nursing Care | End MEPD – Nursing Facility EDG and add MEPD EDG Determine the impact of any transfer of assets and impact of home equity on waiver eligibility | No application needed Submit Form H1746-A |
Intermediate Care Facility for Individuals with an Intellectual Disability or Related Condition (ICF/IID) to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA12 | ME – State Group Home | End appropriate ICF/IID EDG and add ME EDG Determine the impact of any transfer of assets and impact of home equity on waiver eligibility. | No application needed Submit Form H1746-A |
TA26 | ME – SSI Non-State Group Home | End appropriate ICF/IID EDG and add ME EDG Determine the impact of any transfer of assets and impact of home equity on waiver eligibility. | No application needed Submit Form H1746-A |
TP10 | ME – State Supported Living Center | End appropriate ICF/IID EDG and add ME EDG Determine the impact of any transfer of assets and impact of home equity on waiver eligibility. | No application needed Submit Form H1746-A |
TP15 | ME – Non-State Group Home | End appropriate ICF/IID EDG and add ME EDG Determine the impact of any transfer of assets and impact of home equity on waiver eligibility. | No application needed Submit Form H1746-A |
TP16 | ME – State Hospital | End appropriate ICF/IID EDG and add ME EDG Determine the impact of any transfer of assets and impact of home equity on waiver eligibility. | No application needed Submit Form H1746-A |
ICF/IID to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA12 | ME – State Group Home | End appropriate ICF/IID EDG and add ME – State Supported Living Center EDG | No application needed Submit Form H1746-A and Form H0090-I |
TA26 | ME – SSI Non-State Group Home | End appropriate ICF/IID EDG and add ME – State Supported Living Center EDG | No application needed Submit Form H1746-A and Form H0090-I |
TP10 | ME – State Supported Living Center | End appropriate ICF/IID EDG and add ME – State Supported Living Center EDG | No application needed Submit Form H1746-A and Form H0090-I |
TP15 | ME – Non-State Group Home | End appropriate ICF/IID EDG and add ME – State Supported Living Center EDG | No application needed Submit Form H1746-A and Form H0090-I |
TP16 | ME – State Hospital | End appropriate ICF/IID EDG and add ME – State Supported Living Center EDG | No application needed Submit Form H1746-A and Form H0090-I |
Community Medical Assistance Only (MAO) to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | No change to EDG | No application needed No Form H1746-A needed |
TA18 | ME – Grandfathered LTC | No change to EDG | No application needed No Form H1746-A needed |
TP03 | ME – Pickle | No change to EDG | No application needed No Form H1746-A needed |
TP18 | ME – Disabled Adult Child | No change to EDG | No application needed No Form H1746-A needed |
TP21 | ME – Disabled Widow(er) | No change to EDG | No application needed No Form H1746-A needed |
TP22 | ME – Early Aged Widow(er) | No change to EDG | No application needed No Form H1746-A needed |
TP87 | ME – Medicaid Buy In (MBI) | No change to EDG | No application needed No Form H1746-A needed |
Community MAO to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TA18 | ME – Grandfathered LTC | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP03 | ME – Pickle | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP14 | ME – Community Attendant | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP18 | ME – Disabled Adult Child | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP21 | ME – Disabled Widow(er) | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP22 | ME – Early Aged Widow(er) | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP87 | ME – Medicaid Buy-In | End ME EDG and add ME – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
Texas Works-Related Medicaid to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA31 | MA – Parents and Caretaker Relatives – Emergency | No change to EDG. | No application or Form H1746-A needed |
TP02 | MA – Refugee Medical Assistance (RMA) | No change to EDG. | No application or Form H1746-A needed |
TP07 | MA – Earnings Transitional | No change to EDG. | No application or Form H1746-A needed |
TP08 | MA – Parents and Caretaker Relatives | No change to EDG. | No application or Form H1746-A needed |
TP20 | MA – Spousal Support Transitional | No change to EDG. | No application or Form H1746-A needed |
TP40 | MA – Pregnant Women | No change to EDG. | No application or Form H1746-A needed |
TP43 | MA – Children Under One Year | No change to EDG. | No application or Form H1746-A needed |
TP44 | MA – Children Six to 18 Years | No change to EDG. | No application or Form H1746-A needed |
TP45 | MA – Newborn Children | No change to EDG. | No application or Form H1746-A needed |
TP48 | MA – Children One to Five Years | No change to EDG. | No application or Form H1746-A needed |
TP70 | Medicaid for the Transitioning Foster Care Youth (MTFCY) | No change to EDG. | No application or Form H1746-A needed |
TP92 | Adoption Assistance - Federal Match - With Cash | No change to EDG. | No application or Form H1746-A needed |
TP93 | Foster Care - Federal Match - No Cash | No change to EDG. | No application or Form H1746-A needed |
TP94 | Foster Care - Federal Match - With Cash | No change to EDG. | No application or Form H1746-A needed |
TP95 | Adoption Assistance - No Federal Assistance - No Cash | No change to EDG. | No application or Form H1746-A needed |
TP96 | Adoption Assistance - No Federal Assistance - With Cash | No change to EDG. | No application or Form H1746-A needed |
TP97 | Foster Care - No Federal Match - With Cash | No change to EDG. | No application or Form H1746-A needed |
TP98 | Foster Care - No Federal Match - With Cash | No change to EDG. | No application or Form H1746-A needed |
TP99 | MA - Non-AFDC Foster Care | No change to EDG. | No application or Form H1746-A needed |
CAS to QI-1
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP14 | ME – Community Attendant | End MEPD – Community Attendant EDG and add MC -QI-1 EDG | No application needed Submit Form H1746-A Include a statement that the individual is willing to give up CAS to obtain QI-1 |
Waiver to QI-1
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | End MEPD – Waiver EDG and add MC – QI-1 EDG | No application needed Submit Form H1746-A Include a statement that the individual is willing to give up waiver to obtain QI-1 |
Waiver to CAS
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | End MEPD – Waiver EDG and add MEPD – Community Attendant EDG | No application needed Submit Form H1746-A |
Waiver to Nursing Facility
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | End MEPD – Waiver EDG and add MEPD – Nursing Facility EDG | No application needed No Form H1746-A needed |
Waiver to ICF/IID
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | End MEPD – Waiver EDG and add MEPD EDG for the ICF/IID | No application needed No Form H1746-A needed |
Waiver to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | End MEPD – Waiver EDG and add MEPD – State Supported Living Center EDG | No application needed Submit Form H1746-A and Form H0090-I |
Medicaid Buy-In for Children to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP88 | ME – Medicaid Buy-In for Children | End MEPD-Medicaid Buy-In for Children EDG and add MEPD EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200 Submit Form H1746-A |
Medicaid Buy-In to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP87 | ME – Medicaid Buy-In | End MEPD EDG and add MEPD – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP88 | ME – Medicaid Buy-In for Children | End MEPD EDG and add MEPD – State Supported Living Center EDG Explore the impact of transfer of assets, home equity and spousal impoverishment | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
Texas Women's Health Program to Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP41 | Health Care – Texas Women's Health Program (TWHP) | Add MEPD EDG Coordinate efforts with Texas Works Do not discuss the TWHP with anyone other than the certified TWHP member. | Submit Form H1200 Submit Form H1746-A Do not discuss the TWHP with anyone other than the certified TWHP member. |
Texas Women's Health Program to CAS
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP41 | Health Care – Texas Women's Health Program (TWHP) | Add MEPD EDG Do not discuss the TWHP with anyone other than the certified TWHP member. | Submit Form H1200 Submit Form H1746-A Do not discuss the TWHP with anyone other than the certified TWHP member. |
One Type Waiver to Another Type Waiver
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TA10 | ME – Waivers | Update Long-term Services and Supports Summary Screen and Medicaid Waivers/Community Attendant Screen | No application needed Submit Form H1746-A |
Foster Care to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP52 | MA – State Foster Care – A | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP53 | MA – State Foster Care – B | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP54 | MA – State Foster Care – 32 | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP57 | MA – State Foster Care – D | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP58 | MA – State Foster Care – JPC | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP88 | MA – Non-AFDC Foster Care – JPC | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP90 | MA – State Foster Care | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP93 | Foster Care – Federal Match – No Cash | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP94 | Foster Care – Federal Match – With Cash | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP97 | Foster Care – No Federal Match – No Cash | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP98 | Foster Care – No Federal Match – With Cash | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
TP99 | MA – Non-AFDC Foster Care | Coordinate efforts with the Texas Department of Family and Protective Services (DFPS) | Submit Form H1200-PFS Submit Form H1746-A |
Adoption Assistance to State Supported Living Center
TIERS Type of Assistance | Program Name in TIERS | MEPD Action | Case Worker Action |
---|---|---|---|
TP91 | Adoption Assistance – Federal Match – No Cash | Coordinate efforts with DFPS | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP92 | Adoption Assistance -Federal Match – With Cash | Coordinate efforts with DFPS | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP95 | Adoption Assistance – No Federal Assistance – No Cash | Coordinate efforts with DFPS | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |
TP96 | Adoption Assistance – No Federal Assistance – With Cash | Coordinate efforts with DFPS | Submit Form H1200-PFS Submit Form H1746-A and Form H0090-I |