3100, Eligibility Determination Procedures

3110 Eligibility for CCSE Services

Revision 17-1; Effective March 15, 2017

40 Texas Administrative Code (TAC) §48.2901(a). To receive Community Care Services Eligibility (CCSE), a client must meet income, resource, age, and need criteria.

40 TAC §48.2910(b). Clients who live in nursing homes are not eligible to receive CCSE services.

An applicant or individual who lives in Texas may qualify to receive most CCSE services regardless of citizenship or the duration of residency. However, individuals may not receive Community Attendant Services or waiver services without verification of citizenship and identity.

Provider agencies must accept HHSC' decision about which individuals are eligible. For eligibility requirements for specific CCSE services, see Section 4000, Specific CCSE Services.

Note: Refer to Appendix XV, Services Available from Other State Agencies, for information about services that may benefit the applicant/individual.

3111 Age Limits

Revision 17-1; Effective March 15, 2017

40 Texas Administrative Code §48.2906, Age Limits

(a) A person must be 18 years of age or older, or an emancipated minor, to receive Community Care Services Eligibility (CCSE) services, except:

(1) a person of any age may receive CCSE Medicaid-funded day activity and health services;
(2) a person of any age who is not eligible for the Texas Health Steps program may receive CCSE Medicaid-funded community attendant services.

Although age limits do not apply to Title XIX Day Activity and Health Services (DAHS), licensure prohibits service providers to deliver DAHS services in facilities that are not licensed to serve individuals under age 18. There are currently no facilities licensed in Texas that can serve non-adults.

3120 Loss of Eligibility

Revision 17-1; Effective March 15, 2017

40 Texas Administrative Code §48.3903(c). The client is not eligible for CCSE services when

(1) he dies;
(2) he is admitted to an institution;
(3) his physician requests service termination (Medicaid services only); or
(4) he requests service termination or repeatedly refuses to accept help, except in an involuntary protective services case, or he refuses to comply with his service plan.

The case worker must notify the provider as soon as an individual has died or is entering a nursing home. Terminate services effective the date of death or entry into the nursing home. The provider cannot bill for attempting to deliver services after the effective date of the termination.