7200, Determination of Financial Eligibility Based on Automated Records

Revision 17-1; Effective March 15, 2017

Refer to Appendix XIV, SAVERR/TIERS Type Program Chart, to determine how existing coverage affects eligibility for Community Care for Aged and Disabled Services.

7210 Safeguarding Personally Identifiable Information

Revision 17-1; Effective March 15, 2017

All personally identifiable information (PII) obtained from the Social Security Administration (SSA) must be safeguarded. Wire Third Party Query (WTPY) System, State On Line Query (SOLQ) or other SSA documentation is considered SSA-protected and cannot be printed or kept in the case record.

Staff must not print or file PII (WTPY/SOLQ) printouts in individual case records. Staff must document the date they verified and viewed the online/printed verification, the amount of income and source (WTPY, SOLQ, other) used to verify the information.

If a WTPY or SOLQ report must be printed for a specific purpose such as a legal request or legislative inquiry, the document must not be filed in the case record or sent for imaging. SSA documents must be stored in a central locked filing cabinet only accessible by Texas Health and Human Services Commission authorized staff.

7220 Financial Eligibility Based on Receipt of Medicaid Buy-In Program Services

Revision 18-1; Effective June 15, 2018

Working Texans are able to purchase health insurance through Medicaid by paying a monthly premium through the Medicaid Buy-In (MBI) program. Participants in MBI must meet specific work, disability, resource and income requirements. Not all MBI recipients pay a premium. Premiums are determined on a sliding scale based on an individual's income.

Categorical Eligibility Status Verification

Individuals applying for Long-term Services and Supports (LTSS) who have MBI coverage are categorically eligible for all Title XX Community Care programs, Title XIX Day Activity and Health Services and Primary Home Care.

MBI coverage can only be verified by:

  • searching the Texas Integrated Eligibility Redesign System (TIERS) database for Type Program (TP) 87 coverage (this information will not appear on the System for Applications, Verifications, Eligibility Reports and Referral inquiry screens); or
  • an award letter sent to the individual documenting MBI eligibility.

Staff may contact either the regional TIERS coordinator or a Special Workers Assisting with TIERS (SWAT) member to verify an applicant's MBI status.

MBI and Receipt of Waiver Services

An MBI recipient interested in an LTSS waiver program should be added to the appropriate interest list. The case worker can determine if an applicant is an MBI recipient by looking in the TIERS database. The MBI program is coded TP 87, ME-Medicaid Buy-In.

More information about the MBI program is available in Section M-1000, Medicaid Buy-In (MBI) Program, of the Medicaid for the Elderly and People with Disabilities Handbook.

7230 Hierarchy of Individual Identification Data

Revision 17-1; Effective March 15, 2017

Before certifying an applicant who has a previously assigned individual number, compare information in the Texas Integrated Eligibility Redesign System (TIERS) to the information in the case record. Note and clear any discrepancies with the individual or other staff involved. Individual demographic information (individual name exactly as it appears in Social Security Administration (SSA) records for date of birth, Social Security number and individual number, if available) should not be entered into a database before a State On Line Query (SOLQ), Wired Third Party Query (WTPY) System or other SSA documentation has been received confirming the validity of the data. See Section 7210, Safeguarding Personally Identifiable Information, for important SSA data security information.

The computer system retains only one set of identification information for each individual. When an individual is active in more than one program area, the identification information is shared by the staff involved. Only the staff member with the highest priority over the information can change the identification information. The following priority applies:

  • A program area supplying benefits to an individual takes precedence over a program area not supplying benefits to that individual. Example: Temporary Assistance for Needy Families (TANF) caretaker information takes precedence over TANF payee information; status in group Code 1 (Medical Assistance Only (MAO) recipient) information takes precedence over Code 3 (MAO eligible spouse) information; and an active case takes precedence over a denied case.
  • For name and birth date identification data:
Priority is given to:Over:
MAOANF, Supplemental Security Income (SSI), Supplemental Nutrition Assistance Program (SNAP)
  • For sex and race identification data:
Priority is given to:Over:

7230.1 Address Changes for SSI Recipients

Revision 17-1; Effective March 15, 2017

For individuals on Supplemental Security Income (SSI) who move from one address to another, inform the individual or his responsible party to contact the Social Security Administration (SSA) to request the residence address change. The address change will be reflected in the Texas Integrated Eligibility Redesign System (TIERS) after SSA makes the change.

HHSC case workers must not send address change requests for SSI recipients to the TIERS Document Processing Center (DPC) in Austin. Although HHSC staff are able to make those address changes, the addresses will revert back to the address on the SSI record at the next state cut off. The address change must be made by SSA.

7240 Merge and Separate

Revision 17-1; Effective March 15, 2017

If an individual is erroneously assigned more than one individual number, or two or more individuals are erroneously assigned the same individual number, the problem should be reported to the state office Data Control Unit.

If the case must be certified prior to merging, decide which number to enter, using the following rules to select the individual number. If you have:

  • an active individual and denied individual in the same or different program area, use the individual number from the active case.
  • two individual numbers in different program areas, use the individual number from the case with Medicaid coverage.
  • an active individual receiving benefits and an active individual not receiving benefits in the same program area, use the individual number from the case receiving benefits.
  • a denied individual with Medicaid and one denied individual with no Medicaid, use the individual number from the denied case with Medicaid.
  • denied individuals in the same program area, use the individual number most recently denied.