An official State of Texas website.
Revision 24-4; Effective Sept. 1, 2024
Refer to Appendix XIV, TIERS Type Program Chart, to determine how existing coverage affects eligibility for Community Care Services Eligibility.
7210 Safeguarding Personally Identifiable Information
Revision 24-4; Effective Sept. 1, 2024
All personally identifiable information (PII) obtained from the Social Security Administration (SSA) must be safeguarded. Wire Third Party Query (WTPY) System, State Online 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 the person’s case records. Staff must document the date they verified and viewed the online or printed verification, the amount of income and source, WTPY, SOLQ, or 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 accessible by Texas Health and Human Services Commission authorized staff.
7220 Financial Eligibility Based on Receipt of Medicaid Buy-In Program Services
Revision 24-4; Effective Sept. 1, 2024
Working Texans can 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 a person's income.
Categorical Eligibility Status Verification
People 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 must be verified by one of the following:
- Searching the Texas Integrated Eligibility Redesign System (TIERS) database for Type Program (TP) 87 coverage. The (TP) 87 information will not appear on the System for Applications, Verifications, Eligibility Reports and Referral inquiry screens.
- An award letter sent to the person documenting MBI eligibility.
Staff may contact 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
Add an MBI recipient interested in an LTSS waiver program to the appropriate interest list. The caseworker can determine if an applicant is an MBI 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 A Person's Identification Data
Revision 24-4; Effective Sept. 1, 2024
Before certifying an applicant with 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 applicant or other staff involved. An applicant’s demographic information must be entered exactly as it appears in the Social Security Administration (SSA) records for date of birth, Social Security number and Individual number, if available. The demographic information should not be entered into a database before a State On Line Query (SOLQ), Wired Third Party Query (WTPY) System or other SSA documentation is received confirming the validity of the data. Review Section 7210, Safeguarding Personally Identifiable Information, for important SSA data security information.
The computer system keeps only one set of identification information for each person. When a person is active in more than one program area, staff members share the identification information. 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 a person takes precedence over a program area not supplying benefits to that person.
- 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 |
|---|---|
| MAO | TANF, Supplemental Security Income (SSI), Supplemental Nutrition Assistance Program (SNAP) |
| TANF | SSI, SNAP |
| SSI | SNAP |
- For sex and race identification data:
| Priority is given to | Over |
|---|---|
| MAO | TANF, SNAP, SSI |
| TANF | SNAP, SSI |
| SNAP | SSI |
7230.1 Address Changes for SSI Recipients
Revision 24-4; Effective Sept. 1, 2024
Tell a person on Supplemental Security Income (SSI) or their responsible party to contact the Social Security Administration (SSA) to request the residence address change when the person changes addresses. The address change will be in the Texas Integrated Eligibility Redesign System (TIERS) after SSA makes the change.
HHSC caseworkers must not send address change requests for SSI recipients to the TIERS Document Processing Center (DPC) in Austin. Although HHSC staff can make those address changes, the addresses will revert 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 24-4; Effective Sept. 1, 2024
If a person is wrongly assigned more than one Individual Number or two or more people are assigned the same Individual Number, the caseworker must report the problem to the state office Data Control Unit.
If the case must be certified before merging, decide which number to enter using the following rules to select the Individual Number. If you have:
- An active person and a denied person 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 person receiving benefits and an active person not receiving benefits in the same program area, use the Individual Number from the case receiving benefits.
- A denied person with Medicaid and one denied person with no Medicaid, use the Individual Number from the denied case with Medicaid.
- Denied people in the same program area, use the Individual Number most recently denied.