Appendix XXII, Community Attendant Services Financial Eligibility Requirements

Revision 17-1; Effective March 15, 2017

Section 42, Code of Federal Regulations, §431.10, specifies that Medicaid eligibility must be determined by a single state agency. The Texas State Plan designates the Texas Health and Human Services Commission (HHSC) as the sole agency with the authority to make eligibility determinations for Medical Assistance Only (MAO) cases.

Therefore, financial eligibility for Community Attendant Services (CAS) is determined exclusively by Medicaid for the Elderly and People with Disabilities (MEPD) staff. However, Community Care Services Eligibility (CCSE) staff must make an effort during the initial visit with each applicant to gather as much documentation as possible to hasten the MEPD specialist’s completion of the eligibility determination.

I. Income and Resource Eligibility

The following income and resource verifications/documentations must be included in the MEPD specialist’s case record to make a financial eligibility decision for a CAS case.

As verification of:the MEPD specialist:
bank accounts

must document the:

  • name of the financial institution and account number;
  • account accessibility by the individual;
  • account balance as of 12:01 a.m. on first day of the appropriate month(s); and
  • source of verification.
cashmay accept without verification the individual’s statement about the amount of cash on hand. Ask the individual if he has any cash in a safety deposit box or if any of his cash on hand is in the form of valuable coins.
trusts

must document the:

  • name of the trustee, settlor and beneficiary;
  • accessibility of the trust;
  • value of the trust that is accessible;
  • amount and frequency of income from the trust to the individual; and
  • source of verification.
stocks

must document the:

  • name of the company, number of shares and type of shares;
  • market value as of 12:01 a.m. on the first day of the appropriate month; and
  • source of verification.
bonds

must document the:

  • name of the company, type of bond and serial number;
  • market value as of 12:01 a.m. on the first day of the appropriate month; and
  • source of verification.
promissory notes, loans and property agreements

must document the:

  • ownership of the note;
  • accessibility by the individual;
  • term and whether it is negotiable;
  • reason for exclusion, if excluded;
  • current market value of the note; and
  • source of verification.
other real property

must document the:

  • location and description of the property;
  • individual’s ownership interest in the property;
  • current equity value of the individual's interest; and
  • source of verification.
life estates

must document the:

  • location of the life estate property;
  • current equity value; and
  • source used as verification.
life insurance

must document the:

  • name of the insurance company, policy number and face value (including the possibility of dividends, if participating);
  • type of insurance coverage;
  • current cash value; and
  • source used to verify the value.
burial spaces

must document the:

  • name of the cemetery;
  • number of vacant spaces and the names and relationships of the designees;
  • ownership;
  • current market value; and
  • source used as verification.
burial funds

must document the:

  • type of liquid resource being designated;
  • amount of assets being designated;
  • written statement from the individual or responsible person designating the asset for burial, unless the resource being designated is a prepaid burial contract or a bank account styled "for burial"; and
  • copy of the insurance policy if a funeral home is listed as the beneficiary.
mineral rights

must document the:

  • location of the property;
  • percentage of interest in mineral rights;
  • individual’s accessibility to the interest in mineral rights;
  • current equity value of the individual's interest; and
  • source of verification.
earned income

must document the:

  • gross earned income (if income fluctuates, amounts for the previous six months or less, depending on the review cycle);
  • sources of all earnings; and
  • source of verification.
support and maintenance provided to individuals living outside of an institution

must document the:

  • name(s) of the person(s) who provided support and maintenance and type of in-kind benefit given to the individual;
  • amount of any payment or contributions made by the individual; and
  • actual market value of the in-kind benefit.
farm income

must document the:

  • type of farm income and the individual's interest and accessibility of the farm income;
  • amount of gross income and allowable expenses from the previous six months;
  • reason, if the amount of income is anticipated to be different; and
  • source of verification.
Social Security benefits

must document the:

  • amount of the gross benefit and the amount of the Supplementary Medical Insurance Benefit (SMIB) premium, if appropriate;
  • claim number;
  • source of verification; and
  • gross benefit verification (for applications).
Railroad Retirement benefits

must document the:

  • gross amount of the benefit and the amount of the SMIB premium, if appropriate;
  • railroad retirement claim number; and
  • source of verification.
Veterans Affairs (VA) compensation and pensions

must document the:

  • gross amount of the benefit and the amount of any deductions, if appropriate;
  • amount of aid-and-attendance or housebound benefits, if any;
  • VA claim number; and
  • source of verification.
other annuities, pensions and retirements plans

must document the:

  • source of payments;
  • amount of the gross benefit;
  • claim number, if a civil service annuity; and
  • source of verification.
interest and dividends

must document the:

  • name of the financial institution or other source of interest or dividend income;
  • account number, if received from a financial institution;
  • frequency of receipt and the amounts paid in the last six months; and
  • source of verification.
rents

must document the:

  • type of rental income and the individual's interest and accessibility of the income;
  • amount of gross income and expenses from the previous six months;
  • reason for the difference in the income, if the amount is anticipated to be different; and
  • source of verification.
royalties

must document the:

  • name, payor and reason for payment;
  • frequency of payment and the amounts paid during the previous six or 12 months; and
  • source of verification.
gifts, inheritances, support and alimony

determines whether the gift, inheritance, support or alimony is to be treated as a lump sum payment, infrequent or irregular income, or regular and predictable income. He documents the:

  • source of the income;
  • frequency received and the amount; and
  • expected continuation.
notes and mortgages

must document the:

  • name of the person making note payments and whether income is accessible to the individual;
  • amount of payment and the frequency of the payments; and
  • source of verification.
the home as a countable resourcemust document the location and ownership of the homestead.

II. Citizenship Requirements for Eligibility

Public Law 109-171, Deficit Reduction Act of 2005, requires that documentation be provided at the initial determination, and for ongoing cases, at the next redetermination of eligibility for all Medicaid cases. Verification of citizenship and identity for eligibility purposes is a one-time activity. Once verification of citizenship is established and documented by MEPD staff, verification is no longer required, even after a break in eligibility.

Long Term Services and Supports (LTSS) case workers must be prepared to assist individuals with this process by informing LTSS individuals of the requirement and helping to identify the documentation needed to prove citizenship and identity. Information available at the time of the home visit must be collected and submitted with the application for an MEPD determination. Individuals may obtain and forward copies to HHSC for transmittal to MEPD staff.

MEPD staff accept copies and faxes only if clear and legible. If the LTSS case worker receives an affidavit as verification, ensure that the reason the applicant or recipient is unable to produce documentary evidence of citizenship and identity is documented on the affidavit. If the affidavit does not contain this information, the reason another source is not available is documented and transmitted to MEPD staff on Form 2067, Case Information, along with the affidavit. The case worker must ensure the applicant/individual is signing the affidavit under penalty of perjury.

Acceptable Documentation for Both Citizenship and Identity

Supplemental Security Income (SSI) Recipients – State Data Exchange (SDX) contains the needed information to verify citizenship. For any active Supplemental Security Income (SSI) recipient, MEPD staff are able to use SDX as verification of both citizenship and identity. For any denied SSI recipient, SDX can be used as a valid verification source of both citizenship and identity when the denial is for any reason other than citizenship. The SDX printout will show action code N13 if the denial is for citizenship.

Medicare Recipients – Active Medicare recipients are exempt from the requirement to provide evidence of citizenship and identity. The Social Security Administration documents citizenship and identity for Medicare recipients.

For any individual entitled to or enrolled in Medicare Part A or B, and subsequently denied Medicare, use the State On Line Query (SOLQ) or Wire Third Party Query (WTPY) System as documentation of both citizenship and identity when the denial is for any reason other than citizenship. If there is an end date listed for Medicare, the individual must provide documentation regarding the loss of Medicare.

All Other Individuals – The following primary documents may be accepted as proof of both identity and citizenship:

  • U.S. passport,
  • Certificate of Naturalization (N-550 or N-570), or
  • Certificate of U.S. Citizenship (N-560 or N-561).

Documents that establish citizenship are divided into second, third and fourth levels based on the reliability of the evidence:

  • One document that establishes U.S. citizenship, and
  • One document that establishes identity.

Hierarchy of Approved Documentation Sources

Primary Evidence of Citizenship and Identity

  • U.S. passport
  • Certificate of Naturalization
  • Certificate of U.S. citizenship
  • SDX for denied SSI recipients when the denial reason is for any reason other than citizenship (N13)
  • SOLQ/WTPY and documentation on reason for Medicare denial

If primary evidence of citizenship is not available, the individual must provide two documents – one to establish U.S. citizenship and one to establish identity, as outlined below. Begin with the second level of evidence of citizenship and continue through the levels to locate the best available documentation.

Second Level of Evidence of Citizenship (Use only when primary evidence is not available)

  • Rico (if born on or after Jan. 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after Jan. 17, 1917), American Samoa, Swain’s Island or the Northern Mariana Islands (after Nov. 4, 1986) - Contact Bureau of Vital Statistics (BVS) for an individual born in Texas. If an individual’s date of birth is earlier than 1903 or if the birth was out of state, accept a legible/non-questionable copy. For a birth out of state, individuals may obtain a birth certificate through the following: BirthCertificate.com; vitalchek.com; usbirthcertificate.net or the toll-free number, 1-888-736-2692.
  • Report of Birth Abroad of a U.S. Citizen (FS-240)
  • Certification of Birth Abroad (FS 545 or DS-1350)
  • U.S. Citizen identification card (Form I-179 or I-197)
  • Northern Mariana identification card (I-873)
  • American Indian card (I-872) issued by Department of Homeland Security with classification code “KIC”
  • Final adoption decree showing the child’s name and U.S. place of birth
  • Evidence of U.S. Civil Service employment before June 1, 1976
  • U.S. Military record showing a U.S. place of birth (Example: DD-214)

Third Level of Evidence of Citizenship (Use only when primary and second level evidence is not available)

  • Hospital record of birth showing a U.S. place of birth
  • Life, health or other insurance record showing a U.S. place of birth
  • Religious record of birth recorded in the U.S. or its territories within three months of birth, which indicates a U.S. place of birth showing either the date of birth or the individual's age at the time the record was made

Fourth Level of Evidence of Citizenship (Use only when primary, second level and third level evidence is not available)

Any listed documents must include biographical information including a U.S. place of birth.

  • Federal or state census record showing U.S. citizenship or a U.S. place of birth and the individual’s age (generally for individuals born 1900-1950)
  • Seneca Indian Tribal census record showing a U.S. place of birth
  • Bureau of Indian Affairs Tribal census records of the Navajo Indians showing a U.S. place of birth
  • U.S. State Vital Statistics official notification of birth registration showing a U.S. place of birth
  • Statement showing a U.S. place of birth signed by the physician or midwife who was in attendance at the time of birth
  • Institutional admission papers from a nursing facility, skilled care facility or other institution showing a U.S. place of birth
  • Medical (clinic, doctor or hospital) record, excluding an immunization record, showing a U.S. place of birth
  • Affidavits from two adults regardless of blood relationship to the individual (use only as a last resort when no other evidence is available)

Evidence of Identity

  • Driver license issued by a state either with a photograph or other identifying information such as name, age, sex, race, height, weight or eye color
  • School identification card with a photograph
  • U.S. Military card or draft record
  • Department of Public Safety identification card with a photograph or other identifying information such as name, age, sex, race, height, weight or eye color
  • Birth certificate
  • Hospital record of birth
  • Military dependent’s identification card
  • Native American Tribal document
  • U.S. Coast Guard Merchant Mariner card
  • Certificate of Degree of Indian Blood or other U.S. American Indian/Alaskan Native and Tribal document with a photograph or other personal identifying information
  • Data matches with other state or federal government agencies (for example, Employee Retirement System and Teacher Retirement System)
  • Adoption papers or records
  • Work identification card with photograph
  • Signed application for Medicaid (accept the signature of an authorized representative or a responsible person acting on the individual’s behalf)
  • Health care admission statement
  • School records for children under age 16, which may include nursery or day care records
  • An affidavit signed by a parent or guardian for a child under age 16, stating the date and place of birth of the child (use as a last resort when no other evidence is available and if an affidavit is not used to establish citizenship)

In the hierarchy of approved documentation sources, some documents listed to verify citizenship are also acceptable to verify identity. When using the hierarchy of approved documentation sources, the same document cannot be the source to verify both citizenship and identity.

If an individual is unable to provide any other documentary evidence of citizenship, an affidavit signed under penalty of perjury will only be accepted as a last resort. MEPD staff are required to document the reason another source is not available to verify citizenship. If the LTSS case worker is provided an affidavit, ensure the reason the applicant or recipient is unable to produce documentary evidence of citizenship and identity is documented on the affidavit. If the affidavit does not contain this information, the reason another source is not available is documented and transmitted to MEPD staff on Form 2067, along with the affidavit. The copies of the affidavit form, available online at https://hhs.texas.gov/laws-regulations/forms, are to be made available in all HHSC benefits offices.

Reasonable Opportunity to Provide Verification

The LTSS case worker must inform all applicants if MEPD staff do not receive documentation of citizenship and identity by the application due date, certification may be delayed and eventually denied if verification documentation is not provided.

Inform ongoing recipients that they will be asked to provide documentation verifying citizenship and identity at the redetermination. If an ongoing recipient cannot provide the required verification(s) at the initial request, eligibility will continue until the next redetermination. Eligibility will be denied if the recipient does not provide the required verification(s) at the next complete redetermination.

Assistance to Individuals in Obtaining Documentary Evidence

To assist an individual who is unable to provide documentary evidence of citizenship and identity in a timely manner because of incapacity of mind or body or the lack of a representative to assist, staff may make referrals to the following entities:

  • Department of Family and Protective Services, Adult Protective Services
  • Legal Aid
  • Community-based organizations
  • Social Security Administration
  • 2-1-1

For individuals born out of state, some sources to obtain a birth certificate are:

  • BirthCertificate.com
  • Vitalchek.com
  • Usbirthcertificate.net or the toll free number, 1-888-736-2692

When assisting the individual in providing documentary evidence of citizenship and identity, use any available documents, regardless of level of evidence.