Section 6000, Supplemental Security Income (SSI) Reimbursement


Revision 20-0; Effective November 2019


6100 General Principles

Revision 20-0; Effective November 2019


To receive retroactive Medicaid reimbursement for Supplemental Security Income (SSI) appellants, a county must comply with the HHSC established standards and procedures contained in this handbook.

Effective Oct. 1, 2008, HHSC can only file Medicaid claims for reimbursement if they are:

  • paid for CIHCP eligible county residents;
  • received within 95 days from the "SSI add date" and within 365 days from the date of service.

In addition, due to changes in the Texas Administrative Code, all Medicaid claims processed through HHSC must meet the 365-day federal filing deadline.


6200 Steps for Applying

Revision 20-0; Effective November 2019




6210 Steps for Requesting Medicaid Reimbursement for SSI Appellants

Revision 20-0; Effective November 2019


Step 1 – County staff must sign and submit Form 3087, TMHP Confidentiality Agreement, to HHSC.

Step 2 – County staff must have a potential Supplemental Security Income (SSI) appellant sign Form 3081, Appellant – Provider Assignment. The form must also be signed by the provider. Note: Claims paid before signatures are obtained will not be eligible for reimbursement.

Step 3 – Submit Form 3080, SSI Appellant Notification, with the requested reimbursement costs and Medicaid approved claim forms (Form CMS-1500, UB-04 or pharmacy statement).

The full Medicaid Reimbursement Manual may be accessed at Medicaid Reimbursement Manual (PDF).