11100 Financial Eligibility Guidelines for Texas Home Living and Home and Community-based Services

Revision 25-1; Effective April 29, 2025

The Texas Health and Human Services Commission (HHSC) requires that every person meet financial eligibility for enrollment in the Texas Home Living (TxHmL) or Home and Community-based Services (HCS) waiver program. After enrollment, financial eligibility must be maintained for the person to continue participation in the program. People eligible for certain types of Medicaid coverage are financially eligible for the program. Not all types of Medicaid coverage, however, ensure eligibility.

There are several ways to meet the financial eligibility requirement for the TxHmL or HCS program through Medicaid certification.

  • People who receive Supplemental Security Income (SSI) from the Social Security Administration (SSA) are categorically eligible for SSI Medicaid.
  • People in certain adoption or foster care cases through the Department of Family and Protective Services (DFPS) are eligible for DFPS Medicaid.
  • People certified for Medicaid for the Elderly and People with Disabilities (MEPD), Texas Works Temporary Assistance for Needy Families (TANF) and certain other Medicaid programs in HHSC are eligible.

Every person certified for Medicaid benefits has a coverage code and a type program assigned to the person’s Medicaid record. The appropriate coverage code for participation in the TxHmL or HCS waiver program is R, regular Medicaid or P, three months prior coverage. No other coverage codes are acceptable. The following chart indicates the acceptable Medicaid coverage codes and program types for HCS and TxHmL.

Required Medicaid Codes and Type Program

AcronymDescription
CAREClient Assignment and Registration
LTCOPLong-Term Care Online Portal
MCPMedicaid Client Portal
MESAVMedicaid Eligibility Service Authorization Verification
TAType Assistance
TOAType of Assistance
TPType Program
Coverage CodesDescription
PThree Months Prior
RRegular Medicaid
MCP TOADescriptionHCS Waiver ProgramTxHmL Waiver ProgramMESAV, CARE or LTCOP Type of ProgramMESAV, CARE or LTCOP Coverage Code
TA02ME - SSI WaiversYesYes13R or P
TA10ME - WaiversYesNo14R or P
TA22ME - Manual SSIYesYes12R or P
TA27ME - Prior Medicaid Institutional - WaiverYesNo14R or P
TA78PCA Medicaid - 
Federal Match - No Cash
YesYes78R or P
TA79PCA Medicaid - 
No Federal Match - No Cash
YesYes79R or P
TA80PCA Medicaid - 
Federal Match - With Cash
YesYes80R or P
TA81PCA Medicaid - 
No Federal Match - With Cash
YesYes81R or P
TA82MA - FFCCYesYes82R or P
TA88ME - Medicaid Buy-In for ChildrenNoYes88R or P
TP03ME - PickleYesYes3R or P
TP07MA - Earnings TransitionalYesYes7R or P
TP08Parent or Caretaker RelativesYesYes1R or P
TP11ME - SSI PriorYesYes11R or P
TP13ME - SSIYesYes13R or P
TP17ME - Nursing FacilityYesNo14R or P
TP18ME - Disabled Adult ChildYesYes18R or P
TP20MA - Alimony or Spousal Support TransitionalYesYes20R or P
TP21ME - Disabled Widow(er)YesYes22R or P
TP22ME - Early Aged Widow(er)YesYes22R or P
TP37MA - EID TransitionalYesNo37R or P
TP38ME - SSI Nursing FacilityYesYes13R or P
TP40MA - Pregnant WomenYesYes40R or P
TP43MA - Children Under 1YesYes43R or P
TP44MA - Children 6-18YesYes44R or P
TP45MA - Newborn ChildrenYesYes45R or P
TP47MA - Children denied TANF with Applied IncYesYes47R or P
TP48MA - Children 1-5YesYes48R or P
TP55MA - Medically NeedyYesYes55R or P
TP56MA - MN with Spend DownYesYes55R or P
TP70MTFCYYesYes9R or P
TP87ME-Medicaid Buy InYesYes2R or P
TP91Adoption Assistance - 
Federal Match - No Cash
YesYes21R or P
TP92Adoption Assistance - 
Federal Match - With Cash
YesYes21R or P
TP93Foster Care - 
Federal Match - No Cash
YesYes9R or P
TP94Foster Care - 
Federal Match - With Cash
YesYes8R or P
TP95Adoption Assistance - 
No Federal Match - No Cash
YesYes15R or P
TP96Adoption Assistance - 
No Federal Match - With Cash
YesYes15R or P
TP97Foster Care - 
No Federal Match - No Cash
YesYes9R or P
TP98Foster Care - 
No Federal Match - With Cash
YesYes10R or P

For specific questions about SSI, contact your local SSA office, call 800-772-1213 or visit the SSA website at www.ssa.gov.For specific questions about MEPD or Texas Works, contact your local HHSC office, call 211 or visit the HHSC website at hhs.texas.gov or Your Texas Benefits. You may search for your local HHSC office here.

For specific questions about DFPS, call 512-929-6900 or visit its website at www.dfps.texas.gov.

11200, Responsibility to Reestablish Medicaid Eligibility

Revision 25-1; Effective April 29, 2025

If a person loses Medicaid eligibility, it is the responsibility of the representative payee or authorized representative to contact the appropriate entity to determine necessary action to reinstate benefits.

If the HCS Program provider is the representative payee or authorized representative, the provider is responsible for making sure action is taken to reestablish Medicaid eligibility.

If a person manages their Medicaid coverage or the person’s family is the representative payee or authorized representative, the service coordinator must assist if requested.

11300, Responsibility to Monitor Medicaid Eligibility

Revision 25-1; Effective April 29, 2025

Program providers must monitor Medicaid eligibility for the people they serve. LIDDAs are also encouraged to monitor Medicaid eligibility for the people they serve.

Program providers and LIDDAs can monitor Medicaid Eligibility on the Texas Medicaid & Healthcare Partnership (TMHP) LTCOP Dashboard for all enrolled people in their HCS or TxHmL contract area. The Medicaid Eligibility reports can be used to identify whose Medicaid eligibility had ended or will end at the month and to prepare for Medicaid renewal due within one year.

In addition to the TMHP LTCOP Dashboard, Medicaid Eligibility can be checked with the following applications:

  • Client Assignment and Registration (CARE) System screen C63,
  • Medicaid Eligibility Search,
  • TMHP TexMed Connect - Medicaid Eligibility and Service Authorization Verification (MESAV) system, or
  • Medicaid Client Portal (MCP).