Revision 09-4; Effective Dec. 1, 2009
Federal law requires that anyone who wishes to apply for a Medicaid program be allowed to file an application without delay, regardless of the person's ultimate eligibility for assistance.
An application form must be mailed within two working days from the receipt of the request for an application.
Use an application form to test eligibility for all Medicaid programs for which a person meets the criteria. A separate application form is not required for each of the different Medicaid programs for the elderly and persons with disabilities.
Consider the application complete with a name, address and signature.
B-3210 Who May Complete an Application for Assistance
Revision 16-3; Effective Sept. 1, 2016
An individual who may complete or sign an application for an applicant may possibly not be on the list of individuals to whom the Texas Health and Human Services Commission (HHSC) can release the applicant’s individually identifiable health information. See Section C-5000, Personal Representatives, for individuals who may receive or authorize the release of an applicant's individually identifiable health information under Health Insurance Portability and Accountability Act (HIPAA) privacy regulations.
An authorized representative may accompany, assist and represent an applicant or recipient in the application or eligibility redetermination process.
Anyone may assist the applicant, guardian, power of attorney or authorized representative in completing an application form. If someone helps complete the application for assistance, the name of the individual completing the form must appear as requested on the application.
See Section B-3220, Who May Sign an Application for Assistance, to determine who may sign an application for assistance form. The requirements for signing a redetermination form are the same as the requirements for signing an application.
See Section C-1100, Responsibility of Applying.
Most applicants in an institutional setting such as a nursing facility are signed into the facility by someone else. An application and information from the applicant and/or the individual(s) having knowledge of the applicant's fina al circumstances are required.
B-3220 Who May Sign an Application for Assistance
Revision 16-3; Effective Sept. 1, 2016
An individual who may complete or sign an application for an applicant may not be on the list of people to whom HHSC can release the applicant’s individually identifiable health information. See Section C-5000, Personal Representatives, for individuals who may receive or authorize the release of an applicant’s individually identifiable health information under HIPAA privacy regulations.
An applicant, authorized representative or someone acting responsibly for the applicant (if the applicant is incompetent or incapacitated) may sign an application for assistance. The application for assistance must be signed under penalty of perjury.
If an applicant has a guardian, the guardian must:
- sign the application for assistance;
- obtain a copy of the guardianship papers; and
- work with the guardian in the eligibility process.
If an application is signed by someone other than the applicant or the applicant’s guardian, power of attorney, family member, or a friend who is knowledgeable of the applicant’s finances, the individual must provide a Form H1003, Appointment of an Authorized Representative, signed by the applicant, or evidence of:
- authority to complete and sign an application on behalf of an applicant;
- the individual’s relationship to the applicant; and
- responsibility for the applicant’s care.
If an applicant makes an "X" on the signature line for applicant/recipient, a witness must sign on the witness signature line.
B-3221 Valid Signatures
Revision 19-1; Effective March 1, 2019
All applications and renewals must be signed under the penalty of perjury statement.
Valid signatures include only the following:
- a traditional written signature;
- a faxed written signature;
- an electronic signature submitted through YourTexasBenefits.com; and
- a telephonic signature submitted by calling 2-1-1.
An applicant may apply for all MEPD programs through YourTexasBenefits.com. Applications submitted online through YourTexasBenefits.com by an applicant or AR are considered electronically signed. A “traditional” written signature is not required before an applicant can be certified.
An applicant may apply for Medicaid by calling 2-1-1. An applicant or AR may complete and sign an application over the phone by:
- providing their information over the phone to a customer care representative (CCR); and
- signing the application telephonically by stating their name and agreeing to the penalty of perjury statement read by the CCR.
The CCR enters and submits the information provided by the applicant or AR through YourTexasBenefits.com.
An application or renewal form received without a signature below the penalty of perjury statement is considered invalid.
If the agency receives an application without a signature and does not accept the application by giving the application an established file date, then the application is considered invalid. Staff must return the application with a letter and a self-addressed return envelope explaining that the application must be signed before the agency can establish a file date.
If the agency receives and accepts an application without a signature and the application is given an established file date in error, the date the application is received is considered a valid file date. Staff must send Form H1020, Request for Information or Action, along with the signature page requesting a signature. If the applicant fails to provide a signed application by the final due date, staff must deny the application for failure to provide information.
Processing Deadlines, B-6400
Who May Sign an Application for Assistance, B-3220
B-3230 Receipt of Duplicate or Identical Applications
Revision 20-3; Effective Sept. 1, 2020
An application filed after another application has already been filed is a duplicate application if it:
- does not include a request for a new program (i.e.: a type of program not requested on the initial application or a type of program not currently received by the applicant); and
- is not needed for a redetermination of the active program(s).
Example: An application is received on January 2 and a second application for the same program is received on January 5. The second application is considered a duplicate application.
If a duplicate application is received while the first application is being processed:
- treat the duplicate application as a report of change; and
- assign to the eligibility staff currently processing the case.
If a duplicate application is received after the first application has been processed, review the application to ensure the person is not applying for a different type of program and that a redetermination is not due. If a new program is not being requested:
- consider the duplicate application as a report of change; and
- assign as a change indicating "duplicate application."
If the person is applying for a new program, the application is not a duplicate application. Process the application as a new request for assistance.
An identical application is an exact copy of an application previously submitted by an applicant.
Example: An application is received by fax on January 2 and an exact copy of the same application (with the same signature and date of the previously submitted application) is received by mail on January 5. The second application is considered an identical application.
Required Action on Identical Application Received
If an identical application is received, write "Identical Application" on the front page of the application and route for imaging. The identical application will be imaged and added to the electronic case record. No other action is needed.
B-3240 Electronic Correspondence
Revision 22-3; Effective September 1, 2022
At any time, an applicant, recipient, or authorized representative (AR) for a case may view available eligibility correspondence electronically through YourTexasBenefits.com instead of receiving them by mail. By selecting this option, applicable forms and notices are posted to the recipient’s or AR’s YourTexasBenefits.com case account. A text message or an e-mail reminder is sent to the recipient each time a new form or notice is posted to their account. The recipient may print a copy of the correspondence from their YourTexasBenefits.com account or request a paper copy be mailed to them. Forms and notices that are not available electronically will continue to be mailed to the recipient or AR.