Revision 11-1; Effective March 1, 2011
The Social Security Administration (SSA) determines Medicaid eligibility for all persons who apply for SSI cash benefits. When SSA makes a determination on an application for SSI cash benefits (either approved or denied), HHSC is notified by means of the SSA/State Data Exchange System (SDX).
SSA is responsible for redetermination of SSI Medicaid eligibility. See Section H-6000, Co-Payment for SSI Cases, for other special handling of SSI eligible individuals.
B-7110 Continuous Medicaid Coverage After SSI Denial for Income
Revision 20-3; Effective September 1, 2020
Certain SSI recipients are eligible for temporary Medicaid following the loss of SSI due to excess income. Medicaid eligibility is automatically extended for a short time for the following SSI recipients:
- children under 18 years old who receive waiver services; and
- people who receive an increase in Social Security Disabled Adult Children (DAC) benefits or Early Aged or Disabled Widow(er)’s benefits, who have no other income.
Recipients must return the Form H1200 and be determined eligible to continue to receive Medicaid after the short-term extended period ends.
Recipients who do not return a Form H1200 will be denied Medicaid at the end of the extended period. If SSA reinstates the recipient’s SSI benefits, SSI Medicaid will be reinstated. Medicaid coverage will not be extended again at subsequent SSI denials or suspensions for the following 12 months.
Send the following correspondence when Medicaid is extended after the loss of SSI:
- Form H1296, Notice of SSI Medicaid Ending – to notify the person that SSI Medicaid is ending due to the loss of SSI benefits.
- Form TF0001, Notice of Case Action – to inform the person of the extended Medicaid period and that they must complete and return the Form H1200 by the due date in order to receive Medicaid after the extended period; and
- Form H1200, Application for Assistance - Your Texas Benefits.
If Form H1200 is received, determine ongoing eligibility for the appropriate type of Medicaid. Expedite processing applications received before the extended Medicaid coverage ends. Expedited applications must be processed within 10 workdays from the date of application.
Children Receiving Waiver Services
Children who receive services through one of the following waiver programs are eligible to receive temporary ME-Waiver Medicaid for one month following the loss of SSI due to excess income:
- Medically Dependent Children Program (MDCP);
- Community Living Assistance and Support Services (CLASS);
- Home and Community-based Services (HCS);
- Youth Empowerment Services (YES); or
- Deaf Blind with Multiple Disabilities (DBMD).
If Form H1200 is received, determine ongoing eligibility for ME-Waiver Medicaid. If eligible, ME-Waiver Medicaid will remain active through the end of the month of the child’s 18th birthday. If the child is determined not eligible under any other Medicaid type of assistance, Medicaid is denied at the end of the one-month extended period.
- Applications submitted by the child or their parent or authorized representative do not require an associated Form H1746-A, MEPD Referral Cover Sheet.
- Applications submitted by program providers, including Managed Care Organizations (MCOs), Local Intellectual & Developmental Disability Authorities (LIDDAs) and Local Authorities (LAs), on behalf of a child receiving extended ME-Waiver Medicaid must include an associated Form H1746-A.
If SSI benefits are reinstated while the child is active ME-Waiver Medicaid, SSI Medicaid will be suppressed, and ME-Waiver Medicaid will remain active. This is to avoid future gaps in coverage.
If SSI benefits are active when the child turns 18, ME-Waiver Medicaid will terminate and SSI Medicaid will be reinstated.
If SSI benefits are not active when the child turns 18, ME-Waiver Medicaid will remain active and will follow the regular renewal process.
Recipients of DAC or Widow/Widower Benefits
SSI recipients denied due to an increase in or receipt of RSDI disabled adult children’s benefits or widow/widower’s benefits, who do not receive income other than RSDI, are eligible to receive temporary Medicaid for two months following the loss of SSI.
- People receiving Social Security DAC benefits are eligible for ME-DAC Medicaid. (Note: People receiving SSI and QMB will receive ME-DAC and MC-QMB.)
- People receiving Social Security Early Aged or Disabled Widow/Widower’s benefits are eligible for ME-Disabled Widow(er) or ME-Early Aged Widow(er) Medicaid.
If Form H1200 is received, determine ongoing eligibility for the appropriate type of Medicaid, ME-DAC, ME-Disabled Widow(er) or ME-Early Aged Widow(er). If the recipient is determined not eligible, Medicaid will be denied at the end of the two-month extended period.