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D-3610 Interstate Requests for Assistance
Revision 09-4; Effective December 1, 2009
If a recipient is eligible for Medicaid in another state and receives Medicaid in that state, the person is not eligible for Medicaid from the state of Texas.
If a person is placed in an institution located in Texas by an agency of another state, the person remains a resident of the state that made the placement.
D-3620 Out-of-State Medicaid and Texas Medicaid Recipients
Revision 09-4; Effective December 1, 2009
Under certain conditions, HHSC makes vendor payment to out-of-state providers on behalf of Texas Medicaid recipients. An out-of-state provider must be contracted with Texas as a Medicaid provider in its own state to provide care or services to Medicaid recipients and the recipients must be eligible for Texas Medicaid for the time involved. No payment commitment can be made until all necessary forms have been completed.
An out-of-state provider can contact Texas' contracted Medicaid claims administrator, currently the Texas Medicaid and Healthcare Partnership (TMHP). TMHP's website for the Texas Medicaid Program is www.tmhp.com.
The provider should furnish as much information as possible about the recipient, including the recipient's full name, Texas Medicaid number, Social Security number, date of birth, date of admission and date of discharge.
Note: If the person receives SSI and intends to live in the other state, inform the person to notify the Social Security Administration immediately about the move.
D-3630 Texas Applicant Outside the State of Texas
Revision 09-4; Effective December 1, 2009
If a person from Texas wishes to apply for Medicaid while outside the state, the person should contact the other state's Medicaid agency. The other state's Medicaid agency determines whether:
- the person plans to live or visit in that state; and
- that state's Medicaid is available to the person.
If the other state's Medicaid agency determines that the person is not eligible for that state's Medicaid, the other state's Medicaid agency contacts HHSC.
HHSC sends the person an application to apply for Texas Medicaid.
When the completed application is returned, use the person's Texas address as the residence address and the out-of-state address as the mailing address. Consider the person as a resident of Texas for the month of application and for the retroactive coverage period if appropriate.
After eligibility is determined, a copy of the decision is sent to the other state's Medicaid agency.
D-3640 Applicant from Another State
Revision 09-4; Effective December 1, 2009
A person from another state may ask to apply for Medicaid in Texas. Although the opportunity to apply for Medicaid cannot be denied to another, ask the following questions to assist the person in determining whether an application in Texas is appropriate:
- Is the person visiting or does the person intend to live in Texas?
- Is the person receiving Medicaid from another state?
- Does the person want to receive Medicaid from Texas or from the other state?
- Has the person declared intent to live in Texas with the full knowledge that if the person is eligible for Medicaid in Texas, the person is not eligible to receive Medicaid from the other state?
- Is the person aware that if the person declares the intent to live in Texas and is certified for Medicaid in Texas, HHSC notifies the other state?
In some instances, a person might tentatively declare intent to live in Texas but is found to be ineligible for Medicaid in Texas. Be careful to avoid action that might jeopardize a person's continued eligibility for Medicaid from another state. Although a person might at first declare intent to live in Texas, the person might decide to continue receiving Medicaid from the other state (if the person learns of ineligibility for Medicaid in Texas). Consequently, the person might revoke the declaration of intent to live in Texas and keep the person's residence in the other state.
D-3650 Out-of-State Recipient Visiting Texas
Revision 09-4; Effective December 1, 2009
If a recipient who receives a money grant (TANF, general assistance, state supplementary payments to SSI) or Medicaid, including Medicare Savings Program benefits, from another state and applies for Medicaid in Texas, determine whether:
- the recipient intends to continue receiving the money grant or Medicaid from the other state; and
- Medicaid benefits are available to the recipient from that state.
Declaration to continue living in the other state — If the recipient declares the intent to continue living in the other state, the recipient is not eligible for Medicaid in Texas. Contact the out-of-state Medicaid agency to determine which services are covered and how providers file claims. Have the recipient inform any Texas Medicaid provider to send any claim to the out-of-state Medicaid agency in the recipient's state of residence.
Declaration to live in Texas — If a recipient who receives a money grant from another state (TANF, general assistance, state supplementary payments to SSI) makes a declaration of intent to live in Texas, this declaration does not automatically establish eligibility. Determine eligibility according to the requirements of the Texas Medicaid Program.
Impact on the medical effective date — If the intent to live in Texas is made by the recipient and the recipient meets Texas MEPD requirements, contact the out-of-state Medicaid agency of the recipient's former state of residence to determine the last day Medicaid claims will be paid by that state. The denial effective date is the last day for which the recipient 's former state of residence will pay Medicaid claims. This is not necessarily the denial effective date on the former state's computer system. The medical effective date for the recipient in Texas is no earlier than the day following the date the recipient 's former state of residence will pay Medicaid claims.
D-3660 SSI Recipient Visiting in Texas
Revision 16-3; Effective September 1, 2016
If an out-of-state SSI recipient indicates an intent to live in Texas, refer the recipient to a Social Security Administration (SSA) office. SSA makes the SSI residence determination. SSA will modify the SSI file indicating the new address. The change in the SSI file will trigger a change in the new address for the Medicaid file.
If the SSI recipient indicates a need for medical care during the month of the move to Texas, give the recipient Form H1300, Declaration of Texas Residency, and refer the recipient to an SSA office for verification of SSI status. SSA accepts Form H1300 via fax.
When the completed Form H1300 is returned, process under ME – Nursing Facility, to begin Medicaid coverage in Texas effective the day after the last date claims will be paid in the former state. Once the application has been disposed, Form H1027-A, Medicaid Eligibility Verification, covering the recipient's residence in Texas can be issued, if needed.
Example: An SSI recipient moves to Texas on Aug. 10 and needs medical care. After receipt of confirmation of SSI status for the month of August and verification from the former state that it will pay no Medicaid claims after Aug. 9, the eligibility specialist processes the application using ME – Nursing Facility for 8/10/YYYY through 8/31/YYYY and issues Form H1027 for those dates, if needed.
Note: Remember that Medicaid coverage in Texas may begin no earlier than the day after the last date claims will be paid by the former state.
If the request for coverage of medical care received in the month of the recipient's move to Texas is made during a subsequent month (or received in the month of the move, but the application is not disposed until the following month), the procedure is the same as above except that the application is processed using ME-SSI Prior for the month of move to Texas. In this instance, the medical effective date would be the first day of the month of move and the denial date would be the last day of that month. Do not issue Form H1027 for a past month. Instead, inform the recipient that Your Texas Benefits Medicaid ID card will be sent so that receipt is within seven to 14 days. The recipient must notify all providers of the added coverage for purposes of timely claims filing.
Example: An SSI recipient moves to Texas on May 24 and receives medical care on May 26. On June 15, the recipient requests assistance for that expense. After receipt of confirmation of SSI status for the month of May and verification from the former state that it will pay no Medicaid claims after May 23, the eligibility specialist processes the application using ME-SSI Prior for 5/1/YYYY through 5/31/YYYY. Inform the recipient that Your Texas Benefits Medicaid ID card will be sent so that receipt is within seven to 14 days, which the recipient must then use to notify provider(s) of Medicaid eligibility.
TIERS Procedures
Process as a manual SSI during the month of move. The medical effective date will be the first of the month.
Note: Even though the medical effective date precedes the actual date the recipient moves into the state, Texas medical claims would not have been incurred prior to the move date.