D-6300, Application for Other Benefits Requirement

Revision 09-4; Effective December 1, 2009

Medicaid is intended to be a program of last resort. Therefore, it is important to assess the other benefits for which a person may be eligible based on the person's own activities or on indirect qualifications through family circumstances.

If a person is not receiving potential benefits, notify the person in writing of the requirement to apply for and comply with the application requirements of the other benefit(s).

A person is not eligible for Medicaid if:

  • HHSC informs the person on a written, dated notice of his/her potential eligibility for other benefits; and
  • the person does not take all appropriate steps to apply for the benefit within 30 days of receipt of such notice.

The notice informs the person or authorized representative that the person must take all appropriate steps to pursue eligibility for other benefits within 30 days of receipt of such notice. Appropriate steps include:

  • applying for the benefit; and
  • providing the other benefit source with the necessary information to determine eligibility for the benefit.

 

D-6310 Other Benefits Subject to Application Requirement

Revision 09-4; Effective December 1, 2009

"Other benefits" includes any payments for which a person can apply that are available to that person on an ongoing or one-time basis of a type that includes annuities, pensions, retirement benefits or disability benefits, including:

  • RSDI Title II benefits;
  • veterans' pension and compensation payments;
  • retirement benefits;
  • workers' compensation payments;
  • pensions; and
  • unemployment insurance benefits.

These benefits are common in that they:

  • require an application or similar action;
  • have conditions for eligibility; and
  • make payments on an ongoing or one-time basis.

See Section D-6340 through Section D-6380 for details regarding benefits subject to the application requirement.

 

D-6320 Other Benefits Exempt from Application Requirement

Revision 09-4; Effective December 1, 2009

"Other benefits" exempt from the requirement to apply for other benefits are:

  • Temporary Assistance for Needy Families (TANF);
  • general public assistance;
  • Bureau of Indian Affairs general assistance;
  • victims' compensation payments;
  • other federal (other than SSI), state, local or private programs that make payments based on need; and
  • earned income tax credits.

 

D-6330 Payments That Are Not Other Benefits

Revision 09-4; Effective December 1, 2009

"Other benefits" do not include:

  • payments that a person may be eligible to receive from a fund established by a state to aid victims of crime; or
  • payments such as child support, alimony and accelerated life insurance.

 

D-6340 Supplemental Security Income (SSI)

Revision 09-4; Effective December 1, 2009

If a person who has no income applies for Medicaid with HHSC, refer that person to the Social Security Administration (SSA) for SSI benefits. SSI eligibility will provide a greater benefit to the person by allowing the person to receive a cash benefit as well as Medicaid.

Exception: Process the application and do not refer a person who has no income to SSA for SSI if the application is for Medicaid coverage for:

  • retroactive months for a deceased person or based on an SSI application; or
  • treatment of an emergency medical condition.

 

D-6341 Reserved for Future Use

Revision 19-4; Effective December 1, 2019

 

D-6350 Veterans Benefits

Revision 09-4; Effective December 1, 2009

The most common types of benefits from the U.S. Department of Veterans Affairs (VA) are:

  • pension;
  • compensation;
  • educational assistance;
  • aid and attendance allowance;
  • housebound allowance;
  • clothing allowance;
  • payment adjustment for unusual medical expenses;
  • payments to Vietnam veterans' children with spina bifida; and
  • insurance payments for disability insurance and life insurance.

Explore the possibility of receipt of, or potential eligibility for, a VA benefit when it appears that a person is:

  • a veteran;
  • the child or spouse of a disabled or deceased service person or veteran;
  • an unmarried widow or widower of a deceased service person or veteran; or
  • the parent of a service person or veteran who died before Jan. 1, 1957, from a service-connected cause.

A person who is potentially eligible for some VA benefits must apply for those benefits. When referring a person to the VA, recommend that the person call the VA first to obtain information on application requirements and proof the person may need to bring.

 

D-6351 VA Pension or Compensation

Revision 10-1; Effective March 1, 2010

Refer a person for VA pension payments (based on a nonservice-connected disability) if all of the following conditions are met:

  • The veteran or deceased service member served at least 90 days, at least one of which was during a wartime period (see Section D-6352, VA Wartime Periods).
  • The person being referred is a veteran, surviving spouse or surviving child.
  • The person has not alleged, in a signed statement, having previously applied for the Department of Veterans Affairs Improved Pension Plan (VAIP).

Refer the person for VA compensation payments if the veteran or deceased service person suffered a service-connected disability (even though minor) or died.

Refer a person for VA payment increases for medical expenses. However, do not monitor for the person’s compliance to apply for other benefits when it is to increase the VA payment for medical expenses. These VA payment increases for medical expenses are known as aid and attendance, housebound benefits or additional payments for unusual medical expenses and are considered exempt payments that do not affect eligibility or co-payment.

See the following references:

Exceptions:

  • Do not refer a person who has been eligible for a VA pension since before 1979.
  • Do not refer a person who is receiving the $90 VA pension in an institutional setting.

See the following references:

 

D-6352 VA Wartime Periods

Revision 14-1; Effective March 1, 2014

The wartime periods are:

War Time Periods
World War I Apr 6, 1917 to Nov 11, 1918
World War II Dec 7, 1941 to Dec 31, 1946
Korea Jun 27, 1950 to Jan 31, 1955
Vietnam (served in the Republic of Vietnam) Feb 28, 1961 to Aug 4, 1975
Vietnam (served other than in the Republic of Vietnam) Aug 5, 1964 to May 7, 1975
(Persian) Gulf War Aug 2, 1990 through a date to be set by law or presidential proclamation (per VA)
Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom 2001 to present
Note: This war period is not yet listed on the VA's website. Refer person to VA Benefit Counselor at 1-800-827-1000.

 

D-6353 VA Payments for Dependents

Revision 09-4; Effective December 1, 2009

The VA may take a dependent's needs into account in determining a pension. Usually, however, the VA does not make a pension payment directly to a dependent during the lifetime of the veteran. Instead, the amount of the veteran's basic pension is increased if the veteran has dependents.

Augmented VA payment — A VA pension payment that has been increased for dependents is an augmented VA payment. For Medicaid purposes, the augmented benefit includes a designated beneficiary's portion and one or more dependents' portions.

Apportioned VA payment — A VA compensation payment made directly to the dependent of a living veteran is an apportioned payment. Apportionment is direct payment of the dependent's portion of VA benefits to a dependent spouse or child. The VA decides whether and how much to pay by apportionment on a case-by-case basis. Apportionment reduces the amount of the augmented benefit payable to the veteran or veteran's surviving spouse.

 

D-6354 Requirement to Apply for Apportionment of Augmented VA Benefit

Revision 09-4; Effective December 1, 2009

To be eligible for Medicaid, a dependent of a veteran must apply for apportionment (direct payment) of an augmented VA benefit if the dependent specifically:

  • is the spouse or child of a living veteran, or the child of a deceased veteran with a surviving spouse, and the veteran or surviving spouse receives VA compensation, pension or educational benefits;
  • does not reside with the designated beneficiary (that is, the veteran or the veteran's surviving spouse); and
  • has not been denied apportionment since living apart from the designated beneficiary.

Dependents who are receiving a VA benefit by apportionment do not receive automatic cost-of-living adjustments. Do not refer these individuals to the VA to request an increase.