An official State of Texas website.
Revision 17-1; Effective March 1, 2017
Long-term care insurance policies pay for nursing facility care. The policies purchased by individuals specify the benefits covered. Long-term care insurance policies do not affect Medicaid eligibility. For individuals who have such policies, report the policies as a third-party resource (TPR), using Form H1039, Medical Insurance Input.
As of March 1, 2015, HHSC Provider Recoupment and Holds cannot accept other insurance payments for individuals when a managed care organization (MCO) pays the nursing facility claims. Nursing facility providers must contact the appropriate MCO for claims submitted on Medicaid eligible individuals enrolled in MCOs on or after March 1, 2015 with service dates on or after March 1, 2015.
For questions about other insurance on Fee-for-Service (FFS) claims or for claims submitted prior to March 1, 2015, contact HHSC Provider Claims Services at 512-438-2200, Option 4.
Send long-term care insurance checks to Provider Claims Services at the Texas Health and Human Services Commission. The payment of large sums from long-term care insurance companies may affect an individuals' resource eligibility if Provider Claims Services provides a refund.
Procedure for TPR checks received for long-term care insurance coverage on FFS claims:
- give the recipient Form H4100, Money Receipt, correctly documented; and
- send the check, a copy of Form H4100 and other information to:
Provider Recoupments and Holds, W-406
P.O. Box 149081
Austin, TX 78714-9081
The policy and procedures in this section do not apply to Long-Term Care Partnership (LTCP) qualified policies. Information for LTCP qualified policies is located in Chapter P, Long-Term Care Partnership (LTCP) Program.