G-7100, Prior Coverage for SSI Applicants

Revision 18-3; Effective September 1, 2018

The Supplemental Security Income (SSI) application asks the individual about unpaid or reimbursable medical bills in the prior three months. An affirmative response is reported to the state using the State Data Exchange (SDX) system. A person claiming unpaid or reimbursable medical expenses incurred during the three months before the date of application receives a computer-generated notice to contact the Texas Health and Human Services Commission (HHSC) if they want their eligibility for prior coverage determined.

  • Certified Recipients —For certified SSI recipients, Medicaid coverage automatically begins with the month prior to the first month of SSI payment. Prior coverage may be determined for  the preceding two months if the individual meets all Medicaid eligibility requirements.
  • Denied Applicants — For denied SSI applicants who have medical expenses, the retroactive period remains the three months prior to the SSI application month.
  • Deceased Applicants — For SSI applicants who die before the SSI eligibility decision by the Social Security Administration (SSA), and for whom SSA will not make a determination, the retroactive period is the three months prior to the receipt of an HHSC application from a bona fide agent. (see G-7210)

To apply for retroactive medical coverage, the individual must complete an HHSC application form. Use SSI program criteria when determining prior coverage eligibility.  

A person may be eligible for more than one retroactive period if the person applies for SSI more than once. Determination of eligibility on a month-to-month basis may result in non-sequential periods of eligibility.

When the eligibility determination for the open or close time-period is complete for the ME-SSI Prior, notify the individual of the decision using Form TF0001, Notice of Case Action.