Revision 09-4; Effective December 1, 2009

If the request for the assessment of resources to determine the SPRA is not part of an application for Medicaid, the couple must provide information on their resources and verification as required by HHSC.

Inform the couple and/or representative of the verifications required to complete an assessment and the time frame to return the verification(s). The couple must provide requested verification of resources within 30 days of the request for assessment, or the request is void. Complete the assessment within 45 days after receipt of verification requested.

If the couple does not provide the verification(s) within the time frame requested by HHSC, HHSC does not complete the assessment and takes no further action.

Note: The couple may not appeal the SPRA at the time of the assessment. The couple may appeal the SPRA after an application for Medicaid is filed.


J-4210 Procedures for Processing the Assessment Request

Revision 09-4; Effective December 1, 2009

Step Procedure
1 Assessment is requested.
2 Send Form H1272, Declaration of Resources.

Note: Form H1272 is not used as an application. If the assessment and application are requested at the same time, only an HHSC application for MEPD Medicaid is needed.
3 If all necessary documentation is not received within 15 calendar days of return of completed Form H1272, send Form H1273, Request for Assessment Information. If the needed documentation is not received by the 30th calendar day, discontinue the assessment.
4 If all necessary documentation is received by the 30th calendar day, the assessment must be completed by the 45th calendar day from the receipt of the signed Form H1272.
5 When the assessment is complete, send Form H1274, Medicaid Eligibility Resource Assessment Notification, showing the protected resource amount.

Note: This form must be sent whether or not the assessment is completed at the same time as an application.