B-540, Centralized Benefit Services

Revision 20-4; Effective October 1, 2020

 

 

B-541 Inpatient Services Provided to Inmates of the Texas Department of Criminal Justice (TDCJ)

Revision 20-4; Effective October 1, 2020

TP 44 and TP 40

This section applies only to people confined in a Texas Department of Criminal Justice (TDCJ) facility. This policy does not apply to any other state, county, or city jails. Applications are submitted to HHSC only by The University of Texas Medicaid Branch at Galveston.

A person confined in a public institution is eligible for Medicaid coverage if the following conditions are met:

  • the confined person meets Medicaid eligibility requirements (pregnant women and children through age 18 could meet current Medicaid eligibility requirements);
  • the confined person receives inpatient services; and
  • the inpatient services are provided by a hospital that is not on the premises of a prison, jail, detention center, or other penal setting, including a facility run by a private health care entity.

Medicaid coverage is limited to the specific days the confined person is admitted as a patient and receives inpatient services as verified by the medical provider using Form H1046, Inpatient Medical Services Certification. Inpatient services are those provided on the recommendation of a physician or dentist and received in a medical institution. The confined person must receive or expect to receive room, board, and professional services in the institution for a 24-hour period or longer.

If the confined person is ineligible due to U.S. citizenship or alien status, the medical provider must also complete Form H3038, Emergency Medical Services Certification. The ineligible person is eligible only for those dates verified as an emergency, even if the inpatient treatment continues after the verified emergency dates.

The confined person is eligible for prior coverage only.

The TDCJ or its designee submits the following documents to HHSC via fax:

  • Form H1205, Texas Streamlined Application, on behalf of the confined person the month following the month the eligible hospital bill was incurred;
  • Form H1046, Inpatient Medical Services Certification;
  • Form H3038, Emergency Medical Services Certification, if applicable; and
  • all required verification, such as verification of citizenship, alien status, etc.

Note: If the required information or verification is not received, call or send secure email to the designated TDCJ contact.

Upon disposition of the application, send Form TF0001, Notice of Case Action, to the representative’s address provided on Form H1205, Texas Streamlined Application.

Related Policy

Applications for Babies Born to Women in Prison, A-116.3

 

B-542 Persons Confined in a Texas County Jail

Revision 20-4; Effective October 1, 2020

All Medical Programs

A county jail may choose to report people who receive health care coverage from HHSC and are confined in their facility for more than 30 days. If applicable, within two business days of the confinement report, Centralized Benefit Services (CBS) staff must review the report of confinement and determine the appropriate action needed.

CBS staff:

  • Suspend the following types of health care coverage:
    • TA 82, MA – Former Foster Care Children
    • TP 40, MA – Pregnant Women
    • TP 44, MA – Children 6–18
    • TP 70 - Medicaid for the Transitioning Foster Care Youth (MTFCY)
  • Terminate the following types of health care coverage:
    • TA 41, Health Care – Healthy Texas Women (HTW)
    • TA 66, MA – MBCC – Presumptive
    • TA 67, MA – MBCC
    • TA 76, MA – Children 6–18 Presumptive
    • TA 77, Health Care – FFCHE
    • TA 83, MA – FFCC Presumptive
    • TA 84, CI – CHIP
    • TA 85, CI – CHIP perinatal
    • TA 86, MA – Parents and Caretaker Relatives Presumptive
    • TP 07, MA – Earnings Transitional
    • TP 08, MA – Parents and Caretaker Relatives
    • TP 20, MA – Alimony/Spousal Support Transitional
    • TP 42, MA – Pregnant Women Presumptive

Do not act on other types of health care coverage.

When the Eligibility Determination Group (EDG) is disposed, if applicable:

  • The person’s health care coverage is suspended or terminated effective the day after HHSC receives the notification. The person receives Medicaid through the date of the confinement notification.
  • The Individual – Medicaid History page is updated to indicate the person’s eligibility is suspended or terminated.
  • The person is removed from other EDGs in which they are included, and benefits are adjusted accordingly for the remaining household members following current policies and procedures.
  • A TF0001, Notice of Case Action, is generated at suspension/termination and reinstatement (TWH Section A-2310, Notice to Applicants).

Note: Terminate the person’s eligibility following policy in B-631, Actions on Changes, if a report of confinement in a county jail is received from a source other than a participating county jail.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Actions on Changes, B-631
General Policy, E-1010
General Policy, M-1010

 

B-543 Child Placed in a Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

The TJJD or a JPD notifies HHSC within 30 days of a child's placement in a juvenile facility. Upon notification of the placement:

  • suspend the child's Medicaid eligibility effective the day after HHSC receives the notification if the child is certified for TP 44;
  • terminate the child's Children's Health Insurance Program (CHIP) eligibility effective the day after HHSC receives the notification if the child is certified for CHIP;
  • terminate the child's Medicaid eligibility allowing adequate notice according to policy in A-2344.1, Form TF0001 Required, Adequate Notice, if the child is certified on a Medicaid type other than TP 44; and
  • remove the child from other Eligibility Determination Groups (EDGs) in which the child is included.

The child receives TP 44 eligibility through the date of the notification of placement.

The following are scenarios for a child certified on Medicaid who is reported as placed in a juvenile facility.

Child is certified for… and HHSC receives notification of the child's placement in a juvenile facility from... then the child's…
TP 44 from Dec. 1, 2019 – Nov. 30, 2020 TJJD on Feb. 7, 2020, TP 44 eligibility is suspended effective Feb. 8, 2020.
TP 44 from Oct. 1, 2019 – Sept. 30, 2020 the child's mother on Dec. 1, 2019, TP 44 eligibility is denied effective Dec. 31, 2019.

Exceptions:

  • Children certified on a Supplemental Security Income (SSI) or a Department of Family and Protective Services (DFPS) type of Medicaid are not terminated by HHSC.
  • Children placed in a non-secure facility may receive TP 44 as an independent child. Therefore, these EDGs are not suspended or denied when a notification of placement is received.

TIERS will automatically suspend or terminate the child’s eligibility and remove the child from associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS must manually process the suspension, termination, or removal of the child from associated EDGs.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531
Child Placed in a Non-Secure Facility, B-544

 

B-544 Child Placed in a Non-Secure Facility

Revision 20-4; Effective October 1, 2020

TP 44

When reporting that a child has been placed in a juvenile facility, TJJD or a JPD notifies HHSC if the facility is a secure or non-secure facility.

Non-Secure Facility with 16 or Fewer Beds

Children placed in a non-secure juvenile facility with 16 or fewer beds are considered independent children and are potentially eligible for Medicaid.  

Non-Secure Facility with More than 16 Beds

In general, children placed in a public, non-secure facility with more than 16 beds are not eligible for Medicaid. However, children residing in a TJJD or a JPD halfway house with more than 16 beds may be eligible for Medicaid if the halfway house meets the federally required criteria listed in A-241.3.1, Children’s Living Arrangements, and if the children meet all other eligibility criteria.

Medical Effective Date

To determine the correct medical effective date (MED) for children in a non-secure facility, follow the chart below:

If the child is ... then ...
not active on Medicaid or Children's Health Insurance Program (CHIP) and the file date is within the same month as the placement date of the child, the MED is the placement date of the child.
not active on Medicaid or CHIP and the file date is not within the same month as the placement date of the child. That is, the application is filed the month after the placement date), the MED is the first day of the application month. Note: For unpaid medical bills prior to the file date, follow policy in A-831.1, How to Apply for Three Months Prior Coverage.
active on CHIP, test for Medicaid eligibility following procedures in A-126.3, Advisor Action for Determining Eligibility for Children.
receiving SSI or Foster Care Title IV-E, deny the application.

 

Related Policy

Advisor Action for Determining Eligibility for Children, A-126.3   
Children's Living Arrangement, A-241.3.1
How to Apply for Three Months Prior Coverage, A-831.1

 

B-545 Notification of Anticipated Release from Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

At least 30 days prior to a child's release, TJJD or a JPD notifies HHSC of the child's anticipated release date. Upon receipt of the information, CBS staff determines whether the child:

  • is eligible for reinstatement of TP 44 eligibility;
  • can be added to an existing case if not eligible for reinstatement; or
  • must reapply.

If the child cannot be reinstated because their original certification period has ended or their TP 44 was not suspended or cannot be added to an existing case, CBS staff are notified in the HHSC Action Status field on the TIERS TJJD/JPD Release page, to send the household an application packet. The application packet includes the following:

  • Form H1205, Texas Streamlined Application;
  • a pre-paid envelope addressed to CBS;
  • a cover letter that provides information and instructions for submitting the application and obtaining help in completing the application; and
  • a list of Community Partners in the household’s area that provide application assistance upon request.

Related Policy

Notification of Actual Release from a Juvenile Facility, B-546

 

B-546 Notification of Actual Release from a Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

Upon notification from TJJD or a JPD of the child's actual release, reinstate eligibility for a child whose eligibility was suspended and there are months remaining on the child's original certification period.

The child is automatically added to an existing case if the child is not eligible for reinstatement but has a sibling receiving Medicaid or CHIP. The child is also added to any other EDGs on the case that require the child to be a household member.

TIERS will automatically reinstate the child’s eligibility and add the child to associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS must manually process the reinstatement or add the child to an existing case.

Within two business days of notification of the child's release, CBS staff must process and dispose any pending applications.

CBS accepts applications up to and including the 14th calendar day after the confirmed release date. Any applications received after the 14th calendar day are routed to the local office for processing.

CBS reports the following to TJJD through the Juvenile Medicaid Tracker:

  • the child has Medicaid or CHIP;
  • the child was denied;
  • the CBS unit never received the application; or
  • the application was sent to the local office.

If the child is eligible for Medicaid, the MED cannot be any earlier than the release date.

Related Policy

Regular Medicaid Coverage, A-820
Adverse Actions Not Requiring Advance Notice, A-2344
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531  
Additions to Household, B-641