M-100, Application Processing

Revision 15-4; Effective October 1, 2015

The Chafee Foster Care Independence Act of 1999 gave states the option to extend Medicaid coverage to the population of youth who are between ages 18 and 21 and have aged out of foster care. Senate Bill 51, 77th Texas Legislature, Regular Session, 2001, was passed and signed into law effective September 1, 2001. This law allows the state to provide Medicaid coverage to youths who are aging out of foster care until they reach their 21st birthday.

The process to cover these individuals is coordinated between the Texas Department of Family and Protective Services (DFPS), which administers the foster care program, and the Texas Health and Human Services Commission (HHSC). When a child who is not eligible for Former Foster Care Children (FFCC) ages out of foster care in Texas, Medicaid eligibility is transferred from Foster Care Medicaid to Medicaid for Transitioning Foster Care Youth (MTFCY). DFPS certifies initial MTFCY eligibility for youths aging out of foster care and HHSC is then responsible for determining their future Medicaid eligibility.

Note: There may be situations in which HHSC processes the initial certification.

M—111 Type of Assistance (TP) 70 – Medical Assistance – MTFCY

Revision 19-4; Effective October 1, 2019

To be eligible for MTFCY, a person must:

  • be ineligible for FFCC (see Part E, Former Foster Care Children [FFCC]);
  • be ages 18 up to 21;
  • have been in foster care in Texas on their 18th birthday, or have had an Interstate Compact on the Placement of Children (ICPC) agreement*;
  • meet medical programs citizenship and Social Security number requirements;
  • be a Texas resident;
  • not have adequate health coverage as defined by HHSC; and
  • have countable income equal to or less than the applicable income limit for TP 70, defined in C-131.1, Federal Poverty Income Limits (FPIL). Exception: Persons who have had an ICPC agreement do not need to meet the income requirement.

* Centralized Benefit Services (CBS) staff must contact DFPS to determine whether the person had an ICPC agreement. DFPS has three business days to respond.

Specialized staff process all MTFCY case actions.

M—112 Application Processing

Revision 20-3; Effective July 1, 2020

Centralized Benefit Services (CBS) staff receive:

  • a new MTFCY case/Eligibility Determination Group (EDG) via an interface with the Texas Department of Family and Protective Services (DFPS); or
  • an application completed by a person who aged out of foster care.

Note: DFPS provides a notice of eligibility to each person.

CBS staff are notified by DFPS or HHSC Quality Assurance when a referral or interface is not completed. If a DFPS referral or interface is not completed or processed, CBS staff must contact DFPS to determine the reason the person was not sent to HHSC via the interface and confirm whether eligibility criteria are met for MTFCY. If the person meets the eligibility criteria in M-111, Type of Assistance (TP) 70 - Medical Assistance - MTFCY, CBS staff certify the person for MTFCY without requiring an application.

There are instances when a person is denied ongoing MTFCY coverage and must submit a new application for benefits. A person may be denied ongoing MTFCY coverage if they:

  • voluntarily withdraw;
  • move out of state; or
  • fail to return verification during a renewal.

A person denied ongoing MTFCY benefits may experience a gap in coverage. When there is a gap in coverage, the person must apply using any of the Medical Programs application channels explained in A-113, Application Requests and Submissions.

The question "Were you in foster care at age 18 or older?" must be marked Yes on the application for eligibility to be considered for MTFCY.

If ineligible for MTFCY, the person will be considered for eligibility under other Medical Programs.

M—113 Requesting an Application

Revision 15-4; Effective October 1, 2015

Applicants may request to apply for MTFCY as explained in A-113, Application Requests and Submissions.

If an applicant requests help completing an application, a volunteer or staff member must provide assistance. Anyone assisting the applicant in completing a paper application must initial the part completed, or sign the form indicating assistance was provided.

Related Policy

Registering to Vote, A-1521

M—114 Authorized Representatives (AR)

Revision 15-4; Effective October 1, 2015

An individual may designate an individual or organization as an AR, following the policy explained in A-170, Authorized Representatives (AR).

M—120 Office Procedures

Revision 10-2; Effective April 1, 2010

M—121 Filing an Application

Revision 17-1; Effective January 1, 2017

Individuals who wish to apply for MTFCY can:

  • submit an application as explained in A-113, Application Requests and Submissions; and
  • sign an application as explained in A-122, Application Signature.

M—122 File Date

Revision 20-4; Effective October 1, 2020

The file date is the day an application is received in one of the following ways:

  • by an HHSC eligibility determination office;
  • online through YourTexasBenefits.com;
  • by phone through 2-1-1; or
  • through an account transfer from the Marketplace.

The file date is the day any HHSC eligibility determination office or call center vendor accepts an application containing the applicant's name, address, and appropriate signature. This is day zero in the application process.

Document why a certain file date was used to determine eligibility when:

  • the file date used differs from the received date on the application; or
  • the application has two received dates (stamp dates).

Note: For applications received outside of normal business hours, the file date is the next business day.

Related Policy

Application Signature, A-122.1

M—130 Interviews

Revision 10-2; Effective April 1, 2010

M—131 General Policy

Revision 10-2; Effective April 1, 2010

An interview is not required when applying for or renewing an application for the MTFCY program. Schedule a phone interview only if the individual requests an interview. The State Portal Scheduler does not support scheduling of the MTFCY program. Any requests for an interview must be scheduled manually.

Note: Do not deny the application if the applicant misses the interview; continue determining eligibility.