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Revision 17-1; Effective March 15, 2017
Section 42, Code of Federal Regulations, §431.10, specifies that Medicaid eligibility must be determined by a single state agency. The Texas State Plan designates the Texas Health and Human Services Commission (HHSC) as the sole agency with the authority to make eligibility determinations for Medical Assistance Only (MAO) cases.
Therefore, financial eligibility for Community Attendant Services (CAS) is determined exclusively by Medicaid for the Elderly and People with Disabilities (MEPD) staff. However, Community Care Services Eligibility (CCSE) staff must make an effort during the initial visit with each applicant to gather as much documentation as possible to hasten the MEPD specialist’s completion of the eligibility determination.
I. Income and Resource Eligibility
The following income and resource verifications/documentations must be included in the MEPD specialist’s case record to make a financial eligibility decision for a CAS case.
|As verification of:||the MEPD specialist:|
|bank accounts||must document the:
|cash||may accept without verification the individual’s statement about the amount of cash on hand. Ask the individual if he has any cash in a safety deposit box or if any of his cash on hand is in the form of valuable coins.|
|trusts||must document the:
|stocks||must document the:
|bonds||must document the:
|promissory notes, loans and property agreements||must document the:
|other real property||must document the:
|life estates||must document the:
|life insurance||must document the:
|burial spaces||must document the:
|burial funds||must document the:
|mineral rights||must document the:
|earned income||must document the:
|support and maintenance provided to individuals living outside of an institution||must document the:
|farm income||must document the:
|Social Security benefits||must document the:
|Railroad Retirement benefits||must document the:
|Veterans Affairs (VA) compensation and pensions||must document the:
|other annuities, pensions and retirements plans||must document the:
|interest and dividends||must document the:
|rents||must document the:
|royalties||must document the:
|gifts, inheritances, support and alimony||determines whether the gift, inheritance, support or alimony is to be treated as a lump sum payment, infrequent or irregular income, or regular and predictable income. He documents the:
|notes and mortgages||must document the:
|the home as a countable resource||must document the location and ownership of the homestead.|
II. Citizenship Requirements for Eligibility
Public Law 109-171, Deficit Reduction Act of 2005, requires that documentation be provided at the initial determination, and for ongoing cases, at the next redetermination of eligibility for all Medicaid cases. Verification of citizenship and identity for eligibility purposes is a one-time activity. Once verification of citizenship is established and documented by MEPD staff, verification is no longer required, even after a break in eligibility.
Long Term Services and Supports (LTSS) case workers must be prepared to assist individuals with this process by informing LTSS individuals of the requirement and helping to identify the documentation needed to prove citizenship and identity. Information available at the time of the home visit must be collected and submitted with the application for an MEPD determination. Individuals may obtain and forward copies to HHSC for transmittal to MEPD staff.
MEPD staff accept copies and faxes only if clear and legible. If the LTSS case worker receives an affidavit as verification, ensure that the reason the applicant or recipient is unable to produce documentary evidence of citizenship and identity is documented on the affidavit. If the affidavit does not contain this information, the reason another source is not available is documented and transmitted to MEPD staff on Form 2067, Case Information, along with the affidavit. The case worker must ensure the applicant/individual is signing the affidavit under penalty of perjury.
Acceptable Documentation for Both Citizenship and Identity
Supplemental Security Income (SSI) Recipients – State Data Exchange (SDX) contains the needed information to verify citizenship. For any active Supplemental Security Income (SSI) recipient, MEPD staff are able to use SDX as verification of both citizenship and identity. For any denied SSI recipient, SDX can be used as a valid verification source of both citizenship and identity when the denial is for any reason other than citizenship. The SDX printout will show action code N13 if the denial is for citizenship.
Medicare Recipients – Active Medicare recipients are exempt from the requirement to provide evidence of citizenship and identity. The Social Security Administration documents citizenship and identity for Medicare recipients.
For any individual entitled to or enrolled in Medicare Part A or B, and subsequently denied Medicare, use the State On Line Query (SOLQ) or Wire Third Party Query (WTPY) System as documentation of both citizenship and identity when the denial is for any reason other than citizenship. If there is an end date listed for Medicare, the individual must provide documentation regarding the loss of Medicare.
All Other Individuals – The following primary documents may be accepted as proof of both identity and citizenship:
- U.S. passport,
- Certificate of Naturalization (N-550 or N-570), or
- Certificate of U.S. Citizenship (N-560 or N-561).
Documents that establish citizenship are divided into second, third and fourth levels based on the reliability of the evidence:
- One document that establishes U.S. citizenship, and
- One document that establishes identity.
Hierarchy of Approved Documentation Sources
|Primary Evidence of Citizenship and Identity|
If primary evidence of citizenship is not available, the individual must provide two documents – one to establish U.S. citizenship and one to establish identity, as outlined below. Begin with the second level of evidence of citizenship and continue through the levels to locate the best available documentation.
|Second Level of Evidence of Citizenship (Use only when primary evidence is not available)|
|Third Level of Evidence of Citizenship (Use only when primary and second level evidence is not available)|
|Fourth Level of Evidence of Citizenship (Use only when primary, second level and third level evidence is not available)|
|Any listed documents must include biographical information including a U.S. place of birth.
|Evidence of Identity|
In the hierarchy of approved documentation sources, some documents listed to verify citizenship are also acceptable to verify identity. When using the hierarchy of approved documentation sources, the same document cannot be the source to verify both citizenship and identity.
If an individual is unable to provide any other documentary evidence of citizenship, an affidavit signed under penalty of perjury will only be accepted as a last resort. MEPD staff are required to document the reason another source is not available to verify citizenship. If the LTSS case worker is provided an affidavit, ensure the reason the applicant or recipient is unable to produce documentary evidence of citizenship and identity is documented on the affidavit. If the affidavit does not contain this information, the reason another source is not available is documented and transmitted to MEPD staff on Form 2067, along with the affidavit. The copies of the affidavit form, available online at https://hhs.texas.gov/laws-regulations/forms, are to be made available in all HHSC benefits offices.
Reasonable Opportunity to Provide Verification
The LTSS case worker must inform all applicants if MEPD staff do not receive documentation of citizenship and identity by the application due date, certification may be delayed and eventually denied if verification documentation is not provided.
Inform ongoing recipients that they will be asked to provide documentation verifying citizenship and identity at the redetermination. If an ongoing recipient cannot provide the required verification(s) at the initial request, eligibility will continue until the next redetermination. Eligibility will be denied if the recipient does not provide the required verification(s) at the next complete redetermination.
Assistance to Individuals in Obtaining Documentary Evidence
To assist an individual who is unable to provide documentary evidence of citizenship and identity in a timely manner because of incapacity of mind or body or the lack of a representative to assist, staff may make referrals to the following entities:
- Department of Family and Protective Services, Adult Protective Services
- Legal Aid
- Community-based organizations
- Social Security Administration
For individuals born out of state, some sources to obtain a birth certificate are:
- Usbirthcertificate.net or the toll free number, 1-888-736-2692
When assisting the individual in providing documentary evidence of citizenship and identity, use any available documents, regardless of level of evidence.