Community Care for Aged and Disabled Handbook

Appendix XXXII
Medicaid Program Transfers

Revision 08-10; Effective July 18, 2008

When a program transfer involves a change in the Medicaid type program/base plan, staff must complete Form 1746, MEPD Referral Coversheet, according to the instructions. Use the following table to determine whether or not a new Form H1010-E , Application for Assistance, must be attached to Form 1746.

 

Current Program

New Program

Health and Human Services Commission (HHSC) Action

Department of Aging and Disability Services (DADS) Action

Supplemental Security Income (SSI)

Any

Web Services updates the Texas Integrated Eligibility Redesign System (TIERS) – No case manager intervention.

DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Qualified Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)

Community Attendant Services (CAS)

Adds the Medicaid Eligibility (ME) CAS eligibility determination group (EDG).

Mails Form 1746 to the Document Processing Center (DPC) in Midland, Texas, identifying the consumer who is applying for CAS.

QMB/SLMB

Waiver

Adds the ME waiver EDG.

Explores the impact of the transfer of assets, home equity and spousal impoverishment.

Mails Form 1746 to the DPC, identifying the consumer who is applying for a waiver program. Must attach Form H1010-E to Form 1746.

Identifies the specific waiver on Form 1746.

Qualifying Individual (QI)-1

CAS

Adds the ME CAS EDG and ends the QI-1 EDG.

Mails Form 1746 to the DPC, identifying the consumer who is applying for CAS, and verifies that the consumer is ending QI-1 to obtain CAS.

QI-1

Waiver

Adds the ME waiver EDG and ends the QI-1 EDG.

Explores the impact of the transfer of assets, home equity and spousal impoverishment.

Mails Form 1746 to the DPC, identifying the consumer who is applying for a waiver program, and verifies that the consumer is ending QI-1 to obtain waiver services. Must attach Form H1010-E to Form 1746.

Identifies the specific waiver on Form 1746.

CAS

Waiver

Adds the ME waiver EDG and ends the ME CAS EDG.

Explores the impact of the transfer of assets, home equity and spousal impoverishment.

Mails Form 1746 to the DPC, identifying the consumer who is transferring from CAS to a waiver program. Must attach Form H1010-E to Form 1746.

Identifies the specific waiver on Form 1746.

Nursing Facility (NF)

Waiver

Determines the impact of any transfer of assets on waiver eligibility, and explores the impact of home equity and spousal impoverishment.

Mails Form 1746 to the DPC, identifying the consumer who is transferring from an NF to a waiver program.

Identifies the specific waiver on Form 1746.

Note: A referral needs to go to the DPC before the DADS transaction is completed to ensure that the consumer meets eligibility for the new program. Transfer of assets policy affects the eligibility for waivers.

Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR)

 

Waiver

Determines the impact of any transfer of assets on waiver eligibility, and explores the impact of home equity and spousal impoverishment.

 

Mails Form 1746 to the DPC, identifying the consumer who is transferring from an ICF/MR to a waiver program.

Identifies the specific waiver on Form 1746.

Note: A referral needs to go to the DPC before the DADS transaction is completed to ensure that the consumer meets eligibility for the new program. Transfer of assets policy affects eligibility for waivers.

Community Medical Assistance Only (MAO) – includes Pickle

Waiver

Adds the copay; no change to the EDG.

Explores the impact of the transfer of assets, home equity and spousal impoverishment.

Mails Form 1746 to the DPC, identifying the consumer who is applying for a waiver program. Must attach Form H1010-E to Form 1746.

Identifies the specific waiver on Form 1746.

Note: A referral needs to go to the DPC before the DADS transaction is completed to ensure that the consumer meets eligibility for the new program. Transfer of assets policy affects eligibility for waivers.

Texas Works (TW)-related Medicaid

Waiver

Adds the copay; no change to the EDG.

Explores the impact of any transfer of assets, home equity and spousal impoverishment.

Mails Form 1746 to the DPC, identifying the consumer who is applying for a waiver program. Must attach Form H1010-E to Form 1746.

Identifies the specific waiver on Form 1746 and indicates that the consumer is currently receiving benefits from TW-related Medicaid.

Note: A referral needs to go to the DPC before the DADS transaction is completed to ensure that the consumer meets eligibility for the new program. Transfer of assets policy affects eligibility for waivers.

Any Program

SSI

The State Data Exchange (SDX) interface updates TIERS; no case manager intervention is required.

DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

CAS

QMB/SLMB

Ends the ME CAS EDG.

Adds the Medicare Cost-Share (MC)-QMB or MC-SLMB, if applicable.

Mails Form 1746 to the DPC, identifying the consumer who is ending CAS. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Waiver

QMB/SLMB

Ends the ME waiver EDG.

Adds the MC-QMB or MC-SLMB, if applicable.

Mails Form 1746 to the DPC, identifying the consumer who is ending waiver services. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

CAS

QI-1

Ends the ME CAS EDG.

Adds the MC-QI-1 EDG.

Mails Form 1746 to the DPC, identifying the consumer who is ending CAS. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Waiver

QI-1

Ends the ME waiver EDG.

Adds the MC-QI-1 EDG.

Mails Form 1746 to the DPC, identifying the consumer who is ending waiver services. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Waiver

CAS

Ends the ME waiver EDG.

Adds the ME CAS EDG.

Mails Form 1746 to the DPC, identifying the consumer who is transferring from a particular waiver program to CAS. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Waiver

NF

Ends the ME waiver EDG.

Adds the ME NF EDG.

Mails Form 1746 to the DPC, identifying the consumer who is transferring from a particular waiver program to an NF. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Waiver

ICF/MR

Ends the ME waiver EDG.

Adds the ME EDG for the ICF/MR.

Mails Form 1746 to the DPC, identifying the consumer who is transferring from a particular waiver program to an ICF/MR. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Waiver

Community MAO – includes Pickle

For active ME waivers, ends the waiver EDG and adds the ME EDG.

For active Community MAO EDGs, removes the copay.

Mails Form 1746 to the DPC, identifying the consumer who is ending waiver services. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

Waiver

TW-related Medicaid

For active ME waivers, ends the waiver EDG.

For active TW-related Medicaid EDGs, removes the copay.

Mails Form 1746 to the DPC, identifying the consumer who is ending waiver services. DADS changes functional programs, which updates the HHSC Web Services notification for TIERS.

One Type of Waiver

Another Type of Waiver

Web Services updates TIERS; no case manager intervention is required.

DADS changes functional programs to transfer the consumer from one waiver type to another, which updates the HHSC Web Services notification for TIERS.