Reminder: Federal law requires that anyone who wishes to apply for Medicaid be allowed to file an application, regardless of the person's ultimate eligibility for services.


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A-1000 General Information

A-1100 Texas Administrative Code Rules

A-2000 Mandatory Coverage Groups

A-2100 Supplemental Security Income (SSI)

A-2200 Emergency Medicaid Coverage for Aliens

A-2300 RSDI Cost of Living Adjustment (COLA) Increase

A-2310 Disabled Adult Children (DAC)

A-2320 Historical 1972 Income Disregard

A-2330 Pickle

A-2340 Widow(er)s

A-2350 SSI Denied Children

A-3000 Optional Coverage Groups

A-3100 SSI Denied Due to Entry into a Long-Term Care Facility

A-3200 Special Income Limit

A-3300 Home and Community-Based Services Waiver Programs

A-3310 Community Living Assistance and Support Services (CLASS)

A-3320 Deaf Blind with Multiple Disabilities (DBMD)

A-3330 Home and Community-based Services (HCS)

A-3340 Youth Empowerment Services (YES)

A-3350 Medically Dependent Children Program (MDCP)

A-3360 Reserved for Future Use

A-3370 Texas Home Living (TxHmL)

A-3380 STAR+PLUS Waiver (SPW)

A-3400 Medicaid Buy-In for Children (MBIC)

A-3500 Medicaid Buy-In (MBI)

A-4000 Other Service-Related Programs

A-4100 Community Attendant Services (CAS)

A-4200 Program of All-Inclusive Care for the Elderly (PACE)

A-4300 Retroactive Coverage

A-4310 General

A-4320 Two Months Prior

A-4330 Deceased Individuals

A-5000 Texas Medicaid Hospice Program

A-5100 Hospice in the Community

A-5200 Hospice in a Long-Term Care Facility

A-6000 Persons in Institutions for Mental Diseases (IMDs)

A-7000 Reserved

A-8000 Medicare Savings Programs

A-8100 Qualified Medicare Beneficiary (QMB)

A-8200 Specified Low-Income Medicare Beneficiaries (SLMB)

A-8300 Qualifying Individuals (QIs)

A-8400 Qualified Disabled Working Individuals (QDWI)

A-9000 Medicaid-Medicare Relationship

A-9100 Medicare Benefits

A-9200 Medicare Buy-In

A-9210 Eligibility Requirements for Medicare Buy-In

A-9220 Time Frames for Medicare Buy-In Enrollment

B-1000 Applications and Redeterminations

B–1100 Texas Administrative Code Rules

B-2000 Responsibilities of an Eligibility Specialist

B-2100 Reporting Abuse and Neglect

B-2200 Conflict of Interest

B-2300 Eligibility Determination

B-2400 Documentation Standards

B-2500 Explaining Policy vs. Giving Advice

B-2600 Medicaid Estate Recovery Program Notification Requirements

B-2610 Types of MEPD Groups Subject to MERP

B-2620 HHSC MERP Notification Requirements

B-3000 Applications

B-3100 Application Process

B-3200 Application Requirements

B-3210 Who May Complete an Application for Assistance

B-3220 Who May Sign an Application for Assistance

B-3221 Valid Signatures

B-3300 Authorized Representative

B-3310 Absence of an Authorized Representative

B-3400 General Procedures

B-4000 Date of Application

B-5000 Previously Completed Application

B-6000 Eligibility Determination

B-6100 Face-to-Face and Telephone Interviews

B-6200 Financial Management

B-6300 Institutional Living Arrangement

B-6400 Processing Deadlines

B-6410 Application Due Dates

B-6420 Missing Information Due Dates

B-6500 Denials

B-6510 Failure to Furnish Missing Information

B-7000 Special Application Procedures

B-7100 SSI Applications

B-7200 SSI Cash Benefits Denied Due to Entry into a Medicaid Facility

B-7210 Ensuring Continuous Medicaid Coverage

B-7300 MEPD Eligibility Pending Adjudication of SSI Claims

B-7400 Application for Institutional Care

B-7410 Persons Under Age 22

B-7420 Level of Care/Medical Necessity

B-7430 Effect of Utilization Review on Eligibility

B-7431 Denial of Level of Care/Medical Necessity Determination

B-7440 Alternate Care Services

B-7450 Medicaid Certified Person Enters Nursing Facility or Home and Community-Based Services Waiver Program

B-8000 Redeterminations

B-8100 Certificates of Insurance Coverage

B-8200 Redetermination Cycles

B-8300 Who May Sign a Redetermination Form

B-8400 Procedures for Redetermining Eligibility

B-8410 Financial Management

B-8420 Notification of Changes as a Result of Redetermination

B-8430 Special Reviews

B-8440 Streamlined Redetermination (Passive Redetermination)

B-8450 Special Reviews when Facility Contract Closure or Cancellation Occurs

B-9000 Denials

B-9100 Administrative Denials

B-9200 Medical Necessity/Level of Care Determination at Redetermination

D-1000 Aged, Blind or Disabled

D-1100 Related Texas Administrative Code Rules

D-1200 Age

D-1210 Definition of a Child

D-1300 Blindness

D-1400 Disability

D-2000 Determining Blindness or Disability

D-2100 When a Medical Determination Is Not Required

D-2200 When a Medical Determination Is Required

D-2300 Requesting a Decision from the Disability Determination Unit (DDU)

D-2400 Disability Determination Unit (DDU) Request Required

D-2500 Supplemental Security Income (SSI) Applicants and Retroactive Coverage

D-2600 Disability Determination Unit (DDU) Decision

D-2700 Use of Decision on the Disability Determination - DDU Page in TIERS

D-2800 Disability Determination at Time of Review

D-3000 Residence

D-3100 Related Texas Administrative Code Rules

D-3200 Eligibility

D-3300 Maintaining Presence in the U.S.

D-3310 Exceptions to U.S. Presence

D-3400 Change of Address

D-3500 Intent to Remain in Texas

D-3510 Intent to Return

D-3520 No Intent to Return

D-3600 Interstate Issues

D-3610 Interstate Requests for Assistance

D-3620 Out-of-State Medicaid and Texas Medicaid Recipients

D-3630 Texas Applicant Outside the State of Texas

D-3640 Applicant from Another State

D-3650 Out-of-State Recipient Visiting Texas

D-3660 SSI Recipient Visiting in Texas

D-3700 Special Situations

D-3800 Inmates in a Public Institution

D-4000 Fiduciary Agents and Living Arrangement

D-4100 Fiduciary Agents

D-4110 Texas Administrative Code Rules

D-4120 Transactions Involving Agents

D-4121 Examples

D-4200 Living Arrangements

D-4210 Deeming

D-4211 Spouse

D-4212 Child

D-4213 Parent

D-5000 Citizenship and Identity

D-5100 Texas Administrative Code Rules

D-5200 Citizenship

D-5210 Child Citizenship Act of 2000

D-5220 Compact of Free Association States

D-5300 Acceptable Documentation of Citizenship and Identity

D-5310 Exceptions to Documentation of Citizenship and Identity Requirement

D-5320 Using Wire Third-Party Query (WTPY) to Verify Citizenship

D-5400 Notification

D-5500 Reasonable Opportunity to Provide

D-5510 Initial Request at Time of Application

D-5520 Initial Request at Time of Redetermination

D-5600 Providing Assistance

D-6000 Social Security Number (SSN) and Application for Other Benefits

D-6100 Texas Administrative Code Rules

D-6200 SSN Requirement

D-6210 When a Person Does Not Have an SSN

D-6300 Application for Other Benefits Requirement

D-6310 Other Benefits Subject to Application Requirement

D-6320 Other Benefits Exempt from Application Requirement

D-6330 Payments That Are Not Other Benefits

D-6340 Supplemental Security Income (SSI)

D-6341 MEPD Eligibility Pending Adjudication of SSI Claims

D-6350 Veterans Benefits

D-6351 VA Pension or Compensation

D-6352 VA Wartime Periods

D-6353 VA Payments for Dependents

D-6354 Requirement to Apply for Apportionment of Augmented VA Benefit

D-6360 Workers' Compensation Payments

D-6370 Private Sector Pensions

D-6380 Public Sector Pensions

D-6400 Treatment of Other Benefits

D-6410 Deeming Situations

D-6420 Payment Options for Other Benefits

D-6421 Survivor's Benefits for Spouses and Other Dependents

D-6422 Other Benefit Lump Sum or Annuity Exception

D-6430 Electing the Month of Entitlement

D-6440 Establishing Eligibility after Denial

D-6500 Exceptions to the Application for Other Benefits Requirement

D-6600 When Not to Refer for Other Benefits

D-7000 Third-Party Resources

D-7100 Texas Administrative Code Rules

D-7200 Cooperation and Assignment of Rights for Medicaid Eligibility

D-7300 Potential Sources of Third-Party Coverage

D-7310 Examples of Third-Party Resources

D-7400 Use of Third-Party Resources

D-7410 Cost Avoidance

D-7420 Post-Payment Recovery

D-7500 Third-Party Resources for SSI Recipients

D-7510 Social Security Administration (SSA) Role and Supplemental Security Income (SSI) Recipients

D-7600 Long-Term Care Insurance Policies

D-7700 Health Insurance Premium Payment Reimbursement Program

D-7800 Medicaid Estate Recovery Program

D-8000 Alien Status

D-8100 Texas Administrative Code Rules

D-8200 Authorized Alien Status

D-8210 Terms

D-8220 Groups of Aliens

D-8221 Date of Qualifying Classification

D-8222 Classifications for Qualified Aliens

D-8300 Qualified Alien Categories

D-8310 Qualified Aliens Subject to a Seven-Year Limited Period

D-8320 Qualified Aliens Not Subject to a Waiting Period or Limited Period

D-8330 Qualified Aliens with a Five-Year Waiting Period

D-8340 Establishing Qualifying Quarters of Social Security Coverage

D-8341 Combining Qualifying Quarters of Spouse/Parent

D-8342 Qualifying Quarters Earned on or After Jan. 1, 1997

D-8343 Non-Covered Wages

D-8344 Procedures for Verifying 40 Quarters

D-8345 Response from WTPY

D-8400 LAPR Conditions for Medicaid

D-8410 Veterans, Armed Forces Active Duty and Dependents

D-8411 Loss of “Veteran/Active Duty” Status

D-8420 American Indians Born Outside the U.S.

D-8430 LAPR Residing in the U.S. on Aug. 22, 1996

D-8500 Qualified Aliens, Retroactive Coverage and SSI

D-8600 Non-Qualified Aliens

D-8610 Ineligible Aliens

D-8611 Documents of Ineligible Aliens

D-8620 Illegal Aliens

D-8700 Verification of Alien Status

D-8710 Documentary Evidence by Classification

D-8720 Lawfully Admitted for Permanent Residence (LAPR)

D-8721 Description of Common Resident Alien Cards

D-8730 Refugees

D-8740 Parolee

D-8750 Asylee

D-8760 Deportation Withheld

D-8770 Cuban/Haitian Entrants

D-8780 Qualified Alien Based on Battery or Extreme Cruelty

D-8800 Systematic Alien Verification for Entitlements (SAVE)

D-8810 Getting Permission to Access to SAVE

D-8820 Primary Verification of Alien Status

D-8830 Additional Verification — Online Process of Alien Status

D-8840 Secondary Verification of Alien Immigration Status

D-8841 Reasonable Opportunity to Provide Verification of Alien Immigration Status

D-8900 Alien Status Eligibility Charts

D-8910 Entry Before 1996

D-8920 Entry On or After Aug. 22, 1996 — Qualified Alien No Waiting Period

D-8930 LAPR Aliens With or Without Five-Year Waiting Period

D-8940 Summary of Charts

D-9000 Alien Sponsorship

D-9100 Definition of Sponsor and Sponsored Alien

D-9200 Sponsor-to-Alien Deeming Policy

D-9210 Deeming Period

D-9220 Deeming Exceptions

D-9230 Providing Verification of Alien Sponsor's Income and Resources

D-9300 Sponsor-to-Alien Resource Deeming

D-9310 Examples of Sponsor-to-Alien Resource Deeming

D-9400 Sponsor-to-Alien Income Deeming

D-9410 Examples of Sponsor-to-Alien Income Deeming

D-9500 Income Excluded from Sponsor-to-Alien Deeming

D-9510 Food

D-9520 Housing and Utilities

D-9530 Education and Employment

D-9540 Native Americans

D-9550 Other

D-9600 Notification Requirements

E-1000 General Income

E-1100 Texas Administrative Code Rules

E-1200 General Income

E-1210 Other Terms

E-1300 Types of Income

E-1310 Relationship of Income to Resources

E-1320 Fiduciary Agent

E-1400 Garnishment or Seizure

E-1410 Garnishment based on Division of Marital Property

E-1420 Deeming and Court-Ordered Support Payments

E-1500 Income and Transfer of Assets

E-1600 Reduction of Checks for Recoupment of Overpayments

E-1610 SSA Overpayments

E-1620 All Other Overpayments

E-1700 Things That Are Not Income

E-1710 Medical Care and Services That are Not Income

E-1720 Social Services That Are Not Income

E-1730 Sale of a Resource is Not Income

E-1740 Miscellaneous Things That May Not Be Income

E-1750 Proceeds of a Loan

E-1760 Wage-Related Payments

E-1770 Mandatory Payroll Deductions

E-1780 Cafeteria Plan

E-2000 Exempt Income

E-2100 Income Exempt Under Federal Laws

E-2110 Food

E-2120 Housing and Utilities

E-2130 Education and Employment

E-2140 Native Americans – Exempt Income

E-2141 Types of Payments Excluded Without Regard to Specific Tribes or Groups

E-2142 Payments to Members of Specific Indian Tribes and Groups

E-2143 Receipts from Lands Held in Trust for Certain Tribes or Groups

E-2150 Other – Exempt Income

E-2200 Earned Income Exemptions

E-2210 Income Tax Credits

E-2220 Student Earnings

E-2300 Unearned Income Exemptions

E-2310 Refunds of Taxes Paid on Real Property or Food

E-2320 Assistance Based on Need

E-2330 Educational Assistance

E-2340 Home Produce for Personal Consumption

E-2350 Child Support Payments

E-2360 Payment Treated Like Other Exemptions

E-2370 Certain Gifts

E-2371 Certain Gifts

E-2372 Ticket for Travel

E-2380 Relocation Assistance

E-2390 Crime Victims Compensation

E-2400 Other Income Exemptions

E-2410 Hazardous Duty Pay

E-2420 Excluded Burial Fund Interest

E-2430 Certain Designated Accounts

E-2440 Certain Health-Related Payments

E-3000 Earned and Unearned Income

E-3100 Types of Earned Income

E-3110 Wages

E-3120 Self-Employment

E-3130 Farm Income

E-3140 Certain Payments in a Sheltered Workshop

E-3150 Certain Royalties and Honoraria

E-3160 Certain Federal Income Tax Refunds

E-3170 Census Bureau Wages

E-3200 Types of Unearned Income

E-3300 Sources of Unearned Income

E-3310 Annuities, Pensions and Other Periodic Payments

E-3311 Medicaid Qualifying Trust Payments

E-3312 Testamentary and Inter Vivos Trusts Payments

E-3313 Revocable and Irrevocable Trusts

E-3314 Exception, Special Needs and Pooled Trust

E-3315 Qualified Income Trust (QIT)

E-3320 Alimony and Support Payments

E-3321 Child Support Payments

E-3330 Dividends, Interest and Royalties

E-3331 Interest and Dividends

E-3331.1 Treatment of Interest/Dividends on Fully Countable Resources

E-3331.2 Treatment of Interest/Dividends on Certain Excluded or Partially Excluded Resources

E-3331.3 Treatment of Interest/Dividends on All Other Resources

E-3332 Income from Joint Bank Accounts

E-3333 Mineral and Timber Rights

E-3333.1 Indian Fishing Rights

E-3340 Rents

E-3341 Rental Income Paid to a Third Party

E-3342 Mortgage Payment Made by Third Party

E-3343 Prorating Rental Expenses

E-3344 Rental Expenses

E-3345 Budgeting

E-3350 Death Benefits

E-3360 Prizes and Awards

E-3370 Gifts and Inheritances

E-3371 Gifts of Domestic Commercial Transportation Tickets

E-3372 Effective Date of Receipt of Inheritance; Disclaimers

E-3373 Facility Payments

E-3380 Support and Maintenance In Kind

E-4000 Fixed Income

E-4100 Social Security Benefits

E-4200 Railroad Retirement Benefits

E-4300 VA Benefits

E-4310 Augmented and Apportioned VA

E-4311 VA Pensions

E-4311.1 1979 VA Pension Plan

E-4311.2 $90 VA Pension and Institutional Setting

E-4312 VA Compensation

E-4313 Dependency and Indemnity Compensation

E-4314 Educational Assistance

E-4315 VA Aid and Attendance and Housebound Payments

E-4316 VA Clothing Allowance

E-4317 Payments to Vietnam Veterans' Children with Spina Bifida

E-4318 VA Contracts

E-4400 Other Annuities, Pensions and Retirement Plans

E-4500 Workers' Compensation

E-4600 Unemployment Benefits

E-4700 Disability Insurance Benefits

E-5000 Variable Income

E-5100 Calculations for Variable Income

E-5200 When to Project Variable Income

E-5300 When Not to Project Variable Income

E-5400 How to Budget Variable Income at Applications

E-5500 How to Budget Variable Income at Redeterminations

E-6000 Self-Employment Income

E-6100 Materially Participating

E-6200 Net Self-Employment Earnings

E-6210 Self-Employment Deductions

E-6300 Budget Options for Self-Employment

E-6310 Annual Projection

E-6320 Six Months Projection

E-6400 Variable Income for Self-Employment

E-6500 Self-Employment Income Examples

E-7000 Deeming Income

E-7100 Living Arrangement

E-7200 When Deeming Procedures Are Not Used

E-7300 When Deeming Procedures Begin

E-7400 Special Income Exemptions Used in Deeming

E-7410 Military Unearned Income

E-8000 Support and Maintenance

E-8100 General Information

E-8110 One-Third Reduction Rule

E-8120 One-Third Reduction + $20 Rule

E-8121 Community Attendant Services

E-8130 Support and Maintenance Items

E-8140 Exceptions to Counting Support and Maintenance (S/M) Income

E-8150 Food, Clothing or Shelter as Wages

E-8160 Living Arrangement

E-8200 Individual Budgets

E-8210 Household of Another Person

E-8211 Contributing Less Than Pro-Rata Share

E-8212 Contributing an Earmarked Share of Food and Shelter

E-8213 Contributing an Earmarked Share of Either Food or Shelter

E-8214 Separate Food Purchases

E-8220 Ownership or Rental Liability

E-8221 Receipt of Support and Maintenance (S/M) from Inside the Household

E-8222 Receipt of Support and Maintenance (S/M) from Outside the Household

E-8223 Receipt of Support and Maintenance (S/M) from Inside and Outside the Household

E-8300 Companion and Couple Budgets

E-8310 Household of Another Person

E-8311 Companion Case Not Contributing Pro-Rata Share

E-8312 Companion Case Contributing Pro-Rata Share

E-8313 Couple Case Not Contributing Pro-Rata Share

E-8314 Couple Case Contributing Pro-Rata Share

E-8320 Ownership or Rental Liability

E-8321 Couple Case Not Contributing Pro-Rata Share

E-8322 Companion Case Not Contributing Pro-Rata Share

E-8323 Companion Case with Contributions Toward Household Expenses

E-8400 Rent-Free Shelter

E-8500 Change of Permanent Living Arrangement

E-8600 Deeming-Eligible Child and Ineligible Parents

E-8610 Excess Contributions Towards Household Expenses

E-8620 Child Living with Parents and Siblings Only

E-8630 Child Living in Own Household with Parents and Another Adult

E-8640 Child Living with Parents in Household of Another Person

E-8700 Long-Term Care Facilities

E-8800 Verification and Documentation

E-9000 Infrequent or Irregular Income

E-9100 Definitions

E-9200 When Income is Not Considered Infrequent

E-9300 When to Apply the Infrequent or Irregular Exclusion

E-9400 Special Treatment for Interest or Dividends

F-1000 General Principles of Resources

F-1100 Texas Administrative Code Rules

F-1200 General Principles of Treatment of Resources

F-1210 Definition

F-1220 Ownership and Accessibility

F-1221 Co-owned Resources

F-1221.1 Co-owned Resource Examples

F-1230 Guardians, Fiduciaries and Other Agents

F-1231 Guardians and Other Agents

F-1231.1 Examples of Treatment of Resources

F-1232 Fiduciary Agent

F-1232.1 Medicaid Recipient Responsibilities as Fiduciary Agent

F-1240 Ownership of Unknown Assets

F-1250 Patrimonial Assets

F-1260 Conversion of Resources

F-1270 Replacement Value of Excluded Resources

F-1300 Resource Limits

F-1310 Points in Time for Establishing Resource Values

F-1311 Encumbered Funds

F-1312 Nursing Facility Refunds

F-1312.1 During a Penalty

F-1312.2 Before Medicaid Eligibility Approval

F-1400 Deeming of Resources

F-1410 Deeming for Spouses

F-1420 Deeming for Children

F-2000 Resource Exclusions – Limited and Related to Exempt Income

F-2100 Resource Exclusions – Limited

F-2110 Cash Reimbursement of Medical or Social Services Expenses

F-2120 Death Benefits

F-2130 Earned Income Tax Credits (EITC)

F-2140 Hazardous Duty Pay

F-2150 SSI and RSDI Retroactive Lump Sum Payments

F-2151 Examples of SSI and RSDI Retroactive Lump Sum Payments

F-2160 Gifts to Children with Life-Threatening Conditions

F-2170 Exclusion of State or Local Relocation Assistance Payments

F-2200 Resource Exclusions Related to Exempt Income

F-2210 Crime Victims' Compensation

F-2220 Certain Designated Accounts

F-2230 Certain Health-Related Payments

F-2240 Indian-Related Exclusions

F-2250 Reparations and Compensation

F-2260 Exclusions from Resources Provided by other Statutes

F-2270 Exclusions from Resources Related to Disaster Payments

F-3000 Home

F-3100 The Home and Resource Exclusions

F-3110 Principal Place of Residence

F-3111 The Home as the Principal Place of Residence

F-3112 Spouse or Dependent Relative Living in the Home

F-3120 Intent to Return Home

F-3121 Intent to Return Policy

F-3121.1 Temporary Absence from the Home

F-3130 Home and Other Real Property Placed for Sale

F-3200 The Home and Resources in a Trust

F-3210 Treatment of a Home in a Revocable or Living Trust

F-3211 Re-established Intent to Return Home

F-3300 The Home as a Countable Resource

F-3400 Replacement of the Home

F-3500 Out-of-State Home Property

F-3600 Substantial Home Equity

F-3610 Persons Impacted by Substantial Home Equity Disqualification

F-3620 Persons Not Impacted by Substantial Home Equity Disqualification

F-3630 When the Equity Value is Greater Than the Limit

F-3640 Reverse Mortgage or Home Equity Loan

F-3650 Documentation

F-3660 Undue Hardship

F-3700 Continuing Care Retirement Communities

F-3800 The Home and Transfer of Assets

F-3810 Transfer of an Excluded Home Cancels the Exclusion

F-3811 Person Retains Some Interest

F-4000 Liquid and Nonliquid Resources

F-4100 Types of Liquid Resources

F-4110 Cash

F-4120 Bank Accounts

F-4121 Joint Bank Accounts

F-4122 Time Deposits

F-4123 Patient Trust Funds

F-4124 Debit Accounts

F-4130 Stocks

F-4140 Bonds

F-4150 Promissory Notes, Loans and Property Agreements

F-4160 Prepaid Burial Contracts

F-4161 Treatment of Refund Penalty

F-4161.1 No Refund Penalty

F-4161.2 Refund Penalty

F-4161.3 Examples of Refund Penalty

F-4170 Burial Contracts Funded by Life Insurance

F-4171 Revocable Assignment

F-4172 Irrevocable Assignment

F-4200 Nonliquid Resources

F-4210 Real Property

F-4211 Real Property in Excess of the Limit

F-4212 Life Estates and Remainder Interests

F-4212.1 Calculation of Value of Life Estate or Remainder Interest

F-4213 Mineral Rights

F-4214 Burial Spaces

F-4215 Nonliquid Resources Located Outside the State

F-4220 Personal Property

F-4221 Automobile

F-4222 Household Goods and Personal Effects

F-4222.1 Other Personal Property

F-4223 Life Insurance

F-4223.1 Policy and Procedure

F-4223.2 Documentation and Verification

F-4224 Life Insurance Dividends

F-4224.1 Dividend Additions and Accumulations

F-4225 Accelerated Life Insurance Payments

F-4225.1 Life Settlement Contract

F-4226 Term and Burial Insurance

F-4226.1 Policy and Procedure

F-4227 Burial Funds

F-4227.1 Calculation of Available Burial Fund Exclusion

F-4227.2 Opportunity to Designate

F-4227.3 Effective Date of Designation

F-4228 Burial Fund Calculation

F-4229 Annual Burial Fund Calculation

F-4229.1 Designated Amount is Less Than $1,500

F-4229.2 Designated Amount Exceeds $1,500

F-4229.3 Increased Value from Person Action

F-4229.4 Increased Value from Person Action and Interest/ Dividends

F-4230 Treatment of Burial Fund Tampering

F-4240 Safe Deposit Box

F-4250 Livestock

F-4260 Nonliquid Resources Converted to Cash

F-4300 Resources Essential to Self-Support

F-4310 Nonbusiness Property – $6000/6%

F-4311 Examples of $6000/6%

F-4312 Rate of Return Less Than Reasonable

F-4320 Employment Related Personal Property

F-4330 Business Property

F-4400 Plan for Achieving Self-Support (PASS)

F-5000 Potential Resource Exclusions

F-5100 Reminders

F-5200 Chart

F-6000 Types of Trusts

F-6100 Testamentary and Inter Vivos Trusts

F-6200 Medicaid-Qualifying Trust

F-6210 Zebley Cases

F-6300 Trusts (August 11, 1993 and After)

F-6310 Limited Partnerships

F-6400 Revocable Trusts

F-6500 Irrevocable Trusts

F-6600 Treatment of Trusts

F-6610 Payments from a Trust

F-6700 Exception Trusts

F-6710 Special Needs Trust

F-6711 Treatment as Resource

F-6712 Treatment as Income

F-6713 Transfer of Assets

F-6720 Pooled Trust

F-6721 Treatment as Resource

F-6722 Treatment as Income

F-6723 Transfer of Assets

F-6800 Qualified Income Trust (QIT)

F-6810 Treatment as Resource

F-6820 Treatment as Income

F-6900 Undue Hardship

F-7000 Annuities

F-7100 Determining Annuity Policy

F-7110 Persons Impacted by Post-DRA Annuity Policy

F-7120 Application File Date or Program Transfer Request Date

F-7130 Annuity Transaction

F-7140 Annuity Purchase or Transaction Date

F-7200 Post-DRA Annuity Policy

F-7210 Employment and Retirement-Related Annuities

F-7220 Post-DRA Treatment of an Annuity

F-7230 Post-DRA Terms and Conditions

F-7240 Treatment of an Annuity When Terms and Conditions Are Not Met

F-7250 Notice Requirements for Application and Redeterminations

F-7300 Pre-DRA Annuity Policy

F-7310 General Treatment of Annuities and the Five Criteria Test

F-7320 Determining a Reasonable Amount of Interest

F-7321 Treatment of Annuities that Return the Principal Within the Life Expectancy but Pay No Interest

F-7322 Treatment of Annuities that Return the Principal Within the Life Expectancy and Pay Interest

F-8000 Educational Funds

F-8100 Educational Assistance

F-8110 Grants, Scholarships and Fellowships

F-8120 Title IV of the Higher Education Act of 1965 or Bureau of Indian Affairs

F-8130 Department of Veterans Affairs Educational Benefits

F-8140 AmeriCorps and the National Civilian Community Corps

F-8200 Tuition Savings Programs (Qualified Tuition Programs)

F-8210 Resource Treatment

F-8220 Income Treatment

F-8300 Uniform Transfers to Minors

F-8400 Coverdell Educational Savings Accounts (ESAs)

G-1000 Eligibility Budgets Overview

G-1100 Texas Administrative Code Rules

G-1200 Definitions

G-1300 Income Limits

G-1310 Community-Based Programs Using SSI Income Limits

G-1320 Special Income Limits

G-2000 Income Treatment

G-2100 Eligibility Exceptions

G-2200 Variable Income

G-2300 Special Income for Noninstitutional Budgets

G-2310 Noninstitutional Deeming

G-2311 Spouse-to-Spouse Noninstitutional Deeming

G-2311.1 Pretest to Deeming

G-2311.2 Examples of Spouse-to-Spouse Deeming

G-2312 Parent-to-Child Noninstitutional Deeming

G-2312.1 Examples of Deeming

G-3000 Noninstitutional Budget Types

G-3100 Noninstitutional Budgets

G-3110 Individual Noninstitutional Budget

G-3120 Companion Noninstitutional Budget (Person with Ineligible Spouse)

G-3130 Couple Noninstitutional Budget

G-3131 Couple Budget Policy

G-4000 Noninstitutional Exclusions

G-4100 Income Exclusions

G-4110 Twenty-Dollar General Exclusion

G-4120 Earned Income Exclusion

G-4121 Examples of the Earned Income Exclusion

G-4200 Special Exclusion for Medicare Savings Programs – Census Bureau Wages

G-4300 Special Income Exclusion for COLA Disregard

G-4310 Computing Social Security Cost-of-Living Increases

G-4311 Pickle

G-4312 Ping-Pong

G-4320 Special Income Exclusion for Disabled Adult Children

G-4330 Special Income Exclusion for Widow/Widower

G-4400 Other Income Exclusions Related to Work

G-4410 Exclusion for Work Expenses for the Blind

G-4420 Exclusion for Impairment-Related Work Expenses

G-4430 Income Needed to Fulfill a Plan for Self-Support (Blind or Disabled)

G-4500 Medicaid Buy-In for Children Income Exclusions

G-5000 Noninstitutional Budget Steps

G-5100 Individual and Couple Noninstitutional Budgets

G-5110 COLA Disregard Programs

G-5120 Community Attendant Services

G-5130 MSP Programs

G-5140 SSI Denied Child

G-5141 SSI Denied Child Eligibility Budget Steps

G-5150 Medicaid Buy-In for Children Program (MBIC)

G-6000 Institutional Eligibility Budget Types

G-6100 Institutional Eligibility Budgets

G-6110 Individual Institutional Eligibility Budget

G-6120 Couple Institutional Eligibility Budget

G-6130 Companion Institutional Eligibility Budget

G-6200 Special Income Limit for the Eligibility Budget

G-6210 30 Consecutive Days and the Special Income Limit

G-6300 Institutional Eligibility Budget Steps

G-6400 Institutional Excess Income

G-7000 Prior Coverage

G-7100 Prior Coverage for SSI Applicants

G-7200 Prior Coverage for Medical Assistance Only (MAO) Applicants

G-7210 Prior Coverage for Deceased Applicants

G-7300 Prior Coverage for Aliens

H-1000 General Information for Co-Payment

H-1100 Texas Administrative Code Rules

H-1200 Income That Is Not Used in the Co-Payment

H-1300 Variable Income and Co-Payment

H-1400 Order of Deductions from Countable Income

H-1500 Personal Needs Allowance (PNA)

H-1550 Guardianship Fees

H-1600 Dependent Allowance

H-1700 Deduction for Home Maintenance

H-1800 Medicare Part B Premium

H-2000 Incurred Medical Expenses

H-2100 Deduction of Incurred Medical Expenses (IMEs)

H-2110 When to Consider an IME Deduction

H-2120 Medically Necessary

H-2130 Form H1263-A and Form H1263-B

H-2140 Deductions for Insurance Premiums

H-2150 Non-Allowable Deductions – General IME

H-2200 Third Party Reimbursement Considerations

H-2300 IME Budget Adjustments Due to Death or Change in Living Arrangement

H-2400 Ongoing IME Budget

H-2500 Medicare Part D Related Expenses

H-2600 Reserved

H-2700 Dental

H-2710 Using the TX Dental IME Fee Schedule

H-2720 Non-Allowable Deductions – Dental

H-2730 Reserved

H-2740 Reserved

H-2750 Codes Not on the TX Dental Fee Schedule

H-2751 Hospice Recipients

H-2760 Replacement of Lost Dentures

H-2770 Emergency Dental Services

H-2780 Notices

H-2790 When the Co-Payment Adjustment is Not Used to Pay Dental Provider

H-2800 Durable Medical Equipment (DME)

H-2810 Using the DME Fee Schedule

H-2820 DME Procedures

H-2830 DME Exception Processing/Codes Not on the Fee Schedule

H-2840 DME Modifier Code for Rental Items

H-2850 Wheelchairs

H-2860 Notices

H-2870 When the Co-Payment Adjustment is Not Used to Pay DME Provider

H-3000 Averaging and Reconciliation

H-3100 When to Project

H-3110 Variable Income

H-3120 Incurred Medical Expenses (IMEs)

H-3200 When Not to Project

H-3210 Variable Income

H-3220 Incurred Medical Expenses (IMEs)

H-3230 Both Variable Income and Incurred Medical Expenses (IME)

H-3300 How to Budget at Application

H-3310 Variable Income

H-3320 Incurred Medical Expenses (IMEs)

H-3330 Both Variable Income and Incurred Medical Expenses (IME)

H-3400 How to Budget at Reviews

H-3410 Variable Income

H-3420 Incurred Medical Expenses (IMEs)

H-3430 Both Variable Income and Incurred Medical Expenses (IME)

H-3500 When to Reconcile

H-3510 Variable Income

H-3520 Incurred Medical Expenses (IMEs)

H-3600 When Not to Reconcile

H-3610 Variable Income

H-3620 Incurred Medical Expenses (IMEs)

H-3630 Both Variable Income and Incurred Medical Expenses (IME)

H-3700 How to Reconcile

H-3710 Variable Income

H-3720 Incurred Medical Expenses (IMEs)

H-3730 Both Variable Income and IMEs

H-3800 How to Reconcile Co-Payment in ICF/ID Cases with Earned Income

H-4000 Co-Payment Budget Types

H-4100 Individual and Couple Cases

H-4200 Companion Cases

H-5000 ICF/IID Co-Payments

H-5100 ICF/IID Individual and Couple Cases

H-5110 ICF/IID Individual

H-5120 ICF/IID Couple

H-5130 ICF/IID Companion Cases

H-6000 Co-Payment for SSI Cases

H-6100 Exceptions to Reduced SSI Payment Standard

H-6200 SSI Applications

H-6210 Manual Certification Procedures

H-6220 Emergency Manual Certification

H-6230 SSI Payment Placed in Suspense by SSA

H-6240 Residence in a Public Institution or Acute Care Hospital

H-6250 Residence in a Medical Care Facility

H-6260 Facility Administrator Responsibilities

H-6270 SSI Monitoring

H-7000 Medicare and Co-Payment

H-7100 General Information

H-7200 Medicare-Related Financial Responsibilities for Skilled Nursing Facility Care

H-7300 Medicaid Coverage Issues Related to Nursing Facility Costs

H-7400 Medicare and Medical Effective Date

H-8000 Vendor Payments and Payment Corrections

H-8100 Co-Payment Corrections

H-8110 Adjustments from Income Averaging

H-8120 Other Adjustments

H-8200 Procedures Relating to Overpayments

H-8210 Willful Withholding of Information

H-8220 Overpayments Resulting from Suspected Fraud

H-8230 Cases Not Submitted for Prosecution

H-8300 Restitution

H-8310 Restitution Defined

H-8320 Restitution Procedures

H-8330 Overpayments Considered for Restitution

H-8340 Overpayments Not Considered for Restitution

H-8350 Steps for Submitting Restitution Payment

H-8360 Steps for Requesting a Refund of Restitution Overpayment

I-1000 Transfer of Assets

I-1100 Texas Administrative Code Rules

I-1200 Overview of Transfer of Assets

I-1210 Transfer of Assets Terms

I-1300 Transfer of Assets

I-1310 Persons Impacted by Transfer of Assets

I-1320 Applications and Other Actions on or After Oct. 1, 2006

I-1330 Transfer Transaction Date

I-1400 Transfer of Income

I-1500 Participation in Transfers

I-1510 Participation Examples

I-1600 Partial Transfers

I-2000 Look-Back Period

I-2100 Look-Back Policy

I-2110 February 2011 and the 60-Month Look-Back Period

I-2120 Revocable Trusts under Pre- and Post-DRA

I-2130 Irrevocable Trusts

I-2200 Look-Back Situations

I-3000 Exceptions to the Transfer of Assets

I-3100 Transfer of Home

I-3200 Transfer of Other Assets and the Home

I-3300 "For the Sole Benefit" Requirements

I-3400 Examples of Transfer of the Home

I-3500 Spousal Impoverishment Transfer Exceptions

I-3510 Spousal Impoverishment Transfer

I-3520 Spousal Impoverishment Transfer Examples

I-3600 Administrative Procedures of Transfers of Nominal Amounts

I-4000 Determining Uncompensated Value

I-4100 Compensation

I-4110 Legal Binding Agreement on or Before the Date of Transfer

I-4120 Forms of Compensation

I-4130 Future Compensation

I-4140 Compensation from Services

I-4150 Cash Compensation

I-4160 Examples of Compensation

I-4200 Rebuttal Procedures

I-4210 Notification of Opportunity for Rebuttal

I-4220 Rebuttal of the Presumption

I-4221 Exclusively for Some Purpose Other than to Qualify

I-4300 Undue Hardship

I-4310 Undue Hardship Example

I-5000 Calculation of Penalty Period

I-5100 Transfer of Assets Divisor

I-5200 The Penalty Start Date

I-5210 Examples of the Penalty Start Date

I-5220 Multiple Transfers

I-5221 Multiple Transfers Example

I-5230 Reported Changes and Redeterminations

I-5231 Changes and Redetermination Examples

I-5240 Multiple Transfers – Historical

I-5241 Example Multiple Transfers – Historical

I-5300 Home and Community-Based Services Waiver Services and State Supported Living Center Services

I-5310 Post-DRA Transfer of Assets Policy

I-5320 Pre-DRA Transfer of Assets Policy

I-5400 Vendor No. 5997, Mason Manor

I-5500 Transfer Penalties and Institutions for Mental Diseases

I-5600 Apportioning Penalty Period Between Spouses

I-5700 Return of Transferred Asset

I-6000 Purchase of Assets and Transfer of Assets

I-6100 Purchase of a Life Estate

I-6110 Policy Implementation Dates

I-6120 Post-DRA Transfer of Assets Policy

I-6121 One-Year Residency Requirement

I-6200 Purchase of a Promissory Note, Loan or Mortgage

I-6210 Policy Implementation Dates

I-6220 Post-DRA Transfer of Assets Policy

I-7000 Reserved

I-8000 Reserved

I-9000 Pre-Deficit Reduction Act (DRA) Rules

I-9100 Texas Administative Code Rules

J-1000 Spousal Impoverishment Overview

J-1100 Texas Administrative Code Rules

J-1200 Spousal Impoverishment Purpose

J-1300 Spousal Definitions

J-1400 Community Spouse Cooperation

J-1410 Refusal of a Community Spouse to Cooperate

J-1420 Separation to Circumvent Medicaid Policy

J-1500 Change in Marital Status

J-1510 Community Spouse Dies

J-1520 Before Certification the Community Spouse Enters an Institutional Setting

J-1530 After Certification the Community Spouse Enters an Institutional Setting

J-1540 Spouses Divorce

J-2000 Spousal Treatment of Income and Resources

J-2100 Spousal Treatment of Income

J-2110 Income Eligibility Test for the Institutional Spouse

J-2111 Treatment of Interest from a Joint Account

J-2112 Treatment of Income from a Trust

J-2113 Other Treatment of Income

J-2200 Spousal Treatment of Resources

J-2210 Out of State Home and Spousal Impoverishment

J-3000 Spousal Transfer of Assets

J-3100 Spousal Transfer of Resources

J-3110 Spousal Resource Transfer Examples

J-3200 Spousal Transfer of Income

J-3300 Other Transfer Information

J-4000 Assessment and SPRA

J-4100 Time Frame to Request the Assessment

J-4110 Automatic SPRA

J-4200 Assessment Request

J-4210 Procedures for Processing the Assessment Request

J-4300 Assessment Date

J-4310 Determining the Assessment Date for a Home and Community-Based Services Waiver

J-4311 Examples of the Assessment Date

J-4400 SPRA Calculation

J-4500 Changing the Assessment Amount

J-5000 Spousal Initial Application

J-5100 Spousal Steps at Application

J-6000 SPRA Expansion

J-6100 Policy and Procedure for SPRA Expansion

J-6200 Spousal Expansion Sept. 1, 2004, or After

J-6210 Sharing Required Information

J-6300 Expanded SPRA for Home and Community-Based Services Waivers

J-6310 Expanded SPRA for Home and Community-Based Services Waiver Applicants in an Assisted Living Facility or Adult Foster Care

J-6400 SPRA Expansion Before Sept. 1, 2004

J-6410 Sharing Required Information

J-7000 Income for Eligibility and Co-Payment

J-7100 Spousal Companion Budget

J-7200 Spousal Co-Payment

J-7300 ICF/IID Spousal Companion Cases

J-7400 Spousal Impoverishment Dependent Allowance

J-8000 After Initial Eligibility Period

J-9000 Notice and Fair Hearing

M-1000 MBI Program

M-1100 Texas Administrative Code Rules

M-1200 Program Overview

M-1300 MBI and Other Programs

M-1310 MBI and Home and Community-Based Services Waivers

M-1320 MBI and Medicare Savings Programs

M-2000 Automation

M-3000 Non-Financial

M-3100 Age

M-3200 Disability

M-3300 Household of One

M-4000 Resources

M-4100 Special MBI Resource Exclusions

M-4110 Retirement Accounts

M-4120 Independence Accounts

M-4130 Plan for Achieving Self-Support (PASS)

M-4140 $3,000 MBI Resource Exclusion

M-5000 Income

M-5100 Income Verification

M-5200 Medicaid Buy-In (MBI) Income Limits

M-6000 Budgeting

M-6100 Income Eligibility Budget

M-6110 Earned Income Tax Credit Payments Exclusion

M-6120 Child Tax Credit Exclusion

M-6130 Infrequent or Irregular Income Exclusion

M-6140 Earned Income – Blind or Students with Disabilities Exclusion

M-6150 $20 General Income Exclusion

M-6160 $65 Earned Income Exclusion

M-6170 Impairment-Related Work-Related Expense (IRWE) Exclusion

M-6180 Blind Work-Related Expense (BWE) Exclusion

M-6190 PASS-Related Earned Income Exclusion

M-7000 Premiums

M-7100 Post Eligibility – Premium Budgets

M-8000 Medical Effective Date, Prior Months' Eligibility and Case Actions

M-8100 Medical Effective Dates

M-8200 Prior Months' Eligibility

M-8300 Case Actions

M-8310 Disposition

M-8320 Eligibility Summary

M-8400 Initial Premium Due Dates

M-8410 Ongoing Premium Due Dates

M-8411 Non-Sufficient Funds for Ongoing Cases

M-8412 Non-Sufficient Funds for Suspended Eligible Cases

M-8420 Premium Payment Notices

M-8430 Presidential-Declared Emergency (PDE)

M-8500 Denial Reasons

M-8510 Redeterminations

M-8520 Appeals

M-9000 Notices and Forms

M-9100 Replacement Medicaid Card

N-1000 Medicaid Buy-In for Children

N-1100 Texas Administrative Code Rules

N-1200 Program Overview

N-1300 Medicaid Buy-In for Children (MBIC) and Other Programs

N-1310 MBIC and Nursing Facilities

N-1320 MBIC and Home and Community-Based Services Waivers

N-1330 MBIC and Medicare Savings Programs

N-1340 Medicaid Estate Recovery Program (MERP)

N-2000 Automation

N-3000 Non-Financial

N-3100 Date of Birth

N-3200 Age

N-3300 Disability

N-3400 Marital Status

N-3500 School or Job Training Attendance

N-4000 Resources and Income

N-4100 Resources

N-4200 Income

N-5000 Employer-Sponsored Health Insurance (ESI)

N-5100 ESI Chart

N-6000 Budgeting

N-6100 Budgeting Concepts

N-6200 Determining the Family Unit

N-6210 School or Job Training

N-6220 Absences Due to Active Duty Military Assignments

N-6300 Eligibility Income Budgeting

N-6310 Income Treatment

N-6320 MBIC Income Exclusion

N-6330 Ineligible Sibling Exclusion

N-6340 Determining the Budget Group

N-6350 Budgeting Steps

N-6351 Examples of Budgeting Steps

N-7000 Premiums

N-7100 Premiums for Alaskan Native or American Indian

N-7200 Premium in Multiple MBIC-eligible Families

N-7300 Premium Due Dates

N-7310 Grace Period for Premiums

N-7320 Premiums and Reapplication for MBIC

N-7330 Coordination with the Children with Special Health Care Needs (CSHCN) Program

N-7400 Premiums Amounts

N-7410 Charts for Premium Amounts

N-7500 Hardship

N-7510 Hardship Approval

N-7511 Hardship Approval Reasons

N-7520 Hardship Denial

N-7521 Hardship Denial Reasons

N-7600 Presidential-Declared Emergency

N-7700 Prior Months' Premiums

N-7800 Health Insurance Premium Payment (HIPP)

N-7900 Cost-Sharing

N-7910 Cost-Share Limit

N-7920 Cost-Share Period

N-7930 Tracking Cost-Share Expenses

N-8000 Medical Effective Date, Prior Months' Eligibility and Case Actions

N-8100 Medical Effective Date

N-8200 Prior Months' Eligibility

N-8300 Case Actions

N-8310 Verification Checklist and Pending Reasons

N-8320 Change Action Reasons

N-8330 Denial Reasons

N-8331 Denial Reasons and Reference Chart

N-8340 Redeterminations

N-8350 Appeals

N-9000 Notices and Forms

N-9100 Replacement Medicaid Card

Q-1000 Medicare Savings Programs Overview

Q-1100 Texas Administrative Code Rules

Q-1200 Medicare Improvement for Patients and Providers Act of 2008(MIPPA)

Q-2000 Qualified Medicare Beneficiaries (QMB) – MC-QMB

Q-2100 Verification and Documentation for QMB

Q-2200 Conditional QMB

Q-2210 Upon Certification of QMB

Q-2300 Social Security Administration QMB Referral Procedures

Q-2400 QMB Benefits

Q-2500 QMB Income and Resource Limits

Q-2600 QMB Cost-of-Living Adjustment

Q-2700 QMB Medical Effective Date

Q-2710 Prior Coverage Under SLMB/QI-1

Q-2800 Ensuring Continuous QMB

Q-2900 QMB Eligibility and Supplemental Security Income

Q-3000 Specified Low-Income Medicare Beneficiaries (SLMB) – MC-SLMB

Q-3100 SLMB Benefits

Q-3200 SLMB Income Limits

Q-3300 SLMB Cost-of-Living Adjustment

Q-3400 SLMB Medical Effective Date

Q-3500 SLMB Eligibility and Other Programs

Q-4000 Medicare Savings Programs and Dual Eligibility

Q-4100 SLMB Dual Eligibility and Medicare Buy-In

Q-4200 Texas Works Medicaid and QMB or SLMB Dual Eligibility

Q-4210 Breast and Cervical Cancer Services Program

Q-4220 Reserved

Q-4230 TANF with QMB

Q-4240 Reserved

Q-4250 Reserved

Q-5000 Qualifying Individuals (QIs)

Q-5100 QI Benefits

Q-5200 QI Income Limit

Q-5300 QI Cost-of-Living Adjustment

Q-5400 QI Medical Effective Date

Q-5500 Reserved

Q-5600 QI-2

Q-6000 Qualified Disabled and Working Individuals (QDWI) – MC-QDWI

Q-6100 QDWI Benefits

Q-6200 QDWI Income Limit

Q-6300 QDWI Cost-of-Living Adjustment

Q-6400 QDWI Medical Effective Date

Q-6500 General SSA Procedures Involving Potential QDWIs

Q-6600 QDWI Application Procedures

Q-6610 Medicare Part A Entitlement

Q-6700 Reserved

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