B-3100, Application Process

Revision 20-2; Effective June 1, 2020

For Medicaid for the Elderly and People with Disabilities (MEPD), the application for assistance is based on one of the following versions of Form H1200:

  • Form H1200, Application for AssistanceYour Texas Benefits, for all MEPD programs;
  • Form H1200-EZ, Application for Assistance — Aged and Disabled, for Medicare Savings Programs (MSP) programs;
  • Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement, for state supported living centers, state hospitals, and state centers;
  • Form H1200-MBI, Application for Benefits — Medicaid Buy-In, for the MBI program only; or
  • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children (MBIC), for the MBIC program only.

If requested, give the applicant a receipt (Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change) to verify they provided an application. An applicant may request Form H1800 by fax or mail. Mail the receipt to the applicant’s listed address.

Related Policy

Date of Application, B-4000
Previous Completed Application, B-5000
Notices and Forms, M-9000
Notices and Forms, N-9000

B-3200, Application Requirements

Revision 09-4; Effective Dec. 1, 2009

Federal law requires that anyone who wishes to apply for a Medicaid program be allowed to file an application without delay, regardless of the person's ultimate eligibility for assistance.

An application form must be mailed within two working days from the receipt of the request for an application.

Use an application form to test eligibility for all Medicaid programs for which a person meets the criteria. A separate application form is not required for each of the different Medicaid programs for the elderly and persons with disabilities.

Consider the application complete with a name, address and signature.

B-3210 Who May Complete an Application for Assistance

Revision 23-2; Effective June 1, 2023

A person who may complete or sign an application for an applicant may not be on the list of people to whom the Texas Health and Human Services Commission (HHSC) can release the applicant’s individually identifiable health information. See Section C-5000, Personal Representatives, for people who may receive or authorize the release of an applicant's individually identifiable health information under Health Insurance Portability and Accountability Act (HIPAA) privacy regulations.

An authorized representative may accompany, help and represent an applicant or recipient in the application or eligibility redetermination process.

Anyone may help the applicant, guardian, power of attorney or authorized representative complete an application form. If someone helps complete the application for assistance, the name of the person completing the form must appear as requested on the application.

See Section B-3220, Who May Sign an Application for Assistance, to determine who may sign an application for assistance form. The requirements for signing a redetermination form are the same as the requirements for signing an application.

See Section C-1100, Responsibility of Applying.

Most applicants in an institutional setting such as a nursing facility are signed into the facility by someone else. An application and information from the applicant or the person(s) having knowledge of the applicant's financial circumstances are required.

B-3220 Who May Sign an Application for Assistance

Revision 16-3; Effective Sept. 1, 2016

An individual who may complete or sign an application for an applicant may not be on the list of people to whom HHSC can release the applicant’s individually identifiable health information. See Section C-5000, Personal Representatives, for individuals who may receive or authorize the release of an applicant’s individually identifiable health information under HIPAA privacy regulations.

An applicant, authorized representative or someone acting responsibly for the applicant (if the applicant is incompetent or incapacitated) may sign an application for assistance. The application for assistance must be signed under penalty of perjury.

If an applicant has a guardian, the guardian must:

  • sign the application for assistance;
  • obtain a copy of the guardianship papers; and
  • work with the guardian in the eligibility process.

If an application is signed by someone other than the applicant or the applicant’s guardian, power of attorney, family member, or a friend who is knowledgeable of the applicant’s finances, the individual must provide a Form H1003, Appointment of an Authorized Representative, signed by the applicant, or evidence of:

  • authority to complete and sign an application on behalf of an applicant;
  • the individual’s relationship to the applicant; and
  • responsibility for the applicant’s care.

If an applicant makes an "X" on the signature line for applicant/recipient, a witness must sign on the witness signature line.

B-3221 Valid Signatures

Revision 24-1; Effective March 1, 2024

All applications and renewals must be signed under the penalty of perjury statement.

Valid signatures include only the following:

  • a traditional written signature;
  • a faxed written signature;
  • an electronic signature submitted through YourTexasBenefits.com;
  • an electronic signature submitted through an account transfer from the Marketplace; and
  • a telephonic signature submitted by calling 2-1-1.

YourTexasBenefits.com

Applications submitted online through YourTexasBenefits.com by a person or authorized representative (AR) are considered electronically signed. A traditional written signature is not required before the person can be certified.

Federal Marketplace Applications

The Marketplace sends a person's information electronically to HHSC through an account transfer. Applications from the Marketplace are received by staff in the same way as an application from YourTexasBenefits.com and are considered electronically signed. 

Other Electronic Signatures

Other electronic signatures not specifically mentioned above, including those captured or copied by electronic devices, are not valid signatures. 

Calling 2-1-1

A person may apply for Medicaid by calling 2-1-1. A person or AR may complete and sign an application over the phone by:

  • providing their information over the phone to a customer care representative (CCR); and
  • signing the application telephonically by stating their name and agreeing to the penalty of perjury statement read by the CCR.

The CCR enters and submits the information provided by the person or AR through YourTexasBenefits.com.

Unsigned Applications

An application or renewal form is considered invalid when:

  • it is received without a signature below the penalty of perjury statement; or
  • the agency receives an application without a signature and does not accept the application by giving the application an established file date. 

Staff must return the application with a letter and a self-addressed return envelope explaining that the application must be signed before the agency can establish a file date.

If the agency receives and accepts an application without a signature and the application is given an established file date in error, the date the application is received is considered a valid file date. Staff must send Form H1020, Request for Information or Action, along with the signature page requesting a signature. If the person applying for Medicaid fails to provide a signed application by the final due date, staff must deny the application for failure to provide information.

Related Policy

Processing Deadlines, B-6400
Who May Sign an Application for Assistance, B-3220

B-3230 Receipt of Duplicate or Identical Applications

Revision 20-3; Effective Sept. 1, 2020

Duplicate Application

An application filed after another application has already been filed is a duplicate application if it:

  • does not include a request for a new program (i.e.: a type of program not requested on the initial application or a type of program not currently received by the applicant); and
  • is not needed for a redetermination of the active program(s).

Example: An application is received on January 2 and a second application for the same program is received on January 5. The second application is considered a duplicate application.

If a duplicate application is received while the first application is being processed:

  • treat the duplicate application as a report of change; and
  • assign to the eligibility staff currently processing the case.

If a duplicate application is received after the first application has been processed, review the application to ensure the person is not applying for a different type of program and that a redetermination is not due. If a new program is not being requested:

  • consider the duplicate application as a report of change; and
  • assign as a change indicating "duplicate application."

If the person is applying for a new program, the application is not a duplicate application. Process the application as a new request for assistance.

Identical Application

An identical application is an exact copy of an application previously submitted by an applicant.

Example: An application is received by fax on January 2 and an exact copy of the same application (with the same signature and date of the previously submitted application) is received by mail on January 5. The second application is considered an identical application.

Required Action on Identical Application Received

If an identical application is received, write "Identical Application" on the front page of the application and route for imaging. The identical application will be imaged and added to the electronic case record. No other action is needed.

B-3240 Electronic Correspondence

Revision 22-3; Effective September 1, 2022

At any time, an applicant, recipient, or authorized representative (AR) for a case may view available eligibility correspondence electronically through YourTexasBenefits.com instead of receiving them by mail. By selecting this option, applicable forms and notices are posted to the recipient’s or AR’s YourTexasBenefits.com case account. A text message or an e-mail reminder is sent to the recipient each time a new form or notice is posted to their account. The recipient may print a copy of the correspondence from their YourTexasBenefits.com account or request a paper copy be mailed to them. Forms and notices that are not available electronically will continue to be mailed to the recipient or AR.

Related Policy

Notices, R-1300

B-3300, Authorized Representative

Revision 21-1; Effective March 1, 2021

An authorized representative (AR) is a person who is familiar with the applicant and knowledgeable of the applicant’s financial affairs.

An applicant, person receiving benefits, head of household (HOH), or someone with legal authority to act on their behalf (e.g., legal guardian or power of attorney) may designate a person or organization as an AR.

When applying for benefits, an AR must be verified using one of the following:

  • applicant's or recipient’s signature on one of the following HHSC applications for benefits containing the AR designation:
    • Form H1200, Application for Assistance — Your Texas Benefits;
    • Form H1200-MBI, Application for Benefits — Medicaid Buy-In;
    • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children; or
    • Form H1206, Health Care Benefits Renewal;
  • applicant's signature on a Marketplace application for health care benefits that is transferred to HHSC and contains the AR designation;
  • legal documentation that the AR has authority to act on behalf of the applicant or recipient under state law (e.g., legal guardianship or power of attorney);
  • letter designating AR authority and containing the applicant's or recipient’s signature, in addition to the name, address and signature of the AR;
  • completed Form H1003, Appointment of an Authorized Representative;
  • applicant’s or recipient’s electronic signature designating the AR on an application, renewal or reported change submitted through YourTexasBenefits.com; or
  • applicant’s or recipient’s telephonic signature submitted by calling 2-1-1.

If a person or organization submits an application on behalf of an applicant and indicates they wish to be the AR but the application is not signed by the applicant, send correspondence to both the unverified AR and the applicant to request the verification.

  • Send the following to the applicant:
    • Form H1020, Request for Information or Action, listing the missing information needed before eligibility can be determined.
    • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.
  • Send the following to the unverified AR:
    • Form H1004, Cover Letter: Authorized Representative Not Verified, explaining what is needed to verify the AR.
    • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.

For the AR to be verified, either the AR or the applicant must return the completed Form H1003 within 10 days (or 39 days from the file date). All missing information listed on the Form H1020 must also be returned timely. If the AR verification is not received by the due date, do not designate an AR.

The AR designation is effective from the date the AR is verified until:

  • the applicant or recipient notifies HHSC that the AR is no longer authorized to act on their behalf;
  • the AR notifies HHSC that they no longer wish to act as the AR for the applicant or recipient;

    Note: The AR will not be able to do this during the redetermination process if the AR is the person completing and signing the redetermination.
     
  • there is a change in the legal authority (i.e., legal guardianship or power of attorney) on which the AR’s designation is based; or
  • the applicant or recipient designates a new AR to act on their behalf. If there is an existing AR designated on a case, the person or organization most recently designated as the AR will replace the existing AR on the case.

Requests to end the designation of an AR must include the signature of the applicant, the recipient or the AR as appropriate.

Note: An AR is not automatically a personal representative.

An AR is designated at the case level to have access to all benefit information for that case. A verified AR may:

  • sign an application on behalf of an applicant;
  • complete and submit a renewal form;
  • receive copies of notices or renewal forms in the preferred language selected on the application, and other communications from HHSC;
  • designate a health plan; and
  • act on behalf of the applicant or the recipient in all other matters with HHSC.

The applicant, recipient or AR may also request that the AR receive the recipient’s Medicaid ID card and enrollment-related agency correspondence.

Mailing Address for AR

When processing the application, obtain the AR’s complete mailing address if not included on the application form. Record the AR’s address on the TIERS Data Collection page, Household – Authorized Representative. If the applicant cannot provide a complete mailing address for the AR, do not pend the case. Record the applicant’s mailing address as the AR’s address in TIERS.

When an applicant or recipient and their designated AR have the same mailing address, correspondence will be sent only to the AR.

When an applicant or recipient has a legal guardian, correspondence will be sent only to the guardian, even if the applicant or recipient and the guardian have different mailing addresses.

Applicants, recipients or ARs who have chosen to receive eligibility correspondence electronically will continue to receive correspondence electronically.

Related Policy

Who May Complete an Application for Assistance, B-3210
Who May Sign an Application for Assistance, B-3220
Prior Coverage for Deceased Applicants, G-7210

B-3400, General Procedures

Revision 21-4; Effective December 1, 2021

If an applicant or authorized representative (AR) contacts HHSC to initiate an application and appears to be eligible for SSI, refer the person or AR to the Social Security Administration (SSA). If the person or AR wishes to file an application with HHSC, provide the appropriate cover letter, application for assistance and Form H0025, HHSC Application for Voter Registration.

Explain that eligibility is determined based on:

  • a completed, signed and dated application for assistance;
  • information obtained from the completed form, the applicant and AR, tape matches and interviews if needed; and
  • required verification documents.

When determining eligibility for a person in an institutional setting using the special income limit, the eligibility determination cannot be disposed in the system of record until the person has resided in an institutional setting for at least 30 consecutive days.  The person must also have an approved level of care (LOC) for an intermediate care facility for persons with intellectual disabilities (ICF/IID)  or an approved medical necessity (MN) with a nursing facility LOC. 

Do not approve medical assistance for a person in an institutional setting unless the person has been in a Medicaid facility for at least 30 days and has an approved LOC or MN determination.

Related Policy

Institutional Living Arrangement, B-6300
Voter Registration, C-7000
Assessment and SPRA, J-4000
 

 

B-3500, Coordination with the Federal Marketplace

Revision 24-1; Effective March 1, 2024

Eligibility determinations for Medicaid must be coordinated with the federal Marketplace. A person who applies for health care coverage through the Marketplace at HealthCare.gov is also assessed for Medicaid eligibility. If the Marketplace assessment does not show the person may be eligible for Medicaid, the person can still request their information be transferred to HHSC for a full eligibility determination.

The Marketplace assesses a person as:

  • potentially eligible for Medicaid based on Modified Adjusted Gross Income (MAGI) rules; or
  • potentially eligible for Medicaid on a non-MAGI basis if the person is 65 or older or reports having a disability or blindness.

If the assessment shows the person may be eligible for Medicaid, the person’s application information is transferred to HHSC.

HHSC must evaluate the person’s eligibility for Medicaid without requiring a new application.

B-3510 Applications Received from the Marketplace

Revision 24-1; Effective March 1, 2024

The federal Marketplace sends a person’s application information to HHSC through an electronic interface when:

  • the Marketplace assessment shows the person may be eligible for Medicaid; or
  • the person requests a full eligibility determination for Medicaid.

The electronic transfer of application information is called an account transfer. The account transfer includes information provided by the person on the Marketplace application and information verified by the Marketplace.

The account transfer process generates a PDF application with the information the Marketplace provides. Verifications completed by the Marketplace are included in the Verifications section of the PDF. Like an application from YourTexasBenefits.com, enter applicant information into the appropriate logical unit of work (LUW) following the verification policies. This includes any required documentation about blanks or discrepancies on the PDF application.

B-3520 Verifications Provided by the Marketplace

Revision 24-1; Effective March 1, 2024

Medical Programs

Marketplace account transfer PDFs also include a Verifications section. Enter information from the verification section as follows:

  • If the Marketplace verified the person's Social Security number (SSN) or citizenship status using data from the Social Security Administration (SSA), accept the information as Verified by SSA.
  • If the Marketplace verified the person's alien status using data from the Department of Homeland Security (DHS), accept the information as Verified by DHS.
  • If the Marketplace verified other eligibility criteria, such as income or resources, per HHSC verification policy, accept the information as verified. 

All other applicant information must be verified as required by the applicable HHSC verification policy. Do not request additional verification for information verified by the Marketplace per HHSC verification policy.

Related Policy

Documentation and Verification Guide, Appendix XVI