E-1000, Medicaid Eligibility
E-1010, General Policy
Revision 20-4; Effective October 1, 2020
To determine the correct eligibility begin dates, follow policy in A-820, Regular Medicaid Coverage. A person is continuously eligible beginning the first day of the application month if all eligibility criteria are met. Certified applicants are eligible to receive benefits beginning the month of their 18th birthday through the end of the month of their 26th birthday.
The Medical Effective Date (MED) cannot precede:
- Jan. 1, 2014, the program effective date; or
- the month of the person's 18th birthday.
Follow policy in B-500, Medical Coverage for Individuals Confined in a Public Institution, for people who are confined in a public institution.
Related Policy
Regular Medicaid Coverage, A-820
Medical Coverage for Individuals Confined in a Public Institution, B-500
E—1011 Three Months Prior Coverage
Revision 15-4; Effective October 1, 2015
Applicants for Medicaid for Former Foster Care Children (FFCC) are eligible for three months prior coverage.
Three months prior coverage under FFCC cannot precede January 1, 2014. If eligible under another Medicaid program, an individual can receive three months prior coverage for months requested prior to January 1, 2014, on the Medicaid program for which the individual would have qualified prior to January 1, 2014. Coverage from January 1, 2014, forward will be under the FFCC program.
E—1012 Types of Coverage
Revision 18-1; Effective January 1, 2018
FFCC recipients are automatically enrolled in STAR Health through the month of their 21st birthday. STAR Health provides a full range of Medicaid-covered medical and behavioral health services for Texas Department of Family and Protective Services (DFPS) individuals. Individuals may opt out of STAR Health for STAR, which allows for a choice of health plans.
People under age 21 who receive Supplemental Security Income (SSI) or reside in a nursing facility have the choice of staying in STAR Health or opting into STAR Kids if they meet one of the following criteria:
- receive Medicaid and Medicare; or
- receive services under one of the following 1915(c) waiver programs:
- Home and Community-based Services (HCS);
- Community Living Assistance and Support Services (CLASS);
- Texas Home Living (TxHmL);
- Deaf Blind with Multiple Disabilities (DBMD);
- Medically Dependent Children Program (MDCP); or
- Youth Empowerment Services (YES).
Once an FFCC recipient attains age 21, coverage will transfer to STAR. STAR provides a full range of Medicaid-covered medical and other services for many children and adults. Exception: Individuals ages 21 up to age 26 who meet the STAR+PLUS criteria must enroll in the STAR+PLUS managed care program.