Revision 20-4; Effective October 1, 2020

All Medical Programs

Medical coverage is terminated for people confined in a public institution, except as provided in Section B-520, Medicaid Suspension, and Section B-541, Inpatient Services Provided to Inmates of the Texas Department of Criminal Justice (TDCJ). When a report of confinement is received, follow policy in B-631, Actions on Changes, to terminate the person’s eligibility.

Related Policy

Medicaid Suspension, B-520
Inpatient Services Provided to Inmates of the Texas Department of Criminal Justice (TDCJ), B-541
Actions on Changes, B-631
Child Leaves the Home, D-1433.2
General Policy, W-910
Medicaid Termination, X-923

Revision 20-4; Effective October 1, 2020

Suspend Medicaid in the following circumstances:

People Certified for TA 82, TP 40, TP 44 and TP 70 Confined in a Texas County Jail

Suspend Medicaid if the person is confined in a Texas county jail for more than 30 days and the county jail chooses to report the person’s confinement to HHSC. Follow policy in B-542, Persons Confined in a Texas County Jail, to suspend the person’s Medicaid effective the day after the confinement is reported by the county jail.

If notified of the person’s confinement from a source other than a Texas county jail, terminate the person’s Medicaid.

Children Certified for TP 44 Confined in a Secured Juvenile Facility

Suspend Medicaid when a child is placed in a secured juvenile facility. The Texas Juvenile Justice Department (TJJD) or a Juvenile Probation Department (JPD) makes the report to HHSC within 30 calendar days of a child’s placement. Follow policy in B-543, Child Placed in a Secured Juvenile Facility, to suspend the child's TP 44 eligibility effective the day after TJJD or a JPD notifies HHSC that the child is placed in a juvenile facility.

If notified of the child's placement from a source other than TJJD or a JPD, terminate the child's TP 44.

The following are scenarios for a child certified on Medicaid who is reported as placed in a juvenile facility.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Persons Confined in a Texas County Jail, B-542
Child Placed in a Secured Juvenile Facility, B-543
General Policy, E-1010
General Policy, M-1010

Revision 20-4; Effective October 1, 2020

B-531 Medicaid Reinstatement for Children Certified for TP 44 Who Are Released from a Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

Upon receiving notification from the Texas Juvenile Justice Department (TJJD) or a Juvenile Probation Department (JPD) that a child whose Medicaid is suspended has been released and the child has months remaining on their original certification period:

• reinstate the child's eligibility effective the date of their release, and
• certify the child for any remaining months of the child’s original certification period.

Add the child back to any associated active TANF, SNAP, Medicaid, CHIP, or Medicaid for the Elderly and People with Disabilities (MEPD) EDGs if the child is a required member of the household.

The child's eligibility is reinstated even if the child is released to a household that is different than the one in which the child resided at the time of their placement.

If the child is not eligible for reinstatement but is released to a home in which a sibling is receiving Medicaid or CHIP, add the child to the sibling’s case.

TIERS will automatically reinstate the child’s eligibility for the remainder of the certification period and add the child to any associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS staff must manually process the reinstatement or add the child to an existing case following B-545, Notification of Actual Release.

Related Policy

Medicaid Suspension, B-520
Child Placed in a Secured Juvenile Facility, B-543
Child Placed in a Non-Secure Facility, B-544
Notification of Actual Release, B-545

B-532 Medicaid Reinstatement for Persons Released from Texas County Jails

Revision 20-4; Effective October 1, 2020

TA 82, TP 40, TP 44 and TP 70

When notified by any source that a person has been released from a Texas county jail, perform individual inquiry to determine if the person:

• has suspended or terminated health care coverage due to county jail confinement; and
• was included in the budget or certified group of any other EDGs at the time their health care coverage was suspended or terminated.

If inquiry shows that the person’s health care coverage was suspended at confinement, perform a County Jail Release - Search to determine if the person has an active suspension (months remaining on their original certification). If so, create a Process a County Jail Confinement/Release task for all active cases on which the person was included prior to suspension and enter the release information into TIERS on the County Jail Release - Details page.

When the health care coverage EDG is disposed:

• The person’s health care coverage is reinstated for the remaining months of the original certification period, effective the date the person is released from the county jail.
• The Individual - Medicaid History page is updated to indicate the person’s eligibility has been reinstated.
• A TF0001, Notice of Case Action, is generated notifying the person of reinstatement.

Reinstatement must occur within two business days of receiving the notification of the person’s release.

Consider the report of release as a change report for all other types of assistance and follow policy in B-641, Additions to the Household, to determine if the person needs to be added to the other types of assistance.

If inquiry shows that the person’s health care coverage was terminated at confinement or that the person’s original certification has ended and is not eligible for reinstatement, send an application to the person’s last known address.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Additions to the Household, B-641
General Policy, E-1010
Action on Changes, E-2220
General Policy, M-1010
Action on Changes, M-2220

B-533 Reasonable Opportunity After a Medicaid Suspension and Reinstatement

Revision 20-4; Effective October 1, 2020

TA 82, TP 40, TP 44 and TP 70

If a person’s reasonable opportunity period expires while their Medicaid is suspended, a new reasonable opportunity period is provided when their Medicaid coverage is reinstated. The new reasonable opportunity period is the earlier of the following:

• 95 days from the date the reinstatement is disposed; or
• the last day of their current certification period.

If the person’s Medicaid coverage is reinstated before the original reasonable opportunity period end date, their original reasonable opportunity due date is retained.

A TF0001, Notice of Case Action, is generated at reinstatement and will include the reasonable opportunity information to remind the person to submit documentation of citizenship or alien status.

Related Policy

Reasonable Opportunity, A-351.1

Revision 20-4; Effective October 1, 2020

B-541 Inpatient Services Provided to Inmates of the Texas Department of Criminal Justice (TDCJ)

Revision 20-4; Effective October 1, 2020

TP 44 and TP 40

This section applies only to people confined in a Texas Department of Criminal Justice (TDCJ) facility. This policy does not apply to any other state, county, or city jails. Applications are submitted to HHSC only by The University of Texas Medicaid Branch at Galveston.

A person confined in a public institution is eligible for Medicaid coverage if the following conditions are met:

• the confined person meets Medicaid eligibility requirements (pregnant women and children through age 18 could meet current Medicaid eligibility requirements);
• the confined person receives inpatient services; and
• the inpatient services are provided by a hospital that is not on the premises of a prison, jail, detention center, or other penal setting, including a facility run by a private health care entity.

Medicaid coverage is limited to the specific days the confined person is admitted as a patient and receives inpatient services as verified by the medical provider using Form H1046, Inpatient Medical Services Certification. Inpatient services are those provided on the recommendation of a physician or dentist and received in a medical institution. The confined person must receive or expect to receive room, board, and professional services in the institution for a 24-hour period or longer.

If the confined person is ineligible due to U.S. citizenship or alien status, the medical provider must also complete Form H3038, Emergency Medical Services Certification. The ineligible person is eligible only for those dates verified as an emergency, even if the inpatient treatment continues after the verified emergency dates.

The confined person is eligible for prior coverage only.

The TDCJ or its designee submits the following documents to HHSC via fax:

• Form H1205, Texas Streamlined Application, on behalf of the confined person the month following the month the eligible hospital bill was incurred;
• Form H1046, Inpatient Medical Services Certification;
• Form H3038, Emergency Medical Services Certification, if applicable; and
• all required verification, such as verification of citizenship, alien status, etc.

Note: If the required information or verification is not received, call or send secure email to the designated TDCJ contact.

Upon disposition of the application, send Form TF0001, Notice of Case Action, to the representative’s address provided on Form H1205, Texas Streamlined Application.

Related Policy

Applications for Babies Born to Women in Prison, A-116.3

B-542 Persons Confined in a Texas County Jail

Revision 20-4; Effective October 1, 2020

All Medical Programs

A county jail may choose to report people who receive health care coverage from HHSC and are confined in their facility for more than 30 days. If applicable, within two business days of the confinement report, Centralized Benefit Services (CBS) staff must review the report of confinement and determine the appropriate action needed.

CBS staff:

• Suspend the following types of health care coverage:
  • TA 82, MA – Former Foster Care Children
  • TP 40, MA – Pregnant Women
  • TP 44, MA – Children 6–18
  • TP 70 - Medicaid for the Transitioning Foster Care Youth (MTFCY)
• Terminate the following types of health care coverage:
  • TA 41, Health Care – Healthy Texas Women (HTW)
  • TA 66, MA – MBCC – Presumptive
  • TA 67, MA – MBCC
  • TA 76, MA – Children 6–18 Presumptive
  • TA 77, Health Care – FFCHE
  • TA 83, MA – FFCC Presumptive
  • TA 84, CI – CHIP
  • TA 85, CI – CHIP perinatal
  • TA 86, MA – Parents and Caretaker Relatives Presumptive
  • TP 07, MA – Earnings Transitional
  • TP 08, MA – Parents and Caretaker Relatives
  • TP 20, MA – Alimony/Spousal Support Transitional
  • TP 42, MA – Pregnant Women Presumptive

Do not act on other types of health care coverage.

When the Eligibility Determination Group (EDG) is disposed, if applicable:

• The person’s health care coverage is suspended or terminated effective the day after HHSC receives the notification. The person receives Medicaid through the date of the confinement notification.
• The Individual – Medicaid History page is updated to indicate the person’s eligibility is suspended or terminated.
• The person is removed from other EDGs in which they are included, and benefits are adjusted accordingly for the remaining household members following current policies and procedures.
• A TF0001, Notice of Case Action, is generated at suspension/termination and reinstatement (TWH Section A-2310, Notice to Applicants).

Note: Terminate the person’s eligibility following policy in B-631, Actions on Changes, if a report of confinement in a county jail is received from a source other than a participating county jail.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Actions on Changes, B-631
General Policy, E-1010
General Policy, M-1010

B-543 Child Placed in a Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

The TJJD or a JPD notifies HHSC within 30 days of a child's placement in a juvenile facility. Upon notification of the placement:

• suspend the child's Medicaid eligibility effective the day after HHSC receives the notification if the child is certified for TP 44;
• terminate the child's Children's Health Insurance Program (CHIP) eligibility effective the day after HHSC receives the notification if the child is certified for CHIP;
• terminate the child's Medicaid eligibility allowing adequate notice according to policy in A-2344.1, Form TF0001 Required, Adequate Notice, if the child is certified on a Medicaid type other than TP 44; and
• remove the child from other Eligibility Determination Groups (EDGs) in which the child is included.

The child receives TP 44 eligibility through the date of the notification of placement.

The following are scenarios for a child certified on Medicaid who is reported as placed in a juvenile facility.

Exceptions:

• Children certified on a Supplemental Security Income (SSI) or a Department of Family and Protective Services (DFPS) type of Medicaid are not terminated by HHSC.
• Children placed in a non-secure facility may receive TP 44 as an independent child. Therefore, these EDGs are not suspended or denied when a notification of placement is received.

TIERS will automatically suspend or terminate the child’s eligibility and remove the child from associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS must manually process the suspension, termination, or removal of the child from associated EDGs.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531
Child Placed in a Non-Secure Facility, B-544

B-544 Child Placed in a Non-Secure Facility

Revision 24-1; Effective Jan. 1, 2024

TP 44

When reporting that a child has been placed in a juvenile facility, Texas Juvenile Justice Department (TJJD) or a Juvenile Probation Department (JPD) notifies HHSC if the facility is a secure or non-secure facility. 

Non-secure TJJD or JPD halfway house facilities with more than 16 beds and non-secure juvenile facilities with 16 or fewer beds may apply for medical assistance on behalf of the children under their care. Independent children residing in a TJJD or a JPD halfway house with more than 16 beds may be eligible for Medicaid if the child meets all other eligibility criteria and the half-way house meets the federally required children’s living arrangement criteria.

These facilities have limited power of attorney and are considered alternate payees for the children’s Medicaid EDG. A facility submits an application listing the child as a case name and a representative from the facility as an authorized representative (AR). If the representative is no longer affiliated with the facility, the facility must name a new representative to serve as the child’s AR. When a child moves out of the facility, it is the responsibility of the facility’s AR to report the change of address and to end the AR designation.

Medical Effective Date

To determine the correct medical effective date (MED) for children in a non-secure facility, follow the chart below:

Related Policy

Advisor Action for Determining Eligibility for Children, A-126.3   
Children's Living Arrangement, A-241.3.1
How to Apply for Three Months Prior Coverage, A-831.1 
Reporting Requirements, B-620

B-545 Notification of Anticipated Release from Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

At least 30 days prior to a child's release, TJJD or a JPD notifies HHSC of the child's anticipated release date. Upon receipt of the information, CBS staff determines whether the child:

• is eligible for reinstatement of TP 44 eligibility;
• can be added to an existing case if not eligible for reinstatement; or
• must reapply.

If the child cannot be reinstated because their original certification period has ended or their TP 44 was not suspended or cannot be added to an existing case, CBS staff are notified in the HHSC Action Status field on the TIERS TJJD/JPD Release page, to send the household an application packet. The application packet includes the following:

• Form H1205, Texas Streamlined Application;
• a pre-paid envelope addressed to CBS;
• a cover letter that provides information and instructions for submitting the application and obtaining help in completing the application; and
• a list of Community Partners in the household’s area that provide application assistance upon request.

Related Policy

Notification of Actual Release from a Juvenile Facility, B-546

B-546 Notification of Actual Release from a Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

Upon notification from TJJD or a JPD of the child's actual release, reinstate eligibility for a child whose eligibility was suspended and there are months remaining on the child's original certification period.

The child is automatically added to an existing case if the child is not eligible for reinstatement but has a sibling receiving Medicaid or CHIP. The child is also added to any other EDGs on the case that require the child to be a household member.

TIERS will automatically reinstate the child’s eligibility and add the child to associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS must manually process the reinstatement or add the child to an existing case.

Within two business days of notification of the child's release, CBS staff must process and dispose any pending applications.

CBS accepts applications up to and including the 14th calendar day after the confirmed release date. Any applications received after the 14th calendar day are routed to the local office for processing.

CBS reports the following to TJJD through the Juvenile Medicaid Tracker:

• the child has Medicaid or CHIP;
• the child was denied;
• the CBS unit never received the application; or
• the application was sent to the local office.

If the child is eligible for Medicaid, the MED cannot be any earlier than the release date.

Related Policy

Regular Medicaid Coverage, A-820
Adverse Actions Not Requiring Advance Notice, A-2344
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531  
Additions to Household, B-641

B-547  Inpatient Services Provided to Juvenile Inmates

Revision 22-3; Effective July 1, 2022

TP 40 and TP 44

This section only applies to people confined in Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) facilities. This policy does not apply to any other state, county or city jails. Applications are only submitted to HHSC by TJJD.

A person confined in a juvenile public institution is eligible for Medicaid coverage if:

• the confined person meets all other Medicaid eligibility requirements (pregnant women and children through 18 could meet current Medicaid eligibility requirements);
• the confined person receives inpatient services; and
• the inpatient services are provided by a hospital, including a facility run by a private health care entity, that is not on the premises of a prison, jail, detention center or other penal setting.

Medicaid coverage is only available for the specific days the confined person is admitted as a patient and receives inpatient services as verified by the medical provider using Form H1046, Inpatient Medical Services Certification. Inpatient services are those services provided on the recommendation of a physician or dentist and received in a medical institution. The confined person must receive or expect to receive room, board and professional services in the institution for a 24-hour period or longer.

If the confined person is ineligible due to U.S. citizenship or immigration status, the medical provider must also complete Form H3038, Emergency Medical Services Certification. The person is eligible only for dates verified as an emergency, even if the inpatient treatment continues after the verified emergency dates identified on Form H3038.

The confined person is only eligible for prior Medicaid coverage.

TJJD submits the following documents to HHSC via YourTexasBenefits.com:

• YourTexasBenefits.com online application on behalf of the confined person the month following the month the person incurred the eligible hospital bill;
• Form H1046;
• Form H3038, if applicable; and
• all required verification for the applicable Medical assistance program, such as verification of citizenship, immigration status, etc.

Note: If TJJD does not provide the required information or verification with the application, call or send a secure email to the designated TJJD contact to request the necessary information.

If the child has an existing case as part of a household with other members in TIERS, perform Application Registration to certify the prior Medicaid coverage on a separate case number from the existing household’s case. Upon disposition of the application, send Form TF0001, Notice of Case Action, to the representative’s address provided on the application.

Related  Policy

Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Who Are Released from a Juvenile Facility, B-531