C-1100, Other/Miscellaneous
C-1110, Medical Information
C—1111 State Medicaid Agencies
Revision 13-3; Effective July 1, 2013
Medical Programs
For links to all State Medicaid Agencies, go to https://www.medicaid.gov/medicaid/by-state/by-state.html.
C—1112 Services Under the Texas Medical Assistance Program
Revision 19-3; Effective July 1, 2019
Medical Programs
Benefits provided through health insuring agent:
- In-patient hospital services*
- Out-patient hospital services*
- Laboratory and x-ray services
- Physician's services
- Podiatrist's services
- Optometric services*
- Ambulance services*
- Family planning services*
- Home health services limited to nurse and home health aide visits*
- Medicare Part A deductible and coinsurance when benefits would otherwise be payable under Medical Assistance and Medicare Part B deductible and coinsurance for assigned claims only
- Chiropractic treatment — limited to Medicare Part B deductible and coinsurance for assigned claims only
- Eyeglasses*
- Rural health clinics*
Services provided through contract or by direct vendor payments from the Health and Human Services Commission (HHSC):
- Nursing care skilled and intermediate care. Skilled care is limited to recipients age 21 and over. Medicare SNF coinsurance.*
- Active treatment for recipients or patients of any age in licensed and approved section of institutions for persons with intellectual disabilities.*
- In-patient hospital care for recipients or patients age 65 and older in contracted mental hospitals and state (tuberculosis) hospitals.*
- Texas Health Steps screening program and limited dental treatment for eligible persons under age 21.
- Prescriptions limited to no more than three covered per month if over 18. Unlimited if 18 and under.
- Prior authorized hearing aid services.*
- Primary home care for recipients age 18 and over.*
- Other medical transportation.
*With limitations — see appropriate provider manuals for details.
The benefits of this program do not extend to:
- Inmates in a public institution. (Recipients in approved medical units in certain contracted institutions are eligible for vendor payments made by HHSC.)
- Special shoes or other supportive devices for the feet or walking aids.
- Services in military medical facilities, Veteran's Administration (VA) facilities, or United States Public Health Service Hospitals.
- Care and treatment related to any condition for which benefits are provided or are available under Workman's Compensation laws.
- Dental care and services except certain oral surgery or that provided under Texas Health Steps.
- Any services or supplies provided in connection with a routine physical examination except family planning services.
- Any care or services payable under Title XVIII (Medicare).
- Any service provided by an immediate relative of the recipient or member of the recipient's household.
- Any services or supplies not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of the malformed body member.
- Custodial care.
- Any services provided to the recipient after a utilization review or medical review finding that such services are not medically necessary.
- Any services or supplies that are payable through a third party.
- Any service or supplies not specifically provided by the Texas Medical Assistance Program.
Disclaimer: This list is for convenient reference and does not have the effect of law, regulation or policy. If there is a conflict between this list and law, regulations, and policy, the latter will prevail. If there is a question, use the appropriate provider manuals or filed releases for clarification.
C—1113 Qualified Hospital/Qualified Entity Policy and Procedures for Presumptive Eligibility Determinations
Revision 15-3; Effective July 1, 2015
TA 66, TA 74, TA 75, TA 76, TA 83, TA 86 and TP 42
Presumptive eligibility (PE)provides short-term medical coverage to pregnant women, Medicaid for Breast and Cervical Cancer (MBCC) applicants, children under age 19, parents and caretaker relatives of dependent children under age 19, and former foster care children. PE provides full fee-for-service Medicaid with the exception of pregnant women. Pregnant women receive ambulatory prenatal care only.
Qualified hospitals (QHs)determine PE for all groups except MBCC.
Qualified entities (QEs)determine PE for pregnant women and MBCC applicants. For MBCC applicants, only QEs that are also Texas Department of State Health Services (DSHS) Breast and Cervical Cancer Services contractors can make MBCC PE determinations, following the process outlined in X-100, Application Processing.
C—1113.1 Eligible Groups
Revision 15-3; Effective July 1, 2015
The following groups can receive presumptive eligibility coverage:
- Children:
- MA-Children Under 1 Presumptive — TA 74
- MA-Children 1–5 Presumptive — TA 75
- MA-Children 6–18 Presumptive — TA 76
- Former Foster Care Children (MA-FFCC Presumptive —TA 83)
- Pregnant Women (MA-Pregnant Women Presumptive — TP 42)
- Parents and Other Caretaker Relatives (MA-Parents and Caretaker Relatives Presumptive — TA 86)
C—1113.2 Household Composition
Revision 15-3; Effective July 1, 2015
The QH/QE uses the non-taxpayer/non-tax dependent rules to determine the household composition.
C—1113.3 Modified Adjusted Gross Income (MAGI) Methodology
Revision 15-4; Effective October 1, 2015
The QH/QE uses a simplified MAGI methodology to determine if an individual meets the income requirements for PE. The income limits for each PE type of assistance are the same as the income limits for the associated regular Medicaid type of assistance. For example, MA-Children Under 1 Presumptive has the same income limit as MA-Children Under 1.
C—1113.4 Verifications
Revision 15-3; Effective July 1, 2015
The individual must attest to being:
- a Texas resident, and
- a United States citizen or an eligible immigrant.
For all other PE criteria, the individual's statement is acceptable verification. Additional forms of verification beyond an individual's statement are not required.
C—1113.5 Medical Effective Dates
Revision 15-4; Effective October 1, 2015
The medical effective date (MED) is the date the QH or QE determines the individual is presumptively eligible for Medicaid. If the individual is presumptively eligible, QH/QE staff give the individual Form H1266, Short-term Medicaid Notice: Approved. It informs the individual when the PE coverage begins and when the PE coverage ends, based on whether the individual applies for regular Medicaid.
Note: An individual is not eligible for PE if they are currently receiving Medicaid, Children's Health Insurance Program (CHIP) or CHIP perinatal.
If the individual does not apply for regular Medicaid, the PE coverage ends the last day of the month after the month of the PE determination (see scenario 1 below).
If the individual submits Form H1205, Texas Streamlined Application, or Form H1010, Texas Works Application for Assistance — Your Texas Benefits, HHSC staff determine whether the individual is eligible for regular Medicaid. If the individual is not eligible for regular Medicaid, the individual's PE coverage ends the date that HHSC determines the individual is ineligible (see scenario 2 below). If the individual is eligible for regular Medicaid, the individual's PE coverage ends when HHSC makes the Medicaid eligibility determination, following cutoff rules.
If an individual is Medicaid-eligible during the application month, the individual receives Medicaid from the first of that month through the PE MED. Regular Medicaid coverage for the ongoing period begins once the PE period ends (see scenarios 3 and 4 below). Exception: Since PE for pregnant women provides only limited prenatal services, ongoing Medicaid coverage overlays the PE coverage (see scenario 5 below).
Examples:
| A child is determined eligible for MA-Children 6–18 Presumptive on February 2. Her mother does not submit an application for regular Medicaid. The child's PE coverage ends on March 31. |
| A child is determined eligible for MA-Children Under 1 Presumptive on April 4. Her father submits an application for regular Medicaid on the same date. HHSC determines on April 20 that the child is not eligible for regular Medicaid. Her PE coverage ends on April 20. |
| A child is determined eligible for MA-Children 1–5 Presumptive on March 6. His mother submits an application for regular Medicaid on the same date. HHSC determines on March 15 (before cutoff) that the child is eligible for regular Medicaid. His PE coverage ends March 31. He is certified for regular Medicaid effective March 1 to March 5 and April 1 through ongoing. |
| A former foster care child is determined eligible for MA-FFCC Presumptive on May 9. He submits an application for regular Medicaid on the same date. HHSC determines on May 22 (after cutoff) that the individual is eligible for regular Medicaid. His PE coverage ends June 30. He is certified for regular Medicaid effective May 1 to May 8 and July 1 through ongoing. |
| A woman is determined eligible for MA-Pregnant Women Presumptive on June 4. She submits an application for regular Medicaid on the same date. HHSC determines on June 10 that the woman is eligible for regular Medicaid. Her PE coverage ends on June 30. Regular Medicaid overlays her PE coverage with an effective date of June 1. |
C—1113.6 Periods of Presumptive Eligibility
Revision 15-3; Effective July 1, 2015
Pregnant women are allowed one PE period per pregnancy.
For all other PE groups, an individual is allowed no more than one period of PE per two calendar years. Example: An individual receives MA-Children 6–18 Presumptive in June 2015. He cannot receive another period of PE until January 2017.
C—1113.7 Three Months Prior Coverage
Revision 15-3; Effective July 1, 2015
Three months prior coverage does not apply to presumptive eligibility. Eligibility for three months prior Medicaid coverage is determined when HHSC eligibility staff make a regular Medicaid determination, if requested.
C—1113.8 Application Processing
Revision 15-4; Effective October 1, 2015
QH/QE staff first must perform a PE portal inquiry to find out if an individual is currently receiving Medicaid, CHIP or CHIP perinatal or if the applicant has received a period of PE within the PE period limit.
QH/QE staff make the PE determination based on information the individual provides about citizenship/immigration status, Texas residency, income and household composition. To determine whether the individual is presumptively eligible, QH/QE staff fill out Form H1265, Presumptive Eligibility (PE) Worksheet, using the information the individual provides.
If the individual is presumptively eligible, QH/QE staff do the following:
- Enter the individual's demographic information and the PE type of assistance for which the individual is eligible into the PE portal. QH/QE staff use the PE portal to conduct limited inquiries and submit PE determinations.
- Give the individual Form H1266, Short-term Medicaid Notice: Approved. QH/QE staff also help the individual complete and submit the regular Medicaid application via YourTexasBenefits.com if the individual wants to apply. Note: An individual is not required to submit a regular Medicaid application to receive PE Medicaid.
If the individual is not eligible for PE, QH/QE staff issue Form H1267, Short-term Medicaid Notice: Not Approved, to the individual and tell the individual about the right to apply for regular Medicaid.
C—1113.9 Due Dates and Processing Time Frames
Revision 15-3; Effective July 1, 2015
Within one business day of the PE determination, the QH/QE must submit the PE determination to HHSC through the PE portal.
C—1113.10 How to Become a Qualified Hospital or Qualified Entity
Revision 15-3; Effective July 1, 2015
Hospitals or entities that want to become qualified to make PE determinations must (1) submit to HHSC a notice of intent, (2) sign a Memorandum of Understanding, and (3) complete online training at the PE website at www.TexasPresumptiveEligibility.com.
C—1113.11 Presumptive Eligibility Forms
Revision 15-3; Effective July 1, 2015
Qualified hospital/qualified entity staff use the following forms in the presumptive eligibility process:
- Form H1265, Presumptive Eligibility (PE) Worksheet—Completed by the QH/QE and used to determine if an applicant is presumptively eligible.
- Form H1266, Short-term Medicaid Notice: Approved-Completed by the QH/QE and given to an individual determined presumptively eligible. This form notifies the individual about PE coverage and lists the eligibility start date and end date, which is based on whether the individual submits an application for regular Medicaid. If an individual needs proof of Medicaid coverage before receiving their Medicaid identification card, the individual can present this form in an HHSC local eligibility determination office, and HHSC staff will provide the individual with Form H1027-A, Medicaid Eligibility Determination.
- Form H1267, Short-term Medicaid Notice: Not Approved— Completed by the QH/QE and given to an individual determined ineligible for PE coverage. This form explains the reason for ineligibility and how to apply for regular Medicaid.
Related Policy
Processing Presumptive Eligibility Applications, A-124
C—1114 Guidelines for Providing Retroactive Coverage for Children and Medical Programs
Revision 23-2; Effective April 1, 2023
Medical Programs
When determining retroactive eligibility for children and pregnant women, use the applicable income, standard MAGI income disregard, and IRS monthly income thresholds charts.
| Federal Poverty Level (FPL) | |||
|---|---|---|---|
| Family Size | 133% FPL (3-1-21) TP 44, 34, TA 76 | 144% FPL (3-1-21) TP 48, 33, TA 75 | 198% FPL (3-1-21) TP 40, 42, 43, 36, 35, TA 74 |
| 1 | $1,428 | $1,546 | $2,126 |
| 2 | $1,931 | $2,091 | $2,875 |
| 3 | $2,434 | $2,636 | $3,624 |
| 4 | $2,938 | $3,180 | $4,373 |
| 5 | $3,441 | $3,725 | $5,122 |
| 6 | $3,944 | $4,270 | $5,871 |
| 7 | $4,447 | $4,815 | $6,620 |
| 8 | $4,950 | $5,360 | $7,369 |
| 9 | $5,453 | $5,904 | $8,118 |
| 10 | $5,957 | $6,449 | $8,868 |
| 11 | $6,460 | $6,994 | $9,617 |
| 12 | $6,963 | $7,539 | $10,366 |
| 13 | $7,466 | $8,084 | $11,115 |
| 14 | $7,969 | $8,628 | $11,864 |
| 15 | $8,473 | $9,173 | $12,613 |
| For each additional person | $504 | $545 | $750 |
| Family Size | 200% FPL (3-19-21) TA 41 | 201% FPL (3-1-21) TA 84 | 202% FPL (3-1-21) TA 85 | 204.42% FPL (3-1-21) TA 41 | 400% FPL (3-1-21) TA 77 | 413% FPL (3-1-21) TP 70 |
|---|---|---|---|---|---|---|
| 1 | $2,147 | $2,158 | $2,169 | $2,192 | $4,294 | $4,433 |
| 2 | $2,904 | $2,918 | $2,933 | $2,965 | $5,807 | $5,996 |
| 3 | $3,660 | $3,679 | $3,697 | $3,737 | $7,320 | $7,558 |
| 4 | $4,417 | $4,439 | $4,461 | $4,510 | $8,834 | $9,121 |
| 5 | $5,174 | $5,200 | $5,226 | $5,282 | $10,347 | $10,683 |
| 6 | $5,930 | $5,960 | $5,990 | $6,055 | $11,860 | $12,246 |
| 7 | $6,687 | $6,721 | $6,754 | $6,828 | $13,374 | $13,808 |
| 8 | $7,444 | $7,481 | $7,518 | $7,600 | $14,887 | $15,371 |
| 9 | $8,200 | $8,241 | $8,282 | $8,373 | $16,400 | $16,933 |
| 10 | $8,957 | $9,002 | $9,047 | $9,145 | $17,914 | $18,496 |
| 11 | $9,714 | $9,762 | $9,811 | $9,918 | $19,427 | $20,059 |
| 12 | $10,470 | $10,523 | $10,575 | $10,690 | $20,940 | $21,621 |
| 13 | $11,227 | $11,283 | $11,339 | $11,463 | $22,454 | $23,184 |
| 14 | $11,984 | $12,044 | $12,104 | $12,235 | $23,967 | $24,746 |
| 15 | $12,740 | $12,804 | $12,868 | $13,008 | $25,480 | $26,309 |
| For each additional person | $757 | $761 | $765 | $773 | $1,514 | $1,563 |
Five Percentage Points of FPL
| Family Size | 2021 Monthly Disregard Amount |
|---|---|
| 1 | $53.70 |
| 2 | $72.60 |
| 3 | $91.50 |
| 4 | $110.45 |
| 5 | $129.35 |
| 6 | $148.25 |
| 7 | $167.20 |
| 8 | $186.10 |
| 9 | $205.00 |
| 10 | $223.95 |
| 11 | $242.85 |
| 12 | $261.75 |
| 13 | $280.70 |
| 14 | $299.60 |
| 15 | $318.50 |
| For each additional person | $18.95 |
IRS Monthly Income Thresholds
| Type of Income | 2021 Threshold | Apply Threshold Value in Form H1042, Modified Adjusted Gross Income (MAGI) Worksheet: Medicaid and CHIP |
|---|---|---|
| Unearned Income | $91.67 |
|
| Earned Income | $1,033.33 |
|
| Federal Poverty Level (FPL) | |||
|---|---|---|---|
| Family Size | 133% FPL (3-1-22) TP 44, 34, TA 76 | 144% FPL (3-1-22) TP 48, 33, TA 75 | 198% FPL (3-1-22) TP 40, 42, 43, 36, 35, TA 74 |
| 1 | $1,510 | $1,631 | $2,243 |
| 2 | $2,034 | $2,198 | $3,022 |
| 3 | $2,559 | $2,764 | $3,800 |
| 4 | $3,083 | $3,330 | $4,579 |
| 5 | $3,607 | $3,897 | $5,358 |
| 6 | $4,132 | $4,463 | $6,137 |
| 7 | $4,656 | $5,030 | $6,916 |
| 8 | $5,180 | $5,596 | $7,694 |
| 9 | $5,705 | $6,162 | $8,473 |
| 10 | $6,229 | $6,729 | $9,252 |
| 11 | $6,753 | $7,295 | $10,031 |
| 12 | $7,278 | $7,862 | $10,810 |
| 13 | $7,802 | $8,428 | $11,588 |
| 14 | $8,326 | $8,994 | $12,367 |
| 15 | $8,851 | $9,561 | $13,146 |
| For each additional person | $525 | $567 | $779 |
| Family Size | 201% FPL (3-1-22) TA 84 | 202% FPL (3-1-22) TA 85 | 204.2% FPL (3-1-22) TA 41 | 400% FPL (3-1-22) TA 77 | 413% FPL (3-1-22) TP 70 |
|---|---|---|---|---|---|
| 1 | $2,277 | $2,288 | $2,313 | $4,530 | $4,678 |
| 2 | $3,067 | $3,083 | $3,116 | $6,104 | $6,302 |
| 3 | $3,858 | $3,877 | $3,919 | $7,677 | $7,927 |
| 4 | $4,649 | $4,672 | $4,723 | $9,250 | $9,551 |
| 5 | $5,439 | $5,466 | $5,526 | $10,824 | $11,176 |
| 6 | $6,230 | $6,261 | $6,329 | $12,397 | $12,800 |
| 7 | $7,020 | $7,055 | $7,132 | $13,970 | $14,425 |
| 8 | $7,811 | $7,850 | $7,935 | $15,544 | $16,049 |
| 9 | $8,602 | $8,644 | $8,739 | $17,117 | $17,673 |
| 10 | $9,392 | $9,439 | $9,542 | $18,690 | $19,298 |
| 11 | $10,183 | $10,233 | $10,345 | $20,264 | $20,922 |
| 12 | $10,973 | $11,028 | $11,148 | $21,837 | $22,547 |
| 13 | $11,764 | $11,823 | $11,951 | $23,410 | $24,171 |
| 14 | $12,555 | $12,617 | $12,754 | $24,984 | $25,796 |
| 15 | $13,345 | $13,412 | $13,558 | $26,557 | $27,420 |
| For each additional person | $791 | $795 | $804 | $1,574 | $1,625 |
Five Percentage Points of FPL
| Family Size | 2020 Monthly Disregard Amount |
|---|---|
| 1 | $56.65 |
| 2 | $76.30 |
| 3 | $96.00 |
| 4 | $115.65 |
| 5 | $135.30 |
| 6 | $155.00 |
| 7 | $174.65 |
| 8 | $194.30 |
| 9 | $214.00 |
| 10 | $233.65 |
| 11 | $253.30 |
| 12 | $273.00 |
| 13 | $292.65 |
| 14 | $312.30 |
| 15 | $332.00 |
| For each additional person | $19.70 |
IRS Monthly Income Thresholds | ||
|---|---|---|
| Type of Income | 2022 Threshold | Apply Threshold Value in Form H1042, Modified Adjusted Gross Income (MAGI) Worksheet: Medicaid and CHIP |
| Unearned Income | $91.67 |
|
| Earned Income | $1,045.83 |
|
C—1115 Immunization Terms
Revision 13-3; Effective July 1, 2013
TANF and Medical Programs
Immunization by inoculation or vaccination protects against childhood diseases. Except for tetanus, these diseases are contagious. Encourage individuals to follow the Texas Department of Health's recommended schedule found on Form H1012, Immunization Record. If a child is on an alternate schedule refer to A-2125, Immunizations.
The following are descriptions of the diseases and symptoms associated with immunizations.
- Diphtheria — An acute, bacterial illness that causes a sore throat and a fever and sometimes causes more serious or even fatal complications.
- Haemophilus Influenza Type b (HIB) — A bacterium that can cause meningitis and pneumonia and infect other body systems such as blood, joints, bones and soft tissue under the skin, throat, and the covering of the heart.
- Hepatitis A — An infection of the liver caused by the Hepatitis A virus.
- Hepatitis B — An infection of the liver caused by the Hepatitis B virus.
- Measles — An acute, highly contagious viral disease involving the respiratory tract that causes a characteristic rash, fever, runny nose, sore eyes, and cough.
- Mumps — An acute viral disease mainly of childhood. It is characterized by a swelling of the parotid (salivary) glands on one or both sides and may cause fever, headache, and difficulty swallowing may develop.
- Pertussis (Whooping Cough) — An acute highly contagious respiratory disease characterized by a severe attack of coughing that ends in a characteristic "whoop" as breath is drawn in.
- Poliomyelitis (Polio – once known as "infantile paralysis") — An infectious disease that may lead to extensive paralysis of the muscles.
- Rubella (German Measles) — A viral infection characterized by a mild fever, swollen glands in the neck and a rash that lasts up to three days.
- Tetanus (Lockjaw) — A very serious disease of the central nervous system caused by an infection of a wound that makes an individual unable to open his/her mouth or swallow and causes muscle spasms in the jaw, neck, leg or other muscles.
- Varicella (Chickenpox) — A highly contagious viral infection which presents as a generalized, itchy, vesicular rash. The rash begins as smooth, red spots which develop into blisters that last three to four days before forming crusty scabs.
C—1116 Managed Care Plans
Revision 19-1; Effective January 1, 2019
Information concerning the medical and dental managed care plans with contact information for each plan is located at https://www.hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip/medicaid-medical-dental-policies.
Related Policy
Managed Care, A-821.2
Releasable Information for Medicaid Providers and Their Contractors, B-1230
Office of the Ombudsman,B-1420
C—1118 Health Care Orientation Quick Reference Guide
Revision 23-3; Effective July 1, 2023
Medical Transportation Service (MTS)
- The Medical Transportation Service provides non-emergency medical transportation (NEMT) services.
- Explain the Medical Transportation Service is available for all Medicaid-covered health care services to those with full Medicaid (not Qualified Medicare Beneficiary [QMB] or Specified Low-Income Medicare Beneficiary [SLMB]), Children with Special Health Care Needs (CSHCN), and Transportation for Indigent Cancer Patients (TICP), who do not have any other means of transportation.
- "Call at least two business days before the appointment in the same county or adjacent county and five business days before an appointment outside the county adjacent to your residence and be prepared to provide your:
- name;
- Medicaid ID number;
- address;
- phone number;
- doctor's name and address;
- doctor's phone number;
- date; and
- time of appointment."
Ways to Travel:
- If you don't have a car and you don't have anyone else to drive you, the Medical Transportation Service will help. This may be by bus tickets or by van.
- If you have a car or know someone who can drive you to the appointment, the Medical Transportation Service can pay you or your driver gas reimbursement by the mile.
How do I get a ride? First, set up an appointment with your doctor or provider.
To request a ride, call at least two workdays before your appointment, or five days before the appointment if it is outside your county. Phones are answered Monday through Friday, 8 a.m.-5 p.m. local time.
You may be able to be approved for same day rides when:
- Your doctor or dentist must see you on the same day.
- You are released from a hospital, clinic, or other health care facility.
- You need a ride to a drugstore.
If you or your child have a Medicaid health plan:
If you or your child do not have a health plan:
- Call 877-633-8747 (877-MED- TRIP).
Children 14 and younger may not travel without a parent or guardian. Children 15 through 17 may travel without a parent, but the parent must provide written permission before the trip is scheduled.
Children's Health Insurance Program (CHIP)
- If anyone in the household is under 19 and does not have health insurance, explain they may be eligible for some type of state-funded health insurance. They may call 2-1-1 Option 2 to apply for CHIP and Children's Medicaid.
WIC (Women, Infant, and Children's Program)
- Explain WIC is a supplemental nutrition and education program to provide nutritious foods to help women, infants and children improve on their nutrition. "If you are receiving Medicaid, you are income-eligible for the program, but you will have to complete a nutritional screening to receive benefits."
- If pregnant or a postpartum woman or a child under 5 years lives in the household, give the parent the 800-942-3678 number to locate their nearest WIC office.
Summary
- "Any questions about Texas Health Steps or Medicaid?"
- Inform the person that they have received a "Health Care Orientation."
- Verify the person's information, phone number, migrant status, and if any other children are in the household.
- If enrolled, recap enrollment information including the names of the primary care provider and main dentist, if known, and the name of the health plan.
- Provide toll free number for future assistance (see chart below). Thank the person for their time.
- If in person, provide literature and any numbers needed from the Resource Directory (see chart below).
Resource Directory
| Resource List | Toll Free Numbers | TTY LINE |
|---|---|---|
| 2-1-1-Information and Referral for other types of community resources | 2-1-1, Option 1 | 2-1-1, Option 1 |
| Billing Questions Hotline for Traditional Medicaid, also known as fee-for-service | 800-335-8957 | 800-735-2988 |
| HHSC | 512-424-6500 | 512-424-6597 |
| Medicaid Hotline Number | 800-252-8263 | 800-735-2988 |
| Medical Transportation Service (MTS) | If you or your child have a Medicaid health plan: Call your health plan’s medical transportation contact number. If you or your child do not have a health plan: Call: 877-633-8747 (877-MED-TRIP) | 800-735-2988 |
| Social Security Administration (for Medicare and SSI Medicaid) | 800-772-1213 | 800-325-0778 |
| STAR/STAR+PLUS/STAR Kids/STAR Health Help Line | 800-964-2777 | 800-735-2988 |
| HHS Ombudsman Managed Care Assistance Team | 866-566-8989 | 7-1-1 |
| Texas Health Steps | 877-847-8377 | 800-735-2988 |
| HHSC Case Management for Children and Pregnant Women information and referral assistance | 877-847-8377 | 800-735-2988 |
| Children's Health Insurance Program (CHIP) | 877-543-7669 | 800-735-2988 |
| WIC | 800-942-3678 | 800-735-2988 |
C-1120, IRS Tax Code
Revision 15-4; Effective October 1, 2015
Unauthorized disclosure or unauthorized inspection of an applicant or client’s federal tax information by HHSC staff is punishable by law, including but not limited to:
- felony charges,
- imprisonment,
- fines,
- employment dismissal, or
- civil charges.
See United States Code (U.S.C.), Title 26, §7213; 26 U.S.C. §7213A; and 26 U.S.C. §7431 for a complete list of penalties for the unauthorized disclosure or inspection of this information.
C-1130, Reserved for Future Use
C-1140, TANF and SNAP Overpayment Determination Chart
C—1141 Timely Reported
Revision 13-3; Effective July 1, 2013
TANF and SNAP
When the individual reports a change timely (i.e., individual reported within 10 days of knowing of the change), use B-600, Changes, B-752.1.2, Errors After Certification, and the following chart to determine the first month of overpayment.
| If the household reported the change... | then the first month of potential overpayment is... |
|---|---|
| January 1-8 January 9-31 |
February March |
| February 1-5 February 6-28 (or 29th) |
March April |
| March 1-8 March 9-31 |
April May |
| April 1-7 April 8-30 |
May June |
| May 1-8 May 9-31 |
June July |
| June 1-7 June 8-30 |
July August |
| July 1-8 July 9-31 |
August September |
| August 1-8 August 9-31 |
September October |
| September 1-7 September 8-30 |
October November |
| October 1-8 October 9-31 |
November December |
| November 1-7 November 8-30 |
December January |
| December 1-8 December 9-31 |
January February |
Note: The first month of overpayment can be no later than two months from the month the change occurred.
C—1142 Untimely Reported
Revision 13-3; Effective July 1, 2013
TANF and SNAP
When the individual fails to report a change timely (i.e., does not report a change later discovered by HHSC or untimely reports a change), use B-600, Changes, B-752.1.2, Errors After Certification, and the following chart to determine the first month of overpayment.
| If the change occurred... | then the first month of potential overpayment is... |
|---|---|
| January 1-31 | March |
| February 1-28 (29) | April |
| March 1-31 | May |
| April 1-30 | June |
| May 1-31 | July |
| June 1-30 | August |
| July 1-31 | September |
| August 1-31 | October |
| September 1-30 | November |
| October 1-31 | December |
| November 1-30 | January |
| December 1-31 | February |
Note: The first month of overpayment can be no later than two months from the month the change occurred.
C-1150, Type Programs (TP) and Type Assistance (TA)
Revision 22-3; Effective July 1, 2022
SNAP, TANF and Medical Programs/Assistance
SNAP
| Code | Description | Long Description |
|---|---|---|
| TA 51 | SNAP-CAP/FS-CAP | Supplemental Nutrition Assistance Program Combined Application Project |
| TA 53 | TSAP/FS-TSAP | Texas Simplified Application Project for SNAP Food Benefits |
| TP 06 | SNAP (PA)/FS-PA | Supplemental Nutrition Assistance Program Public Assistance |
| TP 09 | SNAP/FS-NPA | Supplemental Nutrition Assistance Program |
TANF
| Code | Description | Long Description |
|---|---|---|
| TP 01 | TANF Basic | Cash assistance for caretakers and deprived children with income below TANF recognizable needs |
| TP 60 | One-Time TANF for Relatives | Once in a lifetime TANF payment for certain relatives who are the caretaker or payee of a related dependent child certified for TANF |
| TP 61 | TANF State Program | Cash assistance for two-parent household with income below TANF recognizable needs |
| TP 71 | OTTANF – 1 Adult | One-Time TANF (OTTANF) payment for households with one parent |
| TP 72 | OTTANF – 2 Parents | OTTANF payment for households with two parents |
Medical Programs/Assistance — Texas Works
| Code | Description | Long Description |
|---|---|---|
| TA 31 | MA – Parents and Caretaker Relatives – Emergency | Medicaid for an emergency condition for parents and caretaker relatives who do not meet alien status requirements and are caring for a dependent child who receives Medicaid |
| TA 41 | Health Care – Healthy Texas Women | Healthy Texas Women (HTW) for women 15–44 with income at or below the applicable income limit |
| TA 66 | MA – MBCC – Presumptive | Medicaid for Breast and Cervical Cancer – Presumptive |
| TA 67 | MA – MBCC | Medicaid for Breast and Cervical Cancer |
| TA 74 | MA – Children Under 1 Presumptive | Short-term Medicaid for children under 1 with income at or below the applicable income limit |
| TA 75 | MA – Children 1–5 Presumptive | Short-term Medicaid for children 1–5 with income at or below the applicable income limit |
| TA 76 | MA – Children 6–18 Presumptive | Short-term Medicaid for children 6–18 with income at or below the applicable income limit |
| TA 77 | Health Care – FFCHE | Health Care for Former Foster Care in Higher Education with income at or below the applicable income limit |
| TA 82 | MA – Former Foster Care Children | Medicaid for former foster care children 18–25 |
| TA 83 | MA – FFCC Presumptive | Short-term Medicaid for former foster care children 18–25 |
| TA 84 | CI – CHIP | The Children’s Health Insurance Program (CHIP) is health care coverage for children under 19 who are ineligible for Medicaid due to income and who have income at or below the applicable income limit |
| TA 85 | CI – CHIP perinatal | CHIP perinatal is health care coverage for unborn children whose mother is ineligible for Medicaid or CHIP due to income or immigration status and whose income is at or below the applicable income limit |
| TA 86 | MA – Parents and Caretaker Relatives Presumptive | Short-term Medicaid for parents and caretaker relatives caring for a dependent child |
| TP 07 | MA – Earnings Transitional | Twelve months of transitional Medicaid resulting from an increase in earnings |
| TP 08 | MA – Parents and Caretaker Relatives | Medicaid for parents and caretaker relatives caring for a dependent child with income at or below the applicable income limit |
| TP 20 | MA Alimony/Spousal Support Transitional | Up to four months of post Medicaid resulting from an increase in alimony or spousal support |
| TP 32 | MA – MN w/Spend Down – Emergency | Medicaid for an emergency condition for children or pregnant women who do not meet alien status requirements and who are ineligible for any other type of Medicaid, but who have medical expenses that spend down their income to below the Medically Needy Income Limit (MNIL) |
| TP 33 | MA – Children 1–5 – Emergency | Medicaid for an emergency condition for children 1–5 who do not meet alien status requirements and who have income at or below the applicable income limit |
| TP 34 | MA – Children 6–18 – Emergency | Medicaid for an emergency condition for children 6–18 who do not meet alien status requirements and who have income at or below the applicable income limit |
| TP 35 | MA – Children Under 1 – Emergency | Medicaid for an emergency condition for children under 1 who do not meet alien status requirements and who have income at or below the applicable income limit |
| TP 36 | MA – Pregnant Women – Emergency | Medicaid for an emergency condition for pregnant women who do not meet alien status requirements and who have income at or below the applicable income limit |
| TP 40 | MA – Pregnant Women | Medicaid for pregnant woman with income at or below the applicable income limit |
| TP 42 | MA – Pregnant Women Presumptive | Short-term Medicaid for pregnant women with income at or below the applicable income limit |
| TP 43 | MA – Children Under 1 | Medicaid for children under 1 with income at or below the applicable income limit |
| TP 44 | MA – Children 6–18 | Medicaid for children 6–18 with income at or below the applicable income limit |
| TP 45 | MA – Newborn Children | Medicaid for children through 1 who are born to a Medicaid-eligible mother |
| TP 48 | MA – Children 1–5 | Medicaid for children 1–5 with income at or below the applicable income limit |
| TP 56 | MA – MN w/Spend Down | Medicaid for children or pregnant women who are ineligible for any other type of Medicaid, but who have medical expenses that spend down their income to below the MNIL |
| TP 70 | Medicaid for the Transitioning Foster Care Youth | Medicaid for Transitioning Foster Care Youth people with income at or below the applicable income limit |
| TPAL | MA – Historical FMA – Emergency | N/A |
| TPDE | MA – Deceased Prior Medical | Medicaid for a deceased person |
| TPPM | MA/ME – Historical Prior Medical | Three months of prior Medicaid – not currently eligible |
| TP 52 | MA – State Foster Care – A | Medicaid |
| TP 53 | MA – State Foster Care – B | Medicaid |
| TP 54 | MA – State Foster Care – 32 | Medicaid |
| TP 57 | MA – State Foster Care – D | Medicaid |
| TP 58 | MA – State Foster Care – JPC | Medicaid |
| TA 78 | PCA Medicaid – Federal Match – No Cash | Permanency Care Assistance (PCA) Medicaid – Federal Match – No Cash |
| TA 79 | PCA Medicaid – No Federal Match – No Cash | PCA Medicaid – No Federal Match – No Cash |
| TA 80 | PCA Medicaid – Federal Match – With Cash | PCA Medicaid – Federal Match – With Cash |
| TA 81 | PCA Medicaid – No Federal Match – With Cash | PCA Medicaid – No Federal Match – With Cash |
| TP 88 | MA – Non-AFDC Foster Care – JPC | Medicaid |
| TP 90 | MA – State Foster Care | Medicaid |
| TP 91 | Adoption Assistance – Federal Match – No Cash | Adoption Assistance – Federal Match – No Cash |
| TP 92 | Adoption Assistance – Federal Match – With Cash | Adoption Assistance – Federal Match – With Cash |
| TP 93 | Foster Care – Federal Match – No Cash | Foster Care – Federal Match – No Cash |
| TP 94 | Foster Care – Federal Match – With Cash | Foster Care – Federal Match – With Cash |
| TP 95 | Adoption Assistance – No Federal Match – No Cash | Adoption Assistance – No Federal Match – No Cash |
| TP 96 | Adoption Assistance – No Federal Match – With Cash | Adoption Assistance – No Federal Match – With Cash |
| TP 97 | Foster Care – No Federal Match – No Cash | Foster Care – No Federal Match – No Cash |
| TP 98 | Foster Care – No Federal Match – With Cash | Foster Care – No Federal Match – With Cash |
| TP 99 | MA – Non-AFDC Foster Care | Medicaid |
| TPAS | MA – Historical Adoption Subsidy | Medicaid |
Medical Programs/Assistance — Medicaid for the Elderly and People with Disabilities
| Code | Description | Long Description |
|---|---|---|
| TA 02 | ME – SSI Waivers | SSI Recipient Waivers |
| TA 03 | ME – Manual SSI Waivers | Manual SSI Waivers |
| TA 04 | ME – Manual SSI State Group Home | Manual SSI Recipient State Community-based Group Homes |
| TA 05 | ME – Manual SSI Non-State Group Home | Manual SSI Recipient Non-State Community-based Group Homes |
| TA 06 | ME – Manual SSI Nursing Facility | Medicaid for Nursing Facility Resident |
| TA 07 | ME – Manual SSI State Hospital | Medicaid for State Hospital Resident |
| TA 08 | ME – SSI State Group Home | SSI Recipient State Community Based Group Home |
| TA 09 | ME – Manual SSI State Supported Living Center | Medicaid for State Supported Living Center Resident |
| TA 10 | ME – Waivers | Home and Community-Based (HCBS) Medicaid |
| TA 12 | ME – State Group Home | Medicaid for ICF/IID Resident |
| TA 22 | ME – Manual SSI | Manually certified SSI — processed by SSA |
| TA 26 | ME – SSI Non-State Group Home | SSI Non-State Community-based Group Homes |
| TA 27 | ME – Prior Medicaid Institutional/Waiver | Prior Medicaid for person applying for Institutional or Waiver Medicaid |
| TA 88 | ME – Medicaid Buy-In for Children | Medicaid benefits to eligible children with disabilities who are not eligible for Supplemental Security Income (SSI) for reasons other than disability. Individuals must pay a share of the Medicaid premium |
| TP 03 | ME – Pickle | RSDI COLA Disregard Programs — considered eligible based on the 1977 Pickle Amendment |
| TP 10 | ME – State Supported Living Center | Medicaid for State Support Living Center Resident |
| TP 11 | ME – SSI Prior | SSI, two or three months prior, as appropriate |
| TP 13 | ME – SSI | SSI (processed by SSA) |
| TP 14 | ME – Community Attendant | Community Attendant Services |
| TP 15 | ME – Non-State Group Home | Medicaid for ICF/IID Resident |
| TP 16 | ME – State Hospital | Medicaid for State Hospital Resident |
| TP 17 | ME – Nursing Facility | Medicaid for Nursing Facility Resident |
| TP 18 | ME – Disabled Adult Child | Adult children who are at least 18 who have a disability and who were denied SSI due to an entitlement to or an increase in their RSDI Disabled Adult Child (DAC) benefits and who are eligible for Medicaid to ensure continued coverage |
| TP 21 | ME – Disabled Widow(er) | Widows, widowers or surviving divorced spouses who are at least 50 and less than 60 with a disability and who are ineligible for Medicare and were denied SSI due to an increase in their RSDI widow/widower benefits. They are eligible for Medicaid under TP 21 until they reach age 60 or become eligible for Medicare, whichever occurs first |
| TP 22 | ME – Early Aged Widow(er) | Early age widows, widowers or surviving divorced spouses who are 50–65 and ineligible for Medicare and who were denied SSI due to an increase in their RSDI widow/widower benefits. They are eligible for Medicaid under TP 22 until they reach 65 or become eligible for Medicare, whichever occurs first |
| TP 23 | MC – SLMB | Medicare Savings Program — Specified Low-Income Medicare Benefits |
| TP 24 | MC – QMB | Medicare Savings Program — Qualified Medicare Beneficiary |
| TP 25 | MC – QDWI | Qualified Disabled and Working Individuals — A special Medicare savings program that pays Part A Medicare premiums for certain working people under 65 who have a disability and are no longer eligible for free Medicare Part A because of earnings |
| TP 26 | MC – QI 1 | Medicare savings program — Qualified people |
| TP 30 | ME – A and D Emergency | Emergency Medicaid for a nonqualified alien |
| TP 38 | ME – SSI Nursing Facility | Medicaid for Nursing Facility Resident |
| TP 39 | ME – SSI State Hospital | Medicaid for State Hospital Resident |
| TP 46 | ME – SSI State Supported Living Center | Medicaid for State Supported Living Center Residents |
| TP 87 | ME – Medicaid Buy In | Working people with disabilities who pay a share of the Medicaid premium to be eligible for Medicaid |
| TA 88 | ME-MBIC | A Medicaid program for children with disabilities up to 19 - years old with family income up to 300 percent of the federal poverty level (FPL). |