Effective Date: 8/2016


Pdf: H0005.pdf



Updated: 8/2016


To obtain a case-specific policy clarification from the Medicaid for the Elderly and People with Disabilities (MEPD) Field Policy Unit.


When the MEPD eligibility specialist, Texas Works advisor, supervisor, and program area policy clarification contact (PCC) have reviewed all applicable MEPD policy sources (handbook, bulletins, and policy clarifications currently in effect) and are unable to determine the appropriate course of action for a particular case, the PCC sends this form to the MEPD Field Policy Unit for a case-specific policy clarification. Service Improvement Program (SIP) specialists, Centralized Representation Unit (CRU) staff and others may also submit this form for the same purpose. SIP and CRU should follow their established procedures for requesting case-specific policy clarifications from the MEPD Field Policy Unit.

Number of Copies

If the clarification is pertinent to the eligibility determination, image the request and subsequent response for the case record.


Electronically mail the form as an attachment to the HHSC MEPD_Policy_Support mailbox in Outlook.



Policy Clarification Requested By

Provide required information for the individual originating the request. By submitting Form H0005, the requestor has indicated that the requestor has reviewed all applicable MEPD policy sources and is unable to determine the appropriate course of action for a particular case.  The requestor should ensure the form is properly completed and contains all relevant and essential information. The requestor is the individual Field Policy will contact if additional information is needed.

Policy Clarification Reviewed by Supervisor

Indicate whether the requestor’s supervisor has reviewed the clarification request and provide the required information for the supervisor. By submitting Form H0005, the supervisor has indicated:

  1. the policy clarification request is appropriate;
  2. the form has been properly completed and contains all relevant and essential information; and
  3. the supervisor is unable to provide a response to the requestor after reviewing all applicable MEPD policy sources.

Complete Case Details

Provide the required case information, including any explanation and information that could be important, in the available space. For example, include the program type, whether the individual is under a transfer of resources penalty, the applicable budgeting situation (individual, couple, spousal), etc., if it will have a bearing on the clarification. Reminder: If an attorney has contacted the worker, or if the individual has an attorney involved, provide the attorney’s information along with any legal paperwork pertaining to the case that the attorney has prepared.

Legal paperwork should be reviewed by the regional attorney before the policy clarification request is submitted to the MEPD Policy Support mailbox.

Questions and Substantiating Documentation

Provide the question or specific clarification request and all substantiating documentation. Identify all applicable handbook sections that the requestor, supervisor and PCC reviewed. It is not necessary to quote entire sections of the handbook on the Policy Clarification Request (PCR) form.  Provide the policy citation (as in the example below: Chapter E, Section 3110, Wages and the entire Chapter J, Section 4000, Assessment and SPRA) and then identify by paragraph, bullet, or short quotations, the pertinent policy in question.  If the clarification involves a bulletin or another policy clarification, identify the bulletin or include the previous policy clarification and email responses. Provide all relevant and essential information (such as what, when, why, how, etc.) at the time of initial clarification request to avoid unnecessary delays.

Example: (The Complete Case Details section of Form H0005 indicates a file date of Dec. 23, 2008.) Below are the entries for each bolded section of Form H0005.

Case Situation: SPRA month is November 2008.  Total resources as of Nov. 1, 2008, were $96,516.43; SPRA was $48,258.21.  Worker was unable to expand the SPRA because the community spouse was receiving monthly earnings of $5,879.79. Total resources as of Dec. 1, 2008, were $86,294.16.  Individual was ineligible due to excess resources. Community spouse lost his job in January 2009.  Case was certified in error on Feb. 9, 2009, with a medical effective date of Dec. 1, 2008, and is still active.

Reviewed policy material related to this case-specific clarification: We reviewed MEPD Chapter E, Section 3110, Wages, and entire Chapter J, Section 4000, Assessment and SPRA. Neither section addressed the questions we have.

Questions related to the case-specific policy clarification: What is the correct way to handle this case now? Do we deny it and ask the individual to reapply, in which case we would only count the resources in the individual’s name? Or could we have expanded the SPRA in January or February after the spouse lost his job?

Consultations and Supporting Documents

If the requestor, supervisor or PCC consulted with a Texas Health and Human Services (HHS) attorney, provide the agency attorney information and a description of the agency attorney’s explanation/legal interpretation. Provide all electronic/faxed documents to/from the agency attorney at the time of initial clarification request to avoid unnecessary delays.

Response from MEPD Field Policy Unit

MEPD Field Policy Unit staff complete this section.



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