Revision 17-1 Effective March 15, 2017

 

 

The following chart may be used for the determination of financial eligibility based on automated records. It indicates the type of programs registered on the System for Applications, Verifications, Eligibility Reports and Referral (SAVERR) and the Texas Integrated Eligibility Redesign System (TIERS), and how existing coverage affects eligibility for Community Care for Aged and Disabled (CCAD) services.

 

If the automated record shows:
SAVERR Type Program (TP) and SAVERR Base Plan (BP) or TIERS Type of Assistance ...then the individual has Eligibility for Community Care Program?

01

n/a

TP 01

Temporary Assistance for Needy Families (TANF) and Medicaid (three prescriptions, or unlimited if covered by HMO)

Check SAVERR individual screen to determine if applicant is receiving Regular Medicaid – if so, categorically eligible for Title XIX.

03

13

TP 03

Medicaid for the Elderly and People with Disabilities (MEPD) Medicaid (three prescriptions)

Title XIX categorical eligibility

07

n/a

TP 07

Medicaid only, for 12 months after TANF eligibility ends (three prescriptions, or unlimited if covered by managed care organization (MCO))

Title XIX categorical eligibility

08

n/a

TP 98

Child Protective Services (CPS) Foster Care Medicaid (unlimited prescriptions)

Title XIX categorical eligibility

09

29
31
32
33
34
35
n/a

TP 70
TP 87
TP 88
TP 93
TP 94
TP 97
TP 99

CPS Foster Care Medicaid (unlimited prescriptions)

Title XIX categorical eligibility

10

30
31
32
33
34
35
n/a

TP 52
TP 53
TP 54
TP 57
TP 58
TP 59
TP 70

TANF foster care (unlimited prescriptions)

Title XIX categorical eligibility

11

13

TA 27

Prior Medicaid for an individual applying for institutional or waiver Medicaid

Categorically eligible for Title XIX during the months in which individual has active coverage.

11

13

TP 11

MEPD three-months-prior Medicaid (three prescriptions)

Categorically eligible for Title XIX during the months in which individual has active coverage.

11

n/a

TP PM

Historical prior medical – MEPD or Texas Works (TW)

Categorically eligible for Title XIX during the months in which individual has active coverage.

12

10

TA 06

Manual Supplemental Security Income (SSI) Medicaid for nursing facility resident

Not eligible for Community Care for Aged and Disabled (CCAD) under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a Community Attendant Services (CAS) referral.

12

13

TA 03

Manual SSI recipient waivers

Already covered under a Medicaid Waiver, so may or may not be eligible for CCAD. Community Living Assistance and Support Services (CLASS) cannot receive any CCAD service, except Title XX Day Activity and Health Services (DAHS). See Appendix XX, Mutually Exclusive Services.

12

13

TA 22

Manual SSI

Title XIX categorically eligible

12

15

TA 05

Manual SSI recipient, non-state community based group homes

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact Social Security Administration (SSA) (at the local office or at 1-800-772-1213) to correct the eligibility record.

12

15

TA 07

Medicaid for state hospital resident

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

12

16

TA 09

Medicaid for state supported living center resident

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

12

17

TA 04

Manual SSI recipient, state community based group homes

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

12

n/a

TP 12

Temporary manual SSI

Title XIX categorically eligible

13

10

TP 38

Institutional SSI Medicaid coverage for individuals in nursing facilities (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

13

13

TA 01

Interim SSI denied child

Categorically eligible for Title XIX CCAD services during active months.

13

13

TA 02

SSI recipient waivers

Already covered under a Medicaid Waiver, so may or may not be eligible for CCAD. CLASS cannot receive any CCAD service, except Title XX DAHS. See Appendix XX.

13

13

TP 13

SSI Medicaid for individuals living in the community (three prescriptions)

Title XIX categorical eligibility

13

15

TA 26
TP 39
TP 41

Institutional SSI Medicaid coverage for individuals in ICF/IID facilities (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

13

16

TP 46

Institutional SSI Medicaid coverage for individuals in state supported living centers (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

13

17

TA 08

SSI recipient, state community-based group home

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

13

17

TA 21

SSI Medicaid for recipients in chest hospitals

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then have the individual or authorized representative contact SSA (at the local office or at 1-800-772-1213) to correct the eligibility record.

13

n/a

TP SS

Temporary SSI

Categorically eligible for Title XIX CCAD services during active months.

14

10

TP 17

Institutional Medical Assistance Only (MAO) Medicaid coverage for individuals in nursing facilities (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

14

10

TP IN

Temporary institutional

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

14

13

TA 10

Medicaid waivers – Home and Community-based Services (HCS), CLASS, Deaf Blind with Multiple Disabilities (DBMD) (unlimited prescriptions)

Already covered under a Medicaid waiver, so may or may not be eligible for CCAD. CLASS cannot receive any CCAD service, except Title XX DAHS. See Appendix XX.

14

13

TP WA

Temporary waivers

Already covered under a Medicaid waiver, so may or may not be eligible for CCAD. CLASS cannot receive any CCAD service, except Title XX DAHS. See Appendix XX.

14

15

TP 15

Institutional MAO Medicaid coverage for individuals in Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Condition (ICF/IID) (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

14

15

TP 16

Medicaid for state hospital residents

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

14

16

TP 10

Institutional MAO Medicaid coverage for individuals in state supported living centers (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

14

17

TA 12

Medicaid for ICF/IID resident

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

14

20

TP 14

CAS (no prescription coverage)

The CAS program provides PHC, funded through §1929(b)(2)(B) of the Social Security Act.

14

n/a

TP IW

Historical institutional waivers

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

18

13

TP 18

Medicaid for disabled adult children (three prescriptions)

Title XIX categorical eligibility

19

13

TP 19
TA 01

SSI transitional Medicaid for children (three prescriptions)
Interim SSI denied child (three prescriptions)

Title XIX categorical eligibility – will be denied or transferred to other coverage at age 18.

20

n/a

TP 20

Additional four months of Medicaid for the child following denial due to receipt of child support (three prescriptions)

Title XIX categorical eligibility for the child during eligible months

21

n/a

 

Adoption assistance

Not categorically eligible

22

13

TP 21

Disabled widow/widowers – Medicaid (three prescriptions)

Title XIX categorical eligibility

22

13

TP 22

Early Aged widow/widowers – Medicaid (three prescriptions)

Title XIX categorical eligibility

22

13

TP WI

Temporary widow/widowers – Medicaid (three prescriptions)

Title XIX categorical eligibility during eligible months

23

13

TP 23

Specified Low-Income Medicare Beneficiary (SLMB) – Pays Part B premium, but no Medicaid (no prescription coverage)

Title XX categorical eligibility

23

13

TP 26

Qualifying Individual (QI)-1 – Pays Part B premium, but no Medicaid (no prescription coverage)

Title XX categorical eligibility

23

13

TP SL

Temporary SLMB/QI-1

Title XX categorical eligibility

24

13

TP 24

Qualified Medicare Beneficiary (QMB). Pays Part B premium, deductibles, co-insurance, but no Medicaid (no prescription coverage)

Title XX categorical eligibility

25

13

TP 25

Qualified disabled and working individuals

Title XX categorical eligibility

29

n/a

TP 29

Medicaid for 12-18 months after TANF for certain caretakers (three prescriptions, or unlimited if covered by MCO)

Title XIX categorical eligibility during eligible months

30

13

TP 30

Aid and Attendance emergency Medicaid for aliens (three prescriptions)

Title XIX categorical eligibility during eligible months

30

n/a

TP 31

Medicaid for an emergency condition

Title XIX categorical eligibility during eligible months

30

n/a

TP 32

Medicaid for an emergency condition with spend-down

Categorically eligible for Title XIX services for the coverage period if an effective date appears on the SAVERR record. The case worker will be required to confirm continued eligibility on a monthly basis. Failure to confirm eligibility could result in an invalid finding if the case is pulled for casereading and the individual is no longer Title XIX eligible.

If the individual name, but no effective date, appears in the SAVERR record, resource eligibility for Title XX already determined by TANF. Test for income eligibility only for Title XX.

30

n/a

TP 33

Medicaid for an emergency condition for children 1-5

Title XIX categorical eligibility during eligible months

30

n/a

TP 34

Medicaid for an emergency condition – for children 6-18

Title XIX categorical eligibility during eligible months

30

n/a

TP 35

Medicaid for an emergency condition – for children under 1

Title XIX categorical eligibility during eligible months

30

n/a

TP 36

Medicaid for an emergency condition for pregnant women

Title XIX categorical eligibility during eligible months

30

n/a

TP AL

Medicaid for an emergency condition (historical Family Medical Assistance (FMA))

Title XIX categorical eligibility during eligible months

30

n/a

TA 31

Medicaid for an emergency condition for TF-level families

Title XIX categorical eligibility during eligible months

37

n/a

TP 37

Medicaid for 12-18 months after TANF eligibility (three prescriptions, or unlimited if covered by MCO)

Title XIX categorical eligibility during eligible months

40

n/a

TP 40

Medicaid for pregnant women – coverage ends two full months after birth of child (three prescriptions, or unlimited if covered by MCO)

Title XIX categorical eligibility during eligible months

42

n/a

TP 42

Presumptive Medicaid for pregnant women – converted to TP-40 if ongoing coverage is granted (three prescriptions, or unlimited if covered by MCO)

Very short-term Title XIX categorical eligibility during eligibility period – check SAVERR for ongoing TP 40 coverage.

43

n/a

TP 43

Medicaid for children under age 12 months – coverage may convert to another TP at end of eligibility period

Title XIX categorical eligibility for the child

44

n/a

TP 44

Medicaid for children age 6-18 – coverage ends at 19th birthday

Title XIX categorical eligibility for the child

45

n/a

TP 45

Medicaid for newborns – coverage opened by TMHP when mother is covered by Medicaid in birth month. Coverage under this program ends at end of 12th month, although may convert to another TP

Title XIX categorical eligibility

47

n/a

TP 47

Medicaid for children ineligible for TANF based on stepparent or grandparent income

Title XIX categorical eligibility for child

48

n/a

TP 48

Medicaid for children at least 13 months, but under 6 – may convert to another TP at end of eligibility period

Title XIX categorical eligibility for child

51

10

TA 17

Grandfathered institutional MAO Medicaid coverage for individuals in nursing facilities (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

51

13

TA 17

Grandfathered Medicaid individuals in the community who were discharged from an institution setting when the ICF II level was phased out (three prescriptions)

Title XIX categorical eligibility

51

13

TP 50

Grandfathered Medicaid individuals eligible under Rider 51J

Title XIX categorical eligibility

51

13

TP 51

Rider 51 waiver recipients

Already covered under a Medicaid waiver during covered months, so may or may not be eligible for CCAD. CLASS cannot receive any CCAD service, except Title XX DAHS. See Appendix XX.

51

13

TP RI

Temporary Rider 51

Title XIX categorically eligible during eligible months unless receiving waiver services. If so, not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

51

15

TA 15

Grandfathered institutional MAO Medicaid coverage for individuals in ICF/IID facilities (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

51

15

TA 25

Grandfathered institutional MAO Medicaid coverage for individuals in state hospitals (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

51

16

TA 16

Grandfathered institutional MAO Medicaid coverage for individuals in state supported living centers (unlimited prescriptions)

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

51

17

TA 24

Rider 51 ICF/IID state community-based homes

Not eligible for CCAD under this TP/BP. Confirm living arrangement, then check with MEPD staff to determine if they are aware the individual has moved from the facility. They will test for community programs; inform MEPD if this will be a CAS referral.

55

n/a

TP 02

Medicaid for refugees

Categorically eligible for Title XIX during eligible months

55

n/a

TP 55

Medicaid for the medically needy

Categorically eligible for Title XIX during eligible months

55

n/a

TP 56

Medicaid spend-down program – eligibility for CCAD services depends on eligibility status on the SAVERR record.

Categorically eligible for Title XIX services for the coverage period if an effective date appears on the SAVERR record. The case worker will be required to confirm continued eligibility on a monthly basis. Failure to confirm eligibility could result in an invalid finding if the case is pulled for casereading and the individual is no longer Title XIX eligible.

If the individual name, but no effective date, appears in the SAVERR record, resource eligibility for Title XX already determined by TANF. Test for income eligibility only for Title XX.

61

n/a

TP 61

TANF and Medicaid for two-parent households (three prescriptions, or unlimited if covered by MCO)

Title XIX categorical eligibility

63

n/a

 

Medicaid for two-parent households (three prescriptions, or unlimited if covered by MCO)

Title XIX categorical eligibility

71

n/a

TP 71

One-time TANF – no Medicaid coverage (one adult)

Not categorically eligible

72

n/a

TP 72

One-time TANF – no Medicaid coverage (two parents)

Not categorically eligible

n/a

n/a

TP 87

Medicaid Buy-In

Categorically eligible for all Title XX programs, DAHS XIX, PHC and Texas Home Living waiver

 

Individuals with an active Supplemental Nutrition Assistance Program case are also categorically eligible for Title XX benefits.