Revision 16-1; Effective March 1, 2016

 

HHSC also determines Medicaid eligibility for MEPD for persons who fall into an optional coverage group. Although federal regulations may allow other optional coverage groups, HHSC only provides benefits to a member of an optional coverage group if the group is included in the Texas Medicaid State Plan.

 

A-3100 SSI Denied Due to Entry into a Long-Term Care Facility

Revision 09-4; Effective December 1, 2009

 

This optional coverage group covers a person who would be eligible for SSI, if the person were not in an institutional setting.

 

A-3200 Special Income Limit

Revision 16-1; Effective March 1, 2016

 

The special income limit applies to persons who will reside in a Medicaid-approved long-term care facility or who apply for certain Home and Community-Based Services (HCBS) waiver programs. Countable income must be equal to or less than the special income limit established by HHSC (see Appendix XXXI, Budget Reference Chart). A person must live in one or more Medicaid-certified long-term facilities at least 30 consecutive days to be eligible under the special income limit. The following are included in this group:

  • Persons of any age in Medicaid-certified nursing facilities who meet medical necessity
  • Persons of any age in Medicaid-certified sections of state supported living centers and private facilities for persons with intellectual disabilities
  • Persons age 65 and over in Medicaid-approved sections of state hospitals (institutions for mental diseases)
  • Persons applying for certain HCBS waiver programs who are not already Medicaid eligible under another coverage group covered by the waiver and who meet the waiver eligibility criteria.

Automated System Program Identifier
TIERS – ME-Nursing Facility; ME-State School; ME-Non-State Group Home; ME-State Group Home; ME-State Hospital; ME-Waivers

 

A-3300 Home and Community-Based Services Waiver Programs

Revision 16-1; Effective March 1, 2016

 

Home and Community-Based Services (HCBS) waiver programs may have limited enrollment and are an alternative to institutionalization. A person can enroll in only one HCBS waiver at a time, but may be on the interest list for multiple HCBS waivers. Persons applying for certain HCBS waiver programs who are not already Medicaid eligible under another coverage group covered by the waiver and who meet the waiver eligibility criteria may be Medicaid eligible using the special income limit.

For additional information about HCBS waiver programs, including interest lists, go to http://hhs.texas.gov/services/disability/intellectual-or-developmental-disabilities-idd-long-term-care.  

Descriptions for some of the Home and Community-Based Services waiver programs follow in this section.

 

A-3310 Community Living Assistance and Support Services (CLASS)

Revision 16-1; Effective March 1, 2016

 

A person may be eligible for services through CLASS if the person:

  • is residing in the community;
  • is age 65 or older or, if less than 65, receives a Social Security Administration (SSA), Supplemental Security Income (SSI), or Railroad Retirement (RR) disability benefit or has a disability determination by HHSC, which is required;
  • has an ICF/IID Level of Care (LOC) VIII;
  • has an approved plan of care or service plan;
  • has a service begin date no later than 30 days from certification; and
  • is eligible for Medicaid using the special income limit.

Automated System Program Identifier
TIERS – ME-Waivers

 

A-3320 Deaf Blind with Multiple Disabilities (DBMD)

Revision 16-1; Effective March 1, 2016

 

A person may be eligible for services through DBMD if the person:

  • is residing in the community;
  • is 65 or older or, if less than 65, receives a Social Security Administration (SSA), Supplemental Security Income (SSI), or Railroad Retirement (RR) disability benefit or has a disability determination by HHSC, which is required;
  • has an ICF/IID Level of Care (LOC) VIII;
  • has an approved plan of care or service plan;
  • has a service begin date no later than 30 days from certification; and
  • is eligible for Medicaid using the special income limit.

Automated System Program Identifier
TIERS – ME-Waivers

 

A-3330 Home and Community-based Services (HCS)

Revision 16-1; Effective March 1, 2016

 

A person may be eligible for services through HCS if the person:

  • is residing in the community;
  • is age 65 or older or, if less than 65, receives a Social Security Administration (SSA), Supplemental Security Income (SSI), or Railroad Retirement (RR) disability benefit or has a disability determination by HHSC, which is required;
  • has an ICF/IID Level of Care (LOC) VIII;
  • has an approved plan of care or service plan;
  • has a service begin date no later than 30 days from certification; and
  • is eligible for Medicaid using the special income limit.

Automated System Program Identifier
TIERS – ME-Waivers

 

A-3340 Youth Empowerment Services (YES)

Revision 16-1; Effective March 1, 2016

 

A person may be eligible for services through YES if the person:

  • is residing in the community;
  • is at least age 3, but less than age 19;
  • receives a Social Security Administration (SSA), Supplemental Security Income (SSI), or Railroad Retirement (RR) disability benefit or has a disability determination by HHSC, which is required;
  • meets clinical level of care criteria;
  • has an approved individual plan of care (IPC);
  • has a service begin date no later than 30 days from certification; and
  • is eligible for Medicaid using the special income limit.

Note: This program is administered by the Department of State Health Services. For additional information, go to www.dshs.state.tx.us/mhsa/yes.

Automated System Program Identifier
TIERS – ME-Waivers

 

A-3350 Medically Dependent Children Program (MDCP)

Revision 16-1; Effective March 1, 2016

 

A person may be eligible for services through MDCP if the person:

  • is residing in the community;
  • is less than age 21;
  • receives a Social Security Administration (SSA), Supplemental Security Income (SSI), or Railroad Retirement (RR) disability benefit or has a disability determination by HHSC, which is required;
  • has an MN;
  • has an approved plan of care or service plan;
  • has a service begin date no later than 30 days from certification; and
  • is eligible for Medicaid using the special income limit.

Automated System Program Identifier
TIERS – ME-Waivers

 

A-3360 Reserved for Future Use

Revision 16-1; Effective March 1, 2016

 

 

A-3370 Texas Home Living (TxHmL)

Revision 16-1; Effective March 1, 2016

 

A person may be eligible for services through TxHmL if the person:

  • is residing in the community;
  • has an ICF/IID Level of Care (LOC) VIII;
  • has an approved plan of care or service plan; and
  • is currently a Medicaid recipient.

Eligibility is not determined using the special income limit.

Automated System Program Identifier
TIERS shows this as ME-Pickle, ME-Disabled Adult Child, etc. DADS puts the person on TxHmL.

 

A-3380 STAR+PLUS Waiver (SPW)

Revision 16-1; Effective March 1, 2016

 

The SPW provides for the managed care delivery of home and community-based Medicaid services in addition to all other services provided through STAR+PLUS.

 

A-3400 Medicaid Buy-In for Children (MBIC)

Revision 16-1; Effective March 1, 2016

 

This program covers children with disabilities up to the age of 19 with family income up to 300 percent of the federal poverty level. A family may have to pay a monthly premium as a condition of eligibility. The MBIC program began Jan. 1, 2011. For more information, see Chapter N, Medicaid Buy-In for Children.

Automated System Program Identifier
TIERS – ME-MBIC
TA 88

 

A-3500 Medicaid Buy-In (MBI)

Revision 16-1; Effective March 1, 2016

 

Texans with disabilities who work can apply for health insurance benefits even if their income exceeds traditional Medicaid limits. A person may have to pay a monthly premium as a condition of eligibility. For more information on the Medicaid Buy-In Program, see Chapter M, Medicaid Buy-In Program.

Automated System Program Identifier
TIERS – ME-MBI
TA 87