Revision 15-4; Effective December 1, 2015
A previously completed application for assistance may be used in the following situations:
- The application for assistance was only used for the assessment in determining the spousal protected resource amount, and the institutionalized spouse files an initial application for Medicaid for the Elderly and People with Disabilities (MEPD) within 12 months of the signature date on the application for assistance.
- An active companion case becomes a couple case; that is, one spouse is already receiving benefits and the other spouse applies for benefits. The spouses do not need to be in the same program.
Example: One spouse may be a Community Attendant Services (CAS) recipient and the other a Qualified Medicare Beneficiary (QMB) recipient.
- If an application is denied for failure to provide information and all requested information is provided within 90 days of the date of denial, reopen the application and re-evaluate eligibility using the information provided and the previously submitted application. A written request to reopen is not required. The date all requested information and verification is provided is the file date.
- If a renewal is denied for failure to provide information and the missing information is provided after the date of denial but within 90 days of the last day of the last benefit month, reopen the eligibility determination group (EDG) and re-evaluate eligibility using the information provided and the previously submitted renewal form. A written request to reopen is not required. The date all requested information and verification is provided is the file date.
- If an application or renewal is denied for a reason other than failure to provide information and the person requests to reopen the application or renewal:
- the previously completed application for assistance is valid for 90 days from the date of denial, or
- the previously completed renewal form is valid for 90 days from the last day of the last benefit month.
When using a previously completed application or renewal form in this situation, obtain a written, dated and signed statement of request to reapply from the person or authorized representative to establish the file date. Verification must be updated if circumstances have changed. See Section B-4000, Date of Application.
- If an application is denied in error, the original date of application must be protected no matter how old the application for assistance. If a renewal is denied in error, the receipt date of the renewal packet must be protected no matter how old. If the application/renewal denial is determined to be agency error with supervisory approval, no new application or statement to reapply from the person or authorized representative is required to reopen.
- Texas Department of Aging and Disability Services (DADS) staff refer the application for assistance to the Texas Health and Human Services Commission for a determination of eligibility for CAS, regardless of the signature date on the form.
- Example: DADS staff refer a Family Care recipient for CAS with an application signed six months ago. Make follow-up contact with the recipient or authorized representative, if necessary.
- Accept an application from a person entering a noncertified facility pending certification of the facility as a Medicaid provider to protect the date of application.
- If a person’s application is denied because the facility has not been certified by the application due date, use the previously completed application whenever the facility is certified.
- Verification must be updated if circumstances have changed. Use Form H1020, Request for Information or Action, to request missing information or verifications.
See Section B-6400, Processing Deadlines, for application due dates.