Revision 10-2; Effective June 1, 2010

 

§358.601. Rights.

An applicant or recipient has the right to:

(1) be treated fairly and equally regardless of race, color, religion, national origin, gender, political beliefs, or disability;

(2) have information collected for determining his or her eligibility to be treated as confidential;

(3) request a review of an action;

(4) have his or her eligibility tested for other programs before HHSC denies eligibility;

(5) review all information that contributed to an eligibility decision; and

(6) request a fair hearing to appeal an action by HHSC.

 

§358.602. Disclosure of Official Records and Information.

The Texas Health and Human Services Commission follows 20 CFR §§401-403 concerning disclosure of information about a person, both with and without the person's consent; the maintenance of records; and the general guidelines in deciding whether to make a disclosure.

 

§358.603. Release of Medical Information.

A person requesting assistance on the basis of disability must complete a medical information release form.

 

§358.604. Responsibility To Provide Information and Report Changes.

(a) An applicant or recipient must provide the Texas Health and Human Services Commission (HHSC) the necessary documentation and information to determine eligibility for Medicaid.

(b) An applicant or recipient must report to HHSC certain events that affect benefits in accordance with 20 CFR Subpart G.

 

§358.605. Fraud Referral and Restitution.

(a) The Texas Health and Human Services Commission (HHSC) follows 42 CFR §§455.13-455.16 for issues governing fraud referral and restitution.

(b) HHSC evaluates a person's willful withholding of information for fraud, including:

(1) willful misstatements, oral or written, made by the person or the person's authorized representative in response to oral or written questions from HHSC concerning the person's income, resources, or other circumstances that may affect the amounts of benefits, including understatements or omission of information about income and resources; and

(2) willful failure by the person or the person's authorized representative to report changes in income, resources, or other circumstances that may affect the amount of benefits, if HHSC has clearly notified the person or the person's authorized representative of the person's obligation to report these changes.

 

C-1100 Responsibility of Applying

Revision 10-2; Effective June 1, 2010

 

Federal law requires that anyone who wishes to apply for Medicaid be allowed to file an application, regardless of the person's ultimate eligibility for services. See Chapter B, Applications and Redeterminations, for more information.

In addition to meeting other requirements, a person must file an application to become eligible to receive benefits. An authorized representative may accompany, assist and represent an applicant or recipient in the application or eligibility redetermination process.

Someone who is Supplemental Security Income (SSI) eligible automatically receives Medicaid and does not have to file a separate application unless coverage for unpaid or reimbursable bills during prior months to the SSI application is requested. See Section A-4300, Retroactive Coverage.

To apply for an MEPD program, an application for assistance must be received that is:

  • HHSC approved for MEPD Medicaid,
  • completed according to HHSC instructions, and
  • signed and dated under penalty of perjury by the applicant and/or authorized representative or someone acting responsibly for the applicant (if the applicant is incompetent or incapacitated).

An applicant or authorized representative must also provide all requested information according to HHSC instructions. See Section C-8000, Responsibility to Provide Information and Report Changes.

If someone helps an applicant or authorized representative complete the application for assistance, the name of the person completing the form must appear as requested on the application.

Filing an application will:

  • permit HHSC to make a formal determination whether or not a person is eligible to receive Medicaid; and
  • give a person the right to appeal if there is a disagreement with the determination.