Revision 21-1; Effective March 1, 2021

 

B-3100 Application Process

Revision 20-2; Effective June 1, 2020

 

For Medicaid for the Elderly and People with Disabilities (MEPD), the application for assistance is based on one of the following versions of Form H1200:

  • Form H1200, Application for AssistanceYour Texas Benefits, for all MEPD programs;
  • Form H1200-EZ, Application for Assistance — Aged and Disabled, for Medicare Savings Programs (MSP) programs;
  • Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement, for state supported living centers, state hospitals, and state centers;
  • Form H1200-MBI, Application for Benefits — Medicaid Buy-In, for the MBI program only; or
  • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children (MBIC), for the MBIC program only.

If requested, give the applicant a receipt (Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change) to verify they provided an application. An applicant may request Form H1800 by fax or mail. Mail the receipt to the applicant’s listed address.

Related Policy
Date of Application, B-4000
Previous Completed Application, B-5000
Notices and Forms, M-9000
Notices and Forms, N-9000

 

B-3200 – Application Requirements

Revision 09-4; Effective December 1, 2009

 

Federal law requires that anyone who wishes to apply for a Medicaid program be allowed to file an application without delay, regardless of the person's ultimate eligibility for assistance.

An application form must be mailed within two working days from the receipt of the request for an application.

Use an application form to test eligibility for all Medicaid programs for which a person meets the criteria. A separate application form is not required for each of the different Medicaid programs for the elderly and persons with disabilities.

Consider the application complete with a name, address and signature.

 

B-3210 Who May Complete an Application for Assistance

Revision 16-3; Effective September 1, 2016

 

An individual who may complete or sign an application for an applicant may possibly not be on the list of individuals to whom the Texas Health and Human Services Commission (HHSC) can release the applicant’s individually identifiable health information. See Section C-5000, Personal Representatives, for individuals who may receive or authorize the release of an applicant's individually identifiable health information under Health Insurance Portability and Accountability Act (HIPAA) privacy regulations.

An authorized representative may accompany, assist and represent an applicant or recipient in the application or eligibility redetermination process.

Anyone may assist the applicant, guardian, power of attorney or authorized representative in completing an application form. If someone helps complete the application for assistance, the name of the individual completing the form must appear as requested on the application.

See Section B-3220, Who May Sign an Application for Assistance, to determine who may sign an application for assistance form. The requirements for signing a redetermination form are the same as the requirements for signing an application.

See Section C-1100, Responsibility of Applying.

Most applicants in an institutional setting such as a nursing facility are signed into the facility by someone else. An application and information from the applicant and/or the individual(s) having knowledge of the applicant's fina al circumstances are required.

 

B-3220 Who May Sign an Application for Assistance

Revision 16-3; Effective September 1, 2016

 

An individual who may complete or sign an application for an applicant may not be on the list of people to whom HHSC can release the applicant’s individually identifiable health information. See Section C-5000, Personal Representatives, for individuals who may receive or authorize the release of an applicant’s individually identifiable health information under HIPAA privacy regulations.

An applicant, authorized representative or someone acting responsibly for the applicant (if the applicant is incompetent or incapacitated) may sign an application for assistance. The application for assistance must be signed under penalty of perjury.

If an applicant has a guardian, the guardian must:

  • sign the application for assistance;
  • obtain a copy of the guardianship papers; and
  • work with the guardian in the eligibility process.

If an application is signed by someone other than the applicant or the applicant’s guardian, power of attorney, family member, or a friend who is knowledgeable of the applicant’s finances, the individual must provide a Form H1003, Appointment of an Authorized Representative, signed by the applicant, or evidence of:

  • authority to complete and sign an application on behalf of an applicant;
  • the individual’s relationship to the applicant; and
  • responsibility for the applicant’s care.

If an applicant makes an "X" on the signature line for applicant/recipient, a witness must sign on the witness signature line.

 

B-3221 Valid Signatures

Revision 19-1; Effective March 1, 2019

 

All applications and renewals must be signed under the penalty of perjury statement.

Valid signatures include only the following:

  • a traditional written signature;
  • a faxed written signature;
  • an electronic signature submitted through YourTexasBenefits.com; and
  • a telephonic signature submitted by calling 2-1-1.

YourTexasBenefits.com

An applicant may apply for all MEPD programs through YourTexasBenefits.com. Applications submitted online through YourTexasBenefits.com by an applicant or AR are considered electronically signed. A “traditional” written signature is not required before an applicant can be certified.

Calling 2-1-1

An applicant may apply for Medicaid by calling 2-1-1. An applicant or AR may complete and sign an application over the phone by:

  • providing their information over the phone to a customer care representative (CCR); and
  • signing the application telephonically by stating their name and agreeing to the penalty of perjury statement read by the CCR.

The CCR enters and submits the information provided by the applicant or AR through YourTexasBenefits.com.

Unsigned Applications

An application or renewal form received without a signature below the penalty of perjury statement is considered invalid.

If the agency receives an application without a signature and does not accept the application by giving the application an established file date, then the application is considered invalid. Staff must return the application with a letter and a self-addressed return envelope explaining that the application must be signed before the agency can establish a file date.

If the agency receives and accepts an application without a signature and the application is given an established file date in error, the date the application is received is considered a valid file date. Staff must send Form H1020, Request for Information or Action, along with the signature page requesting a signature. If the applicant fails to provide a signed application by the final due date, staff must deny the application for failure to provide information.

Related Policy
Processing Deadlines, B-6400
Who May Sign an Application for Assistance, B-3220

 

B-3230 Receipt of Duplicate or Identical Applications

Revision 20-3; Effective September 1, 2020

 

Duplicate Application

An application filed after another application has already been filed is a duplicate application if it:

  • does not include a request for a new program (i.e.: a type of program not requested on the initial application or a type of program not currently received by the applicant); and
  • is not needed for a redetermination of the active program(s).

Example: An application is received on January 2 and a second application for the same program is received on January 5. The second application is considered a duplicate application.

If a duplicate application is received while the first application is being processed:

  • treat the duplicate application as a report of change; and
  • assign to the eligibility staff currently processing the case.

If a duplicate application is received after the first application has been processed, review the application to ensure the person is not applying for a different type of program and that a redetermination is not due. If a new program is not being requested:

  • consider the duplicate application as a report of change; and
  • assign as a change indicating "duplicate application."

If the person is applying for a new program, the application is not a duplicate application. Process the application as a new request for assistance.

Identical Application

An identical application is an exact copy of an application previously submitted by an applicant.

Example: An application is received by fax on January 2 and an exact copy of the same application (with the same signature and date of the previously submitted application) is received by mail on January 5. The second application is considered an identical application.

Required Action on Identical Application Received

If an identical application is received, write "Identical Application" on the front page of the application and route for imaging. The identical application will be imaged and added to the electronic case record. No other action is needed.

 

B-3300 Authorized Representative (AR)

Revision 21-1; Effective March 1, 2021

 

An authorized representative (AR) is a person who is familiar with the applicant and knowledgeable of the applicant’s financial affairs.

An applicant, person receiving benefits, head of household (HOH), or someone with legal authority to act on their behalf (e.g., legal guardian or power of attorney) may designate a person or organization as an AR.

When applying for benefits, an AR must be verified using one of the following:

  • applicant's or recipient’s signature on one of the following HHSC applications for benefits containing the AR designation:
    • Form H1200, Application for Assistance — Your Texas Benefits;
    • Form H1200-MBI, Application for Benefits — Medicaid Buy-In;
    • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children; or
    • Form H1206, Health Care Benefits Renewal;
  • applicant's signature on a Marketplace application for health care benefits that is transferred to HHSC and contains the AR designation;
  • legal documentation that the AR has authority to act on behalf of the applicant or recipient under state law (e.g., legal guardianship or power of attorney);
  • letter designating AR authority and containing the applicant's or recipient’s signature, in addition to the name, address and signature of the AR;
  • completed Form H1003, Appointment of an Authorized Representative;
  • applicant’s or recipient’s electronic signature designating the AR on an application, renewal or reported change submitted through YourTexasBenefits.com; or
  • applicant’s or recipient’s telephonic signature submitted by calling 2-1-1.

If a person or organization submits an application on behalf of an applicant and indicates they wish to be the AR but the application is not signed by the applicant, send correspondence to both the unverified AR and the applicant to request the verification.

  • Send the following to the applicant:
    • Form H1020, Request for Information or Action, listing the missing information needed before eligibility can be determined.
    • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.
  • Send the following to the unverified AR:
    • Form H1004, Cover Letter: Authorized Representative Not Verified, explaining what is needed to verify the AR.
    • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.

For the AR to be verified, either the AR or the applicant must return the completed Form H1003 within 10 days (or 39 days from the file date). All missing information listed on the Form H1020 must also be returned timely. If the AR verification is not received by the due date, do not designate an AR.

The AR designation is effective from the date the AR is verified until:

  • the applicant or recipient notifies HHSC that the AR is no longer authorized to act on their behalf;
  • the AR notifies HHSC that they no longer wish to act as the AR for the applicant or recipient;

    Note: The AR will not be able to do this during the redetermination process if the AR is the person completing and signing the redetermination.
     
  • there is a change in the legal authority (i.e., legal guardianship or power of attorney) on which the AR’s designation is based; or
  • the applicant or recipient designates a new AR to act on their behalf. If there is an existing AR designated on a case, the person or organization most recently designated as the AR will replace the existing AR on the case.

Requests to end the designation of an AR must include the signature of the applicant, the recipient or the AR as appropriate.

Note: An AR is not automatically a personal representative.

An AR is designated at the case level to have access to all benefit information for that case. A verified AR may:

  • sign an application on behalf of an applicant;
  • complete and submit a renewal form;
  • receive copies of notices or renewal forms in the preferred language selected on the application, and other communications from HHSC;
  • designate a health plan; and
  • act on behalf of the applicant or the recipient in all other matters with HHSC.

The applicant, recipient or AR may also request that the AR receive the recipient’s Medicaid ID card and enrollment-related agency correspondence.

Mailing Address for AR

When processing the application, obtain the AR’s complete mailing address if not included on the application form. Record the AR’s address on the TIERS Data Collection page, Household - Authorized Representative. If the applicant cannot provide a complete mailing address for the AR, do not pend the case. Record the applicant’s mailing address as the AR’s address in TIERS.

When an applicant or recipient and their designated AR have the same mailing address, correspondence will be sent only to the AR.

When an applicant or recipient has a legal guardian, correspondence will be sent only to the guardian, even if the applicant or recipient and the guardian have different mailing addresses.

Applicants, recipients or ARs who have chosen to receive eligibility correspondence electronically will continue to receive correspondence electronically.

Related Policy
Who May Complete an Application for Assistance, B-3210
Who May Sign an Application for Assistance, B-3220
Prior Coverage for Deceased Applicants, G-7210

 

B-3400 General Procedures

 

Revision 10-3; Effective September 1, 2010

 

If an applicant or authorized representative contacts HHSC to initiate an application and appears to be eligible for SSI, refer the person or authorized representative to the Social Security Administration. If the person or authorized representative wishes to file an application with HHSC, give the person or authorized representative the appropriate form letter, an application for assistance and Form H0025, HHSC Application for Voter Registration.

Explain that eligibility is determined on the basis of:

  • a completed, signed and dated application for assistance;
  • information obtained from the applicant and authorized representative from the completed form, tape matches and possible interviews; and
  • required verification documents.

When eligibility is based on the special income limit, finalization of the person's eligibility cannot be processed or disposed in the system of record until the 30 days in an institutional setting have been met. A determination that a person requires the services of a licensed nurse in an institutional setting to carry out a physician's planned regimen for total care is also required.

See Section B-6300, Institutional Living Arrangement. Use the special income limit for the month of entry to the Medicaid-certified facility (Medicare-SNF, NF or ICF/MR) if it is anticipated that the person will remain in a Medicaid-certified facility for at least 30 days. The person cannot be determined eligible based on the special income limit until the 30 consecutive days have been met.

See Section J-4000, Assessment and SPRA. When determining the 30-day stay requirement, consider both the days in a medical facility and the days in the Home and Community-Based Services waiver setting.

See Section C-7000, National Voter Registration Act of 1993, for information regarding voter registration.

Note: Explain the availability and benefits of Texas Health Steps (formerly EPSDT) programs for applications for children under age 21.