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Revision 10-2; Effective June 1, 2010
When a person applies for Medicaid, HHSC will ask for documents and any other information needed to make sure all the requirements for Medicaid are met. HHSC will ask for information about income, resources and other eligibility requirements.
As a requirement of Medicaid, a person must provide HHSC MEPD staff with the necessary documentation and information to determine eligibility for Medicaid.
If HHSC sends an applicant or authorized representative a request for missing information or verification documents, or both, the applicant or authorized representative must provide the requested information to HHSC by the due date given in the request, or eligibility may be denied.
See Section B-6510, Failure to Furnish Missing Information.
Report to HHSC MEPD staff certain events that affect Medicaid eligibility and co-payment.
HHSC requires that the applicant/recipient or authorized representative must report certain events because they may affect eligibility or continued eligibility or the amount of the co-payment in the cost of care. See Chapter H, Co-Payment.
Who, What, When and How of Reporting Changes
Who must make reports? The person(s) responsible for making required reports to HHSC include an:
- eligible individual;
- eligible spouse;
- eligible child; or
- applicant awaiting a final determination upon an application.
- If the applicant/recipient has an authorized representative and has not been legally adjudged incompetent, either the applicant/recipient or the authorized representative must make the required reports.
- If the recipient’s co-payment is impacted by either the community spouse or a dependent family member, the recipient, authorized representative, community spouse or dependent family member is responsible for making required reports to HHSC.
- If the applicant/recipient has an authorized representative (legal guardian) and has been legally adjudged incompetent, the authorized representative (legal guardian) is responsible for making required reports to HHSC.
What must be reported?
Although not all inclusive, events that must be reported are:
- Change of address — Report any change in mailing address and any change in the address where the person (or spouse/dependent family member) lives.
- Change in living arrangements — Report any change in the make-up of the household; that is, any person who comes to live in the household and any person who moves out of the household.
- Change in income — Report any increase or decrease in income, and any increase or decrease in the income of:
- the ineligible spouse who lives with the recipient;
- the community spouse or dependent family member;
- the parent, if the recipient is an eligible child and the parent lives with the eligible child; or
- an ineligible child who lives with the eligible child.
- Change in resources — Report any resources received or parted with by the:
- ineligible spouse who lives with the recipient;
- community spouse or dependent family member; or
- parent, if the recipient is an eligible child and the parent lives with the eligible child.
- Eligibility for other benefits — Report eligibility for benefits. Responsibility to apply for any other benefits for which a person may be eligible is required. See Section D-6000, Social Security Number (SSN) and Application for Other Benefits.
- Certain deaths — If the person is an eligible individual, the individual or the individual's authorized representative must report the death of:
- the eligible spouse;
- the ineligible spouse who was living with the individual; and
- any other person who was living with the individual including a parent of an eligible child.
Additionally, if the recipient’s co-payment is impacted by either the community spouse or a dependent family member, the recipient, authorized representative, community spouse or dependent family member is responsible for making required reports to HHSC.
- Change in marital status — Report the marriage, divorce or annulment of a marriage of the:
- eligible individual;
- parent who lives with the eligible child; or
- spouse or dependent family member.
Additionally, report the marriage of an ineligible child who lives with an eligible individual.
- Medical improvements — If eligible for Medicaid because of disability or blindness, report any medical condition improvement.
- A termination of residence in the U.S. — Report leaving the U.S. voluntarily with the intention of abandoning residence in the U.S. or leaving the U.S. involuntarily.
- Leaving the U.S. temporarily — Report leaving the U.S. for 30 or more consecutive days or for a full calendar month (without the intention of abandoning residence in the U.S.).
Include in the Reports
When reporting changes either in writing or verbally, include the following:
- applicant or recipient's name and Social Security number;
- event and the date it happened; and
- reporter’s name.
Reports are due to HHSC when:
- an event happens, the report is due within 10 days of the event.
- HHSC requests a report and provides a due date.