Medicaid for the Elderly and People with Disabilities Handbook

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Chapter A, General Information and MEPD Groups

Section A-1000 General Information

Section A-2000 Mandatory Coverage Groups

Section A-3000 Optional Coverage Groups

Section A-4000 Other Service-Related Program

Section A-5000 Texas Medicaid Hospice Program

Section A-6000 Persons in Institutions for Mental Diseases (IMDs)

Section A-7000 Type Programs (TP) and Type Assistance (TA)

Section A-8000 Medicare Savings Programs

Section A-9000 Medicaid-Medicare Relationship

Chapter B, Applications and Redeterminations

Section B-1000 Applications and Redeterminations

Section B-2000 Responsibilities of an Eligibility Specialist

Section B-3000 Applications

Section B-4000 Date of Application

Section B-5000 Previously Completed Application

Section B-6000 Eligibility Determination

Section B-7000 Special Application Procedures

Section B-8000 Redeterminations

Section B-9000 Denials

Chapter C, Rights and Responsibilities

Section C-1000 Texas Administrative Code

Section C-2000 Confidential Nature of the Case Record

Section C-3000 When and What Information May Be Disclosed

Section C-4000 Confidential Nature of Medical Information

Section C-5000 Personal Representatives

Section C-6000 Fraud and Fair Hearings

Section C-7000 National Voter Registration Act of 1993

Section C-8000 Responsibility to Provide Information and Report Changes

Section C-9000 Interpreter and Translation Services

Chapter D, Non-Financial

Section D-1000 Aged, Blind or Disabled

Section D-2000 Determining Blindness or Disability

Section D-3000 Residence

Section D-4000 Fiduciary Agents and Living Arrangement

Section D-5000 Citizenship and Identity

Section D-6000 Social Security Number (SSN) and Application for Other Benefits

Section D-7000 Third-Party Resources

Section D-8000 Alien Status

Section D-9000 Alien Sponsorship

Chapter E, General Income

Section E-1000 General Income

Section E-2000 Exempt Income

Section E-3000 Earned and Unearned Income

Section E-4000 Fixed Income

Section E-5000 Variable Income

Section E-6000 Self-Employment Income

Section E-7000 Deeming Income

Section E-8000 Support and Maintenance

Section E-9000 Infrequent or Irregular Income

Chapter F, Resources

Section F-1000 General Principles of Resources

Section F-2000 Resource Exclusions – Limited and Related to Exempt Income

Section F-3000 Home

Section F-4000 Liquid and Nonliquid Resources

Section F-5000 Potential Resource Exclusions

Section F-6000 Types of Trusts

Section F-7000 Annuities

Section F-8000 Educational Funds

Chapter G, Eligibility Budgets

Section G-1000 Eligibility Budgets Overview

Section G-2000 Income Treatment

Section G-3000 Noninstitutional Budget Types

Section G-4000 Noninstitutional Exclusions

Section G-5000 Noninstitutional Budget Steps

Section G-6000 Institutional Eligibility Budget Types

Section G-7000 Prior Coverage

Chapter H, Co-Payment

Section H-1000 General Information for Co-Payment

Section H-2000 Incurred Medical Expenses

Section H-3000 Averaging and Reconciliation

Section H-4000 Co-Payment Budget Types

Section H-5000 ICF/IID Co-Payments

Section H-6000 Co-Payment for SSI Cases

Section H-7000 Medicare and Co-Payment

Section H-8000 Vendor Payments and Payment Corrections

Chapter I, Transfer of Assets

Section I-1000 Transfer of Assets

Section I-2000 Look-Back Period

Section I-3000 Exceptions to the Transfer of Assets

Section I-4000 Determining Uncompensated Value

Section I-5000 Calculation of Penalty Period

Section I-6000 Purchase of Assets and Transfer of Assets

Section I-7000 Reserved for Future Use

Section I-8000 Reserved for Future Use

Section I-9000 Pre-Deficit Reduction Act (DRA) Rules

Chapter J, Spousal Impoverishment

Section J-1000 Spousal Impoverishment Overview

Section J-2000 Spousal Treatment of Income and Resources

Section J-3000 Spousal Transfer of Assets

Section J-4000 Assessment and SPRA

Section J-5000 Spousal Initial Application

Section J-6000 SPRA Expansion

Section J-7000 Income for Eligibility and Co-Payment

Section J-8000 After Initial Eligibility Period

Section J-9000 Notice and Fair Hearing

Chapter K, Reserved for Future Use

Chapter L, Reserved for Future Use

Chapter M, Medicaid Buy-In Program

Section M-1000 MBI Program

Section M-2000 Automation

Section M-3000 Non-Financial

Section M-4000 Resources

Section M-5000 Income

Section M-6000 Budgeting

Section M-7000 Premiums

Section M-8000 Medical Effective Date, Prior Months' Eligibility and Case Actions

Section M-9000 Notices and Forms<

Chapter N, Medicaid Buy-In for Children

Section N-1000 Medicaid Buy-In for Children

Section N-2000 Automation

Section N-3000 Non-Financial

Section N-4000 Resources and Income

Section N-5000 Employer-Sponsored Health Insurance (ESI)

Section N-6000 Budgeting

Section N-7000 Premiums

Section N-8000 Medical Effective Date, Prior Months' Eligibility and Case Actions

Section N-9000 Notices and Forms

Chapter O, Waiver Programs, Demonstration Projects and All-Inclusive Care

Section O-1000 Waiver Programs

Section O-2000 All-Inclusive Care

Section O-3000 Waiver Programs and Managed Care

Section O-4000 Demonstration Projects

Section O-5000 Waiver Programs and 30 Consecutive Days

Section O-6000 Waiver Programs and Spousal Impoverishment

Section O-7000 Waiver Programs and Transfer of Assets

Chapter P, Long-term Care Partnership (LTCP) Program

Chapter Q, Medicare Savings Program

Section Q-1000 Medicare Savings Programs Overview

Section Q-2000 Qualified Medicare Beneficiaries (QMB)

Section Q-3000 Specified Low-Income Medicare Beneficiaries (SLMB)

Section Q-4000 Medicare Savings Programs and Dual Eligibility

Section Q-5000 Qualifying Individuals (QIs)

Section Q-6000 Qualified Disabled and Working Individuals (QDWI) – MC-QDWI

Chapter R, Case Disposition

Section R-1000 Medical Effective Date and Notices

Section R-2000 Other Actions and Notifications

Section R-3000 Automated Systems

Section R-4000 Automated Data Exchanges and Tape Matches