Medicaid for the Elderly and People with Disabilities Handbook

Chapter B, Applications and Redeterminations

Section B-1000 Applications and Redeterminations

B-1000 Applications and Redeterminations
- B–1100 Texas Administrative Code Rules

Section B-2000 Responsibilities of an Eligibility Specialist

B-2000 Responsibilities of an Eligibility Specialist

Section B-3000 Applications

B-3000 Applications

Section B-4000 Date of Application

B-4000 Date of Application

Section B-5000 Previously Completed Application

B-5000 Previously Completed Application

Section B-6000 Eligibility Determination

B-6000 Eligibility Determination

Section B-7000 Special Application Procedures

B-7000 Special Application Procedures

Section B-8000 Redeterminations

B-8000 Redeterminations

Section B-9000 Denials

B-9000 Denials

Chapter C, Rights and Responsibilities

Section C-1000 Texas Administrative Code

C-1000 Texas Administrative Code
- C-1100 Responsibility of Applying

Section C-2000 Confidential Nature of the Case Record

C-2000 Confidential Nature of the Case Record

Section C-3000 When and What Information May Be Disclosed

C-3000 When and What Information May Be Disclosed

Section C-4000 Confidential Nature of Medical Information

C-4000 Confidential Nature of Medical Information

Section C-5000 Personal Representatives

C-5000 Personal Representatives

Section C-6000 Fraud and Fair Hearings

C-6000 Fraud and Fair Hearings
- C-6100 Appeals
  - C-6110 Program Representation at Fair Hearings
- C-6200 Applicant/Recipient and Provider Fraud Detection and Referral

Section C-7000 National Voter Registration Act of 1993

C-7000 National Voter Registration Act of 1993

Section C-8000 Responsibility to Provide Information and Report Changes

C-8000 Responsibility to Provide Information and Report Changes

Section C-9000 Interpreter and Translation Services

C-9000 Interpreter and Translation Services
- C-9100 Requirement for Interpreter and Translation Services
- C-9200 Availability of Translated Written Material

Chapter D, Non-Financial

Section D-1000 Aged, Blind or Disabled

D-1000 Aged, Blind or Disabled

Section D-2000 Determining Blindness or Disability

D-2000 Determining Blindness or Disability

Section D-3000 Residence

D-3000 Residence

Section D-4000 Fiduciary Agents and Living Arrangement

D-4000 Fiduciary Agents and Living Arrangement
- D-4100 Fiduciary Agents
  - D-4110 Texas Administrative Code Rules
  - D-4120 Transactions Involving Agents
    - D-4121 Examples
- D-4200 Living Arrangements
  - D-4210 Deeming

Section D-5000 Citizenship and Identity

D-5000 Citizenship and Identity

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

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

Section D-7000 Third-Party Resources

D-7000 Third-Party Resources

Section D-8000 Alien Status

D-8000 Alien Status

Section D-9000 Alien Sponsorship

D-9000 Alien Sponsorship

Chapter E, General Income

Section E-1000 General Income

E-1000 General Income

Section E-2000 Exempt Income

E-2000 Exempt Income

Section E-3000 Earned and Unearned Income

E-3000 Earned and Unearned Income

Section E-5000 Variable Income

E-5000 Variable Income

Section E-6000 Self-Employment Income

E-6000 Self-Employment Income

Section E-7000 Deeming Income

E-7000 Deeming Income

Section E-8000 Support and Maintenance

E-8000 Support and Maintenance

Section E-9000 Infrequent or Irregular Income

E-9000 Infrequent or Irregular Income

Chapter F, Resources

Section F-1000 General Principles of Resources

F-1000 General Principles of Resources

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

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

Section F-3000 Home

F-3000 Home

Section F-4000 Liquid and Nonliquid Resources

F-4000 Liquid and Nonliquid Resources

Section F-5000 Potential Resource Exclusions

F-5000 Potential Resource Exclusions
- F-5100 Reminders
- F-5200 Chart

Section F-7000 Annuities

F-7000 Annuities

Section F-8000 Educational Funds

F-8000 Educational Funds

Chapter G, Eligibility Budgets

Section G-1000 Eligibility Budgets Overview

G-1000 Eligibility Budgets Overview

Section G-2000 Income Treatment

G-2000 Income Treatment

Section G-3000 Noninstitutional Budget Types

G-3000 Noninstitutional Budget Types

Section G-4000 Noninstitutional Exclusions

G-4000 Noninstitutional Exclusions
- G-4100 Income Exclusions

Section G-5000 Noninstitutional Budget Steps

G-5000 Noninstitutional Budget Steps
- G-5100 Individual and Couple Noninstitutional Budgets

Section G-6000 Institutional Eligibility Budget Types

G-6000 Institutional Eligibility Budget Types

Section G-7000 Prior Coverage

G-7000 Prior Coverage

Chapter H, Co-Payment

Section H-1000 General Information for Co-Payment

H-1000 General Information for Co-Payment

Section H-2000 Incurred Medical Expenses

H-2000 Incurred Medical Expenses

Section H-3000 Averaging and Reconciliation

H-3000 Averaging and Reconciliation

Section H-4000 Co-Payment Budget Types

H-4000 Co-Payment Budget Types
- H-4100 Individual and Couple Cases
- H-4200 Companion Cases

Section H-5000 ICF/IID Co-Payments

H-5000 ICF/IID Co-Payments

Section H-6000 Co-Payment for SSI Cases

H-6000 Co-Payment for SSI Cases
- H-6100 Exceptions to Reduced SSI Payment Standard
- H-6200 SSI Certifications

Section H-7000 Medicare and Co-Payment

H-7000 Medicare and Co-Payment

Section H-8000 Vendor Payments and Payment Corrections

H-8000 Vendor Payments and Payment Corrections

Chapter I, Transfer of Assets

Section I-1000 Transfer of Assets

I-1000 Transfer of Assets

Section I-2000 Look-Back Period

I-2000 Look-Back Period
- I-2100 Look-Back Policy
- I-2200 Look-Back Situations

Section I-3000 Exceptions to the Transfer of Assets

I-3000 Exceptions to the Transfer of Assets

Section I-4000 Determining Uncompensated Value

I-4000 Determining Uncompensated Value

Section I-5000 Calculation of Penalty Period

I-5000 Calculation of Penalty Period

Section I-6000 Purchase of Assets and Transfer of Assets

I-6000 Purchase of Assets and Transfer of Assets
- I-6100 Purchase of a Life Estate
  - I-6110 Policy Implementation Dates
  - I-6120 Post-DRA Transfer of Assets Policy
    - I-6121 One-Year Residency Requirement
- I-6200 Purchase of a Promissory Note, Loan or Mortgage
  - I-6210 Policy Implementation Dates
  - I-6220 Post-DRA Transfer of Assets Policy

Section I-7000 Reserved for Future Use

Section I-7000 Reserved for Future Use

Section I-8000 Reserved for Future Use

Section I-8000 Reserved for Future Use

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

I-9000 Pre-Deficit Reduction Act (DRA) Rules
- I-9100 Texas Administrative Code Rules

Chapter J, Spousal Impoverishment

Section J-1000 Spousal Impoverishment Overview

J-1000 Spousal Impoverishment Overview

Section J-2000 Spousal Treatment of Income and Resources

J-2000 Spousal Treatment of Income and Resources
- J-2100 Spousal Treatment of Income
- J-2200 Spousal Treatment of Resources
  - J-2210 Out of State Home and Spousal Impoverishment

Section J-3000 Spousal Transfer of Assets

J-3000 Spousal Transfer of Assets

Section J-4000 Assessment and SPRA

J-4000 Assessment and SPRA

Section J-5000 Spousal Initial Application

J-5000 Spousal Initial Application
- J-5100 Spousal Steps at Application

Section J-6000 SPRA Expansion

J-6000 SPRA Expansion

Section J-7000 Income for Eligibility and Co-Payment

J-7000 Income for Eligibility and Co-Payment

Section J-8000 After Initial Eligibility Period

J-8000 After Initial Eligibility Period

Section J-9000 Notice and Fair Hearing

J-9000 Notice and Fair Hearing

Chapter K, Reserved for Future Use

Chapter K, Reserved for Future Use

Chapter L, Reserved for Future Use

Chapter L, Reserved for Future Use

Chapter M, Medicaid Buy-In Program

Section M-1000 MBI Program

M-1000 MBI Program

Section M-2000 Automation

M-2000 Automation

Section M-3000 Non-Financial

M-3000 Non-Financial

Section M-4000 Resources

M-4000 Resources
- M-4100 Special MBI Resource Exclusions

Section M-5000 Income

M-5000 Income
- M-5100 Income Verification
- M-5200 Medicaid Buy-In (MBI) Income Limits

Section M-6000 Budgeting

M-6000 Budgeting
- M-6100 Income Eligibility Budget

Section M-7000 Premiums

M-7000 Premiums
- M-7100 Post Eligibility – Premium Budgets

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

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

Section M-9000 Notices and Forms

M-9000 Notices and Forms
- M-9100 Replacement Medicaid Card

Chapter N, Medicaid Buy-In for Children

Section N-1000 Medicaid Buy-In for Children

N-1000 Medicaid Buy-In for Children

Section N-2000 Automation

N-2000 Automation

Section N-3000 Non-Financial

N-3000 Non-Financial

Section N-4000 Resources and Income

N-4000 Resources and Income
- N-4100 Resources
- N-4200 Income

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

N-5000 Employer-Sponsored Health Insurance (ESI)
- N-5100 ESI Chart

Section N-6000 Budgeting

N-6000 Budgeting

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

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

Section N-9000 Notices and Forms

N-9000 Notices and Forms
- N-9100 Replacement Medicaid Card

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

Section O-1000 Waiver Programs

O-1000 Waiver Programs

Section O-2000 All-Inclusive Care

O-2000 All-Inclusive Care
- O-2100 Program of All-Inclusive Care for the Elderly (PACE)

Section O-3000 Waiver Programs and Managed Care

O-3000 Waiver Programs and Managed Care
- O-3100 Reserved for Future Use
- O-3200 STAR+PLUS Waiver (SPW)

Section O-4000 Demonstration Projects

O-4000 Demonstration Projects

Section O-5000 Waiver Programs and 30 Consecutive Days

O-5000 Waiver Programs and 30 Consecutive Days
- O-5100 Waiver Co-Payment
- O-5200 Medicare and Co-Payment
  - O-5210 Medicaid Coverage Code Issues

Section O-6000 Waiver Programs and Spousal Impoverishment

O-6000 Waiver Programs and Spousal Impoverishment
- O-6100 Spousal Impoverishment

Section O-7000 Waiver Programs and Transfer of Assets

O-7000 Waiver Programs and Transfer of Assets
- O-7100 Transfer of Assets

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

Section P-1000 LTCP Overview

P-1000 LTCP Overview
- P-1100 Texas Administrative Code Rules
- P-1200 Program Overview

Section P-2000 Program Resources

P-2000 Program Resources
- P-2100 Notices and Forms
- P-2200 Inquiries

Chapter Q, Medicare Savings Programs

Section Q-1000 Medicare Savings Programs Overview

Q-1000 Medicare Savings Programs Overview
- Q-1100 Texas Administrative Code Rules
- Q-1200 Medicare Improvement for Patients and Providers Act of 2008(MIPPA)

Section Q-2000 Qualified Medicare Beneficiaries (QMB) – MC-QMB

Q-2000 Qualified Medicare Beneficiaries (QMB) – MC-QMB

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

Q-3000 Specified Low-Income Medicare Beneficiaries (SLMB) – MC-SLMB

Section Q-4000 Medicare Savings Programs and Dual Eligibility

Q-4000 Medicare Savings Programs and Dual Eligibility
- Q-4100 SLMB Dual Eligibility and Medicare Buy-In
- Q-4200 Texas Works Medicaid and QMB or SLMB Dual Eligibility

Section Q-5000 Qualifying Individuals (QIs)

Q-5000 Qualifying Individuals (QIs)

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

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

Chapter R, Case Disposition

Section R-1000 Medical Effective Date and Notices

R-1000 Medical Effective Date and Notices

Section R-2000 Other Actions and Notifications

R-2000 Other Actions and Notifications

Section R-3000 Automated Systems

R-3000 Automated Systems

Section R-4000 Automated Data Exchanges and Tape Matches

R-4000 Automated Data Exchanges and Tape Matches

Medicaid for the Elderly and People with Disabilities Handbook

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