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 Reserved for Future Use

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-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 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
  - Q-4210 Breast and Cervical Cancer Services Program
  - Q-4220 Reserved for Future Use
  - Q-4230 TANF with QMB
  - Q-4240 Reserved for Future Use
  - Q-4250 Reserved for Future Use

Section Q-5000 Qualifying Individuals (QIs)

Q-5000 Qualifying Individuals (QIs)
- Q-5100 QI Benefits
- Q-5200 QI Income Limit
- Q-5300 QI Cost-of-Living Adjustment
- Q-5400 QI Medical Effective Date
- Q-5500 Reserved for Future Use
- Q-5600 QI-2

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)