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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
- A-3000 Optional Coverage Groups
- A-3100 SSI Denied Due to Entry into a Long-Term Care Facility
- A-3200 Special Income Limit
- A-3300 Home and Community-Based Services Waiver Programs
- A-3310 Community Living Assistance and Support Services (CLASS)
- A-3320 Deaf Blind with Multiple Disabilities (DBMD)
- A-3330 Home and Community-based Services (HCS)
- A-3340 Youth Empowerment Services (YES)
- A-3350 Medically Dependent Children Program (MDCP)
- A-3360 Reserved for Future Use
- A-3370 Texas Home Living (TxHmL)
- A-3380 STAR+PLUS Waiver (SPW)
- A-3400 Medicaid Buy-In for Children (MBIC)
- A-3500 Medicaid Buy-In (MBI)
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
- B-7000 Special Application Procedures
- B-7100 SSI Applications
- B-7200 SSI Cash Benefits Denied Due to Entry into a Medicaid Facility
- B-7300 MEPD Eligibility Pending a Decision of SSI Application
- B-7400 Application for Institutional Care
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
- D-2000 Determining Blindness or Disability
- D-2100 When a Medical Determination Is Not Required
- D-2200 When a Medical Determination Is Required
- D-2300 Requesting a Decision from the Disability Determination Unit (DDU)
- D-2400 Disability Determination Unit (DDU) Request Required
- D-2500 Supplemental Security Income (SSI) Applicants and Retroactive Coverage
- D-2600 Disability Determination Unit (DDU) Decision
- D-2700 Use of Decision on the Disability Determination - DDU Page in TIERS
- D-2800 Disability Determination at Time of Review
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
- D-6000 Social Security Number (SSN) and Application for Other Benefits
- D-6100 Texas Administrative Code Rules
- D-6200 SSN Requirement
- D-6300 Application for Other Benefits Requirement
- D-6310 Other Benefits Subject to Application Requirement
- D-6320 Other Benefits Exempt from Application Requirement
- D-6330 Payments That Are Not Other Benefits
- D-6340 Supplemental Security Income (SSI)
- D-6350 Veterans Benefits
- D-6360 Workers' Compensation Payments
- D-6370 Private Sector Pensions
- D-6380 Public Sector Pensions
- D-6400 Treatment of Other Benefits
- D-6500 Exceptions to the Application for Other Benefits Requirement
- D-6600 When Not to Refer for Other Benefits
Section D-7000 Third-Party Resources
- D-7000 Third-Party Resources
- D-7100 Texas Administrative Code Rules
- D-7200 Cooperation and Assignment of Rights for Medicaid Eligibility
- D-7300 Potential Sources of Third-Party Coverage
- D-7400 Use of Third-Party Resources
- D-7500 Third-Party Resources for SSI Recipients
- D-7600 Long-Term Care Insurance Policies
- D-7700 Health Insurance Premium Payment Reimbursement Program
- D-7800 Medicaid Estate Recovery Program
Section D-8000 Alien Status
- D-8000 Alien Status
- D-8100 Texas Administrative Code Rules
- D-8200 Authorized Alien Status
- D-8300 Qualified Alien Categories
- D-8400 LAPR Conditions for Medicaid
- D-8500 Qualified Aliens, Retroactive Coverage and SSI
- D-8600 Non-Qualified Aliens
- D-8700 Verification of Alien Status
- D-8710 Documentary Evidence by Classification
- D-8720 Lawfully Admitted for Permanent Residence (LAPR)
- D-8730 Refugees
- D-8740 Parolee
- D-8750 Asylee
- D-8760 Deportation Withheld
- D-8770 Cuban/Haitian Entrants
- D-8780 Qualified Alien Based on Battery or Extreme Cruelty
- D-8790 Victims of Severe Human Trafficking
- D-8800 Systematic Alien Verification for Entitlements (SAVE)
- D-8900 Alien Status Eligibility Charts
- D-8910 Entry Before 1996
- D-8920 Entry On or After Aug. 22, 1996 — Qualified Alien No Waiting Period
- D-8930 LAPR Aliens With or Without Five-Year Waiting Period
- D-8940 Reserved for Future Use
Section D-9000 Alien Sponsorship
Chapter E, General Income
Section E-1000 General Income
Section E-2000 Exempt Income
- E-2000 Exempt Income
- E-2100 Income Exempt Under Federal Laws
- E-2200 Earned Income Exemptions
- E-2300 Unearned Income Exemptions
- E-2310 Refunds of Taxes Paid on Real Property or Food
- E-2320 Assistance Based on Need
- E-2330 Educational Assistance
- E-2340 Home Produce for Personal Consumption
- E-2350 Child Support Payments
- E-2360 Payment Treated Like Other Exemptions
- E-2370 Certain Gifts
- E-2380 Relocation Assistance
- E-2390 Crime Victims Compensation
- E-2400 Other Income Exemptions
Section E-3000 Earned and Unearned Income
- E-3000 Earned and Unearned Income
- E-3100 Types of Earned Income
- E-3200 Types of Unearned Income
- E-3300 Sources of Unearned Income
- E-3310 Annuities, Pensions and Other Periodic Payments
- E-3320 Alimony and Support Payments
- E-3330 Dividends, Interest and Royalties
- E-3331 Interest and Dividends
- E-3331.1 Treatment of Interest/Dividends on Fully Countable Resources
- E-3331.2 Treatment of Interest/Dividends on Certain Excluded or Partially Excluded Resources
- E-3331.3 Treatment of Interest/Dividends on All Other Resources
- E-3331.4 Treatment of Interest and Dividends Earned on an Achieving a Better Life Experience (ABLE) Account
- E-3331.5 Treatment of Interest/Dividends on School-Based Savings Accounts
- E-3332 Income from Joint Bank Accounts
- E-3333 Mineral and Timber Rights
- E-3331 Interest and Dividends
- E-3340 Rents
- E-3350 Death Benefits
- E-3360 Prizes and Awards
- E-3370 Gifts and Inheritances
- E-3380 Support and Maintenance In Kind
- E-3390 Texas Lottery Commission
Section E-4000 Fixed Income
- E-4000 Fixed Income
- E-4100 Social Security Benefits
- E-4200 Railroad Retirement Benefits
- E-4300 VA Benefits
- E-4400 Other Annuities, Pensions and Retirement Plans
- E-4500 Workers' Compensation
- E-4600 Unemployment Benefits
- E-4700 Disability Insurance Benefits
Section E-5000 Variable Income
Section E-6000 Self-Employment Income
Section E-7000 Deeming Income
Section E-8000 Support and Maintenance
- E-8000 Support and Maintenance
- E-8100 General Information
- E-8200 Individual Budgets
- E-8300 Companion and Couple Budgets
- E-8400 Rent-Free Shelter
- E-8500 Change of Permanent Living Arrangement
- E-8600 Deeming-Eligible Child and Ineligible Parents
- E-8700 Long-Term Care Facilities
- E-8800 Verification and Documentation
Chapter F, Resources
Section F-1000 General Principles of Resources
- F-1000 General Principles of Resources
- F-1100 Texas Administrative Code Rules
- F-1200 General Principles of Treatment of Resources
- F-1300 Resource Limits
- F-1400 Deeming of Resources
Section F-2000 Resource Exclusions – Limited and Related to Exempt Income
- F-2000 Resource Exclusions – Limited and Related to Exempt Income
- F-2100 Resource Exclusions – Limited
- F-2110 Cash Reimbursement of Medical or Social Services Expenses
- F-2120 Death Benefits
- F-2130 Earned Income Tax Credits (EITC)
- F-2140 Hazardous Duty Pay
- F-2150 SSI and RSDI Retroactive Lump Sum Payments
- F-2160 Gifts to Children with Life-Threatening Conditions
- F-2170 Exclusion of State or Local Relocation Assistance Payments
- F-2200 Resource Exclusions Related to Exempt Income
- F-2300 Additional Resource Exclusions
- F-2100 Resource Exclusions – Limited
Section F-3000 Home
- F-3000 Home
- F-3100 The Home and Resource Exclusions
- F-3200 The Home and Resources in a Trust
- F-3300 The Home as a Countable Resource
- F-3400 Replacement of the Home
- F-3500 Out-of-State Home Property
- F-3600 Substantial Home Equity
- F-3700 Continuing Care Retirement Communities
- F-3800 The Home and Transfer of Assets
Section F-4000 Liquid and Nonliquid Resources
- F-4000 Liquid and Nonliquid Resources
- F-4100 Types of Liquid Resources
- F-4200 Nonliquid Resources
- F-4210 Real Property
- F-4220 Personal Property
- F-4221 Automobile
- F-4222 Household Goods and Personal Effects
- F-4223 Life Insurance
- F-4224 Life Insurance Dividends
- F-4225 Accelerated Life Insurance Payments
- F-4226 Term and Burial Insurance
- F-4227 Burial Funds
- F-4228 Burial Fund Calculation
- F-4229 Annual Burial Fund Calculation
- F-4230 Treatment of Burial Fund Tampering
- F-4240 Safe Deposit Box
- F-4250 Livestock
- F-4260 Nonliquid Resources Converted to Cash
- F-4300 Resources Essential to Self-Support
- F-4400 Plan for Achieving Self-Support (PASS)
Section F-5000 Potential Resource Exclusions
Section F-6000 Types of Trusts
Section F-7000 Annuities
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
- G-4000 Noninstitutional Exclusions
- G-4100 Income Exclusions
Section G-5000 Noninstitutional Budget Steps
Section G-6000 Institutional Eligibility Budget Types
Chapter H, Co-Payment
Section H-1000 General Information for Co-Payment
- H-1000 General Information for Co-Payment
- H-1100 Texas Administrative Code Rules
- H-1200 Income That Is Not Used in the Co-Payment
- H-1300 Variable Income and Co-Payment
- H-1400 Order of Deductions from Countable Income
- H-1500 Personal Needs Allowance (PNA)
- H-1600 Dependent Allowance
- H-1700 Deduction for Home Maintenance
- H-1800 Medicare Part B Premium
Section H-2000 Incurred Medical Expenses
- H-2000 Incurred Medical Expenses
- H-2100 Deduction of Incurred Medical Expenses (IMEs)
- H-2200 Third Party Reimbursement Considerations
- H-2300 IME Budget Adjustments Due to Changes in Living Arrangement
- H-2400 Ongoing IME Budget
- H-2500 Medicare Part D Related Expenses
- H-2600 Reserved for Future Use
- H-2700 Dental
- H-2710 Using the TX Dental IME Fee Schedule
- H-2720 Non-Allowable Deductions – Dental
- H-2730 Reserved for Future Use
- H-2740 Reserved for Future Use
- H-2750 Codes Not on the TX Dental Fee Schedule
- H-2760 Replacement of Lost Dentures
- H-2770 Emergency Dental Services
- H-2780 Reserved for Future Use
- H-2790 When the Co-Payment Adjustment is Not Used to Pay Dental Provider
- H-2800 Durable Medical Equipment (DME)
- H-2900 IME Notices
Section H-3000 Averaging and Reconciliation
- 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
- I-3000 Exceptions to the Transfer of Assets
Section I-4000 Determining Uncompensated Value
Section I-5000 Calculation of Penalty Period
- I-5000 Calculation of Penalty Period
- I-5100 Transfer of Assets Divisor
- I-5200 The Penalty Start Date
- I-5300 Home and Community-Based Services Waiver Services and State Supported Living Center Services
- I-5400 Vendor No. 5997, Mason Manor
- I-5500 Transfer Penalties and Institutions for Mental Diseases
- I-5600 Apportioning Penalty Period Between Spouses
- I-5700 Return of Transferred Asset
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
- M-6000 Budgeting
- M-6100 Income Eligibility Budget
- M-6110 Earned Income Tax Credit Payments Exclusion
- M-6120 Child Tax Credit Exclusion
- M-6130 Infrequent or Irregular Income Exclusion
- M-6140 Earned Income – Blind or Students with Disabilities Exclusion
- M-6150 $20 General Income Exclusion
- M-6160 $65 Earned Income Exclusion
- M-6170 Impairment-Related Work-Related Expense (IRWE) Exclusion
- M-6180 Blind Work-Related Expense (BWE) Exclusion
- M-6190 PASS-Related Earned Income Exclusion
- M-6100 Income Eligibility Budget
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
- N-7000 Premiums
- N-7100 Premiums for Alaskan Native or American Indian
- N-7200 Premium in Multiple MBIC-eligible Families
- N-7300 Premium Due Dates
- N-7400 Premiums Amounts
- N-7500 Hardship
- N-7600 Presidential-Declared Emergency
- N-7700 Prior Months' Premiums
- N-7800 Health Insurance Premium Payment (HIPP)
- N-7900 Cost-Sharing
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
- O-1000 Waiver Programs
- O-1100 Application for Waiver Programs
- O-1200 Community Based Alternatives (CBA) Program
- O-1300 Community Living Assistance and Support Services (CLASS)
- O-1400 Youth Empowerment Services (YES)
- O-1500 Deaf Blind with Multiple Disabilities (DBMD)
- O-1600 Home and Community-based Services (HCS)
- O-1700 Medically Dependent Children Program (MDCP)
- O-1800 Texas Home Living (TxHmL)
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
Section P-1000 LTCP Overview
Section P-2000 Program Resources
Chapter Q, Medicare Savings Program
Section Q-1000 Medicare Savings Programs Overview
Section Q-2000 Qualified Medicare Beneficiaries (QMB)
- Q-2000 Qualified Medicare Beneficiaries (QMB) – MC-QMB
- Q-2100 Verification and Documentation for QMB
- Q-2200 Conditional QMB
- Q-2300 Social Security Administration QMB Referral Procedures
- Q-2400 QMB Benefits
- Q-2500 QMB Income and Resource Limits
- Q-2600 QMB Cost-of-Living Adjustment
- Q-2700 QMB Medical Effective Date
- Q-2800 Ensuring Continuous QMB
- Q-2900 QMB Eligibility and Supplemental Security Income
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
- R-2000 Other Actions and Notifications
- R-2100 Persons Discharged to Hospitals from Institutional Settings
- R-2200 Reserved for Future Use
- R-2300 Your Texas Benefits Medicaid Card
- R-2400 Issuance of Form H1027, Medicaid Eligibility Verification
- R-2500 Explanation of Benefits
- R-2600 Reserved for Future Use
- R-2700 Notification of Pre-Screening Result for Medicaid
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