Title: A-800, Medicaid Eligibility | Texas Health and Human Services
Headings: A-800, Medicaid Eligibility
A-800, Medicaid Eligibility
Texas Works Handbook
A—810 General Policy
Medical Programs
Medical Programs, Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB)
A—820 Regular Medicaid Coverage
Medical Programs
TP 40
TP 45
TP 56
Emergency Medicaid
A—821 Types of Coverage
Medical Programs
A—821.1 Fee-for-Service
Medical Programs
A—821.2 Managed Care
Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, and TP 56
A—822 Medicaid Coverage for New State Residents
Medical Programs
A—823 Lock-In Status
Medical Programs
A—824 Issuance of Form H1027-A, Medicaid Eligibility Verification
Medical Programs
Medicaid with No Enrollment Lock-in or Managed Care Coverage
Enrollment Lock-in
Managed Care Coverage
TA 74, TA 75, TA 76, TA 83, TA 86 and TP 42
State Paid Medicaid
TA 62
A—825 Medicaid Termination
TP 08
Emergency Medicaid
Related Policy
TP 40
TP 43, TP 44 and TP 48
Related Policy
TP 45
Notes:
A-825.1 Recipients of TANF and TP 08
Notes:
A—826 Reserved for Future Use
A—827 Your Texas Benefits Medicaid Card
Medical Programs
A—830 Medicaid Coverage for the Months Prior to the Month of Application
A—831 Three Months Prior Coverage
Medical Programs except TP 40
TP 40
A—831.1 How to Apply for Three Months Prior Coverage
Medical Programs except TP 45
A—831.2 Eligibility for Three Months Prior Coverage
Medical Programs except TP 40
TP 08
TP 40
A—831.2.1 Reopening Three Months Prior Applications
Medical Programs
A—831.3 Income Computation
Medical Programs
A—831.4 Determining the Appropriate Type Program for the Prior Month
Medical Programs
A—831.5 Medical Eligibility Date for Three Months Prior Coverage
Medical Programs
A—831.6 Applications Based on Incapacity
TP 08 and TA 31
A—832 Continuous Medicaid Coverage
TP 40
TP 43, TP 44 and TP 48
Exceptions:
A—833 TP 45 Retroactive Coverage
TP 45
A—834 Retroactive Medicaid Coverage for Abandoned Children
Medical Programs
A—840 Transitional Medicaid Coverage
A—841 General Eligibility Information
TP 07
A—841.1 Multiple Changes That Cause TP 08 Ineligibility
TP 08
A—841.2 Notice to Clients
TP 08
A—841.3 Eligibility Criteria During Transitional Medicaid Coverage
TP 07
A—842 TP 07 Transitional Medicaid
TP 08
A—842.1 Determining the First Month of TP 07 Medicaid
TP 08
A—842.2 Determining the Three of Six Months Eligibility Requirement
TP 08
TP 08 with Other Household Members on a Medical Program
A—842.3 Automatic Denial of TP 07
TP 07
A—843 Reserved for Future Use
A—844 Transitional Medicaid Reporting Requirements for TP 07
TP 07
A—844.1 Staff Action on the Fourth Month Medicaid Report
TP 07
A—844.2 Staff Action on the Seventh and Tenth Month Medicaid Reports
TP 07
A—844.3 185% FPIL Test
TP 07
Exceptions:
A—844.4 Good Cause Determinations
TP 07
A—845 Reinstatement of Denied Transitional Coverage
TP 07
A—845.1 Advisor Action on Reinstatements
TP 07
Notes:
A—846 Special Household Composition Policies for Transitional Medicaid
A—846.1 Parents and Caretaker Relatives Enter or Already Live in the Home
TP 07
A—846.2 Child Enters or Already Lives in the Home
TP 07
A—846.3 Household Member Leaves the Home
TP 07
A—846.4 Minor Parents Certified as Children
TP 07
A—847 Other EDG Actions
A—847.1 Changes Affecting Transitional Medicaid EDGs
A—847.2 Reapplication for TP 08
TP 07
A—850 TP 20 Alimony/Spousal Support Transitional Medicaid Coverage
A—851 General Eligibility Information
TP 20
A—851.1 Multiple Changes That Cause TP 08 Ineligibility
TP 08
A—852 Eligibility Criteria During Transitional Medicaid Coverage
TP 20
A—853 Automated Process
TP 08
A—854 Denial of TP 20
TP 20
A—855 Reinstatement of Denied TP 20 Coverage
TP 20
A—856 Special Household Composition Policies for Transitional Medicaid
A—856.1 Parents and Caretaker Relatives Enter or Already Live in the Home
TP 20
A—856.2 Child Enters or Already Lives in the Home
TP 20
A—856.3 Minor Parents Certified as Children
TP 20
A—857 Reapplication for TP 08
TP 20
A—860 Third-Party Resources (TPR)
Medical Programs
A—861 Third-Party Resources (TPR) and Accidents
Medical Programs
A—861.1 Reporting the Accident to the Third-Party Resources (TPR) Unit
Medical Programs
A—861.2 Responding to Third-Party Resources (TPR) Unit Noncooperation Notices
Medical Programs
A—861.3 Third-Party Resources (TPR) Reimbursements
A—861.3.1 Client-Initiated Reimbursements
Medical Programs
A—861.3.2 Reporting Non-Reimbursement to the Third-Party Resources (TPR) Unit
Medical Programs
A—861.4 Responding to Third-Party Resources (TPR) Unit Recovery Requests
Medical Programs
A—861.5 Remitting Cash Medical Support Payments to the Third-Party Resources (TPR) Unit
Medical Programs
A—862 Third-Party Resources (TPR) Reporting System
Medical Programs
A—863 Health Insurance Premium Payment (HIPP) Program
Medical Programs
Related Policy
A—870 Verification Requirements
Medical Programs
Emergency Medicaid
TP 40
Related Policy
A—880 Documentation Requirements
Medical Programs
TP 40

Content: A newborn child born to a mother who received Emergency Medicaid coverage at the time of the child's birth is eligible to receive TP 45 coverage from the date of birth through the end of the month of the child's first birthday. The MED for the initial certification is always the child's date of birth. Before resuming coverage for a newborn who has been denied TP 45, verify that the child resides in Texas. Related Policy
Provider Referral Process, A-125
TP 56
Medicaid coverage for children or pregnant women with spend down begins the first day the household meets spend down. The applicant meets spend down by submitting or having a provider submit medical bills to the Clearinghouse. The Clearinghouse: determines when the person meets spend down; and
notifies TIERS via an interface. TIERS sets the MED for the certified members. Note: