3110 Eligibility for CCSE Services

Revision 25-4; Effective Sept. 1, 2025

To receive Community Care Services Eligibility (CCSE), a client must meet income, resource, age and need criteria.

People who live in nursing homes are not eligible to receive CCSE services.

An applicant or person who lives in Texas may qualify to receive most CCSE services regardless of citizenship or the duration of residency. However, a person may not receive Community Attendant Services or waiver services without verification of citizenship and identity.

Provider agencies must accept HHSC's decision about which people are eligible. Visit 4000, Specific CCSE Services for eligibility requirements for specific CCSE services.

Note: Refer to Appendix XV, Services Available from Other State Agencies, for information about services that may benefit the applicant/individual.

Related Policy

26 Texas Administrative Code Section 271.51(a) 
26 Texas Administrative Code Section 271.51(b)

3111 Age Limits

Revision 25-4; Effective Sept. 1, 2025

A person must be 18 years or older or an emancipated minor to receive Community Care Services Eligibility (CCSE) services. However, a person of any age:

• may receive CCSE Medicaid-funded day activity and health services;
• who is not eligible for the Texas Health Steps program may receive CCSE Medicaid-funded Community Attendant Services (CAS).

Although age limits do not apply to Title XIX Day Activity and Health Services (DAHS), licensure prohibits service providers to deliver DAHS services in facilities that are not licensed to serve people younger than 18. No facilities currently licensed in Texas can serve non-adults.

Related Policy

26 Texas Administrative Code Section 271.61 
 

3120 Loss of Eligibility

Revision 25-4; Effective Sept. 1, 2025

A person is not eligible for CCSE services when the person:

• dies;
• is admitted to an institution;
• physician requests service termination for Medicaid services only;
• requests service termination;
• repeatedly refuses to accept help, except in an involuntary protective services case; or
• refuses to comply with their service plan.

The caseworker must notify the provider as soon as a person dies or enters a nursing home. Services are terminated effective the date of death or entry into the nursing home. The provider cannot bill for trying to deliver services after the effective date of the termination.

Related Policy

26 Texas Administrative Code Section 271.155(c) 


 

3210 Resource Limits

Revision 25-4; Effective Sept. 1, 2025

A person is not eligible for CCSE services if the value of nonexempt resources owned by them exceeds $5,000. A couple is not eligible for CCSE services if the value of nonexempt resources they own exceeds $6,000.

The individual limit applies to people who are single, even if they live with relatives. The individual limit also applies to people whose spouses live in different households. The couple limit applies to married people who live in the same household, even if the spouses are ineligible.

Include in the person’s resources what they own even if the resources are managed and controlled by someone else acting on their behalf. Also include funds that are not in the person’s name if those funds clearly belong to them and are available for use. Determine ownership based on the person’s statement unless contradictory evidence from another source exists.

Related Policy

26 Texas Administrative Code Section 271.89 

3220 Types of Resources

Revision 25-4; Effective Sept. 1, 2025

HHSC counts the following as resources to determine eligibility for CCSE services:

• Liquid resources include cash on hand, CDs, checking or savings accounts, money market funds, revocable trust funds, saving certificates, stocks or bonds. Liquid resources also include the person's or couple's portion of money in a checking or savings account, or a money market fund held jointly with another person.
  • Jointly held liquid resources are the resources of the applicant or person if they have unrestricted access to the funds, no matter the source. The applicant or person may move their portion of jointly held funds from a joint account to a new account. Although the new account may be jointly owned, all funds in the new account are considered the applicant’s or person’s.
  • Money received as a nonrecurring lump sum payment is only considered a resource 30 days from the date of receipt. Lump sum payments include, but are not limited to:   
    • income tax refunds;
    • earned income tax credits or rebates;
    • one-time bonuses from mineral rights;
    • retroactive lump sum Social Security, SSI or railroad retirement benefits;
    • lump sum insurance settlements;
    • one-time gifts, awards or prizes; and
    • refunds from rental or utility deposits. The applicant or person is responsible for reporting the receipt of a lump sum payment.
• Nonliquid resources include:
  • nonexempt licensed or unlicensed vehicles;
  • buildings and land not designated as homestead that are not producing income or are producing income less than 6% of the equity value; and
  • any other property not specifically excluded.

Evaluate nonliquid resources based on their equity value. Equity value is the market value of the resource minus any recorded encumbrances.

Money received from the sale of a countable or excluded resource, other than a homestead, is counted as a resource on the first day of the month following an entire month after it was sold. Example: The resource is sold on June 15 so proceeds are not counted until Aug. 1.

Annuities

A revocable annuity is a countable resource. If a person has an annuity, the caseworker must review the contract or agreement terms to determine if the principal is an available resource. Refer the annuity document to the regional attorney if there is a question about if the annuity is revocable.

Irrevocable annuities are not countable resources for Community Care Services Eligibility people. However, the purchase of an annuity may affect the person’s eligibility for institutional care or waiver services. If the person is concerned about the effect the annuity may have on future eligibility for services, refer them to consult with a Medicaid for the Elderly and People with Disabilities specialist.

Guardianships and Power of Attorney

If the person is a guardian for someone other than their spouse, do not include in their resources any separately identifiable funds that belong to the other person but are accessible to them as that person's guardian.

A person who has a financial power of attorney for another acts solely as a fiduciary agent. The fiduciary agent acts in a financial capacity, whether formal or informal, regardless of title, including representative payee, guardian or conservator. Therefore, assets that belong to the other person should not be considered as part of the person's available assets.

Assets held by a fiduciary agent for a person are considered available to the person unless otherwise excludable.

Related Policy

26 Texas Administrative Code Section 271.91 

3230 Resource Exclusions

Revision 25-2; Effective March 31, 2025

To determine eligibility for CCSE services, the department does not consider the following as resources. They are considered excluded for eligibility purposes. Any item not listed as an exclusion is considered a resource.

Homestead — Any structure used by the person as a residence, including other buildings and contiguous land. Mobile homes, houseboats, and motor homes are considered structures. Vacant property is not a homestead. Contiguous land means land adjacent to the home, including any land separated only by roads, rivers, and streams. Land is contiguous if it is not separated by property owned by another person. The homestead is excluded as a resource regardless of its location, even if the person no longer lives there unless they have purchased another residence. If they own two houses, their homestead is the property that they use as a residence. Only one homestead may be excluded for each person or couple.
If the person lives in a house, but also has a mobile home, houseboat or motor home on the property, these are all excluded as part of the homestead.

Personal property — Household goods and personal effects.

Property essential to employment — Tools and equipment required for employment or self-employment.

Prepaid burials — Prepaid burial arrangements, burial insurance, and burial plots. The cash surrender value of all life insurance.

Vehicles — One passenger car or other vehicle, such as a van or truck, used for transportation; or one unlicensed vehicle.

• A second vehicle may be excluded if it is:
  • specially equipped to enable a person with a disability to drive; or
  • essential to the employment or self-employment of the family.
• Any additional vehicles, licensed or unlicensed, are considered resources.

An inoperable junk vehicle can be assigned a value of $100, if the person's resources are less than:

• $4,900 for a single person; or
• $5,900 for a couple.

The caseworker must verify the value of an inoperable vehicle when the person's resources are within $100 of the CCSE resource limit $5,000 for a single person or $6,000 for a couple.

Income-producing property — Property that annually produces net income equal to or greater than 6% of the property's equity value. The equity value is the current market value of the property less any recorded encumbrances. Review 3231, Rate of Return on Income-Producing Property.

Installment contracts from mortgages, notes or loans — The value of installment contracts for the sale of land, other property, or repayment of loans, if the contract or agreement is producing income per fair market value at the time of the agreement. An installment is a mortgage or similar contract where the buyer promises to pay a fixed amount over a period until the principal of the note is paid. Even though the seller retains legal title, the property is not considered a countable resource if the buyer is fulfilling the contractual obligation. The payment is considered income.

Disaster assistance — Government payments granted for the rebuilding of homes destroyed or damaged in a disaster.

Reverse mortgages are treated as loans. The money received is not considered to be income. However, it is a resource the month after receipt.

Energy assistance — Payments or allowances for energy assistance made under any federal, state, or local law.

Supplemental Nutrition Assistance Program (SNAP) allotments — The value of SNAP allotments and USDA-donated foods.

Inaccessible resources — The cash value of resources that are inaccessible to the person. Examples are irrevocable trust funds, property in probate, and pension funds. Real property that the person or family is making a good faith effort to sell is exempt. The person or family must ask a fair price for the property, for its current market value. Property is also exempt if it is jointly owned and the other co-owners refuse to sell.

If jointly owned property is not excluded, the market value of the person's share of the property is countable. However, if the value will not affect eligibility, enter the full value of undivided property and document that the property is jointly owned.

An IRA should be treated as a pension fund, and therefore not considered as a resource for eligibility determination.

Mineral rights — The value of mineral rights.

Life estates and remainder interests — A life estate is the right a person has to property during the person's lifetime. A remainder interest is the right of ownership to the property when the life estate holder dies.

Replacement value of excluded resources — The replacement value of an excluded resource if it is lost, damaged, or stolen. The cash received from an insurance company for replacing the resource is not considered for three months if the resource is personal property or six months if it is real property. Any cash not spent within the specified period is considered a resource.

Monthly gross income — All income received monthly. Monthly gross income is counted as income in the month received and excluded as a resource in that month.

• Do not deduct income from resources unless the countable resources exceed $5,000 or $6,000 for a couple.
• If resources exceed the $5,000 or $6,000 limit, determine if the monthly income is included in the checking or savings account or cash on hand.
• If cash on hand is money remaining from the current month's income, it may be deducted unless this would duplicate deduction of the same money as a checking or savings account deposit.
• If resources exceed the $5,000 or $6,000 limit, deduct the amount of income the person may have received at the end of the month intended for the next month. Example: Next month's Social Security check arrives early (the last day(s) of the month) and is deposited into the person's checking or savings account.
• If income is deducted and the person receives Veterans Affairs (VA) aid-and-attendance or homebound benefits, deduct the full amount of VA payment even though aid-and-attendance is excluded from income.

Sale of a homestead — Proceeds from the sale of a homestead up to six months after they become available to the seller. The six months gives the person time to acquire another homestead. If they do so, any balance from the original sale must be considered as an available resource. If, before the end of the six-month period, the person declares that they have no intention of acquiring another homestead, the proceeds from the sale must be counted as an available resource.

Agent Orange Settlement Payments — Payments from the Agent Orange Settlement Fund or any other fund established in settlement of the Agent Orange product liability litigation.

Radiation exposure compensation — Payments received under the Radiation Exposure Compensation Act (P.L. 101-246).

Funds from the Transition to Life in the Community Program

Livestock

Earned income tax credit (EITC) refunds from the Internal Revenue Service

3231 Rate of Return on Income-Producing Property

Revision 17-1; Effective March 15, 2017

To determine whether the property is producing enough income to be excluded as a resource:

3310 Income and Income Eligibles

Revision 24-4; Effective Sept. 1, 2024

To be eligible for CCSE services, the person must either be:

• categorically eligible by receiving:
  • Supplemental Security Income (SSI);
  • Temporary Assistance for Needy Families (TANF);
  • Supplemental Nutrition Assistance Program (SNAP);
  • Medicaid, Specified Low-Income Medicare Beneficiary (SLMB) or Qualified Medicare Beneficiary (QMB) benefits; or
• income eligible means the person and their spouse's countable income must be equal to or less than the income limit set by the U.S. Department of Health and Human Services (HHS).

Categorical Eligibility for Title XIX Services

A person with full Medicaid is financially eligible for Title XIX services. These people are referred to as categorically eligible.

Use the Texas Integrated Eligibility Redesign System (TIERS) to determine the eligibility status of a person applying for Title XIX CCSE programs.

Related Policy

Categorical Eligibility, 2341.3
TIERS Inquiries, 7110
TIERS Type Program Chart, Appendix XIV

Categorical Eligibility for Title XX Services

Recipients of some non-Medicaid programs are financially eligible for Title XX benefits based on existing program eligibility. These people are referred to as having categorical eligibility for Title XX services.

Financial Eligibility Determination for Title XX Services

CCSE staff determine financial eligibility for applicants for Title XX programs unless financial eligibility has already been determined based on existing program eligibility. These people are referred to as income eligibles.

Related Policy

Determination of Countable Income, 3320
Budgeting Countable Income, 3330
Computation of Gross Income, 3340
TIERS Inquiries, 7110

Financial Eligibility for Community Attendant Services (CAS)

Medicaid for the Elderly and People with Disabilities (MEPD) or Texas Works (TW) staff determine financial eligibility for CAS. CCSE staff must not deny CAS cases based on income or resources, even if the applicant's assets seem to exceed the eligibility limits.

Effect of Living Arrangement on Financial Eligibility for Title XX Programs

If both spouses apply for services and only one spouse receives SSI, TANF, Medical Assistance Only, or another program that provides categorical eligibility for CCSE services, compare the total income of both spouses with the couple’s income limit to determine the second spouse's eligibility.

If a married person does not live with their spouse, use the individual income limit. Do not consider the income of the spouse unless that income or part of it is given to the person. Income diverted from a spouse in a nursing home to the person at home is included in the person's income calculation. If income diverted from a spouse in a nursing home makes a person ineligible, explain to the person that they can request the amount of income they keep from the institutionalized spouse may be reduced. If the amount they keep is reduced, they will be required to pay more to the nursing home. The person must contact MEPD to request this change. Explain that the person may need to reapply for CCSE, if the situation changes.

A CAS, PHC or Title XIX Day Activity and Health Services recipient who requests a Title XX service, is categorically eligible for Title XX services based on the current Medicaid eligibility certification.

Related Policy

Income and Resource Limits, Appendix XI

3320 Determination of Countable Income

Revision 25-4; Effective Sept. 1, 2025

Countable income is determined by totaling gross income from all the following sources, less all applicable exclusions and exemptions. Applicable exclusions and exemptions are specified in 26 Texas Administrative Code Section 271.55 and 271.59 of this title relating to Income from Excludable Sources and Income from Exempt Sources.

(1) Total gross earnings — This includes money, wages, commissions, tips, piece-rate payments, cash bonuses or salary received for work performed as an employee. This also encompasses pay for members of the armed forces including allotments from any armed forces pay received by a member of the family group from a person not living in the household.
(2) Self-employment income including farm income — For earned income to be considered self-employment, either the person or spouse must be actively involved or materially participating in producing the income.
(3) Social Security and railroad retirement benefits.
(4) Dividends — This consists of dividends from stocks or membership in associations and periodic receipts from estates of trust funds. These payments are averaged over a 12-month period.
(5) Rental income — This includes payments to the person from the rent of housing, store or other property, as well as from boarders or lodgers.
(6) Net income derived from oil, gas or mineral rights — This can include both lease and royalty payments. These payments are averaged over a 12-month period.

Reminder: Refer to 3330, Budgeting Countable Income, to determine if this income can be excluded as infrequent and irregular or as a lump sum payment.

(7) Income from mortgages or contracts.
(8) Public assistance or welfare payments — Temporary Assistance to Needy Families, Supplemental Security Income and general assistance such as cash payments from a county or city are included.
(9) Veterans' pensions and compensation checks — This may include money paid periodically by the Veterans Administration to disabled members of the armed forces or to survivors of deceased veterans, subsistence allowances paid to veterans for education and on-the-job training and refunds paid to ex-servicemen as GI insurance premiums.
(10) Educational loans, grants, fellowships and scholarships.
(11) Unemployment compensation — Unemployment compensation may be received from government employment insurance agencies or private companies during periods of unemployment and includes any strike benefits received from union funds.
(12) Workers compensation and disability payments — This includes compensation received periodically from private or public insurance companies for injuries incurred at work.
(13) Alimony.
(14) Regular monthly cash support payments from friends or relatives.
(15) Pensions, annuities and irrevocable trust funds — Payments may be paid to a retired person or their survivors by a former employer or by a union, either directly or through an insurance company. Periodic payments from annuities, insurance, irrevocable trust fund payments and civil service pensions are included.
(16) Income from the person's share of a life estate.

Related Policy

26 Texas Administrative Code Section 271.55

3330 Budgeting Countable Income

Revision 17-1; Effective March 15, 2017

The sources of income that may be included in the income eligibility budget fall into one of three categories: countable, excludable and exempt. Countable income is addressed in 3320, Determination of Countable Income. Treatment of the excludable and exempt income varies, as illustrated below.

3330.1 Excludable Income

Revision 25-4; Effective Sept. 1, 2025

Income may be fully or partially countable or may be excluded from the current eligibility budget. Excludable income will continue to be monitored by the caseworker at each financial review to determine how eligibility is affected. Excludable sources of income include:

• deductions from earned income, including Social Security payments, Medicare premium payments, bonds, pensions and union dues;
• the first $65 of a client's or couple's net earned income, plus half of the remainder;
• loans, grants, scholarships and fellowship funds obtained and used under conditions that preclude their use for current living costs.
  • any portion used to pay any other expense such as room, board or books cannot be excluded;
• Veterans Administration aid-and-attendance benefits, homebound elderly benefits and payments to certain eligible veterans to purchase medications;
• infrequent or irregular income, including income received less frequently than once a month, that averages $20 per month or less;
• one-third of the total amount of child support payments for an eligible child; and
• allowable exclusions from self-employment income, as indicated on the following chart.

Mandatory deductions from unearned income may also be excluded from the eligibility budget. Documentation  in the case record must clearly state that the deduction is mandatory and if or when the mandatory deductions will end.

For earned income to be considered self-employment, either the person or spouse must be actively involved or materially participating in producing the income. A business owner is determined to be materially participating if they meet any one of the following criteria. The owner:

• engages in periodic advice and consultation with the tenant, inspection of the production activities, and furnishing of machinery, equipment, livestock and production expenses;
• makes management decisions that affect the success of the enterprise;
• performs a specified amount of physical labor to produce the commodities raised and
• does not meet the full requirements above, but their involvement in crop production is still significant.

A blind or disabled student younger than 22 years who regularly attends school, college, a university or a course of vocational or technical training can have limited earnings that are not counted toward the income eligibility budget. This exclusion does not apply to unearned income.

The maximum amount of the income exclusion varies from year to year and is determined annually by the Social Security Administration (SSA). Exclusion amounts can be determined on the Student Earned Income Exclusion For SSI webpage.

Section 2002 of the American Recovery and Reinvestment Act of 2009 (ARRA) authorizes more unemployment compensation benefits of $25 per week for people who receive unemployment benefits. The added $25 is not countable income for either eligibility or co-payment purposes. As the added unemployment compensation may be included with the regular payment or as an added payment, a contact with the Texas Workforce Commission may be needed to determine if any of the payments are part of the ARRA added compensation.

Related Policy

26 Texas Administrative Code Section 271.57

3330.2 Exempt Income

Revision 25-2; Effective March 31, 2025

There are numerous exemptions on countable income. These exemptions can be found in Appendix XXX, Income and Resource Exemptions for Determining Financial Eligibility.

Exempt income is not included in the income eligibility calculation. Once identified and documented, caseworkers will not be required to monitor exempt income at subsequent financial redetermination. Sources of exempt income include:

1. Interest income.
2. Cash received from the sale of a resource which is a resource, not income.
3. Income of minor children who are supported by or dependent upon the client.
4. Refunds from the Internal Revenue Service for earned income tax credit.
5. Reimbursement from an insurance company for health insurance claims.
6. Any cash from a non-governmental medical or social services organization if the cash is:
   • for medical or social services already received by the person and approved by the organization, and which is not more than the value of those services; or
   • a payment restricted to the future purchase of a medical or social service.
7. Proceeds of either a commercial loan or an informal loan, when repayment is required with or without interest. The proceeds amount borrowed are not counted as income in the month they are received but are considered a resource in the following month(s). To claim exemption from the proceeds of a loan, a person must prove that they acknowledge an obligation to repay and that some plan for repayment exists. If these conditions can be verified, no written contract is required.
8. The amount of the cost-of-living increase in any pension or benefit, received on or after Jan. 1, 1985, that would cause the person to be ineligible for continued services. This exclusion applies only to community care people who are already receiving services or case management and would become ineligible because of the increase. It does not apply to applicants.
9. In-kind income, such as food, clothing, shelter, rent subsidies.
10. One-time or lump-sum payments from any source.
11. Funds from the Transition to Life in the Community Program.

For a complete list of income exemptions, review Appendix XXX.

The term lump sum, as listed in 10 above, can be defined as income that is not expected to recur with a predictable pattern of frequency.

Income received less than three times per year that does not meet the $20 monthly average requirement, as listed in 5 above, should be treated as a lump sum payment. If the lump sum could affect eligibility, the case should be monitored 30 calendar days following receipt to ensure that resource eligibility is not affected.

3340 Computation of Gross Income

Revision 25-2; Effective March 31, 2025

If a person receives gross income more than monthly, compute the income as follows.

• Weekly income — multiply by 4.33
• Bi-weekly income — divide by 2 and multiply by 4.33
• Twice monthly income — multiply by 2.

3341 Income Averaging

Revision 25-2; Effective March 31, 2025

Calculate the income average of all income that may be received monthly but is usually received less often. The caseworker also may need to calculate the 12-month average income for monies received for seasonal employment, such as agricultural or construction work.

If a person ends regular employment to accept seasonal employment but later returns to the regular job, calculate the income average from the combined sources over the 12-month period.

3410 Verification of Public Assistance Status

Revision 24-4; Effective Sept. 1, 2024

Within 24 months of the last financial review, verify the correct categorical financial status of current:

• Temporary Assistance for Needy Families (TANF);
• Supplemental Security Income (SSI);
• Qualified Medicare Beneficiary (QMB);
• Specified Low-Income Medicare Beneficiary (SLMB);
• Qualifying Individuals (QI);
• Supplemental Nutrition Assistance Program;
• Medicaid Buy-In; or
• Medicaid people; and
• certify eligibility on this basis.

Place a dated copy of both Form 2064, Eligibility Worksheet, from Service Authorization System Online (SASO) and a Texas Integrated Eligibility Redesign System (TIERS) inquiry in the person's case folder. This will satisfy verification requirements for a person receiving service(s) based on categorical financial status.

Refer to 7110, TIERS Inquiries, for a full listing of programs that provide categorical eligibility for Community Care Services Eligibility programs.

3420 Verification of Income and Resources

Revision 26-1; Effective March 1, 2026

Program Standard: The caseworker must accurately establish the countable amount of income and resources. This determines the income-eligible applicant's financial eligibility.

Determine the amount of countable assets for people who apply as income eligibles. Financial eligibility must also be redetermined for these people within 24 months of the last financial review. A person's declaration of income and resources for all programs is acceptable, excluding waiver services unless:

• There is reason to doubt the reliability of the applicant's statement. The caseworker can request verification whenever any doubt exists.
• The applicant's declared resource amount is within $100 of the resource eligibility limit.
• The applicant's declared income amount is within $10 of the income eligibility limit.
• The applicant seems unsure about the amount of income or resources available. The caseworker may accept a certain level of uncertainty. Example: The person may state they receive about $350 per month. Since this is well below the income eligibility cap, the applicant's statement may be accepted even though the person is not sure about the amount. However, if the applicant responded with somewhere around $1,500, it would be necessary to verify the amount of income, given the uncertainty and the proximity to the eligibility limit.

If a person meets the criteria in 3430, Eligibility Before Verification, refer the person for services before verifying income and resources. Complete the verification within 30 calendar days of the application.

Applicants must provide all income and resource data needed to establish eligibility. Ask the applicant or responsible party to provide the information required to verify income and resources.

Give the applicant or responsible party a specific due date when information is requested. Explain the result of not providing the requested data. During a review, make the due date two weeks before the day the current certification period ends. This allows a few more days to give the person a second chance before terminating services effective the last day of certification. Follow up at least once before denying the applicant for failure to cooperate.

During a financial review, if a person reports closing a bank account or no longer having an account included in the last review, and adding the last known balance would bring the person to within $100 of the resource eligibility limit, verify with the bank that the account has been closed.

If the information can be obtained by making a phone call or mailing a verification form, attempt to get the data before denying the application. If the caseworker cannot get the information and the applicant does not provide it, deny the application. If the caseworker cannot get information needed for a financial recertification and the person does not provide it, send Form 2065-A, Notification of Community Care Services, at least 12 calendar days before termination becomes effective.

Without verifying the income or resources, the caseworker may deny an application because the person reports excess income or resources. Explain the reason for the denial to the person or responsible party. Select statement of client or responsible party as the verification type for income and resources, as applicable, in the Service Authorization System Online (SASO) financial wizard. 

Review Appendix XII, Examples of Methods to Verify Income and Resources, for methods to verify data. The caseworker may use a verification source not listed in Appendix XII if they determine the source is both knowledgeable and objective. A person is considered knowledgeable if they routinely assess values on that type of resource in the area where the resource is located. A person may not be considered objective if they have a vested interest in the person’s eligibility.

Information on Form 2064, Eligibility Worksheet, should contain enough data to determine what, when, where and how the applicant's or person's income and resources were verified and traced to the original source. For categorically eligible applicants and people with Temporary Assistance for Needy Families (TANF), Medical Assistance Only (MAO), Supplemental Security Income (SSI), Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI) and the Supplemental Nutrition Assistance Program, the case record must:

• show that categorical status was verified; and
• include a printed copy of a Texas Integrated Eligibility Redesign System (TIERS) inquiry that shows the applicant's categorical status.

Form 2064 must show that verifications were received before the date eligibility rules were processed. 

3421 Financial Documentation Requirements

Revision 24-4; Effective Sept. 1, 2024

This chart is designed to help determine what is required for financial eligibility documentation.

3422 Exceptions to Verification Requirements

Revision 26-1; Effective March 1, 2026

Income eligible people must complete a new Form H1200, Application for Assistance – Your Texas Benefits, within 24 months of the initial financial determination. The date of application is the date Health and Human Services Commission (HHSC) receives the application. This date must be entered in the Financial Wizard in Service Authorization System Online (SASO). Subsequent financial redeterminations will not require completion of Form H1200, unless the caseworker thinks the person’s financial eligibility may be in question.

Even though a new Form H1200 is not needed, the caseworker must still contact the person and confirm that significant changes in income and resources have not occurred.

If a new source of income or a new resource is at a financial review, reverify all the person’s resources. If adding the person’s new assets to existing income or resources brings the total income within proximity of financial eligibility limits, reverify all the person’s resources.

Following these guidelines at a review, the caseworker may need to verify:

• both income and resources,
• income but not resources,
• resources but not income, or
• neither income nor resources.

If a person loses categorical eligibility between reviews, for example, they stop receiving Temporary Assistance for Needy Families or the Supplemental Nutrition Assistance Program, that person may be able to continue receiving services without a financial review until the next financial review is due. Review 3441, Loss of Categorical Status, for more information. If the person or caseworker reports income and resources within eligibility limits and no other information exists to contradict this report, the person may continue to receive Title XX, block grant services. In this case, the caseworker must verify both income and resources at the next financial review.

3430 Eligibility Before Verification

Revision 25-4; Effective Sept. 1, 2025

A Medicaid-certified applicant for CCSE-purchased services who requires a verbal referral is eligible to receive CCSE-purchased services when their eligibility for Medicaid is verified. A non-Medicaid certified applicant who meets the requirements for a verbal referral is eligible to receive CCSE purchased services while income and resources are verified. Visit 1130, Definitions, and 2631, Negotiated Referrals.

To be eligible, this applicant must:

• be a new applicant for CCSE services;
• appear to be eligible based on the declaration of income and resources on their application for services or to have possession of a current medical care identification card; and
• meet the age and need criteria for the CCSE service he requires.

The eligibility period for non-Medicaid applicants begins on the date of application.

A non-Medicaid applicant must provide the information needed to verify their income and resource amounts to continue receiving services. This must be done within 30 days of the application date.

If, pending financial eligibility verification, the non-Medicaid applicant appears eligible for immediate service initiation, use the following procedures as appropriate.

1. Refer the applicant to the provider per 2631.
2. On Form 2101, Authorization for Community Care Services, enter the earliest date negotiated with the provider as the date services begin.
3. If the applicant is determined ineligible within the 30-day verification period, or if the applicant does not provide the information needed to verify income and resource amounts by the 30th day, send Form 2065-A, Notification of Community Care Services, to the person to terminate services 12 days after the Form 2065-A date. Refer to Appendix IX, Notification Effective Date of Decision.

Related Policy

26 Texas Administrative Code Section 271.151(g)

3440 Changes in Financial Circumstances

Revision 25-4; Effective Sept. 1, 2025

The person must promptly report any changes in:

• income, resources or family size;
• loss of assistance grant or Medicaid benefits; or
• other changes in functional ability or circumstances that affect eligibility.  

The person is subject to fraud prosecution if they willfully fail to report changes and continues to receive services for which they are not eligible.

People must promptly report any changes in income or resources. Note in the case record, but do not verify, reports of changes in income or resources that do not affect eligibility. Newly acquired resources that may affect eligibility, such as an inheritance that involves property, are disregarded for 30 days from the date received. After 30 days, determine the amount of resources and terminate the person’s eligibility if the amount exceeds the resource limit.

Related Policy

26 Texas Administrative Code Section 271.153(f)

3441 Loss of Categorical Status or Financial Eligibility

Revision 24-4; Effective Sept. 1, 2024

If a Community Care Services Eligibility (CCSE) person temporarily loses categorical or financial eligibility for Title XIX services, CAS, PHC and DAHS, the caseworker must contact the person or the appropriate agency to determine the reason for the denial and if reinstatement is likely.

If the person loses Medicaid eligibility because their Supplemental Security Income (SSI) is being denied, the caseworker must contact the person or the Social Security Administration (SSA) to determine the reason for the denial and if the person may be reinstated without a break in coverage.

Caseworkers may receive a copy of a denial notice or the monthly Loss of Eligibility Report for eligibility for the following programs:

• Community Attendant Services (CAS)
• Medicaid Buy-In (MBI)
• Medicaid through Temporary Assistance for Needy Families (TANF)
• Categorical eligibility through the Supplemental Nutrition Assistance Program (SNAP)
• Qualified Medicare Beneficiary (QMB)
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI)
• Medicaid through Type Program (TP) 03 (Pickle), TP 18 (Disabled Adult Children), TP 19 (SSI Denied Children) or TP 22 (Widow /Widower).

When the caseworker learns about the denial, they must check the Texas Integrated Eligibility Redesign System (TIERS) to verify the denial and the reason. The caseworker must contact the person to discuss the situation and if feasible, help the person complete the actions necessary for reinstatement of eligibility. If the person has been denied on failure to furnish information, the caseworker must contact the person as soon as possible to advise them of the loss of service and the necessity of providing the information required by Medicaid for the Elderly and People with Disabilities (MEPD) or TANF. The caseworker may also contact the MEPD or TANF specialist involved, ask about the person's current income and resource amounts, and if reinstatement will occur.

3441.1 Procedures Pending Reinstatement

Revision 25-4; Effective Sept. 1, 2025

Suspension Pending Reinstatement

The caseworker may suspend services for 60 calendar days to allow a determination on the person’s Medicaid status to be made for the reinstatement of services. Within four business days of determining suspension is appropriate, the caseworker prepares  Form 2065-A, Notification of Community Care Services, checks the Notification of Ineligibility or Termination of Benefits, the date services end and notes that services are suspended pending reinstatement of Medicaid or financial eligibility, as applicable. The caseworker sends the completed Form 2065-A to the person within that time frame and also sends Form 2067, Case Information, to the provider to suspend services effective the date of Medicaid denial.

During the period when services are temporarily suspended by Medicaid, all case actions for CAS, PHC and Title XIX DAHS such as monitoring and annual visits, changes and transfers will be suspended. However, the caseworker must set a special review for the 60th day following the suspension to check if eligibility has been re-established.

If at any time during the initial 60 calendar day period the caseworker learns that eligibility has been reestablished, they have 14 calendar days to:

• call the provider to negotiate the earliest date for services to resume;
• follow up the phone call with Form 2067 to the provider and note reinstatement of services with the negotiated date;
• make any 90-day monitoring or annual reassessment visits which would have occurred during the suspension;
• document the reinstatement of eligibility and the reason for delay in monitoring or annual reassessment visits because of the suspension of services; and
• send the person Form 2065-A stating the negotiated date services are to resume. This must be documented in the comments section.

If eligibility is not reestablished on the 60th day, the caseworker may extend the temporary suspension for another 30 calendar days for a total of 90 calendar days if the caseworker determines the person may still have eligibility reinstated. This decision is established based on research of MEPD case-specific information. At any time during the added 30 calendar days the caseworker learns eligibility has been reinstated, they have 14 calendar days to resume services. Caseworkers must send Form 2067 to the provider to have services resumed. They also must make any 90-day monitoring or annual reassessment visits that would have occurred during the suspension. The caseworker documents the reinstatement of eligibility in the case record and the reason for the delay in monitoring or annual reassessment visits because of the suspension of services. The caseworker sends the person Form 2065-A with a statement that services have been reinstated.

Family Care During Suspension

While the person is working on reinstatement, the caseworker explores transferring the person to Family Care (FC). If the region does not have open enrollment, review 2231.1, People Who May Receive Title XX Services with Regional Director Approval, to determine if the person meets the bypass criteria. No one may bypass the FC interest list during times of extreme budget limitations on a regional or statewide basis.

If the person will be transferred to FC, the change must be processed within 14 calendar days of learning of Medicaid denial. If person is not categorically eligible, record the self-declared income and resources in the case record. Update the Service Authorization System Online (SASO) to show the person as income eligible. It is not necessary to get Form H1200, Application for Assistance – Your Texas Benefits, from the person or to verify income and resource amounts until the next financial review is due.

Submit Form 2101, Authorization for Community Care Services, to transfer a person from PHC or CAS to FC. Use the comments section on Form 2101 to document the person’s services being transferred from PHC or CAS to FC because of a loss of Medicaid. Enter the day after the last date of Medicaid coverage as the from date on Form 2101. If the Medicaid denial is unknown until after the last day of Medicaid coverage, use the earliest date FC can begin as the from date.

The caseworker must send F2065-A, Notification of Community Care Services within two business days to notify the person of the CAS or PHC suspension and the transfer to FC pending reinstatement of financial eligibility for CAS or PHC.

When Medicaid is reinstated and the person is transferred back to PHC or CAS, all pre-initiation activities, including a new Form 3052, Practitioner's Statement of Medical Need, is required. Review 4673.6, Temporary Loss of Eligibility and Reinstatement Procedures.

If the person fails to cooperate with the financial reinstatement process, the person cannot remain on FC. The caseworker must send Form 2065-A to deny FC services. The 2065-A denial date must allow for 12 days adverse action.

Denial Because of No Reinstatement

If reinstatement of eligibility is not granted, the caseworker sends the person Form 2065-A denying services. The date of denial is based on the:

• Medicaid eligibility end date, shown in the Texas Integrated Eligibility Redesign System (TIERS); or
• denial date on Form H4808, Notice of Change in Applied Income/Notice of Denial of Medical Assistance, from MEPD.

Send Form 2101 to the provider on the same date and note that services are denied effective the date of the financial denial.

Other Title XX Services During Suspension

If the person is receiving Title XX services, Emergency Response Services (ERS), Home Delivered Meals (HDM) or Title XX Day Activity Health Services (DAHS), continue the same authorization during the Medicaid suspension.

All case actions including financial reassessment, functional reassessment and monitoring for ERS, HDM or Title XX DAHS must continue during the CAS, PHC or Title XIX DAHS suspension period.

3441.2 Reinstatement Procedures After Denial

Revision 25-2; Effective March 31, 2025

If financial or categorical eligibility is re-established within 60 calendar days of the denial date and the person reapplies for services, the caseworker may use the information currently on file to determine eligibility. Completing new forms will not be required, except for a new Form 2110, Community Care Intake, and Form 2101, Authorization for Community Care Services. The caseworker must note in the Comments section of Form 2110 that reinstatement procedures are being used within 60 calendar days of the denial date and may use the following forms currently on file:

• Form 2059, Summary of Client's Need for Service
• Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
• Form 2307, Rights and Responsibilities
• Form 1584, Consumer Participation Choice

The caseworker must contact the person and review the functional assessment, including Form 2060 and Form 2059, to determine if there have been any changes in the person's physical condition or needs. If Form 2060 is over one year old, if there have been changes in the person's condition or needs or if the person has difficulty communicating by phone, the caseworker must make a home visit to review or revise the assessment. Initial eligibility time frames will apply.

The caseworker must send an initial referral packet and initial Form 2101 referral to the selected provider. For Primary Home Care and Community Attendant Services, the provider must complete all pre-initiation activities, including getting a new Form 3052, Practitioner's Statement of Medical Need.