Appendix XXX, Medical Effective Dates (MEDs)

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Revision 26-3; Effective Sept. 1, 2026

Note: This document is effective Jan. 1, 2012.

Community Based

Type Program	MED
ME – Pickle	Three months prior (3MP) policy applies (Form H1200, Application for Assistance – Your Texas Benefits, file date).
ME – Disabled Adult Child	3MP policy applies (Form H1200, Application for Assistance – Your Texas Benefits, file date).
ME – Disabled/Early Aged Widow(er)	3MP policy applies (Form H1200, Application for Assistance – Your Texas Benefits, file date).
ME – SSI Prior	Medicaid coverage automatically begins with the month before the first month of SSI payment for certified SSI clients. The MED may be as early as the first day of the month, two months before the SSI gap month. (SSI Begin Date = Payment Month) The MED may be as early as the three months before the SSI application month for denied SSI applicants.
ME – Waivers	For waiver eligibility, the effective date for medical assistance is either the first day of the month: of nursing facility (NF), intermediate care facility for individuals with intellectual disabilities or related conditions (ICF/IID); of state supported living center entry if the applicant filed a Medicaid application during that month, then requested a program transfer before being certified, and met all eligibility criteria; or the first day of the month if the applicant meets all Waiver Eligibility Component and Financial Medicaid Eligibility Component criteria. Refer to Section O-1100, Application for Waiver Programs. Notes: Consider potential eligibility three months before the application file date if the individual entered an NF, ICF/IID or state supported living center and then transitioned into a waiver setting before being certified. Refer to Institutional Based section of this appendix. Also, refer to B-6300, Institutional Living Arrangement; B-7400, Application for Institutional Care; and J-4310, Determining the Assessment Date for a Home and Community-Based Services Waiver. The MED information for waivers does not apply if the waiver requires Medicaid eligibility before waiver services consideration. For example, Texas Home Living.
ME – Community Attendant	Use the first day of the month: that the application was filed, if the provider started services during that month; services started, if the application was filed by that date; or that the eligibility decision was made.
MC – SLMB	MED is the first day of the month that the application is filed if all eligibility factors are met. MED can be the first of any of the three months prior.
MC – Qualifying Individuals (QI-1)	MED is the first day of the month that the application is filed if all eligibility factors are met. MED can be the first of any of the three months prior. 3MP cannot include the previous calendar year unless the application was filed in the previous year.
MC – QMB	MED is the first day of the month following the month the case is processed and disposed in the eligibility system unless ensuring continuous QMB.
ME – A and D - Emergency	MED is the date the emergency condition began, as documented by the practitioner on Form H3038, Emergency Medical Services Certification. The practitioner will also list the emergency condition end date on Form H3038. These are open and close cases.

Institutional Based

ME – Nursing Facility, ME – State School, ME – Non-state Group Home, ME – State Group Home, ME – State Hospital

Situation	Determination
Apply and Enter Nursing Facility (NF) in Same Month	Must meet 30 consecutive days in the facility. MED is the first day of the month of entry to the facility.
Apply in Month following Month of Entry (Prior Months)	MED may be the first day of any of the 3MP to the application file date. Use the SSI income limit unless the person enters the facility during the application month. If facility entry occurs in a prior month, use the institutional income limit.
Subsequent Month	If the person fails the resource test, the MED is the first day of the subsequent month that all eligibility factors are met.

What to do if:

Situation	Determination
Applicant enters extended care facility (ECF) section of NF:	MED is the first day of the month of entry to ECF. ECF entry establishes medical necessity (MN). Whenever the person moved from ECF or stopped meeting the Medicare care definition of skilled nursing facility, then MN is required. If time in ECF is in any prior months, the MED is the first day of any of the 3MP.
Individual enters NF from the community:	MED may be the first day of any of the 3MP to the application file date. Use the SSI income limit for financial eligibility purposes if the person was not in the facility for any part of the month.
Individual enters facility from the hospital:	MED may be the first day of any of the 3MP to the application file date. Use the special income limit for the month of entry to the facility.

Continuous Coverage

Type Program	Time Frame
ME – Pickle	Continuous coverage is ensured if the application is filed by the end of April or the end of the fourth month after denial. The person must continue to meet eligibility criteria and have unpaid or reimbursable medical bills during this prior time.
ME – Disabled Adult Child	Continuous coverage is ensured if the application is filed by the end of April or the end of the fourth month after denial. The person must continue to meet eligibility criteria and has unpaid or reimbursable medical bills during this prior time.
ME – Disabled/Early Aged Widow(er)	Continuous coverage is ensured if the application is filed by the end of April or the end of the fourth month after denial. The person must continue to meet eligibility criteria and has unpaid or reimbursable medical bills during this prior time.
QMB	Continuous Qualified Medicare Beneficiary (QMB) Program coverage must be ensured, as well as Medicaid coverage. Retroactivity for continuous QMB may be as early as 24 months before the beginning of the current fiscal year, if appropriate. September is considered the start of a fiscal year.