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3111 Interest List Procedures
Revision 26-2; Effective June 1, 2026
3112 Medicaid Eligibility
Revision 25-2; Effective June 6, 2025
Program Support Unit (PSU) staff must verify each applicant's current eligibility for Medicaid through the Texas Integrated Eligibility Redesign System (TIERS). PSU staff initiate the Medicaid financial eligibility determination process if there is no existing acceptable Medicaid coverage. Refer to Appendix V, MEPD Referral Crosswalk, for individuals with Medicaid eligibility to determine if a program transfer by the MEPD specialist is required.
An applicant who currently has Form H1200, Application for Assistance – Your Texas Benefits, on file with the Texas Health and Human Services Commission (HHSC) may not need to complete a new Form H1200. PSU staff must check with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist about the need for a new Form H1200.
PSU staff must maintain Form H1200 in the applicant’s Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record, if applicable.
3113 Transmittal of Form H1200
Revision 18-0; Effective September 4, 2018
When transmitting Form H1200, Application for Assistance – Your Texas Benefits, Program Support Unit (PSU) staff fax all pages of Form H1200 along with any supporting documentation and Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist. PSU staff will upload all pages of Form H1200 and Form H1746-A to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) with the applicant's valid signature.
The original Form H1200 must be kept for three years after the HEART case record is denied or closed. PSU staff must also retain a copy of the successful fax transmittal confirmation in the HEART case record. Scanning Form H1200 and sending by electronic mail is prohibited.
3114 Applicants with Medicaid Eligibility
Revision 18-0; Effective September 4, 2018
At the time of the initial intake for the STAR+PLUS HCBS program, Program Support Unit (PSU) staff must obtain information on the applicant's Medicaid and/or financial status. PSU staff must obtain verification of the applicant's current eligibility for an appropriate type Medicaid program from the Medicaid for the Elderly and People with Disabilities (MEPD) specialist or through inquiry in the Texas Integrated Eligibility Redesign System (TIERS).
To be financially eligible for the STAR+PLUS HCBS program, refer to the mandatory population described in Section 3221, STAR+PLUS Mandatory Groups.
An applicant who receives Supplemental Security Income (SSI) is financially eligible for Medicaid and does not require a financial determination; the Social Security Administration (SSA) has already made this determination.
An applicant receiving services through Community Attendant Services (CAS) (TP14) is not automatically eligible for the STAR+PLUS HCBS program.
MEPD specialists must be consulted for these applicants. Applicants who currently have Form H1200, Application for Assistance – Your Texas Benefits, on file with the Texas Health and Human Services Commission (HHSC) may not need to complete a new Form H1200.
3115 Applicants Without Medicaid Eligibility
Revision 22-3; Effective Sept. 27, 2022
Title 42 Code of Federal Regulations (CFR) Section 431.10, specifies that Medicaid eligibility must be determined by a single state agency. The Texas state plan designates the Texas Health and Human Services Commission (HHSC) as the sole agency with the authority to make eligibility determinations for medical assistance only (MAO) Medicaid cases. The Medicaid for the Elderly and People with Disabilities (MEPD) specialist exclusively determines MAO Medicaid financial eligibility for STAR+PLUS Home and Community Based Services (HCBS) program applicants and members. An individual, applicant or member who does not receive Supplemental Security Income (SSI) may apply for MAO Medicaid.
The individual, applicant or member applies for MAO Medicaid by completing and submitting Form H1200, Application for Assistance – Your Texas Benefits, to the enrollment broker, Program Support Unit (PSU) staff or the MEPD specialist. PSU staff must fax Form H1200 and Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist within two business days of an applicant or member submitting Form H1200 to PSU staff.
3116 Monthly Income Below the SSI Standard Payment
Revision 18-0; Effective September 4, 2018
An applicant in the community (with no ineligible spouse) who has income less than the Supplemental Security Income (SSI) federal benefit rate (FBR) must apply for SSI through the Social Security Administration (SSA). The Texas Health and Human Services Commission (HHSC) cannot determine financial eligibility for these individuals except for cases in which the SSI application for disability has been pending more than 90 days and a decision is made by HHSC Disability Determination Unit (DDU) staff.
If there is a question whether the applicant should apply for SSI or medical assistance only (MAO), Program Support Unit (PSU) staff may consult the regional Medicaid for the Elderly and People with Disabilities (MEPD) specialist.
3117 Coordination with the MEPD Specialist
Revision 18-0; Effective September 4, 2018
The Program Support Unit (PSU) staff must inform the applicant or member without pre-existing Medicaid coverage and/or his or her authorized representative (AR) that the Medicaid for the Elderly and People with Disabilities (MEPD) specialist will complete a financial eligibility (Medicaid) determination. PSU staff must encourage the applicant, member or AR to cooperate with the MEPD specialist and to provide all verifications necessary in a timely fashion.
Any information, including information on third-party insurance, obtained by PSU staff must be shared with the MEPD specialist to prevent the applicant or member from having to provide the information twice.
PSU staff must inform the MEPD specialist of the request for the STAR+PLUS Home and Community Based Services (HCBS) program according to regional procedures. For those applicants or members already on an appropriate type of Medicaid program, PSU staff must fax:
- Form H1200, Application for Assistance – Your Texas Benefits; and
- Form H1746-A, MEPD Referral Cover Sheet.
An applicant for the STAR+PLUS HCBS program who has medical assistance only (MAO) coverage type Medicaid services may only receive the STAR+PLUS HCBS program after a program transfer to Medicaid waivers is completed by the MEPD specialist. When an applicant or member for the STAR+PLUS HCBS program has MAO coverage type, as indicated in the Texas Integrated Eligibility Redesign System (TIERS), a completed Form H1200 must be sent to the applicant or member. The completed application must be forwarded to the MEPD specialist for processing.
PSU staff must also send an email to MEPD at the HHSC OES MEPD IC mailbox that includes the following information:
- the applicant’s or member’s name;
- applicant’s or member’s Medicaid identification (ID) number;
- individual has MAO coverage-type Medicaid, which will require a program transfer; and
- name and telephone number of the PSU staff contact.
The MEPD specialist will make the necessary changes to allow the MAO coverage-type Medicaid individual to receive the STAR+PLUS HCBS program.
ID of MAO Coverage-Type Medicaid
PSU staff can check TIERS to determine an applicant’s or member’s coverage type. In TIERS, the coverage type on the Search/Summary screen is displayed with the preface of MAO.
Form H1200 is not required for members receiving Supplemental Security Income (SSI).
Note: If a STAR+PLUS HCBS program applicant's or member's application for SSI disability has been pending more than 90 days, the Texas Health and Human Services Commission (HHSC) Disability Determination Unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination. The SSI decision must be adopted when it is received from SSA.
3117.1 Income and Resource Verifications for MEPD
Revision 25-2; Effective June 6, 2025
PSU staff must inform the MEPD specialist of the request for the STAR+PLUS Home and Community Based Services (HCBS) program by faxing:
- Form H1746-A, noting if:
- the applicant is pending a Medical Necessity and Level of Care (MN/LOC) Assessment and individual service plan (ISP); or
- the applicant has an approved MN/LOC and ISP;
- Form H1200, if received; and
- any supporting documents, if received.
Texas Health and Human Services Commission (HHSC) Disability Determination unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination, if a STAR+PLUS HCBS applicant’s application for SSI disability has been pending for more than 90 days. The SSI decision must be adopted upon receipt from SSA.
PSU staff must send a second Form H1746-A noting the applicant’s start of care (SOC) for the STAR+PLUS HCBS program if the applicant’s MN/LOC and ISP were pending when the initial Form H1746-A was sent to the MEPD specialist.
3117.2 Reserved for Future Use
Revision 24-4; Effective Dec. 1, 2024
3117.3 Unsigned Applications
Revision 18-0; Effective September 4, 2018
Unsigned applications received by the Medicaid for the Elderly and People with Disabilities (MEPD) specialist are returned to the sender. Program Support Unit (PSU) staff must ensure applications are signed prior to referring to the MEPD specialist; if not, PSU staff are required to obtain signatures when unsigned applications are returned.
The application forms are:
- Form H1200, Application for Assistance – Your Texas Benefits; and
- Form H1200-A, Medical Assistance Only (MAO) Recertification.
If the MEPD specialist receives an unsigned application from HHSC with Form H1746-A, MEPD Referral Cover Sheet, the MEPD specialist returns the application to PSU staff with an annotation on the cover form (Form H1746-A) that the application is unsigned and must be signed before PSU staff can establish a file date. Once PSU staff receive an unsigned application from the MEPD specialist, it is the responsibility of PSU staff to coordinate with the applicant or member to obtain a signed application and return it to the MEPD specialist for processing.
Sending unsigned applications delays the MEPD and HHSC eligibility processes and could adversely affect service delivery to applicants or members.
3117.4 Medicaid Eligibility Decisions Pending Past the Program Due Date
Revision 18-0; Effective September 4, 2018
For most Medicaid for the Elderly and People with Disabilities (MEPD) applications, eligibility decisions are due by the 45th day. However, applications for individuals under the age of 65 may require a 90-day time frame to allow the agency to obtain a disability determination. This applies when the person's age is less than 65 and the person does not receive Retirement, Survivors and Disability Insurance (RSDI), Supplemental Security Income (SSI) or Railroad Retirement (RR). A disability determination by the Texas Health and Human Services Commission (HHSC) is required even if the person has received a Medical Necessity and Level of Care (MN/LOC) Assessment determination under the STAR+PLUS Home and Community Based Services (HCBS) program eligibility component criteria.
For other case actions (for example, program transfers) the MEPD specialist may require time to verify income and resources. This is especially true if the previous case was community-based or included an individual declaration of income or resources. Program Support Unit (PSU) staff will email MEPD at the HHSC OES MEPD IC mailbox, requesting a status update, if the case has been pending more than 45 days.
3117.5 Inquires and Complaints
Revision 18-0; Effective September 4, 2018
Program Support Unit (PSU) staff can direct other general inquiries and complaints regarding Medicaid for the Elderly and People with Disabilities (MEPD) applications and programs to the HHSC OES MEPD IC mailbox.
3118 Address Changes for Supplemental Security Income Individuals
Revision 25-2; Effective June 6, 2025
Program Support Unit (PSU) staff must not send address change requests for Supplemental Security Income (SSI) individuals to the Document Processing Center (DPC). PSU staff must inform the individual or authorized representative (AR) to contact the Social Security Administration (SSA) to request the residence address change. The address change will be reflected in the Texas Integrated Eligibility Redesign System (TIERS) after SSA makes the change.