3100, Ancillary Member Resources

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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 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:

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 26-3; Effective Aug. 14, 2026

Program Support Unit (PSU) staff must inform the Medicaid for the Elderly and People with Disabilities (MEPD) specialist of the request for the STAR+PLUS Home and Community Based Services (HCBS) program by faxing:

PSU staff must fax Form H1746-A a second time and must note the applicant’s start of care (SOC) for the STAR+PLUS HCBS program. They do this if the applicant’s MN/LOC and ISP were pending when the initial Form H1746-A was sent to the MEPD specialist.

3117.2 Unsigned Medicaid Applications

Revision 26-3; Effective Aug. 14, 2026

The Medicaid application form for the STAR+PLUS Home and Community Based Services (HCBS) program is Form H1200, Application for Assistance – Your Texas Benefits. Program Support Unit (PSU) staff must make sure any application received for the STAR+PLUS HCBS program is signed before forwarding to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist. The MEPD specialist returns unsigned applications. 

3117.3 Medicaid Eligibility Decisions Pending Past the Program Due Date

Revision 26-3; Effective Aug. 14, 2026

The Medicaid for the Elderly and People with Disabilities (MEPD) specialist has 45 days to make a Medicaid eligibility determination for applicants over 65 years old. The MEPD specialist time frame is extended to 90 days for individuals under 65 who have not had a disability determination established by the Social Security Administration (SSA). 

A disability determination may be required when an applicant under 65 does not receive:

  • Retirement, Survivors and Disability Insurance (RSDI);
  • Supplemental Security Income (SSI); or
  • Railroad Retirement (RR). 

A disability determination may be required even when the applicant has an approved medical necessity (MN) determination for the STAR+PLUS Home and Community Based Services (HCBS) program. This includes approvals through the Medical Necessity and Level of Care (MN/LOC) Assessment and nursing facility (NF) minimum data set (MDS). 

Program Support Unit (PSU) staff must contact the HHSC OES MEPD IC mailbox if the MEPD time frame has expired.