B-7100, SSI Applications

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Revision 11-1; Effective March 1, 2011  

The Social Security Administration (SSA) determines Medicaid eligibility for all persons who apply for SSI cash benefits. When SSA makes a determination on an application for SSI cash benefits (either approved or denied), HHSC is notified by means of the SSA/State Data Exchange System (SDX).

SSA is responsible for redetermination of SSI Medicaid eligibility. See section H-6000, Co-Payment for SSI Cases, for other special handling of SSI eligible individuals.

B-7110 Medicaid Coverage After SSI Termination  

Revision 25-3; Effective Sept. 1, 2025

Medicaid recipients who stop meeting the eligibility requirements for Supplemental Security Income (SSI) benefits may still be eligible for Medicaid under another eligibility group. Explore eligibility for all other medical programs before ending SSI Medicaid.

Modified Administrative Renewal Process

The system initiates a modified administrative redetermination process before ending Medicaid when notified of an SSI denial. The modified redetermination process uses information from the existing case record and electronic data sources (ELDS) to determine if the person is eligible for any other type of Medicaid benefits. The SSI Medicaid Eligibility Determination Group (EDG) is maintained during the redetermination process.

The Texas Integrated Eligibility Redesign System (TIERS) requests ELDS information on the eighth of the month after the loss of SSI eligibility. The system runs eligibility to test for all non-SSI Medicaid programs, including the Medicare Savings Programs (MSPs) on the third of the next month.

The case is auto-disposed, and TIERS generates a TF0001, Notice of Case Action, if enough information is available to verify all eligibility criteria for another type of Medicaid. The person does not need to submit other information, and no staff action is required.

An eligibility packet is automatically generated and must be completed and returned within 30 days if:

  • the system is unable to determine ongoing eligibility based on existing information and available ELDS information; or
  • the person is only eligible for a lesser Medicaid or MSP.

Note: Eligibility for Medicaid and MSP is determined separately. For example, if eligibility for ME-Waivers is approved but eligibility for MC-QMB is pending, the approved ME-Waivers EDG is disposed. An eligibility packet is generated for the MC-QMB EDG.

If the person might be eligible for an MEPD or MSP program, the packet includes the following forms:

If the person might be eligible for a Texas Works (TW) Medicaid program or the Children's Health Insurance Program (CHIP), the packet includes the following forms:

If the person returns an eligibility form before the 31st day, process the case and explore eligibility for all Medicaid programs, including MSP. Maintain SSI and any SSI-associated QMB coverage until processing is complete.

If the person does not return the eligibility form on or before the 30th day, the maintained SSI EDG and any SSI-associated QMB EDGs are automatically terminated, and a Form TF0001 is generated.

Adults Receiving Waiver Services

If the person was receiving waiver services before the loss of SSI eligibility, a new Form H1746-A, MEPD Referral Cover Sheet, is not needed to explore ongoing waiver eligibility. If it is indicated that the person was receiving waiver services, verify ongoing enrollment. Use the chart below to send an email to the appropriate mailbox based on the type of waiver program in the Long-Term Services and Support (LTSS) Summary screen.

The subject line of the email must be: SSI Termination: Client Initials -XXX where XXX is the last 3 digits of the person’s Medicaid ID number. Example: SSI Termination: JG-123

Waiver ProgramEmail
  • STAR+PLUS Waiver (SPW)
  • Medically Dependent Children Program (MDCP)
HHSC Managed Care Program Support

Community Living Assistance and Support Services (CLASS)

Home and Community-based Services (HCS)

Texas Home Living (TxHML)

HHSC IDD-Program Eligibility and Support
Deaf Blind with Multiple Disabilities (DBMD)Patrick Koch and Casey Zwerneman
Youth Empowerment Services (YES)HHSC Yes Waiver

Include the following information in the body of the email:

        • Full name of recipient

        • Full Medicaid ID number

        • Full Social Security number

        • The following statement: This person’s SSI benefits have been terminated. Case history indicates this person was previously receiving [insert name of Waiver program] services. Please confirm current Waiver enrollment status.

Suspend the case pending a response. Document the program response in case comments and take appropriate action to complete the case when a response is received.

Children Receiving Waiver Services

Determine ongoing eligibility for ME-Waiver Medicaid if a Form H1200 is received by the 30th day. If eligible, ME-Waiver Medicaid remains active through the end of the month the child turns 18.

  • Applications submitted by the child, or their parent or authorized representative do not need an associated Form H1746-A.
  • Applications submitted by program providers, including managed care organizations (MCOs), local intellectual and developmental disability authorities (LIDDAs) and local authorities (LAs), on behalf of a child must include an associated Form H1746-A.

If SSA reinstates SSI benefits while the child is active under ME-Waiver Medicaid, SSI Medicaid is suppressed, and ME-Waiver Medicaid remains active. This avoids future gaps in coverage.

If SSI benefits are active when the child turns 18, ME-Waiver Medicaid ends. The system automatically reinstates SSI Medicaid.

If SSI benefits are not active when the child turns 18, ME-Waiver Medicaid remains active and follows the regular renewal process.

Related Policy

Supplemental Security Income (SSI), A-2100
Disabled Adult Children (DAC), A-2310
Pickle, A-2330
Widow(er)s, A-2340
SSI Applications, B-7100
SSI Cash Benefits Denied Due to Entry into a Medicaid Facility, B-7200
When Deeming Procedures Are Not Used, E-7200

B-7120 Pregnancy and 12-Month Postpartum Coverage After SSI Denial

Revision 24-4; Effective Dec. 1, 2024

Pregnant and postpartum women will automatically transition to Medicaid for Pregnant Women (TP 40) for the remainder of their pregnancy and the 12-month postpartum period if:

  • they received Supplemental Security Income (SSI) Medicaid while pregnant; and
  • lose ongoing eligibility for SSI.

A new TP 40 EDG is created without an application for pregnancy Medicaid. A full redetermination of eligibility must occur at the end of the TP 40 certification period.

Continuous Medicaid and CHIP coverage is provided through the pregnancy and the 12-month postpartum period regardless of any change in circumstance unless the woman:

  • voluntarily withdraws;
  • moves out of state;
  • dies; or
  • is ineligible due to agency error, fraud, abuse or perjury attributed to the person.

Unverified Pregnancy

When a recipient loses SSI eligibility, and pregnancy information is received through an interface, the woman is automatically certified for TP 40 with postponed verification. Form H1020, Request for Information or Action is sent. If verification is provided, the woman is eligible for TP 40 coverage through her pregnancy and postpartum period. If verification is not provided, or shows the woman does not meet eligibility requirements, TP 40 coverage is terminated unless the woman is under 19.

Related Policy

Supplemental Security Income (SSI), A-2100
Disabled Adult Children (DAC), A-2310
Pickle, A-2330
Widow(er)s, A-2340
SSI Applications, B-7100
Extending Postpartum Coverage After MEPD Termination, B-9400
When Deeming Procedures Are Not Used, E-7200