Introduction

Assistance is available to help pay for medical care and supportive services for people with limited income and resources. The following information explains some of the requirements used to determine if you are eligible for help and what must be done to get help.

If you are interested in getting Medicaid to pay for medical and supportive services, you need to file an application. Depending on your income, you will file an application with either the Social Security Administration for Supplemental Security Income (SSI) or with the Texas Health and Human Services Commission (HHSC). If the Social Security Administration determines you are eligible for SSI, you will also be eligible for Medicaid without having to file a separate application with HHSC.

At HHSC, eligibility staff are responsible for determining the financial eligibility for Medicaid. This Medicaid assistance is available for those who do not have SSI and need care:

in a nursing facility;

in an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID);

in an institution for mental diseases (IMD); or

through a home and community-based waiver program (these programs offer services and supports to help you live in the community).

Depending on your income, assistance is also available to help pay for your Medicare premiums (Part A, Part B or both), deductibles and coinsurance costs through a Medicare Savings Programs, Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) or Qualifying Individuals-1 (QI-1).

You or your representative must complete an application for Medicaid and furnish the proof needed to make an eligibility determination. HHSC will determine your eligibility for Medicaid based on the information you provide on the application, documents you send in, and information that you orally explain.

By federal law, HHSC must also use your Social Security number to compare information with other state and federal agencies, such as the Internal Revenue Service, Social Security Administration, Texas Workforce Commission, and any others to ensure that your benefits are correctly determined. If you meet all eligibility requirements, HHSC is required to completely review your circumstances at least once a year to make sure you are still eligible for help.

You have the responsibility to let HHSC know, within 10 days, of any changes in your circumstances, including changes in your address and living arrangements, your income and resources, and your private health insurance premium amounts.