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:

Form H1233P, Redetermination Notice, populated with the maintained EDG number or numbers

Form H1200, Application for Assistance – Your Texas Benefits

Notice H1296, Notice of SSI Medicaid Ending

Form H1020, Request for Information or Action , if TIERS cascaded to a pending EDG

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:

Form H1830P, TW Renewal Packet , populated with the maintained EDG number or numbers

Form H1010R, Your Texas Works Benefits - Renewal Form

Notice H1296, Notice of SSI Medicaid Ending

Form H1020, Request for Information or Action , if TIERS cascaded to a pending EDG

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.