B-7400, Application for Institutional Care

Revision 12-3; Effective September 1, 2012

HHSC is responsible for processing Medicaid applications for certain residents of Medicaid facilities (Medicare SNF , NF , ICF/IID and institutions for mental diseases (IMD)). To qualify for medical assistance for institutional care, a person must:

meet the 30-consecutive-day stay requirement (for verification and documentation requirements, see Appendix XVI , Documentation and Verification Guide);

meet financial criteria; and

have an approved level of care or medical necessity determination.

Reference: Section B-6300 , Institutional Living Arrangement.

HHSC processes:

initial applications from persons whose income is equal to or in excess of the reduced SSI federal benefit rate; and

reapplications for Medicaid from persons who will be or have been denied SSI on the basis of excess income because the SSI federal benefit rate has been reduced after entry into a Medicaid facility.