C-1100, Responsibility of Applying

Revision 10-2; Effective June 1, 2010

Federal law requires that anyone who wishes to apply for Medicaid be allowed to file an application, regardless of the person's ultimate eligibility for services. See Chapter B , Applications and Redeterminations, for more information.

In addition to meeting other requirements, a person must file an application to become eligible to receive benefits. An authorized representative may accompany, assist and represent an applicant or recipient in the application or eligibility redetermination process.

Someone who is Supplemental Security Income (SSI) eligible automatically receives Medicaid and does not have to file a separate application unless coverage for unpaid or reimbursable bills during prior months to the SSI application is requested. See Section A-4300 , Retroactive Coverage.

To apply for an MEPD program, an application for assistance must be received that is:

HHSC approved for MEPD Medicaid,

completed according to HHSC instructions, and

signed and dated under penalty of perjury by the applicant and/or authorized representative or someone acting responsibly for the applicant (if the applicant is incompetent or incapacitated).

An applicant or authorized representative must also provide all requested information according to HHSC instructions. See Section C-8000 , Responsibility to Provide Information and Report Changes.

If someone helps an applicant or authorized representative complete the application for assistance, the name of the person completing the form must appear as requested on the application.

Filing an application will:

permit HHSC to make a formal determination whether or not a person is eligible to receive Medicaid; and

give a person the right to appeal if there is a disagreement with the determination.