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The chart indicates the type program (TP) or type assistance (TA) a person may be receiving in Texas Integrated Eligibility Redesign System (TIERS), and how existing coverage affects eligibility for Community Care Services Eligibility (CCSE) services.
1. Individuals with this Medicaid eligibility through a 1915(c) waiver are eligible for Community First Choice (CFC). Individuals with this Medicaid eligibility through STAR+PLUS Home and Community Based Services (HCBS) program are not eligible for CFC due to federal rules.
The following websites contain helpful information on Texas Medicaid and other state and federal programs: Texas Medicaid & Healthcare Partnership: www.tmhp.com
The Children’s Health Insurance Program (CHIP) is health care coverage for children under 19 who are ineligible for Medicaid due to income and who have income at or below the applicable income limit
The Texas Medicaid Provider Procedures Manual was updated on September 30, 2024, and contains all policy changes through October 1, 2024. The manual is available in both PDF and HTML formats. Claim form examples referenced in the manual can be found on the claim form examples page.
Providers can view Medicaid Eligibility and Service Authorization Verifications (MESAVs) electronically using TexMedConnect . To prevent claim denials, it is necessary to verify a person’s eligibility for Medicaid
This easy-to-use chart shows what services are provided by the various Texas Medicaid waiver programs, which includes STAR+PLUS, CLASS, HCS, DBMD, TxHML, MDCP, and YES. Download the Texas Medicaid Waiver Comparison Chart.
For current eligibility status, please enter 2 of the following 4 data elements for the Client: Patient Control Number. Date of Birth. Social Security Number. Last Name. First Name is an optional field. Any data elements that are populated will be used to determine the client's eligibility. Quick Eligibility Check Guide.
Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL).
Texas Medicaid is always evolving. In response to the COVID-19 public health emergency (PHE), we extended significant flexibilities to ensure continuity of care for our recipients.