Most likely you've heard of the 10 commandments, the 11th commandment is:

Never, ever file a Texas Medicaid application
until you are sure that you qualify
or it is strategically beneficial to be denied!

Don't let the nursing home take your retirement savings. Learn how.

You should submit a TX Medicaid application 90 days or more prior to the date that they believe the loved one will be eligible for benefits, given the current delays in the Medicaid approval process.

A Texas Medicaid application requires a mountain of paperwork, and is then submitted to an overwhelmed and sometime adverse government processing system, which makes filing an application for public benefits an enormous project.

Present the information in a way that it can be easily understood by Texas Medicaid officials. (Texas HHSC)

When applying for Medicaid or other public benefits, there are often many hidden potholes, obstacles, and dangerous curves in the road.

Different Types of Medicaid: STAR, STAR+PLUS, STAR Health, and traditional Medicaid

In Texas, there are 4 different types of Medicaid: STAR, STAR+PLUS, STAR Health, and traditional Medicaid. The type of Medicaid coverage a person gets depends on where the person lives in texas, and what kind of health issues the person has. STAR and STAR+PLUS have several medical plans that deliver Medicaid services.

General Information on Applying for Medicaid in TX

Medicaid Applications in Texas

The pile of paperwork required and sometimes inefficient government processing system can make filing an application for public benefits an enormous project. Although the federal government shares the cost of funding the Medicaid program with the State of Texas and requires the state government to uphold certain standards with respect to efficiency and the granting of Medicaid applications, it is not uncommon for a state or county office to fail to meet the federally imposed guidelines.

Therefore, when applying for Medicaid or other public benefits, it is crucial for applicants
to be well prepared and well versed in the implications of all information
to be supplied in support of the application.

Following is a sample list of Medicaid application issues which should be addressed to avoid unnecessary delays and denials.

1. Timeliness of Filing Your Texas Medicaid Application

It is important that applicants do not apply for Medicaid prematurely. Strategies for Medicaid planning often include triggering a penalty period for TX Medicaid eligibility purposes. While the time in which to wait to file an application may be more or less than five years, filing an application during a period of ineligibility could potentially cause a significant delay in the applicants eligibility approval status. It is, therefore, important to check with a qualified professional as to the date after which the application may be filed.

2. Authorization to Apply

In most cases, the applicant himself or herself is unable to visit the County social services office and offer detailed information on his/her financial status. The law, therefore, specifically provides that a relative, welfare agency staff member, staff member of the institution in which the applicant resides, or a professional may apply on the applicant's behalf. Because the Medicaid eligibility laws and policies are rapidly changing, subject to shifts in politics and lobbying by advocates for the elderly, applicants are well advised to retain individuals with comprehensive knowledge of the Medicaid eligibility rules and all strategies that may be legally employed to expedite eligibility.

3. Physical Criteria for Medicaid Eligibility

Qualifying for TX Medicaid involves not only financial criteria, but also physical requirements. Therefore, applicants must demonstrate through a physical exam that he or she is unable to perform the activities of daily living, including feeding, dressing, bathing, toileting and continence. If it cannot be shown to Medicaid that the care is medically necessary, the Medicaid application will be denied.

4. Substantiating the Data Needed for Approval of a Medicaid Application

The Medicaid application itself is several pages, and the answers to each question must be substantiated by legal or financial documentation. These supporting documents include: social security cards, Medicare cards, health insurance cards, birth certificates, marriage certificates, death certificates, life insurance policies, deeds, car registrations, household expense bills, funeral arrangement documents, pay or pension stubs, and financial statements typically dating back five years prior to the time the Medicaid application is filed.

Each Medicaid office in Texas has a computer program to verify social security numbers, employment history, or other personal information. Likewise, if any financial information is not disclosed to a county social service office, the office may deny the application based on information it periodically receives from the Internal Revenue Service. Intentional failure to disclose relevant financial data is considered Medicaid fraud. Even in cases where Medicaid eligibility has initially been granted, the county welfare office may revoke the approval upon receiving the IRS records.

5. Additional Documentation and County Verification for Medicaid Eligibility

The requirement that financial statements dating back five years prior to the filing of the application be submitted also varies from county to county. Depending on the circumstances, some counties have been known to request as little as forty-two (42) months of statements.

If you need help applying for benefits, call toll-free 2-1-1 (or 1-877-541-7905). Pick a language and then pick option 2. Staff can help you Monday to Friday, 8 a.m. to 6 p.m.

Your Texas Benefits Medicaid Card Questions and Answers

Questions and Answers for Stakeholders

Will you send me a new Your Texas Benefits Medicaid card each month?

No. The card we send you is your everyday Medicaid ID card. We will not send you another Your Texas Benefits Medicaid card unless a) your medical or dental plan changes or b) you ask us to send you a new card to replace one that’s been damaged, lost, or stolen.

Do I still have to renew my Medicaid?       

If you have been renewing your Medicaid coverage every 6 months, you will need to renew each time we send you a renewal application in the mail.

What if I lose my card? How can I order a Your Texas Benefits Medicaid card for me and my family?

If you are approved for Medicaid benefits, you can order a new card by phone or on the web.

Phone

Call toll-free 1-855-827-3748.

• Pick English or Spanish.
• Be ready to give your Medicaid ID number.

Web

Go to www.YourTexasBenefits.com and follow these steps:

• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.”
• Click the tab at the top that says, “Order or print Medicaid ID cards.”
• Find your name (or the name of the family member who needs a new card) and click the link in that same row that says “Order card.”

If I don’t have a Medicaid ID number, who do I call?

Call one of these toll-free numbers:

• 1-800-252-8263
• 2-1-1

After you pick either English or Spanish, pick option 2 – Learn more about the Your Texas Benefits Medicaid card and Medicaid benefits.

If you have Medicaid, the person you speak with can help you get a Medicaid ID number.

I’m not sure if I have Medicaid or not.  How can I find out?

You can find out if you have Medicaid by phone or web.

Phone

Call one of these toll-free numbers:

• 1-800-252-8263
• 2-1-1

After you pick either English or Spanish, pick option 2 – Learn more about the Your Texas Benefits Medicaid card and Medicaid benefits.

Web

Go to www.YourTexasBenefits.com. Follow these steps:

• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen. 
• Click “View services and health history.” 
• Click the “Program” tab at the top of the page. Here you will be able to see who in your family has Medicaid coverage. The page also shows your plan and program name.

How can I find out what Medicaid program I’m in?

You can find out your plan or program either by phone or on the web.

Phone

Call one of these toll-free numbers:

• 1-800-252-8263
• 2-1-1

After you pick either English or Spanish, pick option 2 – Learn more about the Your Texas Benefits Medicaid card and Medicaid benefits.

Web

Go to www.YourTexasBenefits.com. Follow these steps:

• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.”
• Click the “Program” tab at the top of the page. In this section you will be able to see who in your family has Medicaid coverage. The page also shows your plan and program name.

How will the doctor know which Medicaid program I’m in?

In most cases, the Your Texas Benefits Medicaid card shows the name of your Medicaid program in the upper right corner of the card. If your card does not show this, the doctor’s staff will use the magnetic stripe on the back of the card to see what Medicaid program you’re in.

How do I find my doctor’s name and phone number? It is not on the card. Same with my dentist. How do I get this information?

If you get your services through a Medicaid medical plan, you can get the name and phone number of your main doctor (primary care provider) by calling your plan. The plan name and phone number are printed on the front of your card. If you get Medicaid dental benefits, the name of your dental plan and the phone number also are on the front of the Your Texas Benefits Medicaid card. Call your dental plan to get the name and phone number of your main dentist.

You also can find your doctor’s name and phone number by calling a toll-free number or on www.YourTexasBenefits.com.

Phone

Call toll-free 1-800-964-2777 and follow the instructions.

If you get services through traditional Medicaid and need to find a Medicaid doctor, call the number on the back of the Your Texas Benefits Medicaid card – 1-800-252-8263 – or 2-1-1.  Both numbers are free to call.

Web

Go to www.YourTexasBenefits.com and follow these steps:

• From the home page click “View My Case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.” 
• Click the “Program” tab near the top of the page. Here you will find the name, phone number, and address for your main doctor (primary care provider). You also will be able to print a map and directions to your doctor’s office. 

Can I print my card from the Internet?

If your computer is connected to a printer, you can print a paper copy of the Your Texas Benefits Medicaid card for those who are listed on your case. Follow these steps:

• Go to www.YourTexasBenefits.com. 
• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.”
• Click the tab at the top that says, “Order or print Medicaid ID cards.”
• Under the column “Print copy of card” click the box in the row with the name of the person whose card you want to print. If there are several people listed you can print paper copies for each person.
• Click the “Print Selected Card” button. A new window will open with the image of the card.

From the “Order or print Medicaid ID cards” page you also can order cards for one or more of your family members that have Medicaid.   

Can I change my address and phone number on the website?

Yes.  Go to www.YourTexasBenefits.com and click on “View My Case.” From there you can log in and update facts about your case like your phone number and your address.

How do I know if my child is due for a Texas Health Steps checkup?

Texas Health Steps will send you a letter when your child is due for a medical or dental checkup.

You also can find out if your child is due for a Texas Health Steps checkup by going to YourTexasBenefits.com. Follow these steps:   

• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.” The page that appears will show a list of your children that are due for a medical or dental checkup. You can also print the list to keep with you or put up as a reminder on your refrigerator.      

How can I find a drug store that takes Medicaid?

You also can search for a Medicaid drug store on YourTexasBenefits.com. Follow these steps:

• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.” The page that appears will have a section called Helpful Links. These links will help you look for a Medicaid doctor or dentist or a drug store in your area that takes Medicaid. 

You also can call 2-1-1 or 1-800-252-8263 to get help finding a Medicaid drug store near your home.

What should I do if my address is wrong and I need a new card?

You can update your address by phone or on the web.

Phone

Call one of these toll-free numbers:

• 1-800-252-8263
• 2-1-1

After you pick either English or Spanish, pick option 2 – Learn more about the Your Texas Benefits Medicaid card and Medicaid benefits.

Web

Go to www.YourTexasBenefits.com and follow these steps:

• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Click on the “Case facts” link near the top of the page.
• Click on “Report a change to this case.”

It takes two days for us to update our system with your new address. Two days after you’ve updated your address, you can call 855-827-3748 to ask for a new Your Texas Benefits Medicaid card. Or, you can log back in to your YourTexasBenefits.com account and:

• Click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.”
• Click the tab at the top that says, “Order or print Medicaid ID cards.”
• Find your name (or the name of the family member who needs a new card) and click the link in that same row that says “Order card.”

How do you share facts about my health?  What should I do if do not want you to share facts about my health?

HHSC shares facts about your health with doctors and other approved Medicaid providers. They can see this information on a secure website. With these facts, doctors will better understand your health history, which should mean better care for you. 

If you do not want to share facts about your Medicaid health history with your doctors, then you can choose to “opt-out” or not share your health information. To let HHSC know if you want your health history shared or not shared, go to

YourTexasBenefits.com and follow these steps:   

• From the home page click “View my case.”
• Follow the steps for setting up an account or logging in.
• Once you’ve logged in, click the “Medicaid” tab in the upper right part of the screen.
• Click “View services and health history.”
• Click the tab at the top that says “Share My Health Information.”
• Find your name and click the “Share” or “Do not share” button in the “Share My Health Information” column.
• Click “Save” at the bottom of the page.

Or, you can call toll-free 1-877-518-0899 and follow the instructions. 

What does “opt-out” mean?

“Opt-out” means you have chosen not to share facts about your health with doctors or other approved Medicaid providers.

What else can I do on YourTexasBenefits.com?

You can:

• Fill out and submit an application.
• Check the status of your application or your case.
• See what special Medicaid services you can get.

What other information can I view on the website?

HHSC will continue to add access to new Medicaid case information to the website. In the future, HHSC will add to the website a history of your Medicaid doctor visits, prescription drug history, immunization history, and a health summary.

Your Texas Benefits Medicaid Card

The Your Texas Benefits Medicaid card is your Medicaid ID card. Take it with you whenever you go to the doctor, dentist, or drug store. Protect it the way you would your driver’s license or credit card. If you lost your card or it got damaged, you can order a new one by calling 1-855-827-3748. That’s a toll-free call.

To learn more about the Your Texas Benefits Medicaid card, look at the questions and answers we have posted.