June 7th, 2024

Individual Assigned Wrong Medicaid Type Code During The Renewal/Reinstatement Process


it has been brought to my attention that some of Individuals in our IDD waiver programs have sometimes been renewed/reinstated with the wrong type code for Medicaid, which then takes them out of the HCS or TxHmL waiver.  This also means the provider can’t bill.

For many of our individuals, R14 or 14 is the appropriate code for “waiver”.

Some providers have mentioned that their individuals have been assigned the wrong codes beginning with “Q” or “W” for example.   I am not sure what those stand for.  I believe “Q” is related to Medicare, not persons in Medicaid.  Some of our individuals do have both Medicaid & Medicare, but they must have Medicaid to be eligible for the HCS/TxHmL waiver programs.

There is a form that the local authority can fill out to correct this issue. 

The form that the LIDDA completes for Medicaid reinstatement is the MEPD form H1746-A
https://www.hhs.texas.gov/regulations/forms/1000-1999/form-h1746-a-mepd-referral-cover-sheet    The form is called the Medicaid for the Elderly and People with Disabilities (MEPD)
Referral Cover Sheet

Contact information: 

Email for Medicaid Eligibility Issues:  OESMEPDIC@hhsc.state.tx.us

Helpful Tips:

**If you would like to check if your individual has the appropriate Medicaid code, you can go to their Medicaid Hx (history) which you can find on your TMHP dashboard.  

**Call the IDD Ombudsman (800-252-8154) if you are having issues with Medicaid responding at all or if they are not helping or responding in a timely fashion.  The IDD Ombudsman can cite them for this.  Some providers have reported that Medicaid contacted them and resolved their issues immediately.

** Contact your local representative or legislator for help

** Also, be aware that If the client changed Social Security types (SSDI to SSI for example)  this may have caused the issue. Or if the individual changed the type of SS during COVID-19, then it may have kicked them off of the right Medicaid or Medicaid period.

**For all other issues in general for not getting renewed /reinstated to Medicaid Eligibility for your individuals with IDD in our provider programs:

  • Individuals may lose coverage because the state incorrectly denied for many reasons. To get these cases corrected, please escalate them through the Office of the Ombudsman. as I stated before, If the case still can’t get corrected, families have the right to a fair hearing.
  • If you are denied Medicaid because they didn’t submit their renewal or needed information, you have a 90-day window to send the renewal or missing information after losing coverage. Unfortunately, the renewal link on YourTexasBenefits.com is currently not active during the 90-day reconsideration period. To submit information to complete a renewal after a denial, you can submit during this time period by calling 2-1-1 Option 2 or completing a paper application and either faxing, mailing, or bringing it into a local HHSC office.