Under the old system, a caseworker was assigned to each Texas Medicaid application and if there was an error or omission with the application the caseworker was expected to communicate directly with the applicant to resolve the issue if possible.

This new system may entirely eliminate communication between the HHSC caseworker and the Medicaid applicant to resolve any mistakes with the original Medicaid application. Under TIERS, if the caseworker cannot grant Medicaid eligibility on the face of the application as he or she receives it, then the caseworker now has the discretion to deny the application. It would not surprise me to see many caseworkers exercise this option to reduce their ever growing list of files.

If This Has Happened To You

Do not give up if your Medicaid application has been denied. You have three options at this point which you should consider carefully. You can: 1) do nothing and somehow find a way to pay the nursing home bill every month without Texas Medicaid; or 2) file an appeal with an experienced Texas Medicaid Attorney if it seems the caseworker’s decision was based on a mistake of fact or law; or 3) make the required adjustments to establish Medicaid eligibility with a new application.

Remember, every mistake that creates ineligibility results in another month or more of nursing home costs (which average $4,347.15 every month) that Medicaid will not pay so I always recommend getting it done right the first time.

If you would like more information on Texas Medicaid, including how to pay for the nursing home without going broke and losing everything, contact us at 832-592-7913.

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