County Indigent Health Care Program (CIHCP) - Frequently Asked Questions

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General Questions 

  1. What is the County Indigent Health Care Program (CIHCP)?
  2. What types of medical bills are covered by the CIHCP?
  3. Where do I apply for assistance?
  4. What are the eligibility requirements?
  5. Can I be on Medicaid and the CIHCP at the same time?
  6. My CIHCP application has been denied and I disagree with the decision, what are my options?

County Staff Questions  

  1. How do I determine an applicant's Eligibility Effective Date for the CIHCP?
  2. It's my understanding that at least every six months, a county shall review the eligibility of their CIHCP clients.  But which date is used to calculate the six month period?
  3. I am a CIHCP eligibility worker and I'd like to know if there is a way to determine which other programs applicants may be eligible for?
  4. May our county require a person to live in the county for a set duration of time in order to meet CIHCP residency criteria?
  5. May our county make it a requirement that applicants provide a valid photo ID as part of the eligibility process?
  6. What are the requirements of a "common-law" marriage in Texas?  Does the CIHCP recognize "common-law" marriages?
  7. How is the SSI income of a spouse counted when they live with a CIHCP applicant?
  8. A CIHCP applicant lives with his spouse who receives social security income and Medicare parts A and B. Is this counted as unearned income for the applicant?
  9. How do we determine the countable value of a CIHCP applicant's vehicle?
  10. A CIHCP applicant is a joint-owner of a vehicle and they do not live with the other joint-owner of the vehicle, is the car counted as a resource?
  11. If an applicant gets married but has not reported the change, is the applicant now ineligible due to failure to report a change?
  12. If an applicant is pregnant and has children, does being pregnant make her ineligible for the CIHCP?
  13. For CIHCP eligibility must a 62 year old applicant, with a work history, be required to apply for social security retirement benefits?
  14. If a CIHCP applicant applies for SSI, TANF, or Medicaid benefits, must I pend their CIHCP application until a decision is made on their Medicaid application?
  15. A CIHCP applicant claims his adult child on his tax return as a dependent, does this makes them a two person CIHCP household?
  16. If a CIHCP applicant deposits their earnings into a checking account, is the money counted as a resource or income?
  17. A CIHCP applicant receives child support payments for four of her children but two of the children receive Medicaid.  How do I determine the household and income?
  18. A CIHCP applicant states he lost his job 3 weeks ago and is now supported by his mother.  What type of verification should I request?

Claim Questions

  1. How do I determine which fiscal year to apply the maximum county liability of $30,000, if the date of service and claim paid date are in different fiscal years?
  2. If a CIHCP client received $30,000 in heath care services in one county and within the same state fiscal year, the CIHCP client moved to a different county, are they still eligible to receive the full maximum county liability from the current county in which they live?
  3. Can a CIHCP client have a prescription filled for more than a 30-day supply?
  4. May a county limit its CIHCP clients to generic medications, when generic form is available?
  5. Which claim form is a provider required to submit to receive payment for CIHCP services?
  6. Is a provider's signature required on the UB 04 claim forms they submit to the county for CIHCP services?
  7. If an insurance company or Crime Victims Compensation only pays a partial amount of a CIHCP claim, is the county responsible for paying the remainder of the claim?
  8. Are payments for insurance deductibles or co-pays on behalf of CIHCP applicants eligible toward State Assistance?  

General Questions 

Question:
What is the County Indigent Health Care Program (CIHCP)?

Answer:
The County Indigent Heath Care Program is a health care program that is administered locally by the counties, hospital districts and public hospitals to provide health care services to eligible residents in Texas.

Question:
What types of medical bills are covered by the CIHCP?

Answer:
The CIHCP pays for basic health care services such as annual physical examines, laboratory, x-ray, and inpatient/outpatient hospital services. And optional health care services such as home and community health care services, diabetic and colostomy supplies and equipment. A complete list of services is located on the DSHS CIHCP website at www.dshs.state.tx.us/cihcp

Question:
Where do I apply for assistance?

Answer:
You may
contact the County Administrative office, public hospital, or hospital district located in your county of residence.  This information is also available at www.dshs.state.tx.us/cihcp.

Question:
What are the eligibility requirements?

Answer:
CIHCP eligibility is based on four criteria; residence, income, household, and resources. For additional information you may contact your local CIHCP office or the CIHCP website at www.dshs.state.tx.us/cihcp

Question:
Can I be on Medicaid and the CIHCP at the same time?

Answer:
Any person who is on Medicaid or who is categorically eligible to receive Medicaid is ineligible for the CIHCP. Chapter 61, 61.006 (e). Excluding non-comprehensive Medicaid programs such as Women's Health Program and Emergency Medicaid.

Question:
My CIHCP application has been denied and I disagree with the decision, what are my options?

Answer:
You have the right to contact the county office that denied your application and appeal your denial for assistance. Chapter 61, 61.024 (i).

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County Staff Questions 

Question:
How do I determine an applicant's Eligibility Effective Date for the CIHCP?

Answer:
Current eligibility begins on the first calendar day in the month that an identifiable application is filed or the earliest, subsequent month in which an applicant meets all eligibility criteria.

Question:
It's my understanding that at least every six months, a county shall review the eligibility of their CIHCP clients.  But which date is used to calculate the six month period?

Answer:
The six months begins with the actual date the county staff determines a client is eligible for the CIHCP. 

Example:
Applicant's CIHCP Form 100 Identifiable Date is 04/07/08.

County staff receives all requested documentation from client on 05/16/08.

On 05/16/08 county approves client with an Eligibility Effective Date of 04/01/08.

Six month review must take place by 11/30/08.

Question:
I am a CIHCP eligibility worker and I'd like to know if there is a way to determine which other programs applicants may be eligible for?

Answer:
"Your Texas Benefits"; and the "Benefit Eligibility Screening Tool"; (BEST) are programs that screen for potential eligibility for Medicaid, other Texas agency programs, and Social Security administered benefit programs. Their websites are www.yourtexasbenefits.com and https://secure.ssa.gov/apps7/best/benefits/

Question:
May our county require a person to live in the county for a set duration of time in order to meet CIHCP residency criteria?

Answer:
There are no durational requirements for residency. CIHCP Rule, 14.102 (c).

Question:
May our county make it a requirement that applicants provide a valid photo ID as part of the eligibility process?

Answer:
A photo ID is one of several items that may be used to verify residency. CIHCP Handbook, Section 2, Page 1. Policies regarding application, documentation, or verification procedure should not be more restrictive than policies established by Department of State Health Services, Chapter 61, 61.024 (b).

Question:
What are the requirements of a "common-law" marriage in Texas?  Does the CIHCP recognize "common-law" marriages?

Answer:
Yes, the CIHCP recognizes common-law marriage, which is defined as a relationship in which the parties are 18 years or older, are free to marry, live together (no time requirement), and hold out to the public that they are husband and wife (includes receiving mail, filing taxes, or introductions as husband & wife).

Question:
How is the SSI income of a spouse counted when they live with a CIHCP applicant?

Answer:
Persons receiving SSI and/or benefits from Medicaid programs are "disqualified" from a CIHCP household, and therefore their income is not counted in the household. CIHCP Handbook, Section Two, Page 2.

Question:
A CIHCP applicant lives with his spouse who receives social security income and Medicare parts A and B. Is this counted as unearned income for the applicant?

Answer:
Yes. NOTE: Income of a person with Medicaid through QMB, MQMB, SLMB, or QDWI would be exempt. CIHCP Handbook, Section Two, Page 3.

Question:
How do we determine the countable value of a CIHCP applicant's vehicle?

Answer:
The vehicle's fair market value minus the amount still owed on it equals the equity value.  Count only the equity value that is in excess of $4,650.00. Chapter 61, 61.008 (2) and CIHCP Handbook, Section Two, Page 12.

Question:
A CIHCP applicant is a joint-owner of a vehicle and they do not live with the other joint-owner of the vehicle, is the car counted as a resource?

Answer:
No. Consider vehicles jointly-owned with another person not applying for or receiving benefits as inaccessible if the other owner is not willing to sell the vehicle. CIHCP Handbook, Section Two, Page 13.

Question:
If an applicant gets married but has not reported the change, is the applicant now ineligible due to failure to report a change?

Answer:
Only if the actual change now makes them ineligible. CIHCP applicants must report any change in income or resources that might affect their eligibility by the 14th day of the change. Chapter 61, 61.027. 

Question:
If an applicant is pregnant and has children, does being pregnant make her ineligible for the CIHCP?

Answer:
No. However, she may be eligible for a Medicaid program which could make her ineligible for the CIHCP. Chapter 61, 61.006 (e).

Question:
For CIHCP eligibility must a 62 year old applicant, with a work history, be required to apply for social security retirement benefits?

Answer:
This is potential income in which CIHCP households must pursue. CIHCP Rule 14.104 (c).

Question:
If a CIHCP applicant applies for SSI, TANF, or Medicaid benefits, must I pend their CIHCP application until a decision is made on their Medicaid application?

Answer:
Yes. If client is a SSI/Medicaid applicant, eligibility cannot be determined and the case should be pended until SSI/Medicaid decision. CIHCP Handbook, Section Three, Page 3.

Question:
A CIHCP applicant claims his adult child on his tax return as a dependent, does this makes them a two person CIHCP household?

Answer:
No. CIHCP Handbook, Section Two, Pages 2 - 4.

Question:
If a CIHCP applicant deposits their earnings into a checking account, is the money counted as a resource or income?

Answer:
If a payment or a benefit is counted as income for a particular month, do not count as a resource in the same month. If in the following months it exists as a countable fund, such as in a bank account, count it as a resource in each month it exists.

Question:
A CIHCP applicant receives child support payments for four of her children but two of the children receive Medicaid.  How do I determine the household and income?

Answer:
A person receiving Medicaid is a CIHCP disqualified person and all income of a disqualified person is exempt.
CIHCP Handbook Section Two, Page 3 addresses policy for determining household and Pages 15 & 17 addresses policies for determining income.

Question:
A CIHCP applicant states he lost his job 3 weeks ago and is now supported by his mother.  What type of verification should I request?

Answer:
Counties should obtain verification of terminated income from the client's employer.  The county may obtain verification of support in writing or by phone, in which case, they should document the call and the supporter's statement.

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Claim Questions 

Question:
How do I determine which fiscal year to apply the maximum county liability of $30,000, if the date of service and claim paid date are in different fiscal years?

Answer:
It is determined by the date of service.  The $30,000 should be applied to the fiscal year in which the service was provided.

Question:
If a CIHCP client received $30,000 in heath care services in one county and within the same state fiscal year, the CIHCP client moved to a different county, are they still eligible to receive the full maximum county liability from the current county in which they live?

Answer:
Yes.  The maximum county liability is per county for each state fiscal year. Please refer to Chapter 61, Section 61.035.

Question:
Can a CIHCP client have a prescription filled for more than a 30-day supply?

Answer:
Yes. As long as the quantity filled is in accordance with the prescribed quantity.

Question:
May a county limit its CIHCP clients to generic medications, when generic form is available?

Answer:
Counties may implement local policy regarding prescription drugs. Please refer to Chapter 61, Section 61.028 (7) which states "payment for not more than three prescription drugs a month."

Question:
Which claim form is a provider required to submit to receive payment for CIHCP services?

Answer:
Chapter 61 does not identify a specific form. However, if DSHS files Medicaid reimbursement on behalf of counties, the CMS 1500s & UB 04s are required.

Question:
Is a provider's signature required on the UB 04 claim forms they submit to the county for CIHCP services?

Answer:
Chapter 61 does not address specific claim forms. However, the backside of the UB-04 claim form states "Submission of this claim form constitutes certification that the billing information as shown on the face hereof is true, accurate and complete."

Question:
If an insurance company or Crime Victims Compensation only pays a partial amount of a CIHCP claim, is the county responsible for paying the remainder of the claim?

Answer:
Counties are not liable for more than the established payment rate.

Question:
Are payments for insurance deductibles or co-pays on behalf of CIHCP applicants eligible toward State Assistance?

Answer:
No.  However, if the county deems it cost-effective, the county could pay for the client's actual insurance and still receive State Assistance.          

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Last updated December 13, 2011