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Eligibility and Billing – Confusing Concepts Explained!

October 30, 2015 by staff

Lisa Huggins, Billing Specialist at D&S Community Services

Lisa Huggins, Billing Specialist at D&S Community Services

My name is Lisa Huggins and I’m the Eligibility Manager at D&S Community Services. I thought I’d do a quick review of the most common issues we have with Social Security and Medicaid.  The most important thing I can suggest is to pay attention to the mail you receive from the Social Security Administration (SSA), Texas Health and Human Services Commission (HHSC), Department of Assistive and Rehabilitative Services (DARS) and Department of Aging and Disability Services (DADS).  Respond promptly and within the requested time frames, and ALWAYS keep a copy of what you send or the name, phone number and date of anyone with whom you speak.  These are big government agencies, and unfortunately things sometimes get lost.  Failure to provide requested information within the time frame can result in benefits being stopped.  But, whatever happens, don’t panic – if a deadline is missed, it can probably be appealed and fixed if done quickly.

If D&S is the representative payee for an individual in your home, please make sure you communicate closely with the Case Service Manager regarding any payment and benefit issues. We must report any changes in address, bank information, income (including wages from workshops), Foodstamps (SNAP) and possible benefits from a parent.  Many of our consumers may be eligible for Disabled Adult Child benefits if a consumer’s parent retires, becomes disabled, or passes away.   Often people are afraid of how these benefits may affect the consumer’s Medicaid, but there are almost always paths we can take to keep the Medicaid benefits going.

If D&S is not the payee, then this information needs to be communicated directly to SSA or the state agency by the payee. If the consumer is his/her own payee, then the process can be really overwhelming.  D&S can help as long as we know about the issue.

If you are new to either the ICF or HCS programs and are confused about funding sources or how these services are paid for, please don’t hesitate to call our office for more information!

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