TMPPM 2009 > Provider Information > Client Eligibility > Medically Needy Program (MNP)

4.5 Medically Needy Program (MNP)

The MNP with spend down is limited to children 18 years of age or younger and pregnant women.

The MNP provides Medicaid benefits to children (18 years of age or younger) and pregnant women whose income exceeds the eligibility limits under Temporary Assistance for Needy Families (TANF) or one of the Medical Assistance Only (MAO) programs for children but is not enough to meet their medical expenses. Coverage is available for services within the amount, duration, and scope of Texas Medicaid. Individuals are considered adults beginning the month following their 19th birthday.

Medicaid benefits, including family planning and THSteps preventive services through the MNP, are available to:

•Pregnant teens (18 years of age or younger) and women.

•Children 18 years of age or younger.

MNP provides access to Medicaid benefits. MNP application are made through HHSC. HHSC determines:

•If the applicant meets basic Medicaid eligibility requirements.

•If the applicant is eligible without spend down (the difference between the applicant's net income and the MNP income limits). If the applicant is over the Medicaid limit, the spend down amount is determined based on the MNP income limit.

If the applicant is eligible without spend down (income is below the medically needy income limits), the caseworker certifies the applicant as eligible for Medicaid.

If spend down is applicable, HHSC issues a Medical Bills Transmittal (Form H1120) to the MNP applicant that indicates the spend down amount, months of potential coverage (limited to the month of application and any of the three months before the application month that the applicant has unpaid medical bills), and HHSC contact information.

The applicant is responsible for paying the spend down portion of the medical bills. The TMHP Medically Needy Clearinghouse (MNC) determines which bills may be applied to the applicant's spend down according to state and federal guidelines. No Medicaid coverage may be granted until the spend down is met.

Newborns of mothers who must meet a spend down before becoming eligible for Medicaid are not automatically eligible for the full year of newborn coverage because the child's mother would not be continuously eligible for Medicaid. If the mother meets spend down in the month pregnancy terminates and the Medicaid effective date is before or on the day pregnancy terminates, then the newborn and mother are eligible for the birth month and the two following months. Hospitals and other providers that complete newborn reporting forms should continue to follow the procedures in "Eligibility Process" for these newborns.