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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.2 Client Limited Program : 4.4.2.5 Duration of Limited Status

4.4.2.5
The Limited Program duration of limited status is the following:
Clients arrested, indicted, convicted of, or admits to a crime related to Medicaid fraud will be assigned limited status for 60 months or the duration of eligibility and subsequent periods of eligibility up to or equal to 60 months.
HHSC uses the same time frames for clients with a Limited Status as noted on the Your Texas Benefits Medicaid card website at www.YourTexasBenefitsCard.com.
Clients are removed from limited status at the end of the specified limitation period if their use of medical services no longer meets the criteria for limited status. A medical review also may be initiated at the client’s or provider’s request. Clients or providers can reach the Limited Program by calling the HHSC OIG Hotline at 1‑800‑436‑6184 to request this review.
Providers may request to no longer serve as a client’s designated provider at any time during the limited period by contacting the Limited Program by calling the HHSC OIG Hotline at 1-800-436-6184. Providers are asked to serve or refer the client until another arrangement is made. New arrangements are made as quickly as possible.

Texas Medicaid & Healthcare Partnership
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