Table of Contents Previous Next Index

2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.6 Medically Needy Program (MNP)

4.6 Medically Needy Program (MNP)
The MNP with spend down is limited to children 18 years of age and younger and pregnant women.
The MNP provides Medicaid benefits to children (18 years of age and 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:
MNP provides access to Medicaid benefits. Applications are made through HHSC. HHSC determines eligibility for the appropriate Medicaid program.
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. 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 subsection 3.2.4, “Newborn Care” in Inpatient and Outpatient Hospital Services Handbook (Vol. 2, Provider Handbooks) for these newborns.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.