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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.2 Client Lock-in Program : Duration of Lock-in Status
The Lock-in Program duration of lock-in status is the following:
Clients who have been arrested for, indicted for, convicted of, or admitted to a crime that is related to Medicaid fraud will be assigned lock-in status for the duration of eligibility and subsequent periods of eligibility.
HHSC uses the same time frames for clients with a lock-in status as noted by the word “LIMITED” on the Your Texas Benefits Medicaid card website at
Clients are removed from lock-in status at the end of the specified limitation period if their use of medical services no longer meets the criteria for lock-in status. A medical review also may be initiated at the client’s or provider’s request. Clients or providers can reach the Lock-in 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 lock-in period by contacting the Lock-in 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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