Determining Eligibility for Zero Copayments

 Determining Eligibility for Zero Copayments for MAP     Revised 3/18/21

Before Issuing Coverage

• • • Verify the client’s address is in Travis County
    • Verify client meets all other eligibility criteria for MAP

Length of Issuance

• • Issue six months coverage except when:
    • Eligible for Similar Benefits in less than six months (Medicare, Marketplace- term coverage the day before Medicare start date or Marketplace procedure)
    • Enrolled in SMART program- term coverage the day of discharge or at 6 months whichever is less
    • Enrolled in Austin Transitional Center Parole Reintegration Program- issue 3 months coverage

Housing Types Eligible for Zero Copayments

1. 1. Housing Type: Homeless living in a place not meant for habitation

A.) Includes:

• • • Living outdoors or in a car
    • Staying at the ARCH
    • Staying at the Salvation Army Transient Dorm
    • Staying at other homeless shelter

2. Housing Type: Living in special transitional housing

A.) Includes:

• • • Staying in one place less than 30 days
    • Staying in one of the following shelters
      • • Safeplace
        • Integral Care Safe Haven
        • Casa Marianella
        • Posada Esperanza
        • Mary’s House
        • SMART Program
        • Austin Transitional Center-parole integration program
    • Individuals who are clients of and staying in a shelter/residence funded by:

• • • • • Mental Health Public Defender (MHPD)
        • SAFE Alliance

3.  Housing Type: Permanent housing for formerly homeless persons

A.) Includes:

• • • Clients with a previous MAP track with zero copayments within the last 4 months

Procedure for Processing Individuals with Housing Types with Zero Copayments

1. 1. Housing Type: Homeless living in a place not meant for habitation

A.)  Procedure

• • • Complete Section II of the Applicant Residency Statement
      • • Give specific street address or cross streets (e.g. 501 East 8^th St., intersection of IH-35 and Cesar Chavez, the woods at Town Lake and IH-35, under the bridge on 7th St., etc)
    • In VeritySource, select Housing Type: “Homeless living in a place not meant for habitation”
    • Zero copayments will auto-populate

2.  Housing Type: Living in special transitional housing

A.) Procedure

• • • Collect proof of residency

• • • • • Clients staying at one of the listed shelters can complete Section III of the Applicant Residency Statement OR
        • Clients can provide a letter on agency letterhead stating; the date, client name, case worker name and phone number
          • Letters submitted on behalf of clients of the MHPD and SAFE Alliance programs should state they are a client of the program and should include the shelter address where they are currently staying
        • All letters must be dated within the last 45 days of the File Date

• • • In VeritySource, select Housing Type: “Living in special transitional housing”
    • Zero copayments will auto-populate

3.  Housing Type:  Permanent housing for formerly homeless persons

A) Procedure

• • • Collect proof of residency OR Complete Section I of the Applicant Residency Statement
    • Check for a note on the previous track
      • If there is no note
        • In VeritySource, select Housing Type- “Permanent housing for formerly homeless persons”
          • Zero copayments will auto-populate
        • Issue 12 months coverage- unless client meets a length of issuance exception for issuing less than 12 months
        • Add a Note to the Track: Zero copayments valid through mm/dd/yyyy
      • If there is a note
        • If the note states: Homeless status due to previous homelessness valid through mm/dd/yyyy and the client received 6 months coverage
        • In VeritySource, select Housing Type- “Permanent housing for formerly homeless persons”
          • Zero copayments will be assigned
        • Issue 6 months coverage- unless client meets a length of issuance exception for issuing less than 6 months coverage
        • Add a Note to the Track: Zero copayments valid through mm/dd/yyyy

• Determining Zero Copayments for Single Person in the Travis County Jail, Hospital or a Treatment Center

   Individuals who are in the Travis County Jail, an inpatient in a hospital or a residential treatment center may be eligible for coverage with zero copayments

• Definitions for MAP purposes
  1. Hospital-A place for receiving medical or surgical care, usually as an inpatient
  2. Treatment Center– A residential treatment center, sometimes called a rehab, is a live-in health care facility providing therapy for substance abuse, mental illness, or other behavioral problems. The Austin Transitional Program-Other program is included in this definition.

1. Procedure
   1. Ask where client lived prior to admission
      • If resided outside of Travis County prior to admission- not eligible for MAP
      • If resided inside Travis County prior to admission- continue
   2. Ask where client will live post discharge
      • If plans to reside outside of Travis County-not eligible for MAP
      • If plans to reside inside Travis County-continue
   3. Collect client’s proof of address OR Complete Section IV of the Applicant Residency Statement
   4. Determine Housing type
      • Select- Homeless living in a place not meant for habitation if client met the definition prior to admission or client will meet the definition upon discharge
        • Zero copayments will auto-populate
      • Select- Living in special transitional housing if client met the definition prior to admission or will meet the definition upon discharge
        • Zero copayments will auto-populate
      • Select – Permanent housing for formerly homeless persons if client met the definition prior to admission or will meet the definition upon discharge
        • Zero copayments will auto populate