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Appendix 1510: Procedures for Issuing HHSC Form 1027-A

CPS October 2009

The purpose of the Health and Human Services Commission (HHSC) Form 1027-A, also called the Temporary Medicaid Card, is to provide clients who are eligible or may be eligible for Medicaid with a document verifying their eligibility.

Criteria for Issuance of a Temporary Medicaid Card

Form 1027-A may be issued only when one of the following situations applies:

A child is in need of medical care and…



  •  has had his or her Medicaid eligibility related to foster care or adoption assistance determined and recorded in IMPACT; and

  •  has not had a Medicaid client number assigned

  •  his or her current Medicaid Identification Card:

  •  has not been issued,

  •  has been lost, or

  •  is not accessible;


  •  his or her Medicaid case is on hold

  •   coverage to a DFPS foster care or adoption assistance program on the HHSC SAVERR/TIERS system is pending certification; and

  •  the child's case has been stage-progressed to substitute care.

Foster care clients who are enrolled in STAR Health Managed Care may also obtain verification of Medicaid eligibility from STAR Health. A foster care client or the client's Medicaid Consenter may contact STAR Health Member Services to request verification of the client's Medicaid eligibility.

Persons Eligible for a Temporary Medicaid Card

Staff may issue Forms 1027-A only to the following:

  ·  Children with Medicaid coverage under one of the DFPS foster care assistance or adoption assistance programs

  ·  Children with DFPS Medicaid coverage who have left DFPS care, and the actual transfer of their DFPS Medicaid eligibility to an HHSC program in the HHSC SAVERR/TIERS system is pending

Staff Authorized to Issue a Temporary Medicaid Card

The only DFPS staff authorized to issue Form 1027-A are foster care or adoption assistance eligibility specialists and their supervisors.

Procedures for Completing a Temporary Medicaid Card

The issuing worker must first verify the child's current Medicaid eligibility through IMPACT or the HHSC SAVERR/TIERS system. The child's information in either system is used to complete the form. The child's DFPS Person ID number must be included on the Temporary Medicaid Form.

Supervisory Approval Procedures

A foster care or adoption assistance eligibility supervisor must approve the completed form by signing and dating the form. If the eligibility supervisor works in another office or is absent, a lead worker may approve the form.

The eligibility supervisor or lead worker may also approve the issuance by telephone. In this situation, the issuing worker must write the approving supervisor or lead worker's name, the date of approval, and the worker's initials on the form.

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