Table of Contents

100 Application Processing

110 Application Procedures

111 Pre-Application Process

112 Application Assistance

113 Application Requests and Submissions

113.1 Application Forms

114 Applications Causing Conflicts of Interest

114.1 Applications Submitted by Texas Works Employees

115 Applications Filed in Hospitals and Clinics

116 Special Application Processes

116.1 Reserved for Future Use

116.2 Applications from Residents of a Homeless Shelter

116.3 Applications for Babies Born to Women in Prison

116.4 SNAP Applications from a Contracted Community Partner (CP)

116.5 Food Distribution Program on Indian Reservation (FDPIR)

116.6 Joint SSI-SNAP Applications

116.7 Types of Assistances Administered by Centralized Benefit Services (CBS)

116.7.1 SNAP-CAP and SNAP-SSI

116.7.2 Applications for SNAP-CAP

116.7.3 Medicaid for Transitioning Foster Care Youth (MTFCY) (TP 70)

116.7.4 Medicaid Coverage for Youth in Juvenile Probation Custody or Released from the Texas Juvenile Justice Department

116.7.5 Medicaid for Breast and Cervical Cancer (MBCC)

116.7.6 Refugee Medical Assistance (RMA)

116.7.7 Former Foster Care in Higher Education (FFCHE) (TA 77)

116.7.8 Former Foster Care Children (FFCC)

117 Applications Filed Online through YourTexasBenefits.com

117.1 Application Registration

117.2 Data Collection

118 Coordination with the Federal Marketplace

118.1 Applications Received from the Marketplace

118.1.1 Non-MAGI Account Transfers

118.1.2 Verifications Provided by the Marketplace

118.2 Applications Sent to the Marketplace

119 Correspondence Options

119.1 Electronic Correspondence

119.2 Preferred Language for Correspondence

120 Office Procedures

121 Receipt of Application

121.1 Receipt of Application from Residential Child Care Facility

121.2 Receipt of Duplicate Application

121.3 Receipt of Identical Application

122 Filing the Application

122.1 Application Signature

122.2 Scheduling Appointments

122.3 Registering an Application

123 Withdrawal of an Application

124 Processing Presumptive Eligibility Applications

124.1 Eligible Groups

124.2 File Clearance

124.3 Task List Manager

124.4 Application Processing

124.5 Verifications

124.6 Medical Effective Date

124.7 Periods of Presumptive Eligibility

124.8 Fair Hearings

124.9 Questions About the Presumptive Eligibility Process

124.10 Presumptive Eligibility Forms

125 TP 45 Provider Referral Process

125.1 Advisor Action in Provider Referral Process

125.2 Suspended Claim Process

125.3 Mandated TIERS Inquiry

126 Processing Children's Insurance Applications

126.1 Front Desk Process

126.2 Inquiry

126.3 Advisor Action for Determining Eligibility for Children

126.3.1 Neonatal Intensive Care Unit (NICU) Newborn Process

126.4 CHIP Good Cause

126.4.1 Claiming Good Cause

127 Prior Medicaid Coverage

128 Processing Applications for Pregnant Women

128.1 Inquiry for Pregnant Women

128.2 Advisor Action for Determining Eligibility for Pregnant Women

128.3 CHIP Perinatal Application Process

129 Data Broker Requirements

130 Interview Procedures

131 Interviews

131.1 Home Visits

131.2 Requirement to Provide Interpreter or Translation Service

131.2.1 Availability of Interpreters/Translation Services

131.2.2 Availability of Translated Written Material

131.3 Interview Requirements

132 Eligibility Factors

132.1 Medical Programs Hierarchy

132.2 Guidelines for Pregnant Women

133 Rights and Responsibilities

134 Documentation Guidelines

135 Pending Information

136 Eligibility Decision

137 Prudent Person Principle

140 Expedited Service

141 Expedited Eligibility Criteria

142 Limit on Expedited Certification

143 How to Determine Eligibility for Expedited Service

144 Expedited Verifications

144.1 Social Security Numbers (SSNs)

144.2 Work Registration

144.3 Citizenship

144.4 Reserved

144.5 Pregnancy

145 Expedited Certification Procedures

145.1 Postponed Verification Procedures

146 Expedited Policy for Migrant or Seasonal Farmworkers

147 Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents

150 Combined Allotment Policy

160 Joint TANF-SNAP Applications

161 When Receipt of TANF Is Uncertain

170 Authorized Representatives (AR)

171 Protective Payee

172 AR Applying for Household

173 AR for Residents of Drug and Alcohol Treatment/Group Living Arrangement (GLA) Facilities

174 Abuse by AR

180 Verification Requirements

181 Verification Sources

190 Documentation Requirements

200 Household Composition

210 General Policy

211 Relationships Resulting from Termination of Parental Rights

212 Relationships Resulting from Adoption Procedures

213 Adoption Household Composition Situations

220 TANF

221 Who Is Included

222 Who Is Not Included

223 Certifying Children on Non-Parent Caretaker EDGs

224 Special Household Composition Situations

224.1 TANF-SP EDGs with Stepchildren or a Parent's Child from a Previous Relationship

224.2 TANF-SP EDGs with an Other-Related Child

230 Supplemental Nutrition Assistance Program (SNAP)

231 Who Is Included

232 Who Is Not Included

232.1 Nonmembers

232.2 Disqualified Persons

240 Medical Programs

241 Budget Group

241.1 Who Is Included

241.1.1 Taxpayer's MAGI Household Composition

241.1.2 Tax Dependent Exceptions

241.1.3 Tax Dependent's MAGI Household Composition

241.1.4 Non-Taxpayer/Non-Tax Dependent’s or Tax Dependent with an Exception MAGI Household Composition

241.1.5 Inclusion of the Unborn

241.2 Who Is Not Included

241.3 Household Composition Situations (Minor Parents, Independent Children, Etc.)

241.3.1 Children's Living Arrangements

241.4 Family Violence Exemption

241.4.1 Referral to a Family Violence Specialist

242 Certified Group

250 Verification Requirements

251 Verification Sources

260 Documentation Requirements

300 Citizenship

310 General Policy

311 Alien Status Policies

311.1 Definition of Qualified Immigrant

312 Contact with the U.S. Citizenship and Immigration Services (USCIS)

313 Absence of Proof of Alien Status

314 Re-verification of Alien Status Due to a USCIS Document's Expiration Date

315 Definition of Public Charge

315.1 Providing Information to Immigrants Regarding Public Charge

315.2 Receiving Other Benefits

316 Sponsored Alien

316.1 Providing Verification of the Alien's Sponsor Income and Resources

320 Definitions of Military Connection

321 Veteran

322 Active Duty Military Member

323 Spouse or Minor Unmarried Dependent Child of Veteran or Active Duty Military Member

324 Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member

330 Lawful Permanent Resident (LPR) and 40 Quarters

331 Whose Quarters Can Be Considered

340 Qualified Alien Status Eligibility Charts

341 SNAP Alien Status Eligibility Charts

342 TANF and Medical Programs Alien Status Eligibility Charts

343 How to Determine Eligibility for Battered Aliens

350 Verification Requirements

351 Verification of Citizenship

351.1 Reasonable Opportunity

351.2 Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship

351.3 Good Cause Determination

351.3.1 Referrals to OIG

351.4 How to Verify Citizenship

352 Verification of Alien Status

353 Verification of Military Connections

353.1 Verification of Veteran Status

353.2 Verification of Active Duty Military

353.3 Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member

354 Verifying 40 "Qualifying Quarters"

354.1 Response from Social Security Administration's (SSA) WTPY System

354.2 Non-Covered Wages

354.3 Quarters Earned On or After January 1, 1997

354.4 Procedures for Verifying 40 Quarters

355 Verifying Alien's USCIS Documents

355.1 SAVE Program's Verification Information System (VIS)

355.2 How to Request an Initial Verification

355.3 How to Request Additional Verification – Online Process

355.4 How to Request Additional Verification – Manual Process

356 Verifying Alien's Date of Entry

357 Verifying Alien's Continuous Presence

358 Verification Sources

358.1 Citizenship

358.2 Alien Status

360 Documentation Requirements

400 Social Security Number

410 General Policy

411 Determining Advisor Action at Application

412 Action at TANF and Medical Program Redetermination — Forms SSA-5028 or SSA-2853

420 Failure to Comply

421 Reestablishing Eligibility

430 Proof Required by SSA

431 Special Situations

432 SSN Discrepancy Clearance Procedures

440 Verification Requirements

441 Verification Sources

450 Documentation Requirements

500 Age/Relationship

510 Age Limits

520 Relationship

521 Eligibility Requirements

522 Legal Parent-Child Relationship

523 When Proof of Relationship Is Unavailable

523.1 How to Make an Evaluative Conclusion

523.2 Children Living with Biological Father

523.2.1 Children Living with Relatives of Biological Father

530 Verification Requirements

531 Verification Sources

540 Documentation Requirements

600 Identity

610 General Policy

611 At Application

612 Redetermination

613 Receipt of Lone Star Card and/or PIN

620 Verification Requirements

621 Verification Sources

630 Documentation Requirements

700 Residence

710 General Policy

720 New Texas Residents

730 Moves Within Texas

740 Moves Out of Texas

750 Temporary Visits Out of Texas

760 Verification Requirements

761 Verification Sources

770 Documentation Requirements

800 Medicaid Eligibility

810 General Policy

820 Regular Medicaid Coverage

821 Types of Coverage

821.1 Fee-for-Service

821.2 Managed Care

822 Medicaid Coverage for New State Residents

823 Lock-In Status

824 Issuance of Form H1027-A, Medicaid Eligibility Verification

825 Medicaid Termination

830 Medicaid Coverage for the Months Prior to the Month of Application

831 Three Months Prior Coverage

831.1 How to Apply for Three Months Prior Coverage

831.2 Eligibility for Three Months Prior Coverage

831.2.1 Reopening Three Months Prior Applications

831.3 Income Computation

831.4 Determining the Appropriate Type Program for the Prior Month

831.5 Medical Eligibility Date for Three Months Prior Coverage

831.6 Applications Based on Incapacity

832 Continuous Medicaid Coverage

833 TP 45 Retroactive Coverage

834 Retroactive Medicaid Coverage for Abandoned Children

840 Transitional Medicaid Coverage

841 General Eligibility Information

841.1 Multiple Changes That Cause TP 08 Ineligibility

841.2 Notice to Clients

841.3 Eligibility Criteria During Transitional Medicaid Coverage

842 TP 07 Transitional Medicaid

842.1 Determining the First Month of TP 07 Medicaid

842.2 Determining the Three of Six Months Eligibility Requirement

842.3 Automatic Denial of TP 07

843 Reserved

844 Transitional Medicaid Reporting Requirements for TP 07

844.1 Advisor Action on the Fourth Month Medicaid Report

844.2 Advisor Action on the Seventh and Tenth Month Medicaid Reports

844.3 185% FPIL Test

844.4 Good Cause Determinations

845 Reinstatement of Denied Transitional Coverage

845.1 Advisor Action on Reinstatements

846 Special Household Composition Policies for Transitional Medicaid

846.1 Parents and Caretaker Relatives Enter or Already Live in the Home

846.2 Child Enters or Already Lives in the Home

846.3 Household Member Leaves the Home

846.4 Minor Parents Certified as Children

847 Other EDG Actions

847.1 Changes Affecting Transitional Medicaid EDGs

847.2 Reapplication for TP 08

850 TP 20 Spousal Support Post Medicaid Coverage

851 Eligibility Criteria During Post Medicaid

852 Automated Process

853 Denial of TP 20

854 Reinstatement of Denied TP 20 Coverage

855 Special Household Composition Policies for Post Medicaid

855.1 Parents and Caretaker Relatives Enter or Already Live in the Home

855.2 Child Enters or Already Lives in the Home

855.3 Minor Parents Certified as Children

856 Reapplication for TP 08

860 Third-Party Resources (TPR)

861 Third-Party Resources (TPR) and Accidents

861.1 Reporting the Accident to the Third-Party Resources (TPR) Unit

861.2 Responding to Third-Party Resources (TPR) Unit Noncooperation Notices

861.3 Third-Party Resources (TPR) Reimbursements

861.3.1 Client-Initiated Reimbursements

861.3.2 Reporting Non-Reimbursement to the Third-Party Resources (TPR) Unit

861.4 Responding to Third-Party Resources (TPR) Unit Recovery Requests

861.5 Remitting Cash Medical Support Payments to the Third-Party Resources (TPR) Unit

862 Third-Party Resources (TPR) Reporting System

863 Health Insurance Premium Payment (HIPP) Program

870 Verification Requirements

880 Documentation Requirements

900 Domicile

910 General Policy

920 Temporary Absence from the Home

921 How to Determine Care and Control

922 Children Admitted into State Hospitals

923 Children Residing in General Residential Operations Facilities

924 Disqualification for Failure to Report Temporary Absence

930 Requirement for Unmarried Minor Parents to Live with an Adult or in an Adult-Supervised Setting

931 Failure to Comply

940 Verification Requirements

941 Verification Sources

950 Documentation Requirements

1000 Deprivation

1010 General Policy

1020 Establishing Deprivation for Children of Unwed Parents

1021 Unwed Parents Living Together

1022 Paternity Conflicts — Unwed Parents

1030 Deprivation Based on Death of a Parent

1040 Deprivation Based on Absence from the Home

1041 How to Determine Deprivation Based on Absence

1041.1 Joint Custody

1042 Contact with the Absent Parent

1043 Absent Parent Returns to the Home (Extension of the TANF Grant or Addition of the Returning Parent)

1050 Deprivation Based on Incapacity

1051 Determining Incapacity

1052 Processing Medical Reviews

1060 Deprivation Based on Unemployment

1061 How to Determine Deprivation Based on Unemployment

1070 TANF-State Program (SP)

1071 Employment Services Requirements

1071.1 Choices Requirements

1080 Disability Verification

1081 Verification Sources

1090 Documentation Requirements

1100 Child Support

1110 General Policy

1111 Office of the Attorney General (OAG) Case Information and Inquiry

1120 Child Support Program Requirements and Procedures

1121 Authorization and Assignment of Child and Medical Support

1122 Parent Profiles for Child and Medical Support Referrals

1122.1 Parent Profile Questionnaire

1122.2 Child Support and Medical Support Referrals

1123 Updates to Child Support Referrals

1124 TANF

1125 OAG Distribution

1130 Explanation of Good Cause

1131 Good Cause Situations

1131.1 Good Cause for Family Violence Option

1131.2 Good Cause Related to Adoptions, Rape or Incest

1140 Noncooperation with Child Support Program Requirements

1141 Sanctions for Noncooperation

1142 Noncooperation Situations

1150 Verification Requirements

1151 Verification Sources

1160 Documentation Requirements

1200 Resources

1210 General Policy

1211 Requirement to Pursue Resources

1212 Transferring Resources

1212.1 Penalties for Transferring Resources

1212.2 How to Determine Intent

1212.3 Length of Denial Period

1212.4 Beginning the Denial Period

1220 Limits

1230 Types of Resources

1231 Accounts

1231.1 Bank Accounts

1231.2 Debit Accounts

1231.3 Individual Development Accounts (IDAs)

1231.4 Retirement Accounts

1231.5 Education Tuition Savings Plan

1232 Government Payments

1232.1 Crime Victim's Compensation Payments

1232.2 Federal Tax Refunds and Earned Income Tax Credits (EIC)

1232.3 Energy Assistance Payments

1232.4 Government Disaster Payments

1232.5 Transitional Living Allowance

1232.6 Native and Indian Claims

1232.7 Payments to Children of Vietnam Veterans

1232.7.1 Payments to Children of Vietnam Veterans Who Are Born with Spina Bifida

1232.7.2 Payments to Children of Women Vietnam Veterans Born with Certain Birth Defects (Public Law 106-419)

1232.8 Payments to Civilians Relocated During Wartime

1232.9 Payments to Victims of Nazi Persecution

1232.10 Radiation Exposure Compensation Act Payments

1232.11 Payments to World War II Filipino Veterans and Spouses

1232.12 Relocation Assistance

1232.13 DFPS Relative Caregiver Reimbursement Program Payments

1233 Insurance

1233.1 Life Insurance

1233.2 Prepaid Burial Insurance

1234 Noneducational Loans

1235 Personal Possessions

1236 Property

1236.1 Burial Plots

1236.2 Homestead

1236.2.1 Homestead Temporarily Unoccupied

1236.2.2 Sale of a Homestead

1236.3 Income-Producing Property

1236.4 Real Property

1236.4.1 Exemption Based on Good Faith Effort to Sell

1236.5 Jointly Owned Property

1237 Trust Funds

1238 Vehicles

1238.1 Solely Owned Vehicles

1238.2 Jointly Owned Vehicles

1238.3 Vehicles Over 20 Years Old

1238.4 Leased Vehicles

1238.5 How to Determine Fair Market Value of Vehicles

1239 Educational Assistance

1240 Determining Countable Resources in Special Situations

1241 Inaccessible Resources

1241.1 Nonliquid Resources

1242 Lump-Sum Payments

1243 Payments Exempt as a Resource While Being Considered Income

1244 Reimbursements

1245 Resources of an Alien's Sponsor

1246 Resources of Residents in Shelters for Battered Persons

1247 Resources of Stepparents

1248 Resources of TANF and SSI Recipients

1249 Resources Resulting from Earnings

1249.1 Earnings of a Child

1249.2 Earnings of a New TANF Spouse

1250 Verification Requirements

1251 Verification Sources

1260 Documentation Requirements

1300 Income

1310 General Policy

1311 Requirement to Pursue Income

1311.1 Requirement to Pursue SSI/RSDI

1311.1.1 SSI/RSDI Application Assistance

1311.1.2 Social Security Administration (SSA) Definitions and Guidelines

1320 Types of Income

1321 Disability Benefits

1321.1 Agent Orange Settlement Payments

1321.2 Disability Insurance Benefits

1321.3 Radiation Exposure Compensation Act Payments

1321.4 Worker's Compensation

1322 Education and Training

1322.1 Educational Assistance

1322.2 Job Training

1322.2.1 Workforce Innovation and Opportunity Act (WIOA)

1322.2.2 Other Job Training and Training Allowances

1323 Employment and Self-Employment Income

1323.1 Children's Earned Income

1323.2 Contractual Earnings

1323.2.1 Monthly Budgeting of Contractual Earnings

1323.3 Military Pay Allotments and Allowances

1323.3.1 Family Subsistence Supplemental Allowance (FSSA)

1323.3.2 Combat (Hazardous Duty) Payments

1323.4 Self-Employment

1323.4.1 Types of Self-Employment Income

1323.4.2 Property Income

1323.4.3 Noncommercial Roomer/Boarder Payments

1323.4.4 Determining the Amount of Self-Employment Income

1323.4.5 Allowable Costs of Producing Income

1323.4.6 Computation Methods

1323.4.7 Determining Net Self-Employment Income

1323.4.8 Changes in Annual or Seasonal Self-Employment Income

1323.4.9 Rebudgeting Income and Expenses

1323.5 Wages, Salaries, Commissions, and Tips

1323.5.1 Federal Tax Refunds and Earned Income Tax Credits (EIC)

1323.5.2 Flexible Fringe Benefits

1323.5.3 Income from Tips

1323.5.4 Vacation Pay

1323.6 Temporary Census Income

1324 Government Payments

1324.1 Adoption Assistance

1324.2 Crime Victim's Compensation Payments

1324.3 Government Disaster Payments

1324.4 Government Housing Assistance

1324.5 Transitional Living Allowance

1324.6 In-Home and Family Support Program (IH/FSP) Payments

1324.7 National and Community Services Act (NCSA)

1324.8 Native and Indian Claims

1324.9 Nutrition Programs

1324.10 One-Time Grandparent Payments

1324.11 One-Time Temporary Assistance for Needy Families (OTTANF)

1324.12 Payments to Vietnam Veterans' Children

1324.12.1 Payments to Vietnam Veterans' Children Born with Spina Bifida (Public Law 104-204)

1324.12.2 Payments to Children of Women Vietnam Veterans Born with Certain Birth Defects (Public Law 106-419)

1324.13 Payments to Victims of Nazi Persecution

1324.14 Payments to World War II Filipino Veterans and Spouses

1324.15 Relocation Assistance

1324.16 Retirement, Survivors and Disability Insurance (RSDI)

1324.17 Supplemental Security Income (SSI)

1324.18 Temporary Assistance for Needy Families (TANF)

1324.18.1 TANF Annual School Subsidy Payment

1324.19 Unemployment Compensation

1324.20 Veterans Benefits

1324.21 DFPS Relative Caregiver Reimbursement Program Payments

1324.22 Healthy Marriage Development Program Payments

1325 Income from Property

1325.1 Dividends and Royalties

1325.2 Payments for Oil, Gas, and Mineral Rights

1326 Other

1326.1 Cash Gifts and Contributions

1326.1.1 Contributions from Noncertified Household Members

1326.1.2 Gifts from Tax-Exempt Organizations

1326.2 Child Support

1326.2.1 Counting Child Support

1326.2.2 Lump-Sum Child Support Payments

1326.2.3 Medical Support Payments

1326.3 Energy Assistance

1326.4 Foster Care and Permanency Care Assistance (PCA) Payments

1326.5 In-Kind Income

1326.6 Interest

1326.7 Loans (Noneducational)

1326.8 Plan for Achieving Self-Sufficiency (PASS)

1326.9 Pensions

1326.10 Trust Funds

1326.11 Resettlement-Reception and Placement (R&P)

1326.12 Refugee Cash Assistance (RCA)

1326.13 Match Grant

1326.14 Spousal Diversion and Dependent Allowance

1326.15 Income Legally Obligated to Children in Department of Family and Protective Services (DFPS) Conservatorship

1326.16 Welfare-to-work Income

1326.17 Alimony (Spousal Support) Received

1326.18 Annuity

1326.19 Capital Gains

1326.20 Housing Allowance

1326.21 Life Estate

1326.22 Jury Duty Pay

1326.23 Court Awards

1326.24 Canceled Debt

1330 Types of Payments

1331 Lump-Sum Payments

1332 Reimbursements

1333 Third-Party Beneficiary

1334 Vendor Payments

1334.1 Vendor Payments from State and Local Government Funds

1340 Income Limits

1341 Income Limits and Eligibility Tests

1341.1 Grant Amount

1350 Calculating Household Income

1351 Irregular and Unpredictable Income

1352 Terminated Income

1353 How to Convert Income to Monthly Amounts

1353.1 Converting New Semi-Monthly Income

1354 How to Budget Actual Income

1355 How to Project Income

1355.1 Budgeting Options for SNAP Households

1355.2 How to Use Texas Workforce Commission (TWC) Quarterly Wage Information to Budget Earned Income

1356 Income Received Less Often Than Monthly

1357 Computing Benefits by EDG Action Type

1358 How to Budget Expenses

1359 How to Determine Spend Down

1359.1 Determining Eligibility/Spend Down for the Application and Following Months

1359.2 Determining Eligibility/Spend Down for Three Months Prior

1359.3 Corrections to a TP 56 EDG

1360 Determining Countable Income in Special Household Situations

1361 Alien Sponsor's Income

1361.1 Budgeting the Individual Sponsor's Income

1361.2 Prorating the Sponsor's Income

1361.3 Budgeting the Organization Sponsor's Income

1362 Disqualified Members

1362.1 TANF — Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits

1362.2 TANF — Budgeting for a Household Member Disqualified for Noncompliance with SSN, TPR, Failure to Timely Report a Certified Child's Temporary Absence, Intentional Program Violation, Being a Fugitive or a Felony Drug Conviction

1362.3 SNAP — Budgeting for Members Disqualified for Citizenship, SNAP ABAWD Work Requirement or Noncompliance with Social Security Number Requirements

1362.4 SNAP — Budgeting for Persons Disqualified for Intentional Program Violations, SNAP Employment Services Noncompliances, Felony Drug Convictions or Being a Fugitive

1363 Diverting Income

1364 Migrant Farm Workers in the Workstream

1364.1 Guidelines for Determining Income of Migrant Workers

1365 Unmarried Minor Parent Income

1366 Stepparent EDGs

1366.1 How to Determine Budgeting Procedures in Stepparent EDGs

1366.2 Stepparent Budgeting Procedures

1366.3 Budgeting Procedures in Stepparent EDGs When Both Parents Have Eligible Children for Whom They Want to Apply

1367 Strikers

1367.1 Eligibility of Strikers

1368 New TANF Spouse's Earnings

1370 Verification Requirements

1371 Verification Sources

1380 Documentation Requirements

1400 Deductions

1410 General Policy

1411 Rules That Apply to Deductions

1420 Types of Deductions

1421 Child Support Deductions

1421.1 Allowable Child Support Deductions

1421.2 Budgeting Child Support Deductions

1422 $75 Disregard Deduction

1423 Dependent Care Deduction

1424 Diversions, Alimony, and Payments to Dependents Outside the Home

1424.1 Determining the Needs Figure

1425 Earned Income Deductions

1425.1 Work-Related Expense ($120 and 20%)

1425.2 1/3 Disregard for Applicants

1425.3 90% Earned Income Deduction

1425.3.1 Who Is Eligible for the 90% Earned Income Deduction

1425.3.2 Who Is Not Eligible for the 90% Earned Income Deduction

1425.3.3 Removing the 90% Earned Income Deduction

1426 Reserved

1427 Homeless Shelter Standard

1428 Medical Deduction

1428.1 Allowable Medical Expenses

1428.2 Budgeting Medical Deductions

1428.2.1 Determining Allowable Costs for Individuals with a Medicare Prescription Drug Plan Part D

1428.3 Budgeting Options

1428.4 Change in Medical Expenses During Certification

1428.5 Switching Between Actual Medical Expenses and the Standard Medical Expense

1429 Shelter Costs

1429.1 Allowable Shelter Costs

1429.2 Shelter Deductions for an Unoccupied Home

1429.3 Utility Allowances

1429.3.1 Standard Utility Allowance (SUA)

1429.3.2 Basic Utility Allowance (BUA)

1429.3.3 Determining the Appropriate Utility Allowance

1429.4 Telephone Standard

1430 Standard Deduction

1440 Verification Requirements

1441 Verification Sources

1450 Documentation Requirements

1500 Reminders

1510 General Reminders

1520 Special Reminders

1521 Registering to Vote

1521.1 Who Cannot Register to Vote

1521.2 Staff Requirements for Voter Registration

1521.3 Voter Registration During Interviews

1521.4 Voter Registration During Non-Interviews

1521.5 Local Office Liaison Duties

1521.6 Documentation

1522 Personal Responsibility Agreement

1523 Child Support Responsibilities

1524 Earned Income Deduction

1525 Voluntary Quit

1526 Family Violence

1527 The Texas Works Message

1528 Handbooks

1528.1 Availability of Handbooks for Client Review

1529 Interactive Voice Response (IVR) System

1530 Medical and Dental Benefits

1531 Texas Health Steps (THSteps)

1531.1 Accessibility of THSteps Services

1531.2 THSteps Service Providers

1531.3 Program Administration

1531.4 Explanation of Benefits

1531.5 Compliance Requirements

1532 Medicaid

1532.1 Spend Down EDGs

1533 Transitional and Post Medicaid

1534 Requirement to Report Accidents

1540 Redeterminations

1541 Periodic Redeterminations and Special Reviews

1542 Special Reviews

1543 Notice of Expiration

1550 Issuance and Use of Benefits

1551 Advisor Responsibilities

1552 EBT Issuance Staff Responsibilities

1553 Use of TANF Benefits

1554 Use of SNAP Benefits

1555 Use of One-Time Temporary Assistance for Needy Families (OTTANF) Benefits

1560 Documentation Requirements

1600 School Attendance

1610 Eligibility Requirement

1620 Determining Attendance

1621 Exemptions from School Attendance Requirements

1630 Failure to Cooperate with School Attendance

1631 Good Cause for Noncooperating with School Attendance

1632 Curing the School Attendance Penalty

1640 Verification Requirements

1641 Verification Sources

1650 Documentation Requirements

1700 Management

1710 General Policy

1720 How to Evaluate Management

1730 Advisor Action

1731 Monitoring Questionable Management

1740 Verification Requirements

1750 Documentation Requirements

1800 Employment Services

1810 General Policy

1811 Strikers and Employment and Training (E&T)

1820 Employment Services Programs (ESP) Procedures

1821 Choices

1821.1 Choices Exemptions

1821.1.1 Claiming Exemption Due to Disability of Self

1821.1.2 Claiming Exemption Due to Caring for a Disabled Household Member

1821.2 Choices Participation

1821.3 Work Registration Code Hierarchy

1821.4 Switching the Exemption — TANF-SP

1821.5 Caretaker Exemption

1821.5.1 Setting the Caretaker Exemption End Date

1821.5.2 Resetting the End Date

1822 E&T Procedures

1822.1 E&T Exemptions

1822.1.1 Claiming Exemption Due to Disability of Self

1822.1.2 Claiming Exemption Due to Caring for a Household Member With a Disability

1823 Work Registration Status Changes

1823.1 Reporting Changes in Work Registration Status

1823.1.1 Advisor Action on Status Changes

1824 Information Transmittal from Choices or E&T Staff

1830 ESP Actions

1831 Action in Full Service Choices Counties or E&T Counties

1831.1 Referral Processes

1831.1.1 Choices Outreach

1831.1.2 ABAWD Referral Process

1831.2 Individual Participation Requirements

1832 Action in Minimum Service Choices Counties or Non-E&T Counties

1832.1 Individual Responsibilities

1840 Noncooperation with ESP

1841 Minimum Penalty Periods

1842 Failure/Refusal to Register

1843 Noncooperation with Choices

1843.1 TANF-SP Procedures

1844 Noncooperation with E&T

1844.1 Determining Primary Wage Earner (PWE) for Noncooperation Situations

1844.2 Tracking the Number of Sanctions

1845 Action on Noncooperation

1845.1 Sending Notice of Failure to Cooperate

1845.1.1 Failing to Timely Send Notice of Adverse Action

1845.1.2 Failing to Impose a Penalty After Providing Notice of Adverse Action

1845.1.3 Penalty is not Applicable

1845.2 Completing the Penalty Action

1846 Re-establishing Eligibility During the Penalty Period

1847 Re-establishing Eligibility After the Penalty Period

1850 Voluntary Quit

1851 Applying Voluntary Quit

1851.1 How to Determine if Voluntary Quit Applies

1852 Determining PWE for Voluntary Quit Situations

1853 Advisor Action on Voluntary Quit or Reduction in Work Hours

1854 Re-establishing Eligibility During the Penalty Period

1855 Re-establishing Eligibility After the Penalty Period

1860 Determining Good Cause

1861 Reasons for Good Cause

1870 Appeals

1880 Verification Requirements

1890 Documentation Requirements

1900 Federal Time Limits (FTLs)

1910 General Policy

1920 Determining the Number of FTL Months Used

1921 Tracking FTL Months

1930 Extended TANF and Hardship Exemptions

1931 General Policy

1932 Eligibility Requirements

1933 Hardship Exemptions

1933.1 Advisor Action at Application

1933.1.1 Personal Disability

1933.1.2 Caring for a Family Member With a Disability

1933.1.3 Family Violence

1933.1.4 Residence in a Minimum Service County

1933.1.5 Lack of Employment

1933.2 Advisor Action at Complete Review

1933.2.1 Personal Disability or Caring for a Family Member With a Disability

1933.2.2 Family Violence

1940 SNAP ABAWD Work Requirements

1941 Definition of Work

1941.1 Meeting the Work Requirement Through Self-Employment

1941.2 Meeting the Work Requirement Through a Work Program

1942 Exemptions

1950 Counting Months Toward Time-Limited Eligibility

1951 After the Three Months of Time-Limited SNAP Eligibility

1960 Regaining Eligibility

1961 Second Time-Limited Three-Month SNAP Eligibility Period

1970 Verification Requirements

1980 Documentation Requirements

2000 Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation

2010 General Policy

2020 Authenticating a Caller

2020.1 Authentication Questions and Verification Sources

2020.2 Actions When Unable to Authenticate the Caller

2020.3 Actions on Inaccurate Responses to the Questions

2020.4 Claiming Hardship for Coming to the Office

2020.5 Actions When Verification Is Provided at the Local Office

2020.6 Denial for Failure to Authenticate Identity

2030 Prevention of Duplicate Participation

2030.1 Inquiry and Sources

2030.2 Duplicate Participation Match Procedures

2040 Verification Requirements

2040.1 Authentication of Caller Identity Verification Sources

2050 Documentation Requirements

2100 Personal Responsibility Agreement

2110 General Policy

2120 Individual Responsibilities

2121 Choices

2121.1 When the Individual Signs Form H1073

2121.2 Ending a Choices Penalty

2122 Child Support

2122.1 When the Individual Signs Form H1073

2122.2 Explanation of Child/Medical Support, Family Violence and Good Cause

2122.3 Good Cause for Child Support Noncooperation

2122.4 Starting a Child Support Penalty

2122.5 Ending a Child Support Penalty

2123 Voluntary Quit

2123.1 When the Individual Signs Form H1073

2123.2 Failure to Cooperate with Voluntary Quit

2123.3 Curing Voluntary Quit

2123.4 Good Cause for Voluntary Quit Noncooperation

2123.5 Advisor Action on Noncooperation

2123.5.1 Starting a Voluntary Quit Penalty

2124 Texas Health Steps (THSteps) Program

2124.1 When the Individual Signs Form H1073

2124.1.1 Setting the THSteps Overdue Month

2124.2 At the First Complete Review After the Caretaker and/or Second Parent Signs Form H1073

2124.2.1 Determining if the Child had a THSteps Medical Checkup

2124.3 Advisor Action if the Overdue Month Is Before or In the Complete Review Interview Month

2124.4 THSteps Overdue Month At Application

2124.5 Good Cause for THSteps Noncooperation

2124.6 Starting a THSteps Penalty

2124.7 Ending a THSteps Penalty

2125 Immunizations

2125.1 When the Individual Signs Form H1073

2125.2 Determining if Immunizations are Current

2125.3 Failure to Cooperate with Immunizations

2125.4 Good Cause for Immunizations Noncooperation

2125.5 Advisor Action on Noncooperation

2125.5.1 Starting an Immunization Penalty

2125.5.2 Ending an Immunization Penalty

2126 School Attendance

2126.1 When the Individual Signs Form H1073

2127 Parenting Skills Training

2127.1 When the Individual Signs Form H1073

2127.2 Actions and Time Frames

2127.3 Referral

2127.4 Failure to Cooperate with Parenting Skills Requirements

2127.5 Good Cause for Parenting Skills Noncooperation

2127.6 Advisor Action on Parenting Skills Noncooperation

2127.6.1 Starting a Parenting Skills Penalty

2127.6.2 Ending a Parenting Skills Penalty or Good Cause

2128 Alcohol or Drugs

2128.1 When the Individual Signs Form H1073

2128.2 Failure to Cooperate with the Alcohol or Drug Requirement

2128.3 Advisor Action on Noncooperation

2128.3.1 Starting an Alcohol or Drug Penalty

2128.3.2 Ending an Alcohol or Drug Penalty

2129 Good Cause

2130 Form H1073, Personal Responsibility Agreement

2131 Processing the PRA at Application

2131.1 Initial Application

2131.2 Applicants Who Previously Received TANF

2131.2.1 Verifying Prior Cooperation Status at TANF Reapplication

2131.3 Imposing a Sanction on a New TANF Household When a Noncooperating Member Moves In

2132 Processing Changes

2132.1 Addition of a Caretaker or Second Parent at Incomplete Review

2132.2 Disqualification of a Caretaker or Second Parent

2132.3 Removing a Penalized Member During the First Noncooperation Month

2132.4 Removing a Penalized Member During the Second Noncooperation Month

2132.5 Adding a Penalized Member to a Household

2132.6 Certified Children Who Age Out Before/After the Caretaker or Payee Fails to Cooperate with PRA Requirements

2140 Full-Family Sanction

2141 When to Start a Full-Family Sanction

2141.1 Determining the First Month of Noncooperation

2141.2 Determining the Second Month of Noncooperation

2141.3 Determining the Forfeit Month(s)

2142 Applying a Full-Family Sanction to Multiple TANF EDGs

2143 Reinstating Cash Assistance After Cooperation

2144 Imposing a Penalty

2144.1 Failing to Impose a Full-Family Sanction

2145 Ending an Open Penalty

2146 Action When an Individual Fails to Cooperate with the PRA at Complete or Incomplete Review

2147 Action When the Individual Cooperates with the PRA Requirements Before the End of the Second Noncooperation Month

2148 Reserved for Future Use

2149 Individual Notices

2150 Pay for Performance

2151 Open Penalty at Reapplication in Pay for Performance

2152 A Second Noncooperation During Pay for Performance

2160 Verification Requirements

2161 Verification Sources

2170 Documentation Requirements

2200 Workforce Orientation

2210 Requirements

2211 Alternative Workforce Orientation

2212 Workforce Orientation Referral

2212.1 Form H2588, Workforce Orientation Referral

2212.2 Workforce Orientation Flyers

2213 Workforce Orientation Session

2213.1 Related Support Services

2213.2 Employment Planning Session (EPS)

2214 Failure or Refusal to Comply with the Workforce Orientation Requirement

2215 Addition of a New Household Member or Disqualified Member

2220 Verification Requirements

2230 Documentation Requirements

2300 Case Disposition

2310 Notice to Applicants

2320 Eligibility Dates and Benefit Amounts

2321 Date Eligibility Begins

2322 Benefits

2323 Proration

2324 Length of Certification

2330 Setting Special Reviews

2330.1 Special Reviews for Known Changes

2330.2 Special Reviews for Questionable Changes

2340 Adverse Action

2341 Denial of an Application

2342 Denial at Redetermination

2342.1 Retesting Eligibility

2343 Advance Notice

2343.1 How to Take Adverse Action if Advance Notice Is Required

2344 Adverse Actions Not Requiring Advance Notice

2344.1 Form TF0001 Required (Adequate Notice)

2344.2 No Form TF0001 Required

2350 Streamlined Reporting Households

2351 Disqualified Members

2360 Documentation Requirements

2400 One Time Payments

2410 General Policy

2411 OTTANF

2412 Grandparent Payments

2420 Eligibility Requirements

2421 OTTANF Requirements

2421.1 Citizenship

2421.2 Deprivation Based on Incapacity

2421.3 Child Support

2421.4 Employment Services

2421.5 Personal Responsibility Agreement (PRA)

2422 Requirements for Grandparent Payments

2422.1 Determining the Budget and Certified Group

2422.2 Income and Resource Guidelines

2430 Who Is Not Eligible

2431 Who Is Not Eligible for OTTANF

2431.1 12-Month Ineligibility Period

2432 Who Is Not Eligible for One-Time Grandparent Payments

2440 Determining Crisis Criteria (OTTANF)

2441 Crisis Criteria One (TP 71 or 72)

2442 Crisis Criteria Two (TP 71)

2443 Crisis Criteria Three (TP 71 or 72)

2444 Crisis Criteria Four (TP 71 or 72)

2450 Issuing Benefits

2451 Issuing OTTANF Benefits

2451.1 Reissuing Benefits

2451.2 Switching from OTTANF to TANF

2451.3 Switching from TANF to OTTANF

2452 Issuing One-Time Grandparent Payment

2452.1 Reissuing Grandparent Payments

2460 Verification Requirements

2470 Documentation Requirements

2500 State Time Limits

2510 General Policy

2520 Time Limit Tiers

2521 Initial Time Limit Tiers

2521.1 Determining the Time Limit Tier

2522 Time Limit Tier Changes

2522.1 Change in Time Limit Tier Because of Functional Literacy Level

2522.2 Change in Time Limit Tier Because of Error

2522.3 Changes to Time Limit Tiers at Reapplication

2530 Counting TANF Months Toward State Time Limit

2531 Counting Months for Tiers 5 and 6

2532 Counting Months for Tier 7

2533 Changes to State Time Limit Months Counted

2533.1 Deleting Months When TANF Benefits are Cancelled or Recouped

2533.2 Deleting Months in Error Situations

2533.3 Deleting Months When the NED Changes

2533.4 Adding State Time Limit Months

2540 State Time Limit Five-Year Freeze-Out Period

2541 State Time Limit Five-Year Freeze-Out End Date

2542 When TIERS Takes Action Automatically

2542.1 Time Limit Disqualification

2542.1.1 Procedures for SNAP EDGs When an Individual Times Out

2543 Hardship Exemptions

2543.1 County Hardship Exemption

2543.1.1 TIERS Action

2543.1.2 Advisor Action

2543.2 Severe Personal Hardship Exemption

2543.2.1 Disabling Illness or Injury of Self

2543.2.2 Disabling Illness or Injury of Close Family Member

2543.3 Employment Hardship Exemption

2543.3.1 Initial Request

2543.3.2 Continuation of Exemption

2543.3.3 Reapplication After Denial

2543.3.4 Good Cause for Not Contacting Employers While Receiving TANF

2550 Notices

2551 Client Notices

2552 TIERS Notices Sent to Clients

2560 TANF-SP 60-Month Time Limit

2561 General Policy

2562 Determining TANF-SP Time Limit Months

2563 Tracking TANF-SP Time Limit Months

2563.1 Denying Clients at the End of the TANF-SP 60 Months

2564 Client Notices

2570 Verification Requirements

2580 Documentation Requirements

100 Processes and Processing Time Frames

110 Applications

111 Reuse of an Application Form After Denial

112 Deadlines

113 Delay in Processing Applications

113.1 Not Held – Agency Fault

114 Missed Appointment

115 Pending Verification on Applications

115.1 Pending Verification for MA - Pregnant Women-Emergency

116 Information Reported During Application Processing

116.1 Information Received During Expedited Application Processing

120 Redeterminations

121 Notice of Redetermination/Certification Expiration

122 Processing Redeterminations

122.1 SNAP Redeterminations Following a Short Certification

122.1.1 Calculating the 30-Day Period After the Last Monthly Full Benefit

122.1.2 Determining the Date the Client Must File the Application for a Timely Redetermination Following a Short Certification

122.1.3 Missed Appointments Following a Short Certification

122.2 HHSC Delays in Processing All Timely Redeterminations

122.3 Delays Caused by Households

122.3.1 Denied for Missed Appointments

122.3.2 Denied for Failure to Provide Information/Verification

122.4 Medical Program Administrative Renewals

122.4.1 Automated Renewal Process

122.4.1.1 Verifications Required by Type Program for Renewals

122.4.1.2 Eligibility Outcomes

122.4.1.2.1 Determining if Verification Is Required for SNAP or TANF During an Adminstrative Renewal

122.4.1.3 Renewal Correspondence

122.4.2 Processing a Manual Renewal

122.4.2.1 When a Medical Program Renewal Form Is Not Returned

123 Processing Children's Medicaid Redeterminations

123.1 Children's Medicaid Redetermination Due Dates

123.2 Children's Medicaid Redetermination Processing Time Frames

123.3 Reuse of Form H1014-R After Denial

123.4 Eligibility Transition from Medicaid to CHIP

123.5 Processing a Redetermination for TP 45 - Transfer to TP 48

123.6 Children's Medicaid Redetermination Expectations

124 Processing Untimely Redeterminations

125 Processing Special Reviews

125.1 Due Dates

126 Processing Desk Reviews

130 Changes

140 Summary of Due Dates for Form H1020, Request for Information or Action

150 Avoiding Invalid Denials Related to Missing Information and Missed Appointments

160 SNAP Timeliness Charts for Applications and All Redeterminations

161 DataMart Reports

170 Documentation Requirements

200 Issuing Benefits

210 General Policy

220 Benefits

221 Types of Benefits

222 Issuing Methods

222.1 Mailing Addresses for Issuing Benefits

230 Electronic Benefit Transfer (EBT)

231 Establishing the Primary Cardholder (PCH)

231.1 When to Send a PCH Record

231.2 Establishing a PCH Record and an EBT Account

231.3 Sending a New PCH Record

231.4 Updating the PCH Record

232 Establishing a Secondary Cardholder

232.1 Secondary Cardholder Established by the Lone Star Help Desk

232.2 Secondary Cardholder Established by Issuance Staff

232.3 Secondary Cardholders Established by the Advisor

232.3.1 Secondary Cardholder Authorization by a Household Member Other than the PCH

232.3.2 Secondary Cardholder Authorization by the Advisor

233 Issuing a Lone Star Card

233.1 When to Reuse a Lone Star Card

233.2 Issuing Lone Star Cards for PCHs

233.2.1 Applicants Interviewed in the Office

233.2.2 Applicants Interviewed by Phone

233.2.3 Applicants Interviewed by Phone in a Location Different Than Interviewing Worker

233.2.4 Applicants Interviewed by Home Visit

233.3 Issuing Lone Star Cards to EBT Representatives

233.4 Issuing Lone Star Cards to Secondary Cardholders

233.5 Card Registration

233.5.1 Issuance Staff Procedures

233.5.2 Special Card Registration Procedures

234 Personal Identification Number (PIN) Selection and Issuance

234.1 Personal Identification Number (PIN) Selection and Issuance Procedures

234.2 Initial PIN Self-Selection Procedures

234.2.1 Initial PIN Self-Selection Procedures for TANF Protective and Representative Payees

234.3 Initial PIN Issuance Procedures for Clients with Barriers that Prevent PIN Self-Selection

234.4 PIN Security

235 Lone Star Card Replacement

235.1 Lone Star Card Replacement Procedures

236 PIN Replacement

236.1 PIN Replacement Procedures

237 Returned Lone Star Cards and PIN Packets

238 Erroneous PIN Entry

239 Client EBT Training Policy

239.1 Advisor Interview Requirements for Client Training

239.1.1 TANF Client Cash-Back Fee Policy

239.2 Issuance Staff Requirements for Client Training

240 Special Certification Situations

241 Applications Processed by Hospital-Based Advisors

242 Itinerant Advisor Site

242.1 Expedited Applications

242.2 Card/PIN Replacements

243 Centralized Benefit Services (CBS) Cases

243.1 Centralized Benefit Services (CBS) Case Changes

243.2 Initial Lone Star Card and PIN Issuance for New PCHs

243.3 Lone Star Card Replacement

243.4 PIN Replacement

244 Homeless

245 SNAP Applications Filed with the Social Security Administration (SSA)

250 EBT Benefit Issuance

251 Monthly Benefit Issuance Schedule

252 Benefit Issuance on Applications

253 Methods for Sending Benefit Records

254 Benefit Issuance When TIERS Is Unavailable

254.1 Priority Issuances

255 Priority Issuances Using the Administrative Terminal Application (ATA)

256 Discrepancies on Benefit Records Sent via the ATA

260 Administrative Terminal Application (ATA)

261 ATA Functions

261.1 Issuing a Lone Star Card and PIN or Enabling PIN Self-Selection

261.2 Creating a Cardholder Record

261.3 Splitting and Merging Primary Cardholder Records

261.3.1 Splitting Primary Cardholder Records

261.3.2 Merging Primary Cardholder Records

261.4 Updating a Primary Cardholder Record

261.5 Creating a SNAP Benefit Record

261.6 Performing ATA Inquiry

261.7 Changing an EDG Number

261.8 Requiring Card Registration or Registering a Lone Star Card

261.8.1 Requiring Card Registration

261.8.2 Registering a Lone Star Card

261.9 Reactivating a Lone Star Card

262 Reconciliation

262.1 Reconciliation Administrative Terminal Application (ATA) Benefit Records to Forms H1175

262.2 Reconciliation Benefit Records

262.3 Reconciliation ATA Card Issuances to Form H1172

262.4 TF-36, More Than One SNAP Benefit Authorized

262.4.1 Advisor Action on TF-36

262.5 TF-07E-01, EBT Reconciliation Exception

262.5.1 Advisor Action on TF-07E-01

263 Security

270 Management of Automation Processes

280 EBT Material Inventory/Distribution

281 Vendor-Produced Material

282 HHSC-Produced Training Material

300 Account Maintenance

310 General Policy

330 Cancelling Benefits

331 Cancelling Benefits in EBT Accounts

332 Cancelling Benefits Not Issued by EBT

340 Replacing Benefits

341 Replacement of Benefits Issued via EBT

341.1 Procedures for Replacing EBT Benefits

342 Non-Receipt of TANF Warrants

342.1 Procedures for Replacing TANF Warrants

342.1.1 Warrant Not Cashed

342.1.2 Warrant Cashed

343 Non-Receipt of One-Time Payments

343.1 Reissuing Grandparent Payments

343.2 Reissuing OTTANF Benefits

344 Destroyed Food

344.1 Procedures for Replacing Destroyed Food

350 Using Benefits Out of State

351 Moves Out of State

352 Households Shopping Out of State

353 Out-of-State Shopping (OSS) Reports

353.1 Advisor Action on OSS Report Activity

354 Card Replacements for Cardholders Who Are Out of State

360 Dormant Accounts

361 Dormant Account Policy

362 Advisor Action on Dormant Accounts

370 Expunged Benefits

371 Expungement Policy

372 Advisor Procedures for Expunged Benefits

380 EBT Problem Resolution

381 Retailer Inquiries

382 Client Inquiries

382.1 Client Problems Accessing Benefits

382.2 Balance Disputes

382.3 Client Problems with Retailers

382.4 Client Problems with an EBT Vendor

390 Documentation Requirements

400 Special Households

410 Students in Higher Education

411 General Policy

412 Student Eligibility Requirements

413 Ineligible Students

414 Work Registration

415 Documentation

420 Other Special Situations

421 Food Distribution Program on Indian Reservations (FDPIR)

421.1 Duplicate Participation

421.2 Intentional Program Violation (IPV)

421.3 Switching from FDPIR to SNAP

421.4 Switching from SNAP to FDPIR

421.5 Verification Requirements

421.6 Documentation Requirements

430 Households with Elderly Members or Members with a Disability

431 Definition of Elderly

432 Definition of Disability

432.1 Social Security's Criteria for Disability

433 Special Provisions for Households with Elderly Members or Members with a Disability

434 Verification Requirements

435 Documentation Requirements

440 Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities

441 Residents of Drug and Alcohol Treatment (D&A) Facilities

442 Residents of Group Living Arrangement (GLA) Facilities

443 HHSC Responsibilities

443.1 Advisor Responsibilities

443.1.1 Monitoring Facilities

443.2 Program Manager Responsibilities

444 Overview of Electronic Benefits Transfer (EBT) Processes for Residents of Drug and Alcohol Treatment/Group Living Arrangement (D&A/GLA) Facilities

445 D&A/GLA Facility Responsibilities as Authorized Representatives

445.1 Use of SNAP Benefits by Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities Which Serve as SNAP Authorized Representative (AR)

445.1.1 Account Access

445.1.2 Returning Lone Star Cards

445.1.3 Returning Unspent Benefits When a Resident Moves Out

445.1.4 Residents Moving Out Before the 16th of a Month

446 Application Processing for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities

446.1 New Resident (or Denied Resident with No Benefits in an Electronic Benefit Transfer [EBT] Account) Who Moves into a D&A/GLA Facility and Applies for SNAP

446.2 Resident Has an Active SNAP EDG (or a Denied-Ongoing SNAP EDG), No Benefits in the Food Account, and All SNAP Household Members Move into the D&A/GLA Facility

446.3 All Other Situations

447 Resident Moves Out of a Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility

448 Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility Replaces the Authorized Representative (AR)

449 Verification Requirements

450 Residents in Family Violence Shelters

451 Eligibility Requirements

452 Approved Centers That Provide Meals

452.1 Buying Meals

453 Authorized Representatives

454 Participation Twice in Same Month

454.1 Duplicate Participation Procedures

460 Prepared Meal Services

461 Communal Dining or Meal Delivery Services

462 Prepared Meals for Homeless

463 Advisor Responsibilities

464 EBT Coordinator Responsibilities

465 Matrix of Prepared Meals, Services, Households and Codes

466 Loss of SNAP Identification (ID) Card (Form H1803)

470 Categorically Eligible Households

471 Eligibility Criteria

472 Special Treatment for Households Meeting Categorical Eligibility Criteria

473 Application Processing

474 Centralized Benefit Services (CBS) Section

474.1 Programs Administered by CBS

474.1.1 SNAP Programs

474.1.1.1 SNAP-Supplemental Security Income (SSI) Caseload

474.1.1.2 Pending SNAP-SSI Redeterminations for Missing Information/Verification

474.1.1.3 SNAP-SSI Redeterminations – Inconsistent or Discrepant Information

474.1.1.4 SNAP-SSI Redetermination Denials

474.1.2 Medical Programs

474.2 Conversion of EDGs

474.3 Methods of Reporting Changes

474.4 Reserved

474.5 Replacement of Lone Star Cards/PINs/Medical Care IDs

474.6 Moving Cases Out of CBS

474.6.1 Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs)

474.7 Denied EDGs

474.8 Opportunity to Register to Vote

475 Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP)

475.1 Overview

475.2 Application Processing

475.2.1 Identifying Intentional Program Violations (IPVs) and Felony Drug Convictions

475.2.2 Switching from the Regular SNAP Program to SNAP-Combined Application Project (CAP)

475.3 Household Composition

475.4 Income

475.5 Shelter and Utility Expenses

475.6 Changes

475.7 Issuing Benefits

475.8 Fair Hearings

475.9 Claims

475.10 Redeterminations

475.10.1 Opting Out of SNAP-CAP

476 Joint Supplemental Security Income (SSI)-SNAP Applications

476.1 Applications Filed in the Social Security Office

476.1.1 Expedited Service

476.1.2 Work Registration

476.1.3 Special Review

476.1.4 Notice of Expiration

476.1.5 Reporting Changes

476.1.6 Redetermination

476.2 Applications Filed in Public Institutions

480 A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20

481 EDGs That Include an Other-Related Child

481.1 At Initial Certification

481.2 Before a TANF or TANF-SP EDG Is Denied

482 Separating Household Members

490 Determining Whether an Individual Who Resides in a Facility Is Institutionalized

491 Documentation Requirements

500 Reserved

600 Changes

610 General Policy

620 Reporting Requirements

621 What to Report

622 When to Report

623 How to Report

623.1 Determining Whether New Income Information Is a Reported Change

624 Receipts for Reported Changes

630 Processing Requirements

631 Actions on Changes

631.1 Multiple Changes

631.2 Actions on Office of Inspector General (OIG) Match Action Alert Changes

632 Mass Changes

633 Changes in Eligibility Test

634 Changes in SNAP EDGs Jointly Processed with Supplemental Security Income (SSI)

635 Shortening Certification Periods as a Result of a Change

636 Change in Head of Household

637 Periodic Income Checks

640 Changes Affecting Benefits

641 Additions to the Household

641.1 Adding Newborns to the Case

641.2 Steps for Adding New Members

641.3 Adding Disqualified Members

642 Changes Increasing Benefits (Other than Additions to the Household)

642.1 Verification Provided Timely

642.2 Verification Not Provided Timely

643 Changes Decreasing Benefits

650 Correcting Incorrect Information

651 Correction Request

652 Action on Denied EDGs or During the Last Month of Certification and the Client Has Not Reapplied

653 Different Review Process

660 Documentation Requirements

700 Claims

710 General Policy

711 Types of Overpayment Claims

720 When to File an Overpayment Referral

730 How to File an Overpayment Referral

740 Texas Works Responsibilities

741 Texas Works Action on Agency Errors

742 Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV)

750 Office of Inspector General (OIG) Responsibilities

751 Office of Inspector General (OIG) Investigation Staff

752 Determining Claim Amounts

752.1 Determining the First Month of Overpayment

752.1.1 Errors at Certification

752.1.2 Errors After Certification

753 Establishing Claims

753.1 Identifying Liable Members

753.2 Demand Letters

753.3 Claim Disposition

760 Fiscal Management Services (FMS) Responsibilities

761 Claims Collection

761.1 Recoupment

761.1.1 Action on Recoupment Cases

761.1.2 Recoupment Hierarchy

761.1.3 Recoupment Amount

761.2 Restitution

761.2.1 Action on Restitution Cases

761.2.2 Restitution Amount

762 Action on Receipt of Payments

763 Debit of SNAP EBT Accounts

763.1 One-Time Debit of an Active EBT Account

763.2 Debit of a Dormant EBT Account

763.3 Monthly Debit of an Active EBT Account

763.4 Offset Expunged Benefits

764 Fair Hearings

770 Filing an Overpayment Referral

771 Filing an Overpayment Referral Using Automated System for the Office of Inspector General (ASOIG)

772 Filing an Overpayment Referral Using TIERS

780 Documentation Requirements

800 Restored Benefits

810 Entitlement to Restored Benefits

820 Time Frames for Qualifying for Restored Benefits

830 How to Determine the Amount of Restored Benefits

831 Procedures for Counting Restored Benefits Toward a Claim

832 How to Verify a Claim Amount

840 Notice to the Household

850 Disputed Benefits

860 Method of Restoration

870 Changes in Household Composition

880 Procedure for Authorizing Restored Benefits

890 Documentation Requirements

900 Referrals for Intentional Program Violation (IPV)

910 General Policy

911 Elements of an IPV

912 IPV Disqualification Penalties

920 When to File an IPV Referral

930 How to File an IPV Referral

940 Texas Works (TW) Responsibilities

941 Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification

942 Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification

943 Expiration of an IPV Disqualification Penalty

944 Reinstatement of an IPV Disqualified Person

945 Request for New Administrative Disqualification Hearing (ADH)

950 OIG Responsibilities

951 Facts Do Not Support an IPV

952 Facts Support an IPV

953 Enforcement of IPV Disqualification

953.1 Notice of an IPV Disqualification

953.2 Imposing an IPV Disqualification

953.3 Amendment of IPV Disqualification Penalties

960 Fiscal Management Services (FMS) Responsibilities

961 IPV Claim Collection

970 HHSC Employee Fraud

980 Documentation Requirements

1000 Fair Hearings

1010 Right to Appeal

1020 Time Period for Requesting Fair Hearing

1030 Appeals Procedures

1031 Local Office Procedures for Hearing Requests

1031.1 Office of Attorney General (OAG) Child Support Division Region Contacts

1031.2 Providing Form H4800-A, Fair Hearing Request Summary (Addendum), to Hearings Division

1032 Centralized Representation Unit (CRU)

1032.1 Centralized Representation Unit (CRU) Staff Responsibilities

1033 Appeals Related to Decisions/Actions of an Electronic Benefit Transfer (EBT) Vendor

1034 Appeals Related to Services for Medicaid Recipients

1035 Appeals Related to Accounts Receivable Tracking System (ARTS)

1040 Timely Action on Fair Hearings

1041 Completing and Reporting Timely Action on Fair Hearings

1050 Handling of Benefits During the Appeal Process

1051 Continued Benefits

1052 Waiver of Continued Benefits

1053 Reducing or Ending Benefits Before the Hearing Decision

1054 Time Frame to Stop Providing Continued Benefits

1060 Fair Hearings Held by Telephone

1070 Administrative and Judicial Reviews

1071 Administrative Review

1071.1 Centralized Representation Unit (CRU) Staff Responsibilities Following an Administrative Review

1072 Judicial Reviews

1072.1 Agency Staff Responsibilities Following a Judicial Review

1080 Verification Requirements

1090 Documentation Requirements

1100 Reserved

1200 Confidentiality

1210 Disclosure of Information

1211 Reporting Abuse and Neglect

1212 Personal Representatives

1212.1 Adults and Emancipated Minors

1212.2 Unemancipated Minors

1212.3 Deceased Individuals

1213 Establishing Identity for Contact Outside the Interview Process

1213.1 Telephone Contact

1213.2 In-Person Contact

1220 Specific Information That May Be Released

1230 Releasable Information for Medicaid Providers and Their Contractors

1240 Preventing Disclosure of Information

1241 Destruction of Confidential Material

1250 Reporting Unauthorized Inspection or Disclosure of Social Security Administration (SSA)-Provided Information

1260 Verification Requirements

1270 Documentation Requirements

1300 Nondiscrimination

1310 Nondiscrimination Policy

1320 Racial and Ethnic Data Collection

1400 Complaints

1410 Discrimination Complaints

1420 Office of the Ombudsman

100 Income Limits and Proration Charts

110 TANF

111 Income Limits

112 How to Prorate TANF Grants

112.1 Proration Multiplier Chart

120 Supplemental Nutrition Assistance Program (SNAP)

121 Maximum Income Limits

121.1 Deduction Amounts

122 How to Determine Monthly SNAP Allotments

123 How to Prorate Benefits

130 Medical Programs

131 Income Limits

131.1 Federal Poverty Income Limits (FPIL)

131.2 Medically Needy and Parents and Caretaker Relatives Medicaid

131.3 Transitional Medicaid

131.4 Standard MAGI Income Disregard

131.5 IRS Monthly Income Thresholds

200 Opening, Denial, and Reinvestigation Codes (Retired)

210 TANF Codes

211 Opening Codes

212 Denial Codes

213 Reinvestigation Codes

220 Supplemental Nutrition Assistance Program (SNAP) Codes

221 Denial Codes

230 Medical Programs Codes

231 Opening Codes

232 Denial Codes

233 Reinvestigation Codes

240 Expanded Denial Code Reference Charts

241 TANF and Medical Programs Chart

242 SNAP Chart

300 County Charts

310 Full and Minimum Service Choices Counties by Region

320 TANF State Time Limit County Hardship Lists

321 Current TANF State Time Limit County Hardship List

322 Previous TANF State Time Limit County Hardship Lists

330 SNAP ABAWD Work Requirement Waiver Counties

331 Current SNAP ABAWD Work Requirement Waiver Counties

332 Previous SNAP ABAWD Work Requirement Waiver Counties

340 SNAP Employment and Training Counties

341 SNAP Non-Employment and Training Counties

350 County Lists

400 Reserved

500 Form H1000-A, Form H1000-B and Form H1000-C Instructions (Retired)

510 General Information

511 Form H1000-A

512 Form H1000-B

520 Form H1000-A and Form H1000-B Completion Instructions

520.1 Section I, Items 01 - 31

520.2 Section II, Items 32 - 39

520.3 Section III, Items 40 - 50

520.4 Section IV, Items 51 - 59

520.5 Section V, Items 60 - 77B

520.6 Section VI, Items 78 - 110

520.7 Section VII, Items 111 - 126

520.8 Section VIII, Items 127 - 152

520.9 Section IX, Items 153 - 160

520.10 Section X, Items 161 - 178

520.11 Section XI, Items 179 - 187

520.12 Section XII

520.13 Section XIII

520.14 Section XIV, Items 188 - 191

530 Form H1000-C, Secondary Client Input Instructions

530.1 Section I, Items 01 - 07

530.2 Section II, Items 201 - 213

530.3 Section III, Items 214 - 215

530.4 Section IV, Items 216 - 223

530.5 Section V

540 Code Summary

600 Form H1000-A and Form H1000-B Entries (Retired)

610 General Information

620 Certification Entries

621 Minimum Entries for Certification

621.1 TANF Minimum Entries

621.2 SNAP Minimum Entries

621.3 Minimum Entries for Medical Programs

621.3.1 TP 45 Minimum Entries

622 Entries for Three Months Prior

622.1 Three Months Prior Medicaid – Currently Eligible – No Gap in Coverage

622.2 Three Months Prior Entries for a Medically Needy Case

623 Entries for Open and Close Certifications

623.1 TP 04, Medical Assistance Only – Deceased

623.2 TP 11, Three Months Prior Medical Assistance – Not Currently Eligible; Gap in Coverage; or Reopened Applications

623.3 Simultaneous Open and Close for TANF

623.4 Simultaneous Open and Close for Medical Programs

624 Entries for Reinstatements

624.1 TANF

624.2 SNAP

624.3 TP 07/20 (Four, 12, or 18 Months Medicaid) for a Case Previously Denied in Error

624.4 TP 37 (12 or 18 Months Medicaid) for a Case Previously Denied in Error

624.5 Reinstatement for Post Medicaid (TP 20), Transitional Medicaid (TP 07 or 37), or TP 29

625 Miscellaneous Certification Entries

625.1 Certifying Benefits for the Month After Certification

625.2 Certifying a TP 29 Case

625.3 Independent Child as the Case Name When a Representative from a Child Care Facility Applies for the Child

630 Entries for Actions Taken During the Certification Period

631 Entries for Case Name Changes

631.1 Case Name Changes with Same Household Members

631.2 Case Name Changes When Head of Household Leaves

632 Entries for Households Becoming Eligible for SSI

632.1 TANF Caretaker Becomes Eligible for SSI

632.2 TANF Child Becomes Eligible for SSI

633 Entries for Adjusting Certification Periods

633.1 Extending the Certification Period of an Active SNAP Case

633.2 Shortening the Certification Period of an Active SNAP Case

634 Miscellaneous Action Entries

634.1 Death of an Active Client

634.2 Canceling a Previous SNAP Issuance

634.3 Households with Disqualified Members

634.3.1 Households with Members Disqualified for Citizenship, or 18-50 Work Requirement, or Noncompliance with SSN Requirements

634.3.2 Households with Members Disqualified for SNAP Employment Services Noncompliances, Felony Drug Convictions, Refusing to Cooperate with the Quality Control Process, or Being a Fugitive

634.4 Reinstating a Person Disqualified for Intentional Program Violation When the Disqualification Expires

634.5 Reporting Increases in Household Composition with More than 11 Persons

634.6 Change of Payee or Caretaker

634.7 Three Months Prior Medicaid – No Gap in Coverage on an Active Case

634.8 Entering the 90% Earned Income Deduction and Child Care to Ensure Automatic Removal of the Deduction

640 Denial Entries

641 Denial of a TANF/Medical Programs Application

642 Denial of a SNAP Application

643 Hold Code 5 Actions Pending Automatic Grant Denial

644 Denial of an Active Case Because of Failure to Comply with Employment Services

700 Reserved

800 Automated Support Systems

810 Texas Integrated Eligibility Redesign System (TIERS)

811 Case Number and Eligibility Determination Group (EDG) Number

812 Individual Number

813 Hierarchy of Individual Identification Data

814 Merge and Separate

815 TIERS Case Modes

815.1 Case Mode Definitions

816 Case Mode Hierarchy

817 Electronic Data Sources (ELDS)

820 Data Broker

821 Access Permission

822 Data Broker Passwords

823 Login Procedures – Stand-alone System

823.1 Online Help Feature

824 Permissible Purpose

825 Reports Not Subject to Permissible Purpose

825.1 Driver License Information

825.2 Persons at Entered Address

825.3 Neighborhood Address Search

825.4 Out-of-State Shopping (OSS) Report

825.5 Texas Vehicle

825.6 Social Security Administration (SSA) Death Index

825.7 Property Value

825.8 Telephone Number

825.9 Texas Marriage and Divorce

825.10 Texas Criminal Convictions

825.11 The Work Number

825.11.1 Using The Work Number as Verification

825.12 Employer New Hire Report (ENHR) and National Directory of New Hires (NDNH) Report

825.13 Texas Workforce Commission (TWC) Wages/Benefits

825.13.1 TWC Error Messages

825.14 Office of the Attorney General (OAG) Child Support

825.14.1 OAG Child Support Data

825.14.2 OAG Error Messages

825.15 SNAP Out-of-State IPV Disqualifications

825.16 Alien Status/Systematic Alien Verification for Entitlements (SAVE)

825.16.1 Alien Status Historical Data

825.16.2 Alien Status Initial Verification

825.17 Inmate/Parolee Match

826 Entry Instructions

826.1 Requesting Data Broker Reports in the Stand-alone System

826.2 Requesting Data Broker Reports in TIERS

827 Data Broker Combined Reports

827.1 Combined Report Without Credit Report Sources

827.1.1 Combined Report With Credit Report Sources

827.1.2 Confirmation Information – Credit Header

827.1.3 Special Messages

827.1.4 Credit Summary

827.1.5 Active and Inactive Accounts

827.1.6 Lender Information

827.1.7 Client Income

827.1.8 Inquiries for New Credit

828 Retention of Data Broker Reports and Providing Copies

829 Case Actions

830 Child Support Systems

831 Grant in Jeopardy Process

832 Office of the Attorney General (OAG) Inquiry

832.1 Accessing Texas Child Support Enforcement System (TXCSES)

832.2 TXCSES Menu Screens

832.3 Exiting TXCSES

833 TXCSES Web Child Support Portal Inquiry

833.1 Requesting Access to TXCSES Web

833.2 Logging On to TXCSES Web

833.3 Procedures for Obtaining Payment Information

833.4 Logging Off of TXCSES Web

834 Child Support Noncooperation (CSNC) Online System

834.1 Requesting Access to CSNC

834.2 CSNC Passwords

834.3 Logging on to CSNC

834.4 Procedures for Requesting CSNC Data

834.5 CSNC Field Descriptions

834.6 Exiting CSNC

840 DataMart

841 DataMart Reports

850 One-Time Grandparent Payment System

851 Sign-On Screen

851.1 GPS Application Access

852 GPS Inquiry Screen

852.1 Case Inquiry

852.2 Client Inquiry

860 Birth Verification System

861 Accessing BVS in TIERS

861.1 BVS Field Entries and Descriptions

870 Other Systems

871 Wire Third-Party Query (WTPY)

872 Accessing Wire Third-Party Query (WTPY)

873 Texas Works Automated Systems Problem Reporting Guide

900 Verification and Documentation

910 Required Verification

911 Required Verification for TANF

912 Required Verification for SNAP

913 Required Verification for Medical Programs

920 Questionable Information

930 Providing Verification

931 Household Responsibility for Providing Verification

932 Advisor Responsibility for Verifying Information

940 Documentation

941 Texas Works Documentation Guide

1000 Procedures for Clearance of Income and Eligibility Verification System (IEVS) Reports and Internal Revenue Service (IRS) Federal Tax Information (FTI)

1010 Clearance of IEVS Reports by the Office of Inspector General (OIG) that Do Not Include IRS FTI

1011 OIG IEVS Process

1012 Review the Case Record

1013 Request Verification

1014 Non-IRS FTI IEVS Income Action Messages

1020 Clearance of IEVS Reports by Texas Works Staff that Do Not Include IRS FTI

1021 Regional IEVS Coordinator

1022 Non-IRS FTI IEVS Action Message Clearance Process

1023 TP 40 and Children's Medicaid Clearance Process

1024 Client Reapplies

1025 Appeals

1026 Non-IRS FTI IEVS Information Message Clearance Process

1030 Clearance of IEVS Reports by OIG that Includes IRS FTI

1031 OIG Procedures

1032 Review Case Record

1033 Request Verification

1034 Types of IRS FTI Action/Information Messages

1040 Clearance of IEVS Reports by Texas Works that Includes IRS FTI

1041 Regional IEVS Coordinator

1042 IRS FTI IEVS Action Message Clearance Process

1043 Client Reapplies

1044 Appeals

1050 Additional IRS FTI Sources and Security Issues

1051 Retention and Distribution of IRS FTI

1052 Discovery of Existing IRS FTI in HHSC Offices and Records

1053 Purging Records

1060 Reporting a Security Incident Regarding Internal Revenue Service (IRS) Federal Tax Information (FTI)

1100 Other/Miscellaneous

1110 Medical Information

1111 State Medicaid Agencies

1112 Services Under the Texas Medical Assistance Program

1113 Qualified Hospital/Qualified Entity Policy and Procedures for Presumptive Eligibility Determinations

1113.1 Eligible Groups

1113.2 Household Composition

1113.3 Modified Adjusted Gross Income (MAGI) Methodology

1113.4 Verifications

1113.5 Medical Effective Dates

1113.6 Periods of Presumptive Eligibility

1113.7 Three Months Prior Coverage

1113.8 Application Processing

1113.9 Due Dates and Processing Time Frames

1113.10 How to Become a Qualified Hospital or Qualified Entity

1113.11 Presumptive Eligibility Forms

1114 Guidelines for Providing Retroactive Coverage for Children and Medical Programs

1115 Immunization Terms

1116 Managed Care Plans

1117 Texas Health Steps (THSteps) Quick Reference Guide and Recipient Enrollment Script

1118 Health Care Orientation Quick Reference Guide and Enrollment Script

1120 IRS Tax Code

1130 Electronic Benefit Transfer (EBT) Charts and Guides

1131 Advisor Guide for Explaining EBT

1132 Issuance Staff Guide for EBT Issuance and Client Training

1140 TANF and SNAP Overpayment Determination Chart

1141 Timely Reported

1142 Untimely Reported

1150 Type Programs (TP) and Type Assistance (TA)

1200 Reserved

1300 Reserved

1400 Reference

1410 Legal Aid

1420 SSA Claim Number Suffixes

1430 SNAP Allotment Charts

1431 Whole Monthly Allotments by Household Size

1432 Prorated SNAP Allotments by Application Date

1440 Relationship Charts

1441 Guide for Determining Relationship

1442 Guide for Determining Extended Relationships

1450 Guidelines for Clearing Quality Control (QC) Findings

1451 Dropped — Subject to Review but Not Completed

1452 Dropped — Not Subject to Review

1453 Completed QC Reviews

1454 Reapplying for Benefits after a Quality Control Penalty

1455 Frequently Asked Questions

1460 Helpful Toll-Free Numbers

1470 Eligibility Environments

1471 Specialized and Centralized Casework Units

Other Medical Programs

100 Overview

110 General Policy

120 Eligibility Qualifications

121 Children's Health Insurance Program (CHIP)

122 CHIP Perinatal

122.1 Post-Birth Eligibility Determination

122.2 Notification of Birth

200 Application Processing

210 Application Procedures

211 Application Assistance

212 Applications Received by Fax, Email, Mail or Internet

213 Applications Received by Telephone

214 Withdrawal of an Application

215 Authorized Representatives (AR)

220 Reopening an Application

230 Application Processing Time Frames

231 CHIP Perinatal Application

231.1 Minor Pregnant Women with Potential Medicaid Eligibility

240 Missing Information Processing for Applications

300 Household Composition

310 Certified Group

320 Budget Group

321 Who Is Included

322 Who Is Not Included

323 Minor Parent Situations

330 Joint Custody

340 Children in State Hospitals

400 Citizenship and Alien Status

410 General Policy

420 Citizenship

430 Immigration/Alien Status

440 Verification

441 Citizenship

441.1 Reasonable Opportunity to Provide Citizenship and Alien Status Verification

441.2 Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship

442 Using Systematic Alien Verification for Entitlements (SAVE) Program to Verify Alien Status

500 Social Security Number

510 Social Security Enumeration

520 Verification Sources

600 Identity

610 General Policy

611 Application

612 Renewals

620 Verification Requirements

630 Documentation Requirements

700 Residency

710 General Policy

800 Child Support

810 General Policy

900 Resources

910 General Policy

1000 Income

1010 General Policy

1020 Income Limits

1030 Types of Income

1040 Reserved

1050 Calculating Household Income

1051 Income Frequency

1052 Terminated Income

1053 Budget Months

1060 Verification Requirements

1061 Verification Sources

1070 Documentation Requirements

1100 Deductions

1110 General Policy

1120 Reserved

1130 Verification Requirements

1131 Verification Sources

1140 Documentation Requirements

1200 Third-Party Resources

1210 Health Insurance

1300 Case Disposition

1310 General Policy

1320 Notice of Decision

1330 Correspondence Processing

1400 Changes

1410 General Policy

1420 Reporting Requirements

1421 How to Report

1422 Receipts for Reported Changes

1430 Processing Requirements

1431 Address Change Processing

1432 Moves

1433 Household Composition Changes

1433.1 Adding a New Child

1433.2 Child Leaves the Home

1433.3 Child Institutionalized

1433.4 Head of Household

1434 Demographic Changes

1435 Pregnancy Reports

1436 Income and Deduction Changes

1437 Third Party Resources Changes

1500 Six-Month Income Check

1510 General Information

1600 Redeterminations

1610 General Policy

1620 Notice of Expiration

1621 Redetermination Reminder Notifications

1630 Timely Redeterminations

1631 Redetermination Processing Time Frames

1632 Changes Reported at Redetermination

1632.1 New Head of Household

1632.2 Health Insurance

1633 Missing Information

1634 Redetermination Application Complete

1634.1 Missing Enrollment Fee

1635 Redetermination Applications Potentially Eligible for Medicaid

1700 Enrollment

1710 General Information

1720 Enrollment Process

1721 Enrollment Packets

1722 Children with Special Health Care Needs

1723 Selecting a Health Plan

1723.1 Enrollment Reminder Notification

1723.2 Missing Information Processing for Enrollment Forms

1723.3 Address Change While Pending Enrollment

1723.4 Enrollment and Non-Sufficient Funds

1723.5 Coverage Start Dates

1723.5.1 Coverage Start Date for Adding a Child

1723.6 Good Cause Exemptions for Children Subject to the 90-day Waiting Period

1723.6.1 CHIP Good Cause and Account Transfers

1730 Continuous Enrollment Period

1731 Exceptions to the Continuous Enrollment Period

1732 Pregnant Members Aging Out of CHIP

1740 Health Plan Change

1741 Plan Change During Current Enrollment Segment

1742 Plan Change at Redetermination

1743 Redetermination Indicates a Change of Address

1750 Dental Benefits

1751 Dental Providers

1760 Disenrollment

1761 Involuntary Disenrollment

1762 Health Plan Request to Disenroll a Member

1800 Cost Sharing

1810 General Information

1820 Enrollment Fees

1821 Enrollment Fees at Application

1821.1 Change During the Enrollment Process

1822 Enrollment Fees at Redetermination

1822.1 Request for Review and Continued Benefits

1823 Enrollment Fee Payment Processing

1824 Refunds

1830 Copayment Requirements

1840 Cost Sharing Cap Amounts

1841 Cost Sharing Processing

1842 Cost Sharing Re-Evaluation

1900 Complaints and Request for Review

1910 CHIP Complaint Process

1920 Request for Review

1921 Request for Review Processing

2000 Confidentiality

2010 General Policy

2011 Community Based Organizations

2012 Providers and Health Plans

2013 Federal and State Executive and Legislative Officials

2014 Teacher Retirement System (TRS)

2020 Health Insurance and Portability Accountability Act (HIPAA)

2100 Reserved for Future Use

2200 Reserved for Future Use

2300 Forms

2400 Glossary

2410 Glossary Listing

100 Application Processing

110 Medicaid for Former Foster Care Children (FFCC)

111 Type of Assistance (TA) 82 – Medical Assistance – FFCC

112 Application Processing

113 Requesting an Application

114 Authorized Representatives (AR)

120 Office Procedures

121 Filing an Application

122 File Date

130 Interviews

131 General Policy

200 Household Composition

210 General Policy

220 Verification Requirements

300 Citizenship

310 General Policy

320 Verification Requirements

400 Social Security Number (SSN)

410 General Policy

500 Age

510 General Policy

520 Verification Requirements

530 Documentation Requirements

600 Relationship

700 Identity

710 General Policy

800 Residence

810 General Policy

900 Adequate Health Coverage (Third-Party Resource)

910 General Policy

920 Verification Requirements

1000 Medicaid Eligibility

1010 General Policy

1011 Three Months Prior Coverage

1012 Types of Coverage

1100 Domicile

1200 Deprivation

1300 Child Support

1400 Resources

1500 Income

1600 Deductions

1700 School Enrollment

1800 Management

1900 Reminders

1910 General Policy

1920 Documentation Requirements

2000 Case Disposition

2010 Notice to Applicants

2020 Length of Certification

2030 Setting Special Reviews

2040 Adverse Action

2100 Processing Time Frames

2110 Applications

2120 Deadlines

2130 Missed Interviews

2140 Pending Information on Applications

2150 Notice of Renewal/Expiration

2160 Processing Renewals

2161 How to Process a Renewal

2161.1 Automated Renewal Process

2161.1.1 Verifications Required for Renewals

2161.1.2 Eligibility Outcomes

2161.1.3 Renewal Correspondence

2161.2 Processing a Manual Renewal

2161.2.1 When a Renewal Form Is Not Returned

2161.2.2 Information or Renewal Form Returned After Termination

2170 Renewal Time Frames

2180 Pending Information

2181 Summary of Due Dates for Form H1020, Request for Information or Action

2200 Changes

2210 How to Report a Change

2220 Action on Changes

2300 Fair Hearings

2310 Appeals Procedures

2400 Automated Support

2410 Electronic Data Sources (ELDS) and Data Broker

100 Application Processing

110 Application Procedures

111 Type of Assistance (TA) 77 – Health Care – FFCHE

112 Application Processing

113 Requesting an Application

114 Authorized Representatives (AR)

120 Office Procedures

121 Filing an Application

122 File Date

130 Interviews

131 General Policy

200 Household Composition

210 General Policy

220 Verification Requirements

300 Citizenship

310 General Policy

400 Social Security Number (SSN)

410 General Policy

500 Age

510 General Policy

520 Verification Requirements

530 Documentation Requirements

600 Relationship

700 Identity

710 General Policy

800 Residence

810 General Policy

900 Adequate Health Coverage (Third-Party Resource)

910 General Policy

920 Verification Requirements

930 Documentation Requirements

1000 Eligibility Begin Dates

1010 General Policy

1011 Types of Coverage

1100 Domicile

1200 Deprivation

1300 Child Support

1400 Resources

1500 Income

1600 Deductions

1700 School Enrollment

1710 General Policy

1720 Verification Requirements

1730 Documentation Requirements

1800 Management

1900 Reminders

1910 General Policy

1920 Documentation Requirements

2000 Case Disposition

2010 Notice to Applicants

2020 Length of Certification

2030 Setting Special Reviews

2040 Adverse Action

2100 Processing Time Frames

2110 Applications

2120 Deadlines

2130 Missed Interviews

2140 Pending Information on Applications

2150 Notice of Renewal/Expiration

2160 Processing Renewals

2161 How to Process a Renewal

2170 Renewal Time Frames

2180 Pending Information

2181 Summary of Due Dates for Form H1020, Request for Information or Action

2200 Changes

2210 How to Report a Change

2220 Action on Changes

2300 Request for Review

2310 Request for Review Procedures

2400 Automated Support

2410 Data Broker

100 Application Processing

110 Medicaid for Transitioning Foster Care Youth (MTFCY)

111 Type of Assistance (TP) 70 – Medical Assistance – MTFCY

112 Application Processing

113 Requesting an Application

114 Authorized Representatives (AR)

120 Office Procedures

121 Filing an Application

122 File Date

130 Interviews

131 General Policy

200 Household Composition

210 General Policy

220 Verification Requirements

300 Citizenship

310 General Policy

400 Social Security Number (SSN)

410 General Policy

500 Age

510 General Policy

520 Verification Requirements

530 Documentation Requirements

600 Relationship

700 Identity

710 General Policy

800 Residence

810 General Policy

900 Adequate Health Coverage (Third-Party Resource)

910 General Policy

920 Verification Requirements

930 Documentation Requirements

1000 Medicaid Eligibility

1010 General Policy

1011 Three Months Prior Coverage

1012 Types of Coverage

1100 Domicile

1200 Deprivation

1300 Child Support

1400 Resources

1500 Income

1510 General Policy

1600 Deductions

1610 General Policy

1700 School Enrollment

1800 Management

1900 Reminders

1910 General Policy

1920 Documentation Requirements

2000 Case Disposition

2010 Notice to Applicants

2020 Length of Certification

2030 Setting Special Reviews

2040 Adverse Action

2100 Processing Time Frames

2110 Applications

2120 Deadlines

2130 Missed Interviews

2140 Pending Information on Applications

2150 Notice of Renewal/Expiration

2160 Processing Renewals

2161 How to Process a Renewal

2170 Renewal Time Frames

2180 Pending Information

2181 Summary of Due Dates for Form H1020, Request for Information or Action

2200 Changes

2210 How to Report a Change

2220 Action on Changes

2300 Fair Hearings

2310 Appeals Procedures

2400 Automated Support

2410 Data Broker

100 General Policy

110 Introduction

120 Definitions

200 Application Processing

210 Introduction

220 Office Procedures

221 Filing an Application

222 Authorized Representatives (AR)

230 File Date

240 Interview

250 Application Processing Time Frames

251 Applications

252 Deadlines

253 Missed Appointments

254 Pending Information on Applications

255 Pending Information

255.1 Summary of Due Dates for Form H1020, Request for Information or Action

300 VolAgs/Sponsors

310 Introduction

320 When Contact Is Required

400 Household Composition

410 General Policy

420 Children Born to a Woman Certified for Refugee Medical Assistance (RMA)

430 Marriage to a U.S. Citizen

440 Marriage to an Ineligible Refugee

500 Refugee Status

510 General Policy

511 Refugee

512 Amerasians

512.1 Children Born in the Philippines to an Amerasian Mother

513 Cuban/Haitian Entrants

514 Asylees

515 Victims of Severe Trafficking

515.1 Family Members of Victims of Severe Trafficking

516 Afghan and Iraq Aliens with Special Immigrant Status

516.1 How to Verify Acceptable Refugee Status

517 Special Immigrant Juvenile (SIJ)

520 Ineligible Statuses

530 Date of Legal Entry

600 Social Security Number

700 Age/Relationship

800 Identity

900 Residence

1000 Medicaid Eligibility

1010 Medical Eligibility Date

1020 Types of Coverage

1021 Fee-for-Service

1022 Managed Care

1030 Medicaid Termination

1040 Texas Health Steps

1050 Third-Party Resources (TPR)

1060 Prior Medicaid Coverage

1100 Domicile

1200 Deprivation/Child Support

1300 Resources

1400 Income

1410 General Policy

1420 Budgeting Income at Application

1421 Process for Adding New Household Members

1430 Continuous RMA Coverage

1500 Management

1600 Deductions

1700 Medicaid Identification (Med ID)

1800 Changes

1900 Case Disposition

1910 Notice to Applicants

1920 Length of Certification

1930 Adverse Action

2000 Eight-Month Limit Chart

2100 Local Refugee Voluntary Agency (VolAg) Offices

2200 Fair Hearings

2210 Appeals Procedures

2300 Automated Support System

2310 Data Broker

100 Application Processing

110 Texas Women's Health Program (TWHP)

111 Type of Assistance (TA) 41 – Health Care – TWHP

112 Application Procedures

113 Requesting an Application

120 Office Procedures

121 Filing an Application

122 File Date

123 Faxed Applications

130 Interviews

131 General Policy

200 Household Composition

210 General Policy

211 Budget Group

212 Certified Group

220 Verification Requirements

300 Citizenship

310 General Policy

400 Social Security Number (SSN)

410 General Policy

500 Age

510 General Policy

520 Verification Requirements

530 Documentation Requirements

600 Relationship

610 General Policy

620 Verification Requirements

630 Documentation Requirements

700 Identity

710 General Policy

800 Residence

810 General Policy

900 Health Care Eligibility

910 General Policy

911 Current Medicaid, Medicare (Part A or B) and Children's Health Insurance Program (CHIP) Recipients

912 Sterile Women

913 Pregnant Women

914 Third-Party Resource (TPR)

920 Verification Requirements

930 Documentation Requirements

1000 Domicile

1010 General Policy

1020 Verification Requirements

1100 Deprivation

1200 Child Support

1300 Resources

1310 General Policy

1400 Income

1410 General Policy

1411 Types of Income

1411.1 Disability Benefits

1411.1.1 Agent Orange Settlement Payments

1411.1.2 Disability Insurance Benefits

1411.1.3 Radiation Exposure Compensation Act Payments

1411.1.4 Worker’s Compensation

1411.2 Education and Training

1411.2.1 Educational Assistance

1411.2.2 Job Training

1411.2.2.1 Workforce Innovation and Opportunity Act (WIOA)

1411.2.2.2 Other Job Training and Training Allowances

1411.3 Employment and Self-Employment Income

1411.3.1 Children’s Earned Income

1411.3.2 Contractual Earnings

1411.3.2.1 Monthly Budgeting of Contractual Earnings

1411.3.3 Military Pay and Allowances

1411.3.3.1 Family Subsistence Supplemental Allowance (FSSA)

1411.3.3.2 Combat (Hazardous Duty) Payments

1411.3.4 Self-Employment

1411.3.4.1 Types of Self-Employment Income

1411.3.4.2 Property Income

1411.3.4.3 Noncommercial Roomer/Boarder Payments

1411.3.5 Wages, Salaries, Commissions and Tips

1411.3.5.1 Federal Tax Refunds and Earned Income Tax Credits (EIC)

1411.3.5.2 Flexible Fringe Benefits

1411.3.5.3 Income from Tips

1411.3.5.4 Vacation Pay

1411.3.6 Temporary Census Income

1411.4 Government Payments

1411.4.1 Adoption Assistance

1411.4.2 Crime Victim’s Compensation Payments

1411.4.3 Government Disaster Payments

1411.4.4 Government Housing Assistance

1411.4.5 Transitional Living Allowance

1411.4.6 In-Home and Family Support Program (IH/FSP) Payments

1411.4.7 National and Community Services Act (NCSA)

1411.4.8 Native and Indian Claims

1411.4.9 Nutrition Programs

1411.4.10 One-Time Grandparent Payments

1411.4.11 One-Time Temporary Assistance for Needy Families (OTTANF)

1411.4.12 Payments to Vietnam Veterans’ Children

1411.4.12.1 Payments to Vietnam Veterans’ Children Born with Spina Bifida (Public Law 104-204)

1411.4.12.2 Payments to Children of Women Vietnam Veterans Born with Certain Birth Defects (Public Law 106-419)

1411.4.13 Payments to Victims of Nazi Persecution

1411.4.14 Payments to World War II Filipino Veterans and Spouses

1411.4.15 Relocation Assistance

1411.4.16 Retirement, Survivors, and Disability Insurance (RSDI)

1411.4.17 Supplemental Security Income (SSI)

1411.4.18 Temporary Assistance for Needy Families (TANF)

1411.4.18.1 TANF Annual School Subsidy Payment

1411.4.19 Unemployment Compensation

1411.4.20 Veterans Benefits

1411.4.21 DFPS Relative Caregiver Reimbursement Program Payments

1411.4.22 Healthy Marriage Development Program Payments

1411.5 Income from Property

1411.5.1 Dividends and Royalties

1411.5.2 Payments for Mineral Rights

1411.6 Other

1411.6.1 Cash Gifts and Contributions

1411.6.1.1 Contributions from Noncertified Household Members

1411.6.1.2 Gifts from Tax-Exempt Organizations

1411.6.2 Child Support

1411.6.2.1 Counting Child Support

1411.6.2.2 Lump-Sum Child Support Payments

1411.6.2.3 Medical Support Payments

1411.6.3 Energy Assistance

1411.6.4 Foster Care and Permanency Care Assistance (PCA) Payments

1411.6.5 In-Kind Income

1411.6.6 Interest

1411.6.7 Loans (Noneducational)

1411.6.8 Pensions

1411.6.9 Trust Funds

1411.6.10 Resettlement-Reception and Placement (R&P)

1411.6.11 Refugee Cash Assistance (RCA)

1411.6.12 Match Grant

1411.6.13 Spousal Diversion and Dependent Allowance

1411.6.14 Welfare-to-work Income

1411.6.15 Alimony Received

1411.6.16 Annuity

1411.6.17 Capital Gains

1411.6.18 Housing Allowance

1411.6.19 Life Estate

1411.6.20 Jury Duty Pay

1411.6.21 Court Awards

1411.6.22 Cancelled Debt

1412 Types of Payments

1412.1 Lump-Sum Payments

1412.2 Reimbursements

1412.3 Third-Party Beneficiary

1412.4 Vendor Payments

1413 Income Limits

1414 Calculating Household Income

1415 Determining Countable Income in Special Household Situations

1420 Adjunctive Eligibility

1430 Reserved

1431 Women, Infants and Children (WIC) Verification

1432 Income Verification

1440 Documentation Requirements

1500 Deductions

1510 General Policy

1511 Rules That Apply to Deductions

1512 Types of Deductions

1512.1 Earned Income Deduction

1512.1.1 Work-Related Expense

1512.2 Dependent Care Deduction

1512.3 Diversions, Alimony and Payments to Dependents Outside the Home

1512.4 Child Support Deductions

1512.4.1 Allowable Child Support Deductions

1512.4.2 Budgeting Child Support Deductions

1512.5 $75 Disregard Deduction

1520 Verification Requirements

1530 Documentation Requirements

1600 School Attendance

1700 Management

1800 Reminders

1810 General Policy

1820 Documentation Requirements

1900 Case Disposition

1910 Notice to Applicants

1920 Eligibility Begin Dates

1930 Length of Certification

1940 Setting Special Reviews

1950 Adverse Action

2000 Processing Time Frames

2010 Applications

2020 Deadlines

2030 Missed Appointments

2040 Pending Information on Applications

2050 Notice of Renewal/Expiration

2060 Processing Renewals

2061 How to Process a Renewal

2062 Summary of Due Dates for Form H1020, Request for Information or Action

2070 Renewal Time Frames

2080 Pending Information

2100 Changes

2110 How to Report a Change

2111 Changes Received via Telephone

2112 Changes Received via Mail

2113 Changes Received at a Local HHSC Benefits Office

2120 Action on Changes

2130 Determining Whether New Income Information Is a Reported Change

2200 Fair Hearings

2210 Appeals Procedures

2300 Automated Support

2310 Data Broker

2400 Confidentiality

2410 Applications

2420 Renewals

2430 Telephone Numbers

2440 Creating Separate Cases

100 Application Processing

110 Medicaid for Breast and Cervical Cancer (MBCC)

111 MBCC-Presumptive

120 General Overview

130 Application Processing

131 Application Procedures

132 MBCC Forms

133 Women's Health Services (WHS) Procedures

134 File Date

135 Interviews

136 Authorized Representatives (AR)

200 Household Composition

210 General Policy

300 Citizenship

310 General Policy

400 Social Security Number (SSN)

410 General Policy

500 Age

510 General Policy

520 Verification Requirements

530 Documentation Requirements

600 Relationship

700 Identity

710 General Policy

800 Residence

810 General Policy

900 Medicaid Eligibility

910 Screening and Active Treatment

911 Screening

912 Active Treatment

920 Medicaid Coverage

921 Medical Effective Date (MED)

922 Prior Coverage

923 Medicaid Termination

930 Creditable Coverage

931 General Overview

932 Other Medical Assistance

932.1 Currently Receiving MBCC and Applies for Other Benefits

940 New State Residents

1000 Domicile

1100 Deprivation

1200 Child Support

1300 Resources

1310 General Policy

1400 Income

1410 General Policy

1500 Deductions

1600 School Attendance

1700 Management

1800 Reminders

1810 General Policy

1820 Documentation Requirements

1900 Case Disposition

1910 Notice to Applicants

1911 Summary of Due Dates for Form H1020, Request for Information or Action

1920 Length of Certification

1930 Setting Special Reviews

1940 Adverse Action

2000 Processing Time Frames

2010 Applications

2020 Deadlines

2030 Missed Appointments

2040 Pending Information on Applications

2050 Notice of Renewal

2060 Processing Renewals

2070 Processing Time Frames

2100 Changes

2110 General Policy

2120 Actions on Changes

2200 Fair Hearings

2210 Appeals Procedures

2300 Confidentiality

2310 General Policy

TIERS Policy and Procedures Guide

1 De-linking TANF and Medicaid

1.1 De-linking TANF and Medicaid

1.2 Family Medical Assistance Hierarchy

1.3 Transitional Medical Assistance

1.4 Clients Denied Due to State Time Limits

1.5 Clients Denied Due to Federal Time Limits

2 Household Composition — Multiple Adults

2.1 Household Composition — Multiple Adults

2.2 Legal Parent of an Unmarried Minor Parent's Child

2.3 Multiple Parent Cases

2.4 Multiple Parent Examples

2.5 Determining the Grant Amount

2.6 Other Information

3 Combining Multiple Parent Cases (Ghost Dollar Cases)

4 Separate Household Status for Elderly/Disabled Members

5 Reserved for Future Use

6 Type Program Lists in the Texas Integrated Eligibility Redesign System (TIERS)

6.1 Texas Works Type Program List in TIERS

6.1.1 Texas Works Type Program List for Medical Programs in TIERS

6.2 Other Programs Type Program List in TIERS

7 Foster Care and Adoption Assistance (FC/AA) Cases

7.1 TIERS Case Structure for Children Receiving FC/AA

7.1.1 FC/AA Case Creation

7.1.2 FC/AA Confidentiality

7.1.3 Alerts and Other Changes

7.1.4 Department of Family and Protective Services (DFPS) Regional Contact List

7.2 Foster Care and Adoption Assistance Recipients’ Eligibility for Texas Works Programs

7.2.1 Temporary Assistance for Needy Families (TANF)

7.2.2 Medicaid

7.2.2.1 Medicaid for Transitioning Foster Care Youth (MTFCY)

7.2.3 Supplemental Nutrition Assistance Program (SNAP)

7.3 Adding a Foster Care and Adoption Assistance Recipient

7.3.1 Household Currently Receives TANF, Medicaid or SNAP

7.3.2 Household Has Benefit History But Does Not Currently Receive Benefits

7.3.3 Household Does Not Have Benefit History But Does Currently Receive Benefits

7.3.4 Child Returns to Original Household Following Removal

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