Texas Health and Human Services Commission
Texas Works Handbook
Revision: 15-4
Effective: October 1, 2015

Part B — Section 100

Processing Time Frames

B—110  Applications

Revision 13-3; Effective July 1, 2013

B—111  Reuse of an Application Form After Denial

Revision 15-4; Effective October 1, 2015

All Programs

Advisors use the original application form until it is 60 days old if an applicant reapplies after being denied for:

  • missing an appointment;
  • failing to furnish information/verification;
  • failure to provide postponed verification; or
  • failure to provide proof of U.S. citizenship.

Notes:

  • If the information on the application form has changed or is more than 45 days old, the individual and advisor must update the form.
  • If the application has been denied for missing an appointment, the denied application is reopened using the contact date as the new file date.
  • Advisors do not request additional income verification when reopening a redetermination denied for failure to provide information. The original income verification the individual provided at the interview date is acceptable, unless the household indicates a change in income.

TANF and Medical Programs except TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

If an applicant reapplies after being denied for missing an appointment, the advisor uses the original application form until it is 60 days old.

TP 32 and TP 56

An application may be used more than one time for TP 56 and TP 32 applicants when both of the following conditions exist:

  • the application interview or process date is after the application month, and
  • the household states that it wishes to reapply and reuse an application form.

B—112  Deadlines

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Advisors must provide Form TF0001, Notice of Case Action, to a denied applicant by the 45th day after the file date.

Advisors must ensure that certified applicants have access to benefits by the 45th day after the file date.

A-140, Expedited Service, may be used for TP 40 expedited Eligibility Determination Groups (EDGs).

A-147, Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents, may be used for expedited time frames for medical program applicants with an active duty military connection.

Exceptions:

  • For applications requiring medical verification, the total processing time the delay caused by obtaining Form H3038, Emergency Medical Services Certification, is not counted.

    Advisors must document the date that:
    • Form H3038 was sent to the practitioner or given to the applicant; and
    • medical information was received.
  • For TANF reapplications with open Choices or school attendance penalties, a period of up to 40 days is excluded from timeliness calculations. The individual must demonstrate cooperation for 30 days before the advisor closes the penalty and processes the application.

SNAP

By the 30th day after the file date, the advisor must:

  • deny or certify an application, and
  • ensure that a certified applicant has an opportunity to participate.

Exception: For expedited service, see A-140.

Related Policy
Eligibility Dates and Benefit Amounts, A-2320
Children’s Medicaid Redetermination Expectations, B-123.6

Medical Programs

Advisors must provide Form TF0001, Notice of Case Action, the same day eligibility is determined for certified applications, including those with spend down, no later than the 45th day from the file date.

B—113  Delay in Processing Applications

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must follow policy below when an application is delayed until the 60th day after the file date:

If ... then ...
the agency is at fault for not completing the application process by the 60th day after the file date and was also at fault for delaying it during the first 30 days after the file date, the advisor must continue to process the original application and provide benefits retroactive to the file date (or the month the individual met all requirements, if later).

If the applicant:
  • misses a Supplemental Nutrition Assistance Program (SNAP) appointment and fails to contact the office by the 10th day as noted on Form H1020, Request for Information or Action, to request a second appointment, the application is denied the following workday. The household loses eligibility for all past months and must reapply if they still want to receive benefits.
  • fails to provide all the required verification by the 10th day noted on Form H1020, then deny the application the following workday. If the household subsequently provides the missing verification within 10 days after the Form H1020 due date, reopen the application using the original file date. Otherwise, the household must reapply if they want to receive benefits.
HHSC was at fault in the first 30 days and the individual was at fault in the second 30 days, deny the application on the 60th day after the file date and provide no benefits.
the individual was at fault the first 30 days and HHSC was at fault in the second 30 days, the advisor must continue to process the original application and provide benefits retroactive to the month following the month of application (or the month the individual met all requirements, if later).

B—113.1  Not Held – Agency Fault

Revision 15-4; Effective October 1, 2015

All Programs except TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44 and TP 48

If the advisor has not contacted the household for the interview either by telephone or for a face-to-face interview by the close of business on the scheduled appointment date, the advisor must mark the Task List Manager (TLM) "Check-In" task associated with the appointment as "Not Held-Agency Fault." This creates a subsequent reschedule task. The advisor must not mark the appointment as "Show" or "No Show" when the advisor has not been able to contact the household for the interview.

Note: This policy applies to applications and redeterminations for all programs that require an interview.

B—114  Missed Appointment

Revision 15-4; Effective October 1, 2015

All Programs except TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44 and TP 48

For telephone interviews, the advisor must make at least two attempts to contact the applicant via telephone. Both attempts must be conducted within the time period listed on Form H1830, Application/Review/Expiration/Appointment Notice. Each attempt must be conducted at least 10 minutes apart. If no contact is made with the applicant after two attempts, the telephone interview is considered a missed appointment. The advisor must document the time of each attempt on the Appointment – Details page.

TANF and Medical Programs except TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44 and TP 48

If the applicant misses the first appointment and does not contact the office on the appointment day, the application is denied no later than the next workday.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule and keep the original file date.

If the applicant contacts the office by the 30th day after the file date to reschedule, the application is reopened using the date of contact as the new file date.

When a requested or required interview is scheduled within the 15-workday active duty military member policy but the applicant requests to reschedule the interview, staff must try to accommodate the rescheduled appointment within the 15-workday time frame. If, at the household's request, the interview is rescheduled after the 15-workday time frame, the advisor must document the reason for not scheduling the appointment within the required time frame.

Note: For requested interviews, if the applicant requests to be rescheduled, the household must be informed that an interview is not required and the processing of the application can begin without an interview. The application must not be denied if the household fails to show for the appointment when an interview is not required.

SNAP

If the applicant misses the first appointment, the advisor must send the applicant Form H1020, Request for Information or Action, on the same day and pend the application. The advisor must inform the applicant that it is the applicant's responsibility to request a second appointment.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule.

If the household misses an appointment and contacts the office on or before the 30th day after the file date, the advisor must reschedule the household for another appointment before the 30th day, if possible. If there are no appointment slots available, the advisor must schedule another appointment after the 30th day, but by the 45th day, and the application is kept pending. If the household keeps that appointment and is determined eligible, the original file date is used to provide benefits.

Note: When a household misses a scheduled appointment and subsequently submits another application, the advisor must consider the second application as a household's request to reschedule the missed appointment.

If the 30th day after the file date is a non-workday, the advisor takes the appropriate action on the following workday. This also must be the final due date on Form H1020.

Additionally, if necessary, hold the application past the 30th day to allow the household at least 10 days to contact the office for a second appointment. If the household does not contact the office by this deadline, the EDG is denied no earlier than the following workday.

Notes:

  • The individual has until close of business (COB) on the final due date listed on Form H1020, Request for Information or Action, to contact the office (COB for the vendor if calling 2-1-1) to request another appointment.
  • If a second or subsequent appointment is scheduled because the individual missed the appointment, the advisor must ensure that second and subsequent appointments have been correctly recorded on the Appointment – Details page.

See B-160, SNAP Timeliness Charts for Applications and All Redeterminations.

Related Policy
Interviews, A-131
Processing Redeterminations, B-122
Children’s Medicaid Redetermination Expectations, B-123.6

TP 36 and TP 40

No appointment is required to process an application.

Note: For requested interviews, if the applicant requests to be rescheduled, the household must be informed that an interview is not required and the processing of the application can begin without an interview. An application must not be denied if the household fails to show for the appointment when interview is not required.

TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

No appointment is required to process an application or renewal unless the individual non-complies with the Health Care Orientation requirement or Texas Health Steps (THSteps) or information needed to determine eligibility can only be obtained through a telephone interview.

Note: For requested interviews, if the applicant requests to be rescheduled, the household must be informed that an interview is not required and the processing of the application can begin without an interview. An application must not be denied if the household fails to show for the appointment when interview is not required.

Related Policy
Scheduling Appointments, A-122.2
Interviews, A-131
Compliance Requirements, A-1531.5
Processing Children's Medicaid Redeterminations, B-123

B—115  Pending Verification on Applications

Revision 15-4; Effective October 1, 2015

All Programs

If more information/verification is required to complete an application, the household is allowed at least 10 days to provide the information/verification. The due date must be a workday.

Advisors request documents that are readily available to the household if the documents are anticipated to be sufficient verification. Each handbook section lists potential verification sources. C-900, Verification and Documentation, provides information on verification procedures.

The advisor must give the applicant Form H1020, Request for Information or Action, explaining:

  • what is required,
  • the date the verification is due, and
  • the date the application will be denied if the verification is not received.

The day Form H1020 is sent is considered day zero of the pending period.

If the applicant does not provide the verification by the 30th day after the file date, or the next workday if the 30th day is not a workday, the application is denied no earlier than the:

  • 30th day if the 30th day is a workday, or
  • following workday if the 30th day is not a workday.

The final due date on Form H1020 must correspond with the 30th day if a workday, or the following workday if the 30th day is not a workday. The advisor must take the appropriate action on the final due date.

Exceptions:

  • If necessary, the advisor may hold the application past the 30th day to allow the household at least 10 days to provide verification. If the household does not provide required verification by this deadline, the EDG is denied no earlier than the following workday. This includes situations in which the 10th day falls on the 30th day.
  • If the eligibility factor in question does not affect eligibility of the entire household, the ineligible member(s) is disqualified and the remaining members are certified.

On an application denied for failure to furnish information or failure to provide postponed verification, if the household provides the required verification by the 60th day after the file date, the application is reopened using the date the individual provided verification as the file date.

TANF

For applications in pay for performance with a noncooperation for Choices or school attendance, the final due date is the 40th day from the date of interview. See A-2151, Open Penalty at Reapplication in Pay for Performance.

Note: When an application is pended for other eligibility verification in addition to the verification of Choices or school attendance cooperation, staff should continue to pend the TANF application until the final due date (40th day from the interview) before taking appropriate action on the TANF EDG.

TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

Advisors must check for any associated EDGs and use appropriate verifications from those EDGs when the applicant does not provide verification with the application form. Advisors use proof of alien status, income or deductions (if provided in the 90 days before the file date) from an associated SNAP, Medicaid or TANF EDG as verification for a child's Medicaid application or redetermination.

SNAP

If the applicant is eligible, the advisor must provide an opportunity to participate by the 30th day after the file date. If not possible, benefits are authorized with a priority issuance the day the applicant provides the required verification.

Related Policy
Expedited Service, A-140

B—115.1  Pending Verification for MA – Pregnant Women – Emergency

Revision 15-4; Effective October 1, 2015

TP 36

An application for a TP 36 is denied by the 45th day after the file date if the applicant:

  • or her representative does not provide Form H3038, Emergency Medical Services Certification; Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification; or other required verification; and
  • had at least 10 days to provide the verification.

Advisors use the following chart to process the application for the individual's emergency condition if the required verification is received:

If the emergency condition occurs ... and Form H3038/H3038-P is received ... then ...
during the month of application, by the 45th day after the file date, dispose the EDG using the original file date.
during the month of application, after the EDG is denied but by the 60th day after the file date, reopen the EDG, using the same application, as specified in B-111, Reuse of Application Form After Denial. Use the date Form H3038/Form H3038-P is received as the new file date.*
after the application month but by the 60th day after the file date, by the 45th day after the file date, use the date Form H3038/H3038-P is received as the file date.*
after the application month but by the 60th day after the file date, after the EDG is denied but by the 60th day after the file date, reopen the EDG, using the same application, as specified in B-111. Use the date Form H3038/H3038-P is received as the new file date.*

* Form H1113, Application for Prior Medicaid Coverage, is not required if processing the emergency coverage for a prior month.


B—116  Information Reported During Application Processing

Revision 15-4; Effective October 1, 2015

All Programs

In determining eligibility, the advisor must consider any information the individual reports between the application date and the decision date. The advisor must include any information the individual reports in the application decision process and send Form H1020, Request for Information or Action, if verification of the reported information is required to complete the application process, following procedures in B-115, Pending Verification on Applications.

Advisors must add a new household member the month the household member joins the household. For newborns, this is the:

  • birth month for TANF and Medical Programs, and
  • month the newborn comes home from the hospital for SNAP.

If the household has an existing case and submits a new application that includes new information, such as a new job, advisors must address changes that may impact eligibility for other programs.

Related Policy
Receipt of Duplicate Application, A-121.2
Receipt of Identical Application, A-121.3

B—116.1  Information Received During Expedited Application Processing

Revision 15-4; Effective October 1, 2015

SNAP

Advisors use the following chart to determine what action to take when the advisor receives information after certifying an expedited application with postponed verifications:

If, between the certification date and the date you release the hold ... then ...
  • an individual provides postponed verification that results in lowered or denied benefits; or
  • the advisor discovers information that existed on the interview date but the household failed to report, and the information results in lowered or denied benefits,
  • determine eligibility and benefits using the new information; and
  • release the hold and deny or issue lowered benefits effective the hold month providing adequate notice of adverse action.
an individual reports a change that occurred after the certification date, release the hold and issue benefits based on the originally requested information. Work the change using change policy in B-600, Changes, allowing advance notice of adverse action, if required.

Note:Advisors must send a fraud/overpayment referral, if applicable. See B-742, Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV).

Related Policy
Expedited Service, A-140
Action on Changes, B-631

B—120  Redeterminations

Revision 15-4; Effective October 1, 2015

Redetermination is the generic term in TIERS and the State Portal used to identify:

  • periodic reviews of TANF;
  • recertification of SNAP; and
  • renewal TP 08, TP 43, TP 44, and TP 48.

Note: Certification periods and redeterminations for individuals on Medical Programs who are receiving TANF and SNAP may not align.

If the household reports new information during a redetermination, such as a new job, advisors must address changes that may impact eligibility for other programs.

Redeterminations can be submitted through any of the channels explained in A-113, Application Requests and Submissions.

TANF and SNAP

Form H1830-R, Texas Works Renewal Notice, is sent to households, along with Form H1010-R, Your Texas Benefits: Renewal Form, for redeterminations.

TP 08, TP 43, TP 44 and TP 48

The following forms are generated for clients during the automated renewal process explained in B-122.4.1, Automated Renewal Process:

  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter;
    • Form H1020, Request for Information or Action, may be included with Form H1211;
  • Form H1206, Health Care Benefits Renewal - MA*; and
  • Form M5017, Documents to Send with Your Renewal Application.*

* The system generates these forms but does not automatically mail them to the client, as explained in B-121, Notice of Redetermination/Certification Expiration.

Form H1206, Health Care Benefits Renewal - ME, is mailed to the household when the individual receiving Medicaid for the Elderly and People with Disabilities (MEPD) is eligible to renew their benefits.

B—121  Notice of Redetermination/Certification Expiration

Revision 15-4; Effective October 1, 2015

TANF

TIERS Scheduling triggers the Texas Works renewal packet mail-out date in Correspondence 60 days before the review due date for approved Eligibility Determination Groups (EDGs).

Advisors must schedule an appointment after the household returns Form H1010-R, Your Texas Works Benefits: Renewal Form.

SNAP

TIERS Scheduling triggers the Texas Works renewal packet mail-out date in Correspondence during the first week of the month before last benefit month (LBM) of the approved EDG.

Advisors must schedule an appointment after the household returns Form H1010-R, Your Texas Works Benefits: Renewal Form. Advisors schedule the appointment no sooner than five days after the Form H1830-I, Interview Notice (Applications or Reviews), mail date, if possible.

For timely redeterminations, advisors schedule the first appointment early enough in the last benefit month to allow at least 13 days after the interview to ensure the EDG can be disposed by the last day of the certification period. This allows two days for Form H1020, Request for Information or Action, to be mailed from the central mail facility; 10 days after the H1020 issue date for the household to provide the information; and one additional day to process a denial for missed appointment, if applicable, in order to be timely.

Note: If the 10th day falls on a non-workday, the due date is the following workday.

Related Policy
Redetermination, B-476.1.6

TP 08, TP 43, TP 44 and TP 48

The system generates renewal correspondence automatically in the ninth month of the 12-month certification period.

The system generates and sends Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, to the client with no advisor action. Form H1211 is dynamic based on the eligibility outcome and program.

The system generates Form H1020, Request for Information or Action, and sends it with Form H1211 when additional information or verifications are needed from the client to complete the renewal processing.

The system generates Form H1206, Health Care Benefits Renewal - MA, but does not automatically mail it to the client. Form H1206 is pre-populated with information from the client’s case and may also include information from electronic data sources. There are different versions of this form depending on the type program in which the recipient is currently enrolled. Clients can access Form H1206 using the following methods:

  • Logging into YourTexasBenefits.com using a case access account and selecting the “Letters and forms” tab to view or print the form;
  • Dialing 2-1-1, selecting option 2, and requesting that Form H1206 be mailed to the client; or
  • Visiting a local office and receiving lobby assistance to access the form through YourTexasBenefits.com or having local office staff print a copy of the form.

The system generates Form M5017, Documents to Send with Your Renewal Application, to include with Form H1206.

Note: Form H1010-R, Your Texas Benefits: Renewal Form, must be accepted if it contains Modified Adjusted Gross Income (MAGI) client information and a signature. The signature provided on Form H1010-R is considered valid as long as it is provided by the certified client or an individual who is allowed to sign for the client, as explained in A-121, Receipt of Application. The advisor should enter the information provided on Form H1010-R and pend for any information that cannot be verified through electronic data sources.

B—122  Processing Redeterminations

Revision 15-4; Effective October 1, 2015

TANF

Advisors must process redeterminations before cutoff in the month:

  • the redetermination date falls, if the redetermination is due on or before cutoff; or
  • after the redetermination date, if the redetermination is due after cutoff.

When the Texas Works Renewal Packet Is Returned and a Packet Received Date Is Entered

If the household must provide verification to complete the redetermination, the household must be allowed at least 10 days to provide verification.

For telephone interviews, advisors must make at least two attempts to contact the applicant via telephone. Both attempts must be conducted within the time period listed on Form H1830-I, Interview Notice (Applications or Reviews). Each attempt must be conducted at least 10 minutes apart. If no contact is made with the applicant after two attempts, the telephone interview is considered a missed appointment. The advisor must document the time of each attempt on the Appointment – Details page.

If a household fails to keep a face-to-face or telephone interview appointment, the advisor must send Form TF0001, Notice of Case Action, to deny the EDG the workday following the scheduled appointment date.

If the individual contacts the office during the adverse action period, the advisor must reschedule the appointment to process the redetermination as soon as possible to avoid interruption of the benefit issuance cycle for the following month. The EDG is not reactivated and the EDG remains denied until the individual keeps the second appointment. A second Form TF0001 is not required if the individual misses the second appointment. If the individual keeps the appointment, the EDG must be processed as a Reactivation/Redetermination for correct eligibility determination and timeliness calculation.

When the Texas Works Renewal Packet Is Not Returned and/or a Packet Received Date Is Not Entered

TIERS runs a Mass Update (MU) on the fifth, sixth or seventh day of each month to terminate EDGs with due dates on or before cutoff of the current month.

For example: On July 5, the MU will terminate EDGs with a review due date on or before July cutoff.

Normal MU rules for exceptions may prevent an EDG from being terminated. Staff must process these EDGs online and verify that a Texas Works renewal packet has been sent and not returned.

When the Texas Works renewal packet is:

  • not returned, go to Initiate Interview in Change Action mode; the advisor must run Eligibility and dispose the TANF EDG.
  • returned, go to Initiate Interview in Ongoing mode; the advisor must enter the packet received date in the Miscellaneous Packet Received logical unit of work (LUW).

If the household returns Form H1010–R, Your Texas Works Benefits: Renewal Form, within the adverse action period, the advisor must schedule an appointment to process the complete redetermination. These EDGs must be processed as a Reactivation/Redetermination for correct eligibility determination and timeliness calculation.

Where to Find the Packet Received Date

In State Portal, the packet received date can be found in PT Inquiry in the EDG Details section in the column labeled Recertification Packet Date.

In TIERS, the packet received date can be found in two places in Data Collection:

  • Miscellaneous Packet Received LUW, which can be viewed in any mode; and
  • Initiate Interview – Initiate Review page, which can be viewed only in Complete Action mode.

Related Policy
Not Held – Agency Fault, B-113.1
The Texas Works Message, A-1527
Data Broker, C-820

SNAP

To reapply in a timely manner, the individual must submit the completed application form by the 15th day of the last month of the certification period. Exception: See B-122.1, SNAP Redeterminations Following a Short Certification.

When an individual misses a timely redetermination appointment, the advisor must send Form H1020, Request for Information or Action, on the day of the missed appointment but no later than the next workday. Form H1020 advises the household to contact the Texas Health and Human Services Commission (HHSC) before the end of the certification period to request a second appointment, or the application will be denied.

If the household contacts the office on or before the last workday of the last month of its certification period, the advisor must reschedule the household for a second appointment before the end of the certification period, if possible. If there are no appointment slots available, a second appointment should be scheduled no later than the 15th day of the following month and the application kept pending. If the household keeps the second appointment and is determined eligible, the original file date is used and a full month's benefits are provided for the first month of the new certification period.

If the household does not contact HHSC by the last workday of the certification period to request a second appointment, the redetermination application is denied on the last workday of the certification period using adequate notice.

For telephone interviews, the advisor must make at least two attempts to contact the individual via telephone. Both attempts must be conducted within the specified time period listed on Form H1830-I. Each attempt must be conducted at least 10 minutes apart. If no contact is made with the individual after two attempts, the telephone interview is considered a missed appointment. The advisor must document the time of each attempt on the Appointment – Details page.

Note: When a household misses a scheduled appointment and subsequently submits another application, the second application is considered as a household's request to reschedule the missed appointment.

Advisors must process timely redeterminations by the last workday of the certification period. If the advisor pends the redetermination for verification, the household is allowed until the last workday of the month to provide the required verification before denial action is taken. The advisor must ensure that the individual's normal issuance cycle is not interrupted.

Exception: The redetermination is pended past the last workday of the month if necessary to allow the individual at least 10 days to provide requested verification. If the individual:

  • provides verification before the end of the current certification month, then the action is processed by the last day of the month.
  • provides verification after the end of the certification period but by the end of the 10-day period, the advisor must ensure that the household receives an opportunity to participate within five workdays of receipt of the verification, if eligible. If the household is not eligible, the denial is processed by the fifth workday after receipt of verification.
  • does not provide verification by the end of the 10-day period, the redetermination is denied the next workday.

For households that miss the first appointment but keep the second appointment scheduled before the 15th day of the following month, if additional information is requested, the household is allowed at least 10 days to provide the requested verification. If the household:

  • provides the verification on or before the due date on Form H1020, the advisor must ensure that the household receives an opportunity to participate within five workdays of receipt of the verification.
  • does not provide the verification by the due date on Form H1020, the redetermination is denied the next workday.

See B-160, SNAP Timeliness Charts for Applications and All Redeterminations.

Situations in Which HHSC Fails to Timely Schedule the Redetermination Appointment

If the individual misses an appointment for a timely redetermination scheduled without enough time to allow the household 10 days to respond to the missed appointment notice before the end of the certification period, the advisor must, on the day of the missed appointment, send Form H1020 informing the individual to contact the office by the 10th day (or the following workday) to schedule a second appointment.

If the individual:

  • fails to contact the office by the due date, the application is denied on the workday after the Form H1020 due date; or
  • contacts the office by the due date to request another appointment, the advisor must schedule a second appointment within 10 days and keep the application pending for the second appointment.

Notes for SNAP policies in B-122:

  • For missed appointments, TIERS notices are mailed from the central mail facility two days after being requested in TIERS, so the Form H1020 due date is 12 days after the request date.
  • The individual has until close of business on the final due date listed on Form H1020 to contact the office (close of business day for the vendor if calling 2-1-1) to request another appointment.

Related Policy
Interviews, A-131
Missed Appointment, B-114
Redetermination, B-476.1.6
Children’s Medicaid Redetermination Expectations, B-123.6
Not Held – Agency Fault, B-113.1

TP 08, TP 43, TP 44 and TP 48

These programs complete an administrative renewal process, explained in B-122.4, Medical Program Administrative Renewals.

TP 07 and TP 20

Recipients of TP 07 and TP 20 must be retested for eligibility in other Medical Programs following the policy explained in A-2342.1, Retesting Eligibility, at the end of their certification period. These individuals are referred to the Marketplace if they are determined ineligible for all other Medical Programs.

Related Policy
Retesting Eligibility, A-2342.1
Denied for Failure to Provide Information/Verification, B-122.3.2
Processing Untimely Redeterminations, B-124
Required Verification, C-910

B—122.1  SNAP Redeterminations Following a Short Certification

Revision 13-3; Effective July 1, 2013

SNAP

Advisors must provide eligible households with benefits by the 30th day after the last monthly full benefit was provided if the individual reapplied timely and was previously certified with a short certification. A short certification is defined as a SNAP certification in which the household is certified:

  • for a one-month period; or
  • in the second month of a two-month certification.

The household must reapply within 15 days of receiving Form H1830, Application/Review/Expiration/Appointment Notice, and the application for assistance to be considered timely.

Notes:

  • This policy does not apply to households that are certified in the first month of a two-month certification. These households must continue to file their Form H1010 by the 15th of the last benefit month for a timely redetermination. Advisors must continue to process timely redeterminations on these cases by the last day of the current certification period.
  • Advisors must continue to provide Form H1830 and an application for assistance to households that are certified in the first month of a two-month certification or after cutoff in the first month of a three-month certification, because these households will not receive a redetermination packet even though they are not considered to have received a short certification.

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

Revision 15-4; Effective October 1, 2015

SNAP

To calculate the 30-day period, the advisor considers the date the individual received the last full benefit as day zero. If the 30th day falls on a non-workday, the advisor must complete the case by the last workday preceding the 30th day.

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

Revision 15-4; Effective October 1, 2015

SNAP

To calculate the date the individual must file the application to be considered timely, the advisor must count 15 days after the individual received Form H1830, Application/Review/Expiration/Appointment Notice, and the application for assistance. This date is known as the Short Certification Timely Due Date. If the 15th day falls on a weekend or a holiday, the individual must submit the application before the 15th day in order for it to be considered a timely redetermination.

Advisors must follow the chart below in determining a timely redetermination:

If Form H1830 and Form H1010 are ... then count 15 days ...
given to the individual in the office, after the date the individual is given the forms.
mailed to the individual, plus two days (17 days) after the date the forms are mailed.

To schedule timely redeterminations properly, scheduling staff need to know the due date on which the application must be submitted to be considered a timely redetermination. Therefore, when providing Form H1830 and Form H1010, Application for Assistance — Your Texas Benefits, at the time a short certification is completed, advisors must manually document the due date in the Short Cert. Timely Due Date box in the Agency Use Only section of Form H1010. Scheduling staff must then follow B-160, SNAP Timeliness Charts for Applications and All Redeterminations, to properly schedule the appointment.

B—122.1.3  Missed Appointments Following a Short Certification

Revision 15-4; Effective October 1, 2015

SNAP

For timely filed reapplications after a short certification, if an individual misses the appointment, the advisor must send the household Form H1020, Request for Information or Action, advising the household that the household must contact HHSC by the 30th day from the last month's full benefit issuance to request a second appointment.

If the household contacts HHSC on or before the 30th day after the last month's full benefit issuance, the advisor must reschedule the household for a second appointment before the end of the 30th day, if possible. If there are no appointment slots available, the second appointment is scheduled no later than the 45th day after the last month's full benefit issuance and the application is kept pending. If the household keeps the second appointment and is determined eligible, the original file date is used and full month's benefits are provided for the first month of the new certification period.

The advisor must hold the application past the 30th day after the last month's full benefit issuance to allow the household at least 10 days (or longer if the 10th day falls on a non-workday) to contact the office for a second appointment or to provide missing information/verification. The advisor must notify the household of the due date on Form H1020. When this 10-day due date is on or after the 30th day after the last month's full benefit issuance and the household fails to contact the office or provide missing information/verification by the due date, the application is denied the next workday. If the household does not contact HHSC by the 30th day to request a second appointment, the redetermination application is denied on the 30th day (or the last workday before the 30th day if the 30th day is not a workday).

If the household does not contact HHSC by the 30th day to request a second appointment, the redetermination application is denied on the 30th day (or the last workday before the 30th if the 30th day is not a workday).

B—122.2  HHSC Delays in Processing All Timely Redeterminations

Revision 13-3; Effective July 1, 2013

SNAP

If HHSC is at fault for not completing the redetermination process in a timely manner, staff must dispose the EDG the same day the advisor completes the eligibility redetermination. This ensures that benefits are available within 24 hours.

Example 1: A household's last benefit month is October. The household files the redetermination timely, but HHSC does not give the household an appointment until November. The advisor must dispose the EDG on the same day the eligibility redetermination is completed to ensure that benefits are available within 24 hours.

Example 2: A household's last benefit month is October. The household files the redetermination timely and provides all requested verification timely. Due to HHSC delay, the advisor does not complete the recertification process timely. The advisor must dispose the EDG on the same day that the eligibility redetermination is completed to ensure that benefits are available within 24 hours.

B—122.3  Delays Caused by Households

Revision 15-4; Effective October 1, 2015

TANF

When a redetermination is denied for a missed appointment or failure to provide information, the household is allowed until 60 days after the file date to schedule a second appointment or provide the missing information.

SNAP

When a timely redetermination is denied for a missed appointment or for failure to provide information, the household is allowed an additional 30 days after the end of the last benefit month to reschedule a missed appointment or to provide information or verification.

Related Policy
Verification Requirements, A-1370

B—122.3.1  Denied for Missed Appointments

Revision 15-4; Effective October 1, 2015

TANF and TP 08

The date the household requests another appointment is considered the new file date if the household requests a second appointment within 60 days after the original file date.

SNAP

The date the household requests another appointment is considered the new file date if the household requests to reschedule a missed appointment within 30 days after the end of the last benefit month. Benefits are prorated using the new file date.

B—122.3.2  Denied for Failure to Provide Information/Verification

Revision 15-4; Effective October 1, 2015

TANF

The date the household provides the missing information is the new file date if the household provides the missing information within 60 days of the original file date. If the EDG is reopened within 30 days of the denial, a new interview is not required. For TANF, a new Form H1073, Personal Responsibility Agreement, is not required if the EDG is reopened within 30 days of the denial.

SNAP

The date the household provides the information/verification is the new file date and a new interview is not required. Benefits are prorated using the new file date.

Advisors do not request additional income verification when following reuse of application policy for a redetermination denied for failure to provide information. The original income verification the individual provided at the interview date is acceptable, unless the household indicates a change in income.

TP 08, TP 43, TP 44 and TP 48

When a renewal is denied due to failure to provide information or verification and the information or verification is provided after the date of denial but by the 90th day after the last day of the last eligibility month, staff must reopen the existing case and not require a new application from the client. The date the information or verification is provided is the new file date.

Note: This may result in a gap in coverage.

B—122.4  Medical Program Administrative Renewals

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

An administrative renewal is initiated by the system and requires no advisor action. The administrative renewal process uses the automated renewal process, explained in B-122.4.1, Automated Renewal Process, to gather information from a client’s existing case and from electronic data sources to determine whether the client remains potentially eligible for Medical Programs.

TP 08

At redetermination, clients must complete an interview. During the interview, the advisor should remind the client to use YourTexasBenefits.com to:

  • create a case access account,
  • complete the renewal,
  • sign-up for email reminders and electronic correspondence, and
  • find out when the next renewal is due.

Clients cannot be required to complete a face-to-face interview, but have the right to request one.

For TP 08 interviews, advisors must use the interview policy explained in A-131, Interviews (for TP 08).

B—122.4.1  Automated Renewal Process

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

The automated renewal process is the first step in an administrative renewal. The automated renewal process runs the weekend before cutoff in the ninth month of the certification period and does not require advisor action.

The process uses electronic data to automatically:

  • assess the verifications required by type program for renewals;
  • determine the eligibility outcome; and
  • send the renewal correspondence to the client.

B—122.4.1.1  Verifications Required by Type Program for Renewals

Revision 15-4; Effective October 1, 2015

During the automated renewal process, the system checks for the required verification by program.

Automated Renewal Process: Verifications Required by Type Program for Renewals
TP 08, Parents and Caretaker Relatives Medicaid
  • Residence
  • Income and Expenses
  • Immigration Status
  • Domicile
  • Full-time School Attendance, when the only dependent child(ren) is age 18
TP 43, Children Under Age One
TP 44, Children Ages 6–18
TP 48, Children Ages 1–5
  • Income and Expenses
  • Immigration Status
  • Texas Health Steps (only for TP 44 and TP 48)
  • Health Care Orientation

The automated renewal process attempts to verify income by determining whether the client’s income information is reasonably compatible with income information available through electronic data sources, as explained in A-1370, Verification Requirements, Medical Programs.

When there are no earned income electronic data sources (TWC or TALX) available for the client, the automated renewal process checks to see whether there is a New Hire Report. When a New Hire Report exists with an employer's name and hire date that is not currently included in the client's income, the client must provide verification of income from the employer shown on the New Hire Report.

Immigration status is only verified during the automated renewal process if the client’s immigration document expires during the current certification period.

B—122.4.1.2  Eligibility Outcomes

Revision 15-4; Effective October 1, 2015

Once available verifications are assessed, the system runs eligibility. The following chart lists the possible eligibility outcomes of the automated renewal process.

Automated Renewal Process: Eligibility Outcomes
Eligibility Potentially Approved
  • All required eligibility information can be verified during the automated renewal process for the program.
  • No additional verification is required from a client.
  • Clients must review the information used to determine their eligibility.
  • Clients are only required to return a signed renewal Form H1206, Health Care Benefits Renewal, if the information on the renewal form is incorrect or there are changes to the client’s case.
Additional Information Needed
  • This outcome may be the result of two scenarios that require additional verification to determine whether the client remains eligible:
    • Electronic data sources indicate there is a change in income that may result in ineligibility for Medical Programs.
      • The reasonable compatibility calculation result is “Need Info because ELDS above limit” or verification required for information found on the New Hire Report.
      • The client must return a signed renewal Form H1206, Health Care Benefits Renewal, and all required verification(s) within 30 days.
    • No electronic data is available for the client.
      • The client must return a signed renewal Form H1206 and all requested verification(s).
  • SNAP or TANF benefits may be impacted if a member of the MAGI household is included in a SNAP or TANF budget group.
Eligibility Terminated*
  • This outcome may be the result of two scenarios:
    • The previous eligibility outcome was “Additional Information Needed” and eligibility was terminated because the client:
      • did not submit required verifications within 30 days to show that income is under the limit, or
      • submitted verifications that showed that income was over the limit.
    • The client reported a change in income that was over the income limit, and eligibility was terminated before the automated renewal process was triggered.

* See A-2342, Denial at Redetermination, for more information on individuals found ineligible for Medical Programs at renewal.

B—122.4.1.2.1  Determining if Verification Is Required for SNAP or TANF During an Administrative Renewal

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

Verification is required for SNAP and TANF during the automated renewal process when:

  • the eligibility outcome of the automated renewal process is “Additional Information Needed” and the reasonable compatibility calculation result is “Need Info because ELDS above limit” or the client is required to provide verification of information found on a New Hire Report; and
  • an individual in the MAGI household is included in a SNAP or TANF budget group.

The client has 10 days to provide verification for SNAP and TANF. Based on the income type and electronic data source used during the automated income verification process, if the client does not provide verification by the 10th day, the system will automatically take the following action on the 11th day:

  • Deny SNAP and TANF benefits for the following data sources:
    • Quarterly wage data from Texas Workforce Commission (TWC), or
    • New Hire Report data from the Office of the Attorney General (OAG).
  • Notify the advisor to adjust SNAP and TANF benefits for the following data sources:
    • Earned income data from TALX,
    • Unearned Retirement, Survivors and Disability Insurance (RSDI) income data from the Social Security Administration (SSA), or
    • Unearned unemployment data from TWC.

Note: Earned income data from TALX, unearned RSDI data from SSA, and unearned unemployment data from TWC are valid verifications for SNAP and TANF. Since quarterly wage data from TWC and New Hire Report data from OAG are not valid verifications for SNAP and TANF, the client must provide verification for these types of income.

B—122.4.1.3  Renewal Correspondence

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

The system generates client correspondence according to the eligibility outcome of the automated renewal process and the action needed by the client.

The following chart lists the correspondence generated for each eligibility outcome of the automated renewal process and the required client response.

Automated Renewal Process: Renewal Correspondence

Eligibility Outcome
Correspondence and Required Client Response
Eligibility Potentially Approved
  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, notifies the client that they must review the information used to determine their eligibility on Form H1206, Health Care Benefits Renewal - MA.
  • The client is only required to return a signed renewal Form H1206 if the information on the form is incorrect or there are changes to the client’s case.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206.
  • No additional forms are sent with Form H1211.
  • Form TF0001, Notice of Case Action, is mailed to the client to notify him or her of the eligibility determination*.
Additional Information Needed
  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, and Form H1020, Request for Information or Action, are sent to the client.
  • Form H1211 notifies the client that they must return the following:
    • Signed renewal Form H1206, and
    • Required verification(s).
  • Form H1020 identifies all the required verification(s) needed to complete the renewal.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206.

Note: For TP 43, TP 44, and TP 48, Form H1014-A, Children's Health Care Benefits — Final Reminder, is sent if the eligibility outcome is “Additional Information Needed” and the client does not return his or her redetermination packet by the first calendar day in the 11th month of a 12-month eligibility period.

Eligibility Terminated
  • If additional information is needed and the client does not return a renewal form by the 30th day from the date Form H1211 is mailed, eligibility is auto-disposed and denied. No advisor action is needed.
  • If additional information is needed and the client does return a renewal form by the 30th day from the date Form H1211 is mailed, the form is routed to local offices for processing and the advisor manually processes the renewal.
  • Form TF0001, Notice of Case Action, is mailed to the client to notify him or her of the eligibility determination*.

* Form TF0001, Notice of Case Action, is sent when a final eligibility determination has been made. Depending on the renewal status outcome and client action, final eligibility determinations may be made by advisors manually processing renewal documents or by the system automatically. Form TF0001 identifies the dates of the new certification period for Medicaid benefits, potential CHIP eligibility, or the denial reason for not recertifying the case.

B—122.4.2  Processing a Manual Renewal

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

The file date is the day that any local eligibility determination office receives an acceptable Medical Program renewal form. The following are considered acceptable Medical Program renewal forms:

  • Form H1206, Health Care Benefits Renewal – MA
  • Form H1206, Health Care Benefits Renewal – ME
  • Form H1010-R, Your Texas Benefits: Renewal Form

A redetermination is considered timely if a renewal form is received by the first calendar day of the 11th month of the certification period. A redetermination is considered untimely if a renewal form is received after the first calendar day of the 11th month of the certification period and through the last day of the 12th month.

Note: If the first calendar day of the 11th benefit month falls on a weekend or a holiday and the redetermination is received on the following business day, the redetermination is considered timely.

Advisors must process redeterminations (received timely or untimely) by the 30th day from the date the renewal form is received or by cutoff of the last benefit month of the certification period, whichever is later. Advisors must follow the policy in B-123.4, Eligibility Transition from Medicaid to CHIP, when an individual returns a renewal form timely and is determined ineligible for Medicaid but eligible for CHIP.

Examples:

Medicaid coverage period is January through December. If the redetermination file date is:

  • October 10, the redetermination must be completed by the December cutoff date to be considered processed timely.
  • December 1, the redetermination must be completed by December 31 to be considered processed timely.

When HHSC receives an acceptable Medical Program renewal form, the advisor must review the information provided and determine whether the case needs to be updated to reflect the most recent information reported by the client on the form.

The advisor may only request information and verification needed to determine eligibility from the client when it is not available through electronic data sources. Verification previously provided must be used to renew eligibility when the verification is still valid. The advisor must determine whether there is any verification that can be used before requesting verification from the client.

The household must be allowed at least 10 days to provide missing information, and the due date must fall on a workday.

Note: Information reported during renewal processing may impact other benefit programs.

B—122.4.2.1  When a Medical Program Renewal Form Is Not Returned

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

When an acceptable Medical Program renewal form, explained in B-122.4.2, Processing a Manual Renewal, is not returned, the system automatically makes an eligibility determination through a mass update based on the eligibility outcome from the automated renewal process. This does not require the advisor to run eligibility or dispose the EDG.

Below are the eligibility outcomes during the automated process:

  • Eligibility Potentially Approved — the client is auto-disposed and approved without advisor action. The file date is the date the EDG is auto-disposed approved, and the client is granted a new 12-month certification period.
  • Additional Information Needed — the client is auto-disposed and denied without advisor action.

Note: When an individual submits income or expense verification without a signed acceptable Medical Program renewal form, advisors manually process information as a change to determine ongoing eligibility for the remainder of the certification period if the client is in a non-continuous period. A signed acceptable Medical Program renewal form is required if additional information is needed to complete the renewal during the automated renewal process.

B—123  Processing Children's Medicaid Redeterminations

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 use the correspondence and processing requirements explained in B-121, Notice of Redetermination/Certification Expiration (for TP 08, TP 43, TP 44 and TP 48), and B-122.4, Medical Program Administrative Renewals.

TP 44 and TP 48

TP 44 and TP 48 must follow the Texas Health Steps requirements explained in A-1531.5, Compliance Requirements.

Related Policy
Continuous Medicaid Coverage, A-832
Compliance Requirements, A-1531.5
Data Broker, C-820

B—123.1  Children's Medicaid Redetermination Due Dates

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 follow the administrative renewal process and use the timeliness guidelines explained in B-122.4, Medical Program Administrative Renewals.

Related Policy
Eligibility Transition from Medicaid to CHIP, B-123.4

B—123.2  Children's Medicaid Redetermination Processing Time Frames

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 follow the administrative renewal process and use the timeliness guidelines explained in B-122.4, Medical Program Administrative Renewals.

B—123.3  Reuse of Form H1014-R After Denial

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

TP 43, TP 44 and TP 48 follow the policy for reusing renewal forms after the date of denial explained in B-122.3.2, Denied for Failure to Provide Information/Verification.

B—123.4  Eligibility Transition from Medicaid to CHIP

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

When a child certified on TP 43, TP 44 or TP 48 is determined eligible for CHIP at the renewal and there is a delay in CHIP enrollment because of HHSC error and the redetermination packet was received timely, TIERS extends Medicaid eligibility for one or two additional months to allow the family time to complete the process and still retain coverage. The redetermination is considered timely when the redetermination packet is received by the first day of the 11th month and processed by HHSC by the 30th day from the file date.

If the family is solely responsible for the delay, Medicaid coverage is not extended when a child is determined eligible for CHIP.

Advisors use the following chart to determine when to extend Medicaid coverage:

If a child is ineligible for Medicaid but eligible for CHIP and the family ... but HHSC ... then, provide Medicaid coverage ...
completes the redetermination process timely,* does not process the form by the 15th day of the 11th month, for one additional month.
completes the redetermination process timely,* does not process the form by the 15th day of the 12th month, for two additional months.

* Timely means the redetermination form is received from the family by the first day of the 11th month and any required verification is received within specified time frames.

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

Revision 15-4; Effective October 1, 2015

Medical Programs

Advisors use this procedure to provide TP 45 coverage for a child whose TP 45 coverage ends and is eligible for TP 48 coverage.

If the family returns the redetermination packet and the child is eligible for TP 48, the advisor must initiate the review on the TP 45 EDG so that TIERS will build the TP 48 EDG after cutoff in the 11th month of the certification period. Children on TP 45 will be denied at the end of their certification period.

B—123.6  Children's Medicaid Redetermination Expectations

Revision 15-4; Effective October 1, 2015

Children's Medicaid

Staff must process Children's Medicaid redeterminations even if not requested on an associated SNAP application or redetermination, if the SNAP application or redetermination is received in the 10th, 11th or 12th month of a 12-month Children's Medicaid eligibility period.

Note: If the individual misses the appointment for a SNAP application or redetermination, staff must continue processing the Children’s Medicaid redetermination, even if the Children’s Medicaid program was not requested on the application.

The recipient must provide an application or redetermination application to process the Children’s Medicaid redetermination if the SNAP application or redetermination is not received within the specified time frames.

Related Policy
Receipt of Application, A-121
Deadlines, B-112
Missed Appointment, B-114
Redeterminations, B-120
Processing Redeterminations, B-122

B—124  Processing Untimely Redeterminations

Revision 15-4; Effective October 1, 2015

SNAP

If an application form is not received by the time frames in B-122, Processing Redeterminations, the advisor uses the initial application processing time frames in B-112, Deadlines.

If the individual submits an untimely reapplication and misses a scheduled appointment, the advisor uses the charts in B-160, SNAP Timeliness Charts for Applications and All Redeterminations, for processing time frames. The advisor must inform the individual that it is the individual's responsibility to request a second appointment. Form H1020, Request for Information or Action, must be sent no later than the next workday, notifying the individual of the missed appointment and pending the application.

Note: If the individual misses an appointment that the agency scheduled untimely, a second appointment is scheduled if the individual contacts the office by the 10th day after the missed appointment date to request another appointment. Otherwise, the individual must reapply with a new file date.

For telephone interviews, advisors must make at least two attempts to contact the individual via telephone.  Both attempts must be conducted within the specified time period listed on Form H1830-I, Interview Notice (Applications or Reviews). Each attempt must be conducted at least 10 minutes apart. If no contact is made with the individual after two attempts, the telephone interview is considered a missed appointment. Advisors must document the time and date of each attempt on the Appointment – Details page.

At the individual's request, HHSC must reschedule a second appointment even if it cannot be scheduled until after the 30th day. The individual does not have to show good cause for missing the first appointment.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule.

Notes:

  • If a second or subsequent appointment is scheduled because the individual missed the appointment, the advisor must ensure that second and subsequent appointments have been correctly recorded on the Appointment – Detail page.

See B-160, SNAP Timeliness Charts for Applications and All Redeterminations.

  • Benefits are not prorated if an eligible individual submits an untimely reapplication because HHSC fails to provide Form H1830 timely. Benefits are provided from the first day of the month after the last benefits month (enter a file date of the first day of that month).

See A-2323, Proration, and an exception for seasonal and migrant farm workers.

  • Advisors do not use application verification requirements when processing untimely redeterminations. Verification requirements are the same for all redeterminations whether filed timely or untimely. See C-912, Required Verification for SNAP.

TP 08, TP 43, TP 44 and TP 48

If a renewal form is not received by the date of denial in the 12th month of the certification period, the EDG is denied for failure to return a renewal packet. A renewal form received after the last day of the 12-month certification period must be treated as an application using application processing time frames. The file date is the day that any local eligibility determination office receives the renewal form.

If the renewal form is received after the date of denial but before the last day of the 12th month of the certification period, the advisor reopens the Medical Program EDG and processes as a renewal.

Related Policy
Missed Appointment, B-114

B—125  Processing Special Reviews

Revision 15-4; Effective October 1, 2015

All Programs

Special reviews are contacts with the household outside of the redetermination process. Staff may conduct special reviews by home visits, telephone, or by mailing individuals Form H1020, Request for Information or Action, or a letter.

TANF and Medical Programs

Advisors contact the household to determine whether a change occurred. If the household confirms that no change occurred, the advisor documents the contact. To clear the special review alert task, the advisor must be in Data Collection Initiate Interview in Special Review mode. If the household confirms that a change occurred, the advisor follows policy in B-600, Changes.

If the household fails to furnish verification requested on Form H1020 or misses an appointment scheduled for the special review, the advisor must send Form TF0001, Notice of Case Action, to begin adverse action.

If the individual contacts the office during the adverse action period, the advisor must reschedule the appointment to process the review as soon as possible to avoid interruption of the benefit issuance cycle for the following month. A second Form TF0001 is not required if the individual misses the second appointment. If the individual does not keep the second appointment, the advisor uses the time frame of the original Form TF0001 to determine the effective date of the denial.

Related Policy
Setting Special Reviews, A-2330

B—125.1  Due Dates

Revision 15-4; Effective October 1, 2015

All Programs

An alert for a special review is triggered in TIERS, which generates a task in Task List Manager (TLM) for the special review.

TANF and Medical Programs

Advisors process special reviews before cutoff in the month:

  • the review date falls, if the review is due on or before cutoff; or
  • after the review date, if the review is due after cutoff.

SNAP

Advisors process special reviews by cutoff of the month the review date falls.

B—126  Processing Desk Reviews

Revision 15-4; Effective October 1, 2015

SNAP

A desk review is the processing of a timely or untimely filed SNAP redetermination application without scheduling or conducting an interview with the household. A SNAP redetermination may be completed by processing a desk review when all of the following criteria are met:

  • the household's current SNAP certification period is six months or less;
  • the current and new SNAP certification periods combined will not exceed a total of 12 months; and
  • eligibility for the current SNAP certification was determined without using the desk review process.

Exceptions: Staff must conduct an interview when the household:

  • has a member who is receiving or is applying for TANF or TP 08;
  • failed to complete the application form sufficiently enough (as determined by the local office) to process without an interview;
  • has a member with an intentional program violation (IPV) disqualification; or
  • lives in a drug/alcohol treatment center, homeless shelter, family violence shelter or group living arrangement.

Advisors begin processing a SNAP redetermination as a desk review within seven calendar days after the Packet Received Date (day zero) and issue either Form H1020, Request for Information or Action, or Form TF0001, Notice of Case Action, to the household within the same seven calendar days.

Note: When a SNAP redetermination Packet Received Date is the 10th through the 15th calendar day of the Last Benefit Month, the advisor must ensure that Form H1020 or Form TF0001 is sent to the household early enough to allow the household 10 days to provide missing information, while still allowing time for the final case action to be timely. Timeliness for Desk Reviews is calculated the same as if an interview was held.

Related Policy
Processing Redeterminations, B-122
Processing Untimely Redeterminations, B-124

B—130  Changes

Revision 02-1; Effective January 1, 2002

See B-600, Changes, for procedures and time frames for processing changes.

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

Revision 15-4; Effective October 1, 2015

All Programs

The due date and final due date entries are shown in the following table. Note: If the 10th or 30th day falls on a non-workday, the due date is the next workday. If the due date is not an HHSC workday (on a weekend or a holiday), the due date advances to the next HHSC workday.

TANF

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Complete redetermination 10 days 10 days
Incomplete redetermination (including the addition of a household member) 10 days 10 days

SNAP

EDG Action Due Date Final Due Date
Application 10 days*
  • 30 days, or
  • 10th day if 10 days end after 30th day
Untimely redetermination (including adding a person at untimely redetermination) 10 days*
  • 30 days, or
  • 10th day if 10 days end after 30th day
Timely redetermination (including adding a person at timely redetermination) 10 days*
  • last workday of last benefit month, or
  • 10th day if 10 days end after last benefit month
Incomplete redetermination (including adding a person at incomplete redetermination) 10 days 10 days

* For SNAP EDGs pended for a missed appointment, the 10-day due date is calculated from the date the form is mailed, usually two days after the H1020-MA is triggered by TIERS or TLM entries. The two additional days for mail time when sending a Form H1020-MA in TIERS is only applicable to SNAP EDGs pended for a missed appointment.


TP 08, TP 43, TP 44 and TP 48

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Complete redetermination 10 days
  • 30 days or by cutoff in the last benefit month of certification, whichever is later; or
  • 10th day if 10 days end after 30th day
Incomplete redetermination (including the addition of a household member) 10 days 10 days

TP 40

EDG Action Due Date Final Due Date
Application 10 days
  • 15 work days, or
  • 10th day if 10 days end after 15th work day

TA 31, TP 34, TP 35, TP 36, TP 56 and TP 32

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day

B—150  Avoiding Invalid Denials Related to Missing Information and Missed Appointments

Revision 15-4; Effective October 1, 2015

All Programs

Staff must ensure that correspondence is sent to the individual's current address. This requires updating the address in the system if the individual has reported a new address on an application form or a change of address is pending in the Task List Manager or TIERS.

Staff should make two telephone call attempts at least 10 minutes apart during the appointed time frame listed on Form H1830-I, Interview Notice (Applications or Reviews), before determining a telephone interview is a missed appointment. Advisors must document the times and dates of the attempted telephone calls on the Appointment – Details page.

An EDG is denied for failure to furnish information only if:

  • the due date on Form H1020, Request for Information or Action, has expired;
  • the information was requested on Form H1020; and
  • there is confirmation that the requested information is not in the office (front desk, mail room, fax machine, etc.) or imaged and available through the State Portal. Follow local procedures for locating submitted verifications.

An EDG is not denied for missed appointment if:

  • a second appointment has already been scheduled;
  • the denial is before the final due date on Form H1020 for applications and timely redeterminations;
  • the agency failed to make the telephone call for a telephone interview or failed to call within the specified time listed on Form H1830-I; and
  • the individual files another application after missing the initial appointment. Treat the new application as a request to reschedule a missed appointment. Reschedule a timely redetermination appointment before the end of the certification period, if possible. If there are no appointment slots available, schedule the second appointment no later than the 15th day of the following month.

SNAP Denial Reminders

B—160  SNAP Timeliness Charts for Applications and All Redeterminations

Revision 13-3; Effective July 1, 2013

SNAP

The charts in this section may be used as a guide to determine when appointments must be scheduled and benefits provided for the case action to be reported as timely. The charts detail required actions and due dates in the following type situations:

  • applications and untimely redeterminations,
  • timely redeterminations after a regular certification period, and
  • timely redeterminations after a short certification period.

SNAP Applications and Untimely Redetermination

If … then …
  • the household keeps the first appointment; or
  • the household misses the first appointment, keeps the second appointment on or before the 30th day, and the application is not pended for verification; or
  • the household misses the first appointment, keeps the second appointment, and the application is pended for verification and verification is provided timely on or before the 30th day;
  • if eligible, ensure the household has an opportunity to participate by the 30th day after the file date; or
  • if not eligible, deny the application by the 30th day after the file date. Note: If the 30th day is a non-workday, take appropriate action the following workday.
  • the household misses the first appointment and fails to request a second appointment by the 30th day after the file date; or
  • the household misses the first appointment, keeps a second appointment and the application is pended for verification with a Form H1020, Request for Information or Action, due date before the 30th day and the household fails to provide verification timely; or
  • the household misses the first appointment and misses a second appointment scheduled on or before the 30th day and by the 30th day the household does not request another appointment;

deny the application on the 30th day after the file date (or the following workday if the 30th day is a non-workday).

the household misses the first appointment and keeps a second appointment after the 30th day and the application is not pended for verification;

dispose on the day of the interview. If the household is:

  • eligible, ensure the household has an opportunity to participate on the interview date; or
  • not eligible, deny the application on the interview date.

the household misses the first appointment and keeps a second appointment, and the application is pended for verification with a Form H1020 due on or after the 30th day and the household provides verification before the 30th day;

dispose by the 30th day:

  • if eligible, ensure the household has an opportunity to participate by the 30th day; or
  • if not eligible, deny the application by the 30th day.

the household misses the first appointment and keeps a second appointment, and the application is pended for verification and the household provides it timely on or after the 30th day;

dispose on the day the verification is provided. If the household is:

  • eligible, ensure the household has an opportunity to participate on the day verification is provided; or
  • not eligible, deny the application on the day verification is provided.

the household misses the first appointment and keeps a second appointment, and the application is pended for verification with a Form H1020 with a due date on or after the 30th day and verification is not provided timely;

deny the application on the workday after the Form H1020 due date.

the household misses the first appointment and a second or subsequent appointment scheduled after the 30th day is also missed;

deny the application on the day of the missed second or subsequent appointment.

misses the first appointment, misses the second appointment scheduled on or before the 30th day, and, by the 30th day, requests and is scheduled a third appointment after the 30th day;

dispose/process:

  • on the day of the interview if the application is not pended for information/verification; or
  • on the day the information or verification is received if the EDG was pended and the information is provided, or
  • on the workday after the Form H1020 due date if the EDG was pended and the information was not provided.

Timely SNAP Redeterminations After a Regular Certification Period

If … then …
  • the household keeps the first timely appointment; or
  • the household misses the first timely appointment, keeps the second appointment on or before the last workday of the certification period, and the application is not pended for verification; or
  • misses the first appointment, keeps the second appointment, and verification is provided timely on or before the last day of the certification period;
  • if eligible, dispose/process the redetermination application by the last workday of the certification period; or
  • if not eligible, deny the redetermination application by the last workday of the certification period.

Note: If the last day of the certification period is not a workday, take action the last workday before the end of the certification period.

  • the household misses the first appointment and fails to request a second appointment by the last workday of the certification period; or
  • the household misses the first appointment and misses a second appointment scheduled on or before the last workday of the certification period, and by the last workday of the certification period the household does not request another appointment;

deny the application on the last workday of the certification period.

  • the household misses the first appointment and misses a second or subsequent appointment scheduled on or before the 15th of the month after the last benefit month; or
  • the household misses the first appointment and keeps a second appointment on or before the 15th of the month after the last benefit month, and the application is not pended for verification;

dispose the recertification application on the day of the second (or subsequent) appointment.

the household misses the first appointment and keeps a second appointment on or before the 15th of the month after the last benefit month, and the application is pended for verification with a Form H1020 and the household provides verification timely;

  • if verification was provided by the last workday of the certification period, process by the last workday of the certification period; or
  • If verification was provided by the Form H1020 due date but after the certification period:
    • if eligible, ensure the household has an opportunity to participate within five workdays after receipt of the verification; or
    • if not eligible, deny the application within five workdays after receipt of the verification.

the household misses the first appointment and keeps a second appointment on or before the 15th of the month after the last benefit month, and the application is pended for verification with a Form H1020 and the household fails to provide verification by the final due date;

  • if the Form H1020 due date was before the last workday of the certification period, deny the application on the last workday of the certification period; or
  • if the Form H1020 due date was on or after the last workday of the certification period, deny the application on the workday following the due date on Form H1020.

the household misses the first appointment and also misses a second or subsequent appointment scheduled after the end of the certification period;

deny the application on the day of the missed second appointment.

the household misses the first appointment and also misses a second appointment scheduled on or before the end of the certification period, and by the last workday of the certification period the household requests another appointment and is scheduled a third appointment after the end of the certification period;

  • if the application is not pended or if the household misses the appointment, dispose/process the application on the day of the appointment; or
  • if the EDG is pended:
    • dispose/process within five workdays after the receipt of information/verification, if the pended information is provided; or
    • deny the application on the workday following the Form H1020 due date, if the pended information is not provided.

Timely SNAP Redeterminations After a Short Certification Period

If… then…
  • the household keeps the first appointment; or
  • the household misses the first appointment, keeps a second appointment on or before the 30th day after the last month's full benefit issuance, and the application is not pended for verification; or
  • the household misses the first appointment, keeps a second appointment, and the application is pended for verification and verification is provided timely on or before the 30th day after the last month's full benefit issuance;
  • if eligible, process the redetermination by the 30th day; or
  • if not eligible, deny the application by the 30th day.


Note: If the 30th day is not a work day, take action on the last workday before the 30th day.

  • the household misses the first appointment and fails to request a second appointment by the 30th day after the last month's full benefit issuance; or
  • the household misses the first appointment and also misses a second appointment scheduled on or before the 30th day, and by the 30th day (or last workday before the 30th day) the household does not request another appointment;

deny the application on the 30th day (or the last workday before the 30th day if the 30th day is not a workday).

  • the household misses the first appointment and also misses a second or subsequent appointment scheduled on or before the 45th day after the last month's full benefit issuance; or
  • the household misses the first appointment and keeps a second appointment on or before the 45th day and the application is not pended for verification;

dispose the recertification application on the day of the second (or subsequent) appointment.

the household misses the first appointment and keeps a second appointment on or before the 45th day after the last month's full benefit issuance, and the application is pended for verification with a Form H1020 and the household provides verification timely;

  • if verification was provided by the 30th day after the last month's full benefit issuance, process by the 30th day.
  • if verification was provided by the Form H1020 due date but after the 30th day after the last month's full benefit issuance:
    • if eligible, ensure the household has an opportunity to participate within five workdays after receipt of the verification; or
    • if not eligible, deny the application within five workdays after receipt of the verification.

the household misses the first appointment and keeps a second appointment on or before the 45th day, and the application is pended for verification with a Form H1020 and the household fails to provide verification by the final due date;

  • if the Form H1020 due date was before the 30th day after the last month's full benefit issuance, deny the application on the 30th day.
  • if the Form H1020 due date was on or after the 45th day, deny the application on the workday following the due date on Form H1020.

the household misses the first appointment and misses a second or subsequent appointment scheduled after the 30th day from the last month's full benefit issuance;

deny the application on the day of the missed second or subsequent appointment.

the household misses the first appointment and misses a second appointment scheduled on or before the 30th day, and, by the 30th day of the certification period, the household requests and is scheduled for a third appointment after the 30th day;

  • if the application is not pended or if the household misses the appointment, dispose/process the application on the day of the appointment; or
  • if the case is pended:
    • dispose/process within five workdays after the receipt of information/verification, if the pended information is provided; or
    • deny the application on the workday following the Form H1020 due date, if the pended information is not provided.

B—161  DataMart Reports

Revision 13-3; Effective July 1, 2013

All Programs

DataMart provides a series of online reports accessed through the State Portal. The reports are used as monitoring tools for various EDG action activities for cases in TIERS (including timeliness of those activities). See C-840, DataMart.

B—170  Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must document the reason(s) for delays in processing an application and advisor action as explained in B-113, Delay in Processing Applications.

For missed telephone interviews, advisors must document on the Appointment – Details page the time of each call when attempting to contact the applicant according to policy in B-114, Missed Appointment; B-122, Processing Redeterminations; and B-124, Processing Untimely Redeterminations.

Related Policy
The Texas Works Documentation Guide