Allow advance notice of adverse action and deny only the case for which Form H1025 was received. Do not deny associated cases. (See A-2353, Advance Notice.)

Notes:

• Refusal to cooperate with QC does not affect Medicaid.
• Certify eligible household members for appropriate Medicaid cases following the denial of the TANF case.
• The TANF denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF case for refusal to cooperate with QC. Refer to policy in A-1324.18, Temporary Assistance for Needy Families (TANF).

If the case is denied for any other reason by the time the advisor receives Form H1025 (for example, the individual failed to return pending information and the case is denied effective Sept. 30, the QC review month was September, and the advisor receives Form H1025 in October), the advisor must still send Form TF0001 to the individual.

If the individual reports after they move out of state or it is determined by Quality Control (QC), deny the case following A-2354.2, No Form TF0001 Required.

Adjust/deny any other cases in which the individual/household members are included.

IPV cases are not subject to review if, as of the date the case is selected for QC sampling, the case:

• has been referred for investigation to the state's fraud investigation unit, and the investigation is scheduled to begin within five months of sampling;
• is under active fraud investigation; or
• has a pending administrative or judicial IPV hearing.

If Form H1025 does not indicate that returned mail has been received but that the individual has not been located, advisors must send Form TF0001 to deny for unable to locate allowing advance notice of adverse action. (See A-2353, Advance Notice.)

Adjust/deny any other cases in which the individual/household members are included.

Adjust/deny any other cases in which the individual/household members are included.

The child(ren) may be certified as independent children on appropriate Medicaid cases (See A-241.1, Who is Included) or they may be determined eligible in a new TANF household if all other eligibility requirements are met.

Issue TF0001, Notice of Case Action, with the message: "Your case is denied due to your refusal to cooperate with the Quality Control (QC) review. You will incur this penalty through Feb. 2, yyyy, or until you decide to cooperate with the QC review process, whichever occurs first." Include HHSC's Spanish translation: "Se ha rechazado su caso debido a que usted se negó a cooperar con la revisión de la Evaluación de Control de Calidad (QC). Esta sanción se le aplicará hasta el 2 de febrero de [YEAR] o hasta que decida cooperar con el proceso de revisión de la QC, lo que ocurra primero."

Allow advance notice of adverse action and deny only the case for which Form H1025 was received. Do not deny associated cases. (See A-2353, Advance Notice.)

Notes:

• Refusal to cooperate with QC does not affect Medicaid.
• Certify eligible household members for appropriate Medicaid cases following the denial of the TANF case.
• The TANF denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF case for refusal to cooperate with QC. Refer to policy in A-1324.17, Temporary Assistance for Needy Families (TANF).

The advisor needs to adjust the case accordingly and enter the overpayment referral in the Automated System for Office of Inspector General (ASOIG). (See B-771, Filing an Overpayment Referral Using ASOIG)

Note: Consider all changes that have been reported when determining the amount of the overpayment claim including changes reported to QC during exclusionary period and any other information listed by QC as information only.

Adjust/deny any other cases in which the individual/household members are included.

The advisor must adjust the case accordingly. (See B-800)

The advisor should issue supplemental benefits for the current month if the individual is currently eligible.

For agency errors only, issue restored benefits for past months regardless of whether the individual is currently eligible. Do not restore benefits for unreported changes or household errors. Complete and retain Form H1898, Restored Benefits Documentation, for case documentation purposes. Complete and send Form H1825, Entitlement to Restored Benefits, as notification to the individual. If individual has an outstanding claim, complete and send Form H1018, Overpayment Claim, to Claims Investigation. (See B-840, Notice to the Household.)

Note: Consider all changes that have been reported when determining the amount of supplemental or restored benefits.

Adjust/deny any other cases in which the individual/household members are included.

The advisor needs to adjust the case accordingly and enter the overpayment referral in the ASOIG.

Note: Consider all changes that have been reported when determining the amount of the over issuance claim, including changes reported to QC during exclusionary period and any other information listed by QC as information only.

Adjust/deny any other cases in which the individual/household members are included.

Do not disqualify other adults or children who were members of the original penalized household if they apply with or enter another household and the penalized individual(s) is not applying with or entering the new household with them.

Centralized Representation Unit (CRU)

The CRU files appeal requests and assembles Eligibility Determination Group (EDG) information in preparation for the hearing for TIERS cases.

The CRU provides agency representation for fair hearings and implements all decisions for EDGs statewide.

Members of this unit are housed across the state in local eligibility offices. The unit was created in September 2007, and initially processed EDG actions resulting from TIERS fair hearings for both Texas Works and MEPD. More details may be found in the State Processes document. All appeal requests must be filed using the Hearings and Appeal – Create Appeal TIERS functionality accessed through left navigation. A Form H4800, Fair Hearing Request Summary, which is sent directly to the hearings division, will be returned to staff with instructions to enter the information in TIERS.

Customer Care Centers (CCCs)

The CCCs are located in Athens, Austin, Midland and San Antonio. State staff, along with vendor staff, conduct business through the 2-1-1 Texas telephone system. Inquiries and concerns that cannot be resolved by vendor staff are escalated to CCC state staff. The ESS vendor routes non-interview tasks received via telephone, mail, fax or the self-service portal to state staff in the CCCs. The CCCs are supported by TIERS and by Eligibility Supporting Technologies, such as the Task List Manager and the State Portal.

CCC state staff provide information and application assistance, receive applications, perform data broker and other third-party inquiries, collect data, assess missing information, determine eligibility, issue benefits, process individual- and agency-generated changes, and perform other non-interview tasks. In addition, CCCs process applications and renewals for children's Medicaid-only EDGs, except those referred from the CHIP vendor.

CCCs were implemented with the Integrated Eligibility and Enrollment pilot rollout in January 2006.

MEPD

A special statewide eligibility unit was created in January 2007 to process eligibility for MEPD programs. Statewide staff specialize in MEPD eligibility programs to help ensure that MEPD casework is evenly distributed. Members of this unit are housed across the state in local eligibility offices.

Assistance Response Team (ART)

ART staff housed throughout the state serve as on-site support to regional staff. ART was implemented for the Integrated Eligibility and Enrollment pilot rollout in January 2006.

Centralized Benefit Services (CBS)

Staff in this centralized Austin location process SNAP EDGs for households in which all members receive Supplemental Security Income (SSI), using specialized automation that supports the modified eligibility requirements for these households. In addition, the unit also processes SNAP Combined Application Project (SNAP-CAP) EDGs, applications for Medicaid for Breast and Cervical Cancer (MBCC), Medicaid for children under the jurisdiction of the juvenile court and for youth under age 19 in non-secure facilities, Refugee Medical Assistance and any associated SNAP EDGs, Medicaid for Transitioning Foster Care Youth (MTFCY), and the Former Foster Care in Higher Education (FFCHE) health care benefits program. Designated staff process Medicaid requests for babies who are born to mothers who are incarcerated in Texas. Most babies will receive ongoing Medicaid, but eligibility may be affected by factors such as with whom the baby will reside or if the baby will remain in Texas.

If the baby cannot be certified for ongoing newborn Medicaid, the case is referred to Data Integrity to add coverage for the birth of the baby under a state-paid medical program.

Children's Medicaid Center (CMC)

Centralized CMCs process applications and/or renewals for Children's Medicaid and do not process other associated-program case actions, to ensure a streamlined, timely approach. The CMCs were initially located in five regions across the state:

• Region 03 (Dallas Metroplex),
• Region 06 (Houston),
• Region 08 (San Antonio),
• Region 10 (El Paso), and
• Region 11 (Rio Grande Valley).

Before TIERS rollout, the Region 10 (El Paso) CMC processed SAVERR and TIERS Children's Medicaid cases for:

• Region 1 (Lubbock)
• Region 2/9 (Midland/Abilene)
• Region 4 (Tyler)
• Region 5 (Beaumont)
• Region 10 (El Paso)

Currently Regions 3, 6 and 8 have CMCs to process applications and renewals for Children’s Medicaid for their respective regions.

Central Processing Center (CPC)

Staff in a centralized Austin location process Children's Medicaid referrals received from the CHIP vendor and a streamlined Form H3038, Emergency Medical Services Certification, for CHIP perinatal mothers. The first unit was implemented in 2002 and was expanded in 2006. Effective May 2010, CPC staff began processing Children's Medicaid referrals in TIERS received from the CHIP vendor.

Region 8 CPI Unit

Staff in this centralized Region 8 location process applications and redeterminations for all SNAP-interviewed applications from the Community Partners Interviewer (CPI) Pilot Project. This single regional structure simplifies reporting and data gathering; centralizes electronic benefit transfer (EBT) activities under one EBT coordinator, which streamlines record keeping and adds integrity to the EBT accounting and audit functions; adds efficiency to training activities since there is one location for staff; and enhances accountability as all regional activities will be under one management structure.

The five CPI project food banks as of June 2011 are:

• Houston Food Bank
• North Texas Food Bank
• San Antonio Food Bank
• Tarrant Area Food Bank
• South Plains Food Bank (limited to six counties in Region 1 – Bailey, Crosby, Floyd, Hockley, Lamb and Lubbock.)

Texas Women's Health Program (TWHP)

This unit, located in San Antonio, processes TWHP applications, changes and renewals statewide. Staff are housed across the state in local eligibility offices. The TWHP unit processes TIERS Pregnant Women Medicaid (TP 40) applications and changes.