Glossary

Revision 15-4; Effective October 1, 2015

# A B C D E F G H I K L M N O P Q R S T U V W

401(k) — A retirement plan allowing an employee to postpone receiving a portion of current income until retirement.

# A B C D E F G H I J K L M N O P Q R S T U V W

Able Bodied Adult Without Dependents (ABAWD) — An individual age 18-50 who receives Supplemental Nutrition Assistance Program (SNAP) benefits and does not meet any of the exemption criteria in Texas Works policy.

Absent Parent — A child's parent who is not living in the home.

Accessibility Date — The date that benefits are deposited into an Electronic Benefit Transfer (EBT) account.

Account Transfer — The manner in which an applicant’s information moves between the Marketplace and the Texas Health and Human Services Commission (HHSC) when applying for medical programs. The account transfer from the Marketplace to HHSC, and from HHSC to the Marketplace, will include the information the applicant submitted through the original application in addition to information from verifications performed by either the Marketplace or HHSC.

Active Duty Military Member — An individual currently serving in the U.S. Armed Forces/Reserves (Army, Marine Corps, Navy, Air Force or Coast Guard), National Guard (Army, Marine Corps, Navy, Air Force, Coast Guard or Reserve Guard) or the State Military Forces/Texas State Guard.

Adequate Notice — A notice of adverse action that expires the same day it is sent.

Administrative Renewal — The method used to redetermine eligibility for most Medical Programs, including Medicaid for the Elderly and People with Disabilities (MEPD) and the Children’s Health Insurance Program (CHIP). The automated process uses existing client information, electronic data source information, and reasonable compatibility when income verification is required. This results in:

Administrative Review — A desk review of the fair hearing record by a Health and Human Services (HHS) attorney to determine whether the hearing officer's decision is correct. A request for an administrative review must be submitted in writing within 30 calendar days from the date of the hearing officer's decision.

Administrative Terminal Application (ATA) — A software program accessible on one or more Texas Health and Human Services Commission (HHSC) desktop computers in each office and used for Electronic Benefit Transfer (EBT) card issuance and replacement. The ATA allows access to the EBT system and may also be used for inquiry on EBT-related information, expedited Supplemental Nutrition Assistance Program (SNAP) benefit authorization, and account transaction updates to the EBT database.

Advance Notice — A notice of adverse action that expires 13 days after it is sent.

Advanced Authentication —Personal security questions generated by third-party software to perform authentication of an applicant's identity before granting the individual an account through YourTexasBenefits.com with Case Visibility.

Advanced Nurse Practitioner — A registered nurse with additional training and certification in a specific area of medicine. Examples include certified nurse-midwives, clinical nurse specialists, and pediatric nurse practitioners.

Advanced Premium Tax Credit (APTC) — The payment of a tax credit by the federal government, provided on an advanced basis or at tax filing time, to an eligible individual enrolled in a qualified health plan (QHP) through the Marketplace.

Adverse Action — Any Texas Health and Human Services Commission (HHSC) action resulting in denial, suspension, reduction, or termination of assistance. The term also applies to decisions regarding protective and restricted payments.

Agriculturally Related Activities — Employment:

Aid — A benefit, coverage, or service in programs that the Texas Health and Human Services Commission (HHSC) administers.

Alert — A system or user-generated reminder that action needs to be taken on a case or a notification that an action has taken place.

Alerts — A functional area on a navigation bar that allows eligibility staff to request alerts and view outstanding and processed alerts.

Alien Sponsor — A person who signed an affidavit of support (U.S. Citizenship and Immigration Services [USCIS] Form I-864 or I-864-A) on or after December 19, 1997, agreeing to support an alien as a condition of the alien's entry into the U.S.

Note: Not all aliens must obtain a sponsor before being admitted into the U.S.

Alimony — Payments received from a spouse or former spouse under a divorce or separation decree. It is also referred to as spousal support.

Alimony Paid — Payments to a spouse or former spouse under a divorce or separation decree. It is also referred to as spousal support paid.

Alternate Payee — An individual who receives the benefits for the Eligibility Determination Group (EDG) when the EDG is unable or ineligible to receive them. Types of alternate payees include a court appointed guardian, Electronic Benefit Transfer (EBT) representative, Financial Management Information System (FMIS) payee, long-term care (LTC) payee, protective payee, and representative payee.

Annualize — Averaging income over a 12-month period.

Annuity — A series of payments paid under a contract and made at regular intervals over more than one full year. Payments may be either fixed (under which one receives a definite amount) or variable (not fixed). An individual may buy the contract alone or with the help of an employer.

Annulment — A court order declaring a marriage invalid.

Appeal — A request for a fair hearing concerning an Texas Health and Human Services Commission (HHSC) action. Appeals are logged and updated in the "Hearing" functional area on the navigation bar.

Application — A form that an individual or household uses to apply for assistance, such as Form H1010, Texas Works Application for Assistance — Your Texas Benefits, or Form H1205, Texas Streamlined Application.

Application Registration — The functional area in which an individual's application for assistance is recorded.

Application Visibility — Type of YourTexasBenefits.com account given to an applicant who has selected not to go through Advanced Authentication. Individuals with Application Visibility accounts may only apply for benefits and view and modify applications created under their user name.

Applied Income — The countable amount of income after allowing deductions for tax dependents, child support, alimony, and persons a legal parent is legally obligated to support.

Assets — All items of monetary value owned by an individual.

Assignable — Time periods that are available to be used to schedule appointments using the "Scheduling" functional area.

Authorization Code — A code that identifies a retailer as a Food and Nutrition Service (FNS)-participating store. The code is used to request permission to use the Lone Star Card in a transaction.

Authorized Representative (AR)

An individual or organization designated by an applicant or recipient to take the following actions on the applicant’s behalf:

Automated Income Check Process — The first step in a periodic income check (PIC). During this step, information from electronic data sources is automatically requested and a reasonable compatibility test is run. This process occurs without advisor action.

Automated Renewal Process — The first step in an administrative renewal. During this step, information from electronic data sources is automatically requested, reasonable compatibility is run when income verification is required, and correspondence is sent to the client. This process occurs without advisor or specialist action.

Availability Date — The date that benefits are deposited into the Electronic Benefit Transfer (EBT) account.

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Balance Receipt — A paper receipt that shows the available balance in an individual's cash and/or food account.

Basic Utility Allowance (BUA) — Deduction given to a household that has utility costs, but does not qualify for the standard utility allowance (SUA).

Batch Processing — Actions postponed until a later time when they can be processed by the system more efficiently. In many instances batch processing occurs overnight, when Texas Health and Human Services Commission (HHSC) offices are closed and the system is not being heavily used throughout the state. Examples of batch processing include scheduling system-generated correspondence to be printed at and mailed from a central site; mailing out review packets at scheduled intervals from the central mail facility; and gathering information and sharing it through interfaces with other agencies.

Batch Scheduling — The inclusion of an appointment date and time with eligibility staff  within application packets mailed from the central mail facility. See batch processing.

Bendex (Beneficiary Data Exchange) — A computer tape from the Social Security Administration that provides Social Security and Medicare information about Texas Health and Human Services Commission (HHSC) individuals. The system generates an alert when the amount on file does not match the information on the Bendex file.

Beneficiary — The person named to receive benefits.

Benefit Issuance — The functional area that supports the issuance and tracking of benefits that were calculated in the Eligibility Determination Benefit Calculation (EDBC) and authorized by staff in disposition. See dispose.

Birth Verification System (BVS) — The inquiry system used by eligibility staff to verify birth information.

Blocked — Time periods that are designated for specific purposes and cannot be used to schedule appointments using the Scheduling functional area.

Boarder — A person paying reasonable compensation for room and meals. A boarder can receive Supplemental Nutrition Assistance Program (SNAP) benefits only with the household in which he or she boards. Note: This does not include anyone who otherwise qualifies as a resident of a drug/alcohol treatment center, federally subsidized housing for the elderly, a qualifying group living arrangement, a shelter for battered persons, or a shelter for the homeless.

Bona Fide Agent — A person who is familiar with an individual applicant and knowledgeable of the individual's financial affairs.

Budgetary Needs — The full basic needs amount as defined by Texas Health and Human Services Commission (HHSC) necessary for a family to obtain food, clothing, housing, utilities, and incidentals such as telephone, laundry, and recreation. This calculation is based on family size and is used in the Temporary Assistance for Needy Families (TANF) 100 percent budgetary needs gross income test.

Budgeting — The method used to determine eligibility and benefits for Temporary Assistance for Needy Families (TANF), Medical Programs, and the Supplemental Nutrition Assistance Program (SNAP) by calculating income and deductions.

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Cafeteria Plan — Flexible fringe benefit plans offered to employees by their employers.

Canceled Debts — Debts that have been canceled, forgiven, or discharged. The canceled amount is included as countable income on federal income tax returns. Examples include loan foreclosures and canceled credit card debt.

Capital Gains — A profit from the sale of property or of an investment when the sale price is higher than the initial purchase price, such as profits from the sale of stocks, bonds, or real estate.

Capital Goods — The accumulated possessions (property, goods and products) used to produce income or other goods.

Cardholders — Persons authorized to use the Lone Star Card to access benefits in the household's Electronic Benefit Transfer (EBT) account(s). There are two types of cardholders: primary cardholders and secondary cardholders.

Card Sleeve — A durable paper envelope folded to the dimensions of the plastic EBT card so that the card can be slid in and out of the sleeve. The primary use of the sleeve is to protect the magnetic stripe from being damaged by scratches. The sleeve also has important information printed on it for easy reference, such as the Lone Star Help Desk number.

Caretaker — For:

Caretaker Relative — For Temporary Assistance for Needy Families (TANF), a disqualified legal parent, second parent, or a non-parent relative certified as caretaker. For Type Program (TP) 08, a relative within the required degree of relationship, other than a parent, caring for a dependent child who meets the income limits for that program.

Carryover Standby List — Applicants from a previous day's standby list who have not been interviewed.

Cascade Logic — A hierarchy of logic used to build Eligibility Determination Groups (EDGs) and evaluate eligibility for Texas Health and Human Services Commission (HHSC) programs and types of assistance. The EDG is built and eligibility is established at the highest level. If there are no eligible members after cascade logic is applied, the household is ineligible for the program. See EDBC, rebuild EDG, run EDBC and Wrap Up.

Case — All the persons living together, and alien sponsors, who are related by Eligibility Determination Group (EDG) affiliation. The persons may or may not be included in EDGs as certified members.

Case Mode — Status of a case that identifies that:

Case Number — A unique 10-digit number that identifies a group of Eligibility Determination Groups (EDGs). See Case.

Case Visibility — Type of YourTexasBenefits.com account given to an applicant who has been through Advanced Authentication and is therefore granted a Case Visibility level account. With this type of access, individuals can view and modify an application created under their user name and any case data for cases in which they are the head of household, an adult member within the household, or an authorized representative.

Catchment Area — The area covered by service.

Categorically Eligible Household — Households in which all members are either eligible for or receive benefits from Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), or state-financed general assistance programs and have already gone through the eligibility determination for those programs. These households may bypass the income and resources tests and are deemed financially eligible. There are two types of categorically eligible households:

  1. A Supplemental Nutrition Assistance Program (SNAP) household whose members are all approved for TANF or SSI. A household member is a TANF or SSI recipient if the individual is approved for TANF or SSI but the benefit:

    • has not yet been received,
    • is suspended, or
    • is being recouped.
  2. A SNAP household that includes members authorized to receive TANF non-cash services and whose household gross income is less than 165 percent of the Federal Poverty Income Limit (FPIL) for its size and meets the resource criteria.

Certificate of Coverage — A certificate that serves as proof of a Medicaid recipient's most recent period of Medicaid coverage. The certificate, a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), is sent to denied recipients by the Texas Department of State Health Services (DSHS). Former Medicaid recipients may request a certificate within 24 months after their Medicaid is denied by calling 1-800-723-4789.

Certification Date — The date that eligibility staff dispose the Eligibility Determination Group (EDG) to certify an applicant as eligible.

Certification Period — The period of time of eligibility established at disposition. Not all Texas Health and Human Services Commission (HHSC) programs and types of assistance have certification periods.

Certified Group — The members in an Eligibility Determination Group (EDG) who are eligible for a given program. For:

Change Action — A data collection interview mode that allows eligibility staff to navigate to pages on which they want to record information. See Case Mode.

Child — A child is an adoptive, step, or natural child who is under age 19.

Child in a Two-Parent Family — For:

Child Support — A payment made from a biological or adoptive parent to a biological or adoptive child. Child support may be:

Child Support Disregard — The first $75 of the total child support collected in a month that is subtracted before determining TANF eligibility or benefits. After certification, the Office of Attorney General (OAG) sends the individual the first $75 received on monthly child support collections. If the total collection is less than $75, then the amount of the collection is sent to the individual.

Children's Health Insurance Program (CHIP) — Medical coverage for children under age 19 whose family income exceeds the limits for Children's Medicaid.

Children's Medicaid — Medical coverage for children whose family income is under the applicable income limit. In most instances, Children's Medicaid relates to comprehensive policy for Type Programs (TPs) 43, 44, 45, and 48, unless specifically stated otherwise in a particular handbook section.

CHIP Perinatal — Medical services to unborn children of pregnant women ineligible for Medicaid due to income or alien status.

Choices County Service Levels — Counties designated by the Texas Workforce Commission (TWC) as Choices counties. TWC has designated all counties in Texas as Choices counties, and the Local Workforce Development Boards (LWDBs), after coordination with the Texas Health and Human Services Commission (HHSC) state office, assign a service level designation for each county depending upon services available in that county. The two levels of service are:

Claim — An amount owed by an individual for an overpayment of benefits.

Clearinghouse — A centrally located site that processes medical bills submitted by applicants for Medically Needy with Spend Down. Functions of the clearinghouse include:

Collateral Contact — A person the advisor can contact to verify an individual's information. The person must have no vested interest in the household's situation.

Colonias — Unincorporated and unregulated settlements (neighborhoods) along the U.S./Mexico border.

Combat Pay — Supplemental incentive payments for hazardous duty and special pay for duty subject to hostile fire or imminent danger.

Combat Zone — The geographic area or country to which a military member is deployed for combat.

Commingled Resources — Resources of a Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI) recipient combined with those of a non-TANF or SSI household member.

Common Law Marriage — Relationship in which the parties age 18 or older:

A minor child in Texas is not legally allowed to enter a common law marriage unless the claim of common law marriage began before September 1, 1997.

Communal Dining — A public or non-profit establishment approved by Food and Nutrition Services (FNS) that prepares and serves meals to elderly persons or individuals who receive Supplemental Security Income (SSI) and their spouses.

Complete Action — A data collection interview mode that sets up the driver flow for a complete review of all eligibility requirements in an ongoing case. See case mode and interview mode.

Complete Review — A re-evaluation of ongoing eligibility.

Comprehensive Energy Assistance Program (CEAP) — A utility assistance program funded annually by the Low Income Home Energy Assistance Program (LIHEAP). CEAP replaced the Home Energy Assistance Program (HEAP).

Continued Benefits — Continuing or restoring benefits to the level authorized immediately before the notice of adverse action.

Continuing Scheme — A situation in which a recipient commits two or more acts, such as falsifying a document or a statement or providing false information in an interview, with the intent to commit fraud. Failure to report a required Texas Health and Human Services Commission (HHSC) program change in conjunction with one or more of the aforementioned acts may be considered a basis to commit fraud.

Continuous Eligibility — A period of time during which an individual remains eligible during a continuous eligibility period regardless of any change in circumstances, except for:

Convertible Bond — A bond that can be converted to cash according to program policy. Convertible bonds are countable resources.

Copayment — Payment made directly to a provider according to a fee schedule.

Correspondence — The functional area in which system- and user-generated notices and forms are processed. The notices and forms that are processed in this functional area are also called correspondence. All notices and forms processed in this functional area are linked to a specific case. System-generated correspondence cannot be deleted. See batch processing, pending correspondence, print mode, print type, system-generated and user-generated.

Cost-Sharing Reductions — Federal payments toward out-of-pocket costs made for an eligible individual enrolled in a qualified health plan (QHP) through the Marketplace.

Court Awards — Taxable money that an individual receives as the result of a lawsuit, such as compensation for lost wages or punitive damages awards.

Crime Victim's Compensation — Payments from the funds authorized by state legislation to assist a person who:

The payments are distributed by the Office of the Attorney General (OAG) in monthly payments or in a lump-sum payment.

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Data Broker — An intranet application used by eligibility staff to access online data about individuals. The information is compiled from a number of sources. This information is compared to the application and details from the interview to identify case discrepancies, reducing the possibility of case error and fraud. See permissible purpose.

Data Collection — The functional area where individual household, non-financial, resource, income, and deduction information is recorded for use in building Eligibility Determination Groups (EDGs) and determining eligibility for types of assistance. See EDBC and driver flow.

Deductible Part of Self-Employment Tax — A federal income tax deduction for self-employed individuals paying self-employment taxes.

Dependent Child — For:

Deprivation — Loss of parental support caused by death, incapacity, continued absence of one or both natural or adoptive parents, or because of unemployment or underemployment of both parents in a two-parent family.

Derivative Citizenship — U.S. citizenship that is claimed by a person born outside of the U. S. to one or both U.S. citizen parents.

Detail Page — Click the Edit or View icon to edit or view details of a record listed on a Summary Page.

Discovery Date — The date an individual learns of a change. The discovery date is compared with the report date to determine whether a change is reported timely.

Dispose — To process an Eligibility Determination Group (EDG) so eligibility is established or denied.

Disqualified Person — Someone who normally would be considered a participating member of a household but whose needs are not considered because the person failed to meet or comply with a program requirement.

Domestic Production Activities Deduction — A federal income tax deduction that individuals may receive for certain qualified production activities, such as construction of real property or lease, rental, license, sale, exchange, or other disposition of personal property, computer software, sound recordings, produced films, produced electricity, natural gas, or potable water.

Domicile — A residence maintained or being established, as evidenced by continuation of responsibility for day-to-day care of the child, by the relative with whom the child is living.

Dormant Account — An active Electronic Benefit Transfer (EBT) account that has not been accessed by an individual for:

Dormant EDG — An EDG becomes dormant when the EBT account is dormant. See Dormant Account.

Driver Flow — The logical sequence of data collection pages that appear as a case is completed or read. The driver flow is determined by the programs, types of assistance, and answers to questions as the case is worked. In some interview modes, staff cannot advance to pages that have not yet been accessed as part of the driver flow.

Duplicate Application — An application filed after another application has already been filed and:

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Earned Income — Income an individual receives for a certain activity or work.

Earned Income Tax Credits (EIC) — Payments from the Internal Revenue Service (IRS) to people with tax dependents and gross monthly earnings at or below levels established by the IRS.

Educational Expenses/Student Loan Interest — A federal income tax deduction for individuals paying interest on student loans or for individuals with education expenses such as tuition, fees, room and board, books, and other supplies.

Educator Expenses — Expenses for which educators, kindergarten through grade 12 teachers, counselors, principals, or aids can receive a federal income tax deduction. Qualified expenses include purchased books, supplies, equipment, and other classroom materials.

Effective Month — The first month benefits can be affected based on the monthly cutoff date or applicable policy regarding advance and adequate notice of adverse action.

Electronic Benefit Transfer (EBT) — A system that uses electronic technology to complete some or all of a benefit program's functional requirements. EBT involves computers, a variety of cards or types of cards, electronic funds transfer techniques, automated teller machines (ATMs), point-of-sale terminals or other types of terminals, and software to complete the EBT process without the loss of program integrity or individual confidentiality.

Electronic Benefit Transfer (EBT) Account — A benefit account established by the EBT system in which HHSC deposits the household's benefits. There are two types of benefit accounts:

The individual or his representative uses the Lone Star Card and a personal identification number (PIN) to access benefits in the account(s).

Electronic Benefit Transfer (EBT) Card — A plastic card called the Lone Star Card issued to primary and secondary cardholders that allows the cardholders access to the benefits in the EBT system. A stripe of magnetic material, which is machine-readable and allows for the activation of point-of-sale equipment, is affixed to the back of the card at the time of manufacture.

Electronic Benefit Transfer (EBT) Coordinator — A regional manager designated to lead regional planning and to be a point of contact for EBT.

Electronic Benefit Transfer (EBT) Issuance Staff — An HHSC employee who answers EBT questions and accomplishes EBT card and personal identification number (PIN) issuance for individuals in the local HHSC office.

Electronic Benefit Transfer (EBT) Regional Manager — A regional manager designated to oversee, monitor, lead regional planning, and act as a point of contact for EBT.

Electronic Benefit Transfer (EBT) Representative — A primary cardholder other than the case name. This person has access to the EBT account for the Eligibility Determination Group (EDG). This may be a Temporary Assistance for Needy Families (TANF) representative payee or protective payee or a Supplemental Nutrition Assistance Program (SNAP) authorized representative for a resident of a Drug/Alcohol Treatment Center or Group Living Arrangement. See alternate payee.

Electronic Benefit Transfer (EBT) Vendor — One of the companies that performs EBT-related services for the state of Texas.

Electronic Data Sources (ELDS) — Verification sources that are available electronically and presented to advisors in the Texas Integrated Eligibility Redesign System (TIERS) during Data Collection.

Eligibility — The functional area that supports Eligibility Determination Benefit Calculation (EDBC).

Eligibility Determination Benefit Calculation (EDBC) — The process of applying program policy to household, non-financial, resource, income and deduction information entered in the Data Collection functional area. This information is used in the EDBC process to build Eligibility Determination Groups (EDGs) and determine eligibility for programs and types of assistance. See cascade logic.

Eligibility Determination Group (EDG) — Members of a household whose needs, resources, income, and deductions are considered in determining eligibility for benefits. The EDG includes members who are eligible and may include members who are not certified for benefits.

Emancipated Minor — A person under age 18 who has been married. The marriage must not have been annulled.

Emergency Medicaid — All types of emergency Medicaid coverage programs for individuals who are nonimmigrants, undocumented aliens, or certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible. When the term is used in the handbook, it means all of the following programs combined:

Emergency Medical Condition — An eligibility requirement for Emergency Medicaid for nonimmigrants, undocumented aliens and certain legal permanent resident aliens. It is a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably have been expected to result in:

Employable Household Member — A person whose earnings are countable and:

Employer-Paid Taxes — Taxes that are paid by the employer on behalf of the employee rather than deducting the tax amount from the employee's wages. The amount the employer pays is counted as part of the individual's gross income.

Employment Services Program (ESP) — The program for employment assistance and work registration of Temporary Assistance for Needy Families and Supplemental Nutrition Assistance Program individuals. ESP includes Choices and Employment and Training (E&T).

Equity — The fair market value of an item minus all money owed on it and the cost associated with its sale or transfer.

Essential Person — The need for a particular member of a household to be in the home on a continuous basis because another member has a (certified) mental or physical impairment.

Evaluative Conclusion — An advisor's decision, subject to supervisory approval, to accept something other than a birth or hospital certificate or baptismal record as proof of age and relationship.

Excess Payment — A payment sent to a Temporary Assistance for Needy Families (TANF) recipient by the Office of the Attorney General (OAG). When the OAG receives a child support collection on the current monthly obligation and that payment exceeds the TANF grant plus any unreimbursed assistance, the excess is sent to the individual.

Excluded Provider — A Medicaid provider who is not allowed for a period of time to continue participating in the Texas Medicaid program because of fraud conviction, program abuse, and other reasons.

Expedited Service — Special, faster processing of Supplemental Nutrition Assistance Program (SNAP) applicants who qualify for an emergency food allotment, for active duty military members and their dependents applying for medical coverage, and for pregnant women applicants who qualify for current or ongoing medical coverage.

Expenses of Fee-Basis Government Officials — Federal income tax deductible employment-related expenses paid for or accrued by employees of a state or political subdivision who are compensated on a fee basis.

Expenses of Performing Artists — Federal income tax deductible expenses for qualified performing artists paid or accrued through performances while serving as an employee in the performing arts.

Expenses of Reservists — Federal income tax deductible expenses for National Guard and military reserve members who traveled more than 100 miles from home for service.

Expunged Benefits — Benefits that are removed from an Electronic Benefit Transfer (EBT) account by the issuer of the benefits.

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Fair Hearing — A meeting conducted by a regional hearing officer with an applicant or individual who disagrees with and wishes to appeal some action taken on the individual's case.

Fair Market Value — Amount of money an item would bring if sold in the current local market.

Falsified DocumentForm H1010, Texas Works Application for Assistance — Your Texas Benefits; Form H1019, Report of Change; or another signed and dated document that does not report all current income or circumstances.

Falsified Interview — An interview with agency personnel at which time the individual does not report all current income or accurate circumstances.

Falsified Statement — A statement made by an individual, orally or in writing, that is not true, such as claiming to have been without work since a certain date, when the individual was employed during that time period.

Family Violence — An act by a member of a family or household against another member of the family or household that is:

File Clearance — This feature determines whether an applicant has a case record with HHSC. When an individual is added, File Clearance can be processed in Application Registration. If File Clearance is not processed in Application Registration, the system will perform it in Data Collection. File Clearance compares the individual's demographic information against databases for potential matches. These databases contain information for individuals who are currently on assistance and for individuals who have applied for or received assistance in the past.

First Cousin Once Removed — A person who is either one's first cousin's child or the parent's first cousin.

Fixed Income — Unearned income that does not vary.

Flexible Support Payments — Financial assistance provided to relative caregivers in the conservatorship of the Texas Department of Family and Protective Services (DFPS). The purpose of the payments is to reimburse caregivers for expenses such as summer school tuition, tutoring, school supplies, school activities, car insurance for adolescents, and other necessary expenses. The amount of the reimbursement will not exceed $500 annually per child.

Fluctuating Income — Income in which the amount varies because of an increase or decrease in hours worked, rate of pay, or inclusion of a bonus.

Four Months Post-Medical — Medicaid coverage extended for a maximum of four months after denial of a case because of spousal support income.

Fugitive — An individual fleeing to avoid prosecution of or confinement for a felony criminal conviction or found by a court to be violating federal or state probation or parole.

Functional Area — Functions and processes that appear in the Texas Integrated Eligibility Redesign System (TIERS) Left Navigation area and represent a particular business process. Each functional area contains pages that allow authorized staff to perform activities related to the business process. The functional areas that are available to the user are determined by the user's job title and security role(s).

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General Equivalency Diploma (GED) — A high school equivalency certificate issued after an individual completes a State Board of Education-approved high school equivalency program.

General Residential Operations Facility — Residential care facilities that provide a live-in house parent model of care for children under their care. The house parent assumes responsibility and acts in lieu of the parent in meeting the children’s ongoing needs. These facilities have limited power of attorney to obtain health care and educational services for the children under their care.

Good Cause — A term used to indicate that an individual has an acceptable reason for not complying with a program requirement.

Grandparent Payment System (GPS) — An electronic, web-based data system used to inquire, request, and record the issuance of one-time grandparent payments.

Grant in Jeopardy — The Office of the Attorney General's (OAG's) designation for a case that is potentially ineligible for the Temporary Assistance for Needy Families (TANF) grant because the OAG received a child support collection on the current monthly obligation and it equals or exceeds the TANF grant plus the disregard.

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Health Insurance Premium Payment (HIPP) — A reimbursement program administered by the Texas Health and Human Services Commission’s (HHSC’s) Third-Party Resource Unit, which pays for the cost of premiums, coinsurance, and deductibles. The program reimburses the policy holder for private health insurance payroll deductions for Medicaid-eligible persons when HHSC determines that it is cost-effective.

Health Savings Account — A savings account for medical-related expenses that is available to taxpayers. The money contributed to these accounts is not subject to federal income tax at the time of deposit.

Hearing — The functional area where individual appeals are recorded and tracked.

High School Diploma — Certification issued by a state-accredited school to a student who successfully completes the curriculum requirements for secondary school as approved by the State Board of Education.

Historical Correspondence — Records of forms and notices that have been printed. See Correspondence, Print Mode and Print Type.

Historical Data — Records of case, Eligibility Determination Groups (EDGs) and individual information.

Home Energy Assistance Program (HEAP) — A federal program that pays benefits to help eligible people pay utility costs.

Home School — A type of education in which children are taught by their parents, or someone acting in parental authority, at home, using a set curriculum. The parent oversees the curriculum and ensures that the children are actually being educated.

Homeless Household — Households that have no regular nighttime residence or that live in:

Hotline (TANF/SNAP Complaints) — Toll-free number (1-800-252-9330) where staff receive complaints for Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP) cases.

Housing and Urban Development (HUD) — U.S. Department of Housing and Urban Development.

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Identical Application — One or more exact copies of an application previously submitted by an applicant.

Illegally Present Alien — A non-citizen living in the U.S. without proper approval from the U.S. Citizenship and Immigration Services (USCIS) and who has received a final order of deportation.

Immigrant — An alien who abandons residence in a foreign country to live in the U.S. as a permanent resident, for example a lawful permanent resident (LPR).

Inaccessible Resources — Resources not legally available to the individual.

Independent Child — A child who does not live with a parent and who is:

Independent Living Payments — Payments from Title IV-E funds that are distributed by Child Protective Services to certain individuals when they leave foster care. Payments:

Indian Tribal Household — A household in which at least one household member is recognized as a tribal member by any Indian tribe.

Indigent Alien — An indigent alien is a sponsored alien whose total income in the month of application does not exceed 130 percent of the poverty income guidelines for the alien's household size. The following factors are considered in determining the alien's total income:

Individual Development Accounts (IDAs) — An account similar to a savings account that enables an individual to save earned income for a qualifying purpose. IDAs are generally matched dollar-for-dollar with funds from private citizens, corporations, banks, communities, or charitable organizations. The matching funds are inaccessible to the individual if the funds are paid directly to a bank or loan institution, an individual selling a home, or a business account.

Individual Number — A unique nine-digit number that identifies any person known to the Texas Integrated Eligibility Redesign System (TIERS).

Individual Retirement Account (IRA) — An account in which an individual contributes an amount of money to supplement retirement income, regardless of the individual’s participation in a group retirement plan.

Individual Retirement Account (IRA) Deduction — A federal income tax deduction for individuals who contributed to a traditional IRA.

Individually Identifiable Health Information — Information that either identifies or could be used to identify an individual and that relates to the:

Ineligible Alien — A non-citizen whose alien status makes the individual ineligible for program benefits.

Initial Benefits — Benefits issued for the first month of eligibility. Also benefits issued for the first month of eligibility after a break in eligibility of at least one month.

In-Kind Contribution — Any gain or benefit to a person that is not in the form of money payable directly to the individual such as clothing, public housing, or food.

Inquiry — Refers to the functional area that allows users to view case, Eligibility Determination Group (EDG), and individual information.

Institution of Higher Education — Any college (public or private), community college, junior college, technical institute, or university that usually requires a high school diploma or equivalency certificate such as general equivalency diploma (GED) to enter.

Integrated Voice Response (IVR) — A dial-in inquiry system that provides access to automated account information via a digital telephone. This is a toll-free number (2-1-1 or 1-877-541-7905) that individuals may call and inquire about their case, next appointment time, or whether the Texas Health and Human Services Commission (HHSC) received information. The client’s case number or the case name’s Social Security number (SSN) is used to access information. (Also known as the Automated Voice Response [AVR] system.)

Intentional Program Violation (IPV) — The act of intentionally making a false or misleading statement, or misrepresenting, concealing or withholding facts for the purpose of receiving assistance under the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) or Medicaid program. Also, the act of trafficking in SNAP benefits. A household member may be charged with an IPV even if the individual has not actually received benefits to which the individual is not entitled.

Interfaces — The functional area that exchanges information with other systems and agencies.

Interview Mode — A designation in Data Collection that queues the driver flow through appropriate pages for a type of action.

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Judicial Review — A review of the fair hearing decision by a district court in Travis County to determine whether the agency decision is correct. A petition for judicial review must be filed by the appellant in a district court in Travis County within 30 calendar days after the date the administrative decision is issued.

Jury Duty Pay — Taxable income received as compensation for jury duty.

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Keogh — An individual retirement account (IRA) for a self-employed individual.

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Legal Parents — Mother, by having given birth to the child or by proof of adoption; father, by proof of adoption, legal document, court adjudication, or his acknowledgement of paternity.

Legal Requirements — The non- financial eligibility requirements for a Temporary Assistance for Needy Families(TANF) or Medicaid child, such as age, relationship, domicile, citizenship, Social Security number (SSN), and deprivation.

Legally Obligated Child Support — Court order or a legally recorded document requiring the payments of child support to be made in the form of cash, medical support, or to a third party. The official document indicates to and for whom the support is paid, the frequency and the amount of payment.

Licensed Practitioner — A person who has met certain educational requirements and passed an examination to be licensed in the state of Texas and regulated by a state board.

Life Estate — Income an individual receives from ownership of property that an individual only possesses for the duration of one’s life, such as rental income.

Liquid Resources — Resources that are readily negotiable, such as cash, checking or savings accounts, Electronic Benefit Transfer (EBT) cash account, savings certificates, stocks, or bonds.

Lock-in — A status created by the Texas Health and Human Services Commission (HHSC) for certain individuals to help contain Medicaid costs, which allows additional review of high Medicaid users. Those who see several doctors each month and make questionable visits to hospital emergency rooms are limited to seeing one doctor or using one pharmacy for a minimum of six months. Individuals with illnesses that require expensive treatment are not subject to lock-in status.

Logical Unit of Work (LUW) — A set of Texas Integrated Eligibility Redesign System (TIERS) pages that must be completed before information entered on these pages is saved. The LUW is represented by a set of tabs at the top of a TIERS page. To ensure that information has been saved in an LUW in Data Collection, the user can click on the Next button that advances the user to the next LUW or on the Previous button that returns the user to the previous LUW. On the Case Assignment page, the user has reached the end of the driver flow and must use the Left Navigation to return to pages in the case. Clicking the Add, Update or Submit button saves information on specific pages.

Lone Star Card — See Electronic Benefit Transfer (EBT) card.

Low Income Home Energy Assistance Act (LIHEAA) — The federal act that funds assistance for energy costs for low-income households.

Lump-Sum Payment — A financial settlement that often involves funds accumulated over an extended period and that is paid in a single payment.

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Manage Office Resources (MOR) — The functional area that supports the administrative structure in the Texas Integrated Eligibility Redesign System (TIERS) and relationships between regional offices and their local offices, units, and employees.

Managed Care — A health care delivery system with the aim of controlling costs, which relies on a primary care physician who acts as a gatekeeper through whom the patient goes to obtain other health services such as specialty medical care, surgery, or physical therapy. Models of managed care include the health maintenance organization (HMO) and the primary care case management (PCCM) models.

Management — The manner in which a household pays its expenses with available income.

Managing Conservator — A person designated by a court to have daily legal responsibility for a child.

Manual Voucher Transaction — A paper-based debit transaction completed by the food retailer when the automated Electronic Benefit Transfer (EBT) system is down or unavailable. A transaction may also be pre-authorized via telephone.

Marketplace — The governmental entity that makes qualified health plans available to qualified individuals and/or qualified employers. The Marketplace in Texas is operated by the U.S. Department of Health and Human Services. The Marketplace is also known as the Exchange, Health Insurance Marketplace, and Federally Facilitated Marketplace (FFM).

Married Minor — An individual, age 14-17, who is married. These individuals must have parental consent or court permission. An individual under age 18 may not be a party to an informal (common law) marriage.

Meal delivery services — A non-profit establishment approved by Food and Nutrition Services (FNS) that prepares and delivers meals to elderly persons or persons who are housebound, have a physical handicap, or otherwise have a disability that prevents the person from adequately preparing all their meals.

Medicaid — A state and federal cooperative program authorized under Title XIX of the Social Security Act (United States Code [U.S.C.], Title 42, §1396 et seq.) and Texas Human Resources Code, Title 2, Subtitle C, Chapter 32, that pays for certain medical and health care costs for people who qualify. Medicaid is also known as the medical assistance program.

Medicaid Card – An identification card issued to individuals determined eligible for Medicaid that verifies Medicaid coverage.

Medicaid Report – (Form H1146) — A form completed by a transitional Medicaid household in the fourth, seventh and tenth months of medical coverage to report earnings and household composition changes.

Medical Programs — Medicaid for:

Medical Support — Health insurance that absent parents will be ordered to obtain for their children who receive Medicaid when it is available at reasonable cost. Available at reasonable cost is usually defined as being available through the employer.

Migrant Farmworker in the Workstream — Farmworkers who travel to work in agriculture or a related industry and who are presently employed away from their permanent residence or home base.

Migrant Farmworker Not in the Workstream — Farmworkers who travel to work in agriculture or a related industry during part of the year, but who are presently residing at their permanent residence or home base.

Military Member — An individual in the U.S. Armed Forces/Reserves (Army, Marine Corps, Navy, Air Force or Coast Guard), National Guard (Army, Marine Corps, Navy, Air Force, Coast Guard or Reserve Guard) or the State Military Forces/Texas State Guard.

Minor Child — A person under age 18.

Minor Parent — A person under age 18 who has a dependent.

Modified Adjusted Gross Income (MAGI) — The rules used to determine financial eligibility for certain Medical Programs that are based on Internal Revenue Service (IRS) tax rules.

Modified Adjusted Gross Income (MAGI) Financial Eligibility — The result of a comparison between an applicant’s or recipient’s MAGI household income to the applicable Medicaid or Children's Health Insurance Program (CHIP) income limit based on the Federal Poverty Income Limit (FPIL) and the MAGI household size.

Modified Adjusted Gross Income (MAGI) Household Composition — The individuals whose income and needs are considered when determining eligibility for an applicant or recipient for certain Medical Programs based on tax status, tax relationships, living arrangement, and family relationships.

Modified Adjusted Gross Income (MAGI) Household Income — The sum of every individual’s MAGI individual income within an applicant’s or recipient’s MAGI household composition, from which is subtracted the standard MAGI disregard.

Modified Adjusted Gross Income (MAGI) Household Size — The number of individuals in an applicant’s or recipient’s MAGI household composition, including the number of unborn children, if applicable.

Modified Adjusted Gross Income (MAGI) Individual Income — The sum of certain income received by an individual in a MAGI household composition, from which certain expenses are subtracted.

Molar Pregnancy — Also known as hydatidiform mole, a molar pregnancy is considered to be a degenerating pregnancy. Conception occurs, but no fetus ever develops. A molar pregnancy is considered a normal pregnancy that terminates early because of miscarriage or abortion.

Monthly Obligation — The amount of child support which the absent parent has been ordered to pay each month.

Moving Expenses — Federal income tax deductible expenses an individual may claim for relocating for a job or business.

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Newborn Child — A child receiving Type Program (TP) 45, Medical Assistance for Newborn Children, because the child's mother was eligible for and received Medicaid coverage at time of the child's birth or whose mother was eligible for and received Medicaid coverage retroactively for the time of the child's birth. The newborn Medicaid coverage can continue through the month of the child's first birthday as long as the child continues to reside in Texas.

Non-Continuous Eligibility — A period of time during which changes in circumstances may affect an individual’s eligibility.

Nonconvertible Bond — A bond that cannot be converted to cash according to program policy. Nonconvertible bonds are exempt resources.

Non-Employment and Training (E&T) Counties — Those Texas counties in which the Texas Workforce Commission (TWC) determines it does not have sufficient offices to assist individuals who are mandatory work registrants. Supplemental Nutrition Assistance Program (SNAP) applicants and individuals in these counties are still subject to E&T work registration requirements with TWC, but are exempt from E&T participation and are not subject to SNAP federal time limits.

Non-Immigrant — An alien temporarily admitted to the U.S. for a purpose other than permanent residency, such as a religious worker or the fiancé/fiancée of a U.S. citizen.

Nonliquid Resources — Resources such as vehicles, buildings, land, or certain other property that are considered countable, except as explained in the vehicles portion of resource policy or unless the resource is specifically exempted.

Non-Public Assistance (NPA) Household — Supplemental Nutrition Assistance Program (SNAP) households in which no one receives Temporary Assistance for Needy Families (TANF) or only some of the members receive TANF.

Non-Secure Facility — A publicly operated community residence that serves no more than 16 residents, such as a county emergency shelter or non-public group or foster home.

Non-Traditional Retailer — A food retailer who operates in a farmer's market or as a roadside vendor.

Normal Living Expense — Items necessary for a Supplemental Nutrition Assistance Program (SNAP) household to carry on its normal daily activities. These items include housing, utilities, deposits for housing or utilities, food, clothing, and incidentals. Incidentals include such things as normal day-to-day transportation, telephone, laundry, medical supplies not paid by Medicaid, home remedies, recreation, and household equipment.

Notice of Adverse Action — A notice provided to the household on TF 0002 explaining the proposed adverse action, reason for the action, right to a fair hearing, availability of continued benefits, etc.

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Office of Inspector General (OIG) — A division of the Texas Health and Human Services Commission (HHSC) created by the 78th Texas Legislature, Regular Session, 2003, to prevent and reduce waste, abuse, and fraud within the Texas Health and Human Services system.

Off-Line Transaction — The processing of Electronic Benefit Transfer (EBT) transactions using a manual voucher.

One-Time Integration Payment — Financial assistance provided to relative caregivers of children in the conservatorship of the Texas Department of Family Protective Services (DFPS). The purpose of the one-time payment of not more than $1,000 for a sibling group is to defray costs incurred by the caregiver for essential child care items at the time of placement, such as the costs for beds, bedding, clothing and other necessities. The payment is provided once to each sibling group. No additional payments are made if the group moves to the home of another relative.

Ongoing Benefits — Benefits issued for months after the initial benefit month.

Opportunity to Participate — Providing a certified applicant with benefits, a Lone Star Card, personal identification number (PIN), and Electronic Benefit Transfer (EBT) training material.

Other-Related Temporary Assistance for Needy Families/Medical Program (TANF/MP) Child — An eligible child living with a relative other than the child's legal parent.

Overpayment — The amount of benefits issued in excess of what should have been issued.

Override — A Texas Integrated Eligibility Redesign System (TIERS) procedure that allows the user to make a change to the system-determined Eligibility Determination Group (EDG) results. This procedure can be used when policy has changed and TIERS has not yet been updated to process the policy change correctly. Overrides always require Second Level Review before they can be disposed.

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Parent — An individual with either a natural, biological, adopted, or stepchild.

Parental Control — A minor living with an adult is under parental control if one of the following conditions applies:

Participation Status — The designation of an Eligibility Determination Group (EDG) member as an eligible or ineligible member of the certified group. The participation status indicates whether the individual is considered an adult or a child according to policy.

Passive Renewal — A process by which the Texas Integrated Eligibility Redesign System (TIERS) automatically recertifies a Former Foster Care in Higher Education (FFCHE) active Eligibility Determination Group (EDG) for another certification period. This process occurs through a mass update and does not require advisor action.

Payee — A person to whom the Temporary Assistance for Needy Families (TANF) benefits are issued if no one in the household qualifies or wants to be a caretaker. The payee must be within the required degree of relationship.

Payments to Civilians Relocated During Wartime — Payments made to Aleuts or individuals of Japanese ancestry (or their heirs) who were relocated during World War II.

Penalty on Early Withdrawal — A federal income tax deduction for individuals who withdrew money from a time-deposit savings account prior to the certificate maturing and who were charged a penalty for early withdrawal.

Pending — Awaiting conclusion.

Pending Correspondence — Forms or notices that have been generated on a case and are waiting to be processed in batch. All system-generated correspondence is sent to pending correspondence, but it can be retrieved and printed locally. Once correspondence is printed, whether in batch or locally, the record of the printing is stored in History Correspondence. See Print Mode.

Periodic Income Check (PIC) — The process to determine whether electronic data indicates that there has been a change in the Modified Adjusted Gross Income (MAGI) household income that could make the client ineligible for certain Medical Programs. Changes in income identified through this process may impact eligibility for other programs.

Permissible Purpose — A federal requirement that allows staff to legally request a credit report from the Data Broker system only for the purpose of eligibility determination. Permissible purpose means the individual whose credit report is requested must be:

Staff who request credit information without permissible purpose are subject to fines and/or imprisonment in addition to disciplinary action from the Texas Health and Human Services Commission (HHSC).

Personal Account Number (PAN) — The 19-digit number on the front of the Lone Star Card representing the individual's Electronic Benefit Transfer (EBT) account number on the EBT database. The PAN is not related to the individual's Texas Health and Human Services Commission (HHSC) case number.

Personal Identification Number (PIN) — A four-digit numeric code assigned to each cardholder and used to control access to the individual's account. The PIN must be entered on a key pad before any electronic transaction can be processed.

Personal Identification Number (PIN) Security — Actions cardholders should take to prevent others from gaining access to their PIN and Electronic Benefit Transfer (EBT) account. Instructions include not writing their PIN on the card sleeve or anything they carry in their purse or wallet, not revealing their PIN to anyone, or letting anyone use their card.

Personal Possessions — Possessions that include furniture, appliances, jewelry, clothing, livestock, farm equipment, and other items that an applicant uses to meet personal needs essential for daily living.

Personal Representative — An individual who can represent another individual's rights with respect to individually identifiable health information. Only an individual's personal representative may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of an individual.

Personal Responsibility Agreement (PRA) — A requirement for Temporary Assistance for Needy Families (TANF) that certain individuals must be in compliance with the conditions of the agreement. Noncompliance with the PRA results in a sanction.

Point-of-Sale (POS) Transaction — An electronic transaction using an Electronic Benefit Transfer (EBT) card to make a purchase, a cash withdrawal, or inquiry.

Power of Attorney (POA) — Written legal authorization to represent or act on another's behalf in private affairs, business, or some other legal matters.

Practitioner — An individual who holds a license to practice medicine, including a physician (M.D.), osteopathic medical physician (D.O.), dentist (D.D.S.), advanced nurse practitioner (A.N.P.) or registered nurse (R.N.).

Note: A licensed vocational nurse or licensed practical nurse does not meet the definition of practitioner.

Prepaid Burial Insurance — Insurance that pays for a specific funeral arrangement. Also known as a pre-need plan or prepaid funeral agreement.

Preschool Children — Children who are under age 6.

Presumptive Eligibility (PE) — Short-term Medicaid coverage provided to individuals determined potentially eligible for regular Medicaid by a qualified hospital or a qualified entity. This coverage is provided while the Texas Health and Human Services Commission (HHSC) determines eligibility for regular Medicaid.

Primary Cardholder (PCH) — The person designated to receive and be responsible for the household's Lone Star Card. A household may designate a secondary cardholder who has a Lone Star Card and access to the household's Electronic Benefit Transfer (EBT) account. The primary cardholder is usually the Eligibility Determination Group (EDG) name, but the EDG may have an alternate payee who is the primary cardholder.

Print Mode — Indicates where historical correspondence was printed. Batch and Online are the types of print modes. Batch is correspondence managed by batch processing and printed at a central mail facility. All system-generated correspondence is scheduled for batch printing although it can be retrieved from Pending Correspondence and printed locally.

Print Type — Classification of historical correspondence as the original record or a reprint of the original. Each original correspondence is given a unique Correspondence ID (identifying number). Each reprint of an original has the same Correspondence ID as the original.

Priority Supplemental Nutrition Assistance Program (SNAP) Issuances — Expedited SNAP benefits, benefits issued on or after the 25th day from the date of application, and issuances ordered by a hearing officer decision that must be made available in order to meet fair hearing timeliness requirements. These issuances are available to the individual the same day the Eligibility Determination Group (EDG) is disposed.

Processing Time Frames — Number of days eligibility staff has to complete a particular action.

Proration — Portion of total monthly benefits a household is entitled to receive.

Prospective Budgeting —Determination of eligibility for and the amount and type of benefits using the best estimate of the household's current and future circumstances and income.

Protective Payee — Person selected to receive and manage the Temporary Assistance for Needy Families (TANF) benefit when the caretaker is not using the TANF payments for the children's benefit. See alternate payee.

Prudent Person Principle — Reasonable decision made by staff based on the best information available and common sense in a particular situation.

Public Assistance (PA) Household — A Supplemental Nutrition Assistance Program (SNAP) Eligibility Determination Group (EDG) in which:

Public Institution — A facility that is either an organizational part of a governmental entity or over which a governmental unit exercises final administrative control. Examples of public institutions include county and city jails and Texas Department of Corrections prisons. Inmates of facilities that meet the definition of public institution are not eligible for Temporary Assistance for Needy Families (TANF) or Medicaid.

Note: See Publicly Operated Community Residence for additional information about a public facility not considered to be a public institution.

Publicly Operated Community Residence — A facility designed to serve no more than 16 residents and to provide some services beyond food and shelter, such as social services, training in socialization, and life skills. An example of a publicly operated community residence that is not a public institution is a county homeless shelter with a capacity of no more than 16 people. Residents of a publicly operated community residence are potentially eligible for Temporary Assistance for Needy Families (TANF) and Medicaid. They are not considered inmates of a public institution.

Even if designed to serve no more than 16 residents, the following facilities are not considered publicly operated community residences:

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Qualified Entity (QE) — A Medicaid provider (in most instances, but can also be an organization such as a school or clinic) that notifies the Texas Health and Human Services Commission (HHSC) of its election to make presumptive eligibility determinations and agrees to make presumptive eligibility determinations for pregnant women only, per HHSC policies and procedures. Qualified entities that are also Breast and Cervical Cancer Services (BCCS) contractors with the Texas Department of State Health Services (DSHS) may make presumptive eligibility determinations for Medicaid for Breast and Cervical Cancer (MBCC) applicants.

Qualified Health Plan (QHP) — A private insurance plan that is certified by the Marketplace, provides essential health benefits, follows established limits on cost-sharing (such as deductibles, copayments, and out-of-pocket maximum amounts), and meets certain other requirements.

Qualified Health Professional — A person who provides care under the supervision of a licensed practitioner or a medical or dental practice that is state regulated.

Qualified Hospital (QH) — A Medicaid provider that notifies the Texas Health and Human Services Commission (HHSC) of its intent to make presumptive eligibility determinations and agrees to make PE determinations per HHSC policies and procedures. The qualified hospital may choose to make PE determinations for pregnant women, children under age 19, parents and caretaker relatives of dependent children under age 19, and former foster care children.

Quality Control — The functional area that supports the state's approach to quality control and allows authorized staff to enter sample selection criteria. Based on the criteria, the Texas Integrated Eligibility Redesign System (TIERS) generates a sample list.

Questionable Information — Information that is contradictory or incomplete.

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Radiation Exposure Payments — A program to compensate individuals for injury or death resulting from the exposure to radiation from nuclear testing and uranium mining. When the affected individual is deceased, payments are made to the surviving spouse, children, parents, grandchildren or grandparents.

Range of Payment — The highest to the lowest representative pay amounts used to determine the current ongoing budget.

Reactivation Date — The effective date on which benefits for an Eligibility Determination Group (EDG) should be reinstated. This date is entered for various situations including denied in error, continued benefits for a denied EDG, reinstating Transitional Medicaid Assistance (TMA), and reactivating an EDG without requiring a new application form.

Real Property — Land and any improvements on it.

Reapplication

Note: Verification requirements are the same for both timely and untimely applications.

Reapplication Date — Date a new application for redetermination or complete review of eligibility is received by the Texas Health and Human Services Commission (HHSC).

Reasonable Compatibility — The method of verification used for Medical Programs that compares a client’s statement of income against income provided by electronic data sources.

Reasonable Opportunity — The 95-day period following the date on which a notice is sent to an individual to provide a source of citizenship or alien status verification for certain Medical Programs.

Rebuild EDG (Eligibility Determination Group) — A button in the Wrap Up management group used to apply cascade logic by reforming EDGs until eligibility or ineligibility is established. See EDBC and run EDBC.

Reception Log — The functional area in the Texas Integrated Eligibility Redesign System (TIERS) where office contacts by telephone, mail, fax and in-person can be recorded.

Recognizable Needs — The maximum needs amount allowed by the Texas Health and Human Services Commission (HHSC) when determining eligibility.

Recoupment — Withholding part of an individual's current benefit because of a previous overpayment.

Redetermination — A complete action to determine eligibility for a new certification period in a program.

Reimbursement — Repayment for a specific item or service.

Reinstatement — Process of providing Transitional Medical Assistance (TMA) to a household that was denied because of failure to return a complete Medicaid Report.

Report Date — The date on which information is reported to the Texas Health and Human Services Commission (HHSC). Eligibility Determination Benefit Calculation (EDBC) uses the discovery and report dates to determine whether a required report of change is reported timely.

Reports — The functional area that collects information from throughout the Texas Integrated Eligibility Redesign System (TIERS) and produces reports that meet Texas Health and Human Services Commission (HHSC), state and federal reporting requirements.

Representative Payee — In Temporary Assistance for Needy Families (TANF), a person designated to receive and manage the household's benefits for an individual who is incapacitated or incompetent. See alternate payee.

Resident Seasonal Farmworkers — Farmworkers who do not leave their permanent residence to work in agriculture or a related industry.

Resources — Both liquid and nonliquid assets an individual can convert to meet immediate needs.

Restored Benefits — Full or partial months of benefits for a past month that are owed to a household due to an agency error.

Retroactive Benefits — Initial benefits issued for a month before the application is certified.

Review — Temporary Assistance for Needy Families (TANF) evaluative interview that must take place before the individual receives a seventh warrant.

Royalty — A payment to an individual for permitting another to use or market property (such as mineral rights, patents, or copyrights).

RSDI — Retirement, Survivors and Disability Insurance benefits (RSDI) paid by the Social Security Administration.

Run EDBC (Eligibility Determination Benefit Calculation) — A process in the Wrap Up eligibility management group used to determine eligibility of the Eligibility Determination Group (EDG). See EDBC.

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Sanction — Either a disqualification or a penalty applied to a case program because an individual failed to comply with a program requirement.

Scheduling — The functional area that manages eligibility staff's appointments. See Batch Scheduling.

Second Chance Home — An adult-supervised living arrangement that provides independent living services to teen mothers and their children. Independent living services may include, but are not limited to, case management, counseling, mentoring, parenting skills, child development, child care services, school-to-work transition services and family reunification services.

Second Level Review — Review of a case by a second party before the Eligibility Determination Group (EDG) is disposed. The second party selects the Second Level Review interview mode.

Second Parent — The parent who is not the caretaker, when a child lives with both legal parents and both parents are requesting and are eligible for coverage.

Secondary Cardholder — A person designated by the individual (primary cardholder) as eligible to access the individual's Electronic Benefit Transfer (EBT) account with a second EBT card and personal identification number (PIN).

Secure Facility — Secure boot camp settings, such as a county holding facility for juveniles or a facility over which a government unit exercises final administrative authority.

Self-Employed Health Insurance — A federal income tax deduction for self-employed individuals paying for health insurance for themselves, their spouse, their tax dependents, or their child under age 27.

Self-Employed Individual Retirement Account (IRA), Simple IRA, and Qualified Plan Deductions — A federal income tax deduction for self-employed individuals or for partners in a business.

Self-Employment Income — Earned or unearned income available from one's own business, trade or profession rather than from an employer.

Self-Service Portal (SSP) — A web-based application, at www.YourTexasBenefits.com, available to applicants and Community Partners assisting applicants to:

Also referred to as YourTexasBenefits.com.

Sibling — Brother or sister, including legally adopted and half-brothers and half-sisters.

Special Review — A procedure to explore one or more areas of eligibility, such as management, medical, etc., at a specified time other than at application or complete action. A special review is conducted in Special Review mode. See Interview Mode and Case Mode.

Spend Down — The amount of excess income that the applicant must deplete with incurred medical bills before the individual can be certified as medically needy.

Standard MAGI Income Disregard — An income disregard equal to five percentage points of the Federal Poverty Income Limit (FPIL) for the applicable Modified Adjusted Gross Income (MAGI) household size.

Standard Medical Expense — A $137 deduction applied to a Supplemental Nutrition Assistance Program (SNAP) budget and given to an elderly household member and/or a household member with a disability who incurs medical expenses of more than $35 but less than or equal to $137.

Standard of Need — Basic needs of Temporary Assistance for Needy Families (TANF) families represented by a figure predetermined by the state of Texas according to the number of certified persons in the group. This figure represents food, clothing, housing, utilities, and incidentals. Incidentals include such things as normal day-to-day transportation, telephone, laundry, medical supplies not paid by Medicaid, home remedies, recreation and household equipment.

Standard Utility Allowance (SUA) — A standard deduction for the cost of utilities given to a household that either incurs a heating or cooling cost separate from the rent, or receives or anticipates receiving assistance under the Low Income Home Energy Assistance Act (LIHEAA) in any of the next 12 months. For households that receive the SUA based on LIHEAA assistance, allow the SUA even if the household does not have an out-of-pocket expense.

Standby List — Applicants who are awaiting an interview without a specific appointment. See Carryover Standby List.

State Data Exchange (SDX) — Computer tape from the Social Security Administration that provides Supplemental Security Income (SSI) and Medicaid information on Texas Health and Human Services Commission (HHSC) individuals. Social Security information is also available on individuals who receive SSI and/or Medicaid. SDX information can be used as a source of verification and is available to advisors in the Texas Integrated Eligibility Redesign System (TIERS).

Step Grandparent — The spouse of a blood-related grandparent.

Streamlined Reporting (SR) —Households in which all adults are exempt from the 18-50 work requirements due to disability, having a child under age 18 (or is a member of a Supplemental Nutrition Assistance Program [SNAP] Eligibility Determination Group [EDG] where a household member is under age 18), or being pregnant meet the SR criteria. These households receive a six-month certification period.

Subsistence — Life supporting; survival.

Sufficient Employment — Earnings from a job, other than seasonal work such as migrant or seasonal farm work, that would result in Temporary Assistance for Needy Families (TANF) ineligibility without including the 90 percent earned income disregard.

Summary Page — A page that lists a summary of all records available for that Texas Integrated Eligibility Redesign System (TIERS) page. See Detail Page.

Supplemental Benefit — Additional benefits for a current month provided to a household during a month that the Texas Health and Human Services Commission (HHSC) already issued initial or ongoing benefits.

Supplemental Nutrition Assistance Program (SNAP) — Program previously called the Food Stamp Program.

Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP) — A demonstration project that outreaches elderly Supplemental Security Income (SSI) recipients who are not currently certified for SNAP.

Supplemental Nutrition Assistance Program – Supplemental Security Income (SNAP-SSI) Caseload — The Centralized Benefit Services (CBS) unit administers the SNAP-SSI caseload. Households are automatically converted to the SNAP-SSI caseload following an initial certification by a local eligibility office if all household members receive SSI and there is no earned income in the case. There is no age requirement, and households are certified for three years.

Supplemental Security Income (SSI) — A needs-tested program administered by the Social Security Administration providing monthly income to aged individuals and individuals who are blind or have a disability.

Suspended Benefits — The Eligibility Determination Group (EDG) is flagged to prevent the ongoing issuance of benefits until eligibility staff review the EDG.

System-Generated — Created by a computer system programmed with given parameters. For example, a notice is system-generated when an Eligibility Determination Group (EDG) is disposed. The notice contains programmed information based on the program, type of assistance, and eligibility result. See user-generated.

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TALX — A verification of employment and income database created by the TALX Corporation, also known as The Work Number system.

Tax Dependent — An individual who expects to be claimed by someone else as a dependent on a federal income tax return for the taxable year in which Medicaid or Children's Health Insurance Program (CHIP) eligibility is requested.

Taxable Year — The 12-month period that an individual uses to report income for federal income tax purposes. For most individuals, their tax year is the calendar year. A calendar tax year is 12 consecutive months beginning January 1 and ending December 31.

Taxpayer — An individual or a married couple who expects:

Temporary Assistance for Needy Families (TANF) – Basic — Cash assistance for families that include a dependent child and no more than one eligible adult. The Eligibility Determination Group (EDG) name must be within the required degree of relationship to the dependent child.

Temporary Assistance for Needy Families (TANF) Certified Child — A child who is included in a TANF grant.

Temporary Assistance for Needy Families – Non-Cash (TANF-NC) — Consists of services for family planning; adult education; the prevention and treatment of substance abuse; employment services; domestic violence; and Women, Infants, and Children (WIC) nutrition.

Temporary Assistance for Needy Families (TANF) Redirect — A Texas Works message to TANF applicants delivered up front by Texas Health and Human Services Commission (HHSC) staff before the application process begins, explaining that:

Temporary Assistance for Needy Families – State Program (TANF-SP) — Cash assistance for families with a dependent child and at least two adults. Adults on the Eligibility Determination Group (EDG) must be legal parents (including a certified stepparent) to the dependent child. This includes legal parents/stepparents who are disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements.

Ten-Ten-Thirteen Concept — Time periods used to determine the first month of an overissuance claim. The individual has 10 days to report the change; the advisor has 10 days to act on the change; and the notice of adverse action expires in 13 days.

Texas Health Steps (THSteps) — A health-care program of prevention, diagnosis, and treatment for Medicaid individuals.

Texas Integrated Eligibility Redesign System (TIERS) — A computer system that:

Texas Workforce Commission (TWC) — The state governmental agency charged with overseeing and providing workforce development services to employers and job seekers of Texas. TWC is part of a local/state network dedicated to developing the workforce of Texas. The network is comprised of the statewide efforts of TWC along with planning and service provision by 28 local workforce boards on a regional level.

The Workforce Information System of Texas (TWIST) — The computer system used by the Texas Workforce Commission (TWC) for intake, eligibility determination, assessment, service tracking, and reporting of TWC-administered programs, such as child care, Supplemental Nutrition Assistance Program (SNAP), Employment and Training, Choices, and the Workforce Innovation and Opportunity Act.

Third Party — Person or organization outside the certified household.

Third-Party Resource — A source of payment of medical expenses other than the recipient or the Texas Health and Human Services Commission (HHSC).

Three Months Prior — The three-month period before the Medicaid application month. Applicants who meet eligibility requirements during any of the months in this period receive Medicaid benefits for the eligible month(s).

Time Limit — The functional area where Temporary Assistance for Needy Families (TANF) state and federal time-limited months can be viewed. Authorized staff can correct months in this functional area.

Timely Disposed — An Eligibility Determination Group (EDG) that is disposed in accordance with program timeliness standards.

Tip Income — Income earned in addition to wages that is paid by patrons to people employed in service-related occupations (beauticians, waiters, valets, pizza delivery staff, etc.).

Trade Adjustment Assistance Act Program — A program for workers displaced by foreign workers.

Trafficking Supplemental Nutrition Assistance Program (SNAP) —

Transitional Medical Assistance (TMA) — Medicaid coverage provided after denial of certain Eligibility Determination Groups (EDGs) because of new or increased earnings or new or increased spousal support income. EDGs denied because of new or increased earnings will receive a maximum of 12 months of coverage. EDGs denied because of new or increased spousal support income will receive a maximum of four months of coverage.

Trust — Property held by one person for the benefit of another.

Tuition or GI Bill Deduction — A federal income tax deduction for individuals who paid qualified tuition fees to eligible post-secondary educational institutions for themselves, their spouse, or their dependents.

Type of Assistance (TOA) — The specific aid for one or more individuals in an Eligibility Determination Group (EDG). For example, the Supplemental Nutrition Assistance Program (SNAP) has two types of assistance: PA (public assistance) and NPA (non-public assistance).

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Underpayment — Issuance of fewer benefits than an individual is entitled to receive.

Undocumented Alien — An alien living in the U.S. without the knowledge and permission of the U.S. Citizenship and Immigration Services (USCIS).

Unearned Income — Payments received without performing work-related activities, including benefits from other programs.

Unreimbursed Assistance — Money paid in prior months in the form of public assistance under the Title IV-A program (that is, under the current Temporary Assistance for Needy Families [TANF] program or the former Aid to Families with Dependent Children [AFDC] program) that has not yet been recovered from collections that are applied to assigned arrears.

U.S. Citizenship and Immigration Services (USCIS) — The government agency that oversees lawful immigration to the U.S. In 2003, USCIS officially assumed responsibility for the immigration service functions of the federal government. The Homeland Security Act of 2002 dismantled the former Immigration and Naturalization Service (INS) and separated the former agency into three components within the Department of Homeland Security:

User-Generated — Action generated directly by an individual's computer input. For example, a user can:

User Guide — A Texas Integrated Eligibility Redesign System (TIERS) help tool accessed by clicking on the Help icon in the upper right corner of TIERS pages. The User Guide includes information about numerous TIERS topics.

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Vendor Payment — Payment made directly to the individual's creditor or person providing the service by a person or organization outside the household.

Vested Interest — A situation or circumstance to which a person has a strong personal commitment.

Vested Retirement Account — An account to which an employee makes contributions for a specified period of time as defined by the employer. The employer does not match the money contributed by the employee until the defined period of time ends.

Voluntary Quit — Leaving a job without good cause.

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Waiver Counties — Texas counties with an unemployment rate over 10 percent. Supplemental Nutrition Assistance Program (SNAP) applicants and individuals in these counties are not subject to SNAP federal time limits because of the job market. They are still required to be registered for work with the Texas Workforce Commission (TWC) and are mandatory participants if they do not meet work registration exemption requirements.

Waiver of Continued Benefits — An individual option to allow eligibility staff to process an adverse action during the individual's appeal process.

Welfare-to-Work — A federal program designed to support state and local efforts to move hard-to-employ Temporary Assistance for Needy Families (TANF) recipients into unsubsidized jobs and promote their self-sufficiency.

Workforce Innovation and Opportunity Act — A federal program to streamline state workforce development systems combining job training, adult education and literacy, and vocational rehabilitation. The Workforce Innovation and Opportunity Act replaced the Workforce Investment Act of 1998.

Wrap Up — The Texas Integrated Eligibility Redesign System (TIERS) program page in Data Collection where Eligibility Determination Groups (EDGs) are built and the Eligibility Determination Benefit Calculation (EDBC) is run to determine the highest level of eligibility or ineligibility. See Cascade Logic, Rebuild EDG, and Run EDBC.