Texas Health and Human Services Commission
Texas Works Handbook
Revision: 13-4
Effective: October 1, 2013

Part D — Section 1400

Changes

D—1410  General Policy

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Changes are situations in a household that may affect eligibility. Action must be taken on reported changes to ensure program integrity.

Take action on the following types of changes:

  • household composition; and
  • address.

Cost share adjustments are handled by the Enrollment Broker at application, redetermination and the six-month income check.

When a change is processed that is missing required information, send Form H1020, Request for Information or Action, within one business day from the report date. Allow the household 10 full days to provide the requested information or verification. Action must be taken on the change within one business day of receipt of the missing information.

D—1420  Reporting Requirements

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Households are instructed that they must report the following changes:

  • change of address;
  • a certified child who leaves the home or dies;
  • a certified child who is institutionalized;
  • pregnancy termination; and
  • addition of a child to the household, if the household wants health care coverage for the child.

Exceptions: A child is disenrolled if the child reapplies and becomes eligible for Medicaid or at the end of the month of the child’s 19th birthday.

Process all other changes, including agency-generated changes, at the household's next redetermination.

CHIP

The household must report a change in the head of household, income and/or child care expenses in order for cost share responsibilities to be re-evaluated.

CHIP Perinatal

The household must only report address changes and birth outcome, including miscarriage.

D—1421  How to Report

Revision 11-4; Effective October 1, 2011

CHIP, CHIP Perinatal

Persons with case authority may report changes by one of the following means:

  • in person at a Health and Human Services Commission Benefits Office;
  • telephone;
  • mail;
  • fax;
  • Form H1019, Report of Change, and;
  • signed Form H1028, Employment Verification.

A person with case authority is an individual who has the authority to apply on the child’s behalf. This may include the:

  • parents who live with the child (natural, adoptive or step);
  • grandparent who lives with the child;
  • payee or other adult who provides care for the child;
  • spouse;
  • independent child; or
  • authorized representative.

Notes: Health plans and community based organizations are not authorized to report changes on behalf of the household.

D—1422  Receipts for Reported Changes

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Households may request a receipt to acknowledge the change report. The receipt includes the type of change(s) and the date reported. If an individual requests a receipt, issue Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change.

D—1430  Processing Requirements

Revision 08-1; Effective January 1, 2008

D—1431  Address Change Processing

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

The case address is updated when the household reports an address change.

If the household reports a change of address, the individual is mailed Form H0025, HHSC Application for Voter Registration, to register to vote based on the new address. If the individual declines the opportunity to register to vote after receipt of Form H0025, mail Form H1350, Opportunity to Register to Vote, to the individual for their signature. Send Form H1350 for imaging when the individual returns Form and retain Form for at least 22 months.

Related Policy
Registering to Vote, A-1521

D—1432  Moves

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

For moves within Texas, the case is updated to reflect the newly reported address.

For moves outside of Texas, the case is updated to reflect the:

  • temporary address, if the move is temporary.
  • address and disenrolls the child as soon as possible, if the move is permanent.

D—1433  Household Composition Changes

Revision 13-4; Effective October 1, 2013

CHIP Perinatal

No action is taken on a request to add or remove a non-certified person from an existing perinatal Eligibility Determination Group (EDG). Note:  Without an active Medicaid or CHIP EDG, potentially eligible children must apply for health care coverage with a new application.

D—1433.1  Adding a New Child

Revision 13-4; Effective October 1, 2013

CHIP

When a household reports a new child in the household, determine if the child meets Medicaid eligibility criteria. If so, only the new child is certified for Medicaid and the remaining children remain on the CHIP EDG through the end of the continuous eligibility period. 

If the child is ineligible for Medicaid but eligible for CHIP and has siblings or a parent currently enrolled in the program, they are considered to meet good cause. TIERS calculates the child's effective date of coverage for the next possible month following cutoff. The child will receive the remaining months of coverage with the siblings or parent. The coverage end date is the same date as the child's currently enrolled siblings or parent. The new child may not receive the full 12 months of coverage and is required to renew coverage along with the child’s siblings or parent on the scheduled renewal date.

Once the child is determined eligible for CHIP, TIERS notifies the Enrollment Broker via an interface. The Enrollment Broker generates and mails a welcome letter to the household.
   

CHIP Perinatal

Income Above 185% FPIL

A child born to a CHIP perinatal mother whose household income is above 185% FPIL will have an effective date beginning with the date of birth and continuing through the remainder of the 12-month CHIP perinatal enrollment segment. The mother's perinatal coverage ends the last day of the child's birth month or the pregnancy's termination month. The mother will receive two postpartum visits even if they are beyond the birth month.

Example: A pregnant mother is approved for CHIP perinatal effective June 1. The child is born on Oct. 4. The newborn’s effective date of coverage is Oct. 4, and the end date is May 30. The mother’s perinatal coverage ends Oct. 31.

A perinatal child whose coverage ends, and who has siblings currently enrolled in CHIP, meets good cause upon determination of CHIP eligibility. The child's enrollment start date is the first day of the month following the perinatal end date. The child's CHIP end date is the end date of the existing CHIP enrollment segment. The child may not receive the 12 months of CHIP coverage and must renew eligibility in accordance with the existing CHIP redetermination date.

Income at or Below 185% FPIL

A child born to a CHIP perinatal mother whose household income is at or below 185% FPIL and who receives Emergency Medicaid to cover the labor with delivery charges will be enrolled in TP 45 coverage effective the date of birth. The mother's perinatal coverage ends the last day of the child's birth month or the pregnancy's termination month. The mother will receive two postpartum visits even if they are beyond the birth month.

Related Policy
CHIP Perinatal Application Process, A-128.3
Neonatal Intensive Care Unit (NICU) Newborn Process, A-126.3.1

D—1433.2  Child Leaves the Home

Revision 13-4; Effective October 1, 2013

CHIP

When a certified child leaves the home, terminate the child’s coverage as soon as possible. The effective date of the termination is based on cutoff.

When a child dies,  terminate the child’s eligibility effective the last day of the month the child died.

D—1433.3  Child Institutionalized

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

When a certified child enters a state hospital or institution for a temporary absence, the child remains enrolled for the remainder of the 12-month period.  See A-920, Temporary Absence From the Home, to determine if stay is considered a temporary absence.

D—1433.4  Head of Household

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

If an individual with case authority reports that the head of household is:

  • a legal parent or step-parent who is no longer in the household and the other legal parent or step-parent resides in the household, change the case name to that of the other legal parent or step-parent. Use the original case number and certification period.
  • a legal parent or step-parent who is no longer in the household and the other legal parent or step-parent does not reside in the household, another individual must re-apply for the children.
  • not a legal parent or step-parent and is no longer in the household, another individual must re-apply for the children.

Examples:

  • The household consists of the mother, father and two CHIP children. The mother is the head of the household and moves out. The father becomes the head of the household.
  • The household consists of the mother and two CHIP children. The mother leaves the household and the grandmother moves into the home to care for the children. The grandmother must submit a new application.
  • The household consists of an aunt and two CHIP children. The aunt leaves the household and the children move in with the grandmother. The grandmother must submit a new application.

Related Policy
Who is Included, D-321
New Head of Household, D-1632.1

D—1434  Demographic Changes

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

A demographic change is a change to a person's identifying information, such as date of birth, Social Security number (SSN), gender or name. The applicant, authorized representative or someone with case authority may request a change to demographic information by mail, fax or telephone.

Process these changes and do not interrupt  the child’s continuous coverage.

D—1435  Pregnancy Reports

Revision 13-4; Effective October 1, 2013

CHIP

When a household reports a CHIP child's pregnancy before her CHIP end date, the child is tested for TP 40 and verification of the pregnancy is requested. A verbal or written statement of pregnancy from the pregnant child, case name or authorized representative that includes the pregnancy start month, number of children expected and the anticipated date of delivery is an acceptable verification source. If potentially eligible and the household provides the pregnancy verification, the child is terminated from CHIP and certified for Medicaid.

If the pregnant child is determined ineligible for TP 40, she remains in CHIP up to two months beyond the original CHIP end date if the pregnancy due date is in the 11th or 12th month of her CHIP coverage, unless the:

  • pregnant child reports pregnancy termination,
  • household reports she has other insurance,
  • pregnant child no longer lives in Texas, or
  • pregnant child turns age 19.

Before the pregnancy ends, extend coverage for:

  •  one month if the pregnancy due date is in the 11th month of the CHIP certification ; or
  •  two months if the pregnancy due date is in the 12th month of the CHIP certification.

If the household does not report a CHIP child’s pregnancy until she gives birth or later, the child remains in CHIP, and the CHIP child’s newborn is tested for Medicaid eligibility. If eligible, the newborn is certified for TP 43.  If not eligible, the newborn is enrolled in the mother’s CHIP health plan. The effective date of CHIP coverage is the next possible month following cutoff. The newborn’s CHIP coverage ends with the household’s current enrollment segment.

Related Policy
Adding a New Child, D-1433.1

D—1436  Income and Deduction Changes

Revision 13-4; Effective October 1, 2013

CHIP

If the household reports a change in income and requests that its cost share responsibilities be recalculated, refer the household to the Enrollment Broker. 

D—1437  Third Party Resources Changes

Revision 13-4; Effective October 1, 2013

CHIP

If a household reports that they have obtained health insurance during the continuous enrollment period, document the change and process the change at the next redetermination.

Related Policy
Health Insurance, D-1631.2

CHIP Perinatal

Do not take any action if a woman reports private health insurance coverage during her certification period.