A—110  Application Procedures

A—111  Pre-Application Process

TANF

Before the application process begins, staff deliver an up-front Texas Works message to the Temporary Assistance for Needy Families (TANF) applicants explaining that:

• TANF is temporary and has time limits.
• there are other alternatives and options for the applicant instead of TANF benefits.
• an applicant should consider jobs and other resources (such as child support) before pursuing TANF.
• if an applicant chooses to apply for assistance, the individual is requesting help finding a job.
• even if an applicant chooses not to apply for TANF, the individual still can apply for Medicaid and the Supplemental Nutrition Assistance Program (SNAP) to support employment while working toward self-sufficiency.

Remember to use judgment when deciding which messages are appropriate for a particular applicant.

A—112  Application Assistance

All Programs

If an applicant needs help completing the application packet, a volunteer or staff member must help. Anyone helping the applicant complete Form H1010, Texas Works Application for Assistance — Your Texas Benefits, or Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, must initial the part completed or sign the form showing that the volunteer or staff person helped complete it.

A—113  Request for Application

All Programs

Provide an application to anyone who requests the form. Each household has the right to file an application on the same day the household contacts the office during office hours. The local office must ensure that a person can obtain an application packet within 15 minutes of coming into the office.

The applicant or household's representative may request an application by contacting the local eligibility determination office in person, by telephone, fax or mail. Application forms are also available at www.yourtexasbenefits.com/ssp/SSPHome/ssphome.jsp and can be downloaded, printed and electronically submitted.

When submitted by the applicant or authorized representative (AR), consider an application electronically signed except in the following situations:

• The household applies for TANF or Medicaid by telephone (2-1-1) and the customer care representative enters the information provided through the State Portal; or
• A non-client or non-AR completes and submits the application for the household through the Internet.

In both of these situations, a pre-populated application is mailed to the household requesting a traditional signature from the applicant.

Advise the household that an applicant does not have to be interviewed before filing the application. They may file an incomplete application as long as the form contains the applicant's name, address and signature as explained in A-121, Receipt of Application.

On the same day of the request, provide the applicant an application packet that includes:

• Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
• Form H1830, Application/Review/Expiration/Appointment Notice;
• Form H1858, Items We Need When You Apply For Benefits, or Form H1858-S, Documentos que Necesitamos Cuando Solicita Beneficios;
• appropriate program pamphlets;
• Form H0025, Voter Registration Application; and
• a postage-paid return envelope.

If a household contacts the local office by telephone and does not wish to come to their designated office to file an application on the same day of the request and instead prefers receiving the application by mail, send an application packet on the same day of the telephone request. For written requests, including those received electronically or by fax, mail an application packet on the same day the request is received.

The Health and Human Services Commission (HHSC) must accommodate reasonable requests to receive communications by alternative means or at alternative locations.

The individual must specify in writing the alternate mailing address or means of contact and include a statement that using the home mailing address or normal means of contact could endanger the individual.

Children’s Medicaid

The applicant or the applicant's representative may request an application for Children's Medicaid by contacting the local eligibility determination office in person, by telephone, fax or mail. The application is also available electronically at www.chipmedicaid.org. The form can be downloaded and printed but cannot be submitted electronically.

On the same day the request is received, provide the applicant an application packet that includes:

• Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage;
• appropriate program pamphlets;
• Form H0025, Voter Registration Application; and
• a postage-paid return envelope.

Note: Applicants may only use Form H1014 to apply for Medicaid for a child under age 19. Use Form H1010, Texas Works Application for Assistance — Your Texas Benefits, if the applicant wants to apply for an adult or for programs in addition to Children's Medicaid.

When the applicant requests Form H1014, ask if the applicant wants to initiate the process by telephone. Take all of the information; inform the individual of any additional information that is needed; complete Form H1020, Request for Information or Action, requesting any needed information, including the signature and date on Form H1014; and mail the form to the individual. The application is not filed until it is returned to the local eligibility determination office with a signature.

TANF and Medical Programs

Include Form H0050, Parent Profile Questionnaire, for each absent parent.

SNAP

Form H1805, SNAP Food Benefits: Your Rights and Program Rules, must be included in the application packet or given to the applicant during the interview.

Related Policy
Registering to Vote, A-1521

A—113.1  Applicant Contacts Wrong Office

All Programs

If an applicant contacts staff in the wrong certification office, give or mail an application packet to the applicant the same day. Also, give the applicant the address and telephone number of the correct office. Explain that the application-processing period will not begin until the application is filed in the correct office. Follow the policy and procedures in A-121, Receipt of Application, when the applicant returns an application to the wrong office.

Children’s Medicaid

The file date is the date an individual submits Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, to any HHSC office. The application must be faxed or mailed to the correct office the same day it is returned.

A—114  Applications Causing Conflicts of Interest

All Programs

The advisor must avoid the appearance of impropriety or conflict of interest when determining eligibility. The advisor is not allowed to work on a case if the individual is a relative (by blood or marriage), roommate, dating companion, supervisor or someone under the advisor's supervision. The advisor may never work on a case in which the advisor is a case participant or AR.

The advisor may provide anyone with an application and information about how and where to apply for benefits. The advisor may also help a person gather any documents needed to verify eligibility, but must not take any other role in determining eligibility.

The advisor must consult with the supervisor if the individual is a friend, acquaintance or coworker. Generally, the advisor should not work on cases involving these individuals, but the degree and nature of the relationship should be taken into account. In remote areas where it is impractical for another person to process the application, the unit supervisor should be contacted to determine the best method to process the application.

A—114.1  Applications Submitted by Texas Works Employees

All Programs

Special handling must be given to a Texas Works employee's application or redetermination.

• A Texas Works employee at the next higher administrative position must complete the eligibility determination for another Texas Works employee.
• A designated supervisor must complete the eligibility determination for a supervisor or higher position.
• The employee's immediate supervisor or someone in the direct line of supervision may not process the employee's application except in remote areas where it is impractical for another person to process the application.

A—115  Applications Accepted in a County Other Than the County of Residence

All Programs

HHSC accepts and processes applications from households:

• living in an adjoining county, or
• applying in a hospital or clinic in which an advisor works.

TP 32, TP 33, TP 34, TP 35, TP 43, TP 44, TP 48 and TP 56

When a representative from a licensed residential child care facility applies for an independent child who does not live in the county, accept and process the application.

A—115.1  Applications from Adjoining Counties

All Programs

HHSC accepts, processes and maintains applications from households living in an adjoining county. These applications are subject to the regional director's approval. When the regional director approves, accept applications from adjoining counties. The following conditions must be met:

• The household's county of residence and the county where the household applies are in the same HHSC region.
• Accepting the application at the request of the household reduces hardships for the household.
• The county offices coordinate to avoid duplicating benefits.

A—115.2  Applications Filed in Hospitals and Clinics

All Programs

Staff in these outstationed facilities are responsible for processing work from end-to-end and routing completed work to the vendor as Image Only.

When a Texas Works application is received, Texas Works outstationed staff:

• date stamp the document.
• perform inquiry and complete Application Registration in TIERS, if necessary

If the individual requests a program that requires an interview or the individual requests an interview, the appointment will be scheduled through the State Portal Scheduler to the appropriate outstationed facility location listed in the State Portal Scheduler. 

If an appointment is not required or requested, staff must manually create the appropriate Process task via the State Create Task page.

Once an appointment is scheduled in the State Portal Scheduler, an appointment task is created for the designated outstationed facility based on the interview type.

If an application/redetermination received in an outstationed facility meets the SNAP Desk Review criteria, staff should follow the Desk Review process.  

Medical Programs

If an individual is admitted to a hospital, either in the same region or in another region, and the individual has a pending Medicaid application in a local eligibility determination office, the hospital-based advisor must coordinate with the local office to assist in providing missing information so the local office can complete the case.

Children’s Medicaid

The file date is the date a contracted facility accepts the application. If the application is not forwarded to HHSC within three business days, the file date is the date the local eligibility determination office receives the application.

For SNAP or TANF applications filed at hospitals or clinic sites, make arrangements for the household to obtain a Lone Star Card and personal identification number (PIN) at a nearby local office if they are not available at the hospital or clinic site.

A—116  Special Application Processes

A—116.1  Application Processing Exception for MA-Pregnant Women – Emergency

TP 36

Follow these procedures to process an application for a pregnant woman who is undocumented or whose alien status does not qualify her for Medicaid if she files the application within 30 days of her expected delivery date, unless the date she provides is questionable.

When possible, gather all required information and complete the verification process before the baby is born, leaving the case pended only for Form H3038, Emergency Medical Services Certification.

Related Policy
Pending Verification for TP 30 Pregnant Women, B-115.1

A—116.2  Applications from Residents of a Homeless Shelter

SNAP

Households are potentially eligible for SNAP even if they live in a shelter for the homeless that provides more than 50% of the household's meals. The shelter does not have to be authorized to accept SNAP, but must be either a public or private, nonprofit shelter for the homeless. Verify nonprofit status, if questionable.

Homeless households must meet the same household composition, income and resource standards as other households. If the household pays for room in a shelter, consider the payments as shelter expenses.

Related Policy
Prepared Meals for Homeless, B-463
Homeless Shelter Standard, A-1427

A—116.3  Applications for Babies Born to Women in Prison

Medical Programs

A pregnant woman who enters the state prison system is sent to the Texas Department of Corrections women's facility. Before the baby is born, the prison social worker assists the pregnant woman to arrange for a responsible individual to pick up the baby from the hospital. The pregnant woman is sent to a prison section of the University of Texas Medical Branch (UTMB) in Galveston a few weeks before she is due to deliver, unless an emergency occurs earlier. If an emergency does occur, she will deliver at a closer facility when necessary. Before releasing the baby from the hospital, UTMB requires the individual who picks up the baby to complete an application for Medicaid. Designated Texas Works advisors ensure that the baby is certified for Medicaid using special application processing procedures and follow-up activities.

These designated advisors coordinate Medicaid certification by other advisors in special situations when the newborn needs to be added to an active case. Upon request by these designated advisors, an advisor must certify the newborn:

• for Medicaid (TP 43) from the date of birth (DOB), not the day the caretaker brought the baby home from the hospital. The request must be documented in the case record.
• after normal application time frames have passed. If needed, staff may follow procedures to request a timeliness exception.

State law requires Medicaid coverage for Texas newborns for at least 28 days after birth and possibly longer if the child is hospitalized at that time. If the hospital followed required procedures before releasing the baby but the baby does not meet eligibility requirements for TANF or Medicaid, the designated advisor and State Office Data Integrity (SODI) staff certify the baby for TA 62, MA - State-Paid Coverage. Examples of not meeting eligibility requirements are:

• the individual caring for the child does not reside in Texas and the baby will be taken out of state;
• the individual caring for the child refuses to apply for Medicaid;
• the household is over the resource limit; or
• the household is over the income limit.

Related Policy
Documentation Requirements, A-190
Medical Programs, A-240

A—116.4  SNAP Applications from a Contracted Community Partner (CP)

SNAP

In March 2010, HHSC began a pilot program to allow CP staff from certain food banks to conduct the SNAP eligibility interview and collect as much information and verification as possible. A specially designed interview worksheet, Form H0901, HHSC Enhanced Data Gathering Worksheet, guides the CP interviewer through the interview process. Five specific CP food banks are participating in the pilot program. HHSC already contracts with these food banks to provide application assistance. Those food banks are:

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

The file date of both the interviewed and the assistance-only applications is the date the contracted CP receives the application for SNAP assistance and for any other type of Texas Works assistance requested on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. For assistance beyond Texas Works programs (for example, Medicaid for the Elderly and People with Disabilities program requests), follow local office procedures to forward the information through the appropriate channels.

If the CP accepts the application after traditional HHSC business hours (after 5 p.m.) or on a day that is not an HHSC workday (on a weekend or a holiday), the CP must advance the file date to the next HHSC workday. If the CP includes a date that is not an HHSC workday as the file date, the Texas Works advisor must correct the file date and enter the next HHSC workday as the file date, and document why the corrected file date was used. This means the interview date also must be advanced to the same date since the interview date cannot be any earlier than the file date.

CPs will interview expedited as well as regular status households. Applications screened as potentially eligible for emergency benefits must be submitted to HHSC the day of receipt. CP-interviewed applications with regular status, not expedited, must be submitted to HHSC no later than three workdays from the date the CP receives them.

CPs maintain the interviewed applications on an electronic list for tracking purposes. The interviewed applications are then emailed to a designated secure regional HHSC Outlook mailbox using Voltage Encryption. A specially devised interviewing worksheet (Form H0901, HHSC Enhanced Data Gathering Worksheet), used exclusively by the CP interviewers, will be placed at the beginning of each application packet for which an interview was conducted. Since there will still be some households who only receive application assistance from the CP, Form H0901 will serve as the flag to notify HHSC staff that the household has been interviewed for SNAP.

Medicaid and TANF

There is no deviation from normal processing for Texas Works Medicaid or TANF program requests submitted by the CP with SNAP applications. For those households interviewed for SNAP by the CP, the advisor processing the TANF or TANF-Level Medicaid must still conduct the TANF/TANF-Level Medicaid interview. The advisor can conduct this interview without first scheduling the appointment, but in order to meet the timeliness requirement the office must schedule an appointment if the advisor is not able to contact the household to conduct the TANF/TANF-Level Medicaid interview within three workdays after receiving the application.

Assistance-Only Applications – All Programs

Assistance-only application packets are routed by the CP to the Midland Document Processing Center for distribution to the appropriate local HHSC eligibility office by applicant ZIP code for normal processing.

While most CPs submit electronic applications through the HHSC Self-Service Portal (SSP) at yourtexasbenefits.com, community partners use a different computer system that screen eligibility for various programs and services, including some outside of HHSC programs. Two of these systems currently are able to submit electronic applications via an interface with HHSC. These electronic applications currently include applications for SNAP, Texas Works Medicaid and TANF, and are considered e-signed the same as applications filed through the SSP and display “E-signed” on all client signature lines of the application. The CP organization’s name is displayed in the People Helping You section of the application. These applications will not be reported through the CBO portal page, and the CBO Logical Unit of Work (LUW) does not need to be completed with the CP’s information.

Pending Information

If the CP interviewer notes that more information is required to complete the case, the CP interviewer will provide a request for information form to the household.

The CP interviewer will give the applicant Form H0920, Notice from the Community Organization Helping You, explaining:

• what is needed,
• the due date for receipt of the information, and
• the address and telephone number of the HHSC eligibility office where the information listed on Form H0920 should be returned.

The household has the option of returning requested information to the HHSC eligibility office or the CP. If the household chooses to return the requested information to the CP, the CP will facilitate the submission of the pending information to the local HHSC eligibility office. The CP will log the pending information returned by the household and forward it to the appropriate eligibility office by encrypted email within three workdays of receipt.

Eligibility Decision

If the CP interviewer believes all of the information to complete the case is present, the CP interviewer gives the household Form H0920, and indicates by marking the appropriate check box on Form H0920 that the information and verification will be forwarded to HHSC for the final eligibility decision.

Form H0920 also informs the household that HHSC may determine additional information is needed to complete the case.

Rights and Responsibilities

Before completing the interview, CP interviewers will:

• inform the household of their rights and responsibilities, using Form H1805, SNAP Food Benefits: Your Rights and Program Rules, including the right to appeal;
• explain the difference between streamlined reporting and non-streamlined reporting; and
• inform the household that HHSC will send Form H1019, Report of Change, to them indicating the household's specific reporting requirements.

The CP interviewer will address the following forms and activities:

• Form H0025, Application for Voter Registration (HHSC);
• Form H1007, Eligibility for Food Stamps and Medicaid;
• Lone Star Card training and materials; and
• referrals for additional resources if known, or to 2-1-1 Texas Finding Help In Texas if not known.

HHSC Action on CP-Interviewed SNAP Applications

The local HHSC office records receipt of all interviewed applications from the CP on an electronically maintained list. The Texas Works advisor reviews the application and the supporting documentation. If the supporting documentation and application received are complete, the Texas Works advisor processes and disposes the application and sends the primary cardholder record to the Electronic Benefit Transfer (EBT) clerk for the CP-provided Lone Star Card. The HHSC advisor sends an eligibility notice and issues benefits.

If the application is denied, HHSC notifies the individual about the denial action and of the household's right to appeal the decision.

CP SNAP Interviews – Verification of Identity

CP staff who interview applicants for SNAP and indicate on Form H0901, HHSC Enhanced Data Gathering Worksheet, that they verified the applicant's identity must include a copy of the document used to verify identity in the data collection packet that is forwarded to HHSC for eligibility determination and processing.

If the CP interviewer fails to provide a copy of the document used to verify identity, was unable to verify the identity of the applicant, or the Texas Works advisor determines that verification is questionable, the Texas Works advisor must pend the applicant for verification of identity and obtain the verification before certifying the SNAP application.

Pending Information

If information is required to complete the case, the HHSC advisor sends Form H1020, Request for Information or Action, to the household and allows at least 10 days for the household to provide the information, following regular policy.

Advisors must send Form H1020:

• to restate the same information requested by the CP; and
• to request additional information, if any, not noted by the CP.

The Texas Works advisor must then dispose the application following regular policy for pended applications. See A-136, Eligibility Decision.

If the household does not provide the needed information and the 30-day SNAP processing time frame expires, or if the information is not provided by the last workday of the last benefit month for recertifications, the Texas Works advisor denies the request for assistance, and notifies the individual about the denial action and the household's right to appeal the decision.

Advisors must:

• transfer all pertinent information gathered on Form H0920 to TIERS;
• document the interview was conducted by CP staff; and
• document the specific food bank entity that conducted the interview.

Fair Hearings

HHSC staff will represent the agency at all fair hearings. CP staff will be asked to refer individuals to the local HHSC eligibility office that serves them to submit a request for a fair hearing either by phone, in person or by mail. If CP staff accepts a request for a fair hearing, these will be forwarded to HHSC. The date of receipt for the fair hearing request is the date HHSC receives the request.

Scheduling a CP-Interviewed Appointment for TIERS Advisors

Appropriate Office of Eligibility Services (OES) staff must schedule appointments using the Portal Scheduler for TIERS cases interviewed by a CP. This allows for tracking via Task List Manager (TLM). In many instances, the CP interview date will be before the date the application is actually received by the HHSC eligibility office; therefore, OES staff use the Select Appointment option to locate a past appointment slot that corresponds to the CP interview date. To ensure the appointment task is routed to the appropriate location handling the application, staff must overwrite the individual's ZIP code that automatically displays once the TIERS case number is entered into the Portal Scheduler, with the ZIP code of the office that is processing the application.

Interview slots must be published in order to use the Select Appointment option. In the event there are no appointment slots published for a past date, OES staff indicate the appointment date in TIERS on the Appointment Details page. If an appointment date is not indicated, the SNAP Eligibility Determination Group (EDG) will be pended. These appointments, not scheduled in the Portal Scheduler, will not be tracked by the TLM. Note: CP-assisted applications (applications not interviewed by a CP) should follow normal scheduling procedures.

Once the case is completed, the supporting documents used for eligibility decisions should be sent to the vendor for Image-Only processing.

Related Policy
Application Processing, A-100

EBT

Each CP is assigned a specific local HHSC eligibility office to facilitate Lone Star Card distributions and security activities. A list of each local HHSC office assigned to a particular CP is part of the local office security plan, and each CP must comply with the HHSC security plan. Regional EBT coordinators must audit the HHSC eligibility office and the office's related community partner.

If it appears the household could be eligible for benefits, the CP provides an EBT Educational and Information Packet for Clients Applying for Supplemental Nutrition Assistance (SNAP) to the household. The packet includes the Lone Star Card, information explaining the EBT process, and contact information. The household will not be able to register the card or select a PIN until an HHSC staff member enters a primary cardholder record for the individual and associates the correct card to the individual.

If it appears the household is not eligible, the CP interviewer does not provide the Lone Star Card or related materials, but still must process the request for assistance and forward the application to the local HHSC eligibility office for an eligibility determination.

The CP interviewer provides households that appear to be eligible with:

• Form H1184, Benefit Issuance Schedule; and
• Form H1185, Welcome to Your Lone Star Card, or Form H1185-S, Bienvenido a Su Tarjeta Lone Star.

The CP interviewer must discuss the issuance-related items as explained in B-239.1, Advisor Interview Requirements for Client Training, to potentially eligible applicants during the interview, even if the application is pended. In addition, CP interviewers must also inform about the:

• benefits of keeping receipts to monitor one's SNAP EBT account balance;
• expunged benefits policy (benefits that are not accessed after a year are expunged, see B-371, Expungement Policy);
• procedures for using the Lone Star Card to access SNAP benefits in other states as explained in B-351, Moves Out of State.

CP issuance staff provides households that appear to be eligible with:

• a card sleeve;
• Form H1162, Lone Star Card Insert; and
• Form H1183, EBT Pocket Guide.

The CP completes Form H1172, EBT Card, PIN and Data Entry Request, and the individual signs this form as acknowledgement of having received the EBT card. Form H0901, HHSC Enhanced Data Gathering Worksheet, also contains a space to enter an existing cardholder's personal account number (PAN). CP interviewers must ask whether the household currently has a Lone Star Card. If the household indicates there is an existing Lone Star Card, the CP interviewer must record the PAN on the last page of the data collection worksheet if the card is available. HHSC EBT staff must ensure the card is linked to the appropriate case.

Form H1172 becomes part of the application package that is returned to the HHSC local office for eligibility determination. If determined eligible, the HHSC advisor informs the EBT clerk (by forwarding Form H1172) to officially issue the card by linking the primary cardholder record with the card's PAN at the Administrative Terminal.

If applicants wish to add a secondary cardholder to their EBT card, they must contact the Lone Star Help Desk at 1-800-777-7EBT (1-800-777-7328).

If the CP did not issue a Lone Star Card to a household eligible for SNAP benefits, the HHSC advisor must treat this occurrence like a certification following a telephone interview. The HHSC advisor must attempt to contact the household by telephone to give the household the choice of coming to the HHSC eligibility office to pick up the card or having the card mailed to the applicant's address.

Related Policy
Advisor Interview Requirements for Client Training, B-239.1
Issuance Staff Requirements for Client Training, B-239.2
Issuing Lone Star Cards for PCHs, B-233.2
Applicants Interviewed by Phone, B-233.2.2

A—116.5  Food Distribution Program on Indian Reservation (FDPIR)

For application processing related to FDPIR, refer to the policy in B-421, Food Distribution on Indian Reservation (FDPIR).

A—116.6  Joint SSI-SNAP Applications

For application processing related to joint Supplemental Security Income (SSI)-SNAP applications, refer to the policy in B-420, Joint SSI-SNAP Applications.

A—116.7  Types of Assistance Administered by Centralized Benefit Services (CBS)

A—116.7.1  SNAP–CAP and SNAP-SSI

For application processing related to SNAP- Combined Application Project (CAP) and SNAP-SSI, refer to the policy in B-475.1.1, SNAP Programs.

A—116.7.2  Applications for SNAP-CAP

For application processing related to SNAP-CAP, refer to the policy in B-476, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP).

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

For application processing related to MTFCY, refer to policy in B-475.1.2, Medical Programs, 1; and Other Medical Programs, Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

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

For application processing related to Medicaid for eligible youth in the custody of or released from the Texas Juvenile Justice Department, refer to policy in B-475.1.2, Medical Programs, 2.

A—116.7.5  Medicaid for Breast and Cervical Cancer (MBCC)

For application processing related to MBCC, refer to policy in B-475.1.2, Medical Programs, 3; and Other Medical Programs, Part X, Medicaid for Breast and Cervical Cancer (MBCC).

A—116.7.6  Refugee Medical Assistance (RMA)

For application processing related to RMA, refer to policy in B-475.1.2, Medical Programs, 4; and Other Medical Programs, Part R, Refugee Medical Assistance.

A—116.7.7  Former Foster Care in Higher Education (FFCHE) (TA77)

For application processing related to FFCHE, refer to policy in Other Medicaid Programs, Part F, Former Foster Care in Higher Education (FFCHE).

A—117  Applications Filed through the SSP

When the household submits an application using the SSP, a process formats the information entered on the online application and imports certain data into TIERS. The process creates the PDF file of the application that is stored in the image repository and is viewable in the State Portal.

TIERS edits the data passed by the SSP. The fields must contain valid characters and be valid values to be imported into TIERS. Dates must be in the correct format, fields that are numeric must contain only numbers and data must be in accepted ranges for fields with values such as Yes or No, or ZIP codes.

Applications that do not contain required data or have data that may be invalid may be rejected. When an application is rejected for electronic processing into TIERS, the system creates a non-SSP Application Registration TLM task.

Applications that are valid and accepted as electronic input into TIERS have an Application Registration TLM task created for them. The task is routed to the appropriate office based on Type of Assistance (TOA) and individual ZIP code for the clerk to perform the Application Registration process task.

A—117.1  Application Registration

Clerks select the Application Registration task and review the application. Staff will perform Application Registration using certain pre-filled data from the SSP application that was entered by the individual. All SSP applications must have Application Registration processed even if the case is approved. It is important to associate the SSP application to the existing case.

A new logical unit of work (LUW) is added to Application Registration; Self-Service Application Search. Clerks search for the self-service application using any of the fields in the search area. The search results will be displayed by the head of household name even when the search was not on the head of household.

After successful Application Registration, an appointment or process task will be created for Data Collection, depending upon the programs requested on the SSP application.

The Application T number is changed to a case number upon clicking Submit in Application Registration.

A—117.2  Data Collection

When performing Data Collection, the data entered in the SSP application is displayed for the advisor either as:

• pre-filled TIERS fields and a message at the top of the page stating the fields are pre-filled from self-service data (for new applications); or
• SSP information that must be addressed, which displays in a comparison pop-up window (existing cases).

Click on the C icon in the Details page to access the comparison pop-up.

The comparison pop-up window displays the current data in TIERS and the data from the SSP application to allow the advisor to select the correct data to use in Data Collection.

The advisor can choose to accept:

• all TIERS data,
• all SSP data, or
• select each data element to be used individually from the comparison pop-up.

These comparison windows are displayed on most Data Collection pages through Resources; there are no SSP information or comparison windows in Program, Income or Expenses. The advisor must complete the Data Collection driver flow.

A new screen is added in the driver flow just before Run Eligibility. This new screen is a summary screen that displays each LUW with SSP comparison data and the status of that data. Once the case is disposed, all SSP comparison data that was not resolved or processed will be marked completed by the system.

A—120  Office Procedures

A—121  Receipt of Application

All Programs

If the agency receives an application without a signature, follow the policy in A-122.1, Application Signature.

All Programs except TP 43, TP 44, TP 47 and TP 48

Accept applications received by fax. An original signature is not required.

If the applicant returns an application to the wrong office:

• in person, offer to forward the application to the correct office on the day of receipt by interoffice mail or fax on the day of receipt. Explain that the application processing period begins when the correct office receives the application. Give the applicant the address and telephone number of the correct office if the individual prefers to submit the application to the correct office the same day.
• by mail, date the application in the appropriate box. Forward the application to the correct office on the day of receipt by interoffice mail or fax no later than the day after receipt. If faxed, mail the original to the correct office with a notation of the fax date or confirmation notice.
• by fax, date the application in the appropriate box. Forward the application to the correct office on the day of receipt by interoffice mail or fax no later than the day after receipt. Mail the original faxed application to the correct office with a notation of the fax date or confirmation notice.

Exception: See A-115, Applications Accepted in a County Other Than the County of Residence, for households living in an adjoining county or applying in a hospital or clinic where a Texas Works advisor is located, and A-126, Processing Children's Insurance Applications.

TANF, TP 08 and TA 31

Accept an application as long as it contains the applicant's name, address and signature of:

• the applicant, or
• an AR if the applicant is incapacitated or incompetent.

Note: Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, may also be used if the application is for a child.

TP 43, TP 44, TP 47 and TP 48

Accept an application as long as it contains the applicant's name, address and signature of:

• the applicant; or
• an AR, if the applicant is incapacitated or incompetent.

Do not require Form H1010,Texas Works Application for Assistance — Your Texas Benefits, or Form H1014 when an individual has an active Medicaid type program and requests to add another child for whom a new EDG is needed. See B-600, Changes.

Do not apply this policy when there is no existing Children's Medicaid EDG. For example, do not add a child when the only other child is certified for Medicaid because the certified child receives SSI. A separate application is required to initiate benefits for the child being added. Also, do not add a TANF "other-related" child to an existing Medicaid EDG. This situation requires a separate application that establishes a new household and budget group for Children's Medicaid.

SNAP

Accept an application as long as it contains the applicant's name, address, and signature of:

• the applicant,
• other responsible household member, or
• AR.

Related Policy
Request for Application, A-113
Applicant Contacts Wrong Office, A-113.1
Filing the Application, A-122
Application Signature, A-122.1
Authorized Representatives (AR), A-170
Children's Medical Renewal Expectations, B-123.7
Denied Cases, B-475.7

A—121.1  Receipt of Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid and CHIP Perinatal Coverage

Children's Medicaid

Process Form H1014 as long as it contains the applicant's name, address and signature of:

• the applicant; or
• an AR, if the applicant is incapacitated or incompetent.

If Form H1014 is received without a signature, return the application with Form H1020, Request for Information or Action, requesting a signature and any other missing information if not available by telephone.

When a representative from a licensed residential child care facility applies for an independent child who does not live in the county, accept and process the application.

Related Policy
Authorized Representatives (AR), A-170

A—121.2 Receipt of Duplicate Application

All Programs

A duplicate application:

• is an application filed after another application has already been filed;
• does not include a request for programs different from programs requested on the initial application submitted;
• does not include a request for programs different from programs currently received by the applicant; and
• is not needed for a redetermination of any active program.

Example: A household submits an application for SNAP on Jan. 2. If the household later submits one or more additional applications for SNAP that is different from the one they filed on Jan. 2, and is not needed for a redetermination of any active program, the additional application submitted is considered a duplicate application.

Duplicate Application Received While Original Application is Being Processed

If an office receives a duplicate application while staff are in the process of making an eligibility determination (an application or redetermination) based on the original application submitted, staff must:

• treat the duplicate application as a report of change; and
• assign the duplicate application as a change to the advisor currently processing the case.

The advisor processing the original application must:

• review the duplicate application for reported changes;
• document the duplicate application was reviewed for changes;
• document the type of changes, if changes were reported on the duplicate application; and
• use information provided by the household on both the original application and the duplicate application when determining eligibility for the household.

Duplicate Application Received After Original Application is Processed

If an office receives a duplicate application and the applicant has already been certified for assistance based on another application previously submitted, staff must review the duplicate application to determine if the household is applying for programs other than what the household is currently receiving and if any redeterminations are due.

If the household is applying for different types of programs, the application is not a duplicate application and must be processed as a new application for assistance.

If the household is not applying for a different type of program and there are no redeterminations, office staff must:

• treat the duplicate application as a report of change; and
• assign the duplicate application as a change indicating "duplicate application."

Staff are not required to create a T number for TIERS cases and/or dispose of a duplicate application as "filed in error." If staff erroneously create a T number, they must deny/dispose the T number as filed in error, in addition to other required actions listed above.

Note: If the office that receives the duplicate application does not normally process reported changes, staff may mark the application form as a duplicate application and route it to appropriate staff following local office procedures.

Advisors who process the duplicate application as a reported change must review the application to determine if any changes are indicated and take the following action. If no change is indicated on the duplicate application, the advisor must:

• document receipt of the duplicate application in TIERS Case Comments;
• route the duplicate application to be imaged as part of the electronic case record;
• sustain the benefits for each Texas Works program the household receives; and
• send an individual notice to the household that eligibility for benefits has not changed.

If a change is indicated on the duplicate application, staff must follow the procedures outlined in B-600, Changes, when processing changes reported on the duplicate application.

A—121.3  Receipt of Identical Application

All Programs

An identical application is one or more exact copy of an application previously filed by an applicant.

Example: A household faxes in an application on Jan. 2. If, on the same day or at a later date, the household submits an exact copy of the same application the household originally submitted on Jan. 2, which includes the same signature and date of the application it previously submitted, the newly submitted application is considered an identical application.

Required Action on Identical Application Received

If an identical application is received, staff must write, "Identical Application" on the front page of the application and route the application for imaging. The vendor will image the identical application and add it to the electronic case record. No other action is needed.

A—122  Filing the Application

All Programs

Encourage households to file an application the same day the household or its representative contacts the office in person, by telephone, fax or mail, and expresses interest in obtaining assistance. Explain how they can file an application. Application forms are also available at www.yourtexasbenefits.com/wps/portal and can be downloaded, printed and electronically submitted.

The file date is the day the correct local eligibility determination office or document processing vendor receives an application form containing the applicant's name, address and appropriate signature. This is day zero in the application process. Use this file date to determine eligibility for the programs the household requests upon filing the application through the time of the interview.

For electronically filed applications, the file date is the date the applicant clicks the Submit Application button in the Self-Service Portal. For applications received outside of business hours when HHSC is closed, including weekends and holidays, the file date is the next business day.

Exception: For applications received outside of business hours when HHSC is closed, including weekends and holidays, the file date is the next business day.

The household must file another application form to apply for additional programs after the interview is held, even if the case was pended and is not completed at the time of the request for a new program. Exception: If the household requests three months prior Medicaid coverage according to policies in A-831.2, Eligibility for Three Months Prior Coverage, use a previously filed application with a file date that corresponds with the three month prior period as a basis for determining eligibility.

Once an application is filed, staff must take the following actions:

• Enter the file date in the appropriate section on the application form, if received as a paper document
• For SNAP and TP 40, screen the application for expedited service eligibility.
• Upon request, give the household Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change.
• Register the application when required.
• Schedule an interview appointment for the applicant when required as soon as possible.

See special procedures in this section to determine the file date for TP 40, TP 40 Continuous Coverage and TP 45 Retroactive Coverage.

Related Policy
Request for Application, A-113
Applicant Contacts Wrong Office, A-113.1
Receipt of Application, A-121
Documentation Requirements, A-190

TP 40 Continuous Coverage

The file date is the date the advisor determines eligibility, if an application form is not used.

TP 45 Retroactive Coverage

The file date is the date the advisor is notified about the child's unpaid medical bills.

Children’s Medicaid

The file date is the date a contracted facility accepts the application. If the application is not forwarded to the HHSC within three business days, the file date is the date the HHSC office receives the application.

The file date is the date a individual submits an application or Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, to any HHSC office. The application must be faxed or mailed to the correct office the same day it is returned.

For electronically filed applications, the file date is the date the applicant clicks the “Submit Application” button in the Self-Service Portal. For applications received outside of business hours when the HHSC is closed, including weekends and holidays, the file date is the next business day.

A—122.1  Application Signature

All Programs

The applicant is required to provide a signed application form before being certified.

If the agency receives an application without a signature and the application has not been date stamped, the application is considered invalid. Staff must return the application with a letter and a self-addressed return envelope explaining that the application must be signed before the agency can establish a file date.

If the agency accepts an application without a signature and the application has been date stamped, the date the application is received is considered a valid file date. Staff must send Form H1020, Request for Information or Action, along with the signature page requesting a signature. If the applicant fails to provide a signed application by the final due date, deny the application for failure to provide information.

Eligibility Support Vendor Action on Unsigned Applications

If the Eligibility Support vendor receives an unsigned application and takes action on that application within one business day, the application is invalid and is returned to the household with a letter and a self-addressed return envelope explaining that the application must be signed before a file date can be established.

If the Eligibility Support vendor accepts an application without a signature, and it is not identified as such before data entry or the data entry date is more than one business day after the receipt date of the application, the file date is protected. The file date is the receipt date of the application. The missing signature is treated as missing information.

Electronically Filed Applications

For electronically filed applications, when submitted by the applicant or AR, consider an application electronically signed except in the following situations:

• The household applies for TANF or Medicaid by telephone (2-1-1) and the customer care representative enters the information provided through the Self-Service Portal; or
• A non-client or non-AR completes and submits the application for the household through the Internet.

In both of these situations, a pre-populated application is mailed to the household requesting a traditional signature from the applicant.

Signatures Elsewhere

If the applicant signs the first page of Form H1010, Texas Works Application for Assistance — Your Texas Benefits, but not the last page, the application can still be used to establish a file date. The applicant must still provide a signature for the last page to be certified.

If a signed first page of Form H1010 is received, staff must send Form H1020 requesting a signature on the last page of Form H1010 by the final due date. Applicants who fail to provide a signed last page of Form H1010 must be denied for failure to furnish information.

Note: If the applicant only provides a signed last page of Form H1010, do not require an additional signature for the first page of Form H1010.

Related Policy
Request for Application, A-113
Receipt of Application, A-121

A—122.2  Scheduling Appointments

All Programs except TP 40 and Children's Medicaid

Provide the individual with an appointment on Form H1830, Application/Review/Expiration/Appointment Notice, on the same day the individual submits an application unless the individual is interviewed on the same day. This is required even if the application is filed with only a name, address and signature.

Exception: Send Form H1830 no later than the next business day if the individual submits the application by mail or in an office drop box.

Apply this policy to all new applications and untimely SNAP applications that are filed after the last day of the last benefit month.

Note: Attempt to schedule the interview on a date and time that accommodates the needs of the household, such as after working hours if the only adult is working.

When scheduling a telephone interview, enter the individual’s telephone number and the appropriate time, using one-hour increments. For example, a telephone interview will be conducted between 1 p.m. and 2 p.m. Local offices may choose to establish a shorter time increment.

TP 40 and Children's Medicaid

Process the application by mail or telephone unless the individual requests an office appointment. There is no interview requirement for Children's Medicaid or Medicaid for pregnant women.

Exceptions:

• If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice, or for missing an appointment related to Health Care Orientation (HCO) or THSteps, schedule a face-to-face appointment. Deliver the HCO or remind the individual about the importance of the THSteps checkup at that time.
• Conduct a face-to-face interview for an initial application or renewal when HHSC receives conflicting information related to household composition, income or resources that affects eligibility and the information cannot be verified through other means, such as an associated EDG.

Related Policy
Interviews, A-131

A—122.3  Registering an Application

All Programs

Staff must perform Application Registration (App Reg) within one workday after the file date when application registration is required.

To prevent overpayments, staff must take the following action before registering an application:

• screen each application filed; and
• associate the old case number in File Clearance when appropriate.

Perform inquiry on all household members applying for benefits listed on the application for assistance. Use Social Security numbers (SSNs), case name search and/or available case or EDG numbers to determine case status.

SNAP

Staff must review the application for assistance to determine if the household is requesting a telephone interview due to a hardship.

Note: Staff use Form H1000-A, Notice of Application, to register applications and to obtain a unique EDG number when:

• TIERS is down for an extended period,
• the household is not known to TIERS,
• the household is eligible for expedited services, and
• the Administrative Terminal Application (ATA) must be used to assign the EDG number and issue benefits.

A—123  Withdrawal of an Application

All Programs

The individual may voluntarily withdraw an application anytime before certification.

SNAP

If someone other than the head of household, spouse, a responsible household member or an AR requests a withdrawal, contact the household to confirm the withdrawal.

Related Policy
The Texas Works Message, A-1527

A—124  Processing Presumptive Eligibility Applications

TP 42

Presumptive eligibility cases are processed with minimal data that allows TIERS to auto create an EDG without going through the entire data collection and EDG/Eligibility Determination Benefit Calculation (EDBC) process.

When a Qualified Provider sends the Presumptive Eligibility Determination packet to the local office (which contains an application for assistance), staff complete the Application Registration Page – Register Individual – Individual, identifying the woman as pregnant. This identification allows staff to select Presumptive Eligibility as the Case Mode. In this mode, staff can enter the application number, and TIERS creates the presumptive eligibility EDG.

Reminder: The TP 42 Medical Effective Date (MED) is the:

• date the Qualified Provider receives Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
• date the Qualified Provider makes the TP 42 eligibility decision; and
• file date for the TANF or Medicaid application.

Schedule an interview if the application includes a request for TANF or TP 08. No interview is required if the application is for TP 40 only. Next:

• access the case in Data Collection/Initiate Interview;
• initiate the interview by selecting Complete Action interview mode and the case number;
• enter the data and make a final determination of eligibility within 45 days of the date the presumptive eligibility decision was made;
• dispose the results; and
• notify the Qualified Provider of the pregnant woman's eligibility or ineligibility for medical assistance by completing Form H1271, Presumptive Eligibility Application Packet Referral Letter.

Ensure the assigned medical effective date is the earliest day in the application month or the three months prior that all eligibility criteria are met for the new TP. The new TP can overlay the TP 42 coverage. For example, if the pregnant woman is eligible for TP 40 beginning the same month as the presumptive eligibility period, TP 40 will overlay the TP 42 coverage.

Note: TIERS creates one EDG for the presumptive eligibility and one for TP 40 or for TP 08.

Deny the TP 42 EDG if:

• ineligible for continuing Medicaid coverage under TP 08 or TP 40. If the family includes children, consider including them in any TP for which they may be eligible. Note: Because this determination is considered to be an application determination, issue Form TF0001, Notice of Case Action, but do not provide advance notice of adverse action.
• only eligible for TP 56, Medically Needy with Spend Down. If the applicant has sufficient bills to meet spend down, process an open/close disposition for the application month. Use TP 56 procedures for three months prior eligibility.

Related Policy
Qualified Provider Procedures for Presumptive Eligibility Determinations, C-1113

A—125  TP 45 Provider Referral Process

TP 45

SODI uses the Provider Referral Process when a hospital, birthing center or Federally Qualified Health Center (FQHC) submits a referral directly to SODI for a newborn whose mother is Medicaid eligible. The provider does not submit a claim for payment to Texas Medicaid and Healthcare Partnership (TMHP) for the child at this time.

SODI researches eligibility files. After verifying the mother's Medicaid coverage, which can be retroactive, SODI creates a TP 45 EDG for the newborn.

Coverage for the child begins with the child's DOB. The last month of coverage is the month the child turns one year old, unless one of the following situations occurs.

• The hospital notifies SODI using Department of State Health Services Form 7484, Hospital Report (Newborn Child or Children), that the child's mother relinquishes her parental rights.
  • If Form 7484 indicates a relinquishment but the new caretaker’s information is incomplete or is not provided, SODI provides newborn Medicaid coverage from the child's DOB through the end of the month the child is relinquished.
  • If Form 7484 indicates a relinquishment and the new caretaker’s name and address are provided, SODI completes two case actions. The first action is to process an open and close newborn Medicaid EDG with the birth mother as the case name. The coverage begins with the child’s DOB and continues through the end of the month the child was relinquished. The second action is to open a newborn Medicaid case/EDG with the new caretaker as the case name. The coverage begins the first of the month after the original newborn Medicaid coverage ended and continues through the month of the child’s first birthday.
• The child's mother received TP 42 Pregnant Women Presumptive coverage at the time of the child's birth and the mother's application for regular Medicaid coverage is denied. SODI certifies the child through the birth month.
• The child's mother received TP 56 Medically Needy with Spend Down coverage at the time of the child's birth because she met spend down. SODI certifies the child for TP 56 rather than TP 45 for the same period that the mother received TP 56. The mother's coverage is restricted to the birth month and the two months after the birth month.

The computer generates and sends the following documents for each EDG.

• A notice of the newborn's individual number to the referring provider and other providers, if identified on the provider's referral.
• Your Texas Benefits Medicaid card to the newborn's mother.
• A notice informing the newborn's mother/caretaker:
  • that the child is eligible to receive medical coverage through the month the child turns age one, as long as the Texas residence requirement is met, and to report any changes concerning these eligibility requirements;
  • to report to her advisor if information on Form H1027-A, Medicaid Eligibility Verification, is incorrect;
  • that she must contact her advisor if the newborn's siblings receive TANF;
  • if the mother's Medicaid end date changes because the child was not born in the anticipated month.

A—125.1 Advisor Action in Provider Referral Process

TP 45

A task is created whenever a TP 45 EDG is established and the TIERS case contains an active SNAP or TANF EDG. The advisor must take the following actions once the advisor claims the newborn alert task.

A—125.2  Suspended Claim Process

TP 45

The Medicaid provider sends a claim for a newborn child with the child's mother's claim to TMHP. If TMHP cannot find the child on HHSC's eligibility files, TMHP suspends the child's claim and sends an exception notice to SODI. SODI checks the child's mother's Medicaid eligibility. If the mother received Medicaid at the time of the child's birth, including a retroactive determination, SODI follows procedures in the Provider Referral Process to provide Medicaid coverage for the child.

A—125.3  Mandated TIERS Inquiry

TP 45

Field staff must perform TIERS inquiry before providing coverage for a newborn when there is no evidence of SODI TP 45 coverage. Inquire by the newborn's mother's individual number. Look for a process date that is after the child's DOB.

A—126  Processing Children’s Insurance Applications

CHIP and Medical Programs except TP 40 and TP 36

Individuals may apply for health insurance for their children, including Medicaid or CHIP, by:

• calling the CHIP administrator at 1-800-647-6558;
• submitting Form H1014, Application Information for Children’s Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, Form H1010, Texas Works Application for Assistance — Your Texas Benefits, or Form H1015, Children's Medicaid Renewal, by fax, mail or in person at an HHSC eligibility office; and
• applying online at www.yourtexasbenefits.com.

A—126.1  Front Desk Process

CHIP and Medical Programs except TP 40 and TP 36

When individuals come to a local eligibility office to inquire about health insurance for their child(ren), the front desk clerk must:

• offer Form H1014, Application Information for Children’s Health Insurance Program (CHIP), Children’s Medicaid, and CHIP Perinatal Coverage.
• explain the Medicaid application process. If a child is ineligible for Medicaid based on income and or resources, HHSC determines eligibility for CHIP and, if eligible, the CHIP administrator sends an enrollment packet.
• offer individuals a telephone to use to apply for CHIP, if they do not want to apply for Medicaid through HHSC.

A—126.2 Inquiry

CHIP and Medical Programs except TP 40 and Emergency Medicaid

Before certifying a child for any type of Medicaid program, advisors must perform Medicaid, CHIP and CHIP Perinatal inquiry to determine whether the child applying for Medicaid is already enrolled or pending enrollment in Medicaid, CHIP or CHIP Perinatal.

To search in CHIP inquiry, enter the child’s:

• SSN and DOB (optional); or
• first name, middle initial (optional), last name and DOB. When searching by name, the DOB is mandatory.

CHIP inquiry is designed to match children who are currently enrolled in CHIP or pending enrollment with a future start date. If no match is found when searching with the SSN, attempt to search using the child's name and DOB.

If the SSN search results in more than one match for the child, enter the child's:

• SSN and DOB, or
• name and DOB.

When multiple children are found and staff cannot narrow the search criteria, contact the family to:

• verify the child's SSN and DOB;
• ask whether the child is receiving CHIP; and
• obtain CHIP end date, if applicable.

When a match is discovered for a child, all children on the CHIP account are displayed.

Three types of CHIP status are displayed:

• Open – The child is currently enrolled in CHIP.
• Pending – The application or renewal is being processed.
• Closed – The case is closed.

If a child is active or pending enrollment in CHIP, coordinate the child's MED with the CHIP end date to prevent dual enrollment. Document the information obtained via CHIP inquiry in TIERS Case Comments. See A-126.3, Advisor Action for Determining Eligibility for Children.

If the household does not know the CHIP end date or the advisor cannot contact the family, call the regional CHIP coordinator (RCC). The RCC follows procedures to verify the CHIP end date by contacting the CHIP administrator.

Note: For CHIP Perinatal inquiry instructions, see A-128.1, CHIP Perinatal Inquiry.

Related Policy
CHIP and CHIP Perinatal Inquiry, C-873

A—126.3  Advisor Action for Determining Eligibility for Children

CHIP and Medical Programs except TP 40 and Emergency Medicaid

When taking action on an application, apply the following procedures.

A—126.3.1  Neonatal Intensive Care Unit (NICU) Newborn Process

CHIP Perinatal, TP 36, TP 43 and TP 45

Income Above 185% of the FPIL

When a CHIP perinatal mother whose household income is above 185% of the Federal Poverty Income Limit (FPIL) applies for Medicaid for her newborn and HHSC hospital-based staff have information from the applicant or the hospital that the newborn is medically fragile and is admitted into the NICU, HHSC hospital-based staff must certify eligible newborns for TP 43 back to the newborn's DOB and use the following process to remove the CHIP Perinatal coverage to eliminate dual coverage.

• Upon receipt of an application for a Medicaid NICU newborn, HHSC hospital-based staff must complete the CHIP inquiry to determine if the mother is on CHIP perinatal or whether the newborn has been assigned a TIERS individual identification (ID) number and is active on Medicaid.
• If the newborn is not active on Medicaid, certify the eligible newborn for TP 43 following existing policy.
• Send a notification email to the regional CHIP coordinator (RCC) that the CHIP perinatal NICU newborn has been certified for Medicaid back to DOB (or the eligibility date, if not back to DOB). The email must contain the newborn's full name, DOB, individual's number, mother's full name, mother's DOB, CHIP ID number and/or SSN.
• The RCC forwards the email to Joanne Talavera at Joanne.Talavera@hhsc.state.tx.us. Ms. Talavera will instruct the CHIP administrator to remove the CHIP coverage for the newborn or process a birth outcome for the case to disenroll the mother from CHIP perinatal, if the newborn has not been added to the case.

Income at or Below 185% of the FPIL

When HHSC hospital-based staff have information from the applicant or the hospital that a newborn born to a CHIP perinatal mother whose household income is at or below 185% FPIL is medically fragile and is admitted into the NICU, HHSC hospital-based staff must certify eligible mothers for Emergency Medicaid and the newborn for TP 45 effective back to the DOB. The CHIP perinatal mother must submit Form H3038, Emergency Medical Services Certification, to the hospital, but it will not be returned to the CHIP administrator. HHSC hospital-based staff must process Form H3038.

Upon receipt of Form H3038, HHSC hospital-based staff must:

• Perform inquiry on the Newborn Perinatal Match Interface (Interfaces – TIERS Left Navigation) to verify the CHIP perinatal household's FPIL.
• Access MAXe Perinatal to view the CHIP perinatal application and income verification previously provided by the individual that was used to certify the CHIP perinatal case.
• Use the date Form H3038 is provided as the file date for both the Emergency Medicaid and Medicaid for the newborn child.
• Certify the CHIP perinatal mother for Emergency Medicaid.
• Certify the eligible newborn for TP 45 back to the date of birth.
• Send a notification email to the RCC that the CHIP perinatal NICU newborn has been certified for Medicaid back to DOB. The email must contain the newborn's full name, DOB, individual's number, mother's full name, mother's DOB, CHIP ID number and/or SSN.
• The RCC forwards the email to Joanne Talavera at Joanne.Talavera@hhsc.state.tx.us. Ms. Talavera will instruct the CHIP administrator to remove the CHIP coverage for the newborn or process a birth outcome for the case to disenroll the mother from CHIP perinatal if the newborn has not been added to the case.

Related Policy
Adding a New Child, D-1433.1

A—126.4  Deeming Process

CHIP and Medical Programs except TP 40 and Emergenecy Medicaid

Deeming is an automatic process that happens at application disposition notifying the CHIP administrator of a CHIP eligible child. TIERS deems a child as CHIP eligible when:

• certifying one sibling for Medicaid and an older sibling is ineligible because of verified income;
• denying an active Medicaid EDG because of verified adjusted gross income (AGI) and the net countable income is at or below 200% of the Federal Poverty Income Limits (FPIL);
• a child ages out of a Medicaid type program and the verified AGI exceeds the limit for Medicaid, but the net countable income is at or below 200% FPIL;
• denying a Medicaid application referred from the CHIP administrator because of excess income (this deem is specific to the Central Processing Center);
• denying a Medicaid application because of excess income and the net countable income is at or below 200% FPIL;
• denying Medicaid at renewal because of excess resources and the net countable income is at or below 200% FPIL; and
• denying a Medicaid application because of excess resources and the net countable income is at or below 200% FPIL.

Notes:

• The needs of an unborn child are not included when deeming a child to CHIP.
• A child is not deemed to CHIP when the child's Medicaid EDG is denied for failure to provide information.
• A child is not deemed to CHIP when the child's Medicaid EDG is denied solely on failure to provide citizenship verification
• Before deeming a child who is ineligible for Medicaid because of income or resources to CHIP, explore whether the child has Medicare or if the family has private health insurance. If the child has Medicare coverage, do not deem the child to CHIP. If the insurance is a dental or vision plan only, auto, sports or accident insurance only, county medical discount card or workers' compensation, continue deeming the child to CHIP. If a family has private health insurance, determine the cost of the insurance for the child. If the cost is:
  • less than 10% of the family's net countable income, do not deem the child to CHIP.
  • equal to or more than 10% of the family's net countable income, continue deeming the child to CHIP. Inform the family that the insurance must be dropped within 90 days to remain eligible for CHIP coverage. Include the following statement on Form TF0001, Notice of Case Action, when notifying the family of Medicaid ineligibility and deeming to CHIP.
    
    "Your child(ren) has been referred to the Children's Health Insurance Program (CHIP). You will receive an enrollment packet in the mail soon. Your child(ren) cannot be covered by both CHIP and other health insurance at the same time. You must be able to drop your child(ren)'s other insurance before covering your child(ren) under CHIP."
    
    "El nombre de su hijo se envió al Children's Health Insurance Program (CHIP). Muy pronto, recibirá por correo un paquete de inscripción. Su hijo no puede tener cobertura de CHIP y de otro seguro médico al mismo tiempo. Usted tendría que terminar el otro seguro médico de su hijo antes de obtener la cobertura de CHIP."

A—126.4.1  Applications Denied Because of Resources

CHIP and Medical Programs except TP 40 and Emergency Medicaid

After determining a child ineligible for Medicaid, TIERS will test eligibility for CHIP. Families with net income above 150% of the FPIL and less than or equal to 200% FPIL must pass a resource test to qualify for CHIP. The resource test does not apply to households with income less than or equal to 150% FPIL. For households subject to the resource test, if the resources declared by the family on the application exceed the $10,000 CHIP resource limit, the child will not be deemed to CHIP.

When denying an application due to excess resources, explore and document all income with the individual to determine the net countable income. Do not pend the EDG for income verification. Use all available sources to obtain household income such as Data Broker or contact with the employer.

1. If verification is not available, and the information:
   • provided does not conflict with other sources such as Data Broker, accept the individual's statement.
   • provided conflicts with other information available to HHSC, but the net countable income is at or below 200% FPIL, accept the individual's statement.
   • on file indicates the net countable income is above 200% FPIL, deny the EDG. The individual may call 1-800-647-6558 if the individual wants to pursue CHIP.
2. Screen for private health insurance.
3. Inform the individual that the family will receive enrollment information from CHIP (if the household has met the CHIP eligibility criteria).

A—126.4.2  Applications Denied Because of Income

CHIP and Medical Programs except TP 40 and Emergency Medicaid

Use all available sources to obtain household income information such as a current application for assistance, recent SNAP/TANF or Medicaid EDG information, Data Broker inquiry, TWC inquiry or contact with the employer.

1. If the income verification is not available and the information:
   • provided does not conflict with other sources such as TWC inquiry, accept the individual's statement as the best available information.
   • provided conflicts with other information available to HHSC, but the net countable income is at or below 200% FPIL, accept the individual's statement.
   • available indicates the net countable income is above 200% FPIL, deny the EDG. The individual may call 1-800-647-6558 if the individual wants to pursue CHIP.
2. Screen for private health insurance.
3. Inform individuals that they will receive enrollment information from CHIP (if the household has met the CHIP eligibility criteria).

Notes:

• If an active Medicaid EDG is denied because of income, follow Steps 1-3.
• If processing a TP 56, Medically Needy with Spend Down, for a child, do not delay deeming to CHIP, if appropriate. Enrollment for CHIP is prospective; Spend Down requests only cover current and/or prior months.

A—126.5 Electronic Referral Process

CHIP and Medical Programs except TP 40 and Emergency Medicaid

The CHIP administrator electronically refers CHIP applications and renewals determined potentially eligible for Medicaid to HHSC.

Region Customer Care Center (CCC), which is made up of the CCC and the Central Processing Center (CPC), determines children's Medicaid eligibility for all of the electronic referrals received from the CHIP administrator.

After receiving the CHIP electronic referral, Regional CCC staff process the application or renewal.

• For applications, Region CCC staff use the date HHSC or the CHIP administrator receives Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, as the file date.
• For renewals, Region CCC staff use the referral date as the file date. The referral date is the date the CHIP administrator refers the renewal to Medicaid.
• The DOB and SSN for the head of household are entered, as shown on Form H1014.
• The DOB and SSN for the second parent are entered, if available in an associated EDG. If there are no associated EDG or the head of household fails to provide the DOB or SSN, the following steps are taken to obtain the information.

1. The family is telephoned to obtain the correct DOB and SSN.
2. If unable to obtain the DOB and SSN by telephone, Regional CCC staff continue to process the child's application for Medicaid.
3. A randomly selected DOB for the caretaker/second parent is entered, with a year between 1965 and 1975. Using randomly selected DOBs reduces or eliminates the problem of duplicate individual numbers.
4. The SSN field is left blank if the correct number is not available.
5. Staff ensure that all other demographic information is correct and include the individual's middle name, when available.

• A Data Broker Combined Report without a credit report is requested at application and anytime when verification from the Combined Report can be obtained, such as when trying to determine vehicle value.
• Income/deduction verification provided by the CHIP administrator for Medicaid eligibility for the child is acceptable. If Form H1014 contains inconsistent or missing information, the family is contacted by telephone or Form H1020, Request for Information or Action, to clarify or obtain information before making the final eligibility decision.

HHSC staff use CHIP inquiry to determine the CHIP end date if the child was active on CHIP before the referral. On the TIERS Program page, enter the CHIP end date and CHIP identification number. This ensures the child has the correct medical effective date.

Note: A new application is not required when the family is requesting to add a new child to their CHIP case and the new child makes the household eligible for Medicaid. The CHIP administrator electronically refers the new child to Medicaid and the remaining children stay on CHIP through the end of the CHIP enrollment period. The file date is the date the family requested that the new child be added to the CHIP case. Information verified by the CHIP administrator and on Form H1014 on file with the CHIP administrator is used to determine Medicaid eligibility for the new child. If the CHIP case is the result of a deem from Medicaid, Form H1014 will not be on file with the CHIP administrator. HHSC staff must use information already on file to determine Medicaid eligibility for the new child.

A—126.5.1 Disposition of Electronic Referrals

CHIP and Medical Programs except TP 40 and Medicaid

Once a child is deemed to CHIP, the CHIP administrator sends the family a CHIP enrollment packet within seven days. A child is not enrolled in CHIP until the family pays the applicable enrollment fee and chooses a health plan.

Region CCC staff must process (certify or deny) each referral from the CHIP administrator within the appropriate policy time frames, based on the applicable file dates noted in A-125.6, Electronic Referral Process.

A—126.6 CHIP Good Cause

CHIP and Medical Programs except TP 40 and Emergency Medicaid

The CHIP enrollment eligibility date begins three calendar months after the last month in which the child was covered by private health insurance. The wait period for CHIP enrollment extends for a period of three calendar months after the first day of the month:

• in which the applicant is determined eligible for CHIP, if the date eligibility is determined is on or before cutoff of the month; or
• after the month the applicant is determined eligible for CHIP, if the date eligibility is determined is after cutoff of the month.

The wait period for CHIP enrollment may be waived if the family claims one of the following good cause exemptions:

• the parent's employment was terminated due to layoff, reduction-in-force or the closure of a business;
• the loss of Medicaid eligibility, because of income, resources or the child ages out of Medicaid;
• dependent coverage was terminated by an employer;
• the parent's insurance benefit under the Consolidated Omnibus Budget Reconciliation Act of 1984 was terminated;
• a change in a parent's marital status;
• the child is no longer covered by the Texas Employee Retirement System;
• the loss of CHIP eligibility from another state within the past 90 days;
• the health insurance coverage cost is at or more than 10% of the family's income;
• HHSC determines good cause exists, based on information provided by the applicant or information otherwise obtained by HHSC; and
• other similar circumstances that result in an involuntary loss of insurance coverage.

A—126.6.1  Claiming Good Cause

CHIP and Medical Programs except TP 40 and Emergency Medicaid

A family can claim a good cause exemption by:

• telephone or submitting Form H1020, Request for Information or Action. Explore good cause if it is necessary to request verification and accept the household's self-declaration of a good cause exception to the CHIP 90-day waiting period.
• the application check boxes on Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, and Form H1015, Children's Medicaid Renewal. If the household checks "other," but both the "date the health coverage ended" and "cost of insurance" sections on Form H1014 or Form H1015 are blank, do not grant a good cause exception. If there is no indication of a good cause exception on the application, do not contact the household or send Form H1020 for this purpose only.

A—126.7  Regional CHIP Coordinators

A—127  Prior Medicaid Coverage

CHIP, Children's Medicaid and TP 33, TP 32 and TP 35

Determine three months prior coverage for Children's Medicaid using Form H1014, Application Information for Children’s Health Insurance Program (CHIP), Children’s Medicaid, and CHIP Perinatal Coverage, or Form H1015, Children’s Medicaid Renewal. If the family cannot be reached by telephone, send Form H1113, Application for Prior Medicaid Coverage, with Form H1020, Request for Information or Action, to request verification.

Do not delay certification of ongoing eligibility to determine if any child is eligible for prior coverage.

Related Policy
Medicaid Coverage for the Months Prior to the Month of Application, A-830

A—128  Processing Applications for Pregnant Women

CHIP Perinatal, TP 40 and Emergency Medicaid

CHIP perinatal coverage provides services to unborn children of pregnant women, regardless of age, who are ineligible for:

• Medicaid because of immigration status or income above 185% FPIL but at or below 200% FPIL; or
• CHIP because of age or immigration status.

When a pregnant woman submits an application for insurance coverage, determine the woman’s eligibility for TP 40 coverage. If ineligible for TP 40, TIERS will determine if the woman should be deemed to CHIP perinatal.

CHIP perinatal households are exempt from the:

• 90-day waiting period;
• CHIP asset test;
• cost-sharing (enrollment fees and co-payments); and
• six-month income check.

A—128.1  CHIP Perinatal Inquiry

CHIP Perinatal, TP 40 and Emergency Medicaid

Before certifying a child, newborn or pregnant woman for any type of Medicaid program, advisors must perform CHIP and CHIP perinatal inquiry to determine whether a child, newborn or pregnant woman applying for Medicaid is already enrolled or pending enrollment in CHIP or CHIP perinatal.

To increase the possibility for a match, search by the woman's or child's last name and DOB, and also perform an inquiry for newborns.

When viewing the CHIP perinatal inquiry screen, click on the Perinatal Member number to view the pregnant woman’s details.

Three types of CHIP perinatal status are displayed:

• Open – the pregnant woman is enrolled in CHIP perinatal or the newborn is enrolled;
• Pending – the application is being processed; and
• Closed – perinatal coverage has ended.

If the pregnant woman is enrolled in CHIP perinatal, the Status is OPEN and the Enrollment End date is OPEN.

Newborns are added to the perinatal details. The mother’s Enrollment End date is the last day of the birth month. The newborn’s coverage enrollment begin date is effective from the DOB and continues through the remainder of the 12-month continuous eligibility period.

“Perinatal anniversary” identifies the first day following the 12-month CHIP perinatal continuous eligibility period. The child is potentially eligible for traditional CHIP beginning on this date.

A—128.2  Advisor Action for Determining Eligibility for Pregnant Women

CHIP Perinatal, TP 40 and Emergency Medicaid

When taking action on an application, apply the following procedures.

*Pregnant women enrolled in CHIP perinatal must indicate on the application that they wish to test for Medicaid for the pregnancy. Otherwise, do not interrupt the continuous eligibility coverage.

A—128.3  CHIP Perinatal Deeming Process

CHIP Perinatal, TP 40 and Emergency Medicaid

Applicants are automatically deemed to CHIP perinatal at Disposition, provided the individual meets CHIP perinatal eligibility criteria. TIERS will not deem a pregnant woman to CHIP perinatal who is denied Medicaid TP 40 because of:

• failure to provide verification; or
• income or alien status, if she has given birth or her pregnancy has ended. A woman who has given birth or whose pregnancy has ended is not eligible for CHIP perinatal.

A—128.4  CHIP Perinatal Application Process

CHIP Perinatal, Emergency Medicaid and TP45

Labor with delivery charges are covered by CHIP perinatal for households with income above 185% FPIL, but not for households who qualify for Emergency Medicaid coverage (women who do not meet citizenship requirements and whose household income is at or below 185% FPIL). These Medicaid-eligible individuals must submit a Form H3038, Emergency Medical Services Certification, to apply for Emergency Medicaid to pay for all these charges.

A child born to a CHIP perinatal mother whose household income is at or below 185% FPIL and who receives Emergency Medicaid to cover labor with delivery charges will be enrolled in Medicaid instead of CHIP perinatal. CPC processes both the Emergency Medicaid coverage for the mother and the TP 45 for the newborn when the newborn is not admitted to NICU. See A-126.3.1, Neonatal Intensive Care Unit (NICU) Process.

The CHIP administrator mails Form H3038 with the Enrollment Confirmation Notice to the individual. On the first of the month prior to the pregnancy due date, the CHIP administrator will send another Form H3038 and a self-addressed postage-paid envelope with the Birth Outcome Letter (BOL), which includes instructions for getting the form completed and signed by the medical practitioner. The individual must return Form H3038 to the CHIP administrator.

Upon receipt of Form H3038, the CHIP administrator:

• associates the form to the mother's CHIP perinatal case,
• creates a task in the MAXe Perinatal system, and
• sends the referral to CPC to certify the mother for Emergency Medicaid and the newborn for TP 45 coverage.

If the individual does not return Form H3038, the CHIP administrator will send another Form H3038 with a pre-paid envelope along with the Birth Outcome Reminder Letter (BOR) one month following the pregnancy due date. If Form H3038 is not returned within 90 days from the date of the BOR, then CPC will not certify the mother for Emergency Medicaid or the baby for TP 45 coverage. See A-831.2.1, Reopening Three Months Prior Applications, for individuals who return Form H3038 after 90 days from the date of delivery.

CPC Staff Process

CPC receives referrals from the CHIP administrator through the MAXe Perinatal system with an image of Form H3038. CPC staff must:

• Perform inquiry to determine if mother and child are already active on Medicaid;
• If not active on Medicaid, use all TP 40 eligibility policies and procedures to determine Emergency Medicaid eligibility with the exception of verifying income and citizenship/alien status;
• Use the verified income provided to determine CHIP perinatal eligibility found in the MAXe Perinatal system to determine Emergency Medicaid eligibility;
• Verify all non-financial eligibility points prior to certification such as:
  • Identity – see A-621, Verifications Sources; and
  • Residence – see A-761 Verifications Sources;
• Use the date the CHIP administrator received Form H3038 as the file date for the Emergency Medicaid and TP 45; and
• Process Form H3038 by the 45th date after the file date as explained in B-112, Deadlines.

The file date for the TP 45 is usually the date Form H3038 is received if it includes the newborn's information. The CHIP administrator can also receive birth outcome information via an interface or from the individual by telephone or in writing. When this information is received after a Form H3038 has already been submitted to the CPC, the CHIP administrator will submit a second referral to CPC to process TP 45 coverage.

Note: The CHIP administrator will not send a referral to certify the newborn for Medicaid unless a Form H3038 has been received for that child's mother.

When CPC staff receive a referral that includes a Form H3038 dated more than 90 days after the date on the BOR, CPC will stamp "Received (Date) CPC" on Form H3038, which indicates the form was provided after the 90 days from the BOR. CPC staff returns Form H3038 to the individual along with Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and a letter informing the individual that she will be required to apply for Medicaid. Individuals are instructed to complete Form H1010 and return it to the nearest HHSC office or appropriate out-stationed worker if an out-stationed worker is housed at the hospital where the delivery took place.

Out-Stationed and HHSC Eligibility Office Staff Process

The chart below explains procedures staff must follow to determine appropriate action.

Note: Fax Form H3038 to the CHIP administrator at 1-877-542-5951. Fax the bar coded Form H3038 provided to the individual. If the Form H3038 is not bar coded, staff must write the mother's CHIP perinatal individual number on the top of the form.

A—129  Data Broker Requirements

Staff must request Data Broker reports as required in C-820, Data Broker.

Related Policy
Permissible Purpose, C-824
Request a Data Broker Combined Report With or Without Credit Information, C-827.2

A—130  Interview Procedures

A—131  Interviews

TANF, SNAP and TP 08

Conducting Interviews for Applications and Redeterminations

Conduct the interview with the applicant or the applicant’s spouse (if the spouse is a member of the household) to determine eligibility.

Exceptions:

• A household may designate an AR, who must also sign the application, as explained in A-170, Authorized Representative (AR).
• For SNAP, another responsible household member may also be interviewed.
• For SNAP, a contracted Community Partner (CP) food bank participating in a pilot program with HHSC may conduct the interview and gather pertinent information and verification (see A-116.4, SNAP Applications from a Contracted Community Partner (CP)).
• For SNAP-SSI redeterminations conducted by CBS, no interview is required unless the household requests an interview, the case contains earned income or it appears the household is going to be denied (see B-475.1.1, SNAP Programs, for more detailed information).

Note: The spouse (or other responsible household member for a SNAP interview) does not have to sign the application to be interviewed. Do not exempt the household from any program or verification requirements due to interviewing an AR or conducting a telephone interview.

Conduct a telephone interview if the household meets any of the following criteria:

• all adult members of the household are elderly or disabled and have no earned income;
• the applicant resides in a family violence shelter and would be in danger if the individual left the shelter; or
• the household meets the telephone interview hardship criteria below. Accept the individual's statement regarding the hardship.

A household meets the hardship criteria if no responsible household member is able to come to the office for any of the following reasons:

• residence is more than 30 miles away from the certification office (even if an itinerant office is less than 30 miles from the individual's home);
• work or training schedule;
• transportation difficulties;
• prolonged severe weather;
• illness;
• care of a household member (the household member does not have to be part of the certified household); or
• victims of family violence.

TP 08 and TA 31

If the TP 08 or TA 31 request for assistance is for a child, no interview is required.

Exception: For SNAP, TANF and adult Medicaid, conduct a face-to-face interview if the household requests one or the household does not provide a telephone contact number.

Regional Option for SNAP, TANF and TP 08

Conduct telephone interviews for households noted in the policy above for applications and redeterminations. At the regional director's option, advisors also may conduct a telephone interview for all households who provide a contact telephone number (including households with a member disqualified for an intentional program violation (IPV)), unless the household requests a face-to-face interview.

Note: If the household contains a member who currently is disqualified from TANF or SNAP based on an IPV, regional directors have the option to require proof that the household meets the hardship criteria, if questionable.

Exception: An interview is not required for TP 40 (see information below).

Additional Policy Related to Telephone Interviews

If the office initially schedules a telephone interview and the individual subsequently requests a face-to-face interview before the telephone interview appointment time, staff must allow the household to receive a face-to-face interview and must not treat it as a missed appointment.

To avoid conflicts with an individual's work schedule, staff should be as flexible as possible when scheduling telephone interviews for households in which all adults are working. This could mean scheduling an appointment at a certain time of day or allowing the individual to call in from work at an appointed time for the interview. If a household does not have a home phone but prefers a telephone interview, staff should also attempt to schedule a telephone interview by allowing the individual to call in at an appointed time using someone else's telephone.

Ensure that an interpreter or translation service is available if the applicant/recipient indicates the need for such services on Form H1010.

When conducting a telephone interview, staff must offer the applicant reasonable assistance in obtaining any required verification.

Indicate in TIERS, in the Voter Registration Information section of the Individual Demographics page, to mail Form H0025, HHSC Application for Voter Registration, to applicants who are interviewed by telephone, if a voter registration application is requested. If the request checkbox is marked Yes, TIERS automatically mails Form H0025 to the household.

If the individual declines to register to vote, mail Form H1350, Opportunity to Register to Vote, and ask the individual to sign and return the form. Indicate in TIERS, in the Voter Registration Information section of the Individual Demographics page, the client declined, and document the H1350 was mailed to the individual.

Related Policy
Joint TANF-SNAP Applications, A-160
Missed Appointment, B-114
Processing Reviews/Timely Recertifications, B-122
Advisor Responsibility for Verifying Information, C-932
Registering to Vote, A-1521

Children’s Medicaid

No interview is required to apply for or renew Children's Medicaid. Process the application or renewal form by mail or telephone. Schedule an office interview only if the individual requests a face-to-face interview.

When a family contacts HHSC to request an application for Children's Medicaid, offer the option to start the application process by phone. The family can complete the application process by phone, but must provide or return a signed Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, with any other required verification to complete the process.

Exceptions:

• If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice, or for missing an appointment related to Health Care Orientation (HCO) or THSteps, schedule a face-to-face appointment. Deliver the HCO or remind the individual about the importance of the THSteps checkup at that time. See A-122.2, Scheduling Appointments, and B-123, Processing Renewals.
• Conduct a face-to-face interview for an initial application or renewal when HHSC receives conflicting information related to household composition, income or resources that affect eligibility and the information cannot be verified through other means, such as an associated case.

Related Policy
Scheduling Appointments, A-122.2
General Reminders, A-1510
Compliance Requirement, A-1531.5
Processing Renewals, B-123

TP 40 and TP 36

An interview is not required for TP 40 or TP 36. Schedule an office interview only if the household requests a face-to-face interview.

Provide continuous coverage for a pregnant woman without a Form H1010 or an interview if she meets the criteria in A-832, Continuous Medicaid Coverage.

TP 45 Retroactive Coverage

Provide retroactive TP 45 coverage for the newborn child without Form H1010 or an interview with the child's mother if the household meets the criteria in A-833, TP 45 Retroactive Coverage.

A—131.1  Home Visits

All Programs

Provide notice to the household before making any home visit. Application and redetermination interviews must be scheduled in writing. Notification of other home visits may be:

• verbal,
• given or mailed to the individual, or
• by telephone contact with a responsible household member.

The notification should include the time (at least whether morning or afternoon) and date of the visit. Route the notification for imaging to add to the electronic case record or document the specific information in TIERS Case Comments. If regions have specialized staff that conduct home visits, the documentation may be maintained in a separate location as long as it is accessible if needed.

Home visits to collateral sources do not have to be scheduled in advance.

Do not deny someone for refusing to agree to a home visit unless there is no other sufficient and reliable verification available.

Related Policy
Advisor Responsibility for Verifying Information, C-932

A—131.2  Requirement to Provide Interpreter or Translation Service

All Programs

HHSC is required to provide interpreter services and written translated materials to applicants and recipients who are Limited English Proficient (LEP). HHSC is also required to provide an effective method to communicate with applicants and recipients who indicate they are deaf or hearing impaired. Applicants and recipients indicate on Form H1010, Texas Works Application for Assistance – Your Texas Benefits, or during an interview that they need interpreter services.

A—131.2.1  Availability of Interpreters/Translation Services

All Programs

Local offices must set up procedures to ensure interpreters and translators are available for applicants or recipients who indicate the need for such services on Form H1010.

To meet the requirement for applicants and recipients who indicate they are LEP, offices can use:

• bilingual advisors – when it is reasonably possible to do so, schedule LEP applicants/recipients interviews with bilingual advisors.
• bilingual clerical staff – use bilingual clerical staff as interpreters whenever possible.
• local community interpreter providers.

Use the following only after exhausting local and regional resources:

• Language Line Services – This service is available to all regions. Staff are able to access the service using their 11-digit employee identification number after first calling the toll-free 1-800 number.
• Applicants/recipients can provide their own interpreter (only if they wish to do so). Note: Use minors, age 15 or older, as interpreters only at the individual's request and when the minor accompanies the individual to the interview. Do not use a minor under age 15 as an interpreter.

To meet this requirement for applicants and recipients who indicate they are deaf or hearing impaired, offices can:

• Schedule a telephone interview if the applicant indicates the contact phone on the application is a TDD/TTY line; unless the applicant requests a face-to-face interview. Note: Relay Texas can be reached at three numbers: 7-1-1, 1-800-RELAYTX (1-800-735-2989) and in Spanish at 1-800-662-4954.
• If unable to reach the applicant by phone, schedule a face-to-face interview and arrange for interpreter services at the interview location.

Note: In situations where an interpreter services vendor is not available, staff may use handwritten notes back and forth with the hearing impaired individual as long as the notes are an effective means of communication with the individual.

A—131.2.2  Availability of Translated Written Material

All Programs

Ensure that any requests for information given to LEP applicants/recipients are translated. In addition, if the advisor requests additional information to complete the case of an LEP, the advisor must ensure that the applicant/recipient understands the information requested.

A—131.3  Interview Requirements

All Programs

During the interview, the interviewer must:

• protect the applicant's confidentiality and conduct the interview as a confidential discussion of household circumstances;
• review the application and resolve unclear and incomplete information with the household;
• advise the household of their rights and responsibilities, including the right to appeal;
• advise the household of the application processing time frames;
• advise the household of their responsibility to report changes;
• ensure that the address in TIERS reflects the individual's current address; and
• explain the various policies, rights and responsibilities as required in A-1500, Reminders.

The following are actions the advisor must take, information the advisor must collect, and referrals and information the advisor must provide during the interview.

• Does the household agree that the information is complete and correct on the application form and in the case documentation for household composition, income and expenses?
• Does the income and expense information obtained for past periods (including self-employment) accurately reflect the amounts that can be anticipated for future income and expenses, according to policy in A-1355, How to Project Income? If not, why?
• For households with questionable or negative management, as described in A-1710, General Policy, does the household explain how they pay their bills?
• For households with other discrepancies in information that could affect eligibility, what information can the household provide to resolve those discrepancies?
• For households who have not provided all verification requested on Form H1020, Request for Information or Action, is there some reason beyond the household's control that makes it unable to provide verifications? Should the advisor designate a collateral source, accept the individual statement, or use other forms of verification for the missing verifications as required by policy in A-1370, Verification Requirements?
• For households with income verification missing for a particular pay period(s), can the advisor calculate the missing information based on year-to-date information from other paychecks the household has provided, instead of requesting it on Form H1020?
• Refer the household to other state or local resources for types of assistance the household requested on the application form, such as child care, child support, utilities or rent that are provided by other agencies.

SNAP

• For households qualifying for the standard medical expense, ask if the household wants to claim actual expenses according to the policy in A-1428.3, Budgeting Options.
• If applicable, ask if the household wants to prorate an expense or income according to policy in A-1428.3, A-1355.1, Budgeting Options for SNAP Households, and A-1358, How to Budget Expenses.
• Ask if any household member claims an exemption to Employment and Training (E&T) work requirements.
• Use reminders, including the household's change reporting requirement, E&T requirements, able-bodied adult without dependents (ABAWD) time limit policy (if there is an ABAWD in the household), and how the household can obtain and use SNAP benefits issued via EBT.
• Determine if an ABAWD received any countable months of benefits in another state.
• Determine if any member of the household has been disqualified from participating in SNAP for an IPV or a felony drug conviction in another state.

TANF

• Has any adult household member received TANF cash assistance from another state since October 1999? Refer to A-1920, Determining the Number of FTL Months Used.
• Has any member of the household been disqualified in another state for a felony or drug conviction?

A—132  Eligibility Factors

All Programs

Note: For medical programs, the eligibility factors noted above do not necessarily apply in all cases.

A—132.1  Medical Programs Hierarchy

Medical Programs

Related Policy
Receipt of Form H1014, Application Information for Children’s Health Insurance Program (CHIP), Children’s Medicaid, and CHIP Perinatal Coverage, A-121.1
Income Limits, C-131
Qualified Provider Procedures for Presumptive Eligibility Determinations, C-1113
Guidelines for Providing Retroactive Coverage for Children and Medical Programs, C-1114
Type Programs, C-1116
Former Foster Care in Higher Education, Part F
Medicaid for Transitioning Foster Care Youth (MTFCY), Part M
Refugee Medical Assistance (RMA), Part R
Medicaid for Breast and Cervical Cancer (MBCC), Part X
Texas Women’s Health Program, Part W

A—132.2  Guidelines for Pregnant Women

Medical Programs

A person may receive Medicaid on TP 44 through age 18 (through the month of the person's 19th birthday) even when married or a parent.

For budgeting purposes, a person under age 18 is considered a minor (through the month of the person's 18th birthday).

Married Minor Pregnant Women

• Include the minor pregnant woman in the budget group and TP 40 certified group.
• Include the spouse and any children born to either parent in the budget group.
• Include a minor spouse in the certified group for TP 44 or TP 56.
• Do not include parents or siblings of the pregnant woman or spouse in the budget or certified group.

Married Adult Pregnant Women

• Include the pregnant woman in the budget group and TP 40 certified group.
• Include the spouse and any children born to either parent in the budget group.
• Include a minor spouse in the certified group for TP 44 or TP 56.
• Do not include parents or siblings of the pregnant woman or spouse in the budget or certified group.

Unmarried Minor Pregnant Women

• Include the minor pregnant woman in the budget group and TP 40 certified group.
• Include any children born to the pregnant woman in the budget group.
• Include a parent (under age 19) of a mutual child in the certified group for TP 44 or TP 56.
• Include a parent (over age 18) of a mutual child in the budget group.
• Include parents or siblings of the pregnant woman in the budget group.
• Include parents or siblings of the parent (under age 18) of a mutual child in the budget group.

Unmarried Adult Pregnant Women

• Include the pregnant woman in the budget group and TP 40 certified group.
• Include any children born to the pregnant woman in the budget group.
• Include a parent (under age 19) of a mutual child in the certified group for TP 44 or TP 56).
• Include a parent (over age 18) of a mutual child in the budget group.
• Include parents or siblings of the parent (under age 18) of a mutual child in the budget group.

A—133  Rights and Responsibilities

All Programs except Children's Medicaid

Before completing the interview, ensure the applicant:

• completes Form H1010, Texas Works Application for Assistance — Your Texas Benefits,
• reports any changes that occurred since filling the application; and
• reads and understands the individual's rights and responsibilities as explained on Form H1010.

TANF and TP 08

Also ensure:

• the applicant reads and understands the rights and responsibilities of the child support program explained on Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause;
• TANF applicants read and understand Form H2580, TANF Employment Services Notice, and receive a copy of the form; and
• TANF applicants read, understand, and sign Form H1073, Personal Responsibility Agreement.

SNAP

Provide the applicant with Form H1805, SNAP Food Benefits: Your Rights and Program Rules.

Children's Medicaid

Ensure the applicant:

• completes Form H1010 or Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage; and
• reads and understands an individual's and responsibilities as explained on Form H1010 and Form H1014.

A—134  Documentation Guidelines

A complete list of documentation requirements for determining eligibility can be found at the conclusion of each eligibility section within the Texas Works Handbook. TIERS Data Collection pages handle a vast majority of the required documentation for case records. For the remaining small percentage of documentation still required by policy, staff must include the information in TIERS Case Comments. For documentation that is not captured within the Data Collection pages, a comprehensive guide, The Texas Works Documentation Guide, has been developed. This documentation guide outlines the requirements for documentation that must be entered in TIERS Case Comments.

A—135  Pending Information

All Programs except TP 40

If the applicant cannot furnish all required proof during the interview or with the application, allow the household at least 10 days to provide it. The due date must be a workday. Determine what sources of proof are readily available to the household and request them first if you expect them to be sufficient proof. Section B-115, Pending Verification on Applications, gives more information on verification procedures.

Give the applicant Form H1020, Request for Information or Action, explaining:

• what is needed,
• the due date for receipt of the information, and
• the date the advisor must deny the application if he does not receive the information.

Attach to Form H1020 the page of Form H1020-A, Sources of Proof, that corresponds to the verification requested.

TP 40

Do not allow 10 days for the applicant to provide verification if doing so exceeds the 15-workday processing time frame and you can postpone verification.

A—136  Eligibility Decision

All Programs

After obtaining all required proof, dispose the application and provide the applicant with Form TF0001, Notice of Case Action, detailing the decision.

Give the individual Form H0401, HIPAA – Privacy Notice, and Form H0403, HIPAA – Explanation of Health Information Privacy Rights, at initial certification and after breaks in certification of one or more months.

A—137  Prudent Person Principle

All Programs

The policies and procedures included in the handbook are rules for determining eligibility. It is impossible to provide examples for all policy situations. When staff encounter rare and unusual situations, HHSC encourage s them to use reason and apply good judgment in making eligibility decisions. The "prudent person" principle allows staff to make reasonable decisions based on the best available information using:

• common sense,
• program knowledge,
• experience, and
• expertise.

Document the rationale used to make a decision and any applicable handbook references.

A—140  Expedited Service

SNAP

All expedited applications are screened using the expedited screening questions on Page 1 of the application. HHSC staff screen applications received in the local office. Vendor staff screen applications sent to Midland by fax or mail, and an automated system screens applications sent by the SSP.

Applicants who meet the test for expedited service are entitled to:

• postpone all verification until after receiving the first month's benefit except:
  • identity;
  • proof they meet or are exempt from the 18-50 work requirement if they have already received the maximum number of benefit months without meeting the work requirement; and
• receive benefits the same day they apply, if possible, but no later than the next workday.

  Exception: In the following situations, applicants may not receive benefits in this time frame.

  • Applicants in drug and alcoholic treatment/group living arrangement facilities. Provide benefits to the individual so he or she has an opportunity to participate by the seventh day after the application date.
  • Joint SNAP/SSI applicants released from public institutions. The CBS unit provides benefits so the individual has an opportunity to participate by the fifth day after release from the institution.
  • Late determinations for expedited service. These are households that:
    • were not identified as entitled to expedited service when the household filed the application. Expedited processing begins on the day the office becomes aware the applicant is entitled to this service. Advisors cannot enter a late determination date for this if the agency failed to properly screen the application using Form H1010, Texas Works Application for Assistance — Your Texas Benefits, expedited screening questions.
    • meet expedited criteria and have a member who served the minimum employment and training penalty, but have chosen to delay their certification until all disqualified members have signed Form H1808, Notice of Food Stamp Employment Services Registration.
    • qualify for a telephone interview, but HHSC must mail the application back to the household for signature. The late determination date is the date the applicant provides the signed application.
    • mail or drop off H1010 or H1010-R, Your Texas Works Benefits: Renewal Form. Contact the applicant and schedule an appointment the earliest day the applicant is available. If HHSC cannot contact the applicant by phone, mail Form H1830-I, Interview Notice (Applications or Reviews), the same day the application is screened, notifying the applicant of possible eligibility for expedited service and to contact the office. If the household also applies for TANF or Medicaid, schedule a regular TANF/Medicaid appointment on the same notice. Expedited processing begins the day the applicant returns to the office for an interview.
    • miss their expedited appointment. If the applicant subsequently contacts the office, conduct an interview the earliest date the individual is available. Expedited processing begins the day the applicant returns to the office for an interview.
    • do not provide acceptable authentication proof of identity, or proof of meeting or being exempt from the SNAP 18-50 work requirement as explained in the beginning of this section. Expedited processing begins when the applicant provides the required proof.
    • are not eligible for expedited processing when screened for expedited services at the time of application but meet expedited criteria later in the application month as a result of a change. The late determination date is the date the eligibility for expedited processing is made.
    • submitted an application through the HHSC online system when the office was closed due to weather-related conditions, flooding or other similar situations. The late determination date is the first workday the office reopens following the office closure.

  Notes:

  • Staff can enter the late determination date in TIERS for late determinations caused by the applicant or resulting from a change in the household's circumstances, or due to office closures as explained above.
  • Except for delays in screening due to office closure, staff can enter the late determination date only if HHSC, the vendor, or the system screened the application on the file date or no later than the next workday.
  • The late determination date becomes day zero in determining timeliness on expedited applications.

TP 40

Expedite applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy. These applicants are entitled to:

• have their eligibility determined no later than 15 workdays from the date the application is received;
• use Children's Medicaid simplified or TP 40 policy on TP 40 applications from a child under age 19, whichever benefits the individual most; and
• postpone all verification, except identity, until the 30th calendar day from the application file date. Note: Postponing verification only applies to current and ongoing coverage. For prior coverage, take action no later than the 15th workday. Deny the application if verification is not provided. Reopen denied applications within two years at the applicant's request.

Note: An interview is not required when processing a TP 40 application.

Related Policy
Medicaid Coverage for Months Prior to the Month of Application, C-830, Child Support Systems

A—141  Expedited Eligibility Criteria

SNAP

Applicants are entitled to expedited service if they meet one of the following criteria:

• The household's:
  • liquid resources total $100 or less, and
  • countable gross monthly non-converted income totals less than $150. Note: When determining eligibility for expedited services, count the actual amount of TANF the individual actually receives.
• The household's liquid resources plus actual, non-converted countable gross monthly income total less than the most recent monthly expenses for rent/mortgage and utilities. Include the standard telephone allowance for households with a telephone expense.
• The household includes a migrant or seasonal farmworker and meets the destitute criteria listed in A-146, Expedited Policy for Migrant or Seasonal Farmworkers.

An individual who reapplies within the last month of a current certification period is not eligible for expedited service.

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy are eligible for expedited processing.

A—142  Limit on Expedited Certification

SNAP

A household may receive expedited certification any number of times if the household:

• completes the verification requirements postponed at the last expedited certification, or
• was certified under the usual 30-day processing standards since the last expedited certification.

A—143  How to Determine Eligibility for Expedited Service

SNAP

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to pregnancy are eligible for expedited processing.

A—144  Expedited Verifications

SNAP and TP 40

See A-140, Expedited Service, for postponed verification policy.

A—144.1  Social Security Numbers (SSNs)

SNAP

Include household members for the initial month, or initial two months if receiving a combined allotment, even if they fail to provide or apply for an SSN at the interview.

Disqualify those who fail to provide or apply for an SSN without good cause before the next monthly issuance. See A-410, General Policy, for rules for children six months of age or younger and good cause.

A—144.2  Work Registration

SNAP

Register the applicant being interviewed for work unless:

• exempt from work registration, or
• an AR is applying for the household.

Register other household members if possible. Postpone registration for the initial month if it cannot be completed within the expedited time frames.

A—144.3  Citizenship

SNAP

Household members whose citizenship/eligible alien status is questionable can receive expedited benefits with the household. They must provide verification of citizenship/eligible alien status before the next month's benefits are issued or be disqualified.

TP 40

Citizenship must be verified using policy in A-350, Verification Requirements, for pregnant women who declare to be a U.S. citizen. Citizenship verification can be postponed until the 30th day from the file date, if necessary, to meet expedited time frames.

A—144.4  Reserved

A—144.5  Pregnancy

TP 40

Pregnancy must be verified using the sources listed in A-870, Verification Requirements.

Accept the individual’s (pregnant woman’s, case name’s or AR’s) verbal or written statement of pregnancy as verification. The individual’s statement must provide the following information:

• name of woman who is pregnant;
• pregnancy start month;
• number of expected children; and
• anticipated date of delivery.

Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and Form H1014, Application Information for Children's Health Insurance Program (CHIP), Children's Medicaid, and CHIP Perinatal Coverage, contain a field for the number of expected children and the anticipated date of delivery, but do not contain a field for the applicant to enter the pregnancy start month. Staff must use the following procedures when certain information regarding pregnancy is left blank on any application for benefits.

• If the only item missing on the application form is the pregnancy start month, staff must count nine months back from the pregnancy end month to determine the pregnancy start month. The pregnancy end month is month zero.
• If the only item missing on the application form is the pregnancy end month, staff must count nine months from the pregnancy start month to determine the anticipated date of delivery. The pregnancy start month is month zero.

A—145  Expedited Certification Procedures

SNAP

Assign usual certification periods even if you postpone verifications. See A-2324, Length of Certification, for certification period policy.

Issue the second month's benefits as a combined allotment as explained in A-150, Combined Allotment Policy, if the household applies after the 15th of the month and you prorate benefits.

TP 40

If an applicant provides the minimum information required to process the application, the advisor may certify the application before the 15th workday and allow postponed verification.

Deny the application no later than 15 workdays if:

• the information provided indicates the applicant is not eligible, or
• not enough information was provided to determine eligibility.

Reopen applications denied because there was not enough information provided if the information is received within 60 days of the file date. Use the date the information is provided as the new file date, and follow the expedited processing guidelines.

Note: An interview is not required when processing a TP 40 application.

A—145.1  Postponed Verification Procedures

SNAP

Provide Form TF0001, Notice of Case Action, stating:

• what information is needed;
• the date it is needed; and
• that the individual must provide the information before the issuance of benefits for the:
  • second month; or
  • third month, if the applicant received a combined allotment

TIERS identifies and holds benefits for the second month for households not issued a combined allotment or the third month for combined allotment households. See A-150, Combined Allotment Policy.

If the household provides postponed verification that results in lowered or denied benefits, see B-116.1, Information Received During Expedited Application Processing.

If the household does not provide postponed verifications within 30 days of the application date:

• disqualify the individual when appropriate, or
• deny the SNAP EDG for failing to provide postpned information and send the individual adequate notice using Form TF0001.

A household denied for failure to provide postponed verification must submit a new application to receive benefits if the household does not provide the postponed verification by the 60th day from the file date. If the household provides the verification by the 60th day, reopen the application using the date the household provided the verification as the new file date.

An individual receiving adequate notice of adverse action as noted above cannot receive continued benefits pending appeal.

TP 40

Provide Form TF0001, stating the:

• eligibility start and end date,
• postponed verifications, and
• date the verifications are due.

If the individual does not provide verification by the 30th day following the file date, initiate adverse action. Advance notice is required. The individual must reapply if the verification is not provided by the expiration of the adverse action.

If the individual provides verification by the 30th day following the file date but does not meet eligibility requirements, provide advance notice of adverse action and deny ongoing coverage.

Note: Do not deny the EDG if the individual is eligible in the application month or one of the three prior months.

A—146  Expedited Policy for Migrant or Seasonal Farmworkers

SNAP

The expedited processing procedures apply to migrant or seasonal farmworkers except for the following.

• If verifying something other than identity and the source of verification is out of state, postpone verification until after the household receives the second month's benefit. Use this procedure for only one two-month postponement during one round-trip from home.
• Households with a migrant or seasonal farmworker are destitute if they have $100 or less countable liquid resources and meet any of the following:
  • Their only income for the application month is from a terminated source, and they will not receive any more payments from that source after the application date.
    
    Consider income terminated if it is usually received:
    • monthly or more often but will not be received from that source the following month, or
    • at intervals of more than one month but will not be received from that source in the next usual payment period.
    
    Do not consider income terminated in the following situations:
    • someone changes jobs while working for the same employer,
    • a self-employed person changes contracts or has different customers without having a break in normal income cycle, or
    • someone receives regular contributions, but the contributions are from different sources.

    Note: When determining destitute status, do not consider income terminated if a payment from the same source will be received after the file date in the month of application.

  • All their income in the application month is from a new source, and they will receive income of $25 or less from the first of the month up to and including the 10th day after the application date (or the end of the month if there are not 10 days left in the month).

    Income received monthly or more frequently is from a new source if the household did not receive $25 or more from that new source in the 30 days up to and including the application date.

    Income received at intervals of more than one month is new income if the household has not received more than $25 from that source between the last usual payment month and the application date.

    Count new income received after the application date to determine if the individual is destitute, but disregard it in determining eligibility and benefits for the month of application.

  • They have a combination of terminated income through the application date and new income after the application date if:
    • there is no other income from the terminated source that month, and
    • they will receive income of $25 or less from the new source from the first of the month through the 10th day after the application date (or the end of the month if there are not 10 days left in the month).

    At recertification, disregard income from a new source in the first month of the certification period if that income will not exceed $25 within 10 days after the individual's usual issuance cycle.
    
    Notes:

    • Count an advance of wages for travel expenses as income unless it is a reimbursement.
    • Do not consider the advance in determining if the household is destitute or in determining if later payments from the employer are from a new source.
    • Self-employed farmworkers whose income is annualized are not destitute if they do not receive income each month of the year.
    • The grower, not the crew chief, is the farmworker's source of income. An individual who follows a crew chief to a new grower is leaving a terminated source for a new source.

The policies in this section apply to income determinations for destitute applicants at initial and later certifications but only in the first month of any certification period.

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

Medical Programs – All except Emergency Medicaid and TP 56

All applications for Medicaid from an active duty military member and their dependents applying for coverage are eligible for expedited processing.

Active duty refers to military members who currently are serving full time in their military capacity. A military member is defined as someone in the:

• U.S. Armed Forces/Reserves
  • Army
  • Marine Corps
  • Navy
  • Air Force
  • Coast Guard
• National Guard
  • Army
  • Marine Corps
  • Navy
  • Air Force
  • Coast Guard
  • Reserve/Guard
• Army National Guard
• Air National Guard
• State Military Forces/Texas State Guard
  • Texas State Guard — Unless activated by the governor and placed on paid state active duty, these personnel receive no compensation for their time.
  • Texas Army National Guard
  • Texas Air National Guard

When an application for Texas Works medical assistance is received and includes an active duty military member, take the following action on or before the 15th workday of the application file date:

• provide an interview if requested or required,
• send/provide Form H1020, Request for Information or Action, to request missing information if no interview was requested or required and information was not provided with the application, or
• send/provide Form TF0001, Notice of Case Action, if all verification is provided with the application and no interview was requested or required.

Military status is self-declared. Additional verification is not required.

Use processing time frames stated in B-112, Deadlines, if the household did not provide all required information and verification with the application.

The expedited processing requirement does not apply to TP 56 (Medically Needy with Spend Down) or to Emergency Medicaid for ineligible aliens and only applies to applications and untimely reviews/renewals.

A household is not eligible for expedited processing if the military member is on active duty because of training as a member of the Reserves, National Guard or State Military Forces.

When an application consists of a pregnant member and an active duty member, use TP 40 expedited application processing time frames.

Provide expedited processing for a Medicaid application if the budget group includes the needs of an active duty member even if the active duty member is not included in the certified group.

Do not pend an application if the household:

• fails to answer the Yes/No question and name/designation. Do not process the application using expedited time frames. If left blank, enter No in the system.
• fails to answer the Yes/No question but provides a name or information that can be used to determine who the active military member is. Assume the answer is Yes and process the application using expedited time frames.
• answers Yes to the question but does not provide a name or information that can be used to determine who the active military member is. Do not process the application using expedited time frames.

When an interview is scheduled timely within 15 workdays, but the applicant requests to reschedule the interview, attempt to accommodate the rescheduled appointment within the 15 workday time frame. If, at the household’s request, the interview is rescheduled after the 15 workday time frame, document the reason for not scheduling the appointment within the required time frame.

Note: For requested interviews, if the applicant requests to be rescheduled, inform the household that an interview is not required and the processing of the application can begin without an interview. Do no deny an application if the household fails to show for the appointment when an interview is not required.

A—150  Combined Allotment Policy

SNAP

Issue benefits for the month of application and the following month at the same time if:

• an applicant files the application after the 15th of the month, (including reapplications filed after the 15th of the month following the last benefit month);
• the household is eligible for the application month and the following month (including applicants eligible but not receiving an allotment for the application month because benefits prorate to less than $10); and
• you prorate the initial month's benefits.

Note: For applicants who meet expedited criteria, issue a combined allotment within expedited time frames, even if postponing verification.

Inform households receiving combined allotments:

• when the benefits will be available,
• that no additional benefits will be available until the third month, and
• that the third month’s benefits will be available on the regular issuance schedule.

TIERS identifies and issues benefits to households eligible for a combined allotment and holds the third month's benefits if the combined allotment certification has postponed verification.

A—160  Joint TANF-SNAP Applications

TANF, SNAP and TP 08

A household in which all members are applying for or receiving TANF and/or TP 08 may apply for SNAP at the same time the household applies for TANF and/or TP 08. The advisor then conducts a single interview.

Exception: Conduct the unfinished TANF and/or TP 08 interview later if necessary to meet the SNAP expedited processing time limits.

A—161  When Receipt of TANF is Uncertain

TANF and SNAP

When TANF eligibility is uncertain:

• certify the household for Non-Public Assistance (NPA) SNAP benefits if eligible. Note: If the TANF members have resources, do not exclude the resources for SNAP until you certify the TANF EDG (see A-1248, Resources of TANF and SSI Recipients); and
• assign an NPA certification period (see A-2324, Length of Certification).

If TANF is approved later, process it as a reported change. Add the TANF benefit to the SNAP budget as soon as possible. (See A-1324.17, TANF.) Adjust the certification period to expire when the next TANF periodic review is due. Send or give the applicant Form TF0001 with the new certification period stated. Exception: One-Time Temporary Assistance for Needy Families (OTTANF), A-1324.11.

If the TANF application is denied later, continue SNAP eligibility based on the original application.

A—170  Authorized Representatives (AR)

All Programs

If the individual chooses to designate an AR, the individual must designate the AR on the signature page of Form H1010, Texas Works Application for Assistance — Your Texas Benefits. Exception: An individual does not have to designate an AR in writing if the individual is physically or mentally incapacitated to such a degree that the individual is unable to sign Form H1010.

The AR must sign the acknowledgement on the signature page of Form H1010.

The AR designation is effective from the date the AR signs the acknowledgement through the end of the certification period or periodic review cycle resulting from Form H1010. Exception: In TANF EDGs where the grandparent is designated AR and protective payee due to the parent not using TANF for the child's needs, the designation continues until the advisor receives verification that the household situation no longer warrants the grandparent continuing as AR and protective payee.

Note: An AR is not automatically a personal representative (PR).

Related Policy
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000
Personal Representatives, B-1212
Establishing Identity for Contact Outside the Interview Process, B-1213
Telephone Contact, B-1213.1

TANF

If an individual is incompetent or incapacitated, someone acting responsibly for the individual may represent the household in the application and review process.

A grandparent (including great or great-great grandparent) may represent the household in the application and review process upon the grandparent's request and when the advisor determines the individual is not using TANF for the child's benefit. In these situations, do not require the individual's signature and designation of the grandparent as AR in writing on Form H1010. If the grandparent is designated AR, the grandparent is also designated protective payee.

SNAP

The head of the household, spouse or other responsible household member may choose an AR to apply for the household.

People disqualified for SNAP benefits because of an administrative disqualification hearing or a nonmember living with the household may serve as an AR only if:

• no other responsible household member is reasonably able to be an AR, or
• that person is the only adult living in the household.

HHSC employees involved in certification or issuance and retailers authorized to accept SNAP benefits may serve as an AR only if the unit supervisor gives written approval.

Medical Programs

An individual does not have to be incompetent or incapacitated to designate an AR.

If an individual is incompetent or incapacitated, someone acting responsibly for the individual or who has been designated as an AR may represent the household in the application and review process.

If a general residential operations facilities representative has been designated as an AR on a Children’s Medicaid application/EDG, the representative is also considered an alternate payee for the case.

There is no requirement for written designation when the individual is deceased.

Related Policy
Receipt of Application, A-121
Receipt of Form H1014, Application Information for Children's Health Insurance Program (CHIP),
Children's Medicaid and CHIP Perinatal Coverage, A-121.1
Verification Requirements, A-180
Documentation Requirements, A-190
Children Residing in General Residential Operations Facilities, A-920.3

A—171  AR Applying for Household

All Programs

The AR must be informed about the household circumstances. The individual is liable for any overissuance resulting from inaccurate information that the AR gives, except in situations when drug/alcohol treatment centers or group living facilities act as AR for a SNAP household.

TANF and Medical Programs

The AR must be an adult.

SNAP

The AR must be an adult, if living outside the household, or a responsible household member.

A—172  AR for Residents of Drug and Alcohol Treatment/Group Living Arrangement (GLA) Facilities

SNAP

For these residents, a facility employee must serve as an AR to apply for the household and to use the benefits. See B-440, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities. The AR designated to use SNAP benefits may be a different person from the AR who applies for the household.

A—173  Abuse by AR

SNAP

An advisor who suspects an AR of acting against the household's interests must report the circumstances to the advisor's program manager.

A—180  Verification Requirements

All Programs

Use verifications accepted for TANF, Medical Programs or SNAP for all programs. For example, if you accept wage verification for a SNAP EDG, that same verification is acceptable for TANF or Medical Programs.

Exceptions:

• For Medical Programs, accept only citizenship and identity verification used for SNAP and TANF if it is listed as one of Medical Programs verification sources in A-358.1, Citizenship, or A-621, Verification Sources.
• Children's Medicaid has less income verification requirements and may not meet the requirement for SNAP or TANF.

Make the eligibility decision in each program when you receive all verifications for that program.

Related Policy
Data Broker, C-820
Questionable Information, C-920
Providing Verification, C-930

TANF

Verify that the caretaker is not using TANF benefits for the child's needs when the grandparent requests to be designated AR. If the caretaker requests the grandparent's removal as AR, verify that the caretaker intends to use TANF benefits for the child's needs.

SNAP

Verify the nonprofit status of homeless shelters, if questionable. View IRS documentation that proves the nonprofit status under Section 501(c)(3) of IRS regulations.

A—181  Verification Sources

TANF

Use the following sources to verify when a grandparent requests to be designated as an AR or when the caretaker requests that the grandparent be removed as AR:

• non-related landlord,
• non-related neighbor,
• school officials,
• Child Protective Services worker,
• person without vested interest in outcome of decision.

A—190  Documentation Requirements

All Programs

Document the date and method by which advance notice of a home visit was provided and the date and time of the visit. An imaged copy of the appointment notice provided to the individual is sufficient.

Document why a certain file date was used to determine eligibility when:

• the file date used differs from the received date on Form H1010, Texas Works Application for Assistance — Your Texas Benefits; or
• Form H1010 has two received dates.

When a household requests additional programs after filing an application, document the requested program and the date of the request.

Document the rationale used to make a prudent person principle decision and any applicable handbook references.

Document that Form H0025, Voter Registration Application, was given to the applicant, AR or representative payee under the Agency Use Only section of Form H1010.

Document on Form H1010 and on Form H1350, Opportunity to Register to Vote, in the Agency Use Only section the actions taken when an applicant or individual notifies the local office of the decision to decline the opportunity to register to vote after receipt of Form H0025.

Document information to support the eligibility decision in enough detail that others can understand all computations and advisor decisions explained in C-940, Documentation.

All Programs except Children's Medicaid

For all interviews, document:

• if the individual met telephone interview criteria and a telephone interview was not done;
• how interpreter services were provided when Form H1010 indicates the individual requested these services, including when the advisor conducted the interview and acted as an interpreter.

Medical Programs

Document when a designated Texas Works advisor requests that a child born to a woman in prison be certified for TP 43.

TANF

Document the specific reason for designating an AR.

When the grandparent requests to be the AR, document the:

• information the grandparent gives to support the claim that the parent is not using the TANF benefit for the child's needs;
• information obtained from collateral contacts and/or documents; and
• decision whether or not to designate the grandparent the AR and protective payee.

SNAP

Document the following:

• the name and address of the AR;
• that no one else is available, if a person disqualified for IPV or a nonmember living with the household is appointed as AR;
• the tax-exempt status (Section 501(c)(3)) for public or private homeless shelters, if applicable;
• expedited service eligibility by marking the appropriate box on Form H1010 and explain if eligibility is questionable;
• the decision on the length of certification and reporting requirements for expedited service EDG;
• whether a migrant is in or out of the workforce;
• the reason for entering a late determination date; and
• the reason why an appointment for an expedited applicant is not scheduled for an interview within the expedited time frame.

Related Policy
Documentation, C-940
Registering to Vote, A-1521
The Texas Works Documentation Guide