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

Part A — Section 100

Application Processing

A—110   Application Procedures

Revision 11-2; Effective April 1, 2011


A—111   Pre-Application Process

Revision 15-4; Effective October 1, 2015

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; and
  • even if an applicant chooses not to apply for TANF, the individual still may apply for Medicaid and the Supplemental Nutrition Assistance Program (SNAP) to support employment while working toward self-sufficiency.

Staff must consider and determine which messages are appropriate for a particular applicant.

A—112   Application Assistance

Revision 15-4; Effective October 1, 2015

All Programs

If an applicant needs help completing the application packet, a volunteer or staff member must help. Anyone helping the applicant complete a paper application must initial the completed sections or sign the form showing that  a volunteer or staff person helped complete the application.

A—113   Application Requests and Submissions

Revision 15-4; Effective October 1, 2015

All Programs

Applications must be given 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.

Staff must advise the household  that an applicant does not have to be interviewed before filing the application. The household 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.

Program

Ways to Request an Application*

Ways to Submit an Application

Applications

TANF

  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail; or
  • By fax.
  • YourTexasBenefits.com
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice;
      • Form H0025, HHSC Application for Voter Registration;
      • Form H0050, Parent Profile Questionnaire, for each absent parent;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.

SNAP

  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail; or
  • By fax.
  • YourTexasBenefits.com
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice;
      • Form H0025, HHSC Application for Voter Registration;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.

Note: 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.

Medical Programs

  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • YourTexasBenefits.com
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice (if applicable);
      • Form H0025, HHSC Application for Voter Registration;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.
  • Form H1205, Texas Streamlined Application:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice (if applicable);
      • Form H0025, HHSC Application for Voter Registration;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.

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

The Texas 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.

Note: Individuals applying for Medical Programs may also use the Marketplace-only applications explained in A-113.1, Application Forms. These applications can be submitted to HHSC in person, by fax, by mail, or via an account transfer explained in A-118, Coordination with the Federal Marketplace.

Related Policy
Registering to Vote, A-1521

A—113.1   Application Forms

Revision 15-4; Effective October 1, 2015

YourTexasBenefits.com

The online application on YourTexasBenefits.com integrates HHSC programs into one single application flow. Applicants only see the questions applicable to the programs they request. A PDF copy of the application information is created for applicants and advisors to view. 

Individuals use YourTexasBenefits.com to apply for the following benefits:

  • SNAP food benefits;
  • TANF cash help for families;
  • Health care for:
    • Children;
    • Adults caring for a child;
    • Adults not caring for a child (if this is selected, YourTexasBenefits.com will allow applicants to identify themselves as a refugee; if they are not a refugee, they will be redirected to HealthCare.gov);
    • Pregnant women;
    • Persons age 65 or older or persons with a disability; and
    • Persons under age 26 who were in foster care or who were unaccompanied refugee minors at age 18 or older;
  • Medicare Savings Programs; and
  • Long-term services and supports for:
    • Persons with intellectual or developmental disabilities; and
    • Persons with no intellectual or developmental disabilities.

Form H1010, Texas Works Application for Assistance — Your Texas Benefits

Form H1010 integrates Texas Works programs into one single application.

The addendum to Form H1010 — Form H1010-M, Applying for or Renewing Medicaid or CHIP? — captures the information needed to make an eligibility determination for Medicaid or the Children’s Health Insurance Program (CHIP).

Individuals use Form H1010 to apply for the following benefits:

  • SNAP food benefits;
  • TANF cash help for families; and
  • Health care for:
    • Children;
    • Adults caring for a child;
    • Adults not caring for a child;
    • Pregnant women; and
    • Persons under age 26 who were in foster care or who were unaccompanied refugee minors at age 18 or older. 

Form H1205, Texas Streamlined Application

Form H1205 can only be used to apply for health care benefits.

Individuals use Form H1205 to apply for the following benefits:

  • Health care for:
    • Children;
    • Adults caring for a child;
    • Adults not caring for a child;
    • Pregnant women; and
    • Persons under age 26 who were in foster care or who were unaccompanied refugee minors at age 18 or older. 

Applications Solely Used by the Marketplace

The online Marketplace application is a single interactive application that is based on an applicant’s selections. In addition, there are three paper applications for the Marketplace:

  • Application for Health Coverage — for anyone who needs health coverage, but does not need help paying for health insurance costs.
    • Used by applicants who want to purchase a Qualified Health Plan (QHP) through the Marketplace.
  • Application for Health Coverage & Help Paying Costs (Short Form) — for single adults who need help paying for health care coverage (mostly for states offering Medicaid expansion coverage to single adults ages 19 through 64) and who:
    • are not married, do not claim any tax dependents, and cannot be claimed as a tax dependent on someone else’s federal income tax return;
    • were not formerly in the foster care system; and
    • are not American Indian (AI)/Alaska Native (AN).
  • Application for Health Coverage & Help Paying Costs — for anyone who needs help paying for health care coverage, including:
    • individuals who are married, have tax dependents, or can be claimed as a tax dependent on someone else’s federal income tax return;
    • individuals with or without current health care coverage;
    • families that include immigrants; and
    • individuals who were formerly in the foster care system.

Since these applications do not contain additional questions that were included on Form H1205, Texas Streamlined Application, advisors must send out Form H1020, Request for Information or Action, to request any additional information necessary to make an eligibility determination. 

A—114   Applications Causing Conflicts of Interest

Revision 15-4; Effective October 1, 2015

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 an authorized representative (AR).

The advisor:

  • may provide anyone with an application and information about how and where to apply for benefits;
  • may 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

Revision 15-4; Effective October 1, 2015

All Programs

Special handling must be given to applications and redeterminations submitted by a Texas Works employee.

  • 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; and
  • The employee's immediate supervisor or someone in the direct line of supervision may not process the employee's application.

A—115   Applications Filed in Hospitals and Clinics

Revision 15-4; Effective October 1, 2015

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; and
  • perform inquiry and complete Application Registration in the Texas Integrated Eligibility Redesign System (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.

SNAP and TANF

For SNAP or TANF applications filed at hospitals or clinic sites, staff must 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.

Medical Programs

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

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

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.

A—116   Special Application Processes

Revision 12-2; Effective April 1, 2012


A—116.1  Reserved

Revision 15-4; Effective October 1, 2015


A—116.2   Applications from Residents of a Homeless Shelter

Revision 15-4; Effective October 1, 2015

SNAP

Households are potentially eligible for SNAP even if they live in a shelter for the homeless that provides more than 50 percent 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. Staff must 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, staff must consider the payments as shelter expenses.

Related Policy
Prepared Meals for Homeless, B-462
Homeless Shelter Standard, A-1427

A—116.3   Applications for Babies Born to Women in Prison

Revision 15-4; Effective October 1, 2015

Medical Programs

A pregnant woman who enters the state prison system is sent to the Texas Department of Criminal Justice 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.

The 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 the designated advisors, which must be documented in the case record, 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; or
  • 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 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; 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)

Revision 15-4; Effective October 1, 2015

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 taking part in the pilot program. HHSC contracts with the following food banks to provide application assistance:

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

The file date of the interviewed application is the date the contracted CP receives the application for SNAP assistance and any other type of Texas Works benefits requested on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. For assistance beyond Texas Works programs, such as Medicaid for the Elderly and People with Disabilities program requests, advisors follow local office procedures to send the information through the appropriate channels.

If the CP accepts the application after traditional HHSC business hours 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 uses a date that is not an HHSC workday as the file date, the Texas Works advisor must correct the file date, enter the next HHSC workday as the file date, and document the reason for using the corrected file date. The advisor must also advance the interview date to the same date since the interview date cannot be any earlier than the file date.

CPs interview expedited and regular status households. The CP must send applications screened as potentially eligible for emergency benefits to HHSC on the day of receipt. The CP must send CP-interviewed applications with regular status, not expedited, to HHSC no later than three workdays from the date the CP receives the applications.

CPs maintain the interviewed applications on an electronic list for tracking purposes. The CP then emails the interviewed applications to a designated secure regional HHSC Outlook mailbox using Voltage Encryption. The CP places Form H0901, used exclusively by the CP interviewers, at the beginning of each application packet for which the CP conducted an interview. 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 CP has interviewed the household for SNAP.

TANF and Medical Programs

There is no deviation from normal processing for TANF or Medical Program requests that the CP submits with SNAP applications. For those households interviewed for SNAP by the CP, the advisor processing the TANF or Parents and Caretaker Relatives Medicaid must still conduct the TANF/Parents and Caretaker Relatives Medicaid interview. The advisor  may conduct this interview without first scheduling the appointment, but in order to meet the timeliness requirement, if the advisor is not able to contact the household to conduct the TANF/Parents and Caretaker Relatives Medicaid interview within three workdays after receiving the application, the office must schedule an appointment.

Assistance-Only Applications — All Programs

The CP routes assistance-only application packets to the Austin Document Processing Center for distribution to the proper local HHSC eligibility office (by applicant ZIP code) for normal processing. The file date of the assistance-only application 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.

While most CPs submit electronic applications online through YourTexasBenefits.com, some CPs use different computer systems that screen eligibility for various programs and services, including some services outside of HHSC programs. Two of these systems currently are able to submit electronic applications via an interface with HHSC, including applications for SNAP, Texas Works Medicaid and TANF. HHSC considers these applications e-signed the same as applications filed online. These applications display “E-signed” on all client signature lines and display the CP organization’s name in the People Helping You section. The Community-Based Organization (CBO) portal page does not report these applications, and the advisor does not need to complete the CBO Logical Unit of Work (LUW) with the CP’s information.

Pending Information

If the CP interviewer notes that more information is needed to complete the case, the CP interviewer will give 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 send the pending information to the local HHSC eligibility office. The CP logs the pending information received from the household and forwards it to the proper eligibility office by encrypted email within three workdays of receipt.

Eligibility Decision

If the CP interviewer believes that 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 CP will send the information and verification to HHSC for the final eligibility decision.

Form H0920 also informs the household that HHSC may determine whether 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 them Form H1019, Report of Change, indicating the household's specific reporting requirements.

The CP interviewer addresses the following forms and activities:

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 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 HHSC denies the application, HHSC notifies the individual about the denial action and the household's right to appeal the decision.

CP SNAP Interviews — Verification of Identity

CP staff who interview an applicant for SNAP and indicate on Form H0901 that staff verified the applicant's identity must include a copy of the document used to verify identity in the data collection packet that the CP sends to HHSC for eligibility determination and processing.

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

Pending Information

If HHSC needs information to complete the case, the 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 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 redeterminations, the advisor denies the request for benefits 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 that CP staff conducted the interview; and
  • document the specific food bank entity that conducted the interview.

Fair Hearings

HHSC staff represent the agency at all fair hearings. CP staff should 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, they must send it to HHSC. The date of receipt for the fair hearing request is the date HHSC receives the request.

Scheduling a CP-Interviewed Appointment

Appropriate Office of Eligibility Services (OES) staff must schedule appointments using the Portal Scheduler for cases interviewed by a CP. This allows for tracking via the Task List Manager (TLM). In many cases, the CP interview date will precede the date the HHSC eligibility office actually receives the application; therefore, OES staff use the Select Appointment option to locate a past appointment slot that corresponds to the CP interview date. To make sure that the appointment task is routed to the proper location handling the application, staff must overwrite the individual's ZIP code, which automatically displays once the 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. If there are no appointment slots published for a past date, OES staff note the appointment date in TIERS on the Appointment Details page. If OES staff do not specify an appointment date, the SNAP Eligibility Determination Group (EDG) will be pended. The TLM will not track appointments that are not scheduled in the Portal Scheduler. Note: Assistance-only applications (applications not interviewed by a CP) should follow normal scheduling procedures.

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

Related Policy
Application Processing, A-100

Electronic Benefit Transfer (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 offices and the offices' related community partners.

If it appears that 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 give the household a Lone Star Card or related materials, but still must process the request for benefits and send the application to the local HHSC eligibility office for an eligibility determination.

The CP interviewer gives households that appear to be eligible:

The CP interviewer must discuss the issuance-related items as explained in B-239.1, Advisor Interview Requirements for Client Training, with potentially eligible applicants during the interview, even if the application is pended. In addition, CP interviewers must also tell the applicant 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); and
  • 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 give households that appear to be eligible:

  • a card sleeve; and
  • Form H1162, Lone Star Card Insert.

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 has 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 says that 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 that the card is linked to the proper case.

Form H1172 becomes part of the application package that the CP returns to the HHSC local office for eligibility determination. If HHSC determines the applicant is eligible, the advisor asks the EBT clerk (by sending 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, applicants must contact the Lone Star Help Desk at 1-800-777-7328 (1-800-777-7EBT).

If the CP did not issue a Lone Star Card to a household eligible for SNAP benefits, the advisor must treat this situation like a certification following a telephone interview. The 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)

Revision 11-3; Effective July 1, 2011

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

Revision 11-3; Effective July 1, 2011

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)

Revision 11-3; Effective July 1, 2011

A—116.7.1   SNAP-CAP and SNAP-SSI

Revision 15-4; Effective October 1, 2015

For application processing related to SNAP-Combined Application Project (CAP) and SNAP-SSI, refer to the policy in B-475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP), and B-474.1.1.1, SNAP-Supplemental Security Income (SSI) Caseload.

A—116.7.2   Applications for SNAP-CAP

Revision 15-4; Effective October 1, 2015

For application processing related to SNAP-CAP, refer to the policy in B-475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP).

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

Revision 15-4; Effective October 1, 2015

For application processing related to MTFCY, staff should refer to policy in B-474.1.2, Medical Programs, 2; 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

Revision 15-4; Effective October 1, 2015

For application processing related to Medicaid for eligible youth in the custody of or released from the Texas Juvenile Justice Department, staff should refer to policy in B-474.1.2, Medical Programs, 1.

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

Revision 15-4; Effective October 1, 2015

For application processing related to MBCC, staff should refer to policy in B-474.1.2, Medical Programs, 4; and Other Medical Programs, Part X, Medicaid for Breast and Cervical Cancer (MBCC).

A—116.7.6   Refugee Medical Assistance (RMA)

Revision 15-4; Effective October 1, 2015

For application processing related to RMA, staff should refer to policy in B-474.1.2, Medical Programs, 5; and Other Medical Programs, Part R, Refugee Medical Assistance.

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

Revision 11-3; Effective July 1, 2011

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

A—116.7.8   Former Foster Care Children (FFCC)

Revision 15-4; Effective October 1, 2015

For application processing related to FFCC, refer to policy in Other Medical Programs, Part E, Former Foster Care Children (FFCC).

A—117   Applications Filed Online through YourTexasBenefits.com

Revision 15-4; Effective October 1, 2015

When the household submits an application online, 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 YourTexasBenefits.com. 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 Task List Manager (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

Revision 15-4; Effective October 1, 2015

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

A logical unit of work (LUW) is in 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 online application.

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

A—117.2   Data Collection

Revision 15-4; Effective October 1, 2015

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

  • pre-filled TIERS fields and a message at the top of the page stating that the fields are pre-filled from self-service data (for new applications); or
  • YourTexasBenefits.com 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 online application to allow the advisor to select the correct data to use in Data Collection.

The advisor may choose to:

  • accept all TIERS data,
  • accept all YourTexasBenefits.com 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 is no YourTexasBenefits.com information or comparison windows in the Program, Income or Expenses pages. The advisor must complete the Data Collection driver flow.

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

A—118   Coordination with the Federal Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

HHSC and the federal Marketplace coordinate eligibility determinations for Texas Works Medicaid and CHIP. Information provided by the applicant or verified for the applicant is sent through an interface between the Marketplace and HHSC. The two systems — the Marketplace and HHSC — transfer an applicant’s information from one system to the other. The transfer of application information is referred to as an account transfer. An account transfer is the way in which a client’s information moves between the Marketplace and HHSC.

A—118.1   Applications Received from the Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

The Marketplace sends the individual’s or household’s information electronically to HHSC via an account transfer when:

  • the Marketplace determines the applicant is potentially eligible for Medical Programs available through HHSC; or
  • the applicant requests a final eligibility determination for Texas Works Medicaid or CHIP from HHSC. This is referred to as a “full determination.”

Applications sent via account transfers from the Marketplace are received by staff in the same manner as an application from YourTexasBenefits.com

When an application is sent to HHSC via an account transfer, a PDF is populated with information provided by the applicant on the Marketplace application, along with a “Verifications” section that provides information on any verifications performed by the Marketplace. Advisors should enter the information provided on the PDF into TIERS.

Individuals cannot be required to provide the same information more than once, regardless of whether they apply through the Marketplace or through HHSC. This applies to any information provided on an application, as well as any verification materials provided by the applicant.

Related Policy
Verifications Provided by the Marketplace, A-118.1.2

A—118.1.1   Non-MAGI Account Transfers

Revision 15-4; Effective October 1, 2015

Medical Programs

A non-Modified Adjusted Gross Income (non-MAGI) account transfer is an account transfer that is sent from the Marketplace to HHSC when the Marketplace has identified that an applicant may be eligible for Medicaid for the Elderly and People with Disabilities (MEPD) because the applicant reported being age 65 or older, having a disability, or being blind. In order for an individual to apply for MEPD programs, they must submit an MEPD application, Form H1200, Application for Assistance — Your Texas Benefits.

Advisors must deny the application as “Filed in Error” and send the applicant Form H1200 if:

  • the PDF included in the account transfer indicates “Medicaid Non-MAGI Eligibility” in the Referral Activity Eligibility Reason for an individual on the application;
  • a “full determination” is not requested; and
  • a determination for Texas Works Medicaid or CHIP is not listed for any other applicant on the application.

A—118.1.2   Verifications Provided by the Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

For Marketplace account transfers, the PDF also includes a “Verifications” section. Advisors should use the verification section as follows:

  • If the Marketplace has verified the applicant's Social Security number (SSN) or citizenship status using data from the Social Security Administration (SSA), advisors can identify that information in TIERS as "Verified by SSA."
  • If the Marketplace has verified the applicant's alien status using data from the Department of Homeland Security (DHS), advisors can identify that information in TIERS as "Verified by DHS."
  • All other applicant information, such as income, must be verified by an HHSC advisor according to HHSC procedures explained in C-900, Verification and Documentation. If the Marketplace has verified the information according to HHSC procedures, then that data must be treated as verified.

A—118.2   Applications Sent to the Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

When HHSC determines that a client is ineligible for Texas Works Medicaid or CHIP (due to Texas eligibility requirements), or that the client is only eligible for TP 56, Medically Needy with Spend Down; TP 32, Medically Needy with Spend Down-Emergency; or three months prior Medicaid, HHSC transfers that individual’s account information to the Marketplace to be assessed for eligibility for other health care coverage programs. Form TF0001, Notice of Case Action, informs the client that they have been transferred to the Marketplace.

A—119   Correspondence Options

Revision 15-4; Effective October 1, 2015


A—119.1   Electronic Correspondence

Revision 15-4; Effective October 1, 2015

All Programs

The head of household or authorized representative (AR) for a case may each choose at any time to receive most eligibility correspondence electronically rather than through the mail. By selecting this option, applicable forms and notices are posted to the client’s or AR’s YourTexasBenefits.com case account, and the client or AR receives a cell phone text message or email reminder each time a new form or notice has been posted to their account. Clients may print a copy of the correspondence from their account or request that a paper copy be mailed to them. Any forms or notices that are not available electronically will continue to be mailed to the client. 

Once a head of household or AR has opted to receive electronic correspondence through their case account on YourTexasBenefits.com or by indicating that preference to staff through 2-1-1 (Option 2), a confirmation cell phone text message or email reminder will be sent to the client. The head of household or AR must enter the code provided in that confirmation message in their YourTexasBenefits.com case account in order to confirm their choice to receive electronic correspondence. Once confirmed, Form H1013, Electronic Correspondence Confirmation Letter, will automatically be mailed to the head of household or AR to further confirm the selection and to provide instructions about how to opt out of receiving electronic correspondence.

After a failed delivery of a text or email alert, the client is automatically unsubscribed from electronic correspondence. The eligibility system then automatically prints and mails to the client a paper copy of the correspondence that failed to reach the client with the original generation date, attached to Form H1015, Electronic Correspondence Failed Delivery. The client will receive future correspondence through the mail. However, the client may opt to subscribe again to receive electronic correspondence and start over the confirmation process.

A—119.2  Preferred Language for Correspondence

Revision 15-4; Effective October 1, 2015

All Programs

The head of household or AR for a case has the ability to choose the language in which certain forms and notices are generated from the eligibility system. The head of household or AR can select their primary household language from the following options:

  • English
  • Spanish
  • Both English and Spanish
  • Vietnamese*

* Clients who select Vietnamese as their primary household language will receive correspondence in English, and the eligibility system will automatically attach to the form or notice the Vietnamese Translation Interpreter Form, which directs clients to translation services.

Once a primary household language is selected, both the head of household and AR will receive correspondence in that language.

A—120   Office Procedures

Revision 08-1; Effective January 1, 2008


A—121   Receipt of Application

Revision 15-4; Effective October 1, 2015

All Programs

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

TANF

An application is valid as long as it contains the applicant's name, the applicant’s address, and the signature of:

  • the applicant, or
  • an authorized representative (AR) if the applicant is incapacitated or incompetent.

SNAP

An application is valid as long as it contains the applicant's name, the applicant’s address, and the signature of:

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

Medical Programs

An application is valid as long as it contains the applicant's name, the applicant’s address, and the signature of:

  • the applicant;
  • the AR of  an applicant; 
  • an individual age 19 or older who:
    • is included in the applicant’s household composition; or
    • has a tax relationship with the applicant; or
  • an individual who satisfies the definition of caretaker when the applicant is under age 19.

Note: Individuals are not required to live at the same physical address in order to apply for each other if they have a tax relationship as explained in A-240, Medical Programs. For example, a non-custodial parent may apply for Medicaid and CHIP on behalf of his or her child if the parent expects to claim the child as a tax dependent on his or her federal income tax return.

TP 43, TP 44 and TP 48

A new application is not required when an individual has an active Medicaid type program and requests to add another child for whom a new EDG is needed. Add the child to the case as explained in B-641, Additions to the Household.

This policy does not apply when there is no existing Children's Medicaid EDG. For example, advisors 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, advisors do not add an "other-related" child to an existing Medicaid case. This situation requires a separate application for Children's Medicaid.

Related Policy
Application Requests and Submissions, A-113
Filing the Application, A-122
Application Signature, A-122.1
Authorized Representatives (AR), A-170
Children's Medicaid Redetermination Expectations, B-123.6
Denied EDGs, B-474.7

A—121.1   Receipt of Application from Residential Child Care Facility

Revision 15-4; Effective October 1, 2015

Medical Programs

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

A—121.2 Receipt of Duplicate Application

Revision 15-4; Effective October 1, 2015

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:  If a household submits an application for SNAP on January 2 and later submits one or more additional applications for SNAP that are different from the one the household filed on January 2, and are 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, staff 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

Revision 15-4; Effective October 1, 2015

All Programs

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

Example: If a household faxes in an application on January 2 and later submits an exact copy of the same application, which includes the same signature and date of the application the household 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

Revision 15-4; Effective October 1, 2015

All Programs

Staff should 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. Staff should explain how to file an application. Application forms are also available at YourTexasBenefits.com and can be downloaded, printed, and electronically submitted.

The file date is the day HHSC receives an application form containing the applicant's name, address, and appropriate signature. This is day zero in the application process. Staff use this as the 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 YourTexasBenefits.com.

Exception: For all 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, staff 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; and
  • 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
Application Requests and Submissions, A-113
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.

Related Policy
Continuous Medicaid Coverage, A-832

TP 45 Retroactive Coverage

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

Related Policy
TP 45 Retroactive Coverage, A-833

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

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 HHSC office receives the application.

The file date is the date an individual submits an application 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 YourTexasBenefits.com. For applications received outside of business hours when HHSC is closed, including weekends and holidays, the file date is the next business day.

A—122.1   Application Signature

Revision 15-4; Effective October 1, 2015

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, staff must 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 applications submitted online through YourTexasBenefits.com by the applicant or AR, staff must consider the 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 YourTexasBenefits.com; 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

All Programs

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, staff does not require an additional signature for the first page of Form H1010.

Medical Programs

If an applicant only signs and returns Form H1010-M, Applying for or Renewing Medicaid or CHIP?, without a corresponding application, the application is considered invalid.

If the applicant returns a signed application without Form H1010-M, the application is considered incomplete. The advisor must send Form H1020, Request for Information or Action, with Form H1010-M requesting the necessary information to make a determination based on Modified Adjusted Gross Income (MAGI) rules. If the applicant fails to provide a completed Form H1010-M by the final due date, staff must deny the request for failure to provide information.

Related Policy
Application Requests and Submissions, A-113
Receipt of Application, A-121

A—122.2   Scheduling Appointments

Revision 15-4; Effective October 1, 2015

All Programs except TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44, TP 45 and TP 48

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. An appointment is required even if the application is filed with only a name, address and signature.

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

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

Note: Staff should 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, staff enters 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 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44, TP 45 and TP 48

There is no interview requirement for Children's Medicaid or Medicaid for Pregnant Women. Staff must process the application unless the individual requests an office appointment.  

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, staff should schedule a telephone appointment and deliver the HCO, or remind the individual about the importance of the THSteps checkup at that time.
  • Staff conducts a telephone interview for an initial application or renewal when HHSC receives conflicting information related to household composition or income that affects eligibility and the information cannot be verified through other means, such as an associated EDG.

Related Policy
Interviews, A-131
Explanation of Benefits, A-1531.4

A—122.3   Registering an Application

Revision 15-4; Effective October 1, 2015

All Programs

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

To prevent overpayments or incorrectly providing benefits, 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.

If inquiry shows …

then …

no record,

follow established local office procedures for processing applications.

an individual record,

check case/EDG status (active or denied).

If the case is active, determine if the individual is currently active on another case in the same program. If the individual is:

  • not currently active in the same program, register the application.
  • entitled to dual SNAP participation as a resident of a shelter for battered persons, follow procedures in  B-454.1, Duplicate Participation Procedures.
  • currently active in the same program and is not entitled to dual benefits, take appropriate action to prevent duplicate participation. Process an overpayment, if applicable.

If the case is denied, associate the old case number in File Clearance after determining that this is the same household.

a SNAP-CAP or SNAP-SSI case record,

check for CBS status in TIERS inquiry. SNAP-CAP will be listed as FS-SNAP under Current EDG Affiliations in case inquiry results and under Current Eligibility in individual inquiry results. SNAP-SSI will be listed as FS-SSI under Current EDG Affiliations in case inquiry results and under Current Eligibility in individual inquiry results. Follow established local office procedures applicable to the specific case situation.


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

Revision 15-4; Effective October 1, 2015

All Programs

The individual may voluntarily withdraw an application any time before certification.

SNAP

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

Related Policy
The Texas Works Message, A-1527

A—124   Processing Presumptive Eligibility Applications

Revision 15-3; Effective July 1, 2015

TA 66, TA 74, TA 75, TA 76, TA 83, TA 86 and TP 42

Presumptive eligibility (PE) provides short-term medical coverage to pregnant women, MBCC applicants, children under age 19, parents and caretaker relatives of dependent children under age 19, and former foster care children. PE provides full fee-for-service Medicaid with the exception of pregnant women. Pregnant women receive ambulatory prenatal care only.

Qualified hospitals (QHs) determine PE for all groups except MBCC.

Qualified entities (QEs) determine PE for pregnant women and MBCC applicants. For MBCC applicants, only QEs that are also Texas Department of State Health Services (DSHS) Breast and Cervical Cancer Services contractors may make MBCC PE determinations, following the process outlined in X-100, Application Processing.

A—124.1   Eligible Groups

Revision 15-3; Effective July 1, 2015

The following groups can receive presumptive eligibility coverage:

  • Children:
    • MA-Children Under 1 Presumptive — TA 74
    • MA-Children 1–5 Presumptive — TA 75
    • MA-Children 6–18 Presumptive — TA 76
  • Former Foster Care Children (MA-FFCC Presumptive — TA 83)
  • Pregnant Women (MA-Pregnant Women Presumptive — TP 42)
  • Parents and Other Caretaker Relatives (MA-Parents and Caretaker Relatives Presumptive — TA 86)

A—124.2   File Clearance

Revision 15-3; Effective July 1, 2015

TIERS performs automated file clearance for each individual determined presumptively eligible if the individual has a 100 percent match in TIERS or if there is no match for the individual in TIERS. For individuals for whom TIERS cannot perform automated file clearance, TIERS triggers an alert to create a TLM task for staff to manually do file clearance for the individual. TIERS routes manual file clearance tasks to the Out-stationed Worker Program (OWP) queue for assignment and processing.

A—124.3   Task List Manager

Revision 15-3; Effective July 1, 2015

When TIERS cannot automatically perform file clearance for an individual whom a QH/QE has determined to be presumptively eligible, an OWP advisor needs to take action. TIERS creates the task "Process a File Clearance Failure for Presumptive Eligibility" and sends it to an OWP advisor based on the applicant's ZIP code.

To complete the task, the advisor:

  1. Selects the Work icon.
  2. Selects the individual who needs file clearance from the Presumptive Eligibility Individual — Summary page.
  3. Matches the PE individual to the TIERS individual on the PE File Clearance — Results page.
  4. Selects Auto Process PE on the File Clearance — Results page to complete the task once the advisor has performed file clearance for all individuals on the case.  

The advisor can also manually clear the task. When an advisor searches for an application on the Self Service Application Search page, the SS Application Search Results section displays a Determine PE link if a PE individual on the case requires manual file clearance. TIERS displays the Presumptive Eligibility Individual — Summary page when the advisor clicks the link.

Once the advisor completes file clearance, TIERS notifies TLM to close the QH/QE PE task.

A—124.4   Application Processing

Revision 15-3; Effective July 1, 2015

The TLM routes applications for regular Medicaid from individuals whom a QH/QE has determined to be presumptively eligible for Medicaid to an OWP advisor for processing. If the QH has an OWP advisor, the TLM assigns the application to that advisor for processing. If the QH does not have an OWP advisor or a QE submits the application, the TLM routes the application to the regional OWP queue.

Process the applications using current policy and application processing time frames. See B-112, Deadlines. If both a PE task for file clearance and a regular Medicaid application exist for the same person, clear the PE task first.

A—124.5   Verifications

Revision 15-3; Effective July 1, 2015

Use standard verification requirements when processing an application for regular Medicaid from an individual determined presumptively eligible. See C-900, Verification and Documentation.

Related Policy
Verifications, C-1113.4

A—124.6   Medical Effective Date

Revision 15-4; Effective October 1, 2015

The medical effective date for PE is the date that the QH or QE determines the individual is presumptively eligible for Medicaid. 

Note: An individual is not eligible for PE coverage if the individual is currently certified for Medicaid, CHIP or CHIP perinatal.  

If the individual does not apply for regular Medicaid, PE coverage ends the last day of the month after the month of the PE determination (see scenario 1 below).

If the individual submits Form H1205, Texas Streamlined Application, or Form H1010, Texas Works Application for Assistance — Your Texas Benefits, HHSC determines whether the individual is eligible for regular Medicaid. If the person is not eligible for regular Medicaid, the individual's PE coverage ends the date that HHSC determines the individual is ineligible (see scenario 2 below). If the person is eligible for regular Medicaid, the person’s PE coverage ends when HHSC makes the Medicaid eligibility determination, following cutoff rules. 

If an individual is Medicaid-eligible during the application month, the individual receives Medicaid from the first of that month through the PE MED. Regular Medicaid coverage for the ongoing period starts once the PE period ends (see scenarios 3 and 4 below).  Exception: Since PE for pregnant women provides only limited prenatal services, ongoing Medicaid coverage overlays the PE coverage (see scenario 5 below). 

Examples: 

PE Scenarios
  1. Individual does not apply for regular Medicaid
A child is determined eligible for MA-Children 6–18 Presumptive on February 2. Her mother does not submit an application for regular Medicaid. The child’s PE coverage ends on March 31. 
  1. Individual is ineligible for regular Medicaid

A child is determined eligible for MA-Children Under 1 Presumptive on April 4. Her father submits an application for regular Medicaid on the same date. HHSC determines on April 20 that the child is not eligible for regular Medicaid. Her PE coverage ends on April 20.

  1. Individual is eligible for regular Medicaid (HHSC makes eligibility determination before cutoff)

A child is determined eligible for MA-Children 1–5 Presumptive on March 6. His mother submits an application for regular Medicaid on the same date. HHSC determines on March 15 (before cutoff) that the child is eligible for regular Medicaid. His PE coverage ends March 31. He is certified for regular Medicaid effective March 1 to March 5 and April 1 through ongoing. 

  1. Individual is eligible for regular Medicaid (HHSC makes eligibility determination after cutoff)

A former foster care child is determined eligible for MA-FFCC Presumptive on May 9. He submits an application for regular Medicaid on the same date. HHSC determines on May 22 (after cutoff) that the individual is eligible for regular Medicaid. His PE coverage ends June 30. He is certified for regular Medicaid effective May 1 to May 8 and July 1 through ongoing. 

  1. Pregnant woman is eligible for regular Medicaid

A woman is determined eligible for MA-Pregnant Women Presumptive on June 4. She submits an application for regular Medicaid on the same date. HHSC determines on June 10 that the woman is eligible for regular Medicaid. Her PE coverage ends on June 30. Regular Medicaid overlays her PE coverage with an effective date of June 1.


A—124.7   Periods of Presumptive Eligibility

Revision 15-3; Effective July 1, 2015

Pregnant women are allowed one PE period per pregnancy.

For all other PE groups, an individual is allowed no more than one period of PE per two calendar years. Example: An individual receives PE for children ages 6–18 in June 2015. He cannot receive another period of PE until January 2017.

A—124.8   Fair Hearings

Revision 15-3; Effective July 1, 2015

Appeals and fair hearings do not apply to PE.

A—124.9   Questions About the Presumptive Eligibility Process

Revision 15-3; Effective July 1, 2015

Refer hospitals and entities that are interested in becoming qualified to make PE decisions to the PE website at www.TexasPresumptiveEligibility.com.

Refer individuals with questions about their PE coverage dates to the QH/QE that made the PE determination. For questions about services covered by Medicaid, tell the person to call the Medicaid help line at 1-800-335-9857.

A—124.10   Presumptive Eligibility Forms

Revision 15-3; Effective July 1, 2015

Qualified hospital/qualified entity staff use the following forms in the presumptive eligibility process: 

  • Form H1265, Presumptive Eligibility (PE) Worksheet — Completed by the QH/QE and used to determine if an applicant is presumptively eligible.    
  • Form H1266, Short-term Medicaid Notice: Approved — Completed by the QH/QE and given to an individual determined presumptively eligible. This form notifies the individual about PE coverage and lists the eligibility start and end dates. If an individual takes this form to a local eligibility determination office and requests a temporary Medicaid identification card, give the person Form H1027-A, Medicaid Eligibility Verification.
  • Form H1267, Short-term Medicaid Notice: Not ApprovedCompleted by the QH/QE and given to an individual determined ineligible for PE coverage. This form explains the reason for ineligibility and how to apply for regular Medicaid.

Related Policy
Qualified Hospital/Qualified Entity Policy and Procedures for Presumptive Eligibility Determinations, C-1113

A—125   TP 45 Provider Referral Process

Revision 15-4; Effective October 1, 2015

TP 45

State Office Data Integrity (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 the claims administrator 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 date of birth (DOB). The last month of coverage is the month the child turns age one, unless one of the following situations occurs.

  • The hospital notifies SODI using Texas 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; and
  • 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 if information on Form H1027-A, Medicaid Eligibility Verification, is incorrect;
    • to report if the newborn's siblings receive TANF; and
    • 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

Revision 15-4; Effective October 1, 2015

TP 45

A task is created when 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.

If ... then ...
the newborn is a mandatory member of a TANF-certified group or SNAP household, process to add the child to the TANF or SNAP EDG as explained in B-641.1, Adding Newborns to the Case.
the child is not a mandatory member of a TANF-certified group, but the child's mother or caretaker provides additional information about the child (name, SSN, etc.), add these changes to the TP 45 EDG.
the newborn's siblings are included in the MAGI household composition for a TP 43, 44, or 48, take no action on the siblings' EDG until additional information is requested for the siblings. At that point, request verification of tax status and relationship for the newborn. If the mother provides verification of relationship for the newborn, add the newborn to the siblings' budget groups.
the child becomes ineligible for TP 45 before the child's first birthday, deny TP 45 for the child, using the appropriate denial code.

A—125.2   Suspended Claim Process

Revision 15-4; Effective October 1, 2015

TP 45

The Medicaid provider sends a claim for a newborn child with the child's mother's claim to the claims administrator. If the claims administrator cannot find the child on HHSC's eligibility files, the claims administrator suspends the child's claim and sends an exception notice to State Office Data Integrity (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

Revision 15-4; Effective October 1, 2015

TP 45

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

A—126   Processing Children’s Insurance Applications

Revision 15-4; Effective October 1, 2015

See A-113, Application Requests and Submissions, for how to apply for Medical programs for children.  

A—126.1   Front Desk Process

Revision 15-4; Effective October 1, 2015

CHIP and TP 43, TP 44 and TP 48

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

  • explain the ways to submit an application as outlined in A-113, Application Requests and Submissions; and
  • explain that the Medicaid application process provides that if a child is found ineligible for Medicaid based on income, HHSC will test the child for CHIP and, if eligible, the Enrollment Broker will send an enrollment packet to the household.

A—126.2  Inquiry

Revision 15-4; Effective October 1, 2015

CHIP and TP 43, TP 44 and TP 48

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

A—126.3   Advisor Action for Determining Eligibility for Children

Revision 15-4; Effective October 1, 2015

CHIP and TP 43, TP 44 and TP 48

When taking action on an application, the following procedures must be applied:

If ...

then ...

The child applying is not active in CHIP or pending CHIP enrollment,

test for Medicaid eligibility. Follow the policy for assigning the MED*.

The child applying is active in CHIP and the CHIP end date is the application month or the following month,

test for Medicaid eligibility. If eligible, and it is:

  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.

The child applying is active in CHIP and the CHIP end date is later than the month following the application month,

test for Medicaid eligibility. If eligible, and processing is:

  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.

The child applying is pending CHIP enrollment with a start date the first day of the next month,

test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. If eligible, and it is:

  • before cutoff, follow the policy for assigning the MED.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month. Provide open/close coverage for the application month and/or prior months, if applicable.

The child applying is pending CHIP enrollment with a start date later than the first day of the next month,

test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. Follow the policy for assigning the MED.

The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the application month,

test for Medicaid eligibility. If eligible, begin Medicaid coverage the first day of the month following the CHIP end date.

The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the month following the application month or later,

test for Medicaid eligibility. If eligible, and it is:

  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.

One child in the family applying is active in CHIP and another is not,

test for Medicaid eligibility. If eligible, follow the applicable guidelines given in the preceding scenarios, for each child.

* See A-820, Regular Medicaid Coverage, to apply the MED.

After determining a child is ineligible for Medicaid, TIERS will test eligibility for CHIP.

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

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 36, TP 43 and TP 45

Income Above the Limit for Medicaid for Pregnant Women (TP 40)

When a CHIP perinatal mother whose household income is above the income limit for TP 40 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 that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the newborn using the following process:

  • Upon receipt of an application for a Medicaid NICU newborn, HHSC hospital-based staff must perform 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, staff must deny the CHIP perinatal and certify the eligible newborn for TP 43, if eligible, following existing policy.
  • If not eligible, test the newborn for TP 56 and do not deny the newborn’s CHIP perinatal coverage.
  • If eligible, the newborn may receive TP 56 and CHIP perinatal coverage.

Income at or Below the Limit for Medicaid for Pregnant Women (TP 40)

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 the income limit for TP 40 is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the eligible mother for Emergency Medicaid and the newborn for TP 45, effective on the newborn's date of birth. The CHIP perinatal mother must submit Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification, to the hospital. HHSC hospital-based staff must process Form H3038-P.

Upon receipt of Form H3038-P, 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;
  • use the date Form H3038-P 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 and deny the CHIP perinatal Eligibility Determination Group (EDG); and
  • certify the eligible newborn for TP 45, effective on the newborn's date of birth.

Related Policy
Adding a New Child, D-1433.1

A—126.4   CHIP Good Cause

Revision 15-4; Effective October 1, 2015

CHIP good cause is explained in D-1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

A—126.4.1   Claiming Good Cause

Revision 15-4; Effective October 1, 2015

CHIP good cause is explained in D-1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

A—127   Prior Medicaid Coverage

Revision 15-4; Effective October 1, 2015

Children's Medicaid and TP 33, TP 34 and TP 35

Staff use any valid application or renewal form to determine three months prior coverage for Children's Medicaid. Do not require Form H1113, Application for Prior Medicaid Coverage, if the family provides enough information to determine eligibility for prior months. If the family does not provide enough information and cannot be reached by telephone, staff sends Form H1113 with Form H1020, Request for Information or Action, to request verification. Note: Three months prior coverage does not apply to CHIP. See D-1723.5, Coverage Start Dates, to determine when CHIP coverage begins.

Staff must 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

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 40 and TP 36

A pregnant woman may apply for health care coverage using applications and ways to submit an application explained in A- 113, Application Requests and Submissions.

When a pregnant woman applies for health care coverage, she will first be tested for TP 40 coverage. If ineligible for TP 40, TIERS will determine whether the woman is eligible for CHIP or CHIP perinatal.

CHIP perinatal coverage provides services to unborn children of pregnant women, regardless of age, who are at or below the program income limit and are ineligible for:

  • Medicaid because of immigration status or income; or
  • CHIP because of age or immigration status.

CHIP perinatal households are exempt from the:

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

A—128.1   Inquiry for Pregnant Women

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 40 and TP 36

Before certifying a pregnant woman for any type of health care coverage, advisors must perform inquiry to determine whether the pregnant woman is already certified for Medicaid or enrolled or pending enrollment in CHIP or CHIP perinatal.

Searching by the woman's last name and date of birth may increase the possibility for a match.

A—128.2   Advisor Action for Determining Eligibility for Pregnant Women

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 40 and TP 36

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

If ... then ...
The woman is active in CHIP perinatal and the application indicates she is due in the application month, test for Medicaid eligibility.* If eligible, and she is:
  • not a U.S. citizen or alien with acceptable status, certify for Emergency Medicaid coverage for the birth.
  • certify the newborn for TP 45 Medicaid coverage.
The woman is active in CHIP perinatal and the application indicates she is due in the month following the application month or later, test for Medicaid eligibility.* If eligible, and it is:
  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.

* When an individual enrolled in CHIP perinatal submits a new application, they must be tested for Medicaid coverage. Otherwise, staff do not interrupt the continuous eligibility coverage. 

A—128.3   CHIP Perinatal Application Process

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 36 and TP 45

Labor with delivery charges are covered by CHIP perinatal for households with income above the income limit for Medicaid for Pregnant Women (TP40), 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 the income limit for Medicaid for Pregnant Women [TP40]). These Medicaid-eligible individuals must submit Form H3038-P, CHIP Perinatal — 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 the income limit for Medicaid for Pregnant Women (TP40) and who receives Emergency Medicaid to cover labor with delivery charges will be enrolled in Medicaid instead of CHIP perinatal. The Central Processing Center (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.

Thirty days prior to the due date, TIERS generates Form H3038-P with Form H1061, Birth Outcome Letter, for the individual. If the birth outcome has not been reported by 30 days after the due date, a second Form H3038-P is mailed along with a self-addressed postage-paid envelope and Form H1062, Birth Outcome Reminder Letter, which includes instructions for getting Form H3038-P completed and signed by the medical practitioner. The individual must return Form H3038-P to HHSC.

Upon receipt of Form H3038-P:

  • the form is linked to the mother's case; and
  • a task is created for CPC staff to certify the mother for Emergency Medicaid and the newborn for TP 45.

If Form H3038-P is not returned within 60 days from the date of the pregnancy due date, then CPC will not certify the mother for Emergency Medicaid or the baby for TP 45. See A-831.2.1, Reopening Three Months Prior Applications, for individuals who return Form H3038-P after 60 days from the pregnancy due date.

CPC Staff Process

CPC is assigned a task to process Form H3038-P. CPC staff must:

  • perform an inquiry to determine whether mother and child are already active on Medicaid;
  • if mother and child are 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 to determine Emergency Medicaid eligibility;
  • verify all non-financial eligibility points prior to certification such as:
    • identity – see A-621, Verification Sources; and
    • residence – see A-761, Verification Sources;
  • use the date Form H3038-P is received as the file date for the Emergency Medicaid and TP 45; and
  • process Form H3038-P 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-P is received if it includes the newborn's information. Birth outcome information can also be received via an interface or from the individual by telephone or in writing. When this information is received after Form H3038-P has already been submitted to the CPC, a second task is assigned to CPC to process TP 45 for the newborn.

When CPC staff receive a task that includes Form H3038-P dated more than 60 days after the pregnancy due date, CPC will stamp "Received (Date) CPC" on Form H3038-P, which indicates the form was provided after the 60 days from the pregnancy due date. CPC staff return Form H3038-P to the individual along with an application and a letter informing the individual that she will be required to apply for Medicaid. Individuals are instructed to complete the application 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.

If an applicant … then staff must:

provides Form H3038-P only, and was active on CHIP perinatal at the time of the delivery,

fax Form H3038-P to 1-877-236-4123.

provides an application requesting Medicaid only, provides Form H3038-P, and was active on CHIP perinatal at the time of delivery,

follow policy as explained in A-121.2, Receipt of Duplicate Application, or A-121.3, Receipt of Identical Application, and fax Form H3038-P to 1-877-236-4123.

provides an application requesting Medicaid and other benefits (SNAP/Children's Medicaid/Medicaid/TANF), provides Form H3038-P, and was active on CHIP perinatal at the time of delivery,

  • certify the TP 36 coverage when determining eligibility for the other requested programs (including TP 45) following existing policy, if eligible; or
  • fax only Form H3038-P to 1-877-236-4123 if the mother is ineligible for Emergency Medicaid based on the current information.

provides an application and provides Form H3038-P stamped with “Received (Date) CPC,”

process the request for Medicaid following normal application procedures.

was not active on CHIP perinatal at the time of delivery,

process the Emergency Medicaid request according to existing policy, and provide TP 45 if appropriate.

Notes:

  • Staff fax the bar coded Form H3038-P to  1-877-236-4123. If Form H3038-P is not bar coded, staff must write the mother's CHIP perinatal case and EDG number on the top of the form.
  • If the client requests the fax number for Form H3038-P, staff should instruct the client to fax the form to 1-877-447-2839. 

A—129   Data Broker Requirements

Revision 15-4; Effective October 1, 2015

All Programs

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

Related Policy
Permissible Purpose, C-824

A—130   Interview Procedures

Revision 13-2; Effective April 1, 2013


A—131   Interviews

Revision 15-4; Effective October 1, 2015

TANF, SNAP, TP 08 and TA 31

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 Representatives (AR).
  • For SNAP, another responsible household member may also be interviewed.
  • For SNAP, a contracted Community Partner 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-474.1.1, 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. Staff must not exempt the household from any program or verification requirements due to interviewing an AR or conducting a telephone interview.

SNAP and TANF

Staff must conduct a telephone interview if the household meets any of the following criteria:

  • All adult members of the household are elderly or have a disability 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 and staff accepts 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.

Advisors 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.

TP 08 and TA 31

Applicants and clients are required to complete a telephone interview, unless the client requests a face-to-face interview. Clients cannot be required to complete a face-to-face interview.

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

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 H1205, Texas Streamlined Application, 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 Children’s Medicaid Redeterminations.
  • 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 case.

Related Policy
Scheduling Appointments, A-122.2
General Reminders, A-1510
Compliance Requirements, A-1531.5
Processing Children's Medicaid Redeterminations, B-123

TP 40 and TP 36

Interviews are not required at application for TP 40 or TP 36. Advisors should schedule an interview only if the household requests an interview.

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

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.

Staff must ensure that an interpreter or translation service is available if the applicant/recipient indicates the need for such services on an application.

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

Staff must 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, staff must mail Form H1350, Opportunity to Register to Vote, and ask the individual to sign and return the form. Staff must also indicate in TIERS, in the Voter Registration Information section of the Individual Demographics page, that the client declined, and document that H1350 was mailed to the individual.

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

TP 45 Retroactive Coverage

Retroactive TP 45 coverage must be provided 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

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must 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. Advisors should 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.

No one should be denied 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

Revision 15-4; Effective October 1, 2015

All Programs

HHSC is required to provide interpreter and translation (written or verbal) services to applicants and recipients with Limited English Proficiency (LEP). Consider an individual with LEP even if they do not request an interpreter on the application if the individual indicates they would like to speak a language other than English during the interview. 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 may indicate on an application or during an interview that they need interpreter services.

A—131.2.1   Availability of Interpreters/Translation Services

Revision 15-4; Effective October 1, 2015

All Programs

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

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 applicant/recipient interviews with bilingual advisors.
  • Bilingual clerical staff – use bilingual clerical staff as interpreters whenever possible.
  • Local community interpreter providers.

Advisors use the following methods for interpretation only after exhausting all 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 may provide their own interpreter (only if they wish to do so). Note: Advisors may use minors, age 15 or older, as interpreters only at the individual's request and when the minor accompanies the individual to the interview. Advisors must 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, advisors must 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

Revision 15-4; Effective October 1, 2015

All Programs

Staff must inform applicants/recipients about the availability of translation (written or verbal) services regarding written materials HHSC sends to them by following the two processes below, when applicable.

When staff verbally communicate with LEP applicants/recipients at application, redetermination (including desk reviews) and change actions, staff  must ensure that applicants/recipients understand the eligibility action (Form H1020, Request for Information or Action, and Form TF0001, Notice of Case Action) being taken and the requirements for the  application process (including any missing information being requested). Providing a verbal explanation to all LEP applicants/recipients in their preferred language regarding the eligibility action being taken and/or missing information being requested meets this requirement. 

Note: This requirement is not applicable for desk reviews and change actions when staff process the case action without talking with the applicants/recipients.  

The Vietnamese Translation Interpreter Form is automatically attached to applicable eligibility notices when clients select Vietnamese as their primary household language.

A—131.3   Interview Requirements

Revision 15-4; Effective October 1, 2015

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 on TIERS reflects the individual's current address; and
  • explain the various policies, rights, and responsibilities as required in A-1500, Reminders.

Advisors must take the following actions and provide the following referrals and information during the interview:

  • Verify that the household agrees that the information is complete and correct on the application form and in the case documentation for household composition, income, and expenses;
  • Verify that 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 the information is inaccurate, the advisor must determine why it is inaccurate;
  • Determine whether households with questionable or negative management, as described in A-1710, General Policy, are able to explain how the household’s bills are paid;
  • Determine whether households with other discrepancies in information that could affect eligibility are able to provide information to resolve those discrepancies;
  • Determine whether there is a reason for households who have not provided all verification requested on Form H1020, Request for Information or Action, beyond the household's control that prevents the household from providing verifications. If the advisor designates a collateral source, the advisor should accept the individual statement or use other forms of verification for the missing verifications as required by policy in A-1370, Verification Requirements;
  • Determine whether income verification may be calculated based on year-to-date information from other paychecks provided by the household when income verification is missing for a particular pay period(s), rather than requesting it on Form H1020; and
  • 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.

TANF

  • Determine whether any adult household member has received TANF cash assistance from another state since October 1999. Refer to A-1920, Determining the Number of FTL Months Used.
  • Determine whether any member of the household has been disqualified in another state for a felony or drug conviction.
  • Determine whether any member of the household has been disqualified from participating in TANF for an intentional program violation (IPV) in another state. See B-942, Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification, for policy regarding the IPV information the advisor must gather from the other state.
  • Determine whether applicants must provide information on parent(s) living outside of the home to meet child and medical support requirements, or if applicants meet a good cause exemption, as explained in A-1130, Explanation of Good Cause.

SNAP

  • Determine whether households qualifying for the standard medical expense want to claim actual expenses according to the policy in A-1428.3, Budgeting Options;
  • Determine whether 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;
  • Determine whether any household member claims an exemption to Employment and Training (E&T) work requirements;
  • Provide reminders, including the household's change reporting requirement, regarding 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 whether an ABAWD received any countable months of benefits in another state; and
  • Determine whether any member of the household has been disqualified from participating in SNAP for an IPV or a felony drug conviction in another state. Note: Data Broker displays current out-of-state IPV disqualification data.

Medical Programs

Determine whether applicants experiencing family violence are exempt from providing information about a member of their MAGI household composition because they fear physical or emotional harm by that person, as explained in A-241.4, Family Violence Exemption.

TP 08

Determine whether applicants must provide information on parent(s) living outside of the home to meet medical support requirements, or if applicants meet a good cause exemption, as explained in A-1130, Explanation of Good Cause.

A—132   Eligibility Factors

Revision 15-4; Effective October 1, 2015

All Programs

- TANF SNAP Medical Programs
Household Composition X X All Medical Programs*
Citizenship X X All Medical Programs*
Social Security number X X TPs 08, 40, 43, 44, 48, 56
Age X - TP 08, TA 31, TPs 32, 33, 34, 35, 43, 44, 45, 48, 56
Relationship X - TP 08, TA 31, TPs 32, 33, 34, 35, 43, 44, 45, 48, 56
Identity X X

All Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36*

Residence X X All Medical Programs*
Third-Party Resources X - All Medical Programs*
Domicile X - TP 08, TA 31
Deprivation X -  
Resources X X TP 56 (children) or TP 32 (children)
Income/Deductions/Budgeting X X All Medical Programs*
School attendance X - TP 08
Work registration X X  
Management X X TP 08, TA 31
Responsibility Agreement X -  

* TP 08, TA 31, TPs 32, 33, 34, 35, 36, 40, 43, 44, 45, 48 and 56.

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

A—132.1   Medical Programs Hierarchy

Revision 15-4; Effective October 1, 2015

Medical Programs

Texas Works Medical Programs Hierarchy

Step

Eligible Persons

With Income

Type Program Code

Type

Program

1

Individuals ages 18 through 25 who have aged out of foster care in Texas and were enrolled in Medicaid on their 18th birthday

Not Applicable

TP 82

MA

Former Foster Care Children (FFCC)

2

Individuals ages 18 through 20 who have aged out of foster care and:

  • are not eligible for FFCC (were not receiving federally funded Medicaid when they aged out of foster care); or
  • who aged out of foster care at age 18 or older, currently reside in Texas, and have had an Interstate Compact on the Placement of Children (ICPC) agreement

At or below program FPIL

TP 70

MA

Medicaid for Transitioning Foster Care Youth (MTFCY)

3

Pregnant Women

At or below program FPIL

TP 40

MA

Pregnant Women

4

Pregnant women who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible

At or below TP 40 FPIL

TP 36

MA

Pregnant Women - Emergency

5

Newborn children of Medicaid-eligible mothers up to age 1, including mothers receiving TP 36

Not Applicable

TP 45

MA

Newborn Children (Deemed)

6

Children under age 1

At or below program FPIL

TP 43

MA

Children Under Age One

7

Children ages 1 through 5

At or below program FPIL

TP 48

MA

Children 1–5

8

Children ages 6 through 18

At or below program FPIL

TP 44

MA

Children 6–18

9

Children ages 1 through 5 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible

At or below TP 48 FPIL

TP 33

MA

Children 1–5 - Emergency

10

Children ages 6 through 18 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible

At or below TP 44 FPIL

TP 34

MA

Children 6–18 - Emergency

11

Children under age 1 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible

At or below TP 43 FPIL

TP 35

MA

Children Under Age One - Emergency

12

A parent or caretaker relative caring for a dependent child under age 18 or who meets school attendance requirements who receives Medicaid

At or below program FPIL

TP 08

MA

Parents and Caretaker Relatives Medicaid

13

Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a parent or caretaker relative of a Medicaid-eligible child

At or below TP 08  FPIL

TA 31

MA

Parents and Caretaker Relatives - Emergency

14

Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in earnings

Above the limits for TP 08

TP 07

MA

Earnings Transitional

15

Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in spousal support income

Above the limits for TP 08

TP 20

MA

Child Support Transitional

16

Refugees who are ineligible for any other type of Medicaid or CHIP

At or below program FPIL

TP 02

MA

Refugee Medical Assistance

17

Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer and presumed eligible for Medicaid for Breast and Cervical Cancer (MBCC)

Not Applicable

TA 66

MA

MBCC Presumptive

18

Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer

Not Applicable

TA 67

MA

MBCC

19

Children under age 19 and pregnant women

Above the limits for TPs 40, 43, 44, and 48 FPIL

TP 56

MA

Medically Needy with Spend Down

20

Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a pregnant woman or child under age 19

Above the limits for TPs 40, 44, or 48 FPIL and at or below program limit 

TP 32

MA

Medically Needy with Spend Down - Emergency

21

Children under age 19 ineligible for Medicaid due to income

Above the limits for TPs 43, 48, or 44 FPIL, and at or below program limit 

TA 84

CI

CHIP

22

Unborn children whose mother is ineligible for Medicaid or CHIP due to income or immigration status

Above the limits for TPs 40 and 36, and at or below program limit 

TA 85

CI

CHIP - Perinatal

23

Former foster care youth ages 21 through 22 attending school of higher education who:

  • are not eligible for FFCC; or
  • who aged out of foster care at age 18 or older, currently reside in Texas, and have had an ICPC agreement.

At or below program FPIL

TA 77

Health Care Benefits

Health Care - FFCHE

24

Children under age 1 presumed to be eligible for Medicaid as determined by a Qualified Hospital (QH)

At or below TP 43 FPIL

TP 74

MA

Children Under Age One - Presumptive

25

Children ages 1 through 5 presumed to be eligible for Medicaid as determined by a QH

At or below TP 44 FPIL

TP 75

MA

Children 1–5 - Presumptive

26

Children ages 6 through 18 presumed to be eligible for Medicaid as determined by a QH

At or below TP 48 FPIL

TP 76

MA

Children 6–18 - Presumptive

27

Parents and caretaker relatives presumed to be eligible for TP 08 by a QH 

At or below TP 08 FPIL

TP 86

MA

Parents and Caretaker Relatives - Presumptive

28

Former Foster Care Children presumed to be eligible for Medicaid by a QH

Not Applicable

TP 83

MA

FFCC - Presumptive

29

Texas Women's Health Program

At or below program   FPIL

TA 41

MA

Women's Health Program

30

Pregnant women presumed to be eligible for TP 40 by a QH or Qualified Entity (QE)

At or below TP 40 FPIL

TP 42

 

Pregnant Women - Presumptive

Notes:

  • TIERS will test for TP 56, Medically Needy with Spend Down, for prior coverage or coverage for the application month if medical expenses are indicated in Data Collection for:
    • Pregnant women who are ineligible for Medicaid because of income or alien status.
    • Children ages 0 to 18 who are ineligible for Medical Programs because of income will be tested for CHIP.
  • Foster Care and Adoption Assistance Medicaid programs are above FFCC in the Medical Programs hierarchy.

Related Policy
Income Limits, C-131
Qualified Hospital/Qualified Entity Procedures for Presumptive Eligibility Determinations, C-1113
Guidelines for Providing Retroactive Coverage for Children and Medical Programs, C-1114
Type Programs (TP) and Type Assistance (TA), C-1150
Former Foster Care in Higher Education (FFCHE), 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

Revision 15-4; Effective October 1, 2015

See A-240, Medical Programs.

A—133   Rights and Responsibilities

Revision 15-4; Effective October 1, 2015

All Programs except TP 33, TP 34, TP 35, TP 43, TP 44, TP 45 and TP 48

Before completing the interview, advisors must ensure that the applicant:

  • provides all of the information requested on the application;
  • reports any changes that occurred since filling the application; and
  • reads and understands the individual's rights and responsibilities as explained on the application.

TANF and TP 08

Advisors must also ensure that:

  • 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

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

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

Before completing the interview, if requested, ensure the applicant:

  • completes all sections of the application; and
  • reads and understands an individual's and responsibilities as explained on Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and Form H1205, Texas Streamlined Application.

A—134   Documentation Guidelines

Revision 13-2; Effective April 1, 2013

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

Revision 15-4; Effective October 1, 2015

All Programs except TP 40

If the applicant cannot furnish all required proof during the interview or with the application, advisors must allow the household at least 10 days to provide the information. The due date must be a workday. Advisors must determine what sources of proof are readily available to the household and request that information first as sufficient proof. B-115, Pending Verification on Applications, includes more information on verification procedures.

Advisors must provide 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 the advisor does not receive the information.

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

Medical Programs

The advisor must not request additional verification if verification is available through electronic data sources.

TP 40

Advisors should not allow 10 days for the applicant to provide verification if doing so exceeds the 15-workday processing time frame and verification can be postponed.

A—136   Eligibility Decision

Revision 15-4; Effective October 1, 2015

All Programs

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

Advisors must provide the individual with the HIPAA — Notice of Privacy Practices or HIPAA — Notice of Privacy Practices (Spanish) at initial certification and after breaks in certification of one or more months.

A—137   Prudent Person Principle

Revision 15-4; Effective October 1, 2015

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 encourages 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.

Staff should document the rationale used to make a decision and any applicable handbook references.

A—140   Expedited Service

Revision 15-4; Effective October 1, 2015

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 Austin by fax or mail, and an automated system screens applications submitted online.

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

  • postpone all verification until after receiving the first month's benefit, except:
    • identity, and
    • 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
  • get benefits the same day they apply, if possible, but no later than the next workday.

    Exception: In the following situations, applicants may not get benefits in this time frame.
    • Applicants in drug and alcohol treatment/group living arrangement facilities. Staff must give benefits so the individual has an opportunity to participate by the seventh day after the application date.
    • Joint SNAP/SSI applicants released from public institutions. The CBS unit gives benefits so the individual can participate by the fifth day after release from the institution.
    • Late determinations for expedited service. These are households that:
      • the agency did not identify 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 if the agency failed to properly screen the application using the expedited screening questions on Form H1010, Texas Works Application for Assistance — Your Texas Benefits.
      • meet expedited criteria and have an individual who served the minimum employment and training penalty, but have chosen to delay their certification until all disqualified individuals have signed Form H1808, SNAP Work Rules.
      • 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 returns the signed application.
      • mail or drop off Form H1010 or Form H1010-R, Your Texas Works Benefits: Renewal Form. Staff must contact the applicant and schedule an appointment the earliest day the applicant is available. If HHSC cannot contact the applicant by phone, staff must 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 instructing the applicant to contact the office. If the household also applies for TANF or Medicaid, staff should 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, staff must 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 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 met.
      • 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, 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 automated 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 HHSC receives the application; 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. Staff must deny the application if the applicant does not provide verification and 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 the Months Prior to the Month of Application, A-830

A—141   Expedited Eligibility Criteria

Revision 15-4; Effective October 1, 2015

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, staff must 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. Staff should 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

Revision 15-4; Effective October 1, 2015

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.

Exceptions:

  • If an expedited application with postponed verification is denied for failure to provide requested information/verification, the household may re-apply without submitting a new application until the 60th day after the file date, as explained in B-111, Reuse of an Application Form After Denial. If the household submits another application, staff must consider the second application a duplicate application. Staff must not allow SNAP expedited services.
  • If a redetermination is denied for failure to provide requested information or for a missed appointment, the household may re-apply without submitting a new application until the 30th day following the last benefit month (see B-122.3, Delays Caused by Households). If the household submits another application, staff considers the application a duplicate application. Staff must not allow SNAP expedited services.

A—143   How to Determine Eligibility for Expedited Service

Revision 14-1; Effective January 1, 2014

SNAP

- - Yes No
1.
Does the applicant's Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and statement indicate eligibility for expedited service based on eligibility criteria in A-141, Expedited Eligibility Criteria?
Go to step 2.
Stop, use normal 30-day processing procedures.
2.
Did the applicant already receive SNAP this month?
Stop, use normal 30-day processing procedures.
Go to step 3.
3.

Did the applicant receive expedited service before?

Go to step 4.
Go to step 5.
4.
Did the applicant provide all postponed verifications from previous certification, or did HHSC certify the applicant under normal 30-day processing since the last expedited certification?
Go to step 5.
Stop, use normal 30-day processing procedures.
5.
Was the SNAP EDG denied at redetermination for a missed appointment or for failure to provide requested information, and is it still within 30 days of the last benefit month?
Stop, this application is a duplicate application. Follow reuse of application policy.
Go to step 6
6.
Does the applicant or AR being interviewed have proof of identity?
Go to step 7.
Not eligible for expedited service until he provides proof.
7.
If an applicant age 18 to 50 has already received the maximum number of benefit months without meeting the work requirement, did the applicant verify that the applicant is exempt from or meets the 20-hour-per-week work requirement (even if the AR applies)?
Go to step 8.
Not eligible for expedited service until he provides proof.
8.

Issue benefits today. Postpone all other verification that is:

  • not provided at the interview, or
  • not acceptable.

TP 40

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

Related Policy
Receipt of Duplicate Application, A-121.2
Reuse of an Application Form After Denial, B-111
Delays Caused by Households, B-122.3
Denied for Missed Appointments, B-122.3.1
Denied for Failure to Provide Information/Verification, B-122.3.2

A—144   Expedited Verifications

Revision 15-4; Effective October 1, 2015

SNAP and TP 40

See A-140, Expedited Service.

A—144.1   Social Security Numbers (SSNs)

Revision 15-4; Effective October 1, 2015

SNAP

Staff must 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.

Staff must disqualify individuals 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 age six months or younger and good cause.

A—144.2   Work Registration

Revision 15-4; Effective October 1, 2015

SNAP

Advisors should register the applicant being interviewed for work unless:

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

Advisors should register other household members if possible. Advisors should postpone registration for the initial month if it cannot be completed within the expedited time frames.

A—144.3   Citizenship

Revision 15-4; Effective October 1, 2015

SNAP

Household members whose citizenship/eligible alien status is questionable can receive expedited benefits with the household. These household members 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 95th day from the file date, if necessary, to meet expedited time frames.

Related Policy
Reasonable Opportunity, A-351.1

A—144.4   Reserved

Revision 12-1; Effective January 1, 2012


A—144.5   Pregnancy

Revision 15-4; Effective October 1, 2015

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
  • Anticipated date of delivery

Staff must use the following procedures when certain information regarding pregnancy is not provided 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.
  • If both the pregnancy start and end months are missing, attempt to obtain the information by phone.  If unable to obtain the information by phone, send Form H1020, Request for Information or Action, to request the information.

A—145   Expedited Certification Procedures

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must assign usual certification periods even if staff postpones verifications. See A-2324, Length of Certification, for certification period policy.

Advisors must 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 benefits are prorated.

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.

Advisors must 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.

Advisors must reopen applications denied because there was not enough information provided if the information is received within 60 days of the file date.

Advisors must 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

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must 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 furnishes the postponed verification and the ... then ...
second month is on hold, enter the information and dispose the SNAP EDG within five days or by the first workday of the second month, whichever is later.
third month is on hold (for combined allotment situations), enter the information and dispose the SNAP EDG.

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, advisors must:

  • disqualify the individual when appropriate, or
  • deny the SNAP EDG for failing to provide postponed 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, advisors must 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

Advisors must 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, the advisor must 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, the advisor must provide advance notice of adverse action and deny ongoing coverage.

Note: Advisors must 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

Revision 15-4; Effective October 1, 2015

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, the advisor postpones verification until after the household receives the second month's benefit. Advisors should 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:
    • The household's only income for the application month is from a terminated source, and the household will not receive any more payments from that source after the application date.

      Advisors should consider terminated income 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.

      Advisors should not consider terminated income 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, advisors do not consider terminated income if a payment from the same source will be received after the file date in the month of application.
    • All household income in the application month is from a new source, and the household 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.

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

    • The household has 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
      • the household 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, advisors 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:

      • Advisors count an advance of wages for travel expenses as income unless it is a reimbursement.
      • Advisors do not consider the advance in determining whether the household is destitute or in determining whether 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

Revision 15-4; Effective October 1, 2015

Medical Programs – All Except Emergency Medicaid and TP 56

All applications for Medicaid from active duty military members 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, staff should 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 the household did not provide information with the application; and
  • Send/provide Form TF0001, Notice of Case Action, if the household provided all verification with the application and no interview was requested or required.

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

Advisors should 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, advisors use TP 40 expedited application processing time frames.

Advisors 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.

Advisors must not pend an application if the household:

  • fails to answer the Yes/No question and name/designation. Advisors must not process the application using expedited time frames. If the Yes/No question is left blank, advisors 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. Advisors should assume that 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. Advisors must 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, staff should 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, staff should document the reason for not scheduling the appointment within the required time frame.

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

A—150   Combined Allotment Policy

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must 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
  • advisors must prorate the initial month's benefits.

Note: For applicants who meet expedited criteria, advisors 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

Revision 13-2; Effective April 1, 2013

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

Revision 15-4; Effective October 1, 2015

TANF and SNAP

When TANF eligibility is uncertain, advisors must:

  • certify the household for Non-Public Assistance (NPA) SNAP benefits if eligible. Note: If the TANF members have resources, advisors do not exclude the resources for SNAP until the household’s TANF EDG is certified (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, advisors should process it as a reported change and add the TANF benefit to the SNAP budget as soon as possible. (See A-1324.18, Temporary Assistance for Needy Families [TANF].) Advisors should adjust the certification period to expire when the next TANF periodic review is due. Advisors should send or give the applicant Form TF0001, Notice of Case Action, 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, the advisor should continue SNAP eligibility based on the original application.

A—170   Authorized Representatives (AR)

Revision 15-4; Effective October 1, 2015

All Programs

An applicant, head of household, or someone with legal authority to act for the individual (i.e., legal guardian or power of attorney) may designate an individual or organization as an AR.

An AR must be verified using one of the following:

  • Client’s signature on one of the following HHSC applications for benefits containing the AR designation:
    • Form H1010, Texas Works Application for Assistance — Your Texas Benefits
    • Form H1010-R, Your Texas Works Benefits: Renewal Form
    • Form H1014-R, Renewing Children’s Health-care Benefits
    • Form H1034, Medicaid for Breast and Cervical Cancer
    • Form H1200, Application for Assistance — Your Texas Benefits
    • Form H1200-MBI, Application for Benefits — Medicaid Buy-In
    • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children
    • Form H1205, Texas Streamlined Application
    • Form H1206, Health Care Benefits Renewal
    • Form H1840, SNAP Food Benefits Renewal Form
    • Form H1841, SNAP-CAP Application
    • Form H1842, SNAP-CAP Renewal Application
    • Form H2340, Medicaid for Breast and Cervical Cancer Renewal
    • Form H2340-OS, Medicaid for Breast and Cervical Cancer
  • Client’s signature on a Marketplace application for health care benefits that is transferred to HHSC.
  • Legal documentation that the AR has authority to act on behalf of the client under state law (i.e., legal guardianship or power of attorney).
  • Letter from a client designating AR authority and containing the client’s signature, in addition to the name, address, and signature of the AR.
  • Completed Form H1003, Appointment of an Authorized Representative. 
  • Client’s electronic signature designating the AR through their case account on an application, renewal, or reported change submitted through YourTexasBenefits.com.

If a person or organization has submitted an application on behalf of a client and indicates that they wish to be the client’s AR, and the client has not signed the application, then the AR must be verified before the client’s eligibility for benefits can be determined. Correspondence will be sent to both the unverified AR and the head of household on the case to request the verification.

  • The head of household for the case will be sent:
    • Form H1020, Request for Information or Action, listing what missing information is needed before eligibility can be determined.
    • Form H1003, to capture the client’s and AR’s signatures designating the AR.
  • The AR will be sent:
    • Form H1004, Cover Letter: Authorized Representative Not Verified, to describe what is needed to verify the AR.
    • Form H1003, to capture the client’s and AR’s signatures designating the AR.

In order for the AR to be verified, either the AR or the head of household will need to return the completed Form H1003 within 10 days (or 30 days from the file date) in order for the application to be considered valid. If other missing information was listed on the Form H1020 that was sent to the client, that information must also be returned timely. If the AR verification is not received by the due date, then the application is denied.

Note: During the interview, the advisor must obtain the AR’s complete mailing address, if the AR’s address is not included on the application form. The advisor must record the AR’s address on the corresponding TIERS Data Collection page, Household - Authorized Representative. If the individual cannot provide a complete mailing address for the AR or no interview is required for the program type, the advisor should not pend the case. The advisor must record the household’s mailing address as the AR’s address in TIERS. 

The AR designation is effective from the date the AR is verified until:

  • the client notifies HHSC that the AR is no longer authorized to act on his or her behalf;
  • the AR notifies HHSC that they no longer wish to act as the client’s AR;  

    Note: The AR will not be able to do this during the redetermination process if the AR is completing the redetermination.
  • there is a change in the legal authority (i.e., legal guardianship or power of attorney) on which the AR’s designation is based; or
  • the client designates a new AR to act on their behalf. If there is an existing AR designated on a case, the person or organization that the client most recently designated as the AR will replace the existing AR on the case.

Notices ending the designation of the AR must include the client’s or AR’s signature as appropriate. 

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

An AR is designated at the case level to have access to all benefit information for that case. A verified AR may:

  • sign an application on an applicant’s behalf;
  • complete and submit a renewal form;
  • receive copies of an applicant’s/client’s notices in the preferred language selected on the application, and other communications from HHSC;
  • designate a health plan; and
  • act on an applicant’s/client’s behalf in all other matters with HHSC.

The client or AR may also request that the AR receive the client’s Medicaid or CHIP ID card and enrollment-related agency correspondence.

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

SNAP

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.

A—171  Protective Payee

Revision 15-4; Effective October 1, 2015

TANF

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 that the incompetent or incapacitated individual is not using TANF for the child's benefit. In these situations, the individual's signature and designation of the grandparent as AR in writing is not required on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. If the grandparent is designated AR, the grandparent is also designated protective payee.

Related Policy
Receipt of Application, A-121
Receipt of Application from Residential Child Care Facility , A-121.1
Verification Requirements, A-180
Documentation Requirements, A-190
Children Residing in General Residential Operations Facilities, A-923

A—172  AR Applying for Household

Revision 15-4; Effective October 1, 2015

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.

The AR must be an adult.

A—173  AR for Residents of Drug and Alcohol Treatment/Group Living Arrangement (GLA) Facilities

Revision 15-4; Effective October 1, 2015

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—174  Abuse by AR

Revision 15-4; Effective October 1, 2015

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

Revision 15-4; Effective October 1, 2015

All Programs

When an eligibility determination has been requested for multiple programs and the programs allow the same verification sources, the advisor must use the same verifications for all applicable programs. For example, if an individual is applying for SNAP, TANF, and Medical Programs, and the advisor accepts a wage verification for SNAP, the advisor must not request additional verification of the wage for TANF or Medical Programs if the source used was an acceptable form of verification for TANF or Medical Programs.

Advisors make the eligibility decision in each program when all verifications are received for that program.

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

TANF

Staff must 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, staff must verify that the caretaker intends to use TANF benefits for the child's needs.

SNAP

Staff must verify the nonprofit status of homeless shelters, if questionable. See IRS documentation that proves the nonprofit status under Section 501(c)(3) of IRS regulations.

A—181   Verification Sources

Revision 15-4; Effective October 1, 2015

TANF

Advisors 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, and
  • a person without vested interest in outcome of decision.

A—190   Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must 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.

Advisors must document why a certain file date was used to determine eligibility when:

  • the file date used differs from the received date on the application; or
  • the application has two received dates.

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

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

Advisors must document that Form H0025, HHSC Application for Voter Registration, was given to the applicant, AR, or representative payee under the Agency Use Only section of the application.

Advisors must document on the application 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.

Advisors must 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 TP 33, TP 34, TP 35, TP 43, TP 44, TP 45 and TP 48

For all interviews, staff must document:

  • whether the individual met telephone interview criteria and a telephone interview was not done for TANF and SNAP;
  • how interpreter services were provided when the application indicates the individual requested these services, including when the advisor conducted the interview and acted as an interpreter.

Medical Programs

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

TANF

Advisors must document the specific reason for designating an AR.

When the grandparent requests to be the AR, the following information must be documented:

  • 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 as the AR and protective payee.

SNAP

The following information must be documented:

  • 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