Revision 20-2; Effective April 1, 2020

The Former Foster Care in Higher Education (FFCHE) program provides medical coverage to certain former foster care youth enrolled in an institution of higher education located in Texas. FFCHE is funded entirely by the state and is not considered Medicaid. It is identified as a Health Care Benefits program instead of Medicaid or medical assistance.

People living in Texas who age out of foster care under an Interstate Compact on the Placement of Children (ICPC) agreement may be eligible for FFCHE or Medicaid for Transitioning Foster Care Youth (MTFCY), explained in Part M, Medicaid for Transitioning Foster Care Youth (MTFCY). Automatically recertify current FFCHE recipients who are up for eligibility redetermination.

A person who ages out of foster care under an ICPC agreement may apply for FFCHE by completing Form H1205, Texas Streamlined Application, or Form H1205-S and submitting the form:

• online through YourTexasBenefits.com(link is external);
• by mail to the HHSC Document Processing Center (DPC) at:
  
  HHSC
  P.O. Box 149024
  Austin, TX 78714-9024;

or

• by toll-free fax to 877-447-2839.

Applicants may request to apply for FFCHE as explained in A-113, Application Requests and Submissions.

When a request for Form H1205 is received, Centralized Benefit Services (CBS) staff determine if the applicant needs the English or Spanish version of the form.

Note: CBS staff accept any of the applications explained in A-113, Application Requests and Submissions, and request any additional information needed to make an eligibility determination.

If a local eligibility determination office receives an application, staff must date stamp and fax the application to the DPC non-expedited fax line (877-447-2839) no later than the next business day.

Note: Policy found in A-121, Receipt of Application, outlines what constitutes a valid application and what process to follow when the agency receives an incomplete application.

Related Policy

Receipt of Application, A-121
Registering to Vote, A-1521

 

F—111 Type of Assistance (TA) 77 – Health Care – FFCHE

Revision 19-4; Effective October 1, 2019

To be eligible for FFCHE benefits, a person must:

• have had an ICPC agreement*;
• currently reside in Texas;
• be ages 21 up to 23;
• have been in any state's conservatorship on their 18th birthday;
• be enrolled in an institution of higher education located in Texas;
• not have adequate health coverage as defined by HHSC; and
• meet all other medical programs eligibility criteria such as citizenship or alien eligibility.

*Staff must contact the Texas Department of Family and Protective Services (DFPS) to determine whether the person had an ICPC agreement. DFPS has three business days to respond.

Specialized staff process all FFCHE case actions.

 

F—112 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

 

F—113 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

 

F—114 Authorized Representatives (AR)

Revision 15-4; Effective October 1, 2015

An individual may designate an individual or organization as an AR, following the policy explained in A-170, Authorized Representatives (AR).

F—121 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

 

F—122 File Date

Revision 15-4; Effective October 1, 2015

The file date is the day any local eligibility determination office, call center vendor, or other HHSC-contracted entity accepts an application containing the applicant's name, address and an appropriate signature. The file date is considered day zero in the application process.

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 (stamp dates).

Note: For applications received outside of normal business hours, the file date is the next business day.

F—131 General Policy

Revision 15-4; Effective October 1, 2015

An interview is not required when applying for or renewing an application for the FFCHE program. Advisors must schedule a phone interview only if the individual requests an interview. The State Portal Scheduler does not support scheduling an interview for the FFCHE program. Any requests for an interview must be scheduled manually.

Note: An application must not be denied if the applicant misses the interview, and the advisor should continue to determine eligibility.

Revision 15-4; Effective October 1, 2015

The Modified Adjusted Gross Income (MAGI) household composition and certified Eligibility Determination Group (EDG) for Former Foster Care in Higher Education (FFCHE) consists of the applicant only. The applicant is the only certified member on the FFCHE EDG.

Example: An individual, age 22, is married and lives with her husband and their child. The individual applies for and is eligible for the FFCHE program. The MAGI household composition and certified EDG consists of only the individual. Her husband and child are not included.

Revision 15-4; Effective October 1, 2015

There are no verification requirements for household composition. Accept the individual’s statement as verification.

Revision 15-4; Effective October 1, 2015

The Former Foster Care in Higher Education (FFCHE) program follows the Medical Programs policy for citizenship and alien status eligibility in A-300, Citizenship.

Exception: Applicants do not receive the period of reasonable opportunity explained in A-351.1, Reasonable Opportunity.

Applicants who are U.S. citizens and certain legally admitted alien residents are eligible for FFCHE if they meet all other eligibility criteria.

Reminder: The State Online Query (SOLQ) and the Wire Third-Party Query (WTPY) inquiry systems cannot be used to verify citizenship for this program. See F-2140, Pending Information on Applications.

Revision 20-2; Effective April 1, 2020

All applicants must provide a Social Security number (SSN) or apply for one through the Social Security Administration before certification. The Former Foster Care in Higher Education (FFCHE) program follows the SSN policy in A-400, Social Security Number, under the All Programs or Medical Programs headings.

Revision 15-4; Effective October 1, 2015

Applicants are eligible to receive Former Foster Care in Higher Education (FFCHE) program benefits beginning the month after their 21st birthday through the end of the month of their 23rd birthday. Applicants who wish to have coverage during the month of their 21st birthday must apply for benefits under an appropriate Medicaid program.

Note: These individuals may be eligible for Medicaid for Transitioning Foster Care Youth (MTFCY) during the month of their 21st birthday. See Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

Revision 10-2; Effective April 1, 2010

Accept self-declaration as verification of age.

Revision 10-2; Effective April 1, 2010

Document the individual's self-declaration establishing the age.

Revision 10-2; Effective April 1, 2010

To establish identity, follow the Medical Programs policy in A-600, Identity.

Revision 15-4; Effective October 1, 2015

To determine residence eligibility, follow TP 33, TP 34, TP 35, TP 43, TP 44, TP 45 and TP 48 policy in A-700, Residence.

Revision 17-2; Effective April 1, 2017

An applicant/recipient is not eligible to receive Former Foster Care in Higher Education (FFCHE) benefits if the individual currently has adequate health coverage. Adequate health coverage is also known as a third-party resource (TPR). Adequate health coverage is defined as receiving coverage under:

• group health insurance;
• health insurance coverage;
• Medicare (Part A or Part B);
• Medicaid (with the exception of the Healthy Texas Women, Medicaid with Spend Down, and Community Attendant);
• armed forces insurance; or
• a state health risk pool.

Deny an application for an individual who has adequate health coverage.

Do not consider a plan with a limited scope of coverage such as dental, vision, long-term care, etc., or for only a specific illness/disease, such as drug/substance abuse, as adequate health coverage.

Consider an applicant/recipient as having adequate health coverage even if it has limits on benefits or high deductibles.

If staff receive a task with information that the individual has TPR and the “NHIC” box is greyed out, advisors deny rather than pend the EDG. This information has already been verified by the Office of Inspector General – Third Party Liability area. 

When an FFCHE applicant is denied due to adequate health care coverage, Form TF0001, Notice of Case Action, will read:

“We found that you already have private health insurance. To learn more about the insurance you already get, call toll-free 1-800-846-7307 (after you pick a language, press 2).”

In some instances, the parents of FFCHE recipients have TPR coverage for them without the individual knowing. If the individual states they are not aware of the TPR, staff should advise them to call the claims administrator’s Third Party Liability Customer Service Line at 1-800-846-7307 and select option 2. This will allow the individual to obtain information regarding their TPR.

If the TPR information in the Texas Integrated Eligibility Redesign System (TIERS) has been verified by the claims administrator but needs to be updated, staff should fax the completed Form H1039, Medical Insurance Input, to the claims administrator at 512-514-4215.

Revision 10-2; Effective April 1, 2010

Accept self-declaration of adequate health coverage.

Exception: If an applicant is denied due to receiving adequate health coverage and the applicant calls to notify HHSC that the medical insurance is not adequate health coverage, staff would need to verify if the coverage is considered adequate health coverage.

Revision 10-2; Effective April 1, 2010

Staff must document in case comments the existence of adequate health coverage.

Revision 15-4; Effective October 1, 2015

The applicant is eligible for 12 months beginning the first day of the application month if all eligibility criteria are met. The applicants are eligible to receive benefits beginning the month after their 21st birthday through the end of the month of their 23rd birthday.

The medical effective date cannot precede the:

• effective date of the program (October 1, 2009), or
• the month after the individual's 21st birthday.

If an applicant applies in the month of the applicant’s 21st birthday, the individual cannot be eligible for the Former Foster Care in Higher Education (FFCHE) program until the following month.

Applicants who wish to have coverage during the month of their 21st birthday must apply for benefits under an appropriate Medicaid program.

Note: These individuals may be eligible for Medicaid for Transitioning Foster Care Youth (MTFCY) during the month of their 21st birthday. See Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

Examples:

• An individual turns age 21 on May 5. She filed an FFCHE application on May 1. The individual is ineligible to receive FFCHE during May, the month of application, since she turns 21 during May. Her eligibility begin date will be June 1. If the applicant wishes to receive benefits for the application month, she must file an application for an appropriate Medicaid program.
• The individual turns age 23 on May 5. She is no longer eligible to receive FFCHE benefits effective June 1.

Three months prior coverage is not available in the FFCHE program. An applicant may apply for three months prior coverage under a Medicaid program and receive assistance if eligible.

In the event an FFCHE recipient becomes pregnant and does not apply for or is not eligible for Medicaid, the newborn is not eligible for TP 45 – Medicaid for Newborn Children. If the mother wants coverage for the baby, she must apply for Medicaid; if eligible, the child will be certified for TP 43 – Medical Assistance for Children Under Age 1.

 

F—1011 Types of Coverage

Revision 15-4; Effective October 1, 2015

FFCHE recipients will have two types of coverage. The type of coverage determines how recipients access their health care services.

Fee-for-Service – Initial coverage for FFCHE recipients. Although FFCHE individuals are not Medicaid recipients, they will have access to any Medicaid provider and will be allowed to self-refer to specialists. The provider submits claims directly to the claims administrator for reimbursement of the FFCHE-covered services (the coverage mirrors services available to Medicaid recipients). The Texas Health and Human Services Commission (HHSC) will use state funds to pay these claims.

Managed Care – A service delivery program that provides medical care in a managed care setting. The state pays a monthly premium to the health maintenance organization (HMO) for each recipient enrolled in the plan. The plan processes all provider claims.

Enrollment into managed care is mandatory for FFCHE recipients; however, when a recipient is determined eligible for the FFCHE program, fee-for-service coverage is provided until the recipient is enrolled into managed care. Managed care coverage is determined using prospective enrollment following current cutoff rules. Managed care health benefits are provided through the STAR Program.

Example: An application is received on January 1 and processed on January 25 (after cutoff); the managed care effective date is March 1. The initial months (January and February) will be covered as fee-for-service.

Revision 15-4; Effective October 1, 2015

An applicant or recipient must be enrolled in an institution of higher education located in Texas to receive Former Foster Care in Higher Education (FFCHE) health care benefits. The applicant/recipient may be attending school half-time or full-time. There is no requirement regarding the number of hours the student must be taking. The following are considered institutions of higher education:

• college (public or private),
• community college,
• junior college,
• technical institute, and
• university.

Note: Trade schools such as beauty schools or mechanic schools do not meet the definition of an institution of higher education.

Revision 15-4; Effective October 1, 2015

School enrollment must be verified at application and renewal. The following are valid sources of verification for school enrollment:

• financial aid statement;
• enrollment certification;
• official fee receipt; and
• Form H1870, School Enrollment Verification Form.

Note: Online courses are only acceptable if the university/college has a branch located in Texas.

Revision 10-2; Effective April 1, 2010

Document the type of institution the applicant/recipient is attending and the source of school enrollment verification.

Revision 15-4; Effective October 1, 2015

Before certifying applicants and recertifying recipients, complete the following:

• Ensure the applicant completes each question and signs and dates the application.
• Give the applicant Form H1019-F, Reporting Changes to Your Case. Explain that changes must be reported within 10 days after knowing about the change. Indicate the appropriate reporting requirement on Page 1.
• Refer the applicant to other programs for which the individual might be eligible such as the Supplemental Nutrition Assistance Program (SNAP); Temporary Assistance for Needy Families (TANF); Medicaid; Supplemental Security Income (SSI); or Retirement, Survivors and Disability Insurance (RSDI). Refer individuals with a disability who are ineligible for Medical Programs for families and children to the Texas Health and Human Services Commission (HHSC) Medicaid for the Elderly and People with Disabilities (MEPD) programs.
• Inform applicants of the right to request a review of their case for any HHSC action that affects their eligibility.
• Inform the applicant that the information provided is subject to verification by third parties.

There is no requirement to inform individuals to report accidents.

Revision 15-4; Effective October 1, 2015

Document that Form H0025, HHSC Application for Voter Registration, was given to the applicant, authorized representative or representative payee in the Agency Use Only section of the application.

Related Policy

Registering to Vote, A-1521

Revision 15-4; Effective October 1, 2015

Advisors must make an eligibility determination by the 45th day from the file date.

Reopen an application denied for failing to furnish information/verification if the missing information is provided by the 60th day from the file date. Use the date the missing information/verification was provided as the new file date.

Use the original application or renewal form until it is 60 days old. If the information on the form has changed or is more than 45 days old, the individual and advisor must update the form.

Revision 10-2; Effective April 1, 2010

Provide Form TF0001-F, Notice of Case Action, the same day eligibility is determined for an application but no later than 45 days from the file date.

Revision 10-2; Effective April 1, 2010

No interview is required to process an application or renewal unless requested by the applicant or recipient. If requested, provide the individual with a telephone interview. If the individual fails to keep the interview, do not deny the application or renewal but continue to process the request for assistance.

Revision 10-2; Effective April 1, 2010

Advisors must request documents that are readily available to the household and consider it sufficient verification. Use the verification sources listed in the various eligibility elements of Part A, Determining Eligibility, as potential and acceptable sources of verification. C-900, Verification and Documentation, gives information on verification procedures.

In determining eligibility, staff must consider any information the individual reports between the application date and the decision date. Include any information the individual reports during the application decision process.

Revision 15-4; Effective October 1, 2015

The Texas Integrated Eligibility Redesign System (TIERS) sends a renewal packet containing Form H1869, Renewal for Health Care Services; Form H1870, School Enrollment Verification Form; and a business reply envelope in the 11th month of the 12-month certification period.

F—2161 How to Process a Renewal

Revision 15-4; Effective October 1, 2015

Former Foster Care in Higher Education (FFCHE) recipients receive a passive renewal. Individuals are only required to return a renewal packet if information they provided during the application process has changed. If the individual does not return a renewal packet by the first calendar day of the last month of the certification period, TIERS automatically re-certifies the FFCHE Eligibility Determination Group (EDG) for another 12-month period, or through the month of the individual’s 23rd birthday, whichever is earlier. This will not require the Centralized Benefit Services (CBS) advisor to run eligibility or dispose the case.

Exception: School enrollment must be verified at application or renewal for FFCHE. If an FFCHE individual does not return the renewal packet, TIERS will process the passive renewal and will pend the EDG for school enrollment verification. If verification is not provided, the advisor will be required to run eligibility and dispose the case to sustain or deny benefits.

There is no interview requirement for an FFCHE renewal. The file date is the day any local Texas Health and Human Services Commission (HHSC) eligibility determination office receives the FFCHE application.

Verification from an associated EDG can be used if provided within 90 days of the FFCHE file date.

Follow the policy below when Form H1869/Form H1869-S, Renewal for Health Care Benefits, is returned for a renewal.

If the individual provides Form H1869/Form H1869-S indicating no change and has an associated EDG, review the associated EDG to determine if there is any conflicting data and if there is any documentation to clear the conflicting information. If not, request new verification via Form H1020, Request for Information or Action.

If the individual returns Form H1869/Form H1869-S reporting changes, provides verification and there are no associated EDGs, process the renewal using the new verification.

If the individual returns Form H1869/Form H1869-S reporting changes, provides verification and there are associated EDGs, review the associated EDGs and use the most recent information provided.

If the associated EDGs have other information the family did not report for the FFCHE EDG that would impact FFCHE eligibility, contact the individual (by telephone or Form H1020 with due date) to determine if the information in the associated EDGs is correct before denying or taking adverse action on the EDG.

If the individual returns Form H1869/Form H1869-S reporting changes without verification and has associated EDGs, request new verification via Form H1020.

If the individual returns Form H1869/Form H1869-S indicating changes, does not provide verification and does not have associated EDGs, request information needed to determine eligibility. If the individual does not provide the information, do not renew eligibility.

Revision 10-2; Effective April 1, 2010

If the individual returns a renewal packet, advisors must make an eligibility determination by the 30th day from the file date.

Note: A renewal application is considered a renewal if it is received by the last day of the 12-month certification period.

Reopen a renewal application denied for failing to furnish information or verification if the missing information/verification is provided by the 60th day from the file date. Use the date the missing information/verification was provided as the new file date.

Use the original Form H1869/Form H1869-S, Renewal for Health Care Benefits, until it is 60 days old. If the information on Form H1869/Form H1869-S has changed or is more than 45 days old, the individual and advisor must update the form.

Reminder: Consider a renewal application received after the last day of the 12-month certification period as an application using application processing time frames.

Revision 15-4; Effective October 1, 2015

Allow the household at least 10 days to provide missing information/verification. The due date must be a workday. Advisors must request documents that are readily available to the household if the documents are anticipated to be sufficient verification. If the applicant has any active or inactive EDGs, check to see if any verification previously provided for another EDG can be used to determine eligibility for FFCHE.

Use verifications accepted for Temporary Assistance for Needy Families (TANF), Medical Programs or the Supplemental Nutrition Assistance Program (SNAP).

For example, if you accept wage verification for a SNAP case, that same verification is acceptable for TANF, Medical Programs or FFCHE.

Exception: Verification of U.S. citizenship for applicants must be from a Medicaid-acceptable source. Staff cannot access the State Online Query/Wire Third-Party Query (SOLQ/WTPY) inquiry to verify citizenship or Retirement, Survivors and Disability Insurance (RSDI) for FFCHE processing. Advisors must request other types of verification, such as copies of birth certificates for citizenship and award letters for RSDI benefits.

Note: Do not use verification that is over 90 days old from the FFCHE file date.

 

F—2181 Summary of Due Dates for Form H1020, Request for Information or Action

Revision 15-4; Effective October 1, 2015

Case Action	Due Date	Final Due Date
Application	10 days	30th day, or 10th day if the household's Form H1020 due date extends beyond the 30th day
Renewal	10 days	30th day, or by the 10th day if the household's Form H1020 due date extends beyond the last day of the last benefit month
Incomplete review	10 days	10th day

Note: Staff have until the 45th day from the file date to determine eligibility for applications.

Revision 15-4; Effective October 1, 2015

Centralized Benefit Services (CBS) staff process all changes for Former Foster Care in Higher Education (FFCHE) recipients. FFCHE recipients can report changes:

• online through YourTexasBenefits.com;
• by visiting a local eligibility determination office (which will forward the change to CBS);
• by calling 2-1-1; or
• in writing, by mail or fax, or by completing Form H1019-F, Reporting Changes to Your Case. The individual may mail or fax the change to:
  • Document Processing Center:
    HHSC
    P.O. Box 149024
    Austin, TX 78714-9024
    Toll-free fax: 1-877-447-2839
  • A local eligibility determination office (which must send the change to CBS).

Note: When an FFCHE recipient reports a change by telephone, staff must verify that the person speaking is the individual or the authorized representative.

An FFCHE recipient must report the following changes:

• Address changes
• Receipt of health insurance
• Pregnancy
• If the individual moves out of state
• School enrollment status – no longer attending school

Exception: Individuals receiving FFCHE as of December 2013 and not eligible for Former Foster Care Children (FFCC) must also report income changes.

Revision 10-2; Effective April 1, 2010

Follow policy listed in B-600, Changes, for Medical Programs to determine how to process changes for FFCHE recipients.

Revision 20-4; Effective October 1, 2020

FFCHE recipients receiving notice of adverse action are not entitled to continued benefits when benefits are denied for any reason and granting continued benefits would extend the 12-month eligibility period or extend the benefits past the person’s 23rd birthday.

FFCHE recipients do not have the right to request a fair hearing. FFCHE recipients can request a review of the case action. A request for review is any expression of dissatisfaction with an adverse action. Inform FFCHE recipients that requests for review must be submitted in writing.

FFCHE recipients have 30 business days from the date of the notification letter to submit a request for review concerning the decision that resulted in an adverse action. They must submit the request for review in writing to:

• Texas Health and Human Services Commission
  Attention: Complaint Department
  P. O. Box 149027
  Austin, TX 78714-9027; or
• by toll-free fax to 877-542-5951.

Upon receipt of the request for review, CBS staff review the adverse action and respond in writing within 10 business days from the date of receipt of the request. The response letter (Form TF0001F, Notice of Case Action) has information about the agency’s answer to the request for review. Document the final decision in TIERS Case Comments.

When a request for review is received after 30 business days or the request for review is not for an adverse action, deny the request and generate Form TF0001F, to inform the household of the denial reason.

Revision 15-4; Effective October 1, 2015

Advisors must follow the policy explained in C-817, Electronic Data Sources (ELDS), and C-820, Data Broker.