Revision 20-4; Effective October 1, 2020

M—110 Medicaid for Transitioning Foster Care Youth (MTFCY)

Revision 15-4; Effective October 1, 2015

The Chafee Foster Care Independence Act of 1999 gave states the option to extend Medicaid coverage to the population of youth who are between ages 18 and 21 and have aged out of foster care. Senate Bill 51, 77th Texas Legislature, Regular Session, 2001, was passed and signed into law effective September 1, 2001. This law allows the state to provide Medicaid coverage to youths who are aging out of foster care until they reach their 21st birthday.

The process to cover these individuals is coordinated between the Texas Department of Family and Protective Services (DFPS), which administers the foster care program, and the Texas Health and Human Services Commission (HHSC). When a child who is not eligible for Former Foster Care Children (FFCC) ages out of foster care in Texas, Medicaid eligibility is transferred from Foster Care Medicaid to Medicaid for Transitioning Foster Care Youth (MTFCY). DFPS certifies initial MTFCY eligibility for youths aging out of foster care and HHSC is then responsible for determining their future Medicaid eligibility.

Note: There may be situations in which HHSC processes the initial certification.

M—111 Type of Assistance (TP) 70 – Medical Assistance – MTFCY

Revision 19-4; Effective October 1, 2019

To be eligible for MTFCY, a person must:

• be ineligible for FFCC (see Part E, Former Foster Care Children [FFCC]);
• be ages 18 up to 21;
• have been in foster care in Texas on their 18th birthday, or have had an Interstate Compact on the Placement of Children (ICPC) agreement*;
• meet medical programs citizenship and Social Security number requirements;
• be a Texas resident;
• not have adequate health coverage as defined by HHSC; and
• have countable income equal to or less than the applicable income limit for TP 70, defined in C-131.1, Federal Poverty Income Limits (FPIL). Exception: Persons who have had an ICPC agreement do not need to meet the income requirement.

* Centralized Benefit Services (CBS) staff must contact DFPS to determine whether the person had an ICPC agreement. DFPS has three business days to respond.

Specialized staff process all MTFCY case actions.

M—112 Application Processing

Revision 20-3; Effective July 1, 2020

Centralized Benefit Services (CBS) staff receive:

• a new MTFCY case/Eligibility Determination Group (EDG) via an interface with the Texas Department of Family and Protective Services (DFPS); or
• an application completed by a person who aged out of foster care.

Note: DFPS provides a notice of eligibility to each person.

CBS staff are notified by DFPS or HHSC Quality Assurance when a referral or interface is not completed. If a DFPS referral or interface is not completed or processed, CBS staff must contact DFPS to determine the reason the person was not sent to HHSC via the interface and confirm whether eligibility criteria are met for MTFCY. If the person meets the eligibility criteria in M-111, Type of Assistance (TP) 70 - Medical Assistance - MTFCY, CBS staff certify the person for MTFCY without requiring an application.

There are instances when a person is denied ongoing MTFCY coverage and must submit a new application for benefits. A person may be denied ongoing MTFCY coverage if they:

• voluntarily withdraw;
• move out of state; or
• fail to return verification during a renewal.

A person denied ongoing MTFCY benefits may experience a gap in coverage. When there is a gap in coverage, the person must apply using any of the Medical Programs application channels explained in A-113, Application Requests and Submissions.

The question "Were you in foster care at age 18 or older?" must be marked Yes on the application for eligibility to be considered for MTFCY.

If ineligible for MTFCY, the person will be considered for eligibility under other Medical Programs.

M—113 Requesting an Application

Revision 15-4; Effective October 1, 2015

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

If an applicant requests help completing an application, a volunteer or staff member must provide assistance. Anyone assisting the applicant in completing a paper application must initial the part completed, or sign the form indicating assistance was provided.

Related Policy
Registering to Vote, A-1521

M—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).

M—121 Filing an Application

Revision 17-1; Effective January 1, 2017

Individuals who wish to apply for MTFCY can:

• submit an application as explained in A-113, Application Requests and Submissions; and
• sign an application as explained in A-122, Application Signature.

M—122 File Date

Revision 20-4; Effective October 1, 2020

The file date is the day an application is received in one of the following ways:

• by an HHSC eligibility determination office;
• online through YourTexasBenefits.com;
• by phone through 2-1-1; or
• through an account transfer from the Marketplace.

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

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.

Related Policy

Application Signature, A-122.1

M—131 General Policy

Revision 10-2; Effective April 1, 2010

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

Note: Do not deny the application if the applicant misses the interview; continue determining eligibility.

Revision 15-4; Effective October 1, 2015

To determine the Modified Adjusted Gross Income (MAGI) household composition for Medicaid for Transitioning Foster Care Youth (MTFCY), the advisor follows the policy explained in A-240, Medical Programs.

Exception: An individual received via the Texas Department of Family and Protective Services (DFPS) interface will continue to have a MAGI household size of one. MAGI household size may change at the time of redetermination if additional information is received indicating that additional people should be included in the MAGI household composition.

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

For most Medicaid for Transitioning Foster Care Youth (MTFCY) applications received via the Texas Department of Family and Protective Services (DFPS) interface, citizenship and alien status has been verified. For MTFCY applications not received via the DFPS interface, a period of reasonable opportunity may be granted if necessary, following the Medical Programs policy for citizenship and alien status eligibility in A-300, Citizenship.

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

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 (SSA) before certification.

The Medicaid for Transitioning Foster Care Youth (MTFCY) program follows the SSN policy in A-400, Social Security Number, under the All Programs or Medical Programs headings.

Revision 10-2; Effective April 1, 2010

To receive Medicaid for Transitioning Foster Care Youth benefits, individuals must be at least age 18 and younger than age 21. Applicants are eligible to receive benefits from age 18 through the month of their 21st birthday.

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 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 and TP 48 policy in A-700, Residence.

Revision 15-4; Effective October 1, 2015

An applicant or recipient is not eligible to receive Medicaid for Transitioning Foster Care Youth (MTFCY) 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 Texas Women's Health Program, 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 MTFCY 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 MTFCY 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 20-4; Effective October 1, 2020

The person is continuously eligible for 12 months beginning the first day of the application month if all eligibility criteria are met. Applicants are eligible to receive benefits beginning the month of their 18th birthday through the end of the month of their 21st birthday.

The medical effective date cannot precede the month of the applicant’s 18th birthday.

Follow policy in B-500, Medical Coverage for Individuals Confined in a Public Institution, for people who are confined in a public institution .

Related Policy

Medical Coverage for Individuals Confined in a Public Institution, B-500

M—1011 Three Months Prior Coverage

Revision 10-2; Effective April 1, 2010

Follow policy in A-830, Medicaid Coverage for the Months Prior to the Month of Application, to provide Medicaid coverage if the individual meets eligibility criteria.

M—1012 Types of Coverage

Revision 15-4; Effective October 1, 2015

The type of coverage determines how recipients access Medicaid services. There are two types of coverage. They are fee-for-service and managed care.

Fee-for-Service — Also known as traditional Medicaid, allows access to any Medicaid provider and self-referral to specialists. The provider submits claims directly to the claims administrator for reimbursement of Medicaid-covered services.

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.

Medicaid for Transitioning Foster Care Youth recipients have the option to enroll in either type of coverage. See A-821.2, Managed Care.

Related Policy

Types of Coverage, A-821

Revision 15-4; Effective October 1, 2015

Medicaid for Transitioning Foster Care Youth (MTFCY) individuals must have income less than or equal to the applicable income limit for TP 70, defined in C-131.1, Federal Poverty Income Limits (FPIL).

Advisors must use Modified Adjusted Gross Income (MAGI) rules to determine financial eligibility for MTFCY following the Medical Programs policy, explained in A-1300, Income.

Exception: Individuals who have had an Interstate Compact on the Placement of Children (ICPC) agreement do not need to meet the income requirement.

Revision 10-2; Effective April 1, 2010

Use Medical Programs policy in A-1400, Deductions, to determine which deductions a household is eligible to receive.

Revision 15-4; Effective October 1, 2015

Before certifying applicants and recertifying recipients, advisors must:

• Ensure the applicant completes each question and signs and dates the application.
• Give the applicant Form H1019, Report of Change. 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 the applicant of the right to appeal any HHSC action that affects the individual’s eligibility.
• Inform the applicant that the information the applicant provides 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.

Advisors 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.

Advisors use the original application 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 TF-0001, 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/individual. If requested, provide the applicant/individual 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 15-4; Effective October 1, 2015

Advisors may not request additional information or documentation from clients unless such information is not available electronically or the information obtained electronically is not consistent with the information provided by the client.

If additional information is needed, advisors must request documents that are readily available to the household and are considered to be sufficient verification. Each handbook section lists potential verification sources. C-900, Verification and Documentation, gives information on verification procedures.

In determining eligibility, advisors 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 system generates and sends renewal correspondence to individuals enrolled in Medicaid for Transitioning Foster Care Youth (MTFCY) following the process explained in B-121, Notice of Redetermination/Certification Expiration, for TP 08 and Children's Medicaid (TP 43, TP 44 and TP 48).

Note: The system will generate Form H1206, Health Care Benefits Renewal – MTFCY, rather than Form H1206, Health Care Benefits Renewal – MA, for individuals renewing MTFCY.

M—2161 How to Process a Renewal

Revision 15-4; Effective October 1, 2015

MTFCY recipients complete the administrative renewal process explained in B-122.4, Medical Program Administrative Renewals.

Note: If an individual is required to return a renewal form and returns a paper Form H1206, Health Care Benefits Renewal – MTFCY, the form is routed to Centralized Benefit Services (CBS) for processing.

Revision 15-4; Effective October 1, 2015

For individuals required to return a renewal packet, advisors must process the manual renewal as explained in B-122.4.2, Processing a Manual Renewal.

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 Eligibility Determination Groups (EDGs), check to see if any verification previously provided for the other EDGs can be used to determine eligibility for MTFCY.

Use verifications accepted for the Temporary Assistance for Needy Families (TANF) program, 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 MTFCY.

Exception: Only Medical Programs sources of verification of U.S. citizenship for applicants can be used.

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

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

Revision 15-4; Effective October 1, 2015

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 Medicaid for Transitioning Foster Care Youth (MTFCY) recipients. MTFCY 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, Report of Change. 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 will send the change to CBS).

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

An individual is continuously eligible for MTFCY for 12 months or through the month of his 21st birthday, whichever is earlier.

An individual must report the following changes:

• an address change;
• income, including sources of income, regular hours worked, and pay rate;
• Modified Adjusted Gross Income (MAGI) expenses;
• voluntary withdrawal of the individual;
• receipt of health insurance; or
• if the individual moves out of state.

Process all other changes, including agency-generated changes, at the next renewal.

Exception: If the individual failed to report required information at the time of the application that causes the individual to be ineligible for MTFCY, advisors must deny the benefits and send a fraud referral to the Office of the Inspector General.

Revision 20-4; Effective October 1, 2020

Document all changes or agency generated change tasks received during the 12-month continuous eligibility period and process the change at renewal, except:

• death of the certified person;
• voluntary withdrawal;
• receipt of health insurance;
• moves out of Texas; or
• change of address.

If a change of address is received, mail the person Form H0025, HHSC Application for Voter Registration. If the person contacts CBS or 2-1-1 to decline the opportunity to register to vote after receipt of Form H0025, mail Form H1350, Opportunity to Register to Vote, to the person for a signature. File Form H1350 in the case record when the person returns the form and retain the form for at least 22 months.

Follow policy in B-532, Medicaid Reinstatement for Persons Released from Texas County Jails, if a person was incarcerated in a Texas County Jail and Medicaid is suspended.

Follow Medical Programs policy in B-600, Changes, for verification and documentation requirements.

Related Policy
Registering to Vote, A-1521
Medicaid Reinstatement for Persons Released from Texas County Jail, B-532
Changes, B-600

M—2221 Returned Mail

Revision 16-4; Effective October 1, 2016

When returned mail is received, the vendor creates and assigns a Returned Mail (RTML) task to Centralized Benefit Services (CBS) staff for processing. 

Upon receipt of the RTML task, CBS staff must take the following actions: 

1. Review the address on the returned mail, the case record, and the State Portal to determine whether the household has reported a new address. If a new address has been reported, process the address change and, if there is a Supplemental Nutrition Assistance Program (SNAP) Eligibility Determination Group (EDG), any related changes in shelter expenses.
2. If a new address has not been reported and a forwarding address was not provided, attempt to contact the household via telephone to obtain an updated address and document the attempt. If the household provides a new address, process the address change and, if there is a SNAP EDG, any related changes in shelter expenses. Otherwise go to Step 3.
3. If there is an individual(s) in the household who receives Retirement, Survivor's and Disability Insurance (RSDI) or Supplemental Security Income (SSI), use the State Online Query (SOLQ) to verify the household's address. Use the address in SOLQ to update the address if the address in SOLQ differs from the address on file and, if there is a SNAP EDG, explore shelter expenses.

If the address in SOLQ matches the address in the TIERS record, document in TIERS Case Comments that the SOLQ inquiry address matches the TIERS address and take no further action.

If unable to contact the individual by phone and there is not an individual(s) in the household who receives RSDI or SSI for the:

• MTFCY EDG, go to Step 4; and
• SNAP EDG, follow Step 5 under the process for a case that includes a SNAP EDG in B-638, Returned Mail.

4. If unable to update the address, simultaneously send emails using the following CBS email box to:

• Health Plan Operations (HPO) using the following email box:
  • cbs_ffche-mtfcy@hhsc.state.tx.us  and
• Preparation for Adult Living (PAL) using the following email box:
  • OES_FFCC@hhsc.state.tx.us

HPO Process

• Send an email to the Medicaid CHIP Division (MCD) Health Plan Operations (HPO) at HPO_Star_Plus@hhsc.state.tx.us . 
• Include in the subject line Returned Mail – [last four digits of the client's case number].
• Include the following information in the email:
  • case name;
  • case number;
  • individual’s date of birth (DOB), Social Security Number (SSN), and Medicaid individual Identification Number; and
  • date the response is needed.
• Leave the RTML task pending. 

PAL Process

• Use the link below to identify the Lead Regional PAL staff covering the region of the client's last known address.
  • https://www.dfps.texas.gov/Child_Protection/Youth_and_Young_Adults/Preparation_For_Adult_Living/PAL_coordinators.asp
• Send an email to the identified Lead Regional PAL staff.
• Include in the subject line Returned Mail -- [last four digits of the client's case number].
• Include the following information in the email:
  • case name;
  • case number;
  • individual's DOB, SSN, and Medicaid Individual Identification Number; and
  • date the response is needed.
• Leave the RTML task Pending.

Note:

For an individual who aged out of the Unaccompanied Refugee Minor (URM) Resettlement program, contact the following agencies and individuals to determine if the agency or individual has an updated address for the former URM:

• The URM's former Voluntary Agency (VolAg); and
• The two agencies in Texas that have URM programs:
  • Catholic Charities Diocese of Fort Worth
    • Jennifer Frazier, URM Director, at jfrazier@ccdofw.org
• Catholic Charities Diocese of Galveston-Houston
  • Debbie Sandberg, URM Coordinator, at 713-874-6505 or dsandberg@catholiccharities.org
  • Raj Kendrick, URM Director, at 281-874-6530 or rkendrick@catholiccharities.org

5. The MCD HPO and DFPS PAL staff have ten calendar days to respond. It is important that staff make the request as soon as possible. The response will include either:

• the known address on file for the individual; or
• no known address on file for the individual.

MCD HPO responds to the CBS email mailbox (cbs_ffche-mtfcy@hhsc.state.tx.us ) and copies the original requestor with information from the plan by the tenth calendar day from when the email is sent, either confirming or denying that they have an address on file for the client. If they confirm, the response will include the address on file.

The DFPS PAL program responds to the email box (OES_FFCC@hhsc.state.tx.us ) and copies the original requestor with information from the Lead Regional PAL staff by the tenth calendar day from when the email is sent, either confirming or denying that they have an address on file for the client. If they confirm, the response will include the address on file.

Note: If the MCD HPO and DFPS PAL both respond and provide different addresses, use the address received from the MCD HPO (unless the individual has already provided an address).

6. For cases with a SNAP EDG, if by the Form H1020 due date, the household:

• provides the requested information, process the address change for all active EDGs, including the MTFCY EDG, and address any related changes in shelter expenses for the SNAP EDG; or
• fails to provide the requested information, deny the SNAP EDG for failure to provide information. Send Form TF0001, Notice of Case Action, using the denial reason, "Failed to Provide Information".

For the MTFCY EDG, if by the tenth calendar day due date the HPO/PAL information:

• is provided, use the information to update the address in the TIERS record; or
• is not provided, use the following steps to deny the EDG(s) using the denial reason "Unable to Locate" as stated in A-2344.1, Form TF0001 Required (Adequate Notice).
  • In Change Action Mode, go to "Household Information" and select "Yes" for the question "is the worker unable to locate the household?"
  • Run eligibility.

Note: The HPO/PAL information cannot be used to verify residence for SNAP EDGs.

7. If MCD HPO or DFPS PAL provide an updated address within 30 days of the EDG's denial due to "Unable to Locate,” reopen the EDG.

For the SNAP EDG, if the household is denied for failure to provide information and provides a correct address within the advance notice adverse action period, reopen the EDG using the original certification period and process any related changes in shelter expenses.  Please refer to the TIERS Advance Notice of Adverse Action Reference Guide in the ASK iT Knowledge Base for instructions. 

Notes:

• If an address provided by MCD HPO or the DFPS PAL program differs from an address provided by the household, contact the household to resolve the discrepancy.
• For SNAP EDGs, if the household provides verification of residence, but does not provide information regarding shelter expenses, re-budget eligibility without the shelter expense and notify the household, according to policy in A-631, Actions on Changes.

Related Policy

Actions on Changes, B-631
Returned Mail, B-638

Revision 10-2; Effective April 1, 2010

Medicaid for Transitioning Foster Care Youth applicants or recipients receiving a notice of adverse action are not entitled to continued benefits when benefits are denied for any reason if doing so would extend the 12-month continuous eligibility period or benefits past their 21st birthday.

See B-1000, Fair Hearings, for specific appeals policy and procedures.

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.

Exception: The consent policy explained in C-817 does not apply to individuals that are transferred to the Texas Health and Human Services Commission (HHSC) via the Texas Department of Family and Protective Services (DFPS) interface.