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 19-4; Effective October 1, 2019

YourTexasBenefits.com

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

YourTexasBenefits.com can be used 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;
  • people age 65 or older or with a disability; and
  • people under age 26 who were in foster care in Texas and receiving federally funded Medicaid at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an Interstate Compact on the Placement of Children (ICPC) agreement at age 18 or older;
• Medicare Savings Programs; and
• long-term services and supports for:
  • people with intellectual or developmental disabilities; and
  • people 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).

Form H1010 can be used 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;
  • people under age 26 who were in foster care in Texas and receiving federally funded Medicaid at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an ICPC agreement at age 18 or older.

Form H1205, Texas Streamlined Application

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

Form H1205 can be used to apply for the following benefits:

• health care for:
  • children;
  • adults caring for a child;
  • adults not caring for a child;
  • pregnant women; and
  • people under age 26 who were in foster care at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an ICPC agreement at age 18 or older. 

Applications Solely Used by the Marketplace

The online Marketplace application is a single interactive application 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:
  • people who are married, have tax dependents, or can be claimed as a tax dependent on someone else's federal income tax return;
  • people with or without current health care coverage;
  • families that include immigrants; and
  • people 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, 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 or Medicaid for the Elderly and People with Disabilities Employees

Revision 18-1; Effective January 1, 2018

All Programs

Give special handling to applications and redeterminations submitted by Texas Works and Medicaid for the Elderly and People with Disabilities employees.

• A Texas Works or MEPD 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 Texas Works or MEPD supervisor or higher position.
• The employee's immediate supervisor or someone in the direct line of supervision may not process the Texas Works or MEPD employee's application.

A—115 Applications Filed in Hospitals and Clinics

Revision 19-1; Effective January 1, 2019

All Programs

Facility work is the primary assignment for Outstationed Worker Program (OWP) staff. Staff will process workload following the OWP Hierarchy order below:

• OWP Lobby Facility Workload
• OWP Statewide Facility Workload
• Regional EWMS Teams (Supplemental) Workload

Staff follow the most current business processes found in the Eligibility Operations Procedures Manual to complete this workload.

The file date is the date HHSC receives the application from the contracted facility.

A—116 Special Application Processes

Revision 12-2; Effective April 1, 2012

A—116.1 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

A—116.2 Applications from Residents of a Homeless Shelter

Revision 22-1; Effective January 1, 2022

SNAP

People staying in homeless shelters are potentially eligible for SNAP, regardless of the number of meals the facility provides, if the homeless shelter is an approved institution. A homeless shelter is an approved institution if it is a:

• public or private, nonprofit shelter for the homeless; or
• certified SNAP retailer.

Verify the homeless shelter is an approved institution, if questionable.

People staying in homeless shelters that are not approved institutions are potentially eligible for SNAP if the facility provides half of their meals or less. Consider this when determining if a person staying in a facility is institutionalized.

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

Related Policy

Nonmembers, A-232.1
Prepared Meals for Homeless, B-462
Homeless Shelter Standard, A-1427
Determining Whether a Person Who Resides in a Facility Is Institutionalized, B-490

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 Reserved for Future Use

Revision 20-4; Effective October 1, 2020

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 22-3; Effective July 1, 2022

For application processing related to joint Supplemental Security Income (SSI)-SNAP applications, refer to the policy in B-476, Joint Supplemental Security Income (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 Reserved for Future Use

Revision 22-3; Effective July 1, 2022

 

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 Children Placed in or Released from a Juvenile Facility

Revision 20-4; Effective October 1, 2020

For application processing related to Medicaid for children placed in the custody of or released from the Texas Juvenile Justice Department or Juvenile Probation Department, refer to policy in B-543, Child Placed in a Juvenile Facility, and B-546, Notification of Actual Release from a Juvenile Facility.

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 Reserved for Future Use 

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—121 Receipt of Application

Revision 23-3; Effective July 1, 2023

All Programs

Applications must be signed under or on the same page as the penalty of perjury statement before certification.

TANF

An application is valid if it has the applicant's name, the applicant’s address, and the signature of the:

• applicant; or
• applicant's designated authorized representative (AR).

SNAP

An application is valid if it has the applicant's name, the applicant’s address, and the signature of:

• the applicant;
• another responsible household member; or
• the applicant's designated AR.

Medical Programs

An application is valid if it has the applicant's name, the applicant’s address, and the signature of any of the following people:

• the adult or minor applicant;
• the applicant's designated AR; 
• an adult applying on behalf of a minor child; or 
• a person 19 or older who:
  • is included in the applicant’s MAGI household composition; or
  • has a tax relationship with the applicant.

Note: Applicants are not required to live at the same physical address to apply for each other. For example, a non-custodial parent may apply for Medicaid and CHIP on behalf of their child if the parent expects to claim the child as a tax dependent on their federal income tax return.

TP 43, TP 44 and TP 48

Do not require a new application when a household has an active Medicaid type program and requests to add Medicaid for another child who needs a new EDG. Add the child to the case per additions to the household policy. Exception: Do not add more children to a case where a Medicaid EDG was reinstated due to the child’s release from a juvenile facility. The household must submit an application for the other children. To identify these EDGs, view the Individual – Medicaid History page for the active child. If the Juvenile Placement History field indicates "Yes", the EDG has been reinstated.

This policy does not apply when there is no existing Children's Medicaid EDG. For example, do not add a child when the only other child is certified for Medicaid because the certified child receives SSI. A separate application is required to initiate coverage for the child being added.

Related Policy

Application Requests and Submissions, A-113
Filing the Application, A-122
Application Signature, A-122.1
Authorized Representatives (AR), A-170
Medical Programs, A-240
Children's Medicaid Redetermination Expectations, B-123.6
Denied EDGs, B-474.7
Additions to the Household, B-641

A—121.1 Receipt of Application from Residential Child Care Facility

Revision 24-1; Effective Jan. 1, 2024

Medical Programs

When a representative from a licensed residential child care facility applies for an independent child, 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 B600, 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 20-4; Effective October 1, 2020

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 23-3; Effective July 1, 2023

All Programs

The applicant must provide a signed application form before being certified. The signature can be captured anywhere  on the same page the penalty of perjury statement is captured.

If the agency receives an application with no required signature and the application is not date-stamped, the application is considered invalid. Return the application with a letter and a pre-paid envelope explaining that the application must be signed before the agency can establish a file date.

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

Eligibility Support Vendor Action on Unsigned Applications

If the eligibility support vendor receives an unsigned application, the application is considered invalid. Within one business day, return the application to the household with a letter and a pre-paid 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 the receipt date of the application. The missing signature is treated as missing information.

Electronically Filed Applications

All Programs

Applications submitted online through YourTexasBenefits.com by the applicant or authorized representative (AR), are considered electronically signed.

Exception: Do not consider the application electronically signed when a non-applicant or non-AR completes and submits the online application for the household. In this situation, a pre-populated application is mailed to the household requesting a written signature from the applicant.

Applications Filed by Phone

For certain programs, an applicant or AR may complete and sign an application by phone:

Program	Complete Application by Phone	Sign Application by Phone
SNAP	No	No
TANF	Yes	No
Medical Programs	Yes	Yes

An applicant or AR who requests to apply for all programs by phone is informed that the option to complete and sign an application for all programs by phone is not available. The customer care representative directs the applicant or AR to submit an application online through YourTexasBenefits.com, by mail, by fax or at a local office.

TANF

The applicant or AR completes an application over the phone by providing their information to the customer care representative. However, the applicant or AR does not have the option to sign the application by phone. The customer care representative enters the information provided by the applicant or AR through YourTexasBenefits.com and a pre-populated application is mailed to the household requesting a written signature from the applicant or AR.

SNAP

The applicant or AR does not have the option to complete or sign the application by phone.

Medical Programs

The applicant or AR may complete and sign an application over the phone by:

• providing their information over the phone to the customer care representative; and
• signing the application over the phone by stating their name and agreeing to a penalty of perjury statement read by the customer care representative.

The customer care representative enters and submits the information provided by the applicant or AR through YourTexasBenefits.com.

Note: Staff cannot accept telephonic signatures.

Applications signed and submitted over the phone by the applicant or AR are considered signed by phone except when:

• the applicant or AR declines to sign the application by phone; or
• a non-applicant or non-AR completes and signs the application by phone for the household.

Correspondence is sent based on the following actions taken by the applicant or AR:

Action	Correspondence
Applicant or AR signs the application by phone	Form H1031, Telephonic Signatures Cover Letter, notifies the person they submitted a telephonically-signed application or renewal.
Applicant or AR declines to sign the application by phone	Form M5021A, Request for Missing Signature Cover Letter, notifies the person a signature is needed to complete the application process for TW medical programs; and The unsigned Form H1010, Texas Works Application for Assistance - Your Texas Benefits, populated with information provided over the phone. OR Form M5021C, Cover Letter for Missing Signature Letter, notifies the person a signature is needed to complete the application process for TW medical and MEPD programs; The unsigned Form H1010, which is populated with information provided over the phone; and The unsigned Form H1200, Application for Assistance - Your Texas Benefits, is populated with information provided over the phone.

Notes:

• People who sign a renewal by phone receive the same correspondence, Form H1031, Telephonic Signatures Cover Letter, as people who sign an application by phone.
• People who decline to sign a renewal by phone receive the following correspondence:
  • Form H1032, Cover Letter for Unsigned Your Texas Benefits Renewal Form, which notifies the person a signature is needed to complete the renewal process; and
  • Form H2020-YTB, Your Texas Benefits Renewal Form, the unsigned renewal populated with information provided over the phone.

Related Policy
Application Requests and Submissions, A-113
Authorized Representatives (AR), A-170

Signatures Elsewhere

All Programs

Accept the applicant’s signature on the first or last page of Form H1010, Texas Works Application for Assistance - Your Texas Benefits, to establish a file date if the application meets all other application receipt requirements.

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

Medical Programs

If an applicant signs and returns only Form H1010-MR, MAGI Renewal Addendum, with no corresponding application, the application is considered invalid. Attempt to contact the applicant by phone and advise them to file an application. No action is taken on Form H1010-MR without a corresponding application.

If the applicant returns a signed application without Form H1010-MR, consider the application incomplete. Send Form H1020, Request for Information or Action, with Form H1010-MR 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-MR by the final due date, 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 22-4; Effective Oct. 1, 2022

SNAP, TANF, TP 08 and TA 31

An interview is required at application and redetermination for SNAP, TANF and Medicaid for Parents and Caretaker Relatives. Complete an interview even if the application only contains the applicant’s name, address, and signature. Attempt to interview the applicant as a lobby walk-in or by making a cold call. If the cold call is unsuccessful, mail the applicant Form H1830-FA, Application/Review/Expiration/Appointment Notice that provides the applicant information about how to call the agency for a flexible appointment interview.

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

An interview is not required for Children's Medicaid or Medicaid for Pregnant Women. Process the application unless the applicant requests an interview.

Exceptions:

• If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice, or for missing an appointment related to a Health Care Orientation (HCO) or Texas Health Steps noncompliance, schedule a phone appointment and deliver the HCO or remind the applicant about the importance of the Texas Health Steps  checkup at that time.
• Staff conduct an interview for an initial application or redetermination 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 22-3; Effective July 1, 2022

All Programs

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

To prevent overpayments or incorrectly providing benefits, 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 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 and EDG status (active or denied). If the case is active, determine if the person is currently active on another case in the same program. If the person 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 B454.1, 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-Combined Application Project (CAP) 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. Follow established local office procedures applicable to the specific case situation.

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 X100, 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 B112, 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 C900, Verification and Documentation.

Related Policy

Verifications, C1113.4

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
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.
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.
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.
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.
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 20-4; Effective October 1, 2020

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

Refer a person 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 800-335-8957.

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 Approved — Completed 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, C1113

A—125 TP 45 Provider Referral Process

Revision 16-3; Effective July 1, 2016

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 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 B641.1, 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 16-2; Effective April 1, 2016

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.

When the head of household does not provide their date of birth (DOB) and/or Social Security number (SSN), the following steps are taken to obtain the information:

• Call the household to try to obtain the correct DOB and/or SSN. Let the household know this information is voluntary and is not required to make an eligibility determination for the child; however, it will help expedite the process.
• If unable to obtain the DOB and/or SSN by telephone, continue to process the child's application for Medicaid.
• Select a random DOB for the caretaker/second parent, with a year between 1965 and 1975. Using randomly selected DOBs reduces or eliminates the problem of duplicate individual numbers.
• The SSN field is left blank if the correct number is not available.
• Staff ensure that all other demographic information is correct and include the individual's middle name, when available.

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, D1433.1

A—126.4 CHIP Good Cause

Revision 15-4; Effective October 1, 2015

CHIP good cause is explained in D1723.6, 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 D1723.6, 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 D1723.5, 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 Staff Action for Determining Eligibility for Pregnant Women

Revision 21-2; Effective April 1, 2021

TA 85 (CHIP-P), 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 the woman for Emergency Medicaid coverage for the birth and 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 a woman enrolled in CHIP perinatal submits a new application, they must be tested for Medicaid coverage. When processing a change for a woman certified for CHIP perinatal, TIERS will automatically test for Medicaid eligibility. A new application is not required.

A—128.3 CHIP Perinatal Application Process

Revision 21-2; Effective April 1, 2021

TA 85 (CHIP-P), TP 36 and TP 45

CHIP perinatal (TA 85) covers labor with delivery charges for households with income above the income limit for Medicaid for Pregnant Women (TP40), but not for households that qualify for Emergency Medicaid coverage (women who do not meet citizenship requirements, and whose household income is at or below the income limit for TP40). These Medicaid-eligible households must submit Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification, to apply for Emergency Medicaid to pay for these charges.  A woman certified for TA 85 with household income above the TP40 income limit cannot be certified for Emergency Medicaid to cover the labor with delivery charges.

A child born to a CHIP perinatal mother whose household income is at or below the income limit for TP40 and who receives Emergency Medicaid to cover labor with delivery charges is enrolled in Medicaid instead of CHIP perinatal.  

Thirty days before the expected due date, TIERS generates and sends Form H3038-P with Form H1061, Birth Outcome Letter, to the household. If the household has not reported the child’s birth by 30 days after the expected due date, TIERS sends a Form H1062 , Birth Outcome Reminder Letter, and a second Form H3038-P with instructions for getting Form H3038-P completed and signed by the medical practitioner, along with a self-addressed postage-paid envelope. The household 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 Customer Care Center (CCC) staff to certify the mother for Emergency Medicaid and the newborn for TP 45.

Staff must not certify the mother for Emergency Medicaid or the newborn for TP 45 if the household has not returned Form H3038-P within 60 days from the date of the expected pregnancy due date. Reopen three-month prior applications for people who return Form H3038-P after 60 days from the expected pregnancy due date.

Note: For newborns admitted to the Neonatal Intensive Care Unit (NICU), process both the Emergency Medicaid coverage for the mother and the TP 45 for the newborn.

CCC Staff Process

CCC is assigned a task to process Form H3038-P. Staff must:

• determine whether mother and newborn are already active on Medicaid;
• if mother and newborn are not active on Medicaid, use all TP 40 eligibility policies and procedures to determine Emergency Medicaid eligibility, except when verifying income and citizenship/alien status;
• use the verified income provided to determine CHIP perinatal eligibility to determine Emergency Medicaid eligibility. Note: TIERS will not run financial rules when certifying a recipient for Emergency Medicaid and will instead use the verified income used to determine the woman’s CHIP Perinatal eligibility; 
• verify all non-financial eligibility points prior to certification using: 
  • identity verification sources; and
  • residence 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.

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 the newborn interface or from the person by phone or in writing. When birth outcome information is received after Form H3038-P has already been submitted to the HHSC, a second task is assigned to CCC to process TP 45 coverage for the newborn.

When CCC staff receive a task that includes Form H3038-P dated more than 60 days after the pregnancy due date, CCC must stamp "Received (Date) CCC" on Form H3038-P, to indicate the form was provided after the 60 days from the pregnancy due date. CCC staff must return Form H3038-P along with an application and a letter informing the person that they must apply for Medicaid. The person is 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 877-447-2839.
provides an application requesting Medicaid only, provides Form H3038-P, and was active on CHIP perinatal at the time of delivery,	follow policy for receipt of duplicate or identical application and fax Form H3038-P to 877-447-2839.
provides an application requesting Medicaid and other benefits (SNAP, 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 877-447-2839 if the mother is ineligible for Emergency Medicaid based on the current information.
provides an application and Form H3038-P stamped with “Received (Date) CCC,”	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 per existing policy and certify TP 45 if appropriate.

Notes:

• Fax the bar-coded Form H3038-P to 877-447-2839. If Form H3038-P is not bar-coded, write the mother's case and CHIP perinatal EDG number on the top of the form.
• If the applicant requests the fax number for Form H3038-P, instruct the applicant to fax the form to 877-447-2839.

Related Policy

Receipt of Duplicate Application, A-121.2
Receipt of Identical Application, A-121.3
Neonatal Intensive Care Unit (NICU) Process, A-126.3.1
Verification Sources, A-621
Verification Sources, A-761
Reopening Three Months Prior Applications, A-831.2.1
Deadlines, B-112

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—131 Interviews

Revision 22-3; Effective July 1, 2022

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 authorized representative (AR), who must also sign the application.
• For SNAP, another responsible household member may also be interviewed.
• For TSAP redeterminations, 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.

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 phone interview.

Related Policy

Authorized Representatives, A-170 
SNAP Programs, B-474.1.1 
Texas Simplified Application Project (TSAP) for SNAP Food Benefits, B-477

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, C932

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 and Translation Services

Revision 23-3; Effective July 1, 2023

All Programs

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

To meet the requirement for applicants and recipients who indicate they are Limited English Proficiency (LEP), offices can use:

• Bilingual advisors – when it is reasonably possible to do so, schedule LEP applicant or recipient interviews with bilingual advisors.
• Bilingual clerical staff – use bilingual clerical staff as interpreters whenever possible.
• Local community interpreter providers.

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 can use the service by calling the primary vendor at 844-403-1611 or the secondary vendor at 866-975-3097 and using their 11-digit employee identification number.
• •    Applicants or recipients may provide their own interpreter if they wish to do so. Note: A minor, 15 or older, can act as an interpreter at the person's request and when the minor accompanies the person to the interview. Do not use a minor under 15 as an interpreter.

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

• Schedule a phone 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 these numbers:
  • 7-1-1, 800-RELAYTX (800-735-2989), Spanish to English (Spanish speaking callers to English speaking HHSC staff) at 888-777-5861; and
  • and Spanish to Spanish at 800-662-4954.
• If unable to reach the applicant by phone, schedule a face-to-face interview and arrange for interpreter services at the interview location.

Note: In situations where an interpreter services vendor is not available, the use of handwritten notes with the hearing-impaired person is allowed. The notes must be  an effective and acceptable means of communication for the person.

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 B942, 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 19-4; Effective October 1, 2019

Medical Programs

Texas Works Medical Programs Hierarchy

Step	Eligible Persons	With Income	Type Program Code	Type	Program
1	People 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	People 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 FPL	TP 70	MA	Medicaid for Transitioning Foster Care Youth (MTFCY)
3	Pregnant Women	At or below program FPL	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 FPL	TP 36	MA	Pregnant Women - Emergency
5	Newborn children of Medicaid-eligible mothers up to age 1, including mothers receiving TP 36 for the delivery	Not Applicable	TP 45	MA	Newborn Children (Deemed)
6	Children under age 1	At or below program FPL	TP 43	MA	Children Under Age One
7	Children ages 1 through 5	At or below program FPL	TP 48	MA	Children 1–5
8	Children ages 6 through 18	At or below program FPL	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 FPL	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 FPL	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 FPL	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 FPL	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 FPL	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	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
17	Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer	Not Applicable	TA 67	MA	MBCC
18	Children under age 19 and pregnant women	Above the limits for TPs 40, 43, 44, and 48 FPL	TP 56	MA	Medically Needy with Spend Down
19	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 FPL and at or below program limit	TP 32	MA	Medically Needy with Spend Down - Emergency
20	Children under age 19 ineligible for Medicaid due to income	Above the limits for TPs 43, 48, or 44 FPL, and at or below program limit	TA 84	CI	CHIP
21	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
22	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 FPL	TA 77	Health Care Benefits	Health Care - FFCHE
23	Children under age 1 presumed to be eligible for Medicaid as determined by a Qualified Hospital (QH)	At or below TP 43 FPL	TA 74	MA	Children Under Age One - Presumptive
24	Children ages 1 through 5 presumed to be eligible for Medicaid as determined by a QH	At or below TP 44 FPL	TA 75	MA	Children 1–5 - Presumptive
25	Children ages 6 through 18 presumed to be eligible for Medicaid as determined by a QH	At or below TP 48 FPL	TA 76	MA	Children 6–18 - Presumptive
26	Parents and caretaker relatives presumed to be eligible for TP 08 by a QH	At or below TP 08 FPL	TA 86	MA	Parents and Caretaker Relatives - Presumptive
27	Former Foster Care Children presumed to be eligible for Medicaid by a QH	Not Applicable	TA 83	MA	FFCC - Presumptive
28	Healthy Texas Women	At or below program   FPL	TA 41	MA	Healthy Texas Women
29	Pregnant women presumed to be eligible for TP 40 by a QH or Qualified Entity (QE)	At or below TP 40 FPL	TP 42		Pregnant Women - Presumptive

Notes:

• If the pregnant woman or child under age 19 indicates unpaid medical expenses for any of the three months prior to application month or for the application month, determine eligibility under the following programs:
  • TP 56, Medically Needy with Spend Down, for pregnant women and children under age 19 who are ineligible for Medicaid because of income.
  • TP 32 Medically Needy with Spend Down - Emergency, for pregnant women and children under age 19 who are ineligible for Medicaid because of income and alien status.
• Children ages 0 thru 18 who are ineligible for medical programs because of income are tested for CHIP.

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 
Medicaid for Breast and Cervical Cancer (MBCC), Part X 
Healthy Texas Women, 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 24-1; Effective Jan. 1, 2024

All Programs except TP 40

If the applicant cannot furnish all required proof during the interview or with the application, allow the household at least 10 days to provide the information. The due date must be a business day.

Staff must provide an applicant Form H1020, Request for Information or Action, explaining:

• what is needed;
• the due date for receipt of the information; and
• the date the application must be denied if information is not received.

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

Medical Programs

Do not request additional verification if available through electronic data sources unless questionable.

TP 40

Do not allow 10 days for the applicant to provide verification if doing so exceeds the 15 business day processing time frame and verification can be postponed.

Related Policy

Expedited Certification Procedures, A-145 
Pending Verification on Applications, B-115 
Questionable Information, C-920

A—136 Eligibility Decision and Privacy Notice

Revision 22-1; Effective January 1, 2022

All Programs

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

Medical Programs

HIPAA requires HHSC to provide a notice of privacy practices that explains:

• the person's privacy rights;
• the duties of HHSC to protect the person's health information; and
• how HHSC may use or disclose the person's health information without an authorization. For example, HHSC may share health information with the person's providers to arrange for services or with other government entities to report suspected abuse or neglect.

Provide Form 0401, Notice of Privacy Practices (English), or Form 0401S, Aviso de Normas Sobre la Privacidad (Spanish), as appropriate, to each household enrolled in a medical program.

Provide Form 0401 or Form 0401S with Form TF0001, Notice of Case Action, to each head of household:

• at initial certification; and
• at recertification after a break in services of more than 180 days.

Form 0403, Explanation to Health Information Privacy Rights, provides a reminder of privacy practices and where to find Form 0401.

Provide Form 0403 with Form TF0001 to each head of household:

• at each recertification;
• after a break in services of at least 30 days but not more than 180 days; and
• when a new person is added to a case.

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.

Revision 23-3; Effective July 1, 2023

SNAP

Use the expedited screening questions on Form H1010, Texas Works Application for Assistance to screen all expedited  applications. HHSC staff screen applications received in the local office. Vendor staff screen applications sent to the Document Processing Center by fax or mail. An automated system screens applications submitted online through YourTexasBenefits.com.

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

• postpone all verification until after receiving the first month's benefit, except: 
  • identity; and
  • proof they meet or are currently exempt from the SNAP ABAWD 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 business day.

Exceptions: In the following situations, applicants may not get benefits within this time frame:

• Applicants in a drug and alcohol treatment or a group living arrangement facility. Approve benefits so the resident has an opportunity to participate by the seventh day after the application date.
• Joint SNAP/SSI applicants released from public institutions. The Centralized Benefit Services (CBS) section approves benefits so the person can participate by the fifth day after release from the institution.

Late Determinations

Additionally, applicants may not get benefits within this time frame in 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. Do not enter a late determination date if the agency failed to properly screen the application using the expedited screening questions on Form H1010;
• meet expedited criteria and have a household member who served the minimum employment and training penalty, but the household has chosen to delay their certification until all disqualified members have signed Form H1808, Agreement to Follow SNAP Work Rules;
• require an 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. Contact the applicant to conduct an interview. If the applicant cannot be contacted by phone, mail Form H1830-FA, Application/Review/Expiration/Appointment Notice, the same day the application is screened. The interview must be completed and benefits provided to an eligible applicant by the seventh calendar day from the file date. If the household also applies for TANF or a Medicaid program that requires an interview, schedule a regular TANF or Medicaid appointment on the same notice;
• miss their expedited appointment. If the applicant later contacts the office to complete an interview, expedited processing begins the day the applicant contacts the office for an interview;
• do not provide acceptable proof of identity, or proof of meeting or being exempt from the SNAP ABAWD 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 because of a change in household circumstances after the application was submitted. The late determination date is the date the eligibility for expedited processing is met; or
• submitted an application through YourTexasBenefits.com when the office was closed due to weather-related conditions, flooding or other similar situations. The late determination date is the first business day the office reopens following the office closure.

Notes:

• 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, enter the late determination date only if HHSC, the vendor or YourTexasBenefits.com screened the application on the file date or no later than the next business day.
• 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 business days 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 by the 15th business day. 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

Application Signature, A-122.1  
Postponed Verification Procedures, A-145.1  
Medicaid Coverage for the Months Prior to the Month of Application, A-830  
ABAWD Referral Process, A-1831.1.2  
Counting Months Toward Time-Limited Eligibility, A-1950  
Regaining Eligibility, A-1960  
Residents of D&A Facilities, B-441  
Residents of GLA Facilities, B-442

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 22-2; Effective April 1, 2022

SNAP

A household may receive expedited services any number of times if, before the expedited certification, 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.

The household may provide the postponed verification after denial and qualify for expedited services at a later application.

Notes:

• The household may re-apply without submitting a new application until the 60th day after the file date, when an expedited application with postponed verification is denied for failure to provide requested information or verification.
• The household may re-apply without submitting a new application until the 60th day after the file date. Reopen the application using the date the person provided verification as the new file date. If the household submits another application, consider the second application a duplicate. Follow related policy.
• If the information satisfies the verification requirements postponed at the last expedited certification, the household is eligible for expedited services.
• The household may re-apply without submitting a new application until the 30th day following the last benefit month if a redetermination is denied for:
  • failure to provide requested information; or
  • for a missed appointment.
• If the household submits another application, staff must consider the second application a duplicate and follow related policy.

Related Policy

Receipt of Duplicate Application, A-121.2  
Reuse of an Application Form After Denial, B-111  
Pending Verification on Applications, B-115  
Delays Caused by Households, B-122.3

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, B111  
Delays Caused by Households, B122.3  
Denied for Missed Appointments, B122.3.1  
Denied for Failure to Provide Information/Verification, B122.3.2

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 20-2; Effective April 1, 2020

SNAP

Include household members for the initial month, or initial two months if household members are receiving a combined allotment. This is true even if the household members fail to provide or apply for an SSN at the interview or if State Online Query (SOLQ) does not validate a member’s SSN at the interview. Follow policy outlined in A-413, Social Security Number (SSN) Validation Through State Online Query (SOLQ), if the SSN does not validate at the interview.

Disqualify people who fail to provide or apply for an SSN without good cause or do not provide information to clear the discrepancy related to a SSN validated with verification code F or X before the next monthly issuance. See A-410, General Policy, for rules for children age six months or younger and good cause.

TP 40

Certify a pregnant woman by the 15th working day from the application file date to meet expedited processing timeframes even if:

• she fails to provide or apply for an SSN; or
• her SSN is verified with verification code F or X and unable to clear the discrepancy by viewing case documentation or contacting the household by phone. Postpone verification needed to clear the discrepancy.

Deny the woman’s eligibility if by the postponed verification due date she fails to:

• provide or apply for an SSN; or
• provide information to clear the discrepancy related to a SSN validated with verification code F or X.

Related Policy

Postponed Verification Procedures, A-145.1  
General Policy, A-410  
Social Security Number (SSN) Validation Through State Online Query (SOLQ), A-413

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 16-2; Effective April 1, 2016

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/eligible alien status must be verified using policy in A-350, Verification Requirements, for pregnant women who declare to be a U.S. citizen or declare to have an eligible alien status. If a pregnant woman does not provide proof of citizenship or alien status and:

• no other information is required to determine eligibility, she is provided a period of reasonable opportunity as explained in A-351.1, Reasonable Opportunity.
• other information is required to determine eligibility, she is allowed to postpone verification (except identity) until the 30th calendar day from the application file date, as explained in A-145.1, Postponed Verification Procedures. If during that time she returns the other information, but not proof of citizenship or alien status, she is certified, sent Form TF0001, Notice of Case Action, and provided a period of reasonable opportunity at that time.

Related Policy

Reasonable Opportunity, A-351.1

A—144.4 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

A—144.5 Pregnancy

Revision 18-1; Effective January 1, 2018

TP 40

Accept the individual’s (pregnant woman’s, case name’s or AR’s) verbal or written statement of pregnancy as verification, unless questionable. The woman’s statement would be questionable if the information provided regarding the due date is discrepant, such as the pregnancy start month and pregnancy end month are less than or more than nine months apart or if the woman reports a pregnancy with overlapping start and end months.

The individual’s statement of pregnancy must provide the following information:

• Name of woman who is pregnant
• Pregnancy start month and/or anticipated date of delivery
• Number of expected children

If questionable, advisors must verify pregnancy by using:

• Form H3037, Report of Pregnancy; or
• other documentation containing the same information as Form H3037.

The verification must be from an acceptable source such as:

• a physician;
• a hospital;
• a family planning agency; or
• a social service agency.

A physician, nurse, advanced nurse practitioner or other medical professional must sign Form H3037 or another document for it to be considered verification from a medical source. If another medical professional completes the form, the advisor must ensure that information about the supervising physician is provided.

Staff must use the following procedures when certain information regarding pregnancy is not provided on an 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.

Related Policy

Verification Requirements, A-870

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.

A-145.1 Postponed Verification Procedures Table

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 B116.1, 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.

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.

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.

Revision 21-4; Effective October 1, 2021

All Programs

An applicant, person receiving benefits, head of household (HOH), or someone with legal authority to act on their behalf (e.g., legal guardian or power of attorney) may designate a person or organization as an AR.

An AR must be verified using a(n):

• applicant's or recipient'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 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; or
  • Form H2340-OS, Medicaid for Breast and Cervical Cancer.
• applicant's signature on a Marketplace application for health care benefits that is transferred to HHSC and contains the AR designation;
• legal document that the AR has authority to act on behalf of the applicant or recipient under state law (e.g., legal guardianship or power of attorney);
• letter designating AR authority and containing the applicant's or recipient's signature, in addition to the name, address, and signature of the AR;
• completed Form H1003, Appointment of an Authorized Representative; 
• applicant's or recipient's electronic signature designating the AR on an application, renewal, or reported change submitted through YourTexasBenefits.com.

If a person or organization submits an application on behalf of an applicant, indicates they wish to be the AR and the application is not signed by the applicant, send correspondence to both the unverified AR and the HOH on the case to request the verification.

• Send the following to the HOH for the case:
  • Form H1020, Request for Information or Action, listing the missing information needed before eligibility can be determined; and
  • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.
• Send the following to the unverified AR:
  • Form H1004, Cover Letter: Authorized Representative Not Verified, explaining what is needed to verify the AR; and
  • Form H1003, to capture the AR designation and the signatures of the applicant and the AR.

For the AR to be verified, either the AR or the HOH must return the completed Form H1003 within 10 days (or 30 days from the file date). All missing information listed on the Form H1020 must also be returned timely. If the AR verification is not received by the due date, do not designate an AR.

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

• the applicant or recipient notifies HHSC that the AR is no longer authorized to act on their behalf;
• the AR notifies HHSC that they no longer wish to act as AR for the applicant or recipient;
• 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 applicant or recipient 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.

Requests to end the designation of an AR must include the signature of the applicant, the recipient or the AR as appropriate. During the redetermination process, the AR cannot end their AR designation, if the AR is the person completing and signing the redetermination.

Note: An AR is not automatically a personal representative.

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

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

Note: The AR will not receive Healthy Texas Women (HTW) correspondence.

Mailing Address for AR

During the interview, obtain the AR’s complete mailing address if not included on the application form. Record the AR’s address on the TIERS Data Collection page, Household - Authorized Representative. If the applicant cannot provide a complete mailing address for the AR during the interview or an interview is not required for the program type, do not pend the case. Record the household’s mailing address as the AR’s address in TIERS.

When an applicant or recipient and their designated AR have the same mailing address, correspondence will only be sent to the AR.

When an applicant or recipient has a legal guardian, correspondence will only be sent to the guardian, even if the applicant or recipient and the guardian have different mailing addresses.

Applicants, recipients, or ARs who have chosen to receive eligibility correspondence electronically, will continue to receive them electronically.

Medical Programs

An AR can be verified using an applicant’s or recipient’s telephonic signature submitted by calling 2-1-1.

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 the HOH or AR; or
• that person is the only adult living in the household.

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

Related Policy

Electronic Correspondence, A-119.1
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
Confidentiality, W-2400

A—171 Protective Payee

Revision 22-3; Effective July 1, 2022

TANF

A grandparent, aunt, uncle, brother or sister who is 25 or older may represent the household in the application and review process upon the relative’s request, if staff determine the parent is not using TANF for the child's benefit. In these situations, the parent’s signature and designation of the relative as AR in writing is not required on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. When the relative is designated as the protective payee, the relative is automatically the AR.

The Texas Department of Family and Protective Services (DFPS) may also designate a protective payee.

Related Policy

Receipt of Application, A-121
Authorized Representatives, A-170
Verification Requirements, A-180
Documentation Requirements, A-190
Who Is Not Included, A-222

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 (D&A) or Group Living Arrangement (GLA) Facilities

Revision 22-1; Effective January 1, 2022

SNAP

For residents of D&A facilities, a facility employee must serve as the AR to apply for the household and to use the benefits.

Residents of GLA facilities may apply:

• for themselves;
• through an AR of their choosing; or
• through an AR employed by the facility.

For D&A and GLA facilities, the AR designated to use SNAP benefits may be a different person from the AR who applies for the household.

Related Policy

Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440
D&A or GLA Facility Responsibilities as Authorized Representatives, B-445
Authorized Representatives, B-453

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.

Revision 22-3; Effective July 1, 2022

All Programs

When an eligibility determination is requested for multiple programs and the programs allow the same verification sources, staff must use the same verifications for all applicable programs. For example, if a person is applying for SNAP, TANF and Medical Programs and provides acceptable wage verification for SNAP, do not request additional wage verification for TANF or Medical Programs, provided the source is acceptable verification for TANF or Medical Programs.

Make the eligibility decision for 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

If a grandparent, aunt, uncle, brother or sister reports a parent is not using TANF benefits for the child’s needs, verify the claim. Designate one of these relatives, provided they are 25 or older and meet TANF relationship requirements, to serve as the protective payee and authorized representative (AR). A child’s cousins, nieces and nephews are not included in the list of potentially eligible relatives.

If the parent requests the relative's removal as protective payee and AR, staff must verify the parent intends to use TANF benefits for the child's needs.

Note: A protective payee is automatically the AR.

Related Policy

Relationship Charts, C-1440

SNAP

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 22-3; Effective July 1, 2022

TANF

Use the following sources to verify if the parent is using TANF funds for the child’s needs, based on a claim from a grandparent, aunt, uncle, brother or sister. Use the same sources when the parent requests the removal of the relative as protective payee and AR:

• Non-related landlord
• Non-related neighbor
• School officials
• Child Protective Services worker
• Person without vested interest in the outcome of the decision

Revision 22-3; Effective July 1, 2022

All Programs

Document the date and method that 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 person is sufficient.

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.

Document:

• When a household requests additional programs after filing an application. This includes the requested program and the date of the request.
• The rationale used to make a prudent person principle decision and any applicable handbook references.
• 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.
• On the application and on Form H1350, Opportunity to Register to Vote, in the Agency Use Only section, the actions taken when a person notifies HHSC that they declined the opportunity to register to vote after receipt of Form H0025.
• Information to support the eligibility decision in enough detail that others can understand all computations and advisor decisions.

TANF, SNAP and TP 08

For all interviews, staff must document:

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

Medical Programs

Document when designated staff request that a child born to a woman in prison be certified for TP 43.

TANF

Document the specific reason for designating a protective payee, who will also be the authorized representative (AR).

When a grandparent, aunt, uncle, brother or sister requests to be the protective payee, document the:

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

SNAP

Document:

• the name and address of the AR;
• that no one else is available, if a person disqualified for intentional program (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, Texas Works Application for Assistance - Your Texas Benefits, and explain if eligibility is questionable;
• the decision on the length of certification and reporting requirements for expedited service EDGs;
• 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

Prudent Person Principle, A-137
Documentation, C-940
Registering to Vote, A-1521
The Texas Works Documentation Guide