3410 Verification of Public Assistance Status

Revision 24-4; Effective Sept. 1, 2024

Within 24 months of the last financial review, verify the correct categorical financial status of current:

  • Temporary Assistance for Needy Families (TANF);
  • Supplemental Security Income (SSI);
  • Qualified Medicare Beneficiary (QMB);
  • Specified Low-Income Medicare Beneficiary (SLMB);
  • Qualifying Individuals (QI);
  • Supplemental Nutrition Assistance Program;
  • Medicaid Buy-In; or
  • Medicaid people; and
  • certify eligibility on this basis.

Place a dated copy of both Form 2064, Eligibility Worksheet, from Service Authorization System Online (SASO) and a Texas Integrated Eligibility Redesign System (TIERS) inquiry in the person's case folder. This will satisfy verification requirements for a person receiving service(s) based on categorical financial status.

Refer to 7110, TIERS Inquiries, for a full listing of programs that provide categorical eligibility for Community Care Services Eligibility programs.

3420 Verification of Income and Resources

Revision 24-4; Effective Sept. 1, 2024

Program Standard: The caseworker must accurately establish the countable amount of income and resources. This determines the income-eligible applicant's financial eligibility.

Determine the amount of countable assets for people applying as income eligibles. Within 24 months of the last financial review, financial eligibility must also be redetermined for these people. A person's declaration of income and resources for all programs is acceptable, excluding waiver services unless:

  • There is reason to doubt the reliability of the applicant's statement. The caseworker can request verification whenever any doubt exists.
  • The applicant's declared resource amount is within $100 of the resource eligibility limit.
  • The applicant's declared income amount is within $10 of the income eligibility limit.
  • The applicant seems unsure about the amount of income or resources available. The caseworker may accept a certain level of uncertainty. Example: The person may state they receive about $350 per month. Since this is well below the income eligibility cap, the applicant's statement may be accepted even though the person is not sure about the amount. However, if the applicant responded with somewhere around $1,500, it would be necessary to verify the amount of income, given the uncertainty and the proximity to the eligibility limit.

If a person meets the criteria in 3430, Eligibility Before Verification, refer the person for services before verifying income and resources, and complete the verification within 30 calendar days of the application.

Applicants are responsible for providing all information needed to establish eligibility. Ask the applicant or responsible party to provide the information required to verify income and resources.

When information is requested from the applicant or responsible party, give a specific due date. Explain the result of not providing the requested information. During a review, make the due date two weeks before the day the current certification period ends. This allows a few more days to give the person a second chance before terminating services effective the last day of certification. Follow up at least once before denying the applicant for failure to cooperate.

During a financial review:

  • if a person reports closing a bank account or no longer having an account included in the last review; and
  • adding the last known balance would bring the person to within $100 of the resource eligibility limit;
  • verify with the bank that the account has been closed.

If the information can be obtained by making a phone call or mailing a verification form, attempt to get the information before denying the application. If the caseworker cannot get the information and the applicant does not provide the information, deny the application. If the caseworker cannot get information needed for a financial recertification and the person does not provide the information, send Form 2065-A, Notification of Community Care Services, at least 12 calendar days before termination becomes effective.

Without verifying the income or resources, the caseworker may deny an application because the person reports excess income or resources. Explain the reason for the denial to the person or responsible party. Select statement of client or RP as the verification type for income and resources, as applicable, in the Service Authorization System Online (SASO) financial wizard. 

Review Appendix XII, Examples of Methods to Verify Income and Resources, for examples of methods to verify income and resources. The caseworker may use a verification source not listed in Appendix XII if it is determined the source is both knowledgeable and objective. A person is considered knowledgeable if that person routinely assesses values on that type of resource in the area where the resource is located. A person may not be considered objective if that person has a vested interest in the person’s eligibility.

Documentation on Form 2064 should contain enough information to determine what, when, where and how the applicant's or person's income and resources were verified, so that they can be traced to the original source. For categorically eligible applicants and people Temporary Assistance for Needy Families (TANF), Medical Assistance Only (MAO), Supplemental Security Income (SSI), Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI) and the Supplemental Nutrition Assistance Program), the case record must:

  • show that categorical status was verified; and
  • include a printed copy of a Texas Integrated Eligibility Redesign System (TIERS) inquiry that shows the applicant's categorical status.

Form 2064 must show that verifications were received before the date eligibility rules were processed.

Review 8120, Financial Wizard

3421 Financial Documentation Requirements

Revision 24-4; Effective Sept. 1, 2024

This chart is designed to help determine what is required for financial eligibility documentation.

If the person’s:andthen:
income is not within $10 of the eligibility limit
or
resources are not within $100 of the eligibility limit,		information gathered by the caseworker matches information on the application form,no verification is required. Enter the monthly dollar amount in SASO and select the client statement option. No other documentation is required.
income is not within $10 of the eligibility limit,
or
resources are not within $100 of the eligibility limit,		information gathered by the caseworker does not match information on the application form,no verification is required. Enter the monthly dollar amount in SASO and select the client statement option. No other documentation is required.
income is within $10 of the eligibility limit,
or
resources are not within $100 of the eligibility limit		information gathered by the caseworker matches information on the application form,

view verification containing all information listed in Column 3 of Appendix XII. Enter the monthly dollar amount and select the appropriate documentation source in SASO and TIERS. No further documentation is required.

If the caseworker is not able to view adequate documentation, verification of income and resources is required.

income is within $10 of the eligibility limit, or
resources are not within $100 of the eligibility limit		information gathered by the caseworker does not match information on the application form,view verification containing all information listed in Column 3 of Appendix II. Enter the monthly dollar amount and select the appropriate documentation source in SASO or TIERS. Explain the discrepancy in documentation.
income is within $10 of the eligibility limit, or
resources are within $100 of the eligibility limit		N/Averification of income and resources is required.

3422 Exceptions to Verification Requirements

Revision 25-2; Effective March 31, 2025

Income eligible people must complete a new Form H1200, Application for Assistance – Your Texas Benefits. Within 24 months of the initial financial determination. Subsequent financial redeterminations will not require completion of Form H1200, unless the caseworker thinks the person’s financial eligibility may be in question.

Even though a new Form H1200 is not needed, the caseworker must still contact the person and confirm that significant changes in income and resources have not occurred.

If there is a new source of income at a financial review or a new resource, then re-verify all the person’s resources. If adding the person’s new assets to existing income or resources brings the total income within proximity of financial eligibility limits, re-verify all the person’s resources.

Following these guidelines, at a review the caseworker may need to verify both income and resources, income but not resources, resources but not income, or neither income nor resources.

If a person loses categorical eligibility between reviews, for example, they stop receiving Temporary Assistance for Needy Families or the Supplemental Nutrition Assistance Program, that person may be able to continue receiving services without a financial review until the next financial review is due. Review 3441, Loss of Categorical Status, for more information. If the person or caseworker reports income and resources within eligibility limits and no other information exists to contradict this report, the person may continue to receive Title XX, block grant services. In this case, the caseworker must verify both income and resources at the next financial review.

3430 Eligibility Before Verification

Revision 24-1; Effective March 1, 2024

A Medicaid-certified applicant for CCSE-purchased services who requires a verbal referral is eligible to receive CCSE-purchased services when their eligibility for Medicaid is verified. A non-Medicaid certified applicant who meets the requirements for a verbal referral is eligible to receive CCSE purchased services while income and resources are verified. Visit 1130, Definitions, and 2631, Negotiated Referrals.

To be eligible, this applicant must:

  • be a new applicant for CCSE services;
  • appear to be eligible based on the declaration of income and resources on their application for services or to have possession of a current medical care identification card; and
  • meet the age and need criteria for the CCSE service he requires.

The eligibility period for non-Medicaid applicants begins on the date of application.

A non-Medicaid applicant must provide the information needed to verify the applicant's income and resource amounts to continue receiving services. This must be done within 30 days of the application date. 

If, pending financial eligibility verification, the non-Medicaid applicant appears eligible for immediate service initiation, use the following procedures, as appropriate.

  1. Refer the applicant to the provider per Section 2631.
  2. On Form 2101, Authorization for Community Care Services, enter the earliest date negotiated with the provider as the date services begin.
  3. If the applicant is determined ineligible within the 30-day verification period, or if the applicant does not provide the information needed to verify income and resource amounts by the 30th day, send Form 2065-A, Notification of Community Care Services, to the person to terminate services 12 days after the Form 2065-A date. Refer to Appendix IX, Notification/Effective Date of Decision.

Related Policy

26 Texas Administrative Code Section 271.151(g)

3440 Changes in Financial Circumstances

Revision 24-1; Effective March 1, 2024

The person must promptly report any changes in:

  • income, resources, or family size;
  • loss of assistance grant or Medicaid benefits; or
  • other changes in functional ability or circumstances that affect eligibility.  

The person is subject to fraud prosecution if they willfully fail to report changes and continues to receive services for which they are not eligible.

People must promptly report any changes in income or resources. Note in the case record, but do not verify, reports of changes in income or resources that do not affect eligibility. Newly acquired resources that may affect eligibility, such as an inheritance involving property, are disregarded for 30 days from the date received. After 30 days, determine the amount of resources and terminate the person’s eligibility if the amount exceeds the resource limit.

Related Policy 

26 Texas Administrative Code Section 271.153(f)

3441 Loss of Categorical Status or Financial Eligibility

Revision 24-4; Effective Sept. 1, 2024

If a Community Care Services Eligibility (CCSE) person temporarily loses categorical or financial eligibility for Title XIX services, CAS, PHC and DAHS, the caseworker must contact the person or the appropriate agency to determine the reason for the denial and if reinstatement is likely.

If the person loses Medicaid eligibility because their Supplemental Security Income (SSI) is being denied, the caseworker must contact the person or the Social Security Administration (SSA) to determine the reason for the denial and if the person may be reinstated without a break in coverage.

Caseworkers may receive a copy of a denial notice or the monthly Loss of Eligibility Report for eligibility for the following programs:

  • Community Attendant Services (CAS)
  • Medicaid Buy-In (MBI)
  • Medicaid through Temporary Assistance for Needy Families (TANF)
  • Categorical eligibility through the Supplemental Nutrition Assistance Program (SNAP)
  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualifying Individual (QI)
  • Medicaid through Type Program (TP) 03 (Pickle), TP 18 (Disabled Adult Children), TP 19 (SSI Denied Children) or TP 22 (Widow /Widower).

When the caseworker learns about the denial, they must check the Texas Integrated Eligibility Redesign System (TIERS) to verify the denial and the reason. The caseworker must contact the person to discuss the situation and if feasible, help the person complete the actions necessary for reinstatement of eligibility. If the person has been denied on failure to furnish information, the caseworker must contact the person as soon as possible to advise them of the loss of service and the necessity of providing the information required by Medicaid for the Elderly and People with Disabilities (MEPD) or TANF. The caseworker may also contact the MEPD or TANF specialist involved, ask about the person's current income and resource amounts, and if reinstatement will occur.

3441.1 Procedures Pending Reinstatement

Revision 25-2; Effective March 31, 2025

Suspension Pending Reinstatement

The caseworker may suspend services for 60 calendar days to allow a determination on the person’s Medicaid status be made for the reinstatement of services. Within four business days of determining suspension is appropriate, the caseworker sends the person Form 2065-A, Notification of Community Care Services, checking the Notification of Ineligibility or Termination of Benefits, the date services end, and noting services are suspended pending reinstatement of Medicaid or financial eligibility, as applicable. The caseworker also sends the provider Form 2067, Case Information, suspending services effective the date of Medicaid denial.

During the period when services are temporarily suspended by Medicaid, all case actions for CAS, PHC and Title XIX DAHS such as monitoring and annual visits, changes, and transfers will be suspended. However, the caseworker must set a special review for the 60th day following the suspension to check if eligibility has been re-established. 

If at any time during the initial 60 calendar day period the caseworker learns that eligibility has been re-established, they:

  • Have 14 calendar days to resume services.
  • Must call the provider to negotiate the earliest date for services to resume.
  • Follow up the phone call with Form 2067 to the provider, noting reinstatement of services with the negotiated date.
  • Must make any 90-day monitoring or annual reassessment visits which would have occurred during the suspension.
  • Document the reinstatement of eligibility and the reason in delay for monitoring or annual reassessment visits due to the suspension of services in the case record and sends the person Form 2065-A with a statement that services have been reinstated.

If, on the 60th day eligibility is not re-established, the caseworker may extend the temporary suspension for another 30 calendar days for a total of 90 calendar days if the caseworker determines the person may still have eligibility reinstated. This determination is established based on research of MEPD case-specific information. At any time during the additional 30 calendar days the caseworker learns that eligibility has been reinstated, the caseworker has 14 calendar days to resume services. Caseworkers must send Form 2067 to the provider to have services resumed and must make any 90-day monitoring or annual reassessment visits that would have occurred during the suspension. The caseworker documents the reinstatement of eligibility and the reason in delay for monitoring or annual reassessment visits due to the suspension of services in the case record and sends the person Form 2065-A with a statement that services have been reinstated.

Family Care During Suspension

While the person is working on reinstatement, the caseworker explores transferring the person to Family Care (FC). If the region does not have open enrollment, review 2231.1, People Who May Receive Title XX Services with Regional Director Approval, to determine if the person meets the bypass criteria. During times of extreme budget limitations on a regional or statewide basis, no one may bypass the FC interest list.

If the person will be transferred to FC, the change must be processed within 14 calendar days of learning of Medicaid denial. If person is not categorically eligible, record the self-declared income and resources in the case record. Update the Service Authorization System Online (SASO) to show the person as income eligible. It is not necessary to get Form H1200, Application for Assistance – Your Texas Benefits, from the person or to verify income and resource amounts until the next financial review is due.

Submit Form 2101, Authorization for Community Care Services, to transfer a person from PHC or CAS to FC. Use the comments section on Form 2101 to document the person’s services being transferred from PHC or CAS to FC due to a loss of Medicaid. Enter the day after the last date of Medicaid coverage as the from date on Form 2101. If the Medicaid denial is unknown until after the last day of Medicaid coverage, use the earliest date FC can begin as the from date.

Within two business days of transfer to FC the caseworker must send F2065-A, Notification of Community Care Services notifying the person of the CAS or PHC suspension and the transfer to FC, pending reinstatement of financial eligibility for CAS or PHC.

When Medicaid is reinstated and the person is transferred back to PHC or CAS, all pre-initiation activities, including a new Form 3052, Practitioner's Statement of Medical Need, is required. Review 4673.6, Temporary Loss of Eligibility and Reinstatement Procedures.

If the person fails to cooperate with the financial reinstatement process, the person cannot remain on FC. The caseworker must send Form 2065-A to deny FC services. The 2065-A denial date must allow for 12 days adverse action.

Denial Due to No Reinstatement

If reinstatement of eligibility is not granted, the caseworker sends the person Form 2065-A denying services. The date of denial is based on the:

Send Form 2101 to the provider on the same date, noting services are denied effective the date of the financial denial.

Other Title XX Services During Suspension

If the person is receiving Title XX services, Emergency Response Services (ERS), Home Delivered Meals (HDM) or Title XX Day Activity Health Services (DAHS), continue the same authorization during the Medicaid suspension.

All case actions including financial reassessment, functional reassessment and monitoring for ERS, HDM or Title XX DAHS must continue during the CAS, PHC or Title XIX DAHS suspension period.

3441.2 Reinstatement Procedures After Denial

Revision 25-2; Effective March 31, 2025

If financial or categorical eligibility is re-established within 60 calendar days of the denial date and the person reapplies for services, the caseworker may use the information currently on file to determine eligibility. Completing new forms will not be required, except for a new Form 2110, Community Care Intake, and Form 2101, Authorization for Community Care Services. The caseworker must note in the Comments section of Form 2110 that reinstatement procedures are being used within 60 calendar days of the denial date and may use the following forms currently on file:

The caseworker must contact the person and review the functional assessment, including Form 2060 and Form 2059, to determine if there have been any changes in the person's physical condition or needs. If Form 2060 is over one year old, if there have been changes in the person's condition or needs or if the person has difficulty communicating by phone, the caseworker must make a home visit to review or revise the assessment. Initial eligibility time frames will apply.

The caseworker must send an initial referral packet and initial Form 2101 referral to the selected provider. For Primary Home Care and Community Attendant Services, the provider must complete all pre-initiation activities, including getting a new Form 3052, Practitioner's Statement of Medical Need.