Texas Works Handbook

A-110, Application Procedures

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 11-3; Effective July 1, 2011

For application processing related to joint Supplemental Security Income (SSI)-SNAP applications, refer to the policy in B-420, Joint SSI-SNAP Applications.

A—116.7 Types of Assistance Administered by Centralized Benefit Services (CBS)

Revision 11-3; Effective July 1, 2011

A—116.7.1 SNAP-CAP and SNAP-SSI

Revision 15-4; Effective October 1, 2015

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

A—116.7.2 Applications for SNAP-CAP

Revision 15-4; Effective October 1, 2015

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

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

Revision 15-4; Effective October 1, 2015

For application processing related to MTFCY, staff should refer to policy in B-474.1.2, Medical Programs, 2; and Other Medical Programs, Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

A—116.7.4 Medicaid Coverage for 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-120, Office Procedures

A—121 Receipt of Application

Revision 22-1; Effective January 1, 2022

All Programs

Applications must be signed before certification.

TANF

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

SNAP

An application is valid if it contains 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 contains 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 for whom a new EDG is needed. 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 15-4; Effective October 1, 2015

Medical Programs

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

 

A—121.2 Receipt of Duplicate Application

Revision 15-4; Effective October 1, 2015

All Programs

A duplicate application:

  • is an application filed after another application has already been filed;
  • does not include a request for programs different from programs requested on the initial application submitted;
  • does not include a request for programs different from programs currently received by the applicant; and
  • is not needed for a redetermination of any active program.

Example: If a household submits an application for SNAP on January 2 and later submits one or more additional applications for SNAP that are different from the one the household filed on January 2, and are not needed for a redetermination of any active program, the additional application submitted is considered a duplicate application.

Duplicate Application Received While Original Application Is Being Processed

If an office receives a duplicate application while staff are in the process of making an eligibility determination (an application or redetermination) based on the original application submitted, staff must:

  • treat the duplicate application as a report of change; and
  • assign the duplicate application as a change to the advisor currently processing the case.

The advisor processing the original application must:

  • review the duplicate application for reported changes;
  • document the duplicate application was reviewed for changes;
  • document the type of changes, if changes were reported on the duplicate application; and
  • use information provided by the household on both the original application and the duplicate application when determining eligibility for the household.

Duplicate Application Received After Original Application Is Processed

If an office receives a duplicate application and the applicant has already been certified for assistance based on another application previously submitted, staff must review the duplicate application to determine if the household is applying for programs other than what the household is currently receiving and if any redeterminations are due.

If the household is applying for different types of programs, the application is not a duplicate application and must be processed as a new application for assistance.

If the household is not applying for a different type of program and there are no redeterminations, office staff must:

  • treat the duplicate application as a report of change; and
  • assign the duplicate application as a change indicating "duplicate application."

Staff are not required to create a T number for TIERS cases and/or dispose of a duplicate application as "filed in error." If staff erroneously create a T number, staff must deny/dispose the T number as filed in error, in addition to other required actions listed above.

Note: If the office that receives the duplicate application does not normally process reported changes, staff may mark the application form as a duplicate application and route it to appropriate staff following local office procedures.

Advisors who process the duplicate application as a reported change must review the application to determine if any changes are indicated and take the following action. If no change is indicated on the duplicate application, the advisor must:

  • document receipt of the duplicate application in TIERS Case Comments;
  • route the duplicate application to be imaged as part of the electronic case record;
  • sustain the benefits for each Texas Works program the household receives; and
  • send an individual notice to the household that eligibility for benefits has not changed.

If a change is indicated on the duplicate application, staff must follow the procedures outlined in 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 20-4; Effective October 1, 2020

All Programs

The applicant is required to provide a signed application form before being certified.

If the agency receives an application without a signature and the application has not been date-stamped, the application is considered invalid. 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 signature and the application has been 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 requesting 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: TW Advisors, MEPD Specialists, and other HHSC staff cannot accept telephonic signatures.

Applications signed and submitted over the phone by the applicant or AR, are considered signed by phone except in the following situations:

  • 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, which 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, which notifies the person a signature is needed to complete the application process for TW medical programs; and
  • Form H1010, Texas Works Application for Assistance - Your Texas Benefits, the unsigned application for TW medical programs, which is populated with information provided over the phone.

OR

  • Form M5021C, Cover Letter for Missing Signature Letter, which notifies the person a signature is needed to complete the application process for TW medical and MEPD programs;
  • Form H1010, Texas Works Application for Assistance - Your Texas Benefits, the unsigned application for TW medical programs which is populated with information provided over the phone; and
  • Form H1200, Application for Assistance - Your Texas Benefits, the unsigned application for MEPD, which 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

If the applicant signs the first page of Form H1010, Texas Works Application for Assistance - Your Texas Benefits, but not the last page, the application can still be used to establish a file date. The applicant must still provide a signature for the last page to be certified.

If a signed first page of Form H1010 is received, send Form H1020 requesting a signature on the last page of Form H1010 by the final due date. Deny applicants who fail to provide a signed last page of Form H1010 for failure to provide information.

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. Make an attempt to call the applicant and inform them to file an application. No action is taken on Form H1010-MR, MAGI Renewal Addendum, without a corresponding application.

If the applicant returns a signed application without Form H1010-MR, the application is considered 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 15-4; Effective October 1, 2015

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

Provide the individual with an appointment on Form H1830, Application/Review/Expiration/Appointment Notice, on the same day the individual submits an application unless the individual is interviewed on the same day. An appointment is required even if the application is filed with only a name, address and signature.

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

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

Note: Staff should attempt to schedule the interview on a date and time that accommodates the needs of the household, such as after working hours if the only adult is working.

When scheduling a telephone interview, staff enters the individual’s telephone number and the appropriate time, using one-hour increments. For example, a telephone interview will be conducted between 1 p.m. and 2 p.m. Local offices may choose to establish a shorter time increment.

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

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

Exceptions:

  • If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice, or for missing an appointment related to Health Care Orientation (HCO) or THSteps, staff should schedule a telephone appointment and deliver the HCO, or remind the individual about the importance of the THSteps checkup at that time.
  • Staff conducts a telephone interview for an initial application or renewal when HHSC receives conflicting information related to household composition or income that affects eligibility and the information cannot be verified through other means, such as an associated EDG.

Related Policy

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

 

A—122.3 Registering an Application

Revision 15-4; Effective October 1, 2015

All Programs

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

To prevent overpayments or incorrectly providing benefits, staff must take the following action before registering an application:

  • screen each application filed; and
  • associate the old case number in File Clearance when appropriate.

Perform inquiry on all household members applying for benefits listed on the application for assistance. Use Social Security numbers (SSNs), case name search, and/or available case or EDG numbers to determine case status.

If inquiry shows then
no record, follow established local office procedures for processing applications.
an individual record, check case/EDG status (active or denied). If the case is active, determine if the individual is currently active on another case in the same program. If the individual is:
  • not currently active in the same program, register the application.
  • entitled to dual SNAP participation as a resident of a shelter for battered persons, follow procedures in 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-CAP or SNAP-SSI case record, check for CBS status in TIERS inquiry. SNAP-CAP will be listed as FS-SNAP under Current EDG Affiliations in case inquiry results and under Current Eligibility in individual inquiry results. SNAP-SSI will be listed as FS-SSI under Current EDG Affiliations in case inquiry results and under Current Eligibility in individual inquiry results. Follow established local office procedures applicable to the specific case situation.

SNAP

Staff must review the application for assistance to determine if the household is requesting a telephone interview due to a hardship.

Note: Staff use Form H1000-A, Notice of Application, to register applications and to obtain a unique EDG number when:

  • TIERS is down for an extended period;
  • the household is not known to TIERS;
  • the household is eligible for expedited services; and
  • the Administrative Terminal Application (ATA) must be used to assign the EDG number and issue benefits.

 

A—123 Withdrawal of an Application

Revision 15-4; Effective October 1, 2015

All Programs

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

SNAP

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

Related Policy

The Texas Works Message, A-1527

 

A—124 Processing Presumptive Eligibility Applications

Revision 15-3; Effective July 1, 2015

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

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

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

Qualified entities (QEs) determine PE for pregnant women and MBCC applicants. For MBCC applicants, only QEs that are also Texas Department of State Health Services (DSHS) Breast and Cervical Cancer Services contractors may make MBCC PE determinations, following the process outlined in 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
  1. Individual does not apply for regular Medicaid
A child is determined eligible for MA-Children 6–18 Presumptive on February 2. Her mother does not submit an application for regular Medicaid. The child’s PE coverage ends on March 31. 
  1. Individual is ineligible for regular Medicaid
A child is determined eligible for MA-Children Under 1 Presumptive on April 4. Her father submits an application for regular Medicaid on the same date. HHSC determines on April 20 that the child is not eligible for regular Medicaid. Her PE coverage ends on April 20.
  1. Individual is eligible for regular Medicaid (HHSC makes eligibility determination before cutoff)
A child is determined eligible for MA-Children 1–5 Presumptive on March 6. His mother submits an application for regular Medicaid on the same date. HHSC determines on March 15 (before cutoff) that the child is eligible for regular Medicaid. His PE coverage ends March 31. He is certified for regular Medicaid effective March 1 to March 5 and April 1 through ongoing. 
  1. Individual is eligible for regular Medicaid (HHSC makes eligibility determination after cutoff)
A former foster care child is determined eligible for MA-FFCC Presumptive on May 9. He submits an application for regular Medicaid on the same date. HHSC determines on May 22 (after cutoff) that the individual is eligible for regular Medicaid. His PE coverage ends June 30. He is certified for regular Medicaid effective May 1 to May 8 and July 1 through ongoing. 
  1. Pregnant woman is eligible for regular Medicaid
A woman is determined eligible for MA-Pregnant Women Presumptive on June 4. She submits an application for regular Medicaid on the same date. HHSC determines on June 10 that the woman is eligible for regular Medicaid. Her PE coverage ends on June 30. Regular Medicaid overlays her PE coverage with an effective date of June 1.

 

A—124.7 Periods of Presumptive Eligibility

Revision 15-3; Effective July 1, 2015

Pregnant women are allowed one PE period per pregnancy.

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

 

A—124.8 Fair Hearings

Revision 15-3; Effective July 1, 2015

Appeals and fair hearings do not apply to PE.

 

A—124.9 Questions About the Presumptive Eligibility Process

Revision 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-130, Interview Procedures

A—131 Interviews

Revision 21-4; Effective October 1, 2021

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 SNAP-SSI redeterminations conducted by Centralized Benefit Services (CBS), no interview is required unless:
    • the household requests an interview;
    • the case contains earned income; or
    • it appears the household is going to be denied.

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

SNAP and TANF

Conduct a phone interview for all households who provide a phone number. This includes households with a member disqualified for an intentional program violation (IPV) unless the household requests a face-to-face interview.

TP 08 and TA 31

Applicants and recipients must complete a phone interview unless the person requests a face-to-face interview. Applicants and recipients cannot be required to complete a face-to-face interview.

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

No interview is required to apply for or renew Children's Medicaid. Schedule an interview only if the person requests an interview.

When a family contacts HHSC to request an application for Children's Medicaid, offer the option to start the application process by phone. The family can complete the application process by phone, but they must provide or return a signed Form H1205, Texas Streamlined Application, with any other required verification to complete the process.

Exceptions:

  • If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice, or for missing an appointment related to Health Care Orientation (HCO) or Texas Health Steps, schedule a face-to-face appointment. Deliver the HCO or remind the person about the importance of the Texas Health Steps checkup at that time. 
  • Conduct a face-to-face interview for an initial application or renewal when HHSC receives conflicting information related to household composition, income or resources that affects eligibility and cannot verify the information through other means, such as an associated case.

Related Policy

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

TP 40 and TP 36

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

Provide continuous coverage for a pregnant woman without Form H1205 or Form H1010, Texas Works Application for Assistance - Your Texas Benefits, or an interview if she meets the criteria for continuous Medicaid coverage.

Related Policy

Continuous Medicaid Coverage, A-832 

Additional Policy Related to Phone Interviews

If the office initially schedules a phone interview and the person subsequently requests a face-to-face interview before the phone interview appointment time, staff must allow the household to receive a face-to-face interview and must not treat it as a missed appointment.

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

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

Staff must indicate in TIERS, in the Voter Registration Information section of the Individual Demographics - Citizen page, to mail Form H0025, HHSC Application for Voter Registration, to applicants who are interviewed by phone, if a voter registration application is requested. If "Yes" is selected in the dropdown, TIERS automatically mails Form H0025 to the household.

If the person declines to register to vote, staff must mail Form H1350, Opportunity to Register to Vote, and ask the person to sign and return the form. Staff must also indicate in TIERS, in the Voter Registration Information section of the Individual Demographics - Citizen page, that the person declined, and document that Form H1350 was mailed to the person.

Related Policy

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

TP 45 Retroactive Coverage

Provide retroactive TP 45 coverage for the newborn child without Form H1205 or Form H1010 or an interview with the child's mother if the household meets the criteria for TP 45 retroactive coverage.

Related Policy

TP 45 Retroactive Coverage, A-833 

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/Translation Services

Revision 17-4; Effective October 1, 2017

All Programs

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

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

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

Advisors use the following methods for interpretation only after exhausting all local and regional resources:

  • Language Line Services – This service is available to all regions. Staff can access the service by calling 1-800-375-1184 and using their 11-digit employee identification number.
  • Applicants/recipients may provide their own interpreter (only if they wish to do so). Note: Advisors may use minors, age 15 or older, as interpreters only at the individual's request and when the minor accompanies the individual to the interview. Advisors must not use a minor under age 15 as an interpreter.

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

  • Schedule a telephone interview if the applicant indicates the contact phone on the application is a TDD/TTY line, unless the applicant requests a face-to-face interview. Note: Relay Texas can be reached at these numbers:
    • 7-1-1, 1-800-RELAYTX (1-800-735-2989), Spanish to English (Spanish speaking callers to English speaking HHSC staff) at 1-888-777-5861;
    • and Spanish to Spanish at 1-800-662-4954.
  • If unable to reach the applicant by phone, advisors must schedule a face-to-face interview and arrange for interpreter services at the interview location.

Note: In situations where an interpreter services vendor is not available, staff may use handwritten notes back and forth with the hearing-impaired individual as long as the notes are an effective means of communication with the individual.

A—131.2.2 Availability of Translated Written Material

Revision 15-4; Effective October 1, 2015

All Programs

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

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

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

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

A—131.3 Interview Requirements

Revision 15-4; Effective October 1, 2015

All Programs

During the interview, the interviewer must:

  • protect the applicant's confidentiality and conduct the interview as a confidential discussion of household circumstances;
  • review the application and resolve unclear and incomplete information with the household;
  • advise the household of their rights and responsibilities, including the right to appeal;
  • advise the household of the application processing time frames;
  • advise the household of their responsibility to report changes;
  • ensure that the address on TIERS reflects the individual's current address; and
  • explain the various policies, rights, and responsibilities as required in A-1500, Reminders.

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

  • Verify that the household agrees that the information is complete and correct on the application form and in the case documentation for household composition, income, and expenses;
  • Verify that the income and expense information obtained for past periods (including self-employment) accurately reflect the amounts that can be anticipated for future income and expenses, according to policy in A-1355, How to Project Income. If the information is inaccurate, the advisor must determine why it is inaccurate;
  • Determine whether households with questionable or negative management, as described in A-1710, General Policy, are able to explain how the household's bills are paid;
  • Determine whether households with other discrepancies in information that could affect eligibility are able to provide information to resolve those discrepancies;
  • Determine whether there is a reason for households who have not provided all verification requested on Form H1020, Request for Information or Action, beyond the household's control that prevents the household from providing verifications. If the advisor designates a collateral source, the advisor should accept the individual statement or use other forms of verification for the missing verifications as required by policy in A-1370, Verification Requirements;
  • Determine whether income verification may be calculated based on year-to-date information from other paychecks provided by the household when income verification is missing for a particular pay period(s), rather than requesting it on Form H1020; and
  • Refer the household to other state or local resources for types of assistance the household requested on the application form, such as child care, child support, utilities, or rent, that are provided by other agencies.

TANF

  • Determine whether any adult household member has received TANF cash assistance from another state since October 1999. Refer to A-1920, Determining the Number of FTL Months Used.
  • Determine whether any member of the household has been disqualified in another state for a felony or drug conviction.
  • Determine whether any member of the household has been disqualified from participating in TANF for an intentional program violation (IPV) in another state. See 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 15-4; Effective October 1, 2015

All Programs except TP 40

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

Advisors must provide the applicant Form H1020, Request for Information or Action, explaining:

  • what is needed,
  • the due date for receipt of the information, and
  • the date the advisor
  •  must deny the application if the advisor does not receive the information.

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

Medical Programs

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

TP 40

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

A—136 Eligibility Decision 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.

A-140, Expedited Service

Revision 22-1; Effective January 1, 2022

SNAP

All expedited applications are screened using the expedited screening questions on Form H1010, Texas Works Application for Assistance – Your Texas Benefits. HHSC staff screen applications received in the local office. Vendor staff screen applications sent to the Document Processing Center (DPC) by fax or mail. An automated system screens any application submitted 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 already received the maximum 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 in this time frame:

  • Applicants in a drug and alcohol (D&A) treatment or a group living arrangement (GLA) facility. Process these applications to allow the resident an opportunity to receive benefits by the seventh day after the application date.
  • Joint SNAP and SSI applicants released from public institutions. The Centralized Benefit Services (CBS) unit processes these applications to allow the person an opportunity to receive benefits by the fifth day after release from the institution.

Late Determinations

Applicants may not receive benefits in this time frame in late determinations for expedited service. These are households that:

  • the agency did not identify as entitled to expedited service based on the information provided on the application. Expedited processing begins on the day the office becomes aware the applicant is entitled to expedited 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 penalty period for failure to follow Employment and Training (E&T) service requirements, but the household has chosen to delay their certification until all disqualified members have signed Form H1808, SNAP Work Rules;
  • qualify for a phone interview, but HHSC must mail the application back to the household for signature. The late determination date is the date the agency receives the applicant’s signed application;
  • mail or drop off Form H1010 or Form H1010-R, Your Texas Works Benefits: Renewal Form. Contact the applicant and conduct an interview. If the applicant cannot be contacted by phone, mail Form H1830-I, Interview Notice (Applications or Reviews), the same day the application is screened, notifying the applicant of potential eligibility for expedited service and instructing the applicant to contact HHSC. If the household also applied for a TANF or Medicaid program that requires an interview, schedule a regular TANF or Medicaid appointment on the same notice. Expedited processing begins the day the applicant contacts the office for an interview;
  • miss their expedited appointment. If the applicant subsequently contacts HHSC, conduct an interview on the earliest date the applicant is available. 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 the 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 household meets the criteria for expedited processing; or
  • applied through YourTexasBenefits.com when the office was closed due to weather-related conditions 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: Postponed verification only applies to current and ongoing coverage. For prior coverage, take action no later than 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.

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.

A-150, Combined Allotment Policy

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must issue benefits for the month of application and the following month at the same time if:

  • an applicant files the application after the 15th of the month (including reapplications filed after the 15th of the month following the last benefit month);
  • the household is eligible for the application month and the following month (including applicants eligible but not receiving an allotment for the application month because benefits prorate to less than $10); and
  • advisors must prorate the initial month's benefits.

Note: For applicants who meet expedited criteria, advisors issue a combined allotment within expedited time frames, even if postponing verification.

Inform households receiving combined allotments:

  • when the benefits will be available;
  • that no additional benefits will be available until the third month; and
  • that the third month’s benefits will be available on the regular issuance schedule.

TIERS identifies and issues benefits to households eligible for a combined allotment and holds the third month's benefits if the combined allotment certification has postponed verification.

A-160, Joint TANF-SNAP Applications

Revision 13-2; Effective April 1, 2013

TANF, SNAP and TP 08

A household in which all members are applying for or receiving TANF and/or TP 08 may apply for SNAP at the same time the household applies for TANF and/or TP 08. The advisor then conducts a single interview.

Exception: Conduct the unfinished TANF and/or TP 08 interview later if necessary to meet the SNAP expedited processing time limits.

 

 

A—161 When Receipt of TANF Is Uncertain

Revision 15-4; Effective October 1, 2015

TANF and SNAP

When TANF eligibility is uncertain, advisors must:

  • certify the household for Non-Public Assistance (NPA) SNAP benefits if eligible. Note: If the TANF members have resources, advisors do not exclude the resources for SNAP until the household’s TANF EDG is certified (see A-1248, Resources of TANF and SSI Recipients); and
  • assign an NPA certification period (see A-2324, Length of Certification).

If TANF is approved later, advisors should process it as a reported change and add the TANF benefit to the SNAP budget as soon as possible. (See A-1324.18, Temporary Assistance for Needy Families [TANF].) Advisors should adjust the certification period to expire when the next TANF periodic review is due. Advisors should send or give the applicant Form TF0001, Notice of Case Action, with the new certification period stated. Exception: One-Time Temporary Assistance for Needy Families (OTTANF), A-1324.11.

If the TANF application is denied later, the advisor should continue SNAP eligibility based on the original application.

A-170, Authorized Representatives

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 15-4; Effective October 1, 2015

TANF

A grandparent (including great- or great-great- grandparent) may represent the household in the application and review process upon the grandparent's request and when the advisor determines that the incompetent or incapacitated individual is not using TANF for the child's benefit. In these situations, the individual's signature and designation of the grandparent as AR in writing is not required on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. If the grandparent is designated AR, the grandparent is also designated protective payee.

Related Policy

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

 

A—172 AR Applying for Household

Revision 15-4; Effective October 1, 2015

All Programs

The AR must be informed about the household circumstances. The individual is liable for any overissuance resulting from inaccurate information that the AR gives, except in situations when drug/alcohol treatment centers or group living facilities act as AR for a SNAP household.

The AR must be an adult.

 

A—173 AR for Residents of Drug and Alcohol Treatment (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.

A-180, Verification Requirements

Revision 15-4; Effective October 1, 2015

All Programs

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

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

Related Policy

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

 

TANF

Staff must verify that the caretaker is not using TANF benefits for the child's needs when the grandparent requests to be designated AR. If the caretaker requests the grandparent's removal as AR, staff must verify that the caretaker intends to use TANF benefits for the child's needs.

 

SNAP

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

A-190, Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must document the date and method by which advance notice of a home visit was provided and the date and time of the visit. An imaged copy of the appointment notice provided to the individual is sufficient.

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

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

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

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

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

Advisors must document on the application and on Form H1350, Opportunity to Register to Vote, in the Agency Use Only section the actions taken when an applicant or individual notifies the local office of the decision to decline the opportunity to register to vote after receipt of Form H0025.

Advisors must document information to support the eligibility decision in enough detail that others can understand all computations and advisor decisions explained in C940, Documentation.

 

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

For all interviews, staff must document:

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

 

Medical Programs

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

 

TANF

Advisors must document the specific reason for designating an AR.

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

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

 

SNAP

The following information must be documented:

  • the name and address of the AR;
  • that no one else is available, if a person disqualified for IPV or a nonmember living with the household is appointed as AR;
  • the tax-exempt status [Section 501(c)(3)] for public or private homeless shelters, if applicable;
  • expedited service eligibility by marking the appropriate box on Form H1010 and explain if eligibility is questionable;
  • the decision on the length of certification and reporting requirements for expedited service EDG;
  • whether a migrant is in or out of the workforce;
  • the reason for entering a late determination date; and
  • the reason why an appointment for an expedited applicant is not scheduled for an interview within the expedited time frame.

Related Policy

Documentation, C-940
Registering to Vote, A-1521
The Texas Works Documentation Guide

A-210, General Policy

Revision 22-1; Effective January 1, 2022

TANF

A Temporary Assistance for Needy Families (TANF) certified group:

  • is a person or group of relatives whose needs are included in one Eligibility Determination Group (EDG).
  • must include an eligible child, unless the eligible relative cares for a child who receives:
    • Supplemental Security Income (SSI), Foster Care with Cash or Adoption Assistance with Cash; or
    • SSI Medicaid and the relative chooses not to request TANF for the child.

Some people are required members of the TANF certified group. The applicant may not choose to exclude a required member from the certified group. If the applicant fails to provide available verification for a required member, deny assistance for the entire certified group.

A TANF-State Program (SP) certified group must contain both an eligible:

  • caretaker or parent; and
  • second parent.

Note: Households are eligible for TANF-SP if the budget group contains:

  • two eligible parents who are certified for TANF;
  • one TANF-certified parent and a disqualified parent unless the disqualified parent does not meet citizenship requirements; or
  • two disqualified parents unless the disqualified parents do not meet citizenship requirements.

Related Policy

Who is Not Included, A-222
Alien Sponsor's Income, A-1361
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480

SNAP

A Supplemental Nutrition Assistance Program (SNAP) unit is one person or a group of people who live:

  • together and who usually buy and prepare their food together; or
  • with others and intend to buy and prepare food separately after certification.

Exception: Allow separate household status for a person and the person's spouse, 60 or over, who lives with others but cannot buy and prepare food separately because of permanent incapacity, if required household members are not excluded. To allow separate household status, the gross income of the other household members, not including the elderly person and spouse, must be less than 165 percent of the Federal Poverty Level (FPL) for the number of other people.

The elderly person must:

  • prove that they meet the Social Security disability criteria, if questionable; and
  • provide verification of the other household member's income.

Note: Always include required members in the elderly person's household. For example, the elderly person's spouse or children under 22 are always included in the same household unless elderly members have their own SNAP Combined Application Project (SNAP-CAP) EDGs.

Related Policy

Who Is Included, A-231
Noncommercial Roomer/Boarder Payments, A-1323.4.3
Disqualified Members, A-1362
Alien Sponsor's Income, A-1361
Students in Higher Education, B-410
Definition of Disability, B-432
Joint Supplemental Security Income (SSI)-SNAP Applications, B-476
Categorically Eligible Households, B-470

Medical Programs

Use Modified Adjusted Gross Income (MAGI) household composition to determine whose needs, income, and expenses are considered when determining eligibility for medical programs. Each MAGI household composition is determined at a person's individual level. People living at the same physical address may have a different MAGI household composition. MAGI household composition is based on federal income tax rules.

Exception: Medically Needy with Spend Down has certain exceptions for determining MAGI household composition and income.

A person does not have to file a federal income tax return to apply for Medical Programs.

Related Policy

How to Determine Spend Down, A-1359

A—211 Relationships Resulting from Termination of Parental Rights

Revision 15-4; Effective October 1, 2015

All Programs

When a court terminates the relationship between a biological or adoptive parent and child, a legal parent/child relationship does not exist between the two individuals.

If a biological or adoptive parent's parental rights to a child are terminated, that parent no longer has a legal parent/child relationship to that child, nor to any of the child's children who are born after the date the parental rights were terminated.

Example: Amy's parental rights to her child Julie are terminated when Julie is 16. Julie already has one child, Jill, at the time Amy's parental rights are terminated. Subsequently, Julie has a second child, Bill. As a result, Amy no longer has a legal relationship with Julie or Bill, but she retains her grandparent relationship to Jill.

Note: A parent whose parental rights have been terminated is not considered the natural parent of their biological child.

Relationships that existed between the child and other relatives of the biological parent are not interrupted or terminated. The only relationship terminated is that of the parent that relinquished his or her parental rights. Example: The child's biological or adoptive grandparents, siblings, aunts, uncles, and cousins still have the same relationship to the child they had before the parental rights were terminated.

Related Policy

Child Support and Medical Support Referrals, A-1122.2

A—212 Relationships Resulting from Adoption Procedures

Revision 15-4; Effective October 1, 2015

All Programs

A legal parent/child relationship is created when an individual adopts a child. The adoptive parent/child relationship creates the same relationships with the adoptive parent's relatives that are created with a biological parent/child relationship. Example: When a grandparent adopts a biological grandchild, the:

  • grandparent becomes the child's adoptive parent, and
  • the biological parent becomes the child's adoptive sibling.

A—213 Adoption Household Composition Situations

Revision 15-4; Effective October 1, 2015

TANF

Adoption household composition is determined by the advisor using the following steps:

Step 1

Identify all eligible children for the applicant/recipient.

Step 2

Include all eligible children in the certified group.

Step 3

Include all siblings of the children included in Step 2 if they are eligible children and cannot be certified separately from their sibling. Include a minor's child at the caretaker/payee's request.

Example 1

If a household consists of the applicant, the applicant's two biological children, ages 15 and 17, the 15-year-old's baby (age 1) that the applicant has adopted, and the 17-year-old's 2-year-old baby, the advisor must:

Step 1 Identify eligible children:
  • 15-year-old (daughter of applicant)
  • 17-year-old (daughter of applicant)
  • 1-year-old (adopted daughter)
  • 2-year-old (applicant's grandchild – include at applicant's request)
Step 2 Include in certified group:
  • applicant
  • 15-year-old
  • 17-year-old
  • 1-year-old
Step 3 Include in certified group at the applicant's request:
  • 2-year-old

Example 2

If a household consists of the applicant, adopted child (biological grandchild), and the adopted child's half-sibling, not related to the applicant, the advisor must:

Step 1

Identify eligible children:

  • adopted child
Step 2 Include in certified group:
  • applicant
  • adopted child
Step 3 N/A – there are no optional eligible children.

Note: For TP 32, TP 33, TP 34, TP 35, TP 43, TP 44, TP 48 or TP 56, the half-sibling can be considered an independent child when determining the child's eligibility for Medicaid. See A-910, General Policy.

A-220, TANF

A—221 Who Is Included

Revision 18-1; Effective January 1, 2018

TANF

The following are always included in the TANF certified group:

  1. Eligible Child

    An eligible child is a person who meets TANF requirements, is not married according to Texas state law, and is:
    • under age 18; or
    • age 18 and:
      • is a full-time student (as defined by the school) in high school, attends an accredited general equivalency diploma (GED) class, or regularly attends vocational or technical training as an equivalent to high school attendance; and
      • expects to graduate before or during the month of the child’s 19th birthday.

    Notes:
    • GED is approved only if the class is administered by an accredited institution.
    • When removing a child age 18 or 19 from the grant, A-1424, Diversions, Alimony, and Payments to Dependents Outside the Home, is used to determine whether to divert for the child's needs.
    • A child certified for foster care Medicaid only or adoption assistance Medicaid only is a potentially eligible child.

    An emancipated minor is an eligible child if the:
    • child meets the TANF age criteria;
    • child is not married in accordance with Texas state law; and
    • caretaker/payee exercises parental control of the child.

  2. Eligible Legal Parent

    An eligible legal parent is a legal parent who meets TANF requirements and lives with an eligible child. This includes a parent who is absent solely because of employment or active duty in the U.S. military. See A-1040, Deprivation Based on Absence from the Home. This includes parents receiving foster care or adoption assistance services for themselves, but not the child(ren).

    Exception: See No. 6, Minor Parents, below.
  3. Siblings

    A sibling is a brother or sister of an eligible child, including legally adopted and half-brothers and sisters. Siblings must be certified together if they meet all TANF requirements. If an unborn child will be a required member of the certified group, a special review is set for the first day of the month after the expected delivery month.

    Note: Half-brothers/sisters who do not meet the degree of relationship to the caretaker are not eligible to receive TANF benefits but can be certified as an independent child on a separate Medicaid EDG. See A-910, General Policy.

    Example: The household consists of a grandparent, two grandchildren and a half-sibling to the grandchildren. The two grandchildren can be certified for TANF and Medicaid because they meet the required degree of relationship to the caretaker. The half-sibling does not meet the required degree of relationship to the caretaker and cannot be certified for TANF. The half-sibling can be certified as an independent child on a separate Medicaid EDG.

    Exception: See No. 6, Minor Parent, below.
  4. Caretaker

    A caretaker is any specified relative who:
    • is present in the home; and
    • supervises and cares for the TANF child(ren).

    A caretaker must be the child's:
    • father or mother;
    • grandfather or grandmother;
    • brother or sister;
    • uncle or aunt;
    • first cousin;
    • nephew or niece;
    • stepfather or stepmother;
    • stepbrother or stepsister; or
    • first cousin once removed.

    Relationship extends to the:
    • Spouse of the listed relatives, even after the marriage has ended in death or divorce, regardless of when the child's birth occurred.
    • Degree of "great-great" for uncles/aunts and nephews/nieces.
    • Degree of "great-great-great" for grandparents.

    A caretaker meets the relationship requirement even if a court has jurisdiction over the child or an agency is the child's managing conservator. If a child lives with a managing conservator, the conservator must meet the relationship requirement.

    If a child lives with a married relative (not a parent) who wants to be considered the caretaker, eligibility and benefits are determined using:
    • normal budgeting procedures for the applicant's income, and
    • stepparent budgeting for the income of the applicant's spouse.

    Note: See A-1366, Stepparent EDGs, for budgeting.

    If the person applying for the child cannot qualify to receive TANF, the individual’s needs are not included in the certified group. If no one qualifies as caretaker, only the needs of the eligible children are included.

    No one else is included as caretaker if the legal parent is:
    • in the home; and
    • physically and mentally able to provide care.

    Exception: The stepparent may be certified as caretaker if the stepparent wants to be included and the legal parent has a disability. The stepparent and legal parent who has a disability are certified for TANF-SP when the stepparent is included in the certified group.

    Related Policy
    Relationship, A-520
    Relationship Charts, C-1440

  5. Second Parent

    When a child lives with both legal parents, both parents are included in the certified group. The parent who is not the caretaker is the second parent. The second parent must meet all TANF requirements.

    The household may be certified for TANF-SP when:
    • both parents are eligible and certified for TANF;
    • one parent is eligible and certified for TANF and the other parent is disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements; or
    • both parents are disqualified for one of the reasons listed in A-222, No. 4, unless that disqualification is due to not meeting citizenship requirements.

    Related Policy
    General Policy, A-1310
  6. Minor Parent

    A minor parent and child(ren) living with the minor parent's parent(s) and/or siblings may:
    • be certified separately if the:
      • minor parent's parent(s)/sibling(s) is not a TANF applicant/recipient; or
      • minor parent cannot be included in his parent(s)'/sibling(s)' TANF EDG because he is not an eligible child; or
    • continue to receive TANF on a separate EDG if the minor parent's EDG was certified before the:
      • month the parent(s)/sibling(s) applied for TANF; or
      • day the minor parent moved into the home with the parent(s)/sibling(s).

    Otherwise, the minor parent must be included as a child with the:
    • legal parent(s) who receives TANF/TANF-SP; or
    • sibling certified for TANF/TANF-SP as a child.

    If the caretaker or payee in the EDG requests TANF for the minor parent's child, the child is included in the EDG with the caretaker/payee and the minor parent.

    Exception: A married minor parent is an eligible legal parent and must be certified separately from the minor parent’s parents. See No. 1, Eligible Child, above.

    Related Policy
    Requirement for Unmarried Minor Parents to Live with an Adult or in an Adult-Supervised Setting, A-930
    Unmarried Minor Parent Income, A-1365
    Stepparent Budgeting Procedures, A-1366.2
  7. Stepparents

    A stepparent is not a child's legal parent but is the legal parent's spouse. Stepchildren are deprived of parental support because one legal parent is absent.

    Include the stepparent in the certified group only if the stepparent wants to be included and:

    • the stepparent is the only parent in the home; or
    • both the legal parent and the stepparent are in the home and the legal parent has a disability according to policy in A-1051, Determining Incapacity.
    Certify the stepparent and legal parent with disabilities for TANF-SP when the stepparent is included in the certified group. If the legal parent and stepparent live in the home and have mutual children, they must all be included in the same certified group. Related Policies
    Resources of Stepparents, A-1247
    Stepparent EDGs, A-1366
    A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480
  8. People in Nursing Homes

    If a member of the TANF-certified group temporarily enters a nursing facility, the individual’s needs are left in the TANF budget during the nursing facility stay or until the individual is certified for Supplemental Security Income (SSI). The individual should be referred to the Social Security Office for an SSI eligibility determination.

A—222 Who Is Not Included

Revision 20-4; Effective October 1, 2020

TANF

The following are not included in the TANF-certified group:

  1. Payee

    A payee is a relative who meets relationship requirements and lives with, supervises, and cares for an eligible child. The payee is authorized to receive the TANF benefits for an eligible child but is not a member of the certified group because the person is a:

    • legal parent who would be a caretaker but is ineligible due to receipt of SSI; or
    • relative other than the legal parent who qualifies as a caretaker except the person:
      • chooses not to be included as caretaker;
      • receives SSI, Foster Care with Cash or Adoption Assistance with Cash payments;
      • is disqualified for an intentional program violation (IPV); or
      • fails to comply with a program requirement that would disqualify a legal parent (see No. 4, Disqualified Members, below).


    Note: A payee who chooses not to be included as a caretaker on one EDG may be a caretaker on another TANF EDG for other related children.

  2. Protective Payee

    A protective payee must be selected to receive and manage the TANF benefit if the caretaker is not using the TANF payments for the children's benefit.

    The protective payee must be someone who can help the person spend the household's TANF benefits properly. The person receiving TANF must agree to the person designated as the protective payee unless the:

    • Texas Department of Family and Protective Services (DFPS) designates a protective payee; or
    • staff designate the grandparent (including great- or great-great-grandparent) as authorized representative and protective payee, because the parent is not using the TANF payments for the child's benefit.


    The protective payee cannot be a:

    • Texas Health and Human Services Commission (HHSC) employee; or
    • person who provides HHSC services to the family.


    The protective payee situation must be re-evaluated at each complete redetermination. For EDGs with a:

    • DFPS-requested protective payee, DFPS must be contacted at each complete redetermination to determine whether the protective payee should continue; and
    • grandparent designated as protective payee and authorized representative. Investigate any alleged report of the grandparent not using TANF for the child's benefit.


    Note: When designating or continuing a protective payee, notify the person and allow an opportunity to appeal.

  3. Representative Payee

    A representative payee is designated if a person is unable to receive and manage the household's TANF or Medicaid benefits because of incapacity or incompetence. The representative payee must be knowledgeable about the family members and interested in the family’s welfare. The person must designate this representative in writing if physically or mentally capable of doing so.

    The representative payee may be the authorized representative who assisted in the eligibility process.

  4. Disqualified Members

    A legal parent is disqualified from the certified group if the person:

    • does not meet citizenship requirements;
    • refuses to comply with Medicaid third-party resource (TPR) requirements;
    • does not comply with Social Security number requirements;
    • is found guilty of an IPV;
    • fails to timely report the temporary absence of a certified child;
    • is a fugitive fleeing to avoid prosecution of or confinement for a felony criminal conviction, or found by a court to be violating federal or state probation or parole;
    • is convicted of a felony drug offense (not deferred adjudication) for the possession, use or distribution of a controlled substance as defined in 102(6) of the Controlled Substances Act [U.S. Code (USC) 802(6)] that was committed on or after April 1, 2002, in Texas or another state;
    • has received benefits for the total months allowed by the state time limit;
    • is a minor parent who fails to comply with the unmarried minor parent domicile requirement; or
    • is denied for refusal to cooperate with the program integrity assessment (that is, quality control) process.


    Note: A legal parent is permanently disqualified for a felony drug conviction (not deferred adjudication) for an offense that was committed on or after April 1, 2002.

    A child is disqualified from the certified group if the child:

    • is a fugitive;
    • fails to comply with Social Security number requirements;
    • is a minor parent and fails to report the temporary absence of their child; or
    • is convicted of a felony drug offense that was committed on or after April 1, 2002.


    If the disqualified member wishes to apply for Medicaid, determine which medical program applies to the disqualified household member. If all eligibility requirements are met, the member is certified on the appropriate medical program.

    When the criminal history report in the Data Broker system indicates the person has been convicted of an offense involving a controlled substance, the situation should be discussed with the person. If the person claims not to be the person indicated on the criminal history report but the identifying information on the report (name, date of birth, physical description) leads staff to believe the report is correct, or the person disagrees with other information provided in the report (for example, the type of conviction or whether it was a felony or misdemeanor), staff will:
    • document the person’s response in Case Comments;
    • proceed with the appropriate EDG action without acting on the criminal history report;
    • contact the Office of Inspector General (OIG) Benefits Program Integrity (BPI) Department by emailing the OIG BPI mailbox; and
    • document the reason for contacting OIG BPI in Case Comments. Once OIG BPI obtains information to clear the discrepancy, the assigned OIG BPI investigator provides the information via email. Staff responsible for clearing the task must document the results of the OIG BPI's findings in Case Comments and, if applicable, enter information in the Data Collection-Individual Demographic-Conviction/Rehabilitation page. Make an overpayment referral if appropriate.
  5. SSI Recipients

    A TANF family member is removed from the grant when the person is certified for SSI. The Social Security Administration (SSA) notifies HHSC via an interface when a TANF recipient is determined eligible for SSI.

  6. Residents in State Supported Living Centers for Individuals with Intellectual Disabilities

    If a TANF recipient enters a state supported living center for persons with intellectual disabilities, the person’s needs are removed from the TANF grant. If the recipient is the caretaker or payee, the grant continues for the remaining eligible children in another eligible person's name.

  7. Strikers

    A household's application or ongoing benefits are denied for any month in which a certified or disqualified legal parent is participating in a strike.

  8. Foster Care with Cash Payment, Adoption Assistance with Cash Payment, and Permanency Care Assistance (PCA) with Cash Payment recipients.

    A person receiving these cash benefits is not included in the TANF EDG.

    Note: A person may potentially receive DFPS foster care through their 22nd birthday month. Adoption assistance and PCA are only received through the 18th birthday month unless the family signs an agreement after the youth turns age 16. When this occurs, the youth may receive adoption assistance or PCA through their 22nd birthday month.
  9. Ineligible Children

    A child who is ineligible, such as an ineligible alien child or a child who is not within the required degree of relationship to the adult caretaker or payee, is not included.

Related Policies

Authorized Representatives, A-170
TANF, A-220
Temporary Absence from the Home, A-920
General Policy, A-1210
Disqualified Members, A-1362
Use of TANF Benefits, A-1553
When the Person Signs Form H1073, A-2128.1
Filing an Overpayment Referral, B-770

A—223 Certifying Children on Non-Parent Caretaker EDGs

Revision 16-3; Effective July 1, 2016

TANF

When an eligible child lives with a relative other than the legal parent, the child is certified on:

  • a separate EDG when the relative receives TANF for children who are not the child's natural, adopted, or half siblings (designate the relative as a payee); or
  • the same EDG with the non-parent caretaker when the relative:
    • requests it and is not receiving TANF for any other children; or
    • is receiving TANF for children who are the child's natural, adopted, or half siblings.

Each other-related child (other than siblings) is certified on a separate EDG.

Exception: Other-related children are certified on the same EDG if:

  • at least one EDG is ineligible separately;
  • the members would be eligible if the EDGs were combined; and
  • the relative requests that they be combined.

A child's TANF must not be denied because of the income or resources of a:

  • child who is not the child’s natural, adopted, or half sibling; or
  • caretaker who is not the child’s parent (see A-1366.2, Stepparent Budgeting Procedures).

When an EDG is denied because of the income or resources of a non-parent relative caretaker:

  • process the denial for the EDG including the caretaker's request for aid; and
  • process a separate EDG to determine the child's eligibility without the caretaker.

Note: Households that include a non-parent caretaker are not eligible for TANF-SP.
See B-480, A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, for more information on the action to take when some members must be denied while others remain eligible.

Related Policy OTTANF, A-2411 Grandparent Payments, A-2412 Documentation Requirements, A-2470

>A—224 Special Household Composition Situations

Revision 02-8; Effective October 1, 2002

A—224.1 TANF-SP EDGs with Stepchildren or a Parent's Child from a Previous Relationship

Revision 15-4; Effective October 1, 2015

TANF

The following must be included in the TANF-SP EDG:

  • a child who lives with a natural/adoptive parent, a stepparent, and a sibling who is the parent and stepparent’s mutual child.
  • parents and all children, when:
    • the legal parents of a mutual child are not married to each other, and
    • one or both have a child living in the home who is not a mutual child.

If the household is ineligible for TANF-SP because they do not meet other TANF eligibility requirements such as income or resources, the family unit must remain as one filing unit even when stepchildren are included. In this situation, the advisor must determine whether the household meets eligibility requirements for the Medical Programs.

If an active TANF-SP EDG is denied because of earnings or the removal of the 90 percent earned income deduction and the household is receiving TP 08, the Texas Integrated Eligibility Redesign System (TIERS) will deny both the TANF-SP and TP 08 EDGs and create:

  • a transitional Medicaid EDG if the certified group meets the eligibility criteria; or
  • another Medical Program type of assistance EDG for eligible members if they are not eligible for transitional Medicaid and are otherwise eligible for medical coverage.

Related Policy

Transitional Medicaid Coverage, A-840
General Eligibility Information, A-841
TP 07 Transitional Medicaid, A-842

A—224.2 TANF-SP EDGs with an Other-Related Child

Revision 15-4; Effective October 1, 2015

TANF

Each other-related child living in the family (see A-223, Certifying Children on Non-Parent Caretaker EDGs) is certified on a separate EDG unless the child or other members are ineligible separately. If the child or other members are ineligible separately, the other-related child in the TANF-SP EDG is included. The advisor must ensure that the other-related child has the opportunity to continue receiving TANF when the TANF-SP EDG is denied.

A-230, Supplemental Nutrition Assistance Program

A—231 Who Is Included

Revision 16-4; Effective October 1, 2016

SNAP

The following people must be certified as a Supplemental Nutrition Assistance Program (SNAP) household if they live together:

  1. Parents and children (natural, adopted or step) age 21 or younger. Parents and children living together when the parent or child is away from home for employment or educational purposes only, and returns home at least one day a month are considered. This includes college students who are eligible for SNAP, as explained in B-410, Students in Higher Education.

    Notes:
    • Consider the individual’s age as 22 beginning the month they turn age 22.
    • Do not consider a parent whose parental rights were terminated as the natural parent of a child.
    • The relationship between a stepparent and stepchild terminates when the marriage between the parent and stepparent terminates, either by death or divorce.
    • When DFPS places a child in foster care, the foster child is considered under parental control of the foster parent. If the foster child's parent moves into the home, the parent, child and foster parent must all be included in the SNAP household.
    • If the parents of a child do not live together and the child lives with each parent part of the month, the child can be certified with either parent as long as both parents do not apply. If both parents apply, then certify the parent who provides the majority of meals for the child.
  2. A child under age 18 and any nonparent adult household member with parental control over the child. A child not under parental control may apply separately if the child purchases and prepares food separately. Individuals age 18 are considered beginning the month they turn age 18.

    Exceptions: Even if under parental control of a nonparent household member:
     
    • A foster parent or caregiver has the option to include or exclude a foster/Permanency Care Assistance (PCA) child/adult as a household member in the SNAP-certified group. Households with more than one child/adult can opt to include some foster/PCA children/adults while excluding others, even if the foster/PCA children/adults are related to each other or related to the foster parent or caregiver. A foster/PCA child/adult who is excluded from the foster/PCA family's SNAP-certified group is not eligible to participate in SNAP alone as a separate household or as a certified member on another household's SNAP EDG. See A-1326.4, Foster Care and Permanency Care Assistance (PCA) Payments, for information on how to budget foster care/PCA payments.
    • The household may consider a foster child as a boarder instead of a household member. See A-1323.4.3, Noncommercial Roomer/Boarder Payments.
    • A child under age 18 who purchases and prepares food separately can apply separately if the child is:
      • married and living with the spouse; or
      • the parent of a minor child living in the home.
    • A child under age 18 residing with a SNAP-CAP participant can apply separately. The minor child is certified as the SNAP head of household. See B-475.3, Household Composition.
  3. Spouses. Spouses are people who:
    • are married to each other; or
    • live together and represent themselves to the community as married. This definition may differ from state laws governing common-law marriage.
      • A same-sex marriage that occurred before June 26, 2015, is considered valid effective June 26, 2015.
      • A same-sex marriage that occurred on or after June 26, 2015, is considered valid on the date it occurred.

Note: Spouses are considered to be living together even when one spouse:

  • is away from home for employment or educational purposes only; and
  • returns home at least one day a month.

Exception: SNAP-CAP participants are certified on separate EDGs.

A—232 Who Is Not Included

Revision 15-4; Effective October 1, 2015

 

A—232.1 Nonmembers

Revision 22-1; Effective January 1, 2022 

SNAP

The following are not included in a Supplemental Nutrition Assistance Program (SNAP)-certified group:

  1. Roomers — Certify a roomer who pays for lodging but not food as a separate household unless the person meets one of the three categories of who is included in a SNAP household, if they live together.
  2. Live-in attendants — Certify a live-in attendant as a separate household, unless the person meets one of the three categories of who to include in a SNAP household, if they live together.
  3. Boarders — Boarders in noncommercial boarding houses cannot receive SNAP separate from the household they live with. Boarders who live in a commercial boarding house cannot participate in SNAP. Note: A foster parent or caretaker has the option to include or exclude a foster child or adult as a SNAP household member.  
  4. Ineligible students — Students in higher education who do not meet the student eligibility criteria.
  5. New household members — Do not add new household members certified in another household to the new EDG until they are removed from the previous EDG. Exception: Residents in shelters for battered persons may receive two allotments in the same month, if the original benefits issued to the former household included the battered persons, the children and the abuser.
  6. Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP) participants — Certify people living with an active SNAP-CAP participant as a separate household.
  7. Institutional residents — Residents who are offered more than half their meals from a facility that is not an approved institution. 

Note: Residents of institutions such as homeless shelters, drug and alcohol treatment (D&A) or group living arrangement (GLA) facilities, or family violence shelters are potentially eligible for SNAP, if it is an approved institution. These residents may be certified separately, regardless of how they purchase and prepare meals with other residents. The resident’s SNAP household still includes mandatory required SNAP household members, if they live together.

Common examples of institutions are hospitals, nursing homes, public or private homes for persons with a disability, establishments for delinquents and young offenders, group homes for children, penal and correctional institutions, jails, homeless shelters, and students living in a school dormitory where most meals are provided.

Foster placement agencies place some foster children or adults in homes or facilities other than foster parent homes, and are cared for by people who are employees of, or contract with placement agencies. Such facilities usually house multiple foster children or adults. Foster children or adults who reside in these unapproved institutions rather than in the foster parent’s home, are considered institutionalized and cannot receive SNAP.

Related Policy

Applications from Residents of a Homeless Shelter, A-116.2
Who Is Included, A-231
Noncommercial Roomer/Boarder Payments, A-1323.4.3
Foster Care and Permanency Care Assistance (PCA) Payments, A-1326.4
Students in Higher Education, B-410
Ineligible Students, B-413
Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440
Residents in Family Violence Shelters, B-450
Participation Twice in Same Month, B-454
Prepared Meal Services, B-460
Household Composition, B-475.3
Determining Whether a Person Who Resides in a Facility Is Institutionalized, B-490

A—232.2 Disqualified Persons

Revision 20-4; Effective October 1, 2020

SNAP

The following are people who would be required SNAP household members but are disqualified. They cannot participate during their period of disqualification. However, the disqualified person’s circumstances, including income and resources, are considered in determining the household's benefits.

  1. Fugitives

    People who are fleeing to avoid prosecution of or confinement for a felony criminal conviction, or are found by a court to be violating federal or state probation or parole.
     
  2. People with a felony drug conviction

    A person with a felony drug conviction (not deferred adjudication) in Texas or another state occurring on or after Sept. 1, 2015, for the possession, use or distribution of a controlled substance as defined in 102(6) of the Controlled Substance Act [21 USC 802(6)]:
  • who violates a condition of parole or community supervision, incurs a two-year SNAP disqualification; or
  • A person who is convicted of a subsequent felony drug offense in Texas or another state, while receiving SNAP, incurs a permanent disqualification from receiving SNAP.

The person's statement is accepted as verification of a felony drug conviction.

When the criminal history report in the Data Broker system indicates the person was convicted on or after Sept. 1, 2015, for an offense involving a controlled substance, discuss the situation with the person. If they claim not to be the person indicated on the criminal history report, but the identifying information on the report (name, date of birth, physical description) leads staff to believe the report is correct, or the person disagrees with other information provided in the report (such as the type of conviction or whether it was a felony or misdemeanor):

  • document the person's response in Case Comments;
  • proceed with the appropriate case action without acting on the criminal history report;
  • contact the OIG by emailing the OIG Benefits Program Integrity (BPI) mailbox; and
  • document the reason for contacting OIG BPI in Case Comments. Once OIG BPI obtains information to clear the discrepancy, the assigned OIG BPI investigator provides the information via email. Staff responsible for clearing this task must document the results of the OIG BPI's findings in Case Comments and, if applicable, enter information in the Data Collection-Individual Demographic-Conviction/Rehabilitation page. Make an overpayment referral if appropriate.
  1. Intentional Program Violation (IPV)

    People disqualified for an IPV in Texas or another state.
     
  2. Noncooperation with SNAP Employment and Training (E&T)

    People disqualified for failing to cooperate with E&T requirements.
     
  3. Noncooperation with Social Security number (SSN) requirements

    People disqualified for failing to cooperate with SSN requirements.
     
  4. Ineligible Alien

    People who do not have eligible alien status to receive benefits.
     
  5. SNAP Able Bodied Adult Without Dependents (ABAWD) Work Requirement

    People who are age 18 up to age 50 (ABAWDs) who have received their initial three months of SNAP benefits and who do not meet the ABAWD work requirement.

Related Policy

Absence of Proof of Alien Status, A-313
Failure to Comply, A-420
Disqualified Members, A-1362
Noncooperation with E&T, A-1844
After the Three Months of Time-Limited SNAP Eligibility, A-1951
Filing an Overpayment Referral, B-770
IPV Disqualification Penalties, B-912

A-240, Medical Programs

Revision 16-4; Effective October 1, 2016

Medical Programs

The following individuals may be certified for medical coverage if they meet all eligibility criteria:

  • children under age 19;
  • other-related children under age 19;
  • independent children under age 19;
  • pregnant women;
  • legal parent(s);
  • caretaker relatives; or
  • spouse of caretaker relatives.

MAGI rules are used to determine financial eligibility for certain Medical Programs. MAGI rules are based on Internal Revenue Service tax rules.

The following criteria are considered when determining the MAGI household composition for Medical Programs:

  • tax status;
  • tax relationships;
  • living arrangements; and
  • family relationships.

Tax Status

An individual's tax status must be designated before their MAGI household composition can be determined.

Tax status is based on the individual's self-declaration for what he or she plans to report on his or her federal income tax return for the taxable year in which eligibility for Medical Programs is requested.

Individuals must be designated as one of the following:

  • A taxpayer – an individual who plans to file a federal income tax return for the taxable year in which eligibility for Medical Programs is requested and who is not claimed by another taxpayer. Spouses who plan to file a joint or separate federal income tax return are both considered taxpayers.

Note: For MAGI household composition purposes, an unmarried individual who intends to file a joint tax return is considered a taxpayer filing separately. An individual who is unmarried is not considered a taxpayer filing jointly.

  • A tax dependent – an individual who plans to be claimed as a tax dependent by a taxpayer.

Note: An individual who is both a taxpayer and tax dependent is considered a tax dependent. Example: A college student who plans to file his or her own federal income tax return and expects to be claimed by his or her parents will be considered a tax dependent.

  • A non-taxpayer/non-tax dependent – an individual who does not plan to file a federal income tax return in the taxable year in which eligibility for Medical Programs is requested and does not plan to be claimed by a taxpayer. 

Tax Relationships

Individuals have a tax relationship to one another if they:

  • plan to file a joint federal income tax return;
  • are the taxpayer that plans to claim specific tax dependent(s); or
  • are a tax dependent of a specific taxpayer.

Individuals do not have a tax relationship to anyone if they:

  • do not plan to file a federal income tax return;
  • are not the taxpayer planning to claim the specified tax dependent(s); or
  • are not a tax dependent of a specified taxpayer.

Living Arrangements

Individuals are not required to live at the same physical address in order to apply for each other if they have a tax relationship, as explained in A-121, Receipt of Application.

Domicile requirements explained in A-900, Domicile, apply to TP 08, Parents and Caretaker Relatives Medicaid. A parent/caretaker relative must reside with a dependent child to receive TP 08 benefits.

A child entering a state hospital may qualify as an independent child. The child may qualify even if ordered by the court into a state hospital. A child is considered an independent child if court ordered into a state hospital because the parent/caretaker relative no longer has care and control. If the parent/caretaker relative admitted the child voluntarily into a state hospital, verification of whether the parent/caretaker relative still has care and control to determine independent child status is required.

An inquiry should be performed prior to certifying an independent child. The child is certified as an independent child if all eligibility criteria are met. The coverage continues for 12 months, even if the child is released from the state hospital. If a child is released from the facility prior to the end of the 12-month period, the address change is processed and coverage is continued.

Determining Custodial Parent

A custodial parent is established based on physical custody and who has legal authority to claim a child as a tax dependent specified in a court order, binding separation agreement, divorce agreement, or custody agreement.

  • If there is no order or agreement, or in the event of a shared custody agreement without specifications for filing federal income tax returns, the custodial parent is the parent with whom the child spends most nights. In the event that the child spends an equal amount of nights with both parents, the advisor must make a prudent person decision regarding which parent should be considered the custodial parent.
  • If both a custodial parent and a non-custodial parent declare that they plan to claim the same child as a tax dependent on their federal income tax return, the advisor should build the child's MAGI household composition as a tax dependent of the custodial parent. 

Family Relationships

Family relationships that impact household composition include:

  • marriage;
  • parents of children under age 19; and
  • siblings under age 19 or a child under age 19.

The tax status of the individual impacts how the family relationship is used in determining MAGI household composition.

Notes:

  • For MAGI only applications and renewals, a relationship and tax status of unmarried and intending to file jointly is not an indication that the individual is currently married or that there is a discrepancy in the individual's marital status.
  • For integrated applications and renewals that include SNAP or TANF, a relationship and tax status of unmarried and intending to file jointly should be treated as a case clue if marital status is questionable.
  • For all applications and renewals, if the client provides a tax document with an indication of marital status that is inconsistent with the marital status that was reported on an application, the discrepancy in the marital status must be resolved.

A household cannot choose to exclude a child from the budget group when determining eligibility for Medical Programs. 

The policy in A-241, Budget Group, and A-242, Certified Group, is used to determine whom to include in the budget and certified group.

Related Policy

Children Admitted into State Hospitals, A-922
Verification Requirements, A-940
Documentation Requirements, A-950
Applications for Babies Born to Women in Prison, A-116.3
Eligibility Requirements, A-521

A—241 Budget Group

Revision 12-1; Effective January 1, 2012

A—241.1 Who Is Included

Revision 15-4; Effective October 1, 2015

A—241.1.1 Taxpayer's MAGI Household Composition

Revision 15-4; Effective October 1, 2015

Medical Programs

The following individuals are included in the taxpayer's MAGI household composition:

  • The taxpayer;
  • The taxpayer's spouse, if the taxpayer and the spouse live together;
  • The taxpayer's spouse, if the taxpayer and spouse file a joint federal income tax return; and
  • Any individual the taxpayer plans to claim as a tax dependent.

A—241.1.2 Tax Dependent Exceptions

Revision 19-1; Effective January 1, 2019

Medical Programs

If a tax dependent meets any one of the following exceptions, staff must use the non-taxpayer/non-tax dependent rules explained in A-241.1.4, Non-Taxpayer/Non-Tax Dependent's or Tax Dependent with an Exception MAGI Household Composition, (not the tax dependent rules) to build the tax dependent's MAGI household composition:

  • The tax dependent is not the taxpayer's spouse or the taxpayer's child (natural, adopted or step) regardless of age;
  • The tax dependent is a child under age 19 who lives with both parents who do not plan to file a joint federal income tax return and the child was claimed by one parent; or
  • The tax dependent is a child under age 19 who is claimed as a tax dependent only by a non-custodial parent.

For a child claimed as a tax dependent by both parents who are filing jointly, with one parent living outside the home, the child does not meet the third tax dependent exception. Staff must build the child's MAGI household composition using the tax dependent rules explained in A-241.1.3, Tax Dependent's MAGI Household Composition.

A—241.1.3 Tax Dependent's MAGI Household Composition

Revision 15-4; Effective October 1, 2015

Medical Programs

If an individual is a tax dependent and does not meet a tax dependent exception previously listed, the following individuals must be included in the tax dependent's MAGI household composition:

  • The tax dependent;
  • The individuals in the MAGI household composition of the taxpayer who is planning to claim the tax dependent; and
  • The tax dependent's spouse, if the tax dependent and the spouse live together.

A—241.1.4 Non-Taxpayer/Non-Tax Dependent's or Tax Dependent with an Exception MAGI Household Composition

Revision 15-4; Effective October 1, 2015

Medical Programs

If an individual does not plan to file a tax return nor plans to be claimed as a tax dependent, the individual is considered a non-taxpayer/non-tax dependent. All tax dependents who meet an exception – Tax Dependent Exceptions­ – will build his or her MAGI household composition using the non-taxpayer/non-tax dependent rules.

The following individuals must be included in the non-taxpayer/non-tax dependent's or tax dependent with exception's MAGI household composition if living together

  • The individual,
  • The individual's spouse,
  • The individual's children under age 19, and
  • If the individual is a child under age 19:
    • The individual's parents, and
    • The individual's siblings under age 19.

A—241.1.5 Inclusion of the Unborn

Revision 16-4; Effective October 1, 2016

Medical Programs

The expected number of unborn children are included in the MAGI household composition of:

  • a pregnant woman; and
  • any individual whose MAGI household composition includes a pregnant woman.

Note: When including the expected number of unborn children in the MAGI household composition, the pregnant woman is not required to be certified on a medical program.

Related Policy

General Policy, A-910
Income Limits and Eligibility Tests, A-1341
Who Is Included, D-321
Who Is Not Included, D-322

A—241.2 Who Is Not Included

Revision 15-4; Effective October 1, 2015

Advisors must use the MAGI household composition policy explained in A-241.1, Who Is Included, when determining eligibility for Medical Programs. 

A—241.3 Household Composition Situations (Minor Parents, Independent Children, Etc.)

Revision 15-4; Effective October 1, 2015

Advisors must use MAGI household composition policy explained in A-241.1, Who Is Included, when determining eligibility for Medical Programs.

A—241.3.1 Children's Living Arrangements

Revision 22-1; Effective January 1, 2022

Medical Programs

A child is considered institutionalized if the child is residing in a facility:

  • that is an organizational part of a governmental entity, such as a county holding facility for juveniles; or
  • over which a government unit exercises final administrative control.

A child is not considered institutionalized if the child is residing in a facility that is a:

  • publicly operated community residence that serves no more than 16 residents, such as a county emergency shelter;
  • non-public facility, such as a group or foster home or a general residential operations facility;
  • state hospital; or
  • halfway house operated by the Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) that allows residents freedom of movement and association according to the following tenets:
    • residents are not precluded from working outside the facility in employment available to people not under justice system supervision;
    • residents can use community resources at will; and
    • residents can seek health care treatment in the community to the same or similar extent as other Medicaid enrollees.

Related Policy

Child Placed in a Non-Secure Facility, B-544

A—241.4 Family Violence Exemption

Revision 15-4; Effective October 1, 2015

Medical Programs

Individuals may not be able to or may not want to provide information about a member of their MAGI household composition because they fear physical or emotional harm by that person. Individuals who are pended for missing information about a MAGI household composition member who may be a family violence offender can contact HHSC to request the family violence exemption by calling 2-1-1 or visiting a local office.  

Advisors must ask the individual requesting the family violence exemption, at the time the exemption is requested, if they want to be designated as the head of household for the case. Advisors must also confirm the address that should be used for agency correspondence and offer to set up an alternate address if needed. Individuals experiencing family violence must be allowed to provide an address for agency correspondence other than the address on the case with the offender.

If the individual wants to pursue the family violence exemption, advisors must determine whether the individual has existing approved Office of the Attorney General (OAG) good cause for TANF or TP 08 as explained in A-1130, Explanation of Good Cause. 

  • If the individual has existing OAG good cause, no further action is required for the individual. The advisor must select "OAG Good Cause" as the verification source in TIERS.
  • If the individual does not have existing OAG good cause, the advisor must make a referral to a family violence specialist at a nearby family violence service provider, following the process explained in A-241.4.1, Referral to a Family Violence Specialist. 

A—241.4.1 Referral to a Family Violence Specialist

Revision 15-4; Effective October 1, 2015

Advisors must send the contact information for the nearest family violence shelter to the individual pursuing the family violence exemption using Form H1071, Family Violence Exemption for Medicaid and CHIP. Form H1071 informs the individual how they can claim the family violence exemption and is sent along with Form H1020, Request for Information or Action. 

The individual must contact the family violence specialist and explain the need to claim the family violence exemption. After the family violence specialist makes the recommendation, the family violence specialist completes Form H1706, Good Cause Recommendation and Family Violence Exemption, and may mail or fax the form to HHSC, or send the form back with the individual to HHSC. Only a family violence specialist can recommend the exemption using Form H1706. Form H1706 is due 10 days from the date Form H1020 was sent (or 30 days from the file date, whichever is later).

  • If the family violence specialist recommends the family violence exemption, the exemption is granted and will affect all MAGI EDGs on the case by removing the offender from their MAGI household composition. 
  • If the family violence specialist does not recommend the family violence exemption, the exemption is denied. The advisor must re-pend the MAGI EDGs to give the individual additional time to provide the information that was originally requested for the MAGI household member.
  • If Form H1706 is not returned by the due date, the exemption is denied. All pending MAGI EDGs are denied for failure to provide information that was originally requested for the MAGI household member.
  • If the client withdraws the request for the family violence exemption, the client must provide the information that was originally requested for the MAGI household member by the due date, or the pending MAGI EDGs are denied.

Once the family violence exemption has been established by a family violence specialist, advisors do not need to re-evaluate the exemption. If the individual contacts HHSC to indicate that they no longer wish to receive the family violence exemption, advisors should update the page by indicating that the exemption has been withdrawn by the client.

The individual continues to receive the family violence exemption until there is a break in eligibility for all MAGI EDGs on the case. If an individual wants to pursue the family violence exemption again after a break in eligibility, advisors must follow the referral process explained in this section.

A—242 Certified Group

Revision 17-1; Effective January 1, 2017

Medical Programs

Each EDG will have one individual in the certified group.

TP 08

Parents and caretaker relatives caring for a dependent child who receives Medicaid.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Pregnant women, children under age 19, and parents and caretaker relatives who are ineligible for ongoing Medicaid because they are non-immigrants, undocumented aliens, or certain legal permanent resident aliens who do not meet the citizenship eligibility requirement but meet all other eligibility requirements. Only a person with an emergency medical condition is certified.

TP 40

Minor or adult pregnant woman unless disqualified from Medical Programs for not complying with TPR or SSN requirements.

TP 43

Children under age 1.

If the child is hospitalized on the child's first birthday, eligibility is continued through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 44

Children age 6 to 18. Children are eligible through the month of their 19th birthday.

Note: A child should be certified for TP 48 rather than TP 44 the month of the child's sixth birthday.

If the child is hospitalized on his 19th birthday, eligibility is continued through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 45

Children under 12 months old whose mother was eligible for and receiving Medicaid at the time of the child's birth. The mother's eligibility for the child's birth month can be determined retroactively.

TP 48

Children age 1 to 5. Children are eligible through the month of their sixth birthday.

Note: A child should be certified for TP 45 (or 43) rather than TP 48 the month of the child's first birthday.

If the child is hospitalized on the child's sixth birthday, eligibility continues through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 56

The following individuals should be certified for TP 56 if they meet all other eligibility criteria:

  1. A pregnant woman with household income that exceeds the income limits for TP 40 unless disqualified from Medical Programs for not complying with:
    • TPR requirements; or
    • SSN requirements.
  2. Children under age 19 with household income that exceeds the income limits for TP 43, TP 44 and TP 48 unless disqualified from Medical Programs for not complying with:
    • TPR requirements; or
    • SSN requirements.

A-250, Verification Requirements

Revision 19-1; Effective January 1, 2019

SNAP and TANF

Fugitive status for people who are fleeing felons or violating their probation or parole must be verified.

TANF

There are no verification requirements for household determination. See A-500, Age/Relationship; A-900, Domicile; and A-1000, Deprivation.

Verify out-of-state disqualifications for felony drug convictions.

SNAP

Verify the following:

  • household size, if questionable, or if a regional requirement;
  • out-of-state disqualifications for intentional program violations;
  • out-of-state disqualifications for felony drug convictions;
  • compliance with parole or community supervision for individuals with a felony drug conviction on or after Sept.1, 2015 at each application, renewal, and when adding a new individual with a felony drug conviction at a change; and
  • whether a felony drug conviction is:
    • subsequent to another felony drug conviction on or after Sept. 1, 2015; and
    • received while the individual was receiving SNAP.

The individual's statement is acceptable verification of a felony drug conviction.

The individual's statement about who buys and prepares meals, is acceptable unless questionable.

An elderly person with disabilities claiming separate household status must provide verification of:

  • meeting criteria in B-432.1, Social Security's Criteria for Disability, if questionable; and
  • other household members' income.

Medical Programs

In order for an advisor to determine a person’s MAGI household composition, each individual on the application must provide his or her tax status, which will identify the individual as a taxpayer, tax dependent, a non-taxpayer or non-tax dependent. Additionally, applicants must provide the following information on their tax relationships to one another:

  • a taxpayer who plans to claim one or more dependents must provide the name(s) of the dependent(s);
  • a taxpayer who plans to file a joint federal income tax return with a spouse must provide the spouse’s name;
  • a taxpayer who plans to file a separate federal income tax return from his or her spouse must provide the name and filing status of the spouse; and
  • a tax dependent must provide the name of the taxpayer(s) who expects to claim him or her.

Note: For a pregnant woman, if tax status information is not available and the client cannot be reached, the advisor can create a Medicaid for Pregnant Women (TP 40) EDG and certify the pregnant woman by postponing verification of tax status, as explained in A-145.1, Postponed Verification Procedures. TIERS will use the non-tax payer/non-tax dependent household rules to build and pend the TP 40 EDG for the tax status information. Advisors must verify tax status for a TP 40 EDG after certification if the tax status was not verified by the client during the eligibility determination.

A—251 Verification Sources

Revision 19-1; Effective January 1, 2019

SNAP and TANF

  • Current school record showing the same address as the specified relative
  • Visual observation of the child
  • Statement from non-relative landlord
  • Statement from non-relative neighbor
  • Hospital, clinic, health department or private doctor's record
  • Statement from clergy
  • Court child support order
  • Juvenile court records
  • Child welfare records
  • Marriage license/certificate
  • Juvenile Medicaid Tracker (only for those placed or released by the Texas Juvenile Justice Department or Juvenile Probation Department)

An out-of-state human services agency can verify intentional program violations and felony drug convictions.

Fugitive status for fleeing felons and probation or parole violators can only be verified by law enforcement with a:

  • written notification that law enforcement is actively seeking to apprehend the individual within the next 30 days; and
  • copy of the arrest warrant.

For fugitives who are fleeing felons, the arrest warrant must also contain one of the following National Crime Information Center (NCIC) codes:

  • Escape (4901);
  • Flight to Avoid (4902); or
  • Flight-Escape (4999).

Note: Staff must not pend for, or attempt to obtain, the verification of fugitive status for fleeing felons or probation or parole violators from the household. Verification of fugitive status is provided to HHSC by law enforcement when they are actively seeking to apprehend individuals.

TANF

An out-of-state human services agency can verify time limits.

SNAP

Compliance with parole or community supervision for people with a felony drug conviction on or after Sept. 1, 2015 can be verified using:

  • Form H1806, Parole/Community Supervision Report; or
  • answers to the parole or community supervision compliance questions submitted online through YourTexasBenefits.com or the Your Texas Benefits Mobile App when the person who has the felony drug conviction is the same individual who:
    • signed the online application;
    • signed the renewal; or
    • submitted the change. 

Subsequent felony drug convictions while receiving SNAP can be verified using:

  • Criminal history in Data Broker
  • Out-of-state human services agency
  • TIERS inquiry

Medical Programs

The client’s statement is an acceptable verification source for MAGI household composition, including a person’s tax status and tax relationships.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

A-260, Documentation Requirements

Revision 16-3; Effective July 1, 2016

TANF and TP 08

An explanation of persons living in the home who are not included on the EDG must be documented for TANF and TP 08. See A-540, Documentation Requirements; A-950, Documentation Requirements; and A-1080, Disability Verification, for documentation requirements for relationship, domicile and deprivation.

TANF

The following must be documented:

  • specific reason for designating a representative payee;
  • basis for giving separate household status to married minors;
  • name and telephone number of the out-of-state human services employee;
  • months of TANF cash assistance received in other states since October 1999 by an adult household member;
  • that the household was informed of the one-time payment at application and whether the caretaker requested it or declined it; and
  • that a grandparent was informed of the one-time grandparent payment at application or periodic review if the grandparent is potentially eligible and whether they requested it or declined it.

SNAP

The following must be documented:

  • explanation of the household composition;
  • basis of granting separate household status;
  • individual's response to Data Broker information if the individual disagrees with the information;
  • reason for an OIG referral resulting from the Data Broker criminal history record for a felony drug conviction;
  • the result of OIG's findings;
  • disqualification status of any disqualified household member;
  • name and telephone number of the out-of-state human services employee who provides verification;
  • name of the household member currently disqualified for an intentional program violation in another state (see B-941, Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification, for additional documentation requirements); and
  • number of any countable months of benefits received in another state as an able bodied adult without dependents (ABAWD).

Related Policy
The Texas Works Documentation Guide

A-310, General Policy

Revision 13-2; Effective April 1, 2013

All Programs

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

A person born in the 50 states, District of Columbia, Puerto Rico,
Guam, the U.S. Virgin Islands, America Samoa, Swain's Island or Northern
Marianna Islands is considered a U.S. citizen.

A person born abroad to at least one U.S. citizen parent may claim derivative citizenship. See How to Verify Citizenship, A-351.4.

Exception: Undocumented aliens applying for Emergency Medicaid do not have to meet citizenship status eligibility requirements.

A-311 Alien Status Policies

Revision 22-2; Effective April 1, 2022

All Programs

Before certifying any alien resident, ensure that the U.S. Citizenship and Immigration Services (USCIS):

  • legally admitted the person to live in the United States; and
  • they meet the definition of a "qualified immigrant".

Review the person's USCIS document(s) and the Qualified Alien Status Eligibility charts to determine the programs where the person is potentially eligible. Disqualify a person who does not have acceptable alien status. Check USCIS documents for expiration dates. An expired document is not acceptable.

Exception:

Do not disqualify the person:

  • if the person provides an expired USCIS document; and
  • the Systematic Alien Verification for Entitlements (SAVE) response indicates the person is a Lawful Permanent Resident – Employment Authorized; and
  • the ‘Date Admitted To’ response shows ‘Indefinite’, the person meets alien status criteria.

Notes:

  • Use the TANF and Medical Programs Alien Status Eligibility Charts to determine Emergency Medicaid eligibility for aliens without acceptable status.
  • Before disqualifying a person with an expired document, check the expiration date of the document in SAVE. USCIS automatically extends certain I-766, Employment Authorization Documents, for up to 180 days when USCIS receives a renewal application for the document. When this occurs, SAVE displays the new expiration date. Do not disqualify the person if SAVE shows the I-766 is current.

Related Policy

Definition of Qualified Immigrant, A-311.1
Qualified Alien Status Eligibility Charts, A-340
Verification of Alien Status, A-352
Verifying Alien's USCIS Documents, A-355 

A-311.1 Definition of Qualified Immigrant

Revision 22-2; Effective April 1, 2022

All Programs

The USCIS defines a qualified immigrant as an alien in one of the following categories:

Note: The Qualified Alien Status Eligibility Charts list all the above categories.

Related Policy

Qualified Alien Status Eligibility Charts, A-340
How to Determine Eligibility for Battered Aliens, A-343

A-312 Contact with the U.S. Citizenship and Immigration Services (USCIS)

Revision 15-4; Effective October 1, 2015

TANF and SNAP

An illegal alien is one who has received a final deportation order. Advisors must report applicants who are illegal aliens to USCIS in writing. The supervisor must sign a written notification and send it to the nearest USCIS office, which can be found at https://egov.uscis.gov/crisgwi/go?action=offices.type&OfficeLocator.office_type=LO.

Except for using the SAVE Verification Information System (VIS), advisors may contact USCIS on behalf of an alien only at the individual’s written request. If the alien does not wish to contact USCIS or give the advisor permission, the advisor must advise the household that the household may be certified without the alien (that is, disqualify the alien).

A-313 Absence of Proof of Alien Status

Revision 15-4; Effective October 1, 2015

SNAP and TANF

Advisors must disqualify a household member from the certified group if the member does not have or refuses to provide proof of alien status. The remaining members of the group are certified if they meet all eligibility requirements.

Related Policy

TANF — Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits, A-1362.1

SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

TANF

If the applicant cannot provide proof of eligible alien status for a child, the child is considered ineligible rather than disqualified.

Medical Programs

If the applicant cannot provide proof of eligible alien status after the period of reasonable opportunity explained in A-351.1, Reasonable Opportunity, the applicant is ineligible for benefits.

Household members are included in the budget group even if the member does not have proof of alien status. See A-241.1, Who Is Included.

A-314 Re-verification of Alien Status Due to a USCIS Document's Expiration Date

Revision 18-1; Effective January 1, 2018

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

Advisors must re-verify the alien's USCIS card if the:

  • USCIS document has expired; and
  • alien wants to continue receiving or reapplies for benefits.

Advisors must allow an alien 10 days to update the card with the USCIS. If the individual cannot provide an updated document or proof within 10 days, the alien is disqualified until the individual provides a valid USCIS card or proof of application for a new card.

Exception: If the individual’s USCIS document is expired and the SAVE response shows the individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted To response is Indefinite, the individual meets alien status criteria. These individuals must not be disqualified.

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

When a certified alien's USCIS document expires before the periodic review date, the advisor must schedule a special review the month the document expires.

SNAP

Advisors must set the certification period to end the same month the USCIS document expires or schedule a special review for the month the document expires.

For streamlined reporting (SR) households, the advisor must not set a special review for the month the document expires. A document that expires during the SR certification period does not cause an individual to lose eligibility. The advisor may assume that the household will renew the document upon expiration and re-evaluate at the next certification.

Related Policy

Alien Status Policy, A-311

A-315 Definition of Public Charge

Revision 15-4; Effective October 1, 2015

All Programs

A public charge is defined by law as an alien who has applied for and received public cash assistance for income maintenance, such as Temporary Assistance for Needy Families (TANF) cash assistance, Supplemental Security Income (SSI) or institutionalization for long-term care at government expense, such as nursing home care.

A-315.1 Providing Information to Immigrants Regarding Public Charge

Revision 15-4; Effective October 1, 2015

TANF

If an immigrant inquires, staff must inform the individual that receipt of TANF cash benefits places the immigrant at risk of being considered a public charge and the individual may lose his or her immigrant status.

Exception: According to USCIS, the following individuals are exempt from public charge:

  • refugees,
  • asylees,
  • asylum applicants,
  • refugees and asylees applying for adjustment of permanent resident status,
  • Cuban/Haitian entrants and parolees,
  • Special Immigrant Visa holders from Iraq and Afghanistan,
  • Amerasian immigrants (for their initial admission),
  • individuals granted relief under the Cuban Adjustment Act (CAA),
  • individuals granted relief under the Nicaraguan and Central American Relief Act (NACARA),
  • individuals granted relief under the Haitian Refugee Immigration Fairness Act (HRIFA),
  • individuals applying for a T Visa,
  • individuals applying for a U Visa,
  • individuals who possess a T Visa and are trying to become a permanent resident,
  • individuals who possess a U Visa and are trying to become a permanent resident,
  • individuals who have been certified by the Office of Refugee
    Resettlement as a victim of trafficking (prior to being issued a T Visa
    by USCIS),
  • applications for Temporary Protected Status (TPS), and
  • certain applicants under the LIFE Act Provisions.

SNAP and Medical Programs

If an immigrant inquires, the advisor must assure the individual that receipt of Supplemental Nutrition Assistance Program (SNAP) and/or medical program benefits does not place the immigrant at risk of becoming a public charge.

A-315.2 Receiving Other Benefits

Revision 15-4; Effective October 1, 2015

All Programs

There are other public assistance programs that immigrants may apply for that do not result in public charge considerations. These programs
include: Special Supplemental Nutrition Program for Women, Infants and Children (WIC), immunizations, prenatal care, testing and treatment of communicable diseases, emergency medical assistance, emergency disaster relief, housing assistance, and child care.

A-316 Sponsored Alien

Revision 15-4; Effective October 1, 2015

All Programs

A sponsored alien is an individual who has been sponsored by a person who signed an affidavit of support (USCIS Form I-864 or I-864-A)on or after December 19, 1997, agreeing to support the alien as a condition of the alien's entry into the U.S.

A sponsor is someone who brings family-based or certain employment-based immigrants to the U.S. and demonstrates that he or she can provide enough financial support to the immigrant so that the individual does not rely on public benefits.

If necessary, advisors use the SAVE system to verify whether an alien has a sponsor. The SAVE system, through additional verification, can provide the sponsor's name and address.

A-316.1 Providing Verification of the Alien's Sponsor Income and Resources

Revision 16-2; Effective April 1, 2016

TANF, SNAP, TP 08, TP 43, TP 44, TP 48, TP 40, TP 07, TP 20, TP 56, TP 70, TA 84 and TA 85

For cases involving aliens and their sponsors, the alien is responsible for getting all verification from the sponsor and sponsor's spouse.

Request the following information from the alien if not otherwise available through Systematic Alien Verification for Entitlement (SAVE) or Texas Integrated Eligibility Redesign System (TIERS) inquiry or case documentation:

  • Alien sponsor name,
  • Alien sponsor date of birth,
  • Alien sponsor Social Security number,
  • Alien sponsor earned income,
  • Alien sponsor unearned income,
  • Alien sponsor self-employment income,
  • Alien sponsor resources (if applicable, as explained in A-1245, Resources of an Alien’s Sponsor), and
  • Alien sponsor citizenship status or alien number if the sponsor is a lawful permanent resident.

The income and resources (if applicable) of an alien's sponsor (and the sponsor's spouse if the spouse also signed an affidavit of support, USCIS Form I-864) must be counted (deemed) as belonging to the sponsored alien, regardless of actual availability when determining the sponsored alien's eligibility and benefit amounts.

Deeming of the sponsor’s income and resources (if applicable) to the sponsored alien lasts until the:

  • sponsored alien becomes a naturalized citizen,
  • sponsored alien can be credited with 40 qualifying quarters of work, or
  • sponsor dies.

Sponsored aliens not subject to sponsor deeming are:

  • children under age 18;
  • sponsored aliens who are ineligible for benefits (examples include
    those who are disqualified from getting benefits or those considered
    non-members, such as students who do not meet SNAP student eligibility
    criteria);
  • battered spouses or children;
  • refugees, parolees, asylees, people granted withholding of
    deportation, Amerasians, trafficking victims, and Iraqi and Afghan
    special immigrants;
  • aliens whose sponsor has not signed an affidavit of support;
  • aliens whose sponsor is in the same household/Modified Adjusted Gross Income (MAGI) household composition; and
  • indigent aliens.

TANF, TP 08, TP 43, TP 44, TP 48, TP 40, TP 07, TP 20, TP 56, TP 70, TA 84 and TA 85

If the sponsored alien fails to provide sponsor verification by the required date in B-115, Pending Verification on Applications, the alien's application is denied.

Note: Resources of an alien sponsor must only be verified if resources are counted for that program, as explained in A-1245.

SNAP

If the sponsored alien fails to provide sponsor verification by the required date in B-115, the sponsored alien is disqualified until the alien provides the proof. If eligible, remaining household members may participate while the alien is disqualified. If the disqualified alien later provides the proof, the advisor processes it as a reported change. The Eligibility Determination Group (EDG) is denied if the household fails to provide proof of the disqualified alien's own income.

Related Policy

Resources of an Alien's Sponsor, A-1245
Alien Sponsor's Income, A-1361

A-320, Definitions of Military Connection

Revision 12-4; Effective October 1, 2012

 

A-321 Veteran

Revision 15-4; Effective October 1, 2015

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

A veteran is eligible for benefits because of a military connection if the veteran is:

  • "honorably discharged" from the armed service, and
  • meets the minimum active duty requirement of:
    • 24 months of continuous active duty, or
    • the full period the person was called or ordered to active duty.

Individuals who served in the Philippine Commonwealth Army during World War II, or as Philippine scouts following the war, are veterans for purposes of eligibility.

Related Policy

Verification of Veteran Status, A-353.1

 

 

A-322 Active Duty Military Member

Revision 15-4; Effective October 1, 2015

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

An active duty military member is eligible for benefits because of a military connection if currently on full-time duty in the U.S. Army, Navy, Air Force, Marine Corps or Coast Guard. It does not include full-time National Guard duty.

Active duty training as a member of the Reserves, Army National Guard, or Air National Guard does not establish eligibility for the individual. The advisor must determine that training is not the reason the reserve member is on active duty.

Related Policy

Verification of Active Duty Military, A-353.2

 

 

A-323 Spouse or Minor Unmarried Dependent Child of Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

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

A spouse is eligible for benefits because of a military connection if the individual is currently married to a veteran or active duty military member. A minor unmarried dependent child under age 18 is eligible.

Related Policy

Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member, A-353.3

 

 

A-324 Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

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

To meet the alien eligibility status as a surviving spouse of a deceased veteran or an active-duty military member, the spouse must not have remarried, and the marriage to the veteran or active duty military member must fulfill one of the following requirements:

  • lasted at least one year;
  • occurred within 15 years after the period of service in which the
    injury or disease that resulted in the death of the veteran or active
    duty member ended; or
  • a child was born between the surviving spouse and the veteran or active duty member, either during or before the marriage.

Related Policy

Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member, A-353.3

SNAP

If a currently certified surviving spouse remarries, the spouse retains eligible alien status through the end of the current certification period.

A-330, Lawful Permanent Resident and 40 Qualifying Quarters of Social Security Coverage

Revision 18-1; Effective January 1, 2018

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

LPRs admitted prior to Aug. 22, 1996, meet the alien eligibility requirement by having 40 qualifying quarters of social security coverage.  LPRs admitted on or after Aug. 22, 1996, meet the alien eligibility requirement by having 40 countable qualifying quarters of social security coverage, if five years have passed since the legal date of entry. An LPR does not have to meet the 40-quarter requirement, including the five-year wait, if any of the following apply.

The alien:

  • has a military connection;
  • entered the U.S. with a status described in Chart C of A-342, TANF and Medical Programs Alien Status Eligibility Charts, and meets the eligibility criteria for refugees, asylees, etc., or meets the criteria in A-343, How to Determine Eligibility for Battered Aliens; and
  • is a qualified immigrant or non-immigrant child age 18 and under who lawfully resides in the U.S. with a status described in Chart D of A-342, TANF and Medical Programs Alien Status Eligibility Charts.

SNAP

LPRs with 40 qualifying quarters meet the alien eligibility requirement. An LPR does not have to meet the 40-quarter requirement if the alien:

  • lawfully resided in the U.S. as a qualified immigrant for five years from the date of entry;
  • was admitted to the U.S. on or before Aug. 22, 1996, and was age 65 or older on Aug. 22, 1996;
  • meets the definition of disability in B-432, Definition of Disability (regardless of when the alien acquired a disability or entered the U.S.);
  • is currently under age 18 (regardless of when the alien entered the U.S.);
  • has a military connection; or
  • qualifies as a refugee, asylee, etc., as shown in Chart A of A-341, SNAP Alien Status Eligibility Charts.

Related Policy

Verifying 40 "Qualifying Quarters," A-354

 

 

A-331 Whose Quarters Can Be Considered

Revision 15-4; Effective October 1, 2015

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

For purposes of establishing eligibility through the use of the 40 "qualifying quarters" requirement,  LPRs are credited with quarters of earnings for the:

  • LPR,
  • LPR's current spouse or deceased spouse regardless if the spouse is an LPR or a U.S. citizen, and
  • LPR's parent before the LPR turned age 18. This includes adoptive parents or stepparents.

Note: All of the quarters earned by the LPR's parents through the quarter the LPR turns age 18 are counted.

When determining whether to credit the quarters to an individual's spouse, the advisor must count quarters earned:

  • beginning with the quarter from the date of marriage, and
  • by a deceased spouse only if the marriage was not terminated before the spouse died.

Quarters earned by divorced spouses for either ex-spouses do not count. LPRs who divorce after certification retain their eligible alien status through the end of the current certification period. This also applies to stepchildren.

Until the quarter a child turns age 18, to meet the 40-quarter requirement, a child may use quarters earned by:

  • natural or adoptive parents;
  • stepparents from the date of marriage to the legal parent; and
  • deceased parents.

Related Policy

Verifying 40 "Qualifying Quarters," A-354

A-340, Qualified Alien Status Eligibility Charts

Revision 18-1; Effective January 1, 2018

An alien's eligibility is based on the USCIS status and other criteria as shown in A-341, SNAP Alien Status Eligibility Charts, and A-342, TANF and Medical Programs Alien Status Eligibility Charts.

 

 

A-341 SNAP Alien Status Eligibility Charts

Revision 22-2; Effective April 1, 2022

Chart A

If the qualified alien was admitted as a/an … and the USCIS document provided is a/an … then the alien is …
Refugee
  • *I-551, Permanent Resident Card, annotated with R8-6, RE-1 thru RE-9;
  • I-94, Arrival/Departure Record, annotated with INA Section 207 or Refugee;
  • Original certification letter from the Office of Refugee Resettlement (ORR);
  • I-766, Employment Authorization Document, annotated with Code A3;
eligible from date of entry.
Asylee
  • *I-551, Permanent Resident Card, annotated with AS-6 thru AS-8;
  • I-94, Arrival/Departure Record, annotated with INA Section 208 or Asylee;
  • I-766, Employment Authorization Document, annotated with Code A5;
  • USCIS letter from Asylum Office;
  • Order from an immigration judge granting asylum;
eligible from date of entry.
Deportation Withheld
  • I-94, Arrival/Departure Record, annotated with INA Section 243(h) or 241(b)(3);
  • I-766, Employment Authorization Document, annotated with Code A10;
  • Order from an immigration judge showing deportation withheld under INA Section 243(h) or 241(b)(3). Consider the date of entry as the date the status was assigned.
eligible from date of entry.
Cuban/Haitian Entrant
  • *I-551, Permanent Resident Card, annotated with R8-6, CH-6, CU-6, CU-7;
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) or Cuba/Haitian Entrant;
  • I-94, Arrival/Departure Record, annotated with INA Section 240, Pending Hearing – Cuban granted parole for one year;
  • I-94, Arrival/Departure Record, annotated as Public Interest Parole;
  • I-766, Employment Authorization Document, annotated with Code C8;
  • Receipt from INS Asylum Office indicating filing of Form I-589, Application for Asylum;
  • I-220A, Order of Release on Recognizance; 
  • I-862, Notice to Appear.
eligible from date of entry.
Haitian Orphan
  • I-94, Arrival/Departure Record, indicating the person has humanitarian "parole" status admitted after Jan. 12, 2010;
  • Immigrant visa indicating the person was lawfully admitted for permanent residence;
  • *I-551, Permanent Resident Card, annotated with Status Code CH-6;
eligible from date of entry.
Amerasian
  • *I-551, Permanent Resident Card, annotated with one of the following Status Codes: AM-1, AM-2, AM-3, AM-6, AM-7 or AM-8;
eligible from date of entry.
Victim of Severe Trafficking
  • Derivative T Visa annotated with T-1;
  • Derivative T Visa annotated with T-2, T-3, T-4, T-5 (family members of a victim of severe trafficking);
eligible up to four years from date of entry or until the law enforcement extension expires.
Afghan or Iraqi Special Immigrant Passport with a stamp noting that the person has been admitted under a special immigrant visa (IV) category with one of the following codes:
SI-1 or SQ-1 for the principal applicant;
SI-2 or SQ-2 for the spouse of principal applicant;
SI-3 or SQ-3 for the unmarried child under 21 of principal applicant; and a Department of Homeland Security(DHS) stamp or notation on passport or I-94, showing date of entry.  This includes a DHS/CBP or DHS/USCIS temporary Form I-551 Alien Documentation Identification and Telecommunication (ADIT) stamp.

Or

*I-551 annotated with an IV code for category SQ-1, SQ-2 or SQ-3.

For special immigrants who are Special Immigrant Parolees: 

I-94 noting Special Immigrant Status (SI/SQ) Parole Section 602 (B)(1) AAPA/Sec 1059(a) NDAA 2006 or SQ4/SQ5 SI Parolee notation signed and dated by USCIS officer:

  • SQ-4 for the principal applicant; 
  • SQ-5 for the spouse or unmarried child under 21 of principal applicant.
     

For special immigrants who are adjusting their status to LPR status in the U.S.:
 

*I-551, Permanent Resident Card, annotated with one of the following status codes:

  • SI-6 or SQ-6 for the principal applicant,
  • SI-7 or SQ-7 for the spouse of principal applicant; or
  • SI-8 or SQ-8 for the unmarried child under 21 of principal applicant.


Special immigrants may also demonstrate nationality with an Afghan or Iraqi passport.

For special immigrants who are conditional permanent residents (CPRs) adjusting their status to LPR status in the U.S.:

Passport with a DHS/CBP stamp noting admission under IV Category with one of the following codes:

  • CQ1 for the principal applicant; 
  • CQ2 for the spouse of principal applicant; or 
  • CQ3 for the unmarried child under 21 of principal applicant; and 


a DHS stamp or notation on passport or I-94, showing date of entry. This includes DHS/CBP or DHS/USCIS temporary Form I-551 Alien Documentation Identification and Telecommunication (ADIT) stamp.  

Or

*I-551 with an IV code for category CQ1, CQ2, or CQ3.


Note: The entry date for an Afghan special immigrant must be Dec. 26, 2007, or later. The entry date for an Iraqi special immigrant must be Jan. 26, 2008, or later.

eligible from date of entry.

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Note: The category of aliens listed in Chart A are eligible for SNAP benefits from the date they adjust to any of the specific statuses listed in the chart. For example, once an alien is granted asylee status, they are potentially eligible for SNAP benefits.

Use the following chart to determine the eligibility of these qualified aliens. Their eligibility is indefinite regardless of their date of entry into the U.S.

Chart B

If the alien was admitted as a … and the USCIS document provided is an … then the alien is eligible if the alien …
Parolee
  • I-94, Arrival/Departure Record, showing admission for at least one year under INA Section 212(d)(5) or Parolee;
  • I-766, Employment Authorization Document, annotated with A-4 or C-11;
  • has lawfully resided as a qualified immigrant in the U.S. for five years;
  • meets the SNAP definition of disability regardless of when the alien acquired a disability or when the alien entered the U.S.;
  • is currently under 18 regardless of when the alien entered the U.S.; or
  • is the spouse, unmarried surviving spouse or minor unmarried dependent child of an honorably discharged veteran or is an active duty military member.
Conditional Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 203(a)(7);
  • I-766, Employment Authorization Document, annotated with A3;
  • has lawfully resided as a qualified immigrant in the U.S. for five years;
  • meets the SNAP definition of disability regardless of when the alien acquired a disability or when the alien entered the U.S.;
  • is currently under 18 regardless of when the alien entered the U.S.;
  • is the spouse, unmarried surviving spouse or minor unmarried dependent child of an honorably discharged veteran or is an active duty; or
  • military member.

Use the chart below to determine eligibility for Legal Permanent Residents.

Chart C

If the qualified alien was admitted as a … and the USCIS document provide is an … then the alien is eligible if the alien …
Legal Permanent Resident
  • I-151, Alien Registration Receipt Card (also known as a Green Card);
  • I-551, Resident Alien Card; and
  • *I-551, Permanent Resident Card (introduced Dec. 1997)
  • has lawfully resided as a qualified immigrant in the U.S. for five years;
  • meets the SNAP definition of disability (regardless of when the alien acquired a disability or when the alien entered the U.S);
  • is currently under 18 (regardless of when the alien entered the U.S.);
  • meets the 40 qualifying quarters requirement;
  • is an honorably discharged veteran who met the minimum active duty requirements for 24 months;
    • or the period for which the person was called to active duty;
  • is an active duty military member; or
  • is the spouse, unmarried surviving spouse or minor dependent child of an honorably discharged veteran or active duty military member.

Note: To qualify for SNAP as a surviving spouse of a deceased veteran or an active duty military member, the surviving spouse must not have remarried.

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Chart D

If the alien was admitted as a … and the USCIS document provided is an … then the alien is …
Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551, Permanent Resident Card, annotated with KIP – Kickapoo Indian Pass;
  • *I-551 annotated with S13 – American Indian born in Canada.
  • A letter or other tribal document certifying at least 50 percent American Indian blood, as required by INA Section 289, combined with a birth certificate or other satisfactory evidence of birth in Canada.
eligible.
Hmong or Highland Lao tribe member when the tribe assisted the U.S. Armed
Forces during the Vietnam War, or their spouses, unmarried dependent children, and the unmarried widow(er)s of those who are deceased
  • I-94 or *I-551
eligible if the immigrant:
  • is from Laos, Vietnam or Cambodia; and
  • claims to be a member of a Hmong or Highland Laotian tribe.

*An I-551, Permanent Resident Card, does not always include the holder's signature. 

Related Policy

Verifying 40 “Qualifying Quarters,” A-354
Verifying Alien’s USCIS Documents, A-355
Definition of Disability, B-432
 

A-342 TANF and Medical Programs Alien Status Eligibility Charts

Revision 22-2; Effective April 1, 2022

Use the following chart to determine eligibility for qualified aliens who were admitted into the U.S. before Aug. 22, 1996.

Chart A

If the qualified alien was admitted as a/an … and the USCIS document is a/an … then the alien is …
Refugee
  • *I-551, Permanent Resident Card, annotated with R8-6, RE1 thru RE9
  • I-94, Arrival/Departure Record, annotated with INA Section 207 or Refugee
  • I-766, Employment Authorization Document, annotated with Code A-3
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Asylee
  • *I-551, Permanent Resident Card, annotated with AS-6 thru AS-9
  • I-94, Arrival/Departure Record, annotated with INA Section 208 or Asylee
  • I-766, Employment Authorization Document, annotated with Code A5
  • USCIS Asylum Office letter
  • Order from an immigration judge granting asylum
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Deportation Withheld
  • I-94, Arrival/Departure Record, annotated with INA Section 243(h) or 241(b)(3)
  • I-766, Employment Authorization Document, annotated with code A10
  • Order from an immigration judge showing deportation withheld under INA Section 243(h) or Section 241(b)(3). Consider the date of entry as the date the status was assigned.
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Cuban/Haitian Entrant
  • *I-551, Permanent Resident Card, annotated with R8-6, CH-6, CU-6 or CU-7
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) or Cuban/Haitian Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 240 Pending Hearing – Cuban granted parole for one year
  • I-94, Arrival/Departure Record, annotated with Public Interest Parolee
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Haitian Orphan
  • I-94, Arrival/Departure Record, indicating person has humanitarian "parole" status admitted on or after Jan. 12, 2010
  • Immigrant visa indicating the person was lawfully admitted for permanent residence
  • *I-551, Permanent Resident Card, annotated with status code CH-5
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse including unmarried surviving spouse of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Amerasian
  • *I-551, Permanent Resident Card, annotated with one of the following status codes: AM-1, AM-2, AM-3, AM-6, AM-7 or AM-8
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Parolee
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) showing admission for at least one year
Note: This does not include Cuban or Haitian entrants.
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Conditional Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 203(a)(7)
  • I-766, Employment Authorization Document, annotated with status code A-3
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Legal Permanent Resident
  • I-151, Alien Registration Receipt Card – commonly referred to as Green Card
  • I-551, Resident Alien Card
  • *I-551, Permanent Resident Card
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551 annotated with KIC – Kickapoo Indian Citizen
  • *I-551 annotated with KIP – Kickapoo Indian Pass
  • *I-551 annotated with S13 – American Indian born in Canada
  • Letter — A letter or other tribal document certifying at least 50 percent American Indian blood, as required by INA Section 289, combined with a birth certificate or other satisfactory evidence of birth in Canada
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse, including unmarried surviving spouse, of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid or both on Aug. 22, 1996 and lawfully resided in the U.S. on or before Aug. 22, 1996; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Compact of Free Association (COFA) citizens residing in the U.S.
  • Republic of the Marshall Islands (RMI); 
  • Federated States of Micronesia (FSM); and Republic of Palau (PAL).
I-94 or I-766 annotated with the following Class of Admission (COA) Codes: 
  • CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association 
  • CFA/FSM – Citizen of the Federated States of Micronesia (FSM) 
  • CFA/PAL – Citizen of the Republic of Palau 

I-766 Employment Authorization Document (EAD) annotated with the following Category Code: 

  • A-08 Citizen of the Marshall Islands, Micronesia or Palau admitted as a nonimmigrant

An unexpired passport annotated with one of the following:

  • CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association 
  • CFA/FSM – Citizen of the Federated States of Micronesia (FSM) 
  • CFA/PAL – Citizen of the Republic of Palau 
     

 

  • Eligible for Medicaid

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Use the following chart to determine eligibility for TANF and Medicaid for qualified aliens admitted into the U.S. on or after Aug. 22, 1996.

Chart B

If the qualified alien was admitted as a/an … and the USCIS document provided is a/an … then the alien is …
Refugee
  • *I-551, Permanent Resident Card, annotated with R8-6, RE1 thru RE9
  • I-94, Arrival/Departure Record, annotated with INA Section 207 or Refugee
  • An original certification letter from the Office of Refugee Resettlement (ORR)
  • I-766, Employment Authorization Document, annotated with Code A-3
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Asylee
  • *I-551, Permanent Resident Card, annotated with R8-6, AS-6 thru AS-9
  • I-94, Arrival/Departure Record, annotated with INA Section 208 or Asylee
  • I-766, Employment Authorization Document, annotated with Code A-5
  • USCIS letter from Asylum office
  • Order from an immigration judge granting asylum
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid, including Parents and Caretaker Relatives Medicaid, for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Deportation Withheld
  • I-94, Arrival/Departure Record, annotated with INA Section 243(h) or Section 241(h)(3)
  • I-766, Employment Authorization Document, annotated with Code A-10
  • Order from an immigration judge showing deportation withheld under INA Section 243(h) or Section 241(b)(3). Consider the date of entry as the date the status was assigned.
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid, including Parents and Caretaker Relatives Medicaid, for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Cuban/Haitian Entrant
  • *I-551, Permanent Resident Card, annotated with R8-6, CH-6, CU-6 or CU-7
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) or Cuban/Haitian Entrant I-94, Arrival/Departure Record, annotated with INA Section 240, Pending Hearing – Cuban, granted parole for one year
  • I-94, Arrival/Departure Record, annotated as Public Interest Parole
  • I-220A, Order of Release on Recognizance
     
  • I-862, Notice to Appear
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Haitian Orphan
  • I-94, Arrival/Departure Record, indicating person has humanitarian "parole" status admitted on after Jan. 12, 2010
  • Immigrant visa indicating the person was lawfully admitted for permanent residence
  • *I-551, Permanent Resident Card, annotated with Status Code CH-6
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid, including Parents and Caretaker Relatives Medicaid,  for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Amerasian *I-551, Permanent Resident Card, annotated with one of the following status codes: AM-1, AM-2, AM-3, AM-6, AM-7 or AM-8
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid, including Parents and Caretaker Relatives Medicaid, for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Afghan or Iraqi Special Immigrant Passport with a stamp noting that the person has been admitted under a special immigrant visa (IV) category with one of the following codes:
  • SI-1 or SQ-1 for the principal applicant;

  • SI-2 or SQ-2 for the spouse of  principal applicant;

  • SI-3 or SQ-3 for the unmarried child under 21 of principal applicant; and a DHS stamp or notation on passport (includes DHS/CBP or DHS/USCIS temporary Form I-551 Alien Documentation Identification and Telecommunication (ADIT) stamp) or I-94, showing date of entry.

OR 

*I-551 annotated with an IV code for category SQ-1, SQ-2 or SQ-3.

For special immigrants who are Special Immigrant Parolees:

I-94 noting Special Immigrant Status (SQ/SI) Parole Section 602(B)(1) AAPA/Sec 1059(a) NDAA 2006 or SQ4/SQ5 SI Parolee notation signed and dated by USCIS officer:
•    SQ-4 for the principal applicant;   
•    SQ-5 for the spouse or unmarried child under 21 of principal applicant.
 

For special immigrants who are adjusting their status to LPR status in the U.S.:

*I-551 annotated with one of the following status codes:

  • SI-6 or SQ-6 for the principal applicant;
  • SI-7 or SQ-7 for the spouse of principal applicant; or
  • SI-8 or SQ-8 for the unmarried child under 21 of principal applicant.

Special immigrants also may demonstrate nationality with an Afghan or Iraqi passport.

For special immigrants who are conditional permanent residents (CPRs) adjusting their status to LPR status in the U.S.:
 

Passport with a DHS/CBP stamp noting admission under IV Category with one of the following codes:

  • CQ1 for the principal applicant, 
  • CQ2 for the spouse of principal applicant, or
  • CQ3 for the unmarried child under 21 of principal applicant, and a
  • DHS stamp or notation on passport (includes DHS/CBP or DHS/USCIS temporary Form I-551 Alien Documentation Identification and Telecommunication (ADIT) stamp) or I-94, showing date of entry.
     

OR

*I-551 annotated with an IV code for category CQ1, CQ2 or CQ3.

Note: The entry date for an Afghan special immigrant must be Dec. 26, 2007, or later. The entry date for an Iraqi special immigrant must be Jan. 26, 2008, or later.

  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid, including Parents and Caretaker Relatives Medicaid, for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Victim of Severe Trafficking
  • Derivative T Visa annotated with T-1
  • Derivative T Visa annotated with T-2, T-3, T-4, or T-5 (family members of a victim of severe trafficking)
eligible up to four years from date of entry or until the law enforcement extension expires.

Note: Qualified aliens retain this eligibility even if they have adjusted to LPR status.
Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551 annotated with KIC – Kickapoo Indian Citizen
  • *I-551 annotated with KIP – Kickapoo Indian Pass
  • *I-551 annotated with S13 – American Indian born in Canada
  • Letter — A letter or other tribal document certifying at least 50 percent American Indian blood, as required by INA Section 289, combined with a birth certificate or other satisfactory evidence of birth in Canada
eligible.
Member of a federally recognized Indian tribe Letter — A letter or other tribal document that verifies membership of a federally recognized Indian tribe as defined in United States Code (U.S.C.), Title 25, Chapter 14, Subchapter II, §450b(e) eligible.
Compact of Free Association (COFA) citizens residing in the U.S.
  • Republic of the Marshall Islands (RMI); 
  • Federated States of Micronesia (FSM); and Republic of Palau (PAL).
I-94 or I-766 annotated with the following Class of Admission (COA) Codes: 
  • CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association 
  • CFA/FSM – Citizen of the Federated States of Micronesia (FSM) 
  • CFA/PAL – Citizen of the Republic of Palau 

I-766 Employment Authorization Document (EAD) annotated with the following Category Code: 

  • A-08 Citizen of the Marshall Islands, Micronesia or Palau admitted as a nonimmigrant

An unexpired passport annotated with one of the following:

  • CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association 
  • CFA/FSM – Citizen of the Federated States of Micronesia (FSM) 
  • CFA/PAL – Citizen of the Republic of Palau

 

  • Eligible for Medicaid

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Note: Click on the federal regulatory language hyperlink for a list of the Indian tribes recognized by the United States Bureau of Indian Affairs.

Use the following chart to determine eligibility for all LPRs and Parolees applying for TANF and adult LPRs and Parolees applying for Medicaid who were admitted into the U.S. on or after Aug. 22, 1996.

Chart C

If the qualified alien was admitted as a/an … and the USCIS document provided is a/an … then the alien is …
Legal Permanent Resident
  • I-151, Alien Registration Receipt Card – commonly referred to as Green Card
  • I-551, Resident Alien Card
  • *I-551, Permanent Resident Card

Notes:

  • Any status code that appears on the *I-551, Permanent Resident Card, is acceptable.
  • USCIS did not issue I-151s after 1978; therefore, any alien admitted after 1978 will have an *I-551.
  • If the LPR loses the *I-551, the LPR may present either an I-94 or a passport with the following annotation:

"Processed for *I-551, Temporary Evidence of Lawful Admission for Permanent Residence, valid until ______, Employment Authorized."

not eligible.

Note: A qualified alien retains the refugee eligibility period even if they have adjusted to LPR status.

Exceptions: An LPR meets the eligibility requirements if the person:

  • is a naturalized citizen;
  • is an honorably discharged veteran or active duty military member;
  • is a spouse, unmarried surviving spouse or minor unmarried child of an honorably discharged veteran or active duty military member. (Note: To qualify for TANF/MP as a surviving spouse of a deceased veteran or an active duty military member, the surviving spouse must not have remarried.);
  • entered the U.S. before Aug. 22, 1996, and remained continuously present in the U.S. since at least Aug. 21, 1996, until obtaining qualifying immigrant status and meets the 40 qualifying quarters of Social Security coverage requirement. Note: Aliens who entered the country without proper documents, as well as those who overstayed their visa, are treated the same as those who entered and remained in the country with valid immigration documents. Any single absence from the U.S. of more than 30 days or a combined absence of more than 90 days is considered interrupted "continuous presence.";
  • Received SSI, Medicaid or both on Aug. 22, 1996, and lawfully resided in the U.S. on or before Aug. 22, 1996;
  • entered the U.S. with a status described in Chart B and meets those eligibility criteria, or meets the criteria for Battered Aliens; or
  • meets the 40 qualifying quarters requirements and five years have passed since the alien's legal date of entry.
Parolee
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) showing admission for at least one year.
Note: 
  • This does not include Cuban or Haitian entrants.

not eligible.

Exceptions: A Parolee meets the eligibility requirements if the person:

  • is a naturalized citizen;
  • is an honorably discharged veteran or active duty military member;
  • is a spouse, unmarried surviving spouse or minor unmarried child of an honorably discharged veteran or active duty military member. Note: To qualify for TANF/MP as a surviving spouse of a deceased veteran or an active duty military member, the surviving spouse must not have remarried.;
  • entered the U.S. before Aug. 22, 1996 and remained continuously present in the U.S. since at least Aug. 21, 1996, until obtaining qualifying immigrant status. Note: Aliens who entered the country without proper documents, as well as those who overstayed their visa, are treated the same as those who entered and remained in the country with valid immigration documents. Any single absence from the U.S. of more than 30 days or a combined absence of more than 90 days is considered interrupted "continuous presence.";
  • Received SSI, Medicaid or both on Aug. 22, 1996, and lawfully resided in the U.S. on or before Aug. 22, 1996;
  • entered the U.S. with a status described in Chart B and meets those eligibility criteria, or meets the criteria for Battered Aliens; or
  • has resided in the U.S. for five years since their legal date of entry.
Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551 annotated with KIC – Kickapoo Indian Citizen
  • *I-551 annotated with KIP – Kickapoo Indian Pass
  • *I-551 annotated with S13 – American Indian born in Canada
  • Letter — A letter or other tribal document certifying at least 50 percent American Indian blood, as required by INA Section 289, combined with a birth certificate or other satisfactory evidence of birth in Canada
eligible.
Member of a federally recognized Indian tribe Letter — A letter or other tribal document that verifies membership of a federally recognized Indian tribe as defined in 25 U.S.C. §450b(e) eligible.

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Notes:

  • If the alien is ineligible for Medicaid because of citizenship or alien status, determine the alien's eligibility for Emergency Medicaid.
  • The federal regulatory language (external link) provides a list of the Indian tribes recognized by the United States Bureau of Indian Affairs.

Medical Programs

Certain additional qualified immigrant and non-immigrant children age 18 and under who are lawfully residing in the U.S. may qualify for Medicaid regardless of their date of entry.

Use the following chart to determine eligibility for qualified immigrant and non-immigrant children.

Note: The documents, immigration statuses, or both listed in the chart are not all inclusive. All lawfully residing children with a valid immigration status are eligible.  Follow policy clearance request, procedures for questions about documents or immigration statuses not listed in this chart.

Exceptions:

  • Healthy Texas Women (HTW) recipients who turn 19 during their certification period will continue to receive HTW until their next redetermination. Review the HTW recipient's alien status at redetermination.
  • Medicaid for Transitioning Foster Care Youth (MTFCY) recipients qualify through the month of their 21st birthday.
  • Medicaid for Former Foster Care Children (FFCC) recipients qualify through the month of their 21st birthday.
  • Medicaid for Breast and Cervical Cancer (MBCC) recipients who applied before their 19th birthday remain eligible for Medicaid through the duration of their cancer treatment or until they no longer meet all the other eligibility criteria, whichever is earlier.

Chart D

If the qualified immigrant and non-immigrant's USCIS document is a/an … then the qualified immigrant and non-immigrant is eligible if the annotation is …
I-94
  • INA Section 212(d)(5) showing admission for less than one year – Parolee
  • INA Section 203(a)(7) – Conditional Entrant
Note: The Bureau of Customs and Border Protection (CBP) also notates the I-94 with the letters "D/S," which stands for "duration of status," meaning that the authorized length of stay is not limited.
I-797C, or USCIS referral notice, or hearing notice or order from an immigration judge 241(b)(3):
  • Convention Against Torture (CAT) – An alien who has been granted withholding of removal under CAT
  • Applicants for asylum or withholding of removal, including under CAT
  • Applicants for asylum or withholding of removal, including under CAT if under 14 who has had an application pending for at least 180 days
*I-551

Note: If the LPR loses the *I-551, the LPR may present either an I-94 or a passport with the following annotation:
  • "Processed for I-551, Temporary Evidence of Lawful Admission for Permanent Residence, valid until ______, Employment Authorized."
Any status code that appears on the *I-551 is acceptable.
I-766
  • CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association
  • CFA/FSM – Citizen of the Federated States of Micronesia (FSM)
  • CFA/PAL – Citizen of the Republic of Palau
Aliens who have been granted employment authorization under 8 CFR 274a.12:
  • (c)(8) or C8 - Asylum applicant (w/ pending asylum application) who filed for asylum on or after Jan. 4, 1995
  • (c)(9) or C9 – Applicant for adjustment to lawful permanent resident status
  • (c)(10) or C10 – Applicant for suspension of deportation or cancellation of removal
  • (c)(11) or C11 – Alien paroled into the U.S. in the public interest or temporarily for emergency reasons
  • (c)(14) or C14 – Alien currently in deferred action status
  • (c)(16) or C16 – Applicant for registry (resided in U.S. since before Jan. 1, 1972)
  • (c)(18) or C18 – Under order of supervision
  • (c)(20) – Applicant for special agricultural worker legalization (INA 210)
  • (c)(22) – Applicant for legalization under INA 245A
  • (c)(24) – Applicant for adjustment under the LIFE Act Legalization Program
I-797
  • Alien currently in deferred action status
  • Action notice that identifies the alien as a self-petitioning battered alien
  • Special immigrant status under INA Section 101(a)(27)(J), the person will also have Form I-360
Visa
  • A or G – FSM, RMI or Palauan diplomats
  • TPS – Person under temporary protected status under INA Section 244
Academic student under INA 101(a)(15)(F):
  • F-1 - Academic student
  • F-2 - Spouse or children of F-1
Exchange visitor under INA 101(a)(15)(J)
  • J-1 - Exchange visitor
  • J-2 - Spouse or children of J-1
Fiancé or fiancée of U.S. citizen as permitted under INA Section 101(a)(15)(K):
  • K-1 – Fiancé or fiancée
  • K-2 – Child of K-1
  • K-3 – Spouse of U.S. citizen
  • K-4 – Child accompanying or following to join a K-3 alien
Vocational student under INA 101(a)(15)(M)
  • M-1 - Vocational student
  • M-2 - Spouse or children of M-1
Special immigrant under INA Section 101(a)(15)(N):
  • N-8 – Parent of alien classified SK-3 "Special Immigrant"
  • N-9 – Child of N-8, SK-1, SK-2 or SK-4, "Special Immigrant"
Religious worker under INA Section 101(a)(15)(R):
  • R-1 – Religious worker
  • R-2 – Spouse or children of R-1
Witness or informant as permitted under INA Section 101(a)(15)(S):
  • S-5 – Informant of criminal organization information
  • S-6 – Informant of terrorism information
Victim of severe trafficking as permitted under INA Section (a)(15)(T):
  • Derivative T Visa annotated with T-1
  • Derivative T Visa annotated with T-2, T-3, T-4 or T-5 (family members of a victim of severe trafficking)
Victims of certain crimes – Battered aliens under 101(a)(15)(U):
  • U-1 – People who have suffered substantial physical or mental abuse as victims of criminal activity
  • U-2 – Spouse of U-1
  • U-3 – Child of U-1
  • U-4 – Parent of U-1, if U-1 is under 21
  • U-5 – Unmarried, under 18, sibling of U-1
People with a petition pending for three years or more, as permitted under INA Section 101(a)(15)(V):
  • V-1 – Spouse of an LPR who is the principal beneficiary of a family-based petition (Form I-130) that was filed prior to December 21, 2000, and has been pending for at least three years
  • V-2 – Child of an LPR who is the principal beneficiary of a family-based visa petition (Form I-130) that was filed prior to December 21, 2000, and has been pending for at least three years
  • V-3 – Derivative child of V-1 or V-2
USCIS letter A person who is a spouse or child of a U.S. citizen, whose visa petition has been approved, and who has a pending application for adjustment of status as described in 8 CFR INA Section 103.12(a)(4)
USCIS letter Person under Deferred Enforced Departure pursuant to a decision made by the president
Letter A letter or other tribal document certifying at least 50 percent American Indian blood, as required by INA Section 289, combined with a birth certificate or other satisfactory evidence of birth in Canada
USCIS document Family Unity beneficiaries pursuant to Section 301 of Pub. L. 101-649, as amended
USCIS document An alien who is lawfully present in the Commonwealth of the Northern Mariana Islands under 48 U.S.C. Section 1806(e)
USCIS document A person who is lawfully present in American Samoa under the immigration laws of American Samoa

*An I-551, Permanent Resident Card, does not always include the holder's signature.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Aliens residing in the U.S. who do not meet the citizenship or immigration status requirements for Medical Programs may be eligible for Emergency Medicaid. These people include non-immigrants, undocumented aliens and certain legal permanent resident aliens.

Do not follow SAVE verification requirements for aliens applying for Emergency Medicaid.

Notes:

  • To be eligible for Emergency Medicaid, a person must meet all other eligibility requirements.
  • A person must be caring for a deprived child who meets citizenship or alien status requirements to be eligible for TA 31 as a caretaker or second parent.

Related Policy 

How to Determine Eligibility, A-343
Verifying 40 “Qualifying Quarters,” A-354
Verifying Alien’s USCIS Documents, A-355
 

A-343 How to Determine Eligibility for Battered Aliens

Revision 18-1; Effective January 1, 2018

All Programs

Qualified aliens with a battered alien status do not need to be credited with 40 qualifying quarters of social security coverage, nor do they have a seven-year limited eligibility period.

SNAP

Advisors follow the steps in the chart below to determine whether an alien claiming battered status is potentially eligible for SNAP.

Step Yes No
  1. Can the alien provide USCIS documentation* that identifies the alien as the self-petitioning spouse, ex-spouse or child of an abusive U.S. citizen or LPR?

Note: Once the alien has provided proof that
identifies him/her as a self-petitioning battered alien, the alien meets
the definition of a "qualified alien," as defined in A-311.1, Definition of Qualified Immigrant.

Go to Step 2. Stop — The alien is not eligible.
  1. Can the battered alien meet one of the following conditions? The alien:
    • is under age 18;
    • is the spouse or minor unmarried dependent child of a person who is
      an active duty military member or an honorably discharged veteran;
    • has resided in the U.S. for 5 years from the date that the petition for battered status was approved and issued (Note: This is not the same as residing in the U.S. for 5 years as a qualified alien as defined in A-311.1); or
    • meets the SNAP definition of disability in B-432, Definition of Disability (regardless of when the alien acquired a disability or entered the U.S.).
Go to Step 3. Stop — The alien is not eligible.
  1. Is the battered alien living with the spouse/parent or other family member who abused or battered the alien?
Stop — The alien is not eligible. Go to Step 4.
  1.  Did the alien:
  • enter the U.S. and acquire “qualified alien” status before Aug. 22, 1996;
  • reside in the U.S. before Aug. 22, 1996, adjust to “qualified alien” status on or after Aug. 22, 1996, and provide proof of continuous residence;
  • reside in the U.S. before Aug. 22, 1996, adjust to “qualified alien” status on or after Aug. 22, 1996, did not provide proof of continuous residence, but meets the five-year waiting period; or
  • enter the U.S. on or after Aug. 22, 1996, and meets the five-year waiting period?
The alien is eligible if the alien
meets all other eligibility factors.
Stop — The alien is not eligible.

* Examples of acceptable USCIS documents include:

  • I-551, Permanent Resident Card, annotated with one of the following status codes: IB-1 through IB-3 or IB-6 through IB-8;
  • I-797, Action Notice, that identifies the alien as a self-petitioning battered alien; or
  • a final order from an immigration judge or the Board of Immigration Appeals granting suspension of deportation under Section 244(a)(3) of the Immigration and Nationality Act.

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

Follow the steps in the chart below to determine if an alien claiming battered status is potentially eligible for TANF and/or Medical Programs.

Step Yes No
1. Can the alien provide USCIS documentation* that identifies the
alien, the battered alien’s child or the parent of a battered alien
child as the self-petitioning spouse and/or child of an abusive U.S.
citizen or LPR?
Go to Step 2. Stop — The alien is not eligible.
2. Is the battered alien living with the spouse, ex-spouse, parent or other family member who abused or battered the alien? Stop — The alien is not eligible. Go to Step 3.

3. Did the alien:

  • enter the U.S. and acquire “qualified alien” status before Aug, 22, 1996?
  • reside in the U.S. before Aug. 22, adjust to “qualified alien”status on or after Aug. 22, 1996, and provide proof of continuous residence;
  • reside in the U.S. before Aug.22, 1996, adjust to “qualified alien” status on or after Aug. 22, 1996, did not provide proof of continuous residence, but meets the five-year waiting period; or
  • enter the U.S. on or after Aug. 22, 1996 and meets the five-year waiting period?
The alien is eligible if the alien meets all other eligibility factors. Stop — The alien is not eligible.

 

 

A-350, Verification Requirements

Revision 13-2; Effective April 1, 2013

A-351 Verification of Citizenship

Revision 15-4; Effective October 1, 2015

All Programs

Items used to verify citizenship for TANF can be used for SNAP and vice versa. Items used to verify citizenship for Medical Programs can also be used for TANF and SNAP. For Medicaid Programs, only verification sources listed in A-358.1, Citizenship, can be used to verify citizenship.

TANF

Advisors verify citizenship for all household members applying for benefits. Individuals are allowed 10 days to provide proof. Advisors must document the type of proof provided. Advisors do not reverify citizenship at complete or incomplete reviews unless questionable.

If the applicant or recipient refuses or fails without good cause to provide proof, the individual is disqualified until proof is provided.

Related Policy

TANF — Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits, A-1362.1

SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

SNAP

Advisors must verify U.S. citizenship for certified members if questionable or if a regional requirement.

If an individual fails to provide verification of citizenship for Medical Programs, the claim of U.S. citizenship is not considered questionable for SNAP based solely on this reason.

A person with a questionable claim is disqualified until proof of citizenship is received.

Related Policy

SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

Medical Programs Except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Before certifying an individual who has declared that they are a U.S. Citizen, the advisor must verify that the applicant or recipient is a U.S. citizen. Once verified, citizenship does not need to be verified again unless questionable. 

Applicants requesting three months prior Medicaid coverage must provide citizenship verification before prior coverage can be provided.

Exception: Current Medicare and SSI recipients are exempt from the verification requirement. Individuals who are receiving Retirement, Survivors and Disability Insurance (RSDI) based on disability, and who are in a 24-month waiting period to receive Medicare, are considered Medicare recipients for the citizenship and identity verification requirement.

Related Policy

At Application, A-611
Reasonable Opportunity, A-351.1
Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2

A-351.1 Reasonable Opportunity

Revision 20-4; Effective October 1, 2020

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 45 and TA 85

Medicaid applicants who declare themselves to be U.S. citizens or declare to have an eligible alien status, but for whom verification of citizenship or alien status is unavailable, must be allowed a period of reasonable opportunity to provide verification of citizenship or alien status. Reasonable opportunity is defined as the 95-day period a person is allowed to provide this verification beginning the day the Form TF0001 is generated.

At application and when adding a person during a redetermination or change, if the person does not provide proof of citizenship or alien status and:

  • no other information is required to determine eligibility, certify the person for Medicaid if all other eligibility requirements are met, send Form TF0001, Notice of Case Action, and provide a period of reasonable opportunity.
  • other information is required to determine eligibility, request verification of the other information in addition to citizenship or alien status prior to providing a period of reasonable opportunity. If the other information is not returned, deny the person. If the person returns the other information but does not provide proof of citizenship or alien status, certify the person for Medicaid, send Form TF0001, and provide a period of reasonable opportunity.

Form TF0001 informs the person that verification of citizenship or alien status is required within 95 days and lists the names of each person who must provide citizenship verification. The period of reasonable opportunity begins the day Form TF0001 is generated.

All new applicants must be given a period of reasonable opportunity even if they have received a previous reasonable opportunity period.

The reasonable opportunity period may be triggered under the following conditions:

  • the person cannot provide a Social Security number (SSN) needed to electronically verify citizenship with the Social Security Administration (SSA);
  • the data available from an electronic data source and the person’s declaration of citizenship or alien status are inconsistent; or
  • electronic verification is unsuccessful, including agency efforts to resolve any inconsistencies, and additional documentation is still needed.

The day the reasonable opportunity period expires (the 95th day), TIERS generates an alert that creates a task. If verification of citizenship or alien status has not been provided, deny the person. 30 days advance notice of adverse action is provided to the household after informing them of the denial of ongoing benefits using Form TF0001, Notice of Case Action.

Related Policy

How to Take Adverse Action if Advance Notice Is Required, A-2343.1
Medicaid Suspension, B-520
Reasonable Opportunity after a Medicaid Suspension and Reinstatement, B-533
Reasonable Opportunity to Provide Citizenship and Alien Status Verification, D-441.1

A-351.2 Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship

Revision 15-4; Effective October 1, 2015

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

If an applicant has an SSN, use SOLQ or WTPY to verify citizenship.

The system attempts to verify citizenship using SOLQ through Electronic Data Sources (ELDS). If the SOLQ system is unresponsive or unavailable due to system failure, advisors must attempt to verify using WTPY.

If the SSN is verified, WTPY provides a response code for verification of citizenship. Advisors follow the steps in the chart below to determine the required advisor action for each response code. These response codes are only provided for Medicaid or CHIP requests.

If the WTPY response code is… then staff must …
A

SSN is verified, there is no indication of death, and the allegation of citizenship is consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the citizenship verification drop-down menu.
B

SSN is verified, there is no indication of death, and the allegation of citizenship is NOT consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. See the process for If unable to verify citizenship (Code B) below.
C

SSN is verified, there is indication of death, and the allegation of citizenship is consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. Treat the death information as a change using policy in B-600, Changes.
D

SSN is verified, there is indication of death, and the allegation of citizenship is NOT consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. Treat the death information as a change using policy in B-600.

If unable to, Advisors should attempt to verify citizenship using the Birth Verification System (BVS).

  1. If staff is unable to verify citizenship using BVS and additional information is required to determine eligibility, request the additional information and verification of citizenship and allow the individual at least 10 days to provide proof.
    • If the client does not return the additional information by the final due date, the advisor must deny the case for failure to provide required information.
    • If the client provides the additional information, but does not provide verification of citizenship, the advisor must allow the individual a period of reasonable opportunity (explained in A-351.1, Reasonable Opportunity) to provide the verification of citizenship.
  2. If staff is unable to verify citizenship using BVS and no other information is required to determine eligibility, the advisor must allow the individual a period of reasonable opportunity to provide the verification without pending the EDG.

After allowing reasonable opportunity, if the recipient refuses or fails to provide proof, the advisor must deny the individual until proof of citizenship is provided.

SOLQ or WTPY responses may also include information on the receipt of SSI or RSDI. Advisors can find more information on the treatment of RSDI and SSI income explained in A-1324, Government Payments.

If the WTPY system is unresponsive or unavailable due to system failure, advisors must not deny or delay certification of Medicaid or CHIP coverage for failure to verify SSN or citizenship. Advisors must:

  • enter the SSN as provided by the applicant into TIERS and allow the automated SSA interface to verify the SSN; and
  • allow the individual a period of reasonable opportunity (explained in A-351.1) to provide the verification of citizenship.

A-351.3 Good Cause Determination

Revision 15-4; Effective October 1, 2015

TANF

Good cause exists when the Texas Health and Human Services Commission (HHSC) determines that circumstances beyond the individual's control prevent proving U.S. citizenship. The individual's statement that proof is delayed is acceptable.

At initial application and when adding a person, good cause is allowed until the next complete review. The individual must be advised that the verification must be provided by the next complete review or the individual will be disqualified.

A-351.3.1 Referrals to OIG

Revision 15-4; Effective October 1, 2015

TANF

Advisors must disqualify and refer an individual to the Office of Inspector General (OIG) if:

  • the individual previously claimed to be a U.S. citizen but could not provide proof after allowing good cause; and
  • other information indicates the individual's claim of citizenship is questionable.

A-351.4 How to Verify Citizenship

Revision 15-4; Effective October 1, 2015

All Programs

Advisors may refer to A-358.1, Citizenship, for common sources used to verify U.S. citizenship. For Medical Programs, advisors use the most reliable level of verification available from the sources listed as acceptable for Medical Programs. An affidavit is used only as a last resort when other verification is not available.

Advisors should explore derivative citizenship for any applicant born abroad to at least one U.S. citizen parent. If the applicant claims derivative citizenship, the applicant must provide a Certificate of Citizenship issued by the U.S. Citizenship and Immigration Services.

Related Policy

Reasonable Opportunity, A-351.1
Questionable Information, C-920
Providing Verification, C-930

TANF and SNAP

If the applicant cannot obtain the requested proof but can reasonably explain why it is not available, the advisor must obtain an affidavit signed by someone who knows the applicant's history. The advisor should advise signers that the affidavit is a sworn statement; signers can certify only those facts of which they have personal knowledge. The affidavit must state that the signer:

  • is a U.S. citizen;
  • knows that the applicant is a U.S. citizen; and
  • may be fined, imprisoned or both if false information is given.

Through supervisory channels, the advisor must ask the regional attorney to make a determination if the applicant:

  • does not have proof of citizenship and cannot obtain an affidavit as described above; or
  • claims derivative citizenship and does not have a Certificate of Citizenship.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Verification requirements do not apply for undocumented aliens in the Emergency Medicaid certified group.

A-352 Verification of Alien Status

Revision 18-1; Effective January 1, 2018

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

Advisors must verify alien status by:

  • obtaining documentation of alien status, as explained in A-340, Qualified Alien Status Eligibility Charts; and
  • accessing the USCIS SAVE VIS, as explained in A-355, Verifying Alien's USCIS Documents.

Advisors pend the EDG to allow an alien to update the alien's status with USCIS. An alien who does not have acceptable status is disqualified. If a certified alien’s document expires before the next redetermination, the alien’s immigration status must be re-verified following policies and procedures in A-313, Absence of Proof of Alien Status.

Advisors use the SAVE VIS:

  • at application;
  • when adding a new household member identified as an alien; or
  • when the client’s USCIS document has expired.

Notes: If the alien’s USCIS document is expired and the SAVE response shows;

  • The individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted is “Response is Indefinite,” the individual meets an alien status criteria. These individuals must not be disqualified.
  • The individual's I-766, Employment Authorization Document, is not expired. These individuals must not be disqualified due to having an expired document.

SAVE does not contain information about victims of severe trafficking or nonimmigrant alien family members. At application, advisors must call the trafficking verification toll-free number at 866-401-5510 to confirm the validity of the certification letter or Derivative T Visa and to notify the Office of Refugee Resettlement of the benefits for which the individual is applying.

Medicaid and CHIP applicants or recipients who declare an alien status, but for whom verification of alien status is unavailable, must be allowed a period of reasonable opportunity to provide verification of alien status as explained in A-351.1, Reasonable Opportunity.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Do not follow the SAVE VIS verification procedures.

A-353 Verification of Military Connections

Revision 13-2; Effective April 1, 2013 

A-353.1 Verification of Veteran Status

Revision 15-4; Effective October 1, 2015

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

Advisors must verify an individual's eligible veteran status by:

  • a discharge certificate; or
  • Form DD-214 or equivalent that shows the individual previously met active duty status in the armed forces.

Note: Discharge certificates that show character of discharge as anything but "honorable" are not acceptable. A character of discharge "Under Honorable Conditions" is not an "honorable" discharge for purposes of eligibility.

If the veteran does not have proof of discharge status, the veteran is referred to the Veteran's Administration to obtain verification.

A-353.2 Verification of Active Duty Military

Revision 15-4; Effective October 1, 2015

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

Individuals who claim they are currently on active duty in the military must provide a:

  • current Military Identification Card, Form DD-2 (Active); or
  • copy of their current military orders.

If the active duty military member does not provide proof of active duty status, the advisor must request other forms of proof.

A–353.3 Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

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

Staff must verify whether an alien meets the eligibility requirements as:

  • a spouse or minor unmarried dependent child of a veteran or active duty military member; or
  • an unmarried surviving spouse of a deceased veteran or active duty military member.

To verify, advisors may use one of the following methods:

  • view Form DD-214 for the discharged veteran;
  • view the Military Identification Card (DD-2) that shows that the
    alien is married to or is a minor unmarried dependent child of a veteran
    or active duty military member; or
  • refer the individual to the Veteran's Administration for verification.

A–354 Verifying 40 "Qualifying Quarters"

Revision 15-4; Effective October 1, 2015

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

Advisors must verify 40 qualifying quarters for LPR applicants or household additions that must meet this requirement. Advisors use the WTPY 40 Quarters Verification System to verify covered wages. Once verified, this information does not have to be reverified.

A–354.1 Response from Social Security Administration's (SSA) WTPY System

Revision 15-4; Effective October 1, 2015

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

SSA does not complete the posting of covered earnings quarters for any one year until the following year (around August). Example: Quarters earned in 2012 may not be posted on the WTPY system until August 2013. These quarters are referred to as “Lag” quarters.

A response from SSA on the 40 quarters verification request takes approximately 48 hours to receive.

Advisors base the quarters of covered earnings on the calendar year’s total earnings. Each year, the amount of income needed to earn a quarter changes. State office advises staff of the change each year.

For 2012, an individual must earn $1,130 to earn one quarter. If the individual earned at least $4,520 for 2012 ($1,130 x 4), the client has four qualifying quarters for the year.

Note: Advisors must not allow credit for an incomplete or future quarter. Example: The quarter of July to September 2012 cannot be counted until October
2012, even though the individual earned enough income by March 2012 to receive credit for three quarters in 2012.

A–354.2 Non-Covered Wages

Revision 18-1; Effective January 1, 2018

All Programs Except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

Non-covered wages are those earned by an individual whose employer was not required to pay into the Social Security system (such as certain city, federal, school or religious organization employees).

If the LPR cannot meet the 40 qualifying quarter requirement using covered earnings verified by the SSA, advisors must then obtain sufficient income verification from the individual's employer to determine the earned quarters for the period in question.

Use the chart below to determine if the individual has earned sufficient money to earn a quarter.

1984 $390 1995 $630 2006 $970 2017 $1,300
1985 $410 1996 $640 2007 $1,000    
1986 $440 1997 $670 2008 $1,050    
1987 $460 1998 $700 2009 $1,090    
1988 $470 1999 $740 2010 $1,120    
1989 $500 2000 $780 2011 $1,120    
1990 $520 2001 $830 2012 $1,130    
1991 $540 2002 $870 2013 $1,160    
1992 $570 2003 $890 2014 $1,200    
1993 $590 2004 $900 2015 $1,220    
1994 $620 2005 $920 2016 $1,2060    

Example: A former custodian worked for a school district from 2008 through 2011. The school district did not pay into the Social Security system. The advisor requested that the former custodian provide verification of their earnings for this particular period.* They brought a statement from the school district verifying their wages showing they earned $9,000 for 2008. Using the chart above, the income required to earn a quarter for 2008 is $1,050. This person can be credited with four quarters for 2008 ($1,050 x 4 = $4,200).

*If HHSC already has proof of income earned, advisors do not request that the individual provide additional verification.

Note: Credit for an incomplete or future quarter is not allowed.

A-354.3 Quarters Earned On or After January 1, 1997

Revision 15-4; Effective October 1, 2015

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

Federal law requires that quarters earned on or after January 1, 1997, cannot be credited if the person who earned the quarters received means-tested public benefits.

When determining the total amount of quarters earned by an LPR,
advisors do not allow any quarters earned after January 1, 1997, if the
person received TANF, SNAP, Medicaid or SSI benefits for the quarter.
The WTPY system response does not reflect receipt of these benefits.

The SSA defines a quarter as a period of three calendar months:

  • Quarter 1: January, February, March
  • Quarter 2: April, May, June
  • Quarter 3: July, August, September
  • Quarter 4: October, November, December

A-354.4 Procedures for Verifying 40 Quarters

Revision 15-4; Effective October 1, 2015

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

Advisors must:

Step Action
1 Ensure that the alien's LPR status has been verified.
2 Determine whose quarters of earnings have to be verified.
3 Obtain a consent of release before verifying quarters of coverage through the WTPY system or SSA. Use one of the following forms:

Note: A consent form or signature is not required for spouses or parents who are deceased.
  • Form SSA-3288, Social Security Administration Consent for Release of Information, must be signed by the:
    • LPR, if the LPR did not sign the application;
    • LPR's spouse, if the spouse did not sign the application; or
    • LPR's parent.
  • Form SSA-513, Request for Quarters of Coverage History Based On Relationship, is completed when the LPR, spouse and/or parent:
    • refuses to sign Form SSA-3288; or
    • cannot be located.

Example: A husband, wife and their four children have applied for SNAP benefits. Both spouses and two of the children are LPRs (advisor has verified LPR status). The husband has worked in the U.S. for about six years, and the wife has worked about five years. The advisor must verify the quarters of earnings for both spouses.

Since the husband was the one who signed the application, he does not have to sign Form SSA-3288; however, a signed Form SSA-3288 is required for the wife. The advisor must also complete Form H1079, Qualifying Quarters of Social Security Earnings, for both spouses.

4 If the household signed Form SSA-3288, submit Form H1079 to the appropriate WTPY data entry staff with the following information:
  • LPR's full name, as it appears on the Social Security card;
  • LPR's date of birth; and
  • LPR's correct Social Security number.

If the household signed Form SSA-513, send the completed form to the following address:

Social Security Administration
P.O. Box 17750
Baltimore, MD 21235-0001

5 If you are awaiting the verification from SSA's WTPY system (normally WTPY provides a response within 48 hours), issue Form H1020, Request for Information or Action, and pend the EDG.

If you sent Form SSA-513, disqualify the individual until you receive the response from SSA.
 
6 Use the WTPY or Form SSA-513 response to determine how many countable quarters are in the SSA records for the LPR, spouse and parent. Verify any recent earnings through the employer or case record if not yet posted on the WTPY system or not listed on Form SSA-513. Compute the quarters of covered earnings.
7 Disallow any quarters in which the wage earner received TANF, SNAP, Medicaid or SSI after January 1, 1997.
8 If the LPR:
  • has 40 quarters, the LPR is eligible.
  • does not have 40 quarters, the advisor sends Form TF0001, Notice of Case Action, to notify the household that the LPR is disqualified as an ineligible alien due to the lack of 40 allowable quarters of earnings.
9 If the individual disagrees with SSA's records for quarters of covered earnings, provide the individual with Form H1020. On Form H1020, explain that HHSC will certify the LPR if proof is provided that SSA was contacted to resolve the record of earnings. Provide the LPR copies of the WTPY response(s).

If the LPR needs to resolve a disagreement about a parent's or spouse's SSA record, advise the LPR that the spouse or parent must go to SSA to reconcile the individual's record. The LPR can resolve the SSA records for a deceased spouse or parent.
10 If the LPR contacts SSA to resolve the disagreement, SSA provides the individual with a document or Form SSA-7008, Request for the Correction of Earnings. The document or Form SSA-7008 verifies the action being taken to resolve the disagreement about the individual's SSA record. When the LPR provides the verification, submit the verification for imaging. Consider the LPR an eligible alien for TANF, SNAP and Medical Programs for one of the following time periods:
  • for six consecutive months beginning the month the LPR contacted SSA, or
  • less than six months if the LPR resolves the disagreement with SSA before the sixth month and the LPR does not have 40 allowable quarters of covered earnings.
Document this temporary eligibility period.

Note: On a denied application, if the LPR provides the needed proof by the 60th day after the file date, reopen the application using the date the LPR provided the information as the file date.

A-355 Verifying Alien's USCIS Documents

Revision 20-2; Effective April 1, 2020

A-355.1 SAVE Program's Verification Information System (VIS)

Revision 20-2; Effective April 1, 2020

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

The Systematic Alien Verification for Entitlements (SAVE) program's Verification Information System (VIS) is a web-based application that provides alien status information using the applicants' alien registration number.

The SAVE System provides the following types of responses:

  • Initial Verification Results: First Name, Last Name, Country, Date of Entry, Date of Birth, Class of Admission (COA) and System Response; and
  • Additional Verification Results: Department of Homeland Security (DHS) Response, Expires On, Response Date and DHS Comments.

If the alien’s USCIS document is expired and the SAVE response shows the individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted is “Response is indefinite,” they meet alien status criteria.

Use the SAVE Verification Information System:

  • at application;
  • when adding a new household member identified as an alien; or
  • if a person's alien documentation has expired.

Exceptions:

When SAVE does not contain information about victims of severe trafficking or non-alien family members, call the trafficking verification toll-free number at 866-401-5510 to:

  • confirm the validity of the certification letter or Derivative T Visa; and
  • notify the Office of Refugee Resettlement of the benefits for which the person is applying.

SAVE does not normally contain information about American Indians born outside of the U.S.

Related Policy

American Indians Born Outside the U.S., D-8420

A-355.2 How to Request an Initial Verification

Revision 15-4; Effective October 1, 2015

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

Supervisors complete and route Form 4743, Request for Applications
and System Access, to the regional security officer for employees who
need access to the SAVE system.

Advisors must follow these steps to access the SAVE system:

  1. Open the VIS web site at https://save.uscis.gov/Web/vislogin.aspx?JS=YES.
  2. Enter your User ID and password.
  3. Select Initial Verification from the Case Administration menu.
  4. Enter the document type that the applicant provided.
  5. Enter the applicant's information as it appears on the document:
    • Alien Number — Do not include the letter A when entering the information in SAVE. If the A number has fewer than nine digits, add leading zeroes to make it a nine-digit number. USCIS# is used on the new I-551 cards instead of Alien Number.
    • I-94 Identification Number — known as the admission number, consists of an 11-digit field. Enter leading zeroes if the I-94 number provided has less than 11 digits.
    • Card Number — Card numbers for I-551 cards issued before November 2004 are at the bottom of the card toward the right-hand side. Card numbers for newer versions of I-551 are on the back of the
      card.
    • Last name.
    • First name.
    • Date of birth.
    • Document expiration date, if applicable.
    • Required benefits — Select the benefit type from the Benefits List (SNAP, Medicaid, TANF).
  1. Select Submit Initial Verification. The response appears in the Initial Verification Results section of the same page.
  2. The screen displays one of the following messages:
  • Lawful Permanent Resident – Employment Authorized;
  • Institute Additional Verification; or
  • Temporary Resident/Temporary Employment Authorized.

Note: If the response is Temporary Resident/Temporary Employment Authorized, the alien does not meet eligibility requirements.

  1. Review the results and select Print Case Details.
  2. Select Complete and Close Case to close the case (only if
    additional verification is not necessary). Once a case is closed, the
    user can view it for an additional 90 days.

A-355.3 How to Request Additional Verification – Online Process

Revision 15-4; Effective October 1, 2015

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

To request additional verification:

  1. In the Initial Verification Results section, select Request Additional Verification. The Enter Additional Verification Data section appears.
  2. Edit the default information if necessary, enter required information, and include as much information as possible. Use the Special Comments box to enter additional information to the Immigration Status Verifier (ISV) staff.
  3. Submit the request by selecting Submit Additional Verification. The response section appears indicating that the request is in process and will return the response within three working days.
  4. To view the status of the case, select View Cases from the Case Administration menu. The Case Search page appears.
  5. Enter the Case Search Criteria to search for cases based on the following case status:
      • all open cases;
      • cases requiring action;
      • cases with additional verification responses;
      • cases in process; and
      • closed cases.

Select Display Case Summary List to open the Case Summary List page. The list displays the Case Status for cases that require action, cases in process, and closed cases. Click the Verification Number to view the Case Details. The user is able to print the case details, request additional verification, and close the case.

When the system is unable to verify the immigration status with the information provided by the user in the automated additional verification request, or the document appears counterfeit, altered, or expired, staff may use the manual process in A-355.4, How to Request Additional Verification – Manual Process.

A-355.4 Secondary Verification of Alien Immigration Status

Revision 20-2; Effective April 1, 2020

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

If staff are unable to verify an alien's immigration status through primary verification procedures, use SAVE to request additional information from USCIS by requesting a Data Broker Combined Report through TIERS or the Data Broker Portal.

Once a request from USCIS is obtained for verification of immigration status, the information received must be processed. Staff receive one of the following responses from SAVE via the Combined Report in TIERS or in the Data Broker Portal:

  • First level verification - initial verification request in TIERS.
  • Second level verification - situations that require additional (secondary) verification in the Data Broker Portal.
  • Third level verification - situations that require staff to upload documents for verification in the Data Broker Portal via SAVE.

For the first level verification, staff enter the information provided by the person into TIERS. Once the information is entered and SAVE is requested, SAVE will return an immediate response back indicating if the information entered was able to be verified with USCIS or if more information is needed.

If the information entered can be verified on the first level verification, staff will see the alien status, category code, and entry date. If the information entered is unable to be verified against USCIS records, then staff will have to proceed to second or third level verification responses to correctly verify the person’s citizenship and alien status.

For second level verification and third level verification responses, Data Broker automatically requests additional verification from SAVE. Once obtained from SAVE, staff receive an email from the Data Broker vendor notifying them that the verification requested has been returned from SAVE.

For second level verification responses:

  • The Data Broker vendor sends a subsequent email notifying staff that the verification has been returned from SAVE.
  • Staff must then:
    • login to the Data Broker Portal to retrieve the information; and
    • update the Alien/Refugee Details page in TIERS accordingly.

For third level verification responses:

  • Staff must:
    • upload the verification documents requested into the Data Broker Portal;
    • not mail the documents to USCIS; and
    • ensure only one PDF file containing all required verification documents is uploaded.
  • The Data Broker vendor sends a subsequent email notifying staff SAVE has returned the verification.
    • staff must then login to the Data Broker Portal to retrieve the information; and
    • update the Alien/Refugee Details page in TIERS accordingly.

Note: SAVE only populates alien sponsor information into TIERS for the additional verification response. This is unlike initial verification that populates the response data for the applicant in the appropriate ELDS tables on the TIERS Alien/Refugee-Details page.

Related Policy

Filing an Overpayment Referral, B-770
Referrals for Intentional Program Violation (IPV), B-900

A-356 Verifying Alien's Date of Entry

Revision 15-4; Effective October 1, 2015

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

The date on the alien's immigration document often represents the alien's first date of entry into the United States. In some instances, an alien may be present in the United States without a qualified status. The individual may then depart and then return to the U.S. as an LPR. For these aliens, the date on their immigration document reflects the date of entry with LPR status, rather than the alien's original date of entry.

Advisors use immigration documents to verify date of entry. Advisors must allow aliens with a USCIS document showing an entry date on or after August 22, 1996, who claim to have entered before that date, an opportunity to submit evidence of their claimed date of entry. This evidence may include pay stubs, a letter from an employer, or a lease or utility bill in the alien's name.

A-357 Verifying Alien's Continuous Presence

Revision 20-1; Effective January 1, 2020

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

The USCIS maintains a record of arrivals to and departures from the country for most legal entrants.

To verify continuous presence in the U.S., submit the Form G-845, Verification Request, and Form G-845S, Supplement Verification Request, electronically through the Data Broker system to the USCIS.

Other entrants, including aliens who entered the U.S. without USCIS documents, must provide documentary evidence showing proof of continuous presence, such as a letter from an employer, a series of pay stubs, or utility bills in the alien's name spanning the period in question.

Note: The alien does not have to remain continuously present in the U.S after obtaining qualified immigrant status.

Related Policy

How to Request Additional Verification – Online Process, A-355.3
How to Request Additional Verification – Manual Process, A-355.4

A-358 Verification Sources

Revision 13-2; Effective April 1, 2013 

A-358.1 Citizenship

Revision 15-4; Effective October 1, 2015

TANF and SNAP Verification Sources:

  • Birth Verification System automated process (for individuals born in Texas)
  • Birth certificate (see Note)
  • Naturalization papers (N-560 or N-561)
  • Hospital record of birth
  • Baptismal record with date and place of birth
  • U.S. passport or U.S. passport card
  • Military service papers
  • Census records showing name, U.S. citizenship or U.S. place of birth, and date of birth or age
  • Voter registration card (SNAP only)
  • Local, state or federal records showing birthplace in the U.S.
  • Regional attorney
  • Civil service employment by the U.S. government
  • American Indian Card
  • Report of birth abroad (FS-240)
  • Certificate of birth (FS-545 or DS-1350)

Alternate Sources

  • Family Bible records
  • Affidavit from U.S. citizen

Note: Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless previously certified using a birth certificate issued before July 1, 2010. See C-932, Advisor Responsibility for Verifying Information, for information regarding assisting an individual in obtaining birth verification from Puerto Rico.

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

Citizenship and Identity Verification

Verification sources are divided into two levels: Level 1 and Level
2. Level 1 sources establish both citizenship and identity. Level 2
sources establish citizenship only.

Level 1: Verifies Citizenship and Identity
SOLQ/WTPY
U.S. passport
Certificate of Naturalization (DHS Forms N-550 or N-570)
Certificate of U.S. Citizenship (DHS Forms N-560 or N-561)
State Data Exchange (SDX) for denied SSI recipients when the denial reason is for any reason other than citizenship
Evidence of membership or enrollment in a federally recognized tribe
SOLQ/WTPY and documentation on reason for Medicare denial
Inquiry reflecting a current or denied TP 45 Medicaid EDG
CHIP-P inquiry reflecting a current or denied CHIP-P case for the child
Level 2: Verifies Citizenship Only
If using a source from Level 2, the individual must also provide an additional source from the Medicaid and CHIP identity
verification sources. The same source that was used to verify citizenship cannot be used to verify identity. Identify verification from A-621, Verification Sources, is required.
A U.S. public birth certificate showing birth in one of the 50 states, the District of Columbia, Puerto Rico (if born on or after January 13, 1941)*, Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain's Island or the Northern Mariana Islands (after November 4, 1986)*
BVS inquiry
Report of Birth Abroad of a U.S. Citizen (FS-240)
Certification of Birth Abroad (FS 545 or DS-1350)
U.S. Citizen Identification Card (Form I-179 or I-197)
Northern Mariana Identification Card (I-873)
Final adoption decree showing the child's name and U.S. place of birth
Evidence of U.S. civil service employment before June 1, 1976
U.S. military record showing a U.S. place of birth (Example: DD-214)
SAVE for naturalized citizens
If a child has not yet received a Certificate of Citizenship, N-560 or N-561, evidence of meeting the automatic criteria for U.S. citizenship outlined in the Child Citizenship Act of 2000, which includes:
  • proof that at least one parent of the child is a U.S. citizen, by birth or naturalization;
  • proof that the child is under age 18;
  • proof that the child is residing in the U.S. in the legal and physical custody of the U.S. citizen parent;
  • I-551, Permanent Resident Card; and
  • I-551 with annotation of IR-3 or IR-4, if an adopted child.
Hospital record of birth showing a U.S. place of birth
Life, health, or other insurance record showing a U.S. place of birth
Religious record of birth recorded in the U.S. or its territories within three months of birth, which indicates a U.S. place of birth, showing either the date of birth or the individual's age at the time the record was made
Early school record (preschool or day care) showing a U.S. place of birth
Federal or state census record showing U.S. citizenship or a U.S. place of birth
Institutional admission papers from a nursing facility, skilled care facility or other institution showing a U.S. place of birth
Medical (clinic, doctor, or hospital) record, excluding an immunization record, showing a U.S. place of birth
An affidavit signed by another individual who can reasonably declare to the applicant's citizenship, regardless of blood relationship to the individual and under penalty of perjury, and that contains the applicant's name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized. Use only as a last resort when other evidence is not available.

* Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless certified previously using a birth certificate issued before July 1, 2010. C-932, Advisor Responsibility for Verifying Information, includes information regarding assisting an individual in obtaining birth verification from Puerto Rico.

American Indian/Alaska Natives (AI/AN)

Individuals can self-declare AI/AN status. Form H1205, Texas Streamlined Application, and Form H1010, Texas Works Application for Assistance — Your Texas Benefits, include a general question asking whether anyone in the household is an American Indian, Alaska Native, or member of a federally recognized tribe. In some instances, Yes may be selected on the application for this question, but information is not provided by the applicant in Appendix B, American Indian or Alaska Native Family Member (AI/AN), identifying the member of the household composition for Medical Programs to whom the status applies. If the name of the individual claiming AI/AN status is not provided, AI/AN status is considered not verified.

Related Policy

Providing Verification, C-930
Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2

A-358.2 Alien Status

Revision 15-4; Effective October 1, 2015

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

  • Form I-94, I-151, I-551, I-688B (with special annotations), I-766 (with
    special annotations), or other valid USCIS records
  • Contact with USCIS

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

Alien Entry Date

  • Immigration document
  • Contact with the USCIS
  • Pay stubs
  • Letter from employer
  • Lease or utility bill in the alien's name
  • School records
  • Other document indicating entry date

Alien's Continuous Presence

  • Contact with the USCIS
  • Letter from employer
  • Pay stubs or utility bills in the alien's name spanning the time period in question
  • School records
  • Other documents spanning the time period in question

A-360, Documentation Requirements

Revision 15-4; Effective October1, 2015

All Programs

Advisors must document the:

  • alien's status and how you verified it;
  • USCIS document's expiration date if any;
  • basis of alien's eligibility or ineligibility; and
  • temporary eligibility period for the alien, described in A-354.4, Procedures for Verifying 40 Quarters, if applicable.

Advisors must document the verification number from the SAVE inquiry in case comments.

Related Policy

Documentation, C-940

SNAP

Advisors must document the proof of citizenship, if questionable.

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

Advisors must document proof of citizenship.

Advisors must document the alien's:

  • date of entry; and
  • continuous presence, if necessary to establish eligibility.

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

When using a verification source from Level 2, the advisor must document the reason Level 1 was not used.

Copies of the document used to verify citizenship must be legible and non-questionable.

Related Policy

The Texas Works Documentation Guide

A-410, General Policy

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

All applicants must provide a Social Security number (SSN) or apply for one through the Social Security Administration (SSA) before certification, unless they meet one of the criteria in this section.

Exception: Undocumented aliens are not required to apply for an SSN.

Non-applicants are not required to provide an SSN or proof of an application for an SSN. When non-applicants provide an SSN, advisors may attempt to verify the SSN using the procedures explained in A-440, Verification Requirements. If verification is not available through electronic data sources, verification of the non-applicant’s SSN must not be requested from the applicant.

SNAP

Children age six months or younger are not required to provide proof of an application for an SSN. Newborns may receive benefits with the household without providing proof of an application for an SSN for the later of:

  • six months following the child's birth, or
  • the next recertification/complete review.

Applicants eligible for expedited service may receive initial benefits without providing or applying for an SSN. Initial benefits can include the first two months if receiving a combined allotment.

Applicants who cannot provide required proof to apply for an SSN may receive the Supplemental Nutrition Assistance Program (SNAP) for each month they have good cause. Good cause exists when circumstances beyond the individual's control prevent the individual from securing proof required to obtain an SSN.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Applicants do not need to provide an SSN if they meet any of the following good cause reasons:

  • They are not eligible to receive an SSN;
  • They do not have an SSN and may only be issued an SSN for a valid non-work reason; or
  • They refuse to obtain an SSN because of a well-established religious objection. A well-established religious objection exists when the applicant:
    • is a member of a recognized religious sect or division of the sect; and
    • adheres to the tenets or teachings of the sect or division of the sect and for that reason is conscientiously opposed to applying for or using a national identification number.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Undocumented aliens applying for Emergency Medicaid are not required to provide an SSN.

TP 45

SSN requirements do not apply to TP 45.

If a TP 45 child has an SSN, advisors enter the SSN at Application Registration or during Data Collection in the Individual Information page. If the child does not have an SSN, advisors may refer the parent or caretaker to the SSA to complete Form SS-5, Application for Social Security Number.

A—411 Determining Staff Action at Application

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

If the applicant ... then ...
  • cannot provide an SSN;*
  • provides an SSN that the Texas Integrated Eligibility Redesign System (TIERS) will not accept as valid; or
  • provides Form SSA-5028, Receipt for Application for an SSN, that is more than 30 days old,
  • refer the applicant to the local Social Security Administration (SSA) office using a separate Form H1106, Enumeration Referral, for each member needing a Social Security Number (SSN); and
  • pend the application until SSA returns Form H1106 verifying the applicant has completed the application process.

    Exception: Follow policy in A-410, General Policy, for the applicable exceptions, by program.

  • provides Form SSA-5028 (not more than 30 days old); or
  • provides Form SSA-2853, Message From Social Security, that is not more than 180 days old,
  • accept the form as proof that the applicant applied for an SSN;
  • tell the applicant to report the SSN when the applicant receives it; and
  • enter the SSN in the Eligibility Determination Group (EDG), when reported.

Note: Follow policy in A-412, Action at TANF and Medical Program Redetermination — Forms SSA-5028 or SSA-2853, for action to take at the next periodic review for Temporary Assistance for Needy Families (TANF) or Medicaid recipients.

provides an SSN,
  • enter the SSN at Application Registration or during Data Collection in the Individual Information page.
  • Run State Online Query (SOLQ) during Data Collection if it is not automatically invoked by TIERS. Follow policy in A-413, SSN Validation Through State Online Query (SOLQ), if SOLQ verifies the SSN with a SSN Verification Code of F or X or does not verify the SSN.
provides an SSN but indicates the name and/or date of birth on record with SSA is not correct,
  • enter the SSN at Application Registration or during Data Collection in the Individual Information page; and
  • refer the applicant to the local SSA office to update the person’s SSA file using Form H1106. Do not pend the application for SSA's response. Exception: If SOLQ verifies the SSN with the SSN Verification Code of F or X or does not verify the SSN, follow policy in A-413.
provides an SSN but wants a replacement for a lost card,
  • enter the SSN at Application Registration or during Data Collection in the Individual Information page; and
  • refer the applicant to the local SSA office without Form H1106; and
  • inform applicants age 18 and older that replacement SSN cards can be requested online by visiting the SSA.

* If the applicant cannot provide an SSN because the applicant is a documented alien without work authorization, refer the applicant to the local SSA office using Form H1106.

Explain the following to applicants applying for an SSN:

  • the type of proof they must take to SSA to obtain an SSN (see page 2 of Form H1106, Proofs You Need to Apply for a Social Security Number Card, for common types of proof);
  • the referral procedure and the results of any delay;
  • that SSA must conduct a face-to-face interview with a person age 18 or over applying for an original SSN; and
  • that a person applying for someone else (including an adult applying for a child) must provide proof of that person's own identity in addition to proof needed for the SSN application.

When an applicant takes Form H1106 to the SSA office, SSA:

  • determines whether the applicant is eligible for an SSN;
  • submits Form SS-5, Application for a Social Security Card, for those eligible; and
  • adds information to Form H1106 or provides another SSA receipt or letter verifying the applicant completed the SSN application process.

Follow policy in A-420, Failure to Comply, if the applicant does not return Form H1106 with entries made by SSA, or another receipt or letter, verifying that an application for an SSN was submitted for each applicant by the 30th day after the file date, or later, to allow at least 10 days.

SNAP

If the applicant cannot complete the SSN application process in a timely manner, explain the procedure for claiming good cause. If the applicant claims to have good cause for not complying in a timely manner, determine whether good cause applies. The application is not pended for SSA's response if good cause applies.

Related Policy

General Policy, A-410
Action at TANF and Medical Programs Redetermination, A-412
Social Security Number (SSN) Validation Through State Online Query (SOLQ), A-413
Failure to Comply, A-420

A—412 Action at TANF and Medical Program Redetermination — Forms SSA-5028 or SSA-2853

Revision 20-2; Effective April 1, 2020

TANF and Medical Programs, except TP 43, TP 44, TP 45 and TP 48

Provide the person with Form H1106, Enumeration Referral, at the next complete review when:

  • Form SSA-5028 or SSA-2853 is accepted at application,
  • the form is no longer current; and
  • no SSN has been received.

Inform the applicant that the form must be returned within 60 days. Explain to the person the consequence of noncompliance.

The complete review must not be pended for the return of Form H1106. Set a special review for the end of the 60-day period. Follow procedures in A-420, Failure to Comply, for noncompliance if:

  • Form H1106 is not returned by the deadline; and
  • an SSN is not received.

If an SSN is provided at the next complete review, enter the SSN during Data Collection and run SOLQ if it is not automatically invoked by TIERS. Follow policy in A-413, Social Security Number (SSN) Validation Through State Online Query (SOLQ), if SOLQ

  • verifies the SSN with a SSN Verification Code of F or X; or
  • does not verify the SSN.

TP 43, TP 44 and TP 48

Follow the procedures above, but do not set a special review. Check for compliance at the next review.

Related Policy

Social Security Number (SSN) Validation, A-413
Failure to Comply, A-420

A—413 Social Security Number (SSN) Validation Through State Online Query (SOLQ)

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

A person’s SSN is verified when all the demographic information provided by the person matches the information available in SOLQ. When the information matches, TIERS will display the SSN as validated. If the SSN is not verified, TIERS will display in the SOLQ screen the reason why the SSN is not verified.

SSN Verified

A person’s SSN is verified when SOLQ provides one of the following SSN Verification Codes:

  • F: SSN is verified, but last name does not match SSN (indication that the person has changed last name due to marriage, divorce or adoption;
  • M, P, R and V: SSN is verified; or
  • X: Data exists that the validated SSN belongs to a person who is deceased.

When a person’s SSN is verified via SOLQ, but information provided by the SSA indicates that the person is deceased (code X) or that the name does not match (code F), the person’s identity is questionable. Clear the discrepancy prior to disposing the case action. If the person does not provide the information needed to clear the discrepancy, follow policy in A-420, Failure to Comply, to either disqualify or deny the person. Exception: When processing expedited SNAP benefits or Medicaid for Pregnant Women, certify the person with a validated SSN with verification code F or X if unable to clear the discrepancy by viewing case documentation or contacting the household by phone. Postpone verification needed to clear the discrepancy to meet expedited processing timeframes.

SSN Not Verified

If the person’s SSN is not verified via SOLQ, review the information on the application and other supporting documents and update any information entered incorrectly. After making corrections, manually invoke SOLQ to re-run the verification process.

If the person’s identity is not questionable and the SSN remains unverified after re-running the SOLQ verification process, attempt to contact the person by phone to clear the SSN discrepancy. If unable to clear the discrepancy by phone and:

  • No other information is required to determine eligibility, certify the person if all other eligibility requirements are met.
  • Other information is required to determine eligibility, request information to clear the SSN discrepancy on Form H1020, Request for Information or Action.
    • Manually generate the Form H1020, Request for Information or Action, and attach the Form H-RG83, SSN Maintenance Memorandum, before mailing.

If the person:

  • Returns all information and staff can verify the SSN, certify the person if all other eligibility requirements are met.
  • Returns all information, but staff are unable to verify the SSN with the information provided, certify the person if all other eligibility requirements are met.
  • Returns information, but not the information to clear the SSN discrepancy, certify the person if all other eligibility requirements are met.
  • Does not return other information, disqualify or deny the person.

If the identity of the person is questionable, request information to clear the discrepancy. If the information is not provided or does not clear the discrepancy, disqualify or deny the person.

If unable to verify a person’s SSN via SOLQ, the monthly SSA interface will attempt to validate the SSN. If not validated by the monthly interface, TIERS generates Alert 268, Social Security Administration Unable to Verify SSN (RG-83), or Alert 269, Social Security Administration Reports a Duplicate SSN, to address the discrepancy.

Related Policy

Social Security Numbers (SSNs), A-144.1
Postponed Verification Procedures, A-145.1
Failure to Comply, A-420
SSN Discrepancy Clearance Procedures, A-432
Questionable Information, C-920

A-420, Failure to Comply

Revision 15-4; Effective October 1, 2015

TANF and SNAP

If an application is certified but a member is disqualified, notification of the individual’s disqualification is included on the comment section of Form TF0001, Notice of Case Action.

Exception: Advisors follow policy in A-410, General Policy, for applicable exceptions for SNAP.

Related Policy

TANF — Budgeting for a Household Member Disqualified for Noncompliance with SSN, TPR, Failure to Timely Report a Certified Child's Temporary Absence, Intentional Program Violation, Being a Fugitive or a Felony Drug Conviction, A-1362.2
SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

TANF

Advisors must disqualify a required member of the certified group who fails to comply without good cause.

Exception: Advisors must deny the application/EDG if the:

  • only eligible child or otherwise eligible person does not comply; or
  • caretaker/payee refuses to cooperate and the advisor cannot otherwise determine eligibility of the other members.

SNAP

Advisors must disqualify an applicant who fails to comply.

Exception: Follow policy in A-410 for the following situations:

  • children under age six months,
  • expedited service, and
  • good cause claims.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Advisors must deny an individual's eligibility if the individual fails to comply with the SSN requirements explained in this section. Denying eligibility for an individual who does not comply with SSN requirements does not impact the eligibility for any other individuals applying for or receiving Medical Program benefits.

A—421 Reestablishing Eligibility

Revision 15-4; Effective October 1, 2015

TANF and SNAP

If a member is disqualified at application and later complies, the individual is included effective the month after being notified of the compliance.

A-430, Proof Required by SSA

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

The proof required to get an SSN is shown in the table below, except for special situations that are listed in A-431, Special Situations. The proof needed depends on:

  • place of birth;
  • citizenship status; and
  • whether the request is for an original, duplicate, or corrected SSN.
If the applicant is a/an ... applying for ... then the applicant must furnish proof of ...
U.S. citizen born in the U.S., an original SSN, age, identity, and citizenship.
U.S. citizen born in the U.S., a duplicate SSN, identity.
U.S. citizen born outside the U.S., an original SSN, age, identity, and citizenship.
U.S. citizen born outside the U.S., a duplicate SSN, identity and citizenship.
alien, an original SSN, age, identity, and lawful alien status.
alien, a duplicate SSN, identity and lawful alien status.

Note: To correct/update SSN information, the applicant must provide proof required for a duplicate SSN as well as proof showing the new information.

Acceptable Proof

The documents must be originals, or copies made by the custodian of the record, such as a county clerk or registrar. SSA will return all documents submitted to SSA.

Proof of Age and Citizenship

A birth certificate is the preferred proof.

If no birth certificate is available, a U.S.-born citizen may furnish:

  • a religious record showing age or date of birth (to establish citizenship, it must have been recorded within three months of birth);
  • a hospital birth record;
  • a notice of birth registration; or
  • other documents, at least one year old, that show:
    • name,
    • age or date of birth, and
    • place of birth.

If no birth certificate is available, a foreign-born U.S. citizen may furnish a:

  • U.S. Consular Report of Birth,
  • U.S. Citizen Identification Card (Form I-197),
  • Certificate of U.S. Citizenship (Form N-560),
  • U.S. Passport, or
  • Certificate of Naturalization (Form N-550 or N-570).

Proof of lawful alien status:

  • I-551, Permanent Resident Card (Resident Alien Card);
  • I-151, Alien Registration Receipt Card;
  • I-94, Arrival-Departure Record; or
  • I-688A, Employment Authorization Card.

Proof of Identity

Proof of identity must contain enough information to identify the applicant, such as name, age or date of birth, address, signature, and physical description. Examples of acceptable documents are:

 

Identity card Adoption record
Work identification card Medical record/vaccination record
Driver's license Insurance policy
U.S. passport School record/report card
Marriage or divorce record Voter registration

A—431 Special Situations

Revision 19-4; Effective October 1, 2019

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

The following situations require special handling.

  • If the SSN applicant is a non-U.S. citizen who traditionally uses a name order different from the customary U.S. name order (first name, middle name, last or family name), determine name order according to U.S. custom and enter appropriately on Form H1106, Enumeration Referral.
Example: Vietnamese name on I-94: Nguyen Thi Mai
- last first middle
Enter on Form H1106: Thi Mai Nguyen

 

A—432 SSN Discrepancy Clearance Procedures

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

If an SSN is not verified via SOLQ, the monthly SSA interface attempts to verify a person’s SSN after certification. If a person’s SSN cannot be verified during the interface, or a duplicate SSN is found, TIERS generates either:

  • Alert 268, Social Security Administration Unable to Verify SSN (RG-83) when the information does not match. This triggers the Task List Manager (TLM) Alert 268, Agency Generated Change – Social Security Administration Unable to Verify SSN (RG-83) for Client (Individual ID) XXXXXXXXX and routes it to the Customer Care Center (CCC) for case action; or
  • Alert 269, Duplicate SSN for Individual Number, when the SSN is a duplicate. This triggers the TLM task Alert 269: Agency Generated Change - Social Security Administration Reports a Duplicate SSN XXXXXXXXXX, and routes it to the CCC for case action.  

Upon receipt of Alert 268 or Alert 269, research the case and contact the household to clear the discrepant or duplicate SSN. If staff are unable to clear the discrepant or duplicate SSN and the person does not have good cause for not providing a SSN, TIERS sends the household the following correspondence, allowing a 60-day period for the discrepancy to be cleared:

  • Form TF0001, Notice of Case Action, with the following language in the Notes section of the form:
     
    The individual is granted extra time to resolve the problem with their Social Security Number.

    We need proof that you have gone to the Social Security Administration to resolve the issue with XXXXXXX XXXXX’s Social Security Number by XX/XX/XXXX. If we don’t receive the proof, your XXXXXX benefits will end.
     
  • Form H-RG83, SSN Maintenance Memorandum, instructing the household to go the Social Security Administration (SSA) office in order correct or update the person’s Social Security records.

SSA staff will assist the person in completing an application to correct or update their Social Security records and will provide them with Form SSA-5028, Receipt for Application for a Social Security Number, as proof.  

If the person’s SSN has not been validated by the 60th day from the date the TF0001 and Form H-RG83 are sent, staff are prompted to review the case via Alert #796, Reasonable Opportunity Period has Expired for EDG #.

If the person fails to cooperate in clearing the discrepancy with the SSA or if the SSN has not been validated, follow policy in A-420, Failure to Comply to disqualify or deny the person. Note: This 60-day period is different from the reasonable opportunity period that Medicaid applicants are allowed to provide verification of U.S. citizenship or an eligible alien status, where that verification is unavailable when the person applies.  

If TIERS shows the SSN as verified, but the SSN needs to be corrected, send a memorandum with the correct SSN to State Office Data Integrity (SODI) to make a change:

SODI Section, Data Base Support

P.O. Box 14930, MC Y92-2

Or fax to Data Base Support at 512-706-7140.

Or send the request to the Data Integrity email box at HHSC_DI_Biographical Corrections@hhsc.state.tx.us.

SODI staff notifies the staff member by memo when the change is made.

Related Policy

Failure to Comply, A-420

A-440, Verification Requirements

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Verify that a household member applied for a SSN when the applicant cannot provide an SSN. Refer to A-410, General Policy, for applicable exceptions, by program.

SSNs are verified through:

  • State Online Query (SOLQ) being invoked during Data Collection. Verification of an SSN via this process is identified in both the Individual Household Summary page with a checkmark in the box by the person’s SSN and a checkmark in the Validated by SSA checkbox on either the Data Collection/Add New Individual page, the Modify Non File Cleared Individual page, or the Edit Existing Individual page.
  • The monthly SSA interface. Verification of an SSN via this process is identified in the Individual Summary Page when the SSA box is checked for the individual.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Follow policy in A-351.2, Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, for verifying SSN using SOLQ or Wire Third-Party Query (WTPY).

If unable to verify the SSN using SOLQ or WTPY:

  • Review the information entered into the SOLQ or WTPY request with the information provided by the applicant. If a typographical error is found, submit a new SOLQ or WTPY request with the correct information.
  • If no typographical errors are found, contact the applicant by phone to ensure the information provided is accurate. If the applicant provides new information, submit another SOLQ or WTPY request with the correct information. Update the EDG record with the correct information.
  • If unable to contact the applicant by phone, send the applicant Form H1020, Request for Information or Action, to request verification of the applicant’s SSN along with any additional information needed. Allow the person 10 days to provide proof.
  • If the person fails to cooperate in clearing the discrepancy with the SSA, follow policy in A-420, Failure to Comply.

Follow policy in A-410 to verify all good cause reasons to providing an SSN.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

A—441 Verification Sources

Revision 15-4; Effective October 1, 2015

All Programs

For SSN discrepancies or SSNs that cannot be verified through the SSA interface, SOLQ, or WTPY, the applicant must provide one of the following:

  • Copy of the SSN card; or
  • Social Security Administration letter confirming the SSN.

Acceptable proof of application of an SSN includes:

  • Form SSA-5028, Receipt for Application for an SSN, less than 30 days old;
  • Form SSA-2853, Message From Social Security, less than 180 days old; and
  • Form H1106, Enumeration Referral.

Medical Programs

Form H1106, completed by the Social Security Administration, is the acceptable verification source for not providing an SSN due to ineligibility to receive an SSN or eligibility to receive an SSN only for a valid non-work reason. Advisors must review the response provided by the SSA on the Form H1106 to determine which good cause reason the applicant meets.

Acceptable sources of verification for a well-established religious objection include:

  • an approved IRS Form 4029, Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits; or
  • a letter from a leader of the religious organization, a document setting out the tenets of the religious organization which justify the good cause reason, or a similar document.

Note: If the source of verification for a religious exemption is questionable, advisors must contact their supervisor who will coordinate with the Texas Health and Human Services Commission (HHSC) regional attorneys to ensure the documentation is sufficient.

A-450, Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

In the Data Collection/Individual Demographics-SSN/Armed Services page, the advisor must enter the date the individual was given Form SSA-5028, Receipt for Application for an SSN, or Form SSA-2853, Message From Social Security, or the date the applicant returned Form H1106, Enumeration Referral. For EDGs with an individual currently being enumerated, the advisor sends the following documents for imaging:

  • Form H1106,
  • a copy of Form SSA-5028, or
  • a copy of Form SSA-2853.

Advisors must document that the SSA enumerated the individual or was unable to do so.

Related Policy

Documentation, C-940

SNAP

Advisors must document good cause claims according to A-410, General Policy.

Related Policy
The Texas Works Documentation Guide

A-510, Age Limits

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

For age requirements, see household composition:

A-520, Relationship

Revision 13-2; Effective April 1, 2013

 

A—521 Eligibility Requirements

Revision 21-1; Effective January 1, 2021

TANF

A child must live, or be expected to live, in the home of one of the relatives (either biological or adoptive) listed in A-221, Who Is Included, No. 4, Caretaker.

TANF-SP

A child must live with, or be expected to live, with both legal parents, or one legal parent and a stepparent.

Note: This also includes legal parents or stepparents who are disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements.

TP 08 and TA 31

To qualify for TP 08 or TA 31, a person must be a:

The caretaker must be a:

  • parent;
  • stepparent*;
  • sibling;
  • step-sibling;
  • grandparent;
  • uncle or aunt;
  • nephew or niece;
  • first cousin; or
  • first cousin once removed.

*A stepparent of a dependent child is considered within the degree of relationship for TP 08, Parents and Caretaker Relatives Medicaid, and TA 31, Parent and Caretaker Relative Medicaid - Emergency. The relationship to the dependent child remains even if the legal parent and stepparent are divorced or the legal parent is deceased.

The spouse of a caretaker relative may also be eligible for medical coverage if they live with the caretaker relative who cares for the dependent child receiving Medicaid.  

Example: A grandfather is the caretaker relative of his granddaughter. The grandfather applies for Medicaid for himself, his granddaughter, and his spouse who lives with him. If the granddaughter is eligible for Medicaid, both the grandfather and his spouse may be eligible for TP 08.

A dependent child is a person who:

  • is under age 18; or
  • if age 18, attends school full-time and expects to graduate in or before the month of their 19th birthday.  Note: A child who will not graduate until after the month of their 19th birthday is not considered a dependent child after the month of their 18th birthday.

TP 32, TP 33, TP 34, TP 35, TP 43, TP 44, TP 48 and TP 56

To be eligible for these programs, a child can:

  • live with the child's parents;
  • live with a caretaker within the degree of relationship required for TP 08 and TA 31;
  • live with a person not within the degree of relationship required for TP 08 and TA 31;
  • be abandoned; or
  • live independently.

TP 45

A child whose mother is eligible for and is receiving Medicaid coverage when the child is born, or whose mother is eligible for and receives Medicaid coverage retroactively for the time of the child’s birth, is eligible for TP 45 coverage. The Medicaid coverage for the newborn can continue through the month of the child’s first birthday if the child remains in Texas, even if the child does not reside with the birth mother.

Related Policy
Guide for Determining Relationship, C-1441
Guide for Determining Extended Relationships, C-1442

 

A—522 Legal Parent-Child Relationship

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

A legal parent-child relationship exists between a child and:

  • an adoptive parent by proof of adoption;
  • the mother by proof of having given birth to the child; or
  • a man if one of the following conditions exist:
    • The man and the mother married (including a common-law marriage) in apparent compliance with the law before the child's birth (even if the marriage is or could be voided), and the child was born:
      • while they were married; or
      • within 300 days after the marriage terminated.
    • The man and the mother married (including a common-law marriage) in apparent compliance with the law after the child's birth (even if the marriage is or could be voided), and the man:
      • filed a paternity suit, including a statement of paternity in court;
      • is named the father on the child's birth certificate; or
      • has a written obligation to support the child voluntarily or by court order.
    • The courts determine that the man is the biological father.

If there is no other legal father, a legal parent-child relationship exists between a man and a child if one of the following conditions exists:

  • The man and the mother do not marry, but the man consents in writing to be named as the child's father on the child's birth certificate.
  • Before the child turns age 18, the child lived with the man and holds out to the public that the man is the child's father.
  • The man signs an acknowledgement of paternity (AOP) with the Office of Attorney General or Vital Statistics Unit. The child's mother must also be available to sign the AOP.

 

A—523 When Proof of Relationship Is Unavailable

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

If Birth Verification System (BVS) records do not establish relationship or the applicant cannot provide proof of relationship shown in A-531, Verification Sources, the advisor must use alternative ways to determine relationship. See A-523.1, How to Make an Evaluative Conclusion.

 

A—523.1 How to Make an Evaluative Conclusion

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

The advisor must examine all available proof such as (but not limited to) school records, court records, birth records, health records, insurance policies, refugee's voluntary resettlement agency (VOLAG) or the U.S. Citizenship and Immigration Services (USCIS) records, or other sources of proof that provide the same information. The advisor should offer reasonable assistance if the individual has difficulty obtaining the information.

Advisors must obtain supervisory approval of the evaluative conclusion.

 

A—523.2 Children Living with Biological Father

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and TA 31

A biological father may receive TANF, TP 08, or TA 31 if the biological father proves relationship. If the father cannot provide acceptable proof, the advisor must make an evaluative conclusion to establish relationship for the father and child. The OAG uses the automated child support referral to locate the mother and establish paternity of the biological father. The OAG notifies the advisor via Form H1701, Child Support, TANF Foster Care and TANF/Medicaid Case Information Exchange, that paternity is established or excluded. If paternity is excluded, advisors must process an overpayment claim for the period of time the household erroneously received benefits as specified in B-700, Claims.

Proof of a court determination of paternity is required if, at the time of the child's birth, the child's mother was married to another man who is presumed to be the child's legal father.

 

A—523.2.1 Children Living with Relatives of Biological Father

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

To qualify for TANF or Medical Programs, a caretaker relative must establish required relationship to the child as specified in A-221, Who Is Included, following the steps below:

The caretaker relative must provide acceptable proof of relationship between:

  • the caretaker and the biological father; and
  • the biological father and the child, using the conditions listed in A-522, Legal Parent-Child Relationship.

 

A—530 Verification Requirements

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and TA 31

Advisors must verify the age and relationship of each child to the adult claiming the relationship before certifying or adding the child to the cash grant and/or before certifying the adult for Medicaid. Advisors use BVS inquiry for someone born in Texas and who is at least 46 days old but less than 19 years old.

See A-531, Verification Sources. If these verifications are not available, make an evaluative conclusion. See A-523.1, How to Make an Evaluative Conclusion.

Related Policy

Birth Verification System, C-860

A-530, Verification Requirements

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and TA 31

Advisors must verify the age and relationship of each child to the adult claiming the relationship before certifying or adding the child to the cash grant and/or before certifying the adult for Medicaid. Advisors use BVS inquiry for someone born in Texas and who is at least 46 days old but less than 19 years old.

See A-531, Verification Sources. If these verifications are not available, make an evaluative conclusion. See A-523.1, How to Make an Evaluative Conclusion.

Related Policy

Birth Verification System, C-860

 

A—531 Verification Sources

Revision 15-4; Effective October 1, 2015

Medical Programs

Age and Relationship

  • BVS inquiry
  • Temporary Assistance for Needy Families (TANF) sources

Medical Programs except TP 08 and TA 31

Age and Relationship

  • Individual's self-declaration establishing age and relationship if other sources are unavailable

TANF

Age

  • Birth certificate
  • Hospital or public health birth records
  • Church or baptismal birth record
  • BVS inquiry
  • Local, state, federal or military record
  • Adoption papers or records
  • Indian census records
  • U.S. passport
  • School or day care records
  • U.S. Citizenship and Immigration Services records
  • Attorney General child support paternity records
  • Social Security Administration records

Alternate Age Sources

  • Court or child welfare records
  • Insurance policies
  • Family Bible records
  • Records of voluntary social service agencies
  • Court child support order
  • Written statement from a doctor or clergy who knows date of birth
  • Juvenile court records
  • Census records
  • Written statement from a non-relative who knows date of birth

Relationship

  • Birth certificate
  • Adoption papers or records
  • Hospital or public health records of birth and parentage
  • BVS inquiry (see A-540, Documentation Requirements)
  • Church or baptismal birth record
  • Local, state, federal government or military record
  • School or day care records
  • U.S. Citizenship and Immigration Services records
  • Attorney General child support paternity records
  • Juvenile court records
  • Indian census records
  • U.S. passport
  • Marriage license/certificate
  • Divorce papers
  • Court records of parentage

Alternate Relationship Sources

  • Church records of parentage and relationship (including statement from clergy)
  • Family Bible records
  • Court or child welfare records
  • Insurance policies
  • Records of voluntary social service agencies
  • Statement from clergy, doctor or school official who can verify relationship
  • Statement from non-relative who has known the child since birth

Related Policy

Questionable Information, C-920
Providing Verification, C-930

A-540, Documentation Requirements

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Advisors must document proof of age or relationship and the basis for the evaluative conclusion or enter on the Texas Integrated Eligibility Redesign System (TIERS) Individual Household page and the Relationship page.

Advisors must document the following:

  • The verification source.
  • The verification date.
  • Children's names.
  • Information from the verification source to prove the children live in the home (for collateral contacts include name and address and/or phone number).
  • Reason for any temporary absence.
  • Information from the verification source to prove the household member or payee returned to and lived in the home for at least 30 days when allowing another temporary absence period.

Related Policy

Documentation, C-940
The Texas Works Documentation Guide

A-610, General Policy

Revision 07-4; Effective October 1, 2007

 

A—611 At Application

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and TA 31

Advisors must verify the identity of the person interviewed. Once identity has been verified for an individual, advisors do not need to re-verify.

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

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

Advisors must verify the identity of all individuals requesting benefits. Once identity has been verified for an individual, advisors do not need to re-verify.

If questionable, advisors verify the identity of the person interviewed.

Related Policy

Verification of Citizenship, A-351

SNAP

Advisors must verify the identity of the person interviewed.

If the authorized representative (AR) applies for the household, the advisor must verify the identity of both the AR and the person the AR represents.

Exception: If necessary to meet expedited service time limits, advisors only need to verify the identity of the AR being interviewed.

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

A—612 Redetermination

Revision 15-4; Effective October 1, 2015

SNAP, TANF and TP 08

Advisors must verify the identity of the person interviewed if not previously verified.

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

Advisors must verify the identity of each individual requesting benefits during the redetermination if identity has not been previously verified using a source from the Medical Programs list in A-621, Verification Sources, or a source from the Medical Programs list in A-358.1, Citizenship, that verifies both identity and citizenship. Once identity has been verified for an individual, advisors do not need to re-verify.

Related Policy

Verification of Citizenship, A-351 Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

A—613 Receipt of Lone Star Card and/or PIN

Revision 15-4; Effective October 1, 2015

SNAP and TANF

Advisors must verify the identity of a person receiving a Lone Star Card and/or personal identification number (PIN) (initial issuance or replacement).

A-620, Verification Requirements

Revision 03-5; Effective July 1, 2003

All Programs

Birth records and other official records are preferred sources of verification.

 

A—621 Verification Sources

Revision 15-4; Effective October 1, 2015

SNAP and TANF

  • Driver license or Department of Public Safety (DPS) identification (ID) card (current or expired)
  • Birth certificate (see Note)
  • Hospital or birth records
  • Adoption papers or records
  • Work or school ID card
  • Voter registration card
  • Wage or check stubs or check
  • U.S. passport or U.S. passport card
  • Certificate of Naturalization
  • Certificate of U.S. citizenship
  • Finding of citizenship by another federal/state agency
  • Collateral statement
  • Immigration documents
  • Self-declaration of driver license or DPS ID number already on file, along with other identifying information (Social Security number and date of birth)
  • Self-declaration of driver license or DPS ID number listed on Data Broker, along with other identifying information (Social Security number and date of birth)

Note: Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless certified previously using a birth certificate issued before July 1, 2010. See C-932, Advisor Responsibility for Verifying Information, for information regarding assisting an individual in obtaining birth verification from Puerto Rico.

TP 08, TP 43, TP 44, TP 48, TP 40 and TA 31

Copies of the document used to verify identity for individuals requesting benefits must be legible and non-questionable. Submit the document for imaging.

Identity and Citizenship

A-358.1, Citizenship, includes the sources that verify both identify and citizenship for Medical Programs.

Identity Only

  • One of the following sources is acceptable for verification, if the document has a photograph and other identifying information such as (but not limited to) name, age, date of birth, sex, race, height, weight, eye color, or address:
    • Driver’s license issued by a state or territory;
    • School identification card;
    • U.S. military card or draft record;
    • Identification card issued by the federal, state, or local government with the same information included on driver’s licenses;
    • Military dependent's identification card; or
    • U.S. Coast Guard Merchant Mariner card;
  • Native American Tribal document;
  • Signed application for Medicaid (including the signature of an authorized representative acting on the individual's behalf) — this is applicable for all individuals on the application except the signee (no person may declare to their own identity);
  • Two or more corroborating documents (examples include, but are not limited to, marriage licenses, divorce decrees, or high school diplomas);
  • For children under age 19, a clinic, doctor, hospital, or school record, including preschool or day care records; and
  • Form H1097, Affidavit for Citizenship/Identity, signed by another individual who can reasonably declare to the applicant’s citizenship, regardless of blood relationship to the individual and under penalty of perjury, and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized and should be used only as a last resort when other evidence is not available.

Related Policy

Questionable Information, C-920
Providing Verification, C-930
Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2

A-630, Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must document how the identity of the person interviewed was verified.

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

Advisors must document how the identity of each individual requesting benefits was verified. Copies of the document used to verify identity must be legible and non-questionable. Submit the document for imaging.

Related Policy

Documentation, C-940
The Texas Works Documentation Guide

A-710, General Policy

Revision 18-1; Effective January 1, 2018

All Programs

Applicants must live in Texas to be eligible for benefits. The household is not required to have a permanent dwelling or fixed residence.

TANF and Medical Programs

Individuals who live in Texas (other than for migrant or itinerant work) meet the residency requirement if they are living in Texas intending to remain in Texas. People who live in Texas for a temporary purpose do not meet the residency requirement.

The person's residence becomes questionable when the post office returns Texas Health and Human Services Commission (HHSC) correspondence or benefits as undeliverable.

Migrant and itinerant workers meet the residency requirement when applying if they:

  • live in the state;
  • entered the state with a job commitment or an intention to seek employment (regardless of current employment status); and
  • do not receive assistance from another state.

SNAP

People who live in Texas for any purpose other than a vacation meet the residency requirement, regardless of the length of time they have been here or plan to stay.

Related Policy

Form TF0001 Required (Adequate Notice), A-2344.1

A-720, New Texas Residents

Revision 20-1; Effective January 1, 2020

All Programs

A person cannot participate in more than one state in any month.

When an applicant recently received benefits in another state, verify the last month the benefits were issued.

The following links may be used as resources to contact agencies in other states to verify that a new Texas resident's benefits have ended in another state.

Supplemental Nutrition Assistance Program (SNAP) Agencies:

HSS staff can find the National Directory of SNAP Agencies on The LOOP.

Medicaid and Children’s Health Insurance Program (CHIP) Agencies:

https://www.medicaid.gov/medicaid/by-state/by-state.html

Temporary Assistance for Needy Families (TANF) Agencies:

https://www.acf.hhs.gov/about/contact-us

Medical Programs

New Texas residents may receive overlapping Medicaid coverage. See A-822, Medicaid Coverage for New State Residents, to determine the correct medical effective dates (MEDs) for these persons.

SNAP

Residents in an approved shelter for battered persons may participate twice during the month of application if they participated first with the person who abused or threatened them with abuse.

A-730, Moves Within Texas

Revision 15-4; Effective October 1, 2015

All Programs

Individuals keep their residence status when they move within Texas.

TANF and SNAP

A person cannot participate as a member of more than one household in any month.

SNAP

Residents in an approved shelter for battered persons may participate twice during the month of application if they participated first with the person who abused them or threatened them with abuse.

Related Policy

Household Composition, A-200

A-740, Moves Out of Texas

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

A certified individual becomes ineligible if the individual moves to another state:

  • with the intent to remain there, or
  • without declaring intent to return.

If the individual returns to Texas within 90 days and states that the move was not intended to be permanent, the advisor must:

  • reopen the Eligibility Determination Group (EDG) using the reason denied-in-error; and
  • issue restored benefits, if appropriate.

SNAP

A household is not eligible for benefits issued for a month after the household leaves Texas.

When a household member notifies HHSC that the household moved out of Texas, Form TF0001, Notice of Case Action, is not required. If the household has not yet moved, the advisor must issue Form TF0001 to provide adequate notice. The EDG is denied effective the end of the month they move, if possible.

Related Policy

Canceling Benefits, B-330

A-750, Temporary Visits Out of Texas

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Individuals do not lose their residence status when they temporarily leave Texas.

An individual can be absent from Texas for any length of time. Advisors must review the situation every three months to determine the individual's intent to maintain Texas residence. The individual must reasonably explain:

  • the purpose for leaving Texas,
  • the intent to return to Texas, and
  • which state the individual claims residency in.

An individual is a resident of Texas unless there is substantial, factual evidence that proves otherwise. When the advisor determines that the individual is no longer a resident, the individual is denied.

SNAP

A person is not eligible for SNAP in Texas for any month the individual is out of Texas the entire month.

A-760, Verification Requirements

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

Advisors must verify the actual physical address of a household at each application and redetermination.

Exceptions:

  • Residence verification is not a requirement for SNAP categorically eligible TANF/Supplemental Security Income (SSI) households.
  • Self-declaration is acceptable as verification of residence when certifying a child for TP 56, MA-Medically Needy with Spend Down.

Note: Residence verification is a requirement for TANF and categorically eligible TANF-Non-Cash (NC) households. Refer to B-472, Special Treatment for Households Meeting Categorical Eligibility Criteria.

When an applicant recently received benefits in another state, the advisor must verify the last month the benefits were issued.

When the advisor cannot verify residence with readily available evidence, the advisor must:

  • contact the landlord, neighbors or other sources of reliable information; or
  • observe personal effects and living arrangements.

When residence is difficult to verify because of unusual circumstances, the advisor must document all efforts to verify and certify the EDG.

Note: If residence for any household is questionable, the advisor may require the household to provide a source of verification that is more reliable, such as one of the primary sources of verification listed in A-761, Verification Sources. The advisor cannot restrict verification to a specific source from that list.

TANF and Medical Programs

Advisors must determine that the household intends to remain in Texas at each application and redetermination.

SNAP and TP 40

Advisors must postpone residence verification if trying to meet expedited service time frames.

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

Self-declaration is acceptable as verification of residence.

 

 

A—761 Verification Sources

Revision 22-2; Effective April 1, 2022

All Programs except Children’s Medicaid

The following are acceptable sources to verify the household's current address:

  • utility bills or utility company records;
  • rent receipt or statement from non-relative landlord;
  • mortgage receipt or statement from mortgage company;
  • valid Texas driver license or Department of Public Safety (DPS) identification card;
  • Data Broker residence reported on the DPS data field;
  • Department of Motor Vehicles record;
  • school records;
  • voter registration card;
  • statement from child care provider;
  • employment records or statement from employer;
  • official records confirming ownership of property;
  • home visit;
  • SOLQ for Social Security benefit recipients, including those receiving Medicare;
  • item of mail with household name and address;
  • other HHSC correspondence the applicant can provide showing the household received it at the applicant's current Texas address;
  • inquiry into Office of the Attorney General (OAG), Texas Workforce Commission (TWC) or another entity’s automated system, outside of HHSC, showing the same Texas address currently reported by the household;
  • a local landline number the applicant provides (not a cell phone number) that is either listed in the phone book or an online directory with the same Texas address the household currently reports, or the household can be contacted at that local phone number when conducting a phone interview;
  • searches resulting in a match between the address and the phone number provided by the applicant using the Data Broker Search Options Menu, Telephone Number Search;
  • post office records;
  • city or crisscross directory;
  • church records; or
  • statement from non-relative.

Exception: Self-declaration of residence is acceptable when certifying a child for TP 56, MA - Medically Needy with Spend Down.

TANF and Medical Programs

The applicant's statement of intent to remain in Texas is acceptable.

Children's Medicaid

Self-declaration.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

A-770, Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must document the individual's:

  • proof of address, and
  • all efforts to verify residence when residence is difficult to verify because of unusual circumstances.

TANF and Medical Programs

For temporary visits outside of Texas, advisors must document:

  • the individual's purpose for leaving;
  • the individual's intent to return to Texas; and
  • which state the individual considers their residence.

Related Policy

Documentation, C-940
The Texas Works Documentation Guide

A-810, General Policy

Revision 16-4; Effective October 1, 2016

Medical Programs

Applicants may receive Medicaid during the three-month period before the month they apply for Medicaid. See A-831, Three Months Prior Coverage, for eligibility criteria and application procedures.

Some former individuals on TP 08, TP 43, TP 44, and TP 48 remain eligible for Transitional Medicaid after their eligibility is denied. See the chart that follows for more information.

Reason for Denial Type Program Who Is Covered?
Alimony/Spousal support TP 20 (A-850, Alimony/Spousal Support Transitional Medicaid Coverage) The household
New or increased earnings TP 07 (A-842, TP 07 Transitional Medicaid) The household

Most adopted children receive Medicaid through the Texas Department of Family and Protective Services (DFPS). DFPS works with the Interstate Compact on Adoption and Medical Assistance (ICAMA) to facilitate the timely delivery of Medicaid coverage when a family moves or the adoption involves an interstate placement. If an adopted child is receiving Medicaid in another state, the parent must contact the originating state to coordinate and transfer Medicaid coverage information to Texas. If an adoptive parent has any questions about the adoptive child's Medicaid, advisors should inform them to contact their local DFPS office for assistance.

Medical Programs, Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB)

Individuals receiving some Texas Works Medicaid types of assistance may also qualify for the Medicaid for the Elderly and People with Disabilities (MEPD) Medicare Savings Program types of assistance, MC – QMB (TP 24) or MC – SLMB (TP 23), if they meet the eligibility criteria. See policy in the Medicaid for the Elderly and People with Disabilities Handbook, Q-2000, Qualified Medicare Beneficiaries (QMB) — MC-QMB.

Individuals may receive QMB and the following types of assistance:

  • MA – Earnings Transitional (TP 07)
  • MA – Parents and Caretaker Relatives (TP 08)
  • MA – Pregnant Women (TP 40)
  • MA – Children Under 1 (TP 43)
  • MA – Newborn Children (TP 45)
  • MA – Children 1-5 (TP 48)
  • MA – Children 6-18 (TP 44)
  • MA – Former Foster Care Children (FFCC) (TA 82)

The above programs cannot be dually eligible for SLMB. Even though these programs may meet SLMB eligibility requirements, the Medicare Part B premium is already paid. An individual can be dually eligible for MA – MN with Spend Down (TP 56) and SLMB.

A-820, Regular Medicaid Coverage

Revision 20-4; Effective October 1, 2020

Medical Programs

Regular Medicaid eligibility begins the day a person meets all eligibility criteria. It is usually the first day of the application month if all eligibility criteria are met.

The following are situations when the medical effective date (MED) may not be the first day of the application month:

  • The MED cannot precede a newborn's date of birth.
  • The MED cannot precede the date a child enters the home.

    Exception: Assign the date of birth as the MED for a child born to a woman incarcerated in the Texas Department of Corrections at Gatesville when contacted by HHSC staff housed at the University of Texas Medical Branch (UTMB) Hospital. Document this contact in Case Comments.

  • The MED for the parent or caretaker relative cannot precede the date of birth of the newborn or a child's entry into the home when the newborn or entering child is the only child.

    TP 08 Exception: The MED can be earlier if the parent or caretaker relative has unpaid medical bills and would have been eligible for Medicaid as a pregnant woman from the first day of her infant's birth month.

  • The MED cannot precede the start date of the emergency condition for aliens eligible for Emergency Medicaid.
  • The MED cannot precede the date a disqualified parent or caretaker relative complies.
  • The MED cannot precede the month at least one eligible dependent child is certified for Medicaid.

If the only child of a parent or caretaker relative eligible for TP 08 dies before certification, process an application for Medicaid for a deceased person.  Certify coverage for the child through the date of death and for the parent or caretaker relative through the remainder of that month.

 

TP 40

Medicaid for a pregnant woman does not begin before the first day of the month her pregnancy begins. The applicant’s (pregnant woman's, case name's, or authorized representative's [AR's]) verbal or written statement is an acceptable source of verification for the start month, the number of expected children, and the anticipated date of delivery.

If the applicant’s (pregnant woman's, case name's, or AR's) statement is not available, use one of the verification sources in A-870 to obtain the pregnancy start date and anticipated date of delivery.

If information is requested but not returned by the 15th business day from the file date, deny the application. Reopen the application if the person provides verification by the 60th day from the file date.

Exception: Pregnancy verification is not required if the:

  • application is processed after the pregnancy terminates; and
  • applicant provides proof of her newborn child's birth.

A pregnant woman remains eligible through the second month following the month her pregnancy terminates if all other eligibility requirements are met and countable income is below the income limits in:

  • the application month; or
  • one of the three months prior to the application month if in the prior month she:
    • had unpaid Medicaid-reimbursable bills; or
    • received services from the Texas Department of State Health Services (DSHS).

Example: A pregnant woman applies for Medicaid in May 2020. Her expected delivery date is December 2020. She has unpaid medical bills in February 2020 and meets all other eligibility requirements. She does not have any unpaid medical bills in March or April 2020. Certify her for Medicaid from February 2020 through February 2020.

After determining a pregnant woman is eligible for TP 40, the woman remains eligible even if the budget group's income increases above the income limit.

If a woman is certified for expedited benefits, but postponed verifications prove she is not eligible, provide advance notice of adverse action and deny her coverage.

 

TP 45

Before providing initial TP 45 coverage for a newborn child, verify that the:

  • mother was:
    • eligible for and received Medicaid in Texas on the day the child was born; or
    • retroactively eligible for Medicaid for the day the child was born;
  • child resides in Texas; and
  • mother was continuously eligible for Medicaid (or would have been eligible if pregnant) during the child's birth month.

Note: A newborn child born to a mother who received Emergency Medicaid coverage at the time of the child's birth is eligible to receive TP 45 coverage from the date of birth through the end of the month of the child's first birthday.

The MED for the initial certification is always the child's date of birth.

Before resuming coverage for a newborn who has been denied TP 45, verify that the child resides in Texas.

Related Policy

Provider Referral Process, A-125

TP 56

Medicaid coverage for children or pregnant women with spend down begins the first day the household meets spend down.

The applicant meets spend down by submitting or having a provider submit medical bills to the Clearinghouse.

The Clearinghouse:

  • determines when the person meets spend down; and
  • notifies TIERS via an interface. TIERS sets the MED for the certified members.

Note: The Clearinghouse may discover a discrepancy while processing a spend down EDG. Processing is put on hold and the EDG is referred to State Office Data Integrity (SODI) to research. SODI sends a memo to field staff asking for information to clear the discrepancy. Respond quickly to these requests so that the Clearinghouse can complete the spend down process.

 

Emergency Medicaid

Medicaid eligibility begins on the start date of the emergency medical condition verified by the attending practitioner on Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification.

 

Related Policy

Pregnancy, A-144.5
Medicaid Termination, A-825
Verification Requirements, A-870
How to Determine Spend Down, A-1359
Spend Down EDGs, A-1532.1
Reuse of an Application Form After Denial, B-111
Medicaid Reinstatement, B-530

 

 

A—821 Types of Coverage

Revision 15-4; Effective October 1, 2015

Medical Programs

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

 

 

A—821.1 Fee-for-Service

Revision 15-4; Effective October 1, 2015

Medical Programs

Fee-for-service, also known as Traditional Medicaid, allows access to any Medicaid provider and self-referral to specialists. The provider submits claims directly to the claims administrator for reimbursement of Medicaid-covered services.

 

 

A—821.2 Managed Care

Revision 21-1; Effective January 1, 2021

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, and TP 56

Medicaid managed care is health care provided through a network of doctors, hospitals or other health care providers who contract with a managed care organizations (MCO). The state pays the MCO a capitated rate for each member enrolled, rather than paying for each unit of service. The providers submit claims directly to the MCO for reimbursement of Medicaid-covered services.

Medicaid managed care programs include:

  • STAR (State of Texas Access Reform). STAR provides acute care services (like doctor visits, hospital visits and prescriptions), and each member is enrolled in an MCO and assigned a main doctor to coordinate care. People who are dually eligible for Medicare and Medicaid are excluded from this program.
  • STAR Health. STAR Health provides comprehensive, coordinated health care services for children in foster care and kinship care. Each member is enrolled with a single MCO, Superior HealthPlan, and is assigned a main doctor to coordinate care. People who are dually eligible are excluded from this program.
  • STAR+PLUS. STAR+PLUS provides acute care and long-term services and supports (LTSS). A key feature of this program is service coordination, or specialized care management. Each member is enrolled with an MCO, and Medicaid-only members are assigned a main doctor. STAR+PLUS serves Medicaid-only and dually eligible people, including most nursing facility residents. It is a statewide program.
  • STAR Kids. STAR Kids provides acute care services and LTSS. Additionally, people eligible for Medically Dependent Children’s Program (MDCP) waiver services receive these services through STAR Kids. A key feature of this program is service coordination. Each member is enrolled with an MCO and assigned a main doctor to coordinate care. STAR Kids serves children and young adults age 20 or younger with disabilities.
  • Children's Medicaid Dental Services. Children's Medicaid Dental Services provide primary and preventive dental services through managed care. Each member is enrolled in a dental maintenance organization (DMO) and has a main dental home. Most children, birth through age 20, who receive Medicaid, are eligible for dental services.

Medicaid managed care is available statewide. Information concerning the medical and dental managed care plans with contact information for each plan is located at hhs.texas.gov/services/health/medicaid-chip/provider-information/managed-care-organization-dental-maintenance-organization-provider-services-contact-information.

Texas Works Medicaid recipients must enroll in managed care. Exceptions (not comprehensive):

  • STAR exceptions:
    • people who are dually eligible for Medicaid and Medicare;
    • children enrolled in the DSHS Children with Special Health Care Needs (CSHCN) Program;
    • children and adults residing in institutions (nursing facilities, Intermediate Care Facilities, and State Supported Living Centers);
    • medically-needy program participants;
    • children in foster care or kinship care;
    • adults that receive SSI; and
    • children and adults that are in a 1915(c) waiver program.
  • STAR Health exceptions:
    • youth adjudicated in Texas Juvenile Justice Department (TJJD) facilities;
    • youth from other states placed in Texas, or Texas youth placed in other states; and
    • youth residing in Medicaid-paid facilities.
  • STAR+PLUS exceptions:
    • a person 20 or younger who is not in the Medicaid for Breast and Cervical Cancer (MBCC) program;
    • people over the age of 21 in Former Foster Care in Higher Education (FFCHE); and
    • people over 21 who are in a 1915(c) waiver program or who reside in community home for people with Intellectual Developmental Disabilities and are dually eligible for Medicare and Medicaid.
  • STAR Kids: A person over the age of 21 and a person 20 or younger without disabilities.
  • Children's Medicaid Dental Services exceptions:
    • people 20 or younger who reside in an institution;
    • people in STAR Health;
    • youth placed in other states; and
    • adults 21 and older.

MAXIMUS:

  • Contracts with the state to enroll recipients into Medicaid managed care.
  • Mails enrollment packets that include information about the plan choices available in their county of residence to newly certified recipients.

If a recipient does not choose a plan or a main doctor by the deadline provided in the enrollment packet, MAXIMUS assigns a plan and a main doctor. They then mail the information to the recipient.

Members of federally recognized Indian tribes are exempt from mandatory enrollment in Medicaid managed care but may choose to participate voluntarily.

At all Medicaid applications and redeterminations, identify and determine if the person qualifies for this exemption. If this information is not available, do not designate the person as exempt. Do not pend the application or delay the eligibility determination for this information.

TIERS refers newly certified recipients to MAXIMUS to initiate their enrollment into managed care. MAXIMUS staff is available in some local eligibility determination offices. A recipient can call the MAXIMUS Helpline at 800-964-2777 to initiate enrollment, to request a plan change, or to disenroll from managed care if they are exempt from mandatory enrollment in Medicaid managed care.

If a recipient has difficulty accessing medical services in a managed care plan, refer the person to the Medicaid Managed Care Helpline at 866-566-8989. The Medicaid Managed Care Helpline advocates for managed care recipients who are having trouble accessing the medical and dental care they need.

Related Policy
Office of the Ombudsman, B-1420
Managed Care Plans, C-1116

 

 

A—822 Medicaid Coverage for New State Residents

Revision 15-4; Effective October 1, 2015

Medical Programs

Advisors must determine the correct MED for applicants who:

  • move to Texas from another state during the application month or the three months prior to the application month, and
  • are Medicaid recipients in the losing state in the month they move.
Step Action

1

If the losing state denied the recipient's Medicaid the last day of the month the recipient moved from the state or later, then go to Step 2.

If the losing state denied the recipient's Medicaid the day the recipient moved from the state, then assign an MED = date the applicant became a Texas resident.

2

Did any member of the certified group incur Medicaid-reimbursable bills after they moved to Texas?

If yes, then verify the effective date of denial in the losing state. Go to Step 3.

If no, then verify the effective date of denial in the losing state. Assign an MED = first day of the month after the month the losing state denied the recipient's Medicaid.

3

Will the losing state pay for the bills incurred in Texas after the day the person became a Texas resident?

If yes, then assign an MED = first day of the month after the month the losing state denied the recipient's Medicaid.

If no, then assign an MED = date the applicant became a Texas resident.

Note: If the applicant is unable to provide a contact person in the losing state, the advisor must contact the appropriate state Medicaid director's office. See C-1111, State Medicaid Agencies, for telephone numbers.

When a Texas Medicaid recipient moves to another state, staff from the gaining state may contact the local office about effective dates of denial and coverage of bills incurred in the gaining state. Texas Medicaid pays for Medicaid-reimbursable services provided out-of-state if the:

  • recipient needs services because of a medical emergency documented by the attending physician or other provider;
  • recipient's health could be jeopardized by not obtaining services; and
  • provider enrolls in the Texas Medicaid Program. Out-of-state providers can obtain enrollment information by calling the claims administrator at 1-800-925-9126.

 

 

A—823 Lock-In Status

Revision 15-4; Effective October 1, 2015

Medical Programs

HHSC identifies fee-for-service and managed care individuals who:

  • received duplicative, excessive, contraindicated or conflicting health services, including drugs; or
  • abused, misused or committed fraudulent actions related to Medicaid benefits and services.

These clients may choose one pharmacy and/or one main doctor to be their designated provider for Medicaid services.

The duration periods of lock-in status are as follows:

  • The initial period is 36 months.
  • The second period is an additional 60 months.
  • The third period is for the duration of eligibility and all subsequent periods of eligibility.
  • The period of lock-in status for individuals arrested, indicted or convicted of, or admitting to, a crime related to Medicaid fraud differs from the time period listed for initial, second and third periods of lock-in. These individuals will be assigned lock-in status for 60 months or the duration of eligibility and subsequent periods of eligibility up to or equal to 60 months.

For individuals with enrollment lock-in status, HHSC issues a Your Texas Benefits Medicaid card printed with "Lock-in Doctor" and/or "Lock-in Drug Store" on the front of the card, along with the name of the doctor and/or drug store. If an individual with lock-in status prints a Medicaid card from the YourTexasBenefits.com, the same information is displayed.

Staff must verify current lock-in status when issuing Form H1027-A, Medicaid Eligibility Verification. To verify an individual’s lock-in status, the advisor may access the individual’s Lock-In Enrollment page from the Individual – Summary page’s hover menu. If an individual is in lock-in status, the Lock-In Enrollment page will display the provider name and begin date of the status.

Individuals are removed from lock-in status at the end of the specified period if their use of medical services no longer meets the criteria for lock-in status.

Advisors refer individuals with questions regarding their lock-in status to the HHSC Office of Inspector General (OIG) at 1-800-436-6184.

 

 

A—824 Issuance of Form H1027-A, Medicaid Eligibility Verification

Revision 15-4; Effective October 1, 2015

Medical Programs

Advisors must issue Form H1027-A, Medicaid Eligibility Verification, to an eligible Medicaid individual only if the individual:

  • needs his eligibility verified to receive medical services;
  • does not have access to a Your Texas Benefits Medicaid card; and
  • is unable to reprint the Medicaid card from YourTexasBenefits.com.

The individual may not have a Your Texas Benefits Medicaid card if the individual:

  • is newly certified and has not received it,
  • lost or accidentally destroyed the card, or
  • is temporarily separated from other eligible family members who have their card.

Before issuing Form H1027-A, staff must verify the individual's current eligibility, enrollment lock-in status and managed care enrollment by accessing the Individual – Summary and Individual – Medicaid History pages. If inquiry is unavailable, advisors must follow regional procedures.

Medicaid with No Enrollment Lock-in or Managed Care Coverage

Issue Form H1027-A for current eligibility if the most recent medical coverage period on the Individual – Summary and Individual – Medicaid History pages:

  • is open (no close date shown), and
  • reflects regular Medicaid coverage.

Enrollment Lock-in

If an individual is in enrollment lock-in status, "Yes" will display after Lock-In on the Individual – Summary page. Advisors select Lock-In Enrollment from the hover menu over the individual's client number. The Individual – Lock-In Enrollment page provides information regarding the provider(s) to which the individual is currently or was once locked in.

If an individual is currently in lock-in, advisors issue a separate Form H1027-A for the individual and print LIMITED and the name(s) of the provider(s) to which the individual is locked in. Form H1027-A generated in TIERS is printed with "LIMITED" in the "Type of Coverage" field.

Managed Care Coverage

If an individual is in a managed care service area, "Yes" will display after Managed Care on the Individual – Summary page. Select Managed Care from the hover menu over the individual's client number. Advisors select the Individual – Managed Care page to view the individual's plan to which the individual is enrolled.

Advisors must issue Form H1027-A for everyone on the case in the same managed care plan by printing the appropriate managed care program name (e.g., STAR, STAR Health, STAR+PLUS) and the name and telephone number of the plan. This information is in C-1116, Managed Care Plans.

After staff verify eligibility, enrollment lock-in status and managed care enrollment, advisors complete, sign and date Form H1027-A. The unit supervisor or other second party must approve the form indicating he verified eligibility and lock-in status.

Form H1027-A is not used if the most recent medical period:

  • is closed, or
  • shows institutional coverage.

Form H1027-A instructions include detailed information for completing the form.

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

The advisor must issue Form H1027-A if the person has a completed Form H1266, Short-term Medicaid Notice: Approved, showing the date the person is approved for coverage.

Form H1027-A instructions include detailed information for completing the form.

State Paid Medicaid

TA 62

State Paid Medicaid coverage shows in the Medicaid History screen when the individual was not eligible for Medicaid and staff have issued Form H1027-A in error. State Paid Medicaid is 100 percent state-funded.

 

 

A—825 Medicaid Termination

Revision 22-2; Effective April 1, 2022

TP 08

If an application is not received by the last day of the month, an EDG is automatically denied effective the last day of the last benefit month.

Related Policy

Denial at Redetermination, A-2342

Emergency Medicaid

Eligibility for Emergency Medicaid ends the date the person's medical condition is stabilized as verified by the attending practitioner or other practitioner familiar with the patient's condition. Verification is done on Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification.

A woman certified for Medicaid for Pregnant Women – Emergency (TP 36) on the day her pregnancy ends is eligible to receive TP 36 in the two-month postpartum period if she has another medical emergency.

Related Policy

Regular Medicaid Coverage, A-820

 

TP 40

Medicaid eligibility for a pregnant woman ends on the last day of the second month following the month the pregnancy terminates.

If the pregnancy terminates early because of molar pregnancy, abortion or premature delivery, deny the coverage effective the last day of the second month following the month the pregnancy terminated. If the pregnancy ends in a month later than expected, change the end date to reflect the new termination date.

A woman whose Medicaid for Pregnant Women coverage ends is automatically tested for other types of assistance using current case information without requiring a new application, if the EDG was not denied for the following reasons:

  • voluntary withdrawal;
  • death;
  • move out of Texas;
  • receipt of benefits in another group; or
  • failure to provide postponed verification.

TIERS automatically determines eligibility for another type of assistance. If eligible, the woman receives a new certification period which begins after the TP 40 EDG ends.

TP32, TP36, TP40, and TP56

A woman certified for Medicaid (TP 32, TP 36, TP 40, TP 56) on the day her pregnancy ends, is eligible to receive the same type of Medicaid (TP 32, TP 36, TP 40, TP 56) for two months after her pregnancy ends. 
Medicaid for Pregnant Women– Emergency (TP 36) and Medically Needy with Spend Down (TP 32 and TP 56) are only provided in the two-month postpartum period if the woman meets the additional eligibility requirements for these type programs. The original budget used to certify the Medicaid coverage on the day the woman’s pregnancy ends, is the same budget used in the two-month postpartum period.
 

Related Policy

How to Determine Spend Down, A-1359
Denial of an Application, A-2341
Denial at Redetermination, A-2342 

TP 43, TP 44 and TP 48

A child is continuously eligible for the first six months of the 12-month certification period. If a household fails to report required information at application that causes a child to be ineligible for Medicaid, deny the EDG and send a fraud referral to the Office of the Inspector General (OIG). This does not apply if the household provides verification required by policy. For example, the household applies for Medicaid for a child, provides one pay stub, and is determined eligible. If providing more income verification would result in the child being ineligible, do not deny the Medicaid EDG. The child remains continuously eligible for the first six-months of the 12-month certification period, because policy requires only one pay stub to verify income for a child's Medicaid EDG.

EDGs with end dates do not require staff action to close the EDG when the household does not return a renewal form. These will close effective the last day of the last benefit month of the certification period.

Note: Independent children residing in state hospitals are continuously eligible for the first six months of the 12-month certification period, even if the child is released from the state hospital. If a child is released from the facility prior to the end of the six-month period, process the address change and continue coverage.

A child is eligible through the last day of the month of the child’s:

  • first birthday for TP 43;
  • sixth birthday for TP 48; and
  • 19th birthday for TP 44.

When a child ages out of the current type of assistance during the continuous eligibility period, TIERS:

  • Denies the TP 43 or TP 48 EDG through mass update and opens a new EDG for the next type of assistance for the remainder of the continuous eligibility period if the child is eligible for the next type of assistance.
  • Sustains the TP 43 or TP 48 EDG if the child is not eligible for the next type of assistance.

When a child ages out of the current type of assistance during the non-continuous eligibility period, TIERS denies the TP 43 or TP 48 EDG and opens a new EDG for the next type of assistance if the modified adjusted gross income (MAGI) is equal to or below the corresponding Federal Poverty Level (FPL).

If the MAGI is more than the FPL for the next type program, the child’s eligibility for CHIP is tested.  If ineligible for CHIP, the child is referred to the Federally Facilitated Marketplace (FFM).

Exception: Children aging out of TP 44 are eligible through the last day of the month of their 19th birthday.

If a child is ineligible for the next type of assistance or turns 19, the child may continue to receive Medicaid if the child:

  • is hospitalized on the child's 19th birthday;
  • remains hospitalized (there is not a time limit); and
  • meets all eligibility requirements except age.

Verify the child’s hospitalization and update the child’s living arrangement to “hospital” to prevent TIERS from denying the child’s coverage.

Verify the hospitalization each month and update the child’s living arrangement when the hospitalization ends.

Related Policy

Continuous Medicaid Coverage, A-832
Medical Programs Administrative Renewals, B-122.4
Processing Children’s Medicaid Redeterminations, B-123

 

TP 45

A child's eligibility terminates the last day of the month of the child's first birthday. Deny the TP 45 EDG before the child's first birthday if the:

  • child's mother was presumptively eligible and received TP 42 at the time of the child’s birth but was not eligible for regular Medicaid at the time of the child’s birth. The child is eligible for TP 45 through the end of the birth month; or
  • child no longer resides in Texas. The child is eligible for TP 45 through the month the change occurs.

Notes:

  • If the child's mother met spend down and received TP 56 or TP 32 to cover the child's birth, the child is eligible for TP 45 from the date of birth until the end of the month the child turns one.
  • State Office Data Integrity (SODI) terminates the newborn's coverage before the child's first birthday in situations in which the child's mother relinquishes her parental rights and information about the child's current residency and new caretaker is unknown. 

Related Policy

TP 45 Provider Referral Process, A-125
Regular Medicaid Coverage, A-820

 

 

A-825.1 Recipients of TANF and TP 08

Revision 17-2; Effective April 1, 2017

Recipients of TANF must comply with the Personal Responsibility Agreement (PRA), including cooperating with child support requirements and participating in the Choices program, unless exempt. TP 08 coverage is terminated if an individual receiving both TP 08 and TANF is sanctioned for failure to comply with the Choices PRA requirements.

Individuals certified for TP 08, but not TANF, must cooperate with medical support requirements.  Failure to cooperate with the requirements result in the termination of the individual's TP 08 coverage.

Notes:

  • TANF sanctions due to noncooperation with other PRA requirements do not result in termination of TP 08 coverage.
  • Individuals receiving TP 08 who are not receiving TANF are not required to comply with the TANF PRA.
  • The noncooperating adult may reapply for Medicaid and qualify after the identified forfeit months, with the exception of those who non-comply with child support. These individuals must comply before becoming eligible for Medicaid.

Related Policy

Sanctions for Noncooperation, A-1141
Personal Responsibility Agreement, A-2100
Choices, A-2121
Child Support, A-2122
When to Start a Full-Family Sanction, A-2141
Denial at Redetermination, A-2342

 

 

A—826 Reserved for Future Use

Revision 20-4; Effective October 1, 2020

 

 

 

 

 

A—827 Your Texas Benefits Medicaid Card

Revision 19-4; Effective October 1, 2019

Medical Programs

When a person is certified for ongoing Medicaid benefits, a Your Texas Benefits Medicaid card is mailed, which should:

  • be carried and protected like a driver's license or credit card; and
  • used when visiting a Medicaid provider (i.e., doctor, dentist or pharmacy).

The Your Texas Benefits Medicaid card is plastic, like a credit card, and includes the following information printed on the front:

  • person’s name and Medicaid ID number;
  • managed care program name (if STAR Health);
  • date the card was issued; and
  • billing information for pharmacies.

The back of the card includes the statewide toll-free phone number where people can get more information about the Your Texas Benefits Medicaid card.

Each person certified for Medicaid in a household receives one Your Texas Benefits Medicaid card. It is intended to be the person’s permanent card.  

If a person loses:

  • Medicaid coverage but later regains coverage, the person can use the same Your Texas Benefits Medicaid card.
  • Their Your Texas Benefits Medicaid card, they can request a replacement by:
    • logging on to their YourTexasBenefits.com account;
    • calling 2-1-1 (after selecting language, select Option 2, and then Option 1); or
    • calling 855-827-3748.

If a person forgets their Your Texas Benefits Medicaid card, a provider (i.e., doctor, dentist or pharmacy) can verify Medicaid coverage by:

  • calling the TMHP Contact Center at 800-925-9126; or
  • visiting the Texas Medicaid and Healthcare Partnership’s (TMHP's) TexMedConnect website using the person’s Medicaid ID number or one of the following combinations for the person:  
    • Social Security Number (SSN) and last name;
    • SSN and date of birth (DOB); or
    • last name, first name, and DOB. 

If a person needs quick proof of eligibility, they can;

  • log in to their www.YourTexasBenefits.com account to print a temporary card; or
  • go to a local benefits office to request a card. HHSC staff in the office will:
    • assist the person accessing and printing a Medicaid card from the person’s www.YourTexasBenefits.com account from the office’s lobby computer; or
    • generate a temporary Form H1027-A, Medicaid Eligibility Verification via TIERS if the person prefers not to or has trouble accessing their Medicaid card online.

A-830, Medicaid Coverage for the Months Prior to the Month of Application

Revision 13-2; Effective April 1, 2013

 

 

A—831 Three Months Prior Coverage

Revision 15-4; Effective October 1, 2015

Medical Programs except TP 40

Applicants may be eligible for Medicaid coverage during the three-month period before the month they apply for Medical Programs. Prior coverage may be continuous or there may be interrupted periods of eligibility involving all or some of the certified members.

TP 40

Medicaid for a pregnant woman does not begin before the first day of the month her pregnancy began, as explained in A-820, Regular Medicaid Coverage.

 

 

A—831.1 How to Apply for Three Months Prior Coverage

Revision 15-4; Effective October 1, 2015

Medical Programs except TP 45

A person applies for three months prior Medicaid coverage by completing Form H1113, Application for Prior Medicaid Coverage. Advisors must give this form to applicants who indicate on an application or during the application interview that the family has unpaid medical bills incurred during the three months before the application month. Exception: For Children’s Medicaid, Form H1113 is not required if the family provides enough information to determine eligibility for prior months.

Related Policy

Continuous Medicaid Coverage, A-832
TP 45 Retroactive Coverage, A-833

 

 

A—831.2 Eligibility for Three Months Prior Coverage

Revision 17-1; Effective January 1, 2017

Medical Programs except TP 40

Advisors certify the applicant for Medicaid only for the month(s) the individual meets all eligibility requirements and has:

  • unpaid medical bills for Title XIX-covered services; or
  • received Medicaid services from the Texas Department of State Health Services.

Advisors provide prior Medicaid coverage even if the:

  • family is not currently eligible for Medical Programs; or
  • person with unpaid medical bills is deceased.

TP 08

Certify a parent or caretaker relative for a prior month(s) if they are caring for a dependent child who meets all eligibility requirements in the prior month(s), but is not certified for Medicaid in the prior month(s) because the child does not have unpaid medical bills.

TP 40

Gaps do not apply to TP 40. Once eligibility is determined in one of the prior months, it continues even if there are no unpaid medical bills in a subsequent prior month.

 

 

A—831.2.1 Reopening Three Months Prior Applications

Revision 21-3; Effective July 1, 2021

Medical Programs

Applications for prior Medicaid coverage may be reopened for one or more month(s) in the three-month prior period when:

  • the person requests the application be reopened within two years after the application file date; and
  • Medicaid eligibility (certification with or without spend down) for the person or month(s) of coverage requested was not previously established.

Verify a previous application was filed. Use any application filed by the household within the past two years as a basis for determining eligibility for prior Medicaid coverage, even if the application did not request ongoing Medicaid, prior months’ Medicaid coverage or claim unpaid medical bills. Medicaid eligibility can only be established within two years after the application file date whether or not the request was processed due to agency or applicant error.

Note: Do not reopen an application for prior Medicaid for a month that Medicaid eligibility (certification with or without spend down) was established, even if the spend down was closed by the Clearinghouse.

 

 

A—831.3 Income Computation

Revision 15-4; Effective October 1, 2015

Medical Programs

Staff must determine eligibility for each month in which there are unpaid medical bills using the income and verification rules explained in A-1300, Income

The needs and income of people who would have been considered in the client’s MAGI household composition for each month the client’s MAGI household composition has unpaid medical bills are included.

 

 

A—831.4 Determining the Appropriate Type Program for the Prior Month

Revision 15-4; Effective October 1, 2015

Medical Programs

Use the following chart to determine the type program to use for eligibility in the prior month:

If the type program is … and the modified adjusted gross income for the prior month is … then …
TP 08, less than or equal to the FPIL amount for TP 08 and there is no gap in coverage, certify the application for the prior month.
TP 08, less than or equal to the FPIL amount for TP 08 and:
  • there is a gap in coverage, or
  • the individual is not currently eligible,
certify the application for the prior month(s).
TP 08, more than the FPIL amount for TP 08, do not certify the application for the prior month in this type program. Check eligibility for another type program.
TP 40, TP 43, TP 44, or TP 48, less than or equal to the FPIL amount for that program, certify the application for the prior month.
TP 40, TP 43, TP 44, or TP 48, more than the FPIL amount for that program, do not certify the application for the prior month in this type program. Check eligibility for TP 56.
TP 45, not applicable, these applicants are always eligible back to the date of birth.
TP 56, more than the medically needy income limit (MNIL), determine if the household has enough medical expenses to meet spend down for the prior month.

If yes, then certify the children or pregnant woman.

If no, then deny the application for prior coverage.
TA 31, TP 33, TP 34, TP 35, or TP 36, less than or equal to the FPIL amount for that program, certify the applicant for the prior month only for the dates of the emergency medical condition verified on Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification.
TP 32 above the income limits as stated above (applies only to children [under age 19] and pregnant women), determine if the household has enough medical expenses to meet spend down for the prior month.

If yes, then certify the child or pregnant woman.

If no, then deny the application for prior coverage.

Note: Applicants are considered for eligibility in Medicaid for Former Foster Care Children (TA 82) and Medicaid for Transitioning Foster Care Youth (TP 70) before TP 08.

 

 

A—831.5 Medical Eligibility Date for Three Months Prior Coverage

Revision 13-2; Effective April 1, 2013

Medical Programs

The MED for a month of prior coverage begins the earliest day in the month the individual met all eligibility criteria. It is the first day of the month unless all eligibility criteria were not met.

Related Policy

Regular Medicaid Coverage, A-820

 

 

A—831.6 Applications Based on Incapacity

Revision 15-4; Effective October 1, 2015

TP 08 and TA 31

If the applicant claiming incapacity meets the other eligibility requirements for prior Medicaid coverage, the advisor must document information according to A-1080, Disability Verification.

 

 

A—832 Continuous Medicaid Coverage

Revision 19-1; Effective January 1, 2019

TP 40

Staff provide continuous Medicaid coverage without an application or an interview for a pregnant woman through the second month after the pregnancy terminates regardless of income increases if she:

  • received Medicaid on a program other than TP 40 and was ineligible because of income;
  • provides verification that she was pregnant in the month she becomes ineligible for Medicaid; and
  • received Medicaid within 11 months prior to the application month.

Note: Accept the individual's (pregnant woman's, case name's or AR's) verbal or written statement of pregnancy as verification. The statement must include the name of the woman who is pregnant, pregnancy start month, number of expected children and anticipated date of delivery. The individual also may provide Form H3037, Report of Pregnancy, or another document containing information specified on Form H3037.

Note: Staff provide continuous Medicaid coverage to a pregnant woman who was denied with an administrative denial reason (such as, but not limited to, failure to keep appointment and voluntary withdrawal) if her Medicaid would have been denied because of income if the income had been reported.

The continuous coverage policy applies to women who were receiving benefits from the following programs:

  • SSI or MEPD. Note: When an SSI Medicaid recipient is denied, TIERS sends Form H1296, Notice of SSI Medicaid Ending, informing the recipient that she may be potentially eligible for other Medical Programs within HHSC.
  • A caretaker certified on TP 08 who is not eligible for TP 07 or TP 20.
  • A caretaker or child certified on TP 07 or TP 20.
  • A child certified on TP 44.

TP 43, TP 44 and TP 48

A child under age 19 receives a 12-month certification period. The child is continuously eligible for Medicaid for six months or through the month of the child’s 19th birthday, whichever is earlier. The second six months of coverage is non-continuous, and changes may impact the child’s eligibility.

Exceptions:

  • During the continuous eligibility period, if a household reports that a sibling has moved into the household and requests Medicaid for the sibling, the sibling is added to the current case. TIERS aligns the end of the new Medicaid-eligible child’s certification period with the end of the existing child’s certification period.
  • A child is not eligible for continuous coverage if a household fails to report required information at application that causes a child to be ineligible for Medicaid. See A-825, Medicaid Termination.

If the household is eligible in the application month, process month, or ongoing month, the child is eligible for continuous coverage beginning the first month the household meets the eligibility criteria. Note: This includes situations where the household is eligible in the application or process month, but not in an ongoing month.

If the household is eligible only in a month prior to the application, certify the child for the prior month only. The child is not eligible for continuous coverage.

Note: Explore TP 56 for the child if the individual indicates the child has unpaid bills in a month of ineligibility.

Related Policy
Medicaid Termination, A-825
What to Report, B-621

 

 

A—833 TP 45 Retroactive Coverage

Revision 15-4; Effective October 1, 2015

TP 45

Advisors must provide retroactive TP 45 coverage for newborn children without requiring an application or an interview with the child's mother if all of the following conditions are met:

  • There are unpaid Title XIX bills for the newborn child.
  • The mother of the child is unwilling, unable or refuses to apply for current benefits for the child, or the child is not eligible for current benefits.
  • The advisor has verification of the following eligibility factors for the newborn child:
Eligibility Factor Eligibility Requirement
Age Coverage must be initiated within one year of the child's birth.

The child's coverage cannot continue after the child becomes 13 months old.
Residence Child must be residing in Texas.
Natural mother's Medicaid coverage dates Child's mother must be eligible for and receiving Medicaid on the day the child is born. The mother's eligibility can be determined retroactively. See A-820, Regular Medicaid Coverage.

The file date is the day the advisor is notified about the unpaid bills for the child.

TIERS will allow a:

  • file date as late as the month of the child's first birthday, and
  • medical effective date as early as the child's date of birth.

 

 

A—834 Retroactive Medicaid Coverage for Abandoned Children

Revision 18-1; Effective January 1, 2018

Medical Programs

If a newborn or child is abandoned at an acute care hospital, or at a psychiatric hospital while receiving inpatient services, DFPS requests a court order for custody. Once the court order is obtained, DFPS provides Medicaid coverage from the day in which custody is granted. The MED is the date DFPS takes conservatorship. This may result in the newborn or child having unpaid medical bills if DFPS takes conservatorship after the date of birth or the date of admission to the hospital and the date DFPS takes conservatorship.

A designated DFPS representative completes Form H1113, Application for Prior Medicaid Coverage, requesting coverage on behalf of the abandoned child and forwards the request to a designated Texas Works advisor within Centralized Benefit Services (CBS) at cbs_ffche-mtfcy@hhsc.state.tx.us.

For children abandoned in a psychiatric hospital, DFPS will only submit applications to request retroactive Medicaid for a child receiving inpatient treatment.

CBS advisors provide retroactive Medicaid coverage only during the following situations:

  • A newborn is taken into foster care conservatorship after the date of birth but before the child is released from the hospital, creating a gap in coverage from the date of birth through the day before the foster care conservatorship date.
  • A child of any age is taken into foster care conservatorship while in the hospital, but after the admission date, creating a gap in coverage from the date of admission to the day before the foster care conservatorship date.

Note: The MED for a child (not a newborn) cannot precede the date of admission into the hospital.

A-840, Transitional Medicaid Coverage

Revision 02-6; Effective July 1, 2002

A—841 General Eligibility Information

Revision 15-4; Effective October 1, 2015

TP 07

Some TP 08 household members may be eligible for transitional Medicaid, TP 07.

An eligibility determination for TP 07 is based on whether a parent or caretaker relative is certified for TP 08, Parents and Caretaker Relatives Medicaid, in Texas for three of the six months before the first month of ineligibility. If a parent or caretaker relative certified for TP 08 coverage is eligible for transitional Medicaid, his or her children will be eligible as well. Each individual will be certified on an individual transitional Medicaid EDG for the duration of the certification period.

Example: The household composition consists of mother, father, and two mutual children. The mother and father each are certified on an individual TP 08 EDG in Texas for three of the six months before the month of ineligibility and each child on an individual Children's Medicaid EDG. The father has an increase in income that makes him ineligible for TP 08. The father is then certified on an individual TP 07 EDG. The mother and the two children will be certified on individual TP 07 EDGs, each with the same certification period as the father.

When a TP 07 EDG has been created, other eligible household members receive a new TP 07 EDG. See A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home, and A-846.2,Child Enters or Already Lives in the Home.

A household member is not eligible for TP 07 if the member was ineligible for TP 08 because the individual committed fraud during any of the six months before the TP 07 EDG was opened. The fraud must be determined by a court or through a hearing. If the TP 07 EDG was opened before the fraud determination was known:

  • the household member is disqualified using advance adverse action notice procedures, and
  • transitional child care staff must be notified that the member should not have received transitional benefits because of Medicaid fraud.

TP 08 households denied for any reason (such as failure to keep an appointment) may request TP 07 during the adverse action time frame and have their eligibility determined. For example, a household who failed to keep their appointment because of a new job may be eligible for TP 07.

Individuals may request Medicaid on TP 08 any time after denial. These individuals and their household members may also request TP 07 if they become employed.

The number of months of transitional coverage is 12 months.

A—841.1 Multiple Changes That Cause TP 08 Ineligibility

Revision 15-4; Effective October 1, 2015

TP 08

If two or more changes (when one is new or increased earned income) cause the income to increase from less than the FPIL for TP 08 to more than the FPIL for TP 08 for the same month, and the household has not been notified that members are eligible for TP 07, advisors follow the steps below:

Step Action
1

If all other case factors remain the same, is the household income increased to above the FPIL for TP 08 because of new or increased earnings?

  • Yes. The family is eligible for TP 07 if members meet the other eligibility requirements.
  • No. Go to Step 2.
2

Is the income increased to above the FPIL for TP 08 as a result of a change other than new or increased earnings?

  • Yes. The family is not eligible for TP 07. Go to Step 3.
  • No. Go to Step 4.
3

Does the family meet the income limits for the Medical Program EDGs for which they are certified?

  • Yes. Continue current Medical Program coverage.
  • No. Deny the Medical Program EDG(s) for which the individual is no longer income eligible.
4

Is the income increased to above the FPIL for TP 08 when all changes are considered?

Yes. The family is eligible for TP 07 if the members meet the other eligibility requirements.

Changes reported in a timely manner do not stop the denial of the TP 08 EDG and creation of the TP 07 after the household is notified of transitional Medicaid eligibility, even when both changes affect the same month.

Exceptions: The EDG is denied if the household:

  • moves out of Texas;
  • no longer meets the household composition requirement as specified in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage; or
  • reports a change that makes the household ineligible before the first month of transitional Medicaid eligibility.

A—841.2 Notice to Clients

Revision 15-4; Effective October 1, 2015

TP 08

When TIERS denies a TP 08 EDG and creates a TP 07, TIERS generates Form TF0001, Notice of Case Action, to notify the household:

  • that their TP 08 and their children on associated TP 43, TP 44 and TP 48 EDGs are denied;
  • the date their TP 07 benefits will end; and
  • about the transitional Medicaid eligibility and reporting requirements. Note: If the individual is in the office, the advisor may explain the reporting requirements.

A—841.3 Eligibility Criteria During Transitional Medicaid Coverage

Revision 15-4; Effective October 1, 2015

TP 07

Certified members remain eligible for transitional Medicaid if the:

  • household continues to live in Texas, and
  • EDG meets one of the following household composition requirements.
The transitional EDG includes an eligible child.

Note: For transitional Medicaid, an eligible child is a child who meets all of the following requirements:
  • citizenship,
  • Social Security number (SSN),
  • age,
  • relationship, and
    domicile.
OR A parent or caretaker relative cares for a child who receives:
  • SSI;
  • adoption assistance payments; or
  • federal, state or local foster care payments; or
  • Medicaid (TP 07, 20, 40, 43, 44, 45, or 48.

The noncomplying adult who is certified for TP 07 is denied when the advisor receives notice that the legal parent failed to cooperate with third-party resource (TPR) requirements or has been found guilty of a Medicaid intentional program violation.

If another-related caretaker failed to cooperate with TPR requirements or was found guilty of a Medicaid intentional program violation, the advisor must:

  • change the status to payee, or
  • deny the transitional Medicaid EDG if the other-related caretaker is the only person on the EDG.

The advisor must not:

  • count unearned income of household members when determining continued eligibility for households certified for transitional Medicaid; or
  • deny a transitional Medicaid EDG because of new or increased income of a household member, unless reported in the seventh or tenth month Medicaid Status Report.

A—842 TP 07 Transitional Medicaid

Revision 15-4; Effective October 1, 2015

TP 08

TP 08 certified members are eligible for TP 07 if:

  • at least one of the group members was eligible for and received TP 08 in Texas for three of the six months before the first month of ineligibility; and
  • the denial is because:
    • a certified parent, certified caretaker relative, or disqualified legal parent began receiving or had an increase in gross earned income; or
    • of the earnings of a new or returning absent parent who is added to the certified group because the household meets incapacity or deprivation criteria.

A—842.1 Determining the First Month of TP 07 Medicaid

Revision 15-4; Effective October 1, 2015

TP 08

The first TP 07 month is the month the change is effective (when reported and acted on timely) when new or increased earnings cause a certified parent or caretaker relative on TP 08 to be over the FPIL for TP 08.

Determine the first month of TP 07 eligibility using the following chart:

Step Action
1

The first month of TP 07 is the first month after adverse action expires when the change is reported, verified, and processed timely (or should have expired if the change was not reported, verified, or processed timely).

Note: The first month can be no later than the first month of overpayment as described in B-752.1.2, Errors After Certification, but may be earlier based on the date the notice of adverse action expires (as described in A-2343.1, How to Take Adverse Action if Advance Notice Is Required).

2

Was at least one household member eligible for and did that member receive TP 08 in Texas for at least three of the six months prior to the month identified in Step 1? (See A-842.2, Determining the Three of Six Months Eligibility Requirement.)

If yes, continue to Step 3.

If no, deny the EDG.

3 Designate the month from Step 1 as the first month of TP 07 eligibility.

Individuals who appeal the advisor's decision to deny the TP 08 EDG often receive TP 08 while the appeal is pending. If the hearing officer sustains the advisor's decision, the months the client received continued benefits during the appeal process are counted as TP 07 months.

A—842.2 Determining the Three of Six Months Eligibility Requirement

Revision 20-1; Effective January 1, 2020

TP 08

Advisors must determine whether at least one household member was eligible for and received TP 08 in Texas for three of the six months before the first month of ineligibility.

Advisors must count any month when at least one household member was eligible for and received benefits. Advisors must include any month that someone in the household received TP 08.

Advisors must not count any month benefits were:

  • issued but the household was not eligible;
  • not issued;
  • received in another state;
  • prior Medicaid coverage; or
  • Medicaid only for the application month due to certification in a later month.

TP 08 with Other Household Members on a Medical Program

Advisors must determine whether at least one TP 08 household member was eligible for and received Medicaid in Texas for three of the six months before the first month the income increase is effective.

Advisors must count any month when at least one household member was eligible for and received Medicaid through:

  • TP 08, TP 20, TP 40, TP 43, TP 44, TP 45, TP 48, or TP 56 and spend down was met;
  • SSI, including SSI Medicaid only;
  • federal, state, or local foster care; or
  • adoption assistance.

Advisors must not count any months Medicaid benefits were:

  • certified but the household member was not eligible;
  • received in another state; or
  • prior Medicaid benefits.

A—842.3 Automatic Denial of TP 07

Revision 15-4; Effective October 1, 2015

TP 07

Recipients terminated from TP 07 must be retested for eligibility for any other Medical Programs, as explained in A-2342.1, Retesting Eligibility.

A—843 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

A—844 Transitional Medicaid Reporting Requirements for TP 07

Revision 15-4; Effective October 1, 2015

TP 07

Individuals receiving TP 07 coverage are required to report the following changes during the 4th, 7th and 10th months of the transitional period:

  • Changes in the household members' gross monthly earnings, and
  • Changes in the household composition.

Form H1146, Medicaid Report, is computer-generated and is sent to the household at cutoff in the 3rd, 6th and 9th months. Form H1146:

  • informs the household of the availability of continuing transitional coverage,
  • provides information about the change reporting requirements, and
  • provides a way to report the required information.

Advisors use Form H1146-M, Medicaid Report (Manual), to replace TIERS-generated forms that the household reports are lost or destroyed.

Advisors must not require verification for the transitional Medicaid EDG. Exception: Advisors must require appropriate verifications to determine whether a new household member is eligible to be added to the EDG. See A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home, and A-846.2, Child Enters or Already Lives in the Home.

Note: If the household does not return Form H1146, no action is required.

A—844.1 Staff Action on the Fourth Month Medicaid Report

Revision 21-1; Effective January 1, 2021

TP 07

Use the following procedures to process Form H1146-M, Medicaid Report, for the fourth month. Take action on the household members' other EDGs and cases if the reported information affects those benefits.

If the household returns Form H1146 and Form H1146 indicates … then …
the household still meets the household composition requirements in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage, take no action on the transitional Medicaid case.
a child who is not receiving TP 43, TP 44, TP 45, TP 48, or transitional Medicaid is in the home, see A-846.2, Child Enters or Already Lives in the Home.
a child left the home, see A-846.3, Household Member Leaves the Home.
a returning absent parent or stepparent, see A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home.
a household member certified for TP 07 reports a pregnancy, explore TP40 eligibility for the pregnant household member.
the household no longer meets the household composition requirements in A-841.3,
  • deny the EDG, and
  • send Form TF0001, Notice of Case Action.
  • there are no earnings by the parent or caretaker relative in at least one of the three report months, and there is no good cause for the lack of earnings; or
  • the average monthly gross earnings of the household members* exceeds the applicable income limit for the household size,

shorten the transitional Medicaid coverage to end after the sixth month.

Note: If the medical coverage is shortened because the parent or caretaker relative did not have earnings for a complete month, inform the household that they can show good cause. They must show good cause within 13 days. (See A-844.4, Good Cause Determinations.)

* See A-844.3, 185% FPIL Test, for budgeting policies.

Related Policy
Eligibility Criteria During Transitional Medicaid Coverage, A-841.3
185% FPIL Test, A-844.3
Good Cause Determinations, A-844.4
Parents and Caretaker Relatives Enter or Already Live in the Home, A-846.1
Child Enters or Already Lives in the Home, A-846.2
Household Member Leaves the Home, A-846.3

A—844.2 Staff Action on the Seventh and Tenth Month Medicaid Reports

Revision 21-1; Effective January 1, 2021

TP 07

Use the following procedures to process Form H1146-M, Medicaid Report, for the seventh and tenth months. Take action on the household members' other EDGs and cases if the reported information affects those benefits.

If the household returns Form H1146 and Form H1146 indicates … then …
the household no longer meets the household composition requirements in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage, deny the EDG and send Form TF0001, Notice of Case Action.
  • there are no earnings by the parent or caretaker relative in at least one of the three report months, and there is no good cause for the lack of earnings; or
  • the average monthly gross earnings of the household members* exceeds the applicable income limit for the household size,
  • deny the EDG using the appropriate denial reason;
  • open a new EDG for the appropriate Medical Program if applicable; and
  • send Form TF0001 to the household.

If the EDG is denied and the household is not eligible for another type of Medical Program, send Form H1010, Texas Works Application for Assistance – Your Texas Benefits, along with Form TF0001.

HHSC must act on received information (earnings) that makes the household ineligible for transitional Medicaid even if the information is received outside of the reporting period (i.e., changes); however, eligibility can only be terminated at the end of the seventh or tenth month.

Note: If the denial is because the parent or caretaker relative did not have earnings for a complete month, inform the household that they can show good cause. They must show good cause within 13 days. (See A-844.4, Good Cause Determinations.)
the household continues to be eligible, take no action.
a child who is not receiving TP 43, TP 44, TP 45, TP 48, or transitional Medicaid is in the home, see A-846.2, Child Enters or Already Lives in the Home.
a child left the home, see A-846.3, Household Member Leaves the Home.
a returning absent parent or stepparent, see A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home.
a household member certified for TP 07 reports a pregnancy, explore TP40 eligibility for the pregnant household member.

* See A-844.3, 185% FPIL Test, for budgeting policies.

Note: A denial notice (Form TF0001) will be sent to the household at the end of their 12 months of transitional Medicaid.

Related Policy
Eligibility Criteria During Transitional Medicaid Coverage, A-841.3
Good Cause Determinations, A-844.4
Parents and Caretaker Relatives Enter or Already Live in the Home, A-846.1
Child Enters or Already Lives in the Home, A-846.2
Household Member Leaves the Home, A-846.3

A—844.3 185% FPIL Test

Revision 15-4; Effective October 1, 2015

TP 07

Advisors use the following policies and procedures to determine whether the household's earnings are at or below the 185 percent FPIL when processing Medicaid reports.

Advisors must include all members of the individual’s MAGI household composition when determining the MAGI income.

Exceptions:

  • Advisors must not count the earnings of a child who is exempt according to A-1341, Income Limits and Eligibility Tests.
  • See A-240, Medical Programs, and A-1341 for exceptions to household composition and countable income.
  • When a person is disqualified because of failure to cooperate with child/medical support or TPR requirements, or is found guilty of a Medicaid intentional program violation, the person is not included in the household size.
If the person who fails to cooperate is … then …
a certified legal parent, count the person’s earnings.
an "other relative" caretaker who is the parent or stepparent of a child on the case, count the person’s earnings.
an "other relative" caretaker who is not a parent or stepparent to a child on the case, do not count the person’s earnings.

A—844.4 Good Cause Determinations

Revision 15-4; Effective October 1, 2015

TP 07

Good cause for the caretaker relative not having earnings in one or more of the report months includes:

  • involuntary loss of employment,
  • illness,
  • actively looking for work but unable to find a job, and
  • other reasons beyond the household's control.

A—845 Reinstatement of Denied Transitional Coverage

Revision 15-4; Effective October 1, 2015

TP 07

Certain households whose transitional Medicaid EDGs are denied before the end of their original eligibility period may have transitional Medicaid coverage reinstated. Advisors must reinstate eligible household members for the remainder of their original transitional Medicaid period if:

  • the original transitional Medicaid end date has not expired;
  • the TP 07 was denied — for example, members:
    • were recertified for TP 08; or
    • moved out of Texas;
  • the household does not want to apply for TP 08 or is not eligible for TP 08 (at application, review, or change); and
  • there is a dependent child in the household certified for Medicaid.

Note: Individuals requesting reinstatement of TP 07 transitional Medicaid must have remained continuously eligible for transitional Medicaid during the months the TP 07 EDG was denied. Exception: A household that moved out of Texas must meet all of the eligibility criteria except residence.

A—845.1 Advisor Action on Reinstatements

Revision 15-4; Effective October 1, 2015

TP 07

Advisors must count the months of absence from transitional Medicaid as if the family had actually received transitional Medicaid.

Advisors use the following table to determine the MED:

If the member ... then enter the day ...
remained in Texas during the transitional Medicaid denial period and did not receive other Medicaid coverage, following the denial date.
moved out of the state, the member returned to Texas and was no longer eligible for Medicaid in another state (see A-822, Medicaid Coverage for New State Residents).
was certified for TP 08 or another Medical Program, following the denial date on the other TP 08 or other Medicaid EDG.

To reinstate denied transitional Medicaid, advisors must:

  • Determine which mode to use. If the case status is denied and there is:
    • no active EDG, use Reopen mode.
    • an active EDG, use Complete Action mode.
  • On the Program Summary page, select Reactivation from the Program Action drop-down menu.
  • On the Program Details page, enter the Reactivation Date and select the appropriate Reactivation Reason.
  • From the Program – Individuals Summary display, select the person(s) requesting aid.
  • Change Aid Requested to Yes. Note: The Date Requested is defaulted to the previous date for individuals who were on the EDG when it was terminated.
  • Continue through Data Collection.
  • In Disposition, choose Administrative TMA Reinstatement as the reason for eligibility.

Notes:

  • Advisors must not open a new application. If a new application was created, it is denied as filed in error.
  • When processing the reinstatement, any members who are no longer in the household are removed.
  • Advisors send Form TF0001, Notice of Case Action, to notify the household of their continued eligibility.

Advisors must obtain information on household composition and earnings for the months the household did not receive TP 07 and is required to report on Form H1146, Medicaid Report.

If the household missed the … then obtain information on months …
fourth month Medicaid report, one, two, and three.
seventh month Medicaid report, four, five, and six.
tenth month Medicaid report, seven, eight and nine.
If the household was … then …
certified for Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), or any of the Medical Programs, use case information, requesting additional information from the household only if necessary.
not certified, obtain the necessary information.

Advisors determine whether the individual was continuously eligible for TP 07 Medicaid using:

  • A-844.1, Advisor Action on the Fourth Month Medicaid Report, for the fourth-month Medicaid Report;
  • A-844.2, Advisor Action on the Seventh and Tenth Month Medicaid Reports, for the seventh- and tenth-month Medicaid Reports; and
  • A-844.4, Good Cause Determinations, to determine good cause for no earnings.

A—846 Special Household Composition Policies for Transitional Medicaid

Revision 13-2; Effective April 1, 2013

A—846.1 Parents and Caretaker Relatives Enter or Already Live in the Home

Revision 15-4; Effective October 1, 2015

TP 07

Advisors must follow the procedures below if the household requests TP 07 benefits for a caretaker, returning absent parent, stepparent, or second parent in the home.

Advisors must add the member to the case and open a new TP 07 EDG for the individual, or change an ineligible member to eligible if the person is a caretaker or second parent who:

  • was disqualified on the TP 08 or transitional EDG but has complied with the eligibility requirement for which he was disqualified (for example, TPR);
  • is a returning absent parent/second parent in the home; or
  • is a stepparent caretaker because the legal parent has a disability and is unable to care for the children.

A—846.2 Child Enters or Already Lives in the Home

Revision 15-4; Effective October 1, 2015

TP 07

Advisors follow the procedures in the chart below:

  • when the TP 07 household reports that a child who is not receiving TP 07, TP 43, TP 44, TP 45, or TP 48 is in the home;
  • when denying a TP 08 EDG and opening a TP 07 EDG; and
  • upon review of another Medical Program EDG for a child who lives with a TP 07 recipient.

An other-related child's separate Medical Program EDG continues unless the caretaker needs Transitional Child Care services for the child.

If a child who is not receiving TP 43, TP 44, TP 45, TP 48, or transitional Medicaid … then …
is a newborn, moves in, or already lives in the home,

obtain the appropriate information/verifications and determine if the child meets all of the following requirements:

  • citizenship,
  • SSN,
  • age,
  • relationship, and
  • domicile.

Use information/verifications from other case records when the child is currently or has been a TANF/Medical Program or SNAP recipient.

Do not consider the following criteria:

  • deprivation, and
  • income.

Note: Obtain information regarding a child's earned income when processing the seventh and tenth month Medicaid reports if the child's earnings are counted, following Medical Programs policy explained in A-1341, Income Limits and Eligibility Tests.

If the child is eligible, then send Form TF0001, Notice of Case Action, to the household to inform the household of the child's eligibility.

If the child is not eligible or the household does not provide the information/verification, then:

  • send Form TF0001 to the household;
  • inform the household that:
    • their TP 07 EDG will continue; but
    • the child cannot be added to the case, stating the reason the child cannot be added; and
  • take no action on the case.

If a child who is added to the case has unpaid medical bills for any of the three months prior to the month the request is received to add the child, advisors must:

  • determine and document three months prior eligibility according to Medical Programs policies and procedures in A-830, Medicaid Coverage for the Months Prior to the Month of Application; and
  • assign the child an MED beginning the first prior month the child met all TP 07 eligibility requirements.

The child's MED cannot precede the:

  • first month the household was eligible for TP 07 (advisors must determine a child's eligibility for another Medical Program if the individual applies for prior coverage that precedes the first month the household is eligible for TP 07); or
  • date the child entered the household.

A—846.3 Household Member Leaves the Home

Revision 15-4; Effective October 1, 2015

TP 07

Follow the procedures in the chart below when the transitional Medicaid household reports that a child leaves the household.

If a child leaves the household and the … then …
  • child was part of the transitional certified group, and
  • household continues to meet the household composition requirements in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage,
  • send Form TF0001, Notice of Case Action, to the household informing the household that the child will no longer receive Medicaid, and
  • deny the child’s TP 07 EDG.
household no longer meets the household composition requirements in A-841.3,
  • send Form TF0001 to the household, and
  • deny the TP 07 EDGs that no longer are eligible.

Advisors follow normal procedures to remove a parent or caretaker relative when the household reports the person is no longer in the home.

A—846.4 Minor Parents Certified as Children

Revision 15-4; Effective October 1, 2015

TP 07

See A-240, Medical Programs, for household composition rules.

A—847 Other EDG Actions

Revision 13-2; Effective April 1, 2013

A—847.1 Changes Affecting Transitional Medicaid EDGs

Revision 21-1; Effective January 1, 2021

TP 07

For TP 07 EDGs, only take action for the following changes:

  • A household member reports a pregnancy. Explore TP 40 eligibility for the pregnant household member.
  • A child is born, moves in, or is already living with the certified group. Add the child to the case and open a TP 07 EDG following procedures in A-846.2, Child Enters or Already Lives in the Home.
  • A parent or caretaker relative moves in or otherwise becomes eligible. Add the member to the case and open a TP 07 EDG following procedures in A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home.
  • A member included in a TP 07 EDG leaves the household. Remove the member from the case following procedures in A-846.3, Household Member Leaves the Home.
  • A household member is no longer eligible. Remove the member from the case. For example:
    • A child no longer meets the Medical Programs age criteria.
    • A child moves out of state.

Related Policy  
Parents and Caretaker Relatives Enter or Already Live in the Home, A-846.1
Child Enters or Already Lives in the Home, A-846.2
Household Member Leaves the Home, A-846.3

A—847.2 Reapplication for TP 08

Revision 15-4; Effective October 1, 2015

TP 07

A household receiving TP 07 may reapply for TP 08 by submitting an application. If the household is eligible, TIERS will:

  • deny the TP 07;
  • certify the parent/caretaker relative on a TP 08 EDG and the child on the appropriate Children’s Medicaid EDG; and
  • send Form TF0001, Notice of Case Action, to the household.

Related Policy
Minor Parents Certified as Children, A-846.4

A-850, TP 20 Alimony/Spousal Support Transitional Medicaid Coverage

Revision 16-4; Effective October 1, 2016

 

A—851 Eligibility Criteria for Medicaid when Receiving Alimony or Spousal Support

Revision 21-2; Effective April 1, 2021

TP 20

People denied TP 08 because of new or increased alimony or spousal support may be eligible for TP 20. TP 20 eligibility determinations are based on a parent or caretaker relative  certified for TP 08. Household members are eligible for TP 20 for four months following the last month of TP 08 eligibility if:

  • the modified adjusted gross income before receipt of alimony or spousal support was at or below the income limit for TP 08;
  • new or increased alimony or spousal support income caused the person’s MAGI household income to exceed the income limit for the household's size; and
  • at least one TP 08 household member was eligible for and received Medicaid in Texas for three of the six months before the first month of ineligibility.

If the household is eligible, a separate transitional Medicaid EDG will be created for each parent or caretaker relative and each child.

When a change in new or increased alimony or spousal support is reported, verified, and processed timely, the first month a person may receive TP 20 is the month after the adverse action period expires (or should have expired if the change was not reported, verified, or processed timely). 

A person may receive less than four months of TP 20 coverage if the change of new or increased alimony or spousal support is not reported or processed timely.

Note: If a divorce or separation agreement that includes alimony was executed or last modified after Dec. 31, 2018, alimony received is not counted in the person’s household budget.

Related Policy

Determining the First Month of TP 07 Medicaid, A-842.1
Determining the Three of Six Months Eligibility Requirement, A-842.2 
Alimony (Spousal Support) Received, A—1326.17 
Changes Decreasing Benefits, B-643
 

A—851.1 Multiple Changes That Cause TP 08 Ineligibility

Revision 15-4; Effective October 1, 2015

TP 08

If two or more changes (when one is new or increased spousal support) cause the income to increase above the Federal Poverty Income Limits (FPIL) for TP 08 for the same month, and the household has not been notified that members are eligible for TP 20, advisors follow the steps below:

Step Action
1 If all other case factors remain the same, is the household income increased to above FPIL for TP08 because of new or increased alimony/spousal support?
  • Yes. The household is eligible for TP 20 if members meet the other eligibility requirements.
  • No. Go to Step 2.
2 Is the income increased to above FPIL for TP 08 as a result of a change other than new or increased alimony/spousal support?
  • Yes. The household is not eligible for TP 20. Go to Step 3.
  • No. Go to Step 4.
3 Does the household meet the income limits for the Medical Program EDGs for which they are certified?
  • Yes. Continue current Medical Program coverage.
  •  
  • No. Deny the Medical Program EDG(s) for which the family member is no longer income eligible.
4 Is the income increased to above the FPIL for TP08 when all changes are considered? Yes. The household is eligible for TP 20 if the members meet the other eligibility requirements.

Changes reported in a timely manner do not stop the denial of the TP 08 EDG and creation of the TP 20 after the household is notified of transitional Medicaid eligibility, even when both changes affect the same month.

Exceptions: The EDG is denied if the household

  • moves out of Texas;
  • no longer meets the household composition requirement as specified in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage; or
  • reports a change that makes the household ineligible before the first month of TP 20 eligibility.

Related Policy

Multiple Changes that Cause TP 08 Ineligibility, A-841.1

 

A—852 Eligibility Criteria During Transitional Medicaid Coverage

Revision 16-4; Effective October 1, 2016

TP 20

Certified members remain eligible for Medicaid if the household continues to:

  • live in Texas; and
  • receive alimony/spousal support.

The legal parent who is certified for TP 20 when the advisor receives notice that the legal parent failed to cooperate with child/medical support or TPR requirements or has been found guilty of a Medicaid intentional program violation is denied.

 

A—853 Automated Process

Revision 16-4; Effective October 1, 2016

TP 08

If the Office of the Attorney General (OAG) receives a new or increased alimony/spousal support collection that is greater than the TP 08 income limits, TIERS determines whether the TP 08 EDG should be denied and a TP 20 opened, or whether the TP 08 EDG should be denied. If either is appropriate, TIERS notifies the individual on Form TF0001, Notice of Case Action.

 

A—854 Denial of TP 20

Revision 16-4; Effective October 1, 2016

TP 20

Recipients terminated from TP 20 must be retested for eligibility for any other Medical Programs, as explained in A-2342.1, Retesting Eligibility.

 

A—855 Reinstatement of Denied TP 20 Coverage

Revision 16-4; Effective October 1, 2016

TP 20

Certain households whose TP 20 EDGs are denied before the end of their eligibility period has expired may have transitional Medicaid coverage reinstated. Reinstate eligible household members for the remainder of the original TP 20 Medicaid period if:

  • their original transitional Medicaid end date has not expired;
  • their TP 20 EDG was denied because the members moved out of Texas; and
  • they:
    • do not wish to apply for other medical coverage; or
    • are not eligible for other medical coverage.

Follow procedures in A-845, Reinstatement of Denied Transitional Coverage, to reinstate TP 20 coverage.

 

A—856 Special Household Composition Policies for Transitional Medicaid

Revision 16-4; Effective October 1, 2016

 

A—856.1 Parents and Caretaker Relatives Enter or Already Live in the Home

Revision 16-4; Effective October 1, 2016

TP 20

Advisors follow the procedures below if the household requests TP 20 benefits for a caretaker, returning absent parent, stepparent, or second parent in the home.

Advisors must add the member to the case and open a new TP 20 EDG for the individual if the person is a caretaker relative or second parent who:

  • was disqualified on the TP 08 or transitional EDG but has complied with the eligibility requirement for which the member was disqualified (for example, child/medical support, TPR); or
  • is a returning absent parent/second parent in the home.

 

A—856.2 Child Enters or Already Lives in the Home

Revision 16-4; Effective October 1, 2016

TP 20

Advisors follow the procedures in the chart below:

  • when the TP 20 household reports that a child who is not receiving TP 20 or TP 43, TP 44, TP 45, or TP 48 is in the home;
  • when denying a TP 08 EDG and creating a TP 20 EDG; or
  • upon review of another Medical Program case for a child who lives with a TP 20 recipient.

Advisors must continue an other-related child's separate Medical Program EDG.

If a child who is not receiving TP 43, TP 44, TP 45, TP 48 or TP 20 … then …
is a newborn, moves in, or already lives in the home, obtain the appropriate information/verifications and determine if the child meets all of the following requirements:
  • citizenship,
  • SSN,
  • age,
  • relationship, and
  • domicile.

Use information/verifications from other case records when the child is currently or has been a TANF/Medical Program or SNAP recipient.

Do not consider the following criteria:

  • deprivation, and
  • income.

If the child is eligible, then:

  • send Form TF0001, Notice of Case Action, informing the household of the child's eligibility for TP 20; and
  • add the child to the case and open a new TP 20 EDG for the child.

If the child is not eligible or the household does not provide the information/verification, then:

  • send Form TF0001 to the household;
  • inform the household:
    • their TP 20 EDG will continue; but
    • the child cannot be added to the case, stating the reason the child cannot be added; and
  • take no action on the case.

 

A—856.3 Minor Parents Certified as Children

Revision 16-4; Effective October 1, 2016

TP 20

See A-240, Medical Programs, for household composition rules.

 

A—857 Reapplication for TP 08

Revision 16-4; Effective October 1, 2016

TP 20

A household receiving transitional Medicaid may reapply for TP 08. If the household is eligible, the advisor must:

  • deny the TP 20 EDG;
  • create the applicable Medical Program EDG; and
  • send Form TF0001, Notice of Case Action, to the household.

A-860, Third-Party Resources

Revision 15-4; Effective October 1, 2015

Medical Programs

A TPR is a source of payment for medical expenses other than the recipient or Medicaid. TPR include payments from private and public health insurance and from other liable third parties that can be applied toward the recipient's medical expenses. Title XIX (Medicaid) funds are to be used for the payment of medical services only after all available third-party resources have been used, except for medical services from the following:

  • Texas Department of Assistive and Rehabilitative Services;
  • Texas Commission for the Blind;
  • Texas Kidney Health Care Program;
  • Muscular Dystrophy Association;
  • Children with Special Health Care Needs;
  • Texas Band of Kickapoo Equity Health Program;
  • Maternal and Child Health (Title V);
  • State Legislative Impact Assistance Grant (SLIAG);
  • Crime Victims Compensation Program; and
  • adoption agencies or adoptive parents with medical obligations to the recipient.

Income maintenance insurance policies not related to actual medical expenses are not third-party resources unless the policy is assignable to a hospital or other medical provider.

When an applicant has health insurance, the advisor must instruct the individual to tell medical providers about the health insurance. The provider then bills the insurance company rather than or before billing Medicaid.

Individuals must cooperate:

  • in identifying and pursuing any third party who may be liable for medical support payments, including absent parents who pay cash medical support;
  • in reimbursing HHSC for medical expenses paid by Medicaid from:
    • court settlements, and
    • liability, casualty, or health insurance payments, and
  • with HHSC and its Health Insurance Premium Payment (HIPP) contractor by:
    • providing information about available health insurance coverage;
    • enrolling in their employer's health insurance program; and
    • providing proof of their premium payments.

Individuals who refuse to cooperate without good cause are denied.

The denied legal parent is included in the household composition.

 

A—861 Third-Party Resources (TPR) and Accidents

Revision 15-4; Effective October 1, 2015

Medical Programs

The advisor must instruct individuals to report any accident-related injuries requiring medical care or accident-related unsettled legal claims within 60 days.

 

A—861.1 Reporting the Accident to the Third-Party Resources (TPR) Unit

Revision 15-4; Effective October 1, 2015

Medical Programs

If a recipient reports an injury requiring medical treatment for which liability/casualty insurance (the individual's own or someone else's) may provide payment, the advisor must determine the details of the accident and any legal action involved and forward the information by memorandum to:

HHSC/OIG/TPR Unit
MC 1354
P.O. Box 85200
Austin,Texas78708-5200

Advisors must include in the report:

  • individual-identifying information;
  • the date and nature of the accident and resulting injuries;
  • information regarding the liable or potentially liable third party, including the liability insurance policy number and the name and address of the insurance adjuster, if available;
  • dates, types, and sources of medical services related to the injury; and
  • the status or plans for any legal action, including the name and address of any attorney involved, if available.

 

A—861.2 Responding to Third-Party Resources (TPR) Unit Noncooperation Notices

Revision 15-4; Effective October 1, 2015

Medical Programs

When the TPR Unit becomes aware of a possible accident through information included on a Medicaid claim form, the TPR Unit contacts the individual to obtain information about the accident.

 

A—861.3 Third-Party Resources (TPR) Reimbursements

Revision 15-4; Effective October 1, 2015

 

A—861.3.1 Client-Initiated Reimbursements

Revision 15-4; Effective October 1, 2015

Medical Programs

When a recipient reimburses HHSC for medical expenses from a court settlement or from a liability, casualty, or health insurance payment, the reimbursement should be by personal check, cashier's check, or money order payable to the Texas Department of Health and Human Services.

Advisor action:

  1. Give the individual Form H4100, Money Receipt.
  2. Send the reimbursement and a copy of Form H4100 to ARTS at P.O. Box 149044, Austin, Texas 78714.
  3. Enter the type(s) and date(s) of the medical service(s) in the "For" section of the form.
  4. If unsure what medical services were involved, complete a memorandum giving as much information as is known concerning the reimbursement.
  5. Attach a copy of any information identifying the nature of the payment, such as a statement from the insurance company, to Form H4100.

The actual claim paid by Medicaid is verified in state office, and the individual is reimbursed if the payment made is in excess of the Medicaid payment. The advisor is notified of the reimbursement. Advisors must consider the reimbursement as possible TANF and/or TP 08 income.

 

Related Policy

Lump-Sum Payments, A-1331
Reimbursements, A-1332

 

A—861.3.2 Reporting Non-Reimbursement to the Third-Party Resources (TPR) Unit

Revision 15-4; Effective October 1, 2015

Medical Programs

When an advisor becomes aware that a recipient received a reimbursement for medical expenses paid by Medicaid and failed to reimburse HHSC, the advisor reports the non-reimbursement to the TPR Unit. The advisor must include any available information about the accident and the payment in the report.

The TPR Unit investigates the claim and reports back. The advisor uses the guidelines in A-861.4, Responding to Third-Party Resources (TPR) Unit Recovery Requests, upon receipt of a memo from the TPR Unit confirming the non-reimbursement.

 

A—861.4 Responding to Third-Party Resources (TPR) Unit Recovery Requests

Revision 15-4; Effective October 1, 2015

Medical Programs

Advisors use the following chart in responding to TPR Unit recovery requests.

When the TPR Unit becomes aware that an individual received a private insurance payment and has not made any payments to the Medicaid provider, the TPR Unit sends a memo to the regional director. The memo includes the amount of:

  • Medicaid paid; and
  • the private insurance payment, if known.

The advisor must use the following procedures after receiving the memo:

Step Action

1

Send Form H1020, Request for Information or Action, to the caretaker, requesting that the individual:

  • provide verification of the amount of the private insurance payment, and
  • contact the advisor about reimbursing HHSC.

If the individual does not respond, then go to Step 2.
If the individual does respond, then go to Step 3.

2

Send Form TF0001, Notice of Case Action, to initiate action to disqualify the legal parent from the certified and/or budget group. Process a referral for intentional program violation if the Medicaid payment was $100 or more. To report waste, abuse or fraud to the OIG/TPR Unit, use the online reporting form https://oig.hhsc.state.tx.us/wafrep/ or call toll-free 1-800-436-6184.

3

Collect the lesser of the:

  • Medicaid payment, or
  • private insurance payment.

Note: If the private insurance payment is greater than the Medicaid payment, count the difference as lump-sum payments for TANF, SNAP and Medical Programs. Refer to A-1200, Resources, and A-1300, Income, for policy on how to count the payments.

If the individual does not make a full payment, then go back to Step 2.

If the individual makes full payment, then go to Step 4.

4

When the individual makes a payment:

  • ensure the payment is made by personal check, cashier's check or money order payable to the Texas Department of Health and Human Services;
  • give the individual Form H4100, Money Receipt. Annotate the form with "TPR/TMHP Insurance Recovery”; and
  • send a copy of Form H4100 with the payment to Fiscal Division, State Office, E-411.

 

A—861.5 Remitting Cash Medical Support Payments to the Third-Party Resources (TPR) Unit

Revision 15-4; Effective October 1, 2015

Medical Programs

After certification, Medicaid recipients must remit to the TPR Unit any cash medical support payments received for a certified child. The advisor gives the individual sufficient copies of Form H1710, Payment Identification, and TPR self-addressed envelopes, if payments are being made or might be made. The advisor instructs the individual upon receipt of a cash medical support payment from an absent parent after certification of the requirement to:

  • write on the check or money order "Deposit Only - State Treasury" and to not endorse the check or money order;
  • include Form H1710 with the check or money order; and
  • send it to the HHSC/OIG/TPR Unit, MC 1354, P.O. Box 85200, Austin, TX 78708-5200.

If the individual turns in cash medical support payments to the local office, the advisor must:

  • forward the payment(s) to the HHSC/OIG/TPR Unit; and
  • give the individual a copy of Form H4100, Money Receipt.

Upon becoming aware that an individual did not remit a cash medical support payment, advisors must follow policy in B-700, Claims, and process a claim for the month(s) of unreported income, if required.

Related Policy

TANF, A-1124
Medical Support Payments, A-1326.2.3

 

A—862 Third-Party Resources (TPR) Reporting System

Revision 15-4; Effective October 1, 2015

Medical Programs

The application asks applicants and individuals whether any household members have health insurance. Form H1028, Employment Verification, asks employers to verify if health insurance is available, and whether the employee is enrolled. When an individual reports a new job or a change in employers, the advisor determines whether there is any new or potential private health insurance coverage for certified household members during the eligibility interview or application processing.

If information from the individual, the employer or other source indicates ... then report ...
Medicaid-eligible household members have private health insurance coverage,

information about the private health insurance in the Third Party Resources logical unit of work of the case the individual is a member of in TIERS.

health insurance coverage is available for Medicaid-eligible household members but the members are not enrolled in the health insurance plan,

information about the available health insurance in the Third Party Resources logical unit of work of the case the individual is a member of in TIERS.

The TPR Unit will use the information to initiate an inquiry about HIPP Program eligibility.

To contact the TPR Unit about TPR questions or problems:

  • advisors may call 1-800-846-7307.
  • clients may call the Client Medicaid Hotline at 1-800-252-8263.

 

A—863 Health Insurance Premium Payment (HIPP) Program

Revision 17-1; Effective January 1, 2017

Medical Programs

The Health Insurance Premium Payment (HIPP) program is a Medicaid benefit that helps families pay for employer-sponsored health insurance.

To qualify for HIPP, an employee must either be Medicaid eligible or have a family member that is Medicaid eligible. The HIPP program may pay for individuals and their family members who receive, or have access to, employer-sponsored health insurance benefits when it is determined that the cost of insurance premiums is less than the cost of projected Medicaid expenditures.

Note: An employee and their Medicaid-eligible family member must be enrolled in the employer-sponsored health insurance in order to receive HIPP reimbursements.

Medicaid-eligible HIPP enrollees do not have to pay out-of-pocket deductibles, co-payments, or co-insurance for health care services that Medicaid covers when seeing a provider that accepts Medicaid. Instead, Medicaid reimburses providers for these expenses.

HIPP enrollees who are not Medicaid eligible must pay deductibles, co-payments, and co-insurance required under the employer's group health insurance policy.

Report individuals who are potentially eligible for HIPP on Form H1039, Medical Insurance Input. Send Form H1039  to HHSC's Third Party Resource (TPR) Unit, Mail Code 1354.

HHSC's TPR Unit refers Form H1039 to the current state Medicaid contractor, Texas Medicaid and Healthcare Partnership (TMHP). If TMHP determines it is cost-effective for Medicaid to pay the recipient's employer-sponsored health insurance premiums, then TMHP sends:

  • a letter to the recipient and requests verification of the employer-sponsored insurance plan and premium payments; and
  • a premium reimbursement to the recipient upon receipt of complete documentation and proof of the premium payment.

Note: Do not consider an incurred medical deduction for the reimbursed premium for individuals participating in HIPP.

TMHP will terminate HIPP enrollment if the individual is no longer enrolled in health insurance coverage or fails to provide TMHP with the information needed to determine cost effectiveness or proof of premium payments.

For more information about the HIPP program, see HHSC's website: http://hhs.texas.gov/services/financial/insurance/health-insurance-premium-payment-hipp, or contact the Medicaid HIPP program at MCD_HIPP_Program@hhsc.state.tx.us.

Individuals may call 800-440-0493 for more information.

Related Policy

Reimbursements, A-1332

A-870, Verification Requirements

Revision 20-2; Effective April 1, 2020

Medical Programs

Verification is required for the following:

  • Spousal support to establish eligibility for TP 20
  • Unpaid medical bills for three months prior coverage. Exception: Refer to A-831.2, Eligibility for Three Months Prior Coverage, for TP 40 prior coverage
  • Income for each of the three months prior to coverage. Note: For Children's Medicaid, do not request more income verification for prior Medicaid coverage than what is required for ongoing eligibility. See A-1371, Verification Sources, for Children's Medicaid.
  • An application was filed when reopening an application for prior month coverage according to A-831.2.1, Reopening Three Months Prior Applications
  • Gross earnings and the date the person received the earnings for TP 07. Exception: If verification is not readily available, accept the person's statement unless questionable. If the household provides earnings information sufficient to determine eligibility for TP 07 but does not provide verification of the earnings, deny the TP-08 EDG and create a TP 07 EDG if the person meets the eligibility requirements in A-842, TP 07 Transitional Medicaid.
  • When a household requests continuation of Medicaid for children aging out of TP 44, verify the child:
    • is hospitalized on the child's 19th birthday;
    • remains hospitalized (there is not a time limit); and
    • meets all other criteria according to policy in A-825, Medicaid Termination.
  • Third-Party Resource (TPR).  Report to the TPR Unit any household member who:
    • has private medical insurance; or
    • is not enrolled in group medical coverage that is available to him.

Emergency Medicaid

Verify the emergency medical condition by using Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification. These forms are the only acceptable sources that can be used to verify an emergency medical condition. A licensed practitioner must complete and sign Form H3038 or Form H3038-P.

Note: An original or a faxed copy of Form H3038 or Form H3038-P is acceptable to verify the emergency medical condition.

TP 40

See A-144.5, Pregnancy, for policy relating to verification of pregnancy.

Related Policy

Pregnancy, A-144.5
Regular Medicaid Coverage, A-820
Verification Requirements, A-1370
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480
Questionable Information, C-920
Providing Verification, C-930

A-880, Documentation Requirements

Revision 21-2; Effective April 1, 2021

Medical Programs

Document:

  • Verification of income and unpaid medical bills for the three months prior coverage.
  • Medical insurance other than Medicaid.
  • Method of income computation.
  • Eligibility for transitional Medicaid.
  • Reason for assigning less than the maximum transitional Medicaid coverage.
  • Denial of TP 20 because spousal support payments stopped.
  • Reason for action on a Medicaid EDG.
  • Gross earnings and the dates the person received the earnings.
  • Cost of health insurance premium for the child(ren) before certifying for CHIP.
  • Name and phone number of state hospital employee.

If the household requests continuation of Medicaid for children aging out of TP 44, follow policy in A-825, Medicaid Termination, and document that the child:

  • is hospitalized on their 19th birthday;
  • remains hospitalized through the end of their eligibility period; and
  • meets all other criteria according to A-825 .

If providing prior coverage for more than three months, follow policy in A-831.2.1, Reopening Three Months Prior Applications, and document that:

  • there was an application on file to cover any of the prior months; and
  • the file date on the application was used to cover these months.

TP 40

Document the pregnancy verification method and the anticipated delivery date.

Related Policy
Medicaid Termination, A-825 
Reopening Three Months Prior Applications, A-831.2.1 
Third-Party Resources, A-860 
Documentation Requirements, A-950
Documentation, C-940

A-910, General Policy

Revision 16-4; Effective October 1, 2016

TANF

A child must live in the home with a relative listed in A-221, Who Is Included, No. 4. A home is the family setting maintained or being established, as evidenced by continuation of responsibility for day-to-day care of the child by the relative with whom the child is living.

Medical Programs except TP 08 and TA 31

Domicile requirements do not apply to these programs. Children can live with a parent or caretaker relative, or not live with a parent or caretaker relative (for example, independent children).

TP 08 and TA 31

For a parent or caretaker relative to be eligible for TP 08 or TA 31, they must be living with the dependent child of whom they have care and control. In general, for a caretaker to be considered as having care and control of a child, the child must live in the home with the relative. A home is the family setting maintained or being established, as evidenced by continuation of responsibility for day-to-day care of the child by the relative with whom the child is living.

The parent or caretaker relative may meet the domicile requirement when the dependent child is not included in their Modified Adjusted Gross Income (MAGI) household composition.

Example: A grandfather is living with his grandchild, but the grandchild is claimed as a tax dependent by a non-custodial parent. The grandfather is applying for health care for himself. In this example, the grandchild is not included in the grandfather’s MAGI household composition since the grandfather is not claiming the grandchild as a tax dependent. However, the grandfather meets the domicile requirement if the grandchild lives with the grandfather and meets the care and control requirements explained in A-921, How to Determine Care and Control.

Related Policy
Children Admitted into State Hospitals, A-922
Children Residing in General Residential Operations Facilities, A-923

A-920, Temporary Absence from the Home

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Advisors must not deny assistance because a household member or payee is temporarily out of the home if all of the following conditions are met:

  • The person is out of the home due to:
    • temporary separation from other family members, and the family has no regular place of residence;
    • hospitalization or receipt of outpatient services;
    • attending school or training (including schools for the deaf and blind);
    • being on vacation;
    • being in a home for children not considered to be a public institution; or
    • seeking employment away from home.
  • The parent or caretaker relative/payee is still responsible for the child's care and control. See A-921, How to Determine Care and Control, to determine whether the caretaker/payee still has care and control.
  • The person's absence is not anticipated to be more than the allowable six- or 12-month period.

    Advisors must certify or continue eligibility, and review the Eligibility Determination Group (EDG) every three months. Advisors remove the absent household member from the EDG after:
    • six months (beginning with the first full month of absence from the home); or
    • 12 months for situations when a family member is out of the home because the member is:
      • hospitalized or receiving outpatient services;
      • attending school or training; or
      • in a home for children not considered to be an institution.

The allowable six- or 12-month period begins again if the absent person returns to and resides in the home for at least 30 consecutive days. Advisors must not apply the temporary absence time frames when a parent is out of the home solely because of employment. Advisors must include the employed parent in the certified group if the parent meets all other eligibility criteria. See A-1040, Deprivation Based on Absence from the Home.

If a member of the certified group enters a nursing home, advisors leave the member’s needs in the household composition if the member will be there temporarily or until the member is certified for Supplemental Security Income (SSI). Advisors refer the recipient to the Social Security office for an SSI eligibility determination.

TANF

If the advisor removes the caretaker from the EDG, the EDG must be denied, and the advisor must ask another relative in the home that qualifies as caretaker to apply for the child(ren).

Medical Programs

If the advisor denies the parent or caretaker relative’s EDG, this does not impact the other associated Medical Program EDGs, and the other individuals cannot be required to reapply for Medical Programs.

 

A—921 How to Determine Care and Control

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

The parent or caretaker relative/payee cannot be considered responsible for the absent child's care and control when the child:

  • is placed out of the caretaker/payee's home by the court, and the caretaker/payee has no authority to remove the child; or
  • has a court-appointed guardian other than the caretaker/payee.

These children are independent children. The advisor must determine their eligibility for one of the Medical Programs.

Other considerations for care and control include:

  • Who has the financial responsibility for the child's medical and dental costs?
  • Who makes the decisions about health care, medical care, schooling and other personal care decisions?
  • To what extent is the caretaker/payee involved with the child? How often does the caretaker/payee visit the child? What is the caretaker/payee's involvement with decisions for the care, well-being, schooling, etc.?
  • To what extent does the caretaker/payee actively participate in the guidance and development of the child?
  • What is the caretaker/payee's financial involvement for the child? That is, does the caretaker/payee pay a regular fee for the child's enrollment and participation in the home's programs?
  • What restrictions or limitations have been placed on the caretaker/payee's rights?

Based on the responses to these questions, the advisor must make a prudent person decision about the caretaker/payee still being responsible for the child's care and control.

Related Policy
Prudent Person Principle, A-137

 

A—922 Children Admitted into State Hospitals

Revision 15-4; Effective October 1, 2015

Medical Programs except TP 08 and TA 31

Advisors consider a child admitted into a state hospital as an independent child if the caretaker no longer has care and control and the child was admitted:

  • via a court order, or
  • voluntarily.

The child is not considered an independent child if the child was admitted voluntarily and the caretaker/payee continues to have care and control.

 

A—923 Children Residing in General Residential Operations Facilities

Revision 16-4; Effective October 1, 2016

Medical Programs except TP 08 and TA 31

Advisors consider a child admitted into certain general residential operations facilities that are members of the Texas Coalition of Homes for Children as an independent child. These residential care facilities are considered to have care and control over children in their care.

Once a child is placed in one of these facilities, the facility provides a live-in house parent model of care. The house parent(s) assumes responsibility and acts in lieu of the parent(s) in meeting the children’s ongoing needs.

These facilities may apply for medical assistance on behalf of the children under their care. The facilities have limited power of attorney and are considered alternate payees for the children’s Medicaid EDG.

The facilities submit an application listing the child as a case name and a representative from the facility as an authorized representative.

Below is a list of general residential operations facilities that are members of the Texas Coalition of Homes for Children:

  • ACH Child and Family Services – Fort Worth
  • Arms of Hope – Quinlan and Medina
  • Ben Richey Boys Ranch – Abilene
  • Boys and Girls Country – Hockley
  • The Brownson Home – Victoria
  • Buckner Children and Family Services – Dallas
  • Cal Farley's Boys Ranch – Amarillo
  • Cherokee Home for Children – Cherokee
  • Children at Heart Ministries – Round Rock
  • The Children's Home of Lubbock – Lubbock
  • Children's Village – Tyler
  • Christ's Haven – Keller
  • Foster's Home for Children – Stephenville
  • Hendrick Home for Children – Abilene
  • High Plains Children’s Home – Amarillo
  • Lee and Beulah Moor Children's Home – El Paso
  • Methodist Home for Children – Waco and Waxahachie
  • Miracle Farm – Brenham
  • Presbyterian Children's Home – Austin, San Antonio, Waxahachie and Itasca
  • South Texas Children's Home Ministries – Beeville
  • Sunny Glenn Children's Home – San Benito
  • Texas Baptist Children's Home – Round Rock
  • Texas Boys Ranch – Lubbock
  • West Texas Boys Ranch – San Angelo

This list is not all inclusive. Staff must submit a policy clearance request if they receive an application requesting medical assistance for a child from a facility that is not included on this list. Staff must include a copy of the placement contract and the power of attorney from that facility so it can be determined if the child can be considered an independent child.

Related Policy

Authorized Representatives (AR), A-170
Children’s Living Arrangements, A-241.3.1
Verification Requirements, A-940
Verification Sources, A-941

 

A—924 Disqualification for Failure to Report Temporary Absence

Revision 15-4; Effective October 1, 2015

TANF

If a caretaker relative (a legal parent or other caretaker relative) fails to timely report the temporary absence of a certified child, the caretaker relative is disqualified until the earlier of the following occurs:

  • the child returns to the home,
  • the child is removed from the certified group, or
  • the EDG is denied.

Related Policy

TANF — Budgeting for a Household Member Disqualified for Noncompliance with SSN, TPR, Failure to Timely Report a Certified Child’s Temporary Absence, Intentional Program Violation, Being a Fugitive or a Felony Drug Conviction, A-1362.2
General Policy, A-1210

A-930, Requirement for Unmarried Minor Parents to Live with an Adult or in an Adult-Supervised Setting

Revision 15-4; Effective October 1, 2015

TANF

To receive Temporary Assistance for Needy Families (TANF) benefits, unmarried minor parents must live:

  • with a parent, legal guardian or adult relative; or

    Note: The unmarried minor parent does not have to be included in a TANF EDG with the minor parent's parent unless required by policy in A-221, Who Is Included.
  • in a local second chance home, maternity home or other residential facility that provides an adult-supervised living arrangement, if available in the local community, if the unmarried minor parent:
    • has no parent, legal guardian, or adult relative:
      • who is living;
      • whose whereabouts are known; and
      • who is willing and appropriate; or
    • cannot live with such an individual because of prior or potential abuse or neglect.

Advisors must notify the minor parent of available local facilities.

An unmarried minor parent and child are not required to live in a second chance home, maternity home or other adult-supervised living arrangement if it is not in their best interest. The advisor, using the prudent person principle, determines whether the unmarried minor parent's current living arrangement is in their best interest.

"In their best interest" means either:

  • there is no parent, legal guardian or adult relative with whom the minor parent and child can live; or
  • there is no adult-supervised facility in the community; or
  • their current living arrangement provides as much or more safety and emotional or financial security than living in a local adult-supervised facility.

Examples:

  • An unmarried minor parent is employed, their child has safe child care, and the move would result in the loss of employment.
  • An unmarried minor parent lives alone or with a family friend, has no living adult relative, and no alternative adult-supervised facility is available in the community.

 

A—931 Failure to Comply

Revision 15-4; Effective October 1, 2015

TANF

Advisors must disqualify an unmarried minor parent who fails to comply with the requirement to live with a parent, legal guardian, adult relative, or in an adult-supervised living arrangement.

Related Policy
Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits, A-1362.1

 

A—940 Verification Requirements

Revision 21-1; Effective January 1, 2021

TANF, TP 08 and TA 31

Verify that a person meets the 30-day domicile requirement before allowing additional temporary absence periods.

Related Policy
Temporary Absence from the Home, A-920

TANF

Verify domicile:

  • at application and redetermination for all certified children; and
  • when a change occurs:
    • for newly added children; or
    • if questionable, for all certified children.

For an unmarried minor parent:

  • verify domicile at application and redetermination;
  • obtain a statement from the parent, legal guardian, adult relative or an employee of the adult-supervised setting; or
  • contact school officials or use a current school record showing the same address as the parent, legal guardian, adult relative or approved adult-supervised setting.

 TP 08 and TA 31

Verify domicile of a dependent child:

  • at application and redetermination; and
  • when a change impacts the living situation or care and control of the dependent child.

 
Medical Programs

Verify verbally with a state hospital employee whether a child entered a state hospital via a court order or if the child was admitted voluntarily. If the child was admitted voluntarily, determine whether the caretaker or payee still has care and control.

Verify verbally with a facility employee a child’s placement into a general residential operations facility.

Related Policy
Children’s Living Arrangements, A-241.3.1
Children Admitted into State Hospitals, A-922
Children Residing in General Residential Operations Facilities, A-923

A-940, Verification Sources

A—941 Verification Sources

Revision 17-2; Effective April 1, 2017

TANF, TP 08 and TA 31

  • For a preschool-age child, advisors must:
    • observe the interaction between the child and caretaker/payee in either the home or the office;
    • obtain a statement from a non-relative landlord; or
    • obtain a statement from a non-relative neighbor.
  • For a school-age child, obtain from the individual the name of the school for each school-age child. If the individual does not know where the child attends school and cannot provide a reasonable explanation, consider domicile questionable. When domicile is questionable, contact the school to verify domicile. If domicile is not questionable, use any of the following sources to verify domicile:
    • contact school officials or use a current school record showing the same address as the caretaker;
    • obtain a statement from a non-relative landlord;
    • obtain a statement from a non-relative neighbor; or
    • follow the same observation procedures for a preschool-age child if it does not interfere with school attendance.
  • For individuals reported as released from juvenile placement by Texas Juvenile Justice Department (TJJD)/Juvenile Probation Department, use the Juvenile Medicaid Tracker.

If a child is home schooled, obtain domicile verification from another collateral source. See A-1640, Verification Requirements.

Note: Use Form H1155, Request for Domicile Verification, to request written domicile verification from a non-relative. Use Form H1857, Landlord Verification, to obtain verification from a non-relative landlord.

Medical Programs except TP 08 and TA 31

Advisors may accept self-declaration as verification of domicile.

For a child placed into a general residential operations facility:

  • limited power of attorney to obtain health care and educational services; and
  • placement contract.

Related Policy
Children’s Living Arrangements, A-241.3.1
Children Residing in General Residential Operations Facilities, A-923
Questionable Information, C-920
Providing Verification, C-930

A-950, Documentation Requirements

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Advisors must document:

  • information from the verification source to prove the children live in the home (for collateral contacts, include name and address and/or telephone number);
  • the reason for any temporary absence;
  • information from the verification source to prove the household member or payee returned to and lived in the home for at least 30 days when allowing another temporary absence period;
  • the living arrangement for unmarried minor parents;
  • if the caretaker/relative continues to provide care and control when a child is admitted voluntarily into a state hospital;
  • if a child was admitted into a state hospital voluntarily or via a court order; and
  • if a child was admitted into a general residential operations facility.

Note: For Medical Programs except TP 08 and TA 31, accept self-declaration as verification of domicile.

TANF, TP 08 and TA 31

Advisors must document the school name, obtained from the caretaker/payee during the interview, for each school-age child.

TANF

Advisors must document how the minor parent meets or does not meet the unmarried minor parent domicile requirement, according to policy in A-930, Requirement for Unmarried Minor Parents to Live with an Adult or in an Adult-Supervised Setting.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

A-1010, General Policy

Revision 15-4; Effective October 1, 2015

TANF

Deprivation is the loss of financial support from a legal parent for one of the following reasons:

  • absence of parent(s) from the home;
  • death of parent(s);
  • physical or mental incapacity of parent who is living in the home; or
  • unemployment or underemployment of one or both parents in a two-parent household.

A-1020, Establishing Deprivation for Children of Unwed Parents

Revision 04-7; Effective October 1, 2004

A—1021 Unwed Parents Living Together

Revision 15-4; Effective October 1, 2015

TANF

When a child lives with both biological parents and the father:

  • is not married to the child’s mother;
  • is not the legal father as determined through court adjudication; and
  • acknowledges paternity,

staff should follow the procedures below to establish deprivation:

If the child's mother … then …
is or was married (other than by common-law) to another man presumed to be the child's legal father, the child is deprived based on absence and the biological father should not be certified. Both fathers must be referred to the Attorney General (see A-1100, Child Support).
was never married to a man presumed to be the child's legal father, the child is deprived, but not based on absence.
was married by common-law to another man, the child is deprived, but not based on absence.

A—1022 Paternity Conflicts — Unwed Parents

Revision 15-4; Effective October 1, 2015

TANF

If an application is filed for a child living with the mother and a man who may be the child's father and the couple disagrees about paternity, the mother must provide written proof of her statement.

If the mother proves the man is … then deprivation is …
the child's father, not based on absence, but rather on the relationship to the biological father living in the home.
not the child's father, based on absence.

If the mother is unable to provide written proof, staff must accept the man's statement and determine deprivation accordingly. If there are other paternity conflicts, assistance should be requested from the regional attorney.

A-1030, Deprivation Based on Death of a Parent

Revision 15-4; Effective October 1, 2015

TANF

Deprivation exists when a child's legal parent(s) is deceased. Staff must explore possible survivor's benefits for the child and/or remaining parent.

A-1040, Deprivation Based on Absence from the Home

Revision 03-7; Effective October 1, 2003

A—1041 How to Determine Deprivation Based on Absence

Revision 15-4; Effective October 1, 2015

TANF

Deprivation based on absence exists when:

  • a child's legal parents do not live together because of:
    • divorce,
    • legal separation,
    • desertion,
    • incarceration, or
    • deportation;
  • the child's biological father lives in the home with the mother and child but a legal parent-child relationship exists between the child and another man;
  • a parent resides outside the U.S. and there is a legal impediment that prevents the parent from living in this country; or
  • a parent convicted of an offense and sentenced by a court to perform unpaid community service during work hours lives at home while serving the sentence.

If absence is anticipated to last for:

  • 30 days or less, the absence is considered temporary and the child is not deprived.
  • more than 30 days, the absence is considered continuing.

Note: If the absence is currently less than 30 days but is anticipated to last longer than 30 days, the Eligibility Determination Group (EDG) should not be pended for deprivation.

A parent should be included in the certified group if the parent is temporarily absent for a reason listed in A-920, Temporary Absence from the Home.

Deprivation based on absence does not exist when a parent is absent solely because of:

  • employment; or
  • active duty in the uniformed services of the United States, even if the parent is incarcerated or absent without leave (AWOL).

Exception: Deprivation may exist if there is a break in the family relationship unrelated to active duty in the service, and information indicates the family members are not functioning as a family unit. Information can be a statement from the caretaker that she and the second parent consider themselves to be separated so that the parents and children are not functioning as one family unit.

A—1041.1 Joint Custody

Revision 15-4; Effective October 1, 2015

TANF

A child living with parents who have court-ordered joint custody may be deprived based on absence. In joint custody cases, either parent may apply for Temporary Assistance for Needy Families (TANF) for the child. When the child alternately lives with either parent each month, either parent may apply. See A-910, General Policy.

A—1042 Contact with the Absent Parent

Revision 15-4; Effective October 1, 2015

TANF

Contact the … when the address or phone number is known and … Determine …
legal absent parent,
  • there is reason to believe the absent parent is making cash contributions other than child support; or
  • conflicting information is provided regarding the parent's absence.
  • if the absent parent is making contributions other than child support;
  • the reason for the absence;
  • how long the absent parent has been absent; and
  • if the absent parent has plans to return and the anticipated return date.
alleged parent with no legal parent-child relationship,
  • there is reason to believe the absent parent is making contributions other than child support to the household; or
  • the absent parent lives in the home and is a potential legal father through common-law marital status.
  • if the absent parent is making contributions other than child support; or
  • if a common-law marriage exists.

Advisors must notify the applicant/individual before contacting the absent parent. Advisors should not contact the absent parent if the individual has a pending or valid claim of good cause. See A-1130, Explanation of Good Cause.

>A—1043 Absent Parent Returns to the Home (Extension of the TANF Grant or Addition of the Returning Parent)

Revision 15-4; Effective October 1, 2015

TANF

When an absent parent returns to the home, the absent parent should be added to the case following policy in B-641, Additions to the Household, and eligibility and benefits should be determined.

  • If eligible, advisors must document the new reason for deprivation and notify the Office of the Attorney General (OAG).
  • If ineligible, advisors must deny TANF. If the absent parent’s earnings cause the case to be denied, advisors must transfer the case to TP 07 and include the absent parent.

Related Policy Earnings of a New TANF Spouse, A-1249.2

A-1050, Deprivation Based on Incapacity

Revision 15-4; Effective October 1, 2015

TANF

A parent is incapacitated if a medically determined mental or physical impairment results in a substantial reduction in the ability to support or care for the child. This impairment kept or will keep the parent from performing the parent’s usual work for at least 30 days.

The individual's usual work is the individual's main occupation for the last 15 years. In the case of a homemaker, the activities related to caring for a child are considered usual work.

A—1051 Determining Incapacity

Revision 15-4; Effective October 1, 2015

TANF

Advisors must determine whether the household meets all other eligibility criteria. If the household meets all other eligibility criteria, a disability determination request should be processed as follows:

  1. Advisors must determine whether the household is receiving Supplemental Security Income (SSI) or Retirement, Survivors and Disability Insurance (RSDI) based on disability. If the individual receives either of these benefits, deprivation is established. Note: Eligibility for SSI or RSDI based on age does not establish deprivation.
  2. If the applicant has a disability that is:
  • obvious, advisors must certify the household for TANF and require a completed Form H1836-A, Medical Release/Physician's Statement, at the next redetermination.
  • not obvious, the advisor must complete the disability determination. A disability determination consists of the advisor completing and sending Form H1836-A to the physician who treated the individual within the past 60 days for the incapacity being claimed. Note: The physician is not paid for completing this verification.
If Form H1836-A is returned indicating that the individual has … then the household should be certified for …
a temporary disability, TANF or TANF-State Program (SP), and the individual must be informed that the disability will be reviewed at each periodic redetermination.
a permanent disability, TANF or TANF-SP.
no disability, TANF or TANF-SP, and the requirements for participation in the Choices program must be explained.

A—1052 Processing Medical Reviews

Revision 15-4; Effective October 1, 2015

TANF

Medical reviews must be processed at each periodic review following the steps in A-1051, Determining Incapacity.

If the disability was … then …
determined at initial certification without Form H1836-A, Medical Release/Physician's Statement, or was temporary and has ended (based on Form H1836-A) and the individual still claims to have a disability, the advisors must require the individual to provide Form H1836-A before recertifying the case. If the individual does not provide the statement and the disability is not established, the advisor must then certify the household for TANF, if otherwise eligible.
permanent (based on Form H1836-A) and has not ended, the advisor must continue to base deprivation on incapacity and not require another Form H1836-A unless the individual is working and/or the condition has improved.

A-1060, Deprivation Based on Unemployment

Revision 02-8; Effective October 1, 2002

A—1061 How to Determine Deprivation Based on Unemployment

Revision 15-4; Effective October 1, 2015

TANF

Deprivation based on unemployment may exist when a legal parent is:

  • unemployed, or
  • underemployed.

A-1070, TANF-State Program

Revision 15-4; Effective October 1, 2015

TANF-SP

Eligibility for TANF-SP may be determined when:

  • a child lives with both of the child's natural or adoptive legal parents/stepparents, even if one or both are disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements; and
  • the household meets all other TANF eligibility requirements.

A—1071 Employment Services Requirements

Revision 02-8; Effective October 1, 2002

A—1071.1 Choices Requirements

Revision 15-4; Effective October 1, 2015

TANF

Choices participation requirements and procedures are explained in A-1800, Employment Services.

A-1080, Disability Verification

Revision 15-4; Effective October 1, 2015

TANF

Verify the disability status using Form H1836-A, Medical Release/Physician's Statement.

A—1081 Verification Sources

Revision 15-4; Effective October 1, 2015

TANF

Death

Sources for verification of death include:

  • copy of death certificate;
  • Birth Verification System record;
  • doctor's statement;
  • Social Security claim number or evidence of receipt of widow's or survivor's benefits from the deceased person's Social Security number;
  • U.S. Department of Veterans Affairs or military service records;
  • Indian census record;
  • statement from funeral director;
  • records from the hospital or other institution where the person died; and
  • insurance company records.

Alternate sources include:

  • newspaper death notice listing survivors;
  • state or local public assistance records (including burial payment records);
  • lodge, club or other organization records;
  • police records;
  • statement from clergy; and
  • "In Memoriam" card.

Sources for verification of continued absence include:

  • statement from the absent parent;
  • rent receipt/statement from the absent parent's non-relative landlord;
  • statement from clergy, landlord, or other knowledgeable non-relative;
  • correctional institution records;
  • telephone directory;
  • absent parent's child(ren)’s school records;
  • tax records;
  • absent parent's employment records;
  • union records;
  • court records;
  • statement from law enforcement officials;
  • insurance records;
  • medical records;
  • post office address records for the absent parent;
  • other agency records;
  • absent parent's unemployment compensation records;
  • Department of Motor Vehicles record showing the absent parent's address (includes driver license, identification card, and motor vehicle registration);
  • city or crisscross directory; and
  • Social Security, U.S. Department of Veterans Affairs, or other government agency records.

Sources for proof of deprivation for TANF-SP include:

  • Texas Workforce Commission inquiry;
  • tax records;
  • check stubs;
  • employer's statement;
  • business records; and
  • Form H1028, Employment Verification.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

A-1090, Documentation Requirements

Revision 15-4; Effective October 1, 2015

TANF

Advisors must document the:

  • facts about the incapacity and any expected changes;
  • processing dates of incapacity applications and reviews;
  • facts about good cause claims;
  • facts about adverse actions for noncooperation;
  • name and last known address of the legal and/or biological father of an unborn child, if the mother receives TANF;
  • permanent or temporary disability status; and
  • basis for a special review and the special review date.

Related Policy

Documentation, C-940

The Texas Works Documentation Guide

A-1110, General Policy

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

The Office of the Attorney General (OAG) Child Support Division is responsible for the child support program. The OAG attempts to establish and enforce child support and medical support for children on Temporary Assistance for Needy Families (TANF) and certain medical programs.

TANF

Caretakers and payees must cooperate in obtaining child support and medical support for a child receiving TANF unless good cause exists.

TP 08

Parents and caretaker relatives are mandatory participants and must cooperate in obtaining medical support for a child receiving Medicaid unless good cause exists. They may refuse assistance in obtaining child support, but not medical support. If the individual refuses assistance in obtaining child support, the OAG will not attempt to establish or enforce child support unless the individual has a previous TANF case with arrears that must be paid back to the state. Advisors must explain to individuals that when the OAG pursues medical support, Texas courts also pursue a child support order. If the individual chooses medical support only, the OAG will not attempt to enforce the child support orders.

Note: The advisor must request information on parents living outside of the home during an interview for TP 08. Information about parents living outside of the home is not requested for Medical Programs on the application.

Related Policy
Explanation of Good Cause, A-1130

Medical Programs except TP 08

Medical support requirements do not apply to children's medical programs. Applicants and individuals may volunteer to receive child or medical support services. There is no penalty for noncooperation.

Note: The OAG may contact and continue to collect benefits for a household receiving only children's medical assistance due to previous receipt of TANF.

Households may contact the OAG if they have questions or would like assistance in obtaining OAG services by calling 1-800-252-8014.

A—1111 Office of the Attorney General (OAG) Case Information and Inquiry

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

If the custodial or noncustodial parents or employers have questions regarding child support payments, distribution, or withholdings, they should be referred to the local child support office or to 1-800-252-8014.

Custodial or noncustodial parents should be referred to the local OAG office if they request verification and certification of public assistance received. The OAG staff complete Form 1740, Request for Public Assistance Payment Certification, when the amount of public assistance is in question or when it is needed in court to establish child support. Texas Health and Human Services Commission (HHSC) Fiscal Management Services (E-411) researches and certifies the amounts and date on Form 1745, Report of Total Public Assistance Payments, for the OAG.

A-1120, Child Support Program Requirements and Procedures

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause, is used to explain the:

  • child support process;
  • benefits of the child support program;
  • penalties for noncooperation;
  • details about the family violence option;
  • details of the good cause claim for not cooperating; and
  • individual's responsibility to:
    • provide information to the OAG and HHSC on all possible biological and/or legal parent(s);
    • help the OAG find the absent parent;
    • help the OAG establish paternity, if necessary;
    • go to the OAG office or to court to sign papers or provide necessary information; and
    • remit all child/medical support payments received after TANF is approved.

A—1121 Authorization and Assignment of Child and Medical Support

Revision 15-4; Effective October 1, 2015

TANF and TP 08

The assignment of rights to child and medical support is accomplished when an applicant signs an application that includes a request for TANF or TP 08. Signing the application gives the OAG permission to receive and process any child or medical support payments made payable to the child.

A—1122 Parent Profiles for Child and Medical Support Referrals

Revision 02-6; Effective July 1, 2002

A—1122.1 Parent Profile Questionnaire

Revision 22-2; Effective April 1, 2022

TANF and TP 08

Form H0050, Parent Profile Questionnaire, information is required for each absent parent. The absent parent information may be obtained verbally and entered into the Absent Parent page. If a child has both a legal and a biological absent parent, information on both the legal and biological parent is required unless the person can reasonably explain why it is impossible to provide information or has established good cause. The person must provide the following information about the absent parent:

  • the absent parent's first and last name;
  • information about the relationship (divorced, separated or never married) between the child's parents; and
  • at least one of the following:
    • the absent parent's Social Security number;
    • the absent parent's current or last known address; or
    • the absent parent's current or previous employer information.

Staff must address each item on Form H0050 and help the person obtain information about the absent parent(s). The OAG establishes cases based on information collected from the applicant and entered by HHSC staff. Failure to provide complete and accurate information may affect the successful enforcement of child support.

TP 43, TP 44 and TP 48

If the person volunteers to receive services provided by the OAG, staff must collect absent parent information as noted above and refer the child's Eligibility Determination Group (EDG) to the OAG.

Related Policy 

Explanation of Good Cause, A-1130

A—1122.2 Child Support and Medical Support Referrals

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs except TP 40 and TP 36

Advisors must send referrals to the OAG on legal and biological parent(s):

  • when deprivation is based on absence;
  • when deprivation is based on death;
  • if paternity cannot be established using policy in A-1021, Unwed Parents Living Together, for a biological father who is in the home;
  • if the family volunteers to receive services provided by the OAG for Children's Medicaid programs; or
  • the adult caretaker receives TP 08. See A-1122.1, Parent Profile Questionnaire, for Children's Medicaid programs.

Advisors do not send a referral if:

  • a child in the home is not deprived because both parents are in the home or deprivation is based on unemployment or underemployment (TANF-State Program [SP]);
  • a claim of good cause has been established;
  • deprivation is based on physical or mental incapacity; or
  • the legal or biological father of a pregnant woman's unborn child has no other children receiving Medicaid.

Advisors must review Form H0050, Parent Profile Questionnaire, with the individual to ensure no items are blank, that the individual provided complete and current information, and entered the information in the Absent Parent logical unit of work (LUW). The Texas Integrated Eligibility Redesign System (TIERS) automatically sends the referral to the OAG.

A—1123 Updates to Child Support Referrals

Revision 15-4; Effective October 1, 2015

TANF and TP 08

Advisors must advise the client to report new information about the absent parent(s), review the information previously submitted for accuracy, and update items as needed. The OAG will receive the update automatically.

A—1124 TANF

Revision 15-4; Effective October 1, 2015

After certification, TANF individuals must remit to the OAG all child support payments received for a certified child. Individuals should be given sufficient copies of Form H1710, Payment Identification, and OAG self-addressed envelopes, if payments are being made or might be made. When the individual receives a child support payment from an absent parent following certification, the individual must:

  • write on the check or money order "Deposit Only - State Treasury" and not endorse the check or money order;
  • include Form H1710 with the check or money order; and
  • send it to the Texas Child Support Disbursement Unit, P.O. Box 659791, San Antonio, Texas 78265-9941.

If child support is intended for a child on TANF and one on Supplemental Security Income (SSI), the individual must remit the payment to the OAG for proration and distribution to occur.

If the individual turns in child support payments to the local office, advisors must:

  • forward the payment(s) to the Child Support Disbursement Unit; and
  • give the individual a copy of Form H4100, Money Receipt.

Advisors must send Form H1701, Child Support, TANF Foster Care and TANF/Medicaid Case Information Exchange, including the amounts and months involved, to the OAG if the advisor becomes aware that the individual did not remit a child support payment. Advisors should follow policy in A-1140, Noncooperation with Child Support Program Requirements, to sanction the individual for noncooperation. If the individual indicates they will continue to keep child support received from the absent parent, the advisor should follow policy in B-700, Claims, and process a claim for the month(s) of unreported income.

If the OAG becomes aware that the individual received child support and did not remit the payments, the child support officer notifies the advisor on Form H1701. The advisor must process a claim for the unreported income.

TANF-SP

The household must not be required to remit any child support collected on behalf of a non-mutual child.

Related Policy

Remitting Cash Medical Support Payments to the Third-Party Resources (TPR) Unit, A-861.5
Child Support, A-1326.2

A—1125 OAG Distribution

Revision 15-4; Effective October 1, 2015

TANF

After individuals are certified for TANF, they must send all child support payments received to the OAG Child Support Division. The OAG:

  • sends the $75 disregard to the individual;
  • reimburses the state for TANF paid to the individual; and
  • sends HHSC the monthly interface file of child support collections for TANF recipients.

HHSC uses the information to determine whether the collection exceeds the grant plus the disregard, and to determine grant in jeopardy if it exceeds the grant.

If the individual receives child support for an SSI child in the household, the OAG will distribute (directly to the individual) the prorated share of support intended for the SSI child.

The month after the OAG receives a child support payment, the OAG will send the individual up to $75 (disregard payment). The amount sent is the lesser of:

  • the court-ordered payment amount,
  • the amount the OAG received during a given month, or
  • $75.

When the OAG receives a child support collection that exceeds the grant plus unreimbursed assistance, the excess is sent to the individual. Form H1714, Notice of Grant Jeopardy; Form H1715, Notice of Excess Payment; or Form H1717, Notice of Grant Jeopardy/Excess Payment — Denial, will notify the advisor of the date and amount of the payment.

A grant-in-jeopardy EDG may be generated for EDGs involving SSI children. In processing the grant-in-jeopardy, TIERS determines whether the prorated share of child support exceeds the TANF grant, minus the disregard. If the prorated share exceeds the TANF grant, minus the disregard, TIERS will deny the EDG. If the amount does not exceed the TANF grant, TIERS will allow the TANF EDG to continue.

Example: The household consists of a caretaker and one child who receives TANF and one child who receives SSI.
- $300 child support for both children
- -150 will go directly to SSI child
- 150 child support for TANF child
- - 75 disregard
- $75 does not exceed TANF for a caretaker and one child; the state retains the child support

Note: If the individual appeals the action described in A-852, Automated Process, and receives continued benefits, the advisor must count the excess payment as income during the appeal period if the advisor anticipates that the child support payments will continue.

Related Policy Automated Process, A-852 Child Support, A-1326.2 $75 Disregard Deduction, A-1422 Child Support Systems, C-830

A-1130, Explanation of Good Cause

A—1130 Explanation of Good Cause

Revision 21-2; Effective April 1, 2021

TANF and TP 08

The purpose of good cause is to allow people to access benefits safely. Good cause provides an exemption from cooperating with the OAG’s child support and medical support requirements.

Explain the family violence option and good cause exemption to all households applying for benefits. Use Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause, to explain the good cause exemption from the child support and medical support requirements. The explanation must include the situations that justify good cause and the required verifications. Explain that a person does not have to cooperate with child support or medical support requirements if they can prove that cooperation is not in the child's best interest.

A claim of good cause must be made separately for each absent parent. Notify the OAG of the person's good cause claim. This notification is sent from HHSC to the OAG through an automated interface once staff enter the appropriate information into TIERS and the case is disposed.

After explaining Form H1712 to the person:

  • Review Part I of Form H1713, Service Plan for Family Violence Option and Report of Good Cause, with the person during the interview. Complete only Part I of Form H1713 if the person indicates on this form that they do not want to claim good cause. If the person wants to continue to claim good cause, continue completing Part II and Part III where applicable of Form H1713.
  • Complete Part II Assessment Referral of Form H1713 if the person wants to claim good cause for family violence. Make an assessment referral to a family violence specialist using Part II of Form 1713. The family violence specialist makes a recommendation of good cause for reasons of family violence using the Form H1706, Good Cause Recommendation and Family Violence Exemption.
  • Complete Part III of Form H1713 to indicate the good cause reason and determination date.

Once the family violence specialist makes a recommendation of good cause on the Form H1706, complete Part III of Form H1713 and send the form to the local child support office and HHSC Family Violence Program (FVP) staff to report the final decision.

Note: TIERS will automatically notify the local child support office of the good cause determination through the OAG interface when the EDG is disposed.

Related Policy
Good Cause for Family Violence Option, A-1131.1

A—1131 Good Cause Situations

Revision 15-4; Effective October 1, 2015

TANF and TP 08

Good cause exists when:

  • a child was conceived as a result of incest or rape;
  • a child or caretaker may be physically harmed;
  • a child or caretaker may be emotionally harmed to the extent that the caretaker's capacity to adequately care for the child is impaired; or
  • legal proceedings for the child's adoption are pending before a court or a licensed or private social agency is helping the individual decide whether to keep the child or relinquish the child for adoption.

Note: This issue must not have been under discussion more than three months and staff must update the absent parent referral if the issue remains unsolved beyond the third month.

A—1131.1 Good Cause for Family Violence Option

Revision 22-2; Effective April 1, 2022

TANF and TP 08

Cooperating with the OAG’s child support and medical support requirements could pose a potential safety risk for family violence victims and their children. HHSC and OAG allow good cause for family violence to not comply with child and medical support requirements. Explain and offer the family violence option at each application and redetermination.

Staff must:

  • explain Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause, and give a copy of the form to the person;
  • review Part I of Form H1713, Service Plan for Family Violence Option and Report of Good Cause, with the person; and
  • if the person wants to claim good cause for reasons of family violence, use Part II of Form 1713 to make an assessment referral to a family violence specialist at a nearby family violence service provider. Only a family violence specialist can recommend good cause relating to family violence.

    A list of family violence shelters is searchable in TIERS and located at the HHS Family Violence Program page. If no shelter serves the person's area, give the person the National Domestic Violence Hotline number (800-799-7233 [800-799-SAFE] or 800-787-3324 TTY for people who are deaf) to help the person locate the closest family violence service provider.

If the person wants to claim good cause for not complying with TANF or Medicaid child support and medical support requirements due to family violence:

  • The person arranges to speak with the referred family violence specialist to discuss the need to claim good cause and request a good cause recommendation.
  • After the family violence specialist makes the good cause recommendation, the family violence specialist completes Form H1706, Good Cause Recommendation and Family Violence Exemption, and returns the form to the person or to HHSC to use as verification.
  • For face-to-face interviews at a local HHSC eligibility office, provide the person a confidential phone interview with the family violence specialist from the local eligibility determination office. In this scenario, the Form 1706 is not required, and HHSC staff use “client statement” as verification.

Continue to process the TANF or Medicaid EDG and collect absent parent information verbally or by pending the EDG for the H0050, Parent Profile Questionnaire. Remind the person that HHSC requires a completed Form H0050 if the family violence specialist does not recommend good cause or the person decides not to pursue good cause. If the person does not pursue good cause, they must complete and return Form H0050 or provide absent parent information before staff can approve the TANF or Medicaid EDG

Note: By collecting the absent parent information or pending the EDG for the information at the time of the interview, staff will be able to process the EDG regardless whether the H1706 supports the good cause claim.

Allow the person 10 days to return Form H1706, Form H1713 and Form H0050. Certify the EDG, if otherwise eligible, without the H1706, if not returned or if the H1706 does not support the good cause claim.

HHSC staff requirements for Form H1713:

  • complete Part II and Part III of Form H1713;
  • send a copy to the local child support office; and
  • send a copy to the family violence coordinator by one of the following methods to report the final decision:
    • Interagency mail: Family Violence Coordinator, Mail Code 2010
    • Regular mail: Family Violence Coordinator 909 W. 45th St., Mail Code 2010 Austin, TX 78751; or
    • Email: Send completed and scanned documents only to the HHSC Family Violence Mailbox.

Once the good cause claim has been established, re-evaluate the claim at each redetermination. If the person is no longer claiming good cause, update the absent parent referral by removing the good cause indicator to allow the OAG to help the family get child support or medical support services for their children. If the person continues to claim good cause, continue to uphold good cause.

A—1131.2 Good Cause Related to Adoptions, Rape or Incest

Revision 15-4; Effective October 1, 2015

TANF and TP 08

If an individual claims good cause based on an adoption, rape, or incest, advisors must:

  • allow individuals 20 days to provide evidence;
  • extend the deadline for evidence if additional time is needed to obtain the necessary information;
  • document the reason for extending the deadline and obtain supervisory approval; and
  • flag the case and evaluate the evidence when received and recommend either that the individual:
    • has good cause for not cooperating and the OAG should not continue child support locate and enforcement efforts; or
    • does not have good cause for not cooperating and the OAG should continue child support locate and enforcement efforts.

Note: For adoption situations, the issue must not have been under discussion for more than three months. If the issue is unresolved beyond the third month, staff must update the absent parent referral.

A-1140, Noncooperation with Child Support Program Requirements

Revision 15-4; Effective October 1, 2015

TANF and TP 08

At initial certification and redetermination or incomplete reviews, the advisor must determine whether the individual failed to cooperate with child support requirements.

The advisor determines noncooperation when:

  • an individual fails to cooperate with child support requirements without good cause (see A-1120, Child Support Program Requirements and Procedures, for individual responsibilities); or
  • HHSC receives Form H1708-A, Report of Noncooperation (Automated), from the OAG via the weekly interface.

Medical Programs except TP 08

There is no penalty for noncooperation for Medical Programs. Advisors do not take any action on an individual who volunteers to receive child and medical support services but later noncomplies.

A—1141 Sanctions for Noncooperation

Revision 16-2; Effective April 1, 2016

TANF and TP 08

The Child Support Division of the OAG notifies HHSC via a weekly interface when an individual fails to cooperate with child support or medical support. Upon receipt of the notice of child support noncooperation, HHSC must take action to process the noncooperation within five workdays. See A-2140, Full-Family Sanction, and A-2150, Pay for Performance.

TANF

Adult TANF recipients, second parents and minor parents certified as adults, payees or disqualified adults are required to sign Form H1073, Personal Responsibility Agreement, and cooperate with child support requirements. Failure to do so results in a full-family sanction. If the TANF recipient or payee has more than one TANF EDG and fails to cooperate with child support requirements, the sanction applies to all of their TANF EDGs. See A-2140 and A-2150.

TP 08

Parents and caretaker relatives receiving TP 08 must cooperate in establishing medical support. Failure to cooperate with requirements results in the loss of medical coverage for the noncooperating adult.

The advisor must deny a noncooperating adult's TP 08 EDG. See A-1142, Noncooperation Situations.

Medical Programs except TP 08

Recipients applying for Children's Medicaid programs, including TP 40 for a pregnant teen under age 19, are not required to cooperate with child support requirements. Therefore, there is no penalty for noncooperation. Recipients may volunteer for child support services.

A—1142 Noncooperation Situations

Revision 15-4; Effective October 1, 2015

TANF and TP 08

If a child support noncooperation is received on … and the household does not have good cause, then …
  • a denied EDG in a TANF cash benefit month,
  • TIERS identifies the noncooperation; and
  • sends Form TF0001, Notice of Case Action, advising the household of the noncooperation and how to cooperate.

Note: If the household fails to cooperate by the last calendar day of the second month, the household will be subject to pay for performance requirements when they reapply for TANF.

  • a denied case in a non-TANF cash benefit month,
no action is required.
  • an active TANF or TP 08 EDG, the month after the child is no longer in the home, and the noncooperation date is after the date the child was removed from the EDG,
no further action is required.
  • an EDG already sanctioned for a child support noncooperation on a different absent parent,
TIERS sends Form TF0001 advising the household of the noncooperation and how to cooperate. Note: The OAG will not issue Form H1701, Child Support, TANF Foster Care and TANF/Medicaid Case Information Exchange, until the individual cures all noncooperations.
  • an active TP 08 EDG,
TIERS denies the noncooperating adult's TP 08 EDG.
  • an active EDG and the child receives SSI,
  • a TANF-SP EDG with a child in the household who is deprived due to the absence of a parent,
  • an active TANF cash EDG and the individual and absent parent have reconciled and are in the home together, or
  • an active TP 08 EDG and the individual and absent parent have reconciled and are in the home together,

refer to A-2140, Full-Family Sanction, to impose a full-family sanction. If the household fails to cure the noncooperation before the last day of the second noncooperation month, they will need to reapply under pay for performance.

TIERS denies the noncooperating adult's TP 08 EDG.

Note: The advisor must determine whether the individual has good cause for not cooperating with child support requirements using policy in A-1130, Explanation of Good Cause. If the individual has good cause, the advisor should not impose a full-family sanction.

Related Policy

Explanation of Good Cause, A-1130
Noncooperation with Child Support Program Requirements, A-1140
Good Cause for Child Support Noncooperation, A-2122.3
Full-Family Sanction, A-2140
Pay for Performance, A-2150

A-1150, Verification Requirements

Revision 15-4; Effective October 1, 2015

TANF and TP 08

Advisors must verify all good cause claims.

A—1151 Verification Sources

Revision 15-4; Effective October 1, 2015

TANF and TP 08

The following are acceptable verification sources or evidence for:

  • Emotional or Physical Harm for Individuals — a written recommendation from a family violence specialist. The specialist must be an employee of a family violence program that contracts with HHSC. The family violence specialist must complete Form H1706,Good Cause Recommendation and Family Violence Exemption, which serves as verification for the good cause claim.
  • Incest or Rape — a birth certificate or medical or law enforcement records indicating the circumstances surrounding the child's birth.
  • Adoption or Pending Adoption — a court document, other related records, or written statement of the facts from the social services agency.

Related Policy Questionable Information, C-920 Providing Verification, C-930

A-1160, Documentation Requirements

Revision 15-4; Effective October 1, 2015

TANF and TP 08

Advisors must document:

  • that the individual cooperated with the child support requirements;
  • every aspect of the good cause investigation, the determination, the basis for the determination, and the evidence provided;
  • determination made at each re-evaluation of good cause, which must occur at each periodic review; and
  • the reason an individual cannot provide minimum information on an absent parent.

TANF

Advisors must document the name and last known address of the legal and/or biological father of an unborn child if the mother receives TANF.

Medical Programs except TP 08

Advisors must document that the individual did not want to volunteer for child/medical support services.

Related Policy

Documentation, C-940

The Texas Works Documentation Guide

A-1210, General Policy

Revision 21-4; Effective October 1, 2021

TANF, SNAP, Children on TP 32 and Children on TP 56

Resources are assets or possessions that are either countable or exempt, depending on the program and Type of Assistance (TOA).  There are liquid and nonliquid resources. Liquid resources are those that are readily available, such as cash, checking or savings accounts, debit accounts, savings certificates, stocks or bonds. Nonliquid resources are those that cannot be readily converted to cash, including vehicles, buildings, land or certain other property. Count the equity value of all resources, liquid and nonliquid, unless otherwise specified or listed as exempt. The equity value is the fair market value (FMV) of an item minus:

  • all money owed on it; and
  • the cost associated with its sale or transfer.

Count resources of the:

  • members of the:
    • Temporary Assistance for Needy Families (TANF) certified group;
    • Supplemental Nutrition Assistance Program (SNAP) EDG; and
    • child's TP 32 and child’s TP 56 EDG;
  • alien's sponsor according to the policy.
  • disqualified persons; and
  • stepparents in TANF households according to policy.

If payments exempted as resources are kept in a separate account, those payments remain exempt. If the money is placed in an interest-bearing account, the interest must be counted as income in the month received. If the money is combined with money that is countable, exempt the excluded funds for six months from the date the funds are combined. After six months, the total amount of combined funds should be counted as an available resource.

Related Policy

Resources of an Alien’s Sponsor, A-1245
Resources of Stepparents, A-1247

SNAP

Categorical eligibility extends to any household authorized to receive services funded by the TANF program. TANF non-cash (TANF-NC) services consist of various services such as family planning, adult education, prevention and treatment of substance abuse, and employment services. Households must pass an income and resource test for determination of categorical eligibility based on receipt of TANF-NC services.

The resource test consists of the following criteria:

  • The household’s countable liquid resources plus excess vehicle value must be $5,000 or less.
  • Up to $15,000 of the FMV for the highest valued countable vehicle is exempt. The excess over $15,000 FMV is counted toward the combined resource limit.
  • Up to $4,650 FMV for all other countable vehicles is exempt. The excess over $4,650 FMV is counted toward the combined resource limit. Note: Refer to vehicle policy for more reasons a vehicle can be exempted.

Once the recipient is authorized for TANF-NC services based on the initial resource test, all other nonliquid resources are exempt. Regular TANF policy must be followed when determining countable liquid resources within TANF-NC. Most resources are not applicable to SNAP.

Related Policy

Limits, A-1220
Prepaid Burial Insurance, A-1233.2
Vehicles, A-1238
How to Determine Fair Market Value of Vehicles, A-1238.5
General Policy, A-1310
Categorically Eligible Households, B-470
What to Report, B-621

Medical Programs Except Children on TP 56 and Children on TP 32

Resources are not considered a factor in determining eligibility.

Children on TP 56 and Children on TP 32

Resources are considered as a factor in determining eligibility for children on TP 56 and TP 32.

Exception: Do not consider resources when determining a newborn’s eligibility for TP 56 when the newborn’s mother was eligible for TP 56 or TP 32 at the time of the newborn’s birth.

A—1211 Requirement to Pursue Resources

Revision 15-4; Effective October 1, 2015

TANF

An individual must pursue all resources to which the individual is legally entitled unless it is unreasonable to pursue the resource. Advisors should develop a plan with the individual to pursue the potential resource and allow reasonable time (at least three months) to pursue the resource.

Advisors should use the comment section of Form TF0001, Notice of Case Action, to inform the individual of the requirement to pursue the resource, including the time the individual has to pursue it, and the resource is not considered available during that time.

If the individual does not pursue the resource within a reasonable time, the Eligibility Determination Group (EDG) is denied.

Exception: The individual does not have to pursue a resource if it would be unreasonable. It is unreasonable to pursue a resource if any of the following conditions exist:

  • The cost to the individual to pursue the resource exceeds the potential resource's value or causes the individual financial hardship;
  • Pursuing the resource would endanger the individual's health or safety; or
  • Legal action is required, but a private attorney or legal service refuses to accept the case. The individual must make a reasonable effort to obtain legal assistance.

SNAP

Individuals receiving SNAP benefits do not have to pursue resources.

Note: Pursuing resources could help an individual become self-sufficient, and individuals should be provided examples of resources they might be entitled to receive.

A—1212 Transferring Resources

Revision 13-2; Effective April 1, 2013

A—1212.1 Penalties for Transferring Resources

Revision 15-4; Effective October 1, 2015

TANF and SNAP

Households are ineligible if, within three months before application or any time after certification, the household transfers a countable resource for less than its fair market value to qualify for assistance. This penalty applies if the total of the transferred resource added to other resources affects eligibility.

Resources transferred between members of the same TANF/SNAP household do not affect eligibility. If spouses separate and one spouse transfers individual property, the other spouse's eligibility is not affected.

Children on TP 56 and Children on TP 32

Applicants or individuals who transfer resources to qualify for assistance must not be denied.

A—1212.2 How to Determine Intent

Revision 15-4; Effective October 1, 2015

TANF and SNAP

In determining an individual's intent for transferring resources for TANF and SNAP benefits, staff must consider the following:

  • How recent was the transfer of property? A recent transfer may indicate the household transferred the resource to qualify for benefits.
  • How did the applicant support the household after transferring the resource? If the applicant was self-supporting or supported by the person who received the property, then the applicant's intent was to have support rather than qualify for benefits.
  • How did the applicant transfer the property? If the applicant loaned the property but cannot recover its value after making a reasonable effort, the applicant is eligible.
  • Special or unpredictable hardships that prevent the individual from making payments for the transferred resource do not affect eligibility. The supervisor and program manager must approve these situations.

A—1212.3 Length of Denial Period

Revision 15-4; Effective October 1, 2015

TANF and SNAP

The length of denial must be based on the amount by which the transferred resource exceeds the resource maximum when added to other countable resources.

Amount in Excess of Resource Limit Denial Period
$.01 to $249.99 1 month
$250 to $999.99 3 months
$1,000 to $2,999.99 6 months
$3,000 to $4,999.99 9 months
$5,000 and more 12 months

Examples:

TANF: A two-person household has $1,250 in a bank account and transfers ownership of a car worth $5,650. The first $4,650 of the car's value is exempt. Add the remaining $1,000 to the other $1,250 resource. Subtract the $1,000 resource limit from the total. Use$1,250 to determine the number of months of ineligibility. According to the above chart, the household is ineligible for six months.

SNAP: A two-person household has $2,000 in a bank account and transfers ownership of a car worth $19,000. Exempt the first $15,000 FMV of the vehicle and add the remaining $4,000 to the $2,000 bank account. Subtract the $5,000 resource limit from the total. Use $1,000 to determine the number of months of ineligibility. According to the above chart, the household is ineligible for six months.

A—1212.4 Beginning the Denial Period

Revision 15-4; Effective October 1, 2015

TANF and SNAP

The denial period begins in the application month unless the household is already certified when the advisor discovers the transfer.

Once the household is certified, the advisor must send a notice of adverse action and follow adverse action procedures. The advisor must begin the denial period the first month after the month the notice of adverse action expires unless the individual requests a fair hearing and receives continued benefits.

A-1220, Limits

Revision 15-4; Effective October 1, 2015

TANF

A household is not eligible for benefits if the total value of accessible resources is over $1,000.

A household is not eligible for benefits if resources are over the limit on or after the first interview date.

If a TANF applicant/recipient fails to provide resource verification for TANF, the advisor must:

  • deny the TANF application, and
  • process the application for non-public assistance (NPA) SNAP eligibility.

SNAP

A household is not eligible for benefits if the total value of countable resources (liquid resources and excess vehicle value) is over $5,000.

A household is not eligible for benefits if resources are over the limit on or after the first interview date. Additionally, striker households are ineligible if resources are over the limit the day before the strike.

Children on TP 32 and Children on TP 56

A child is not eligible for benefits if the total value of accessible resources is over:

  • $3,000 in households with a member who is aged or has a disability and meets relationship requirements; or
  • $2,000 for all other households.

Advisors must use the SNAP definitions of aged and disability found in B-431, Definition of Elderly, and B-432, Definition of Disability. The individual who is aged or has a disability does not have to be part of the Medical Programs budget group, but must meet relationship requirements.

A child is not eligible for benefits if resources are over the limit on the process date. In determining eligibility for a prior month, the household is not eligible if resources are over the limit anytime during the prior month.

Related Policy

General Policy, A-1210
Prepaid Burial Insurance, A-1233.2
Vehicles, A-1238
How to Determine Fair Market Value of Vehicles, A-1238.5
General Policy, A-1310
Categorically Eligible Households, B-470

 

A-1230, Types of Resources

 Revision 03-3; Effective April 1, 2003

 

 

A—1231 Accounts

Revision 07-4; Effective October 1, 2007

 

 

A—1231.1 Bank Accounts

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Advisors must count the cash value of checking and savings accounts unless exempt for another reason.

Related Policy

Payments Exempt as a Resource While Being Considered Income, A-1243
Inaccessible Resources, A-1241

 

 

A—1231.2 Debit Accounts

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Advisors must count the cash value of benefits in a debit account, less amounts deposited in the current month, as a resource. Government benefit payments may be deposited into a debit account. Advisors must verify the balance in the account using the most current information.

The most common debit accounts established for deposit of government benefits are the:

  • Electronic Benefit Transfer (EBT) cash accounts for TANF benefits;
  • unemployment insurance benefits (UIB) debit accounts;
  • Texas debit card accounts for child support payments, Office of Attorney General (OAG);
  • debit card accounts for child support payments from other states; and
  • Direct Express card debit accounts for Social Security; Retirement, Survivors and Disability Insurance (RSDI); or Supplemental Security Income (SSI) benefits payments.

This list is not intended to be all inclusive as more agencies and businesses move toward the use of debit cards to issue benefits.

Account inquiry is accessible to:

  • TANF recipients by calling the Lone Star Help Desk automated voice response system at 1-800-777-7EBT (1-800-777-7328);
  • UIB recipients online at https://www.usbankreliacard.com/ or at any automated teller machine (ATM) free of charge;
  • child support recipients online at www.EPPICard.com;
  • Social Security recipients online at www.USDirectExpress.com, by calling 1-888-741-1115, or balance information may be obtained free of charge at any ATM that displays the MasterCard® logo.

Exception: See A-1248, Resources of TANF and SSI Recipients.

Related Policy

Retirement, Survivors, and Disability Insurance (RSDI), A-1324.16
Supplemental Security Income (SSI), A-1324.17
Temporary Assistance for Needy Families (TANF), A-1324.18
Unemployment Compensation, A-1324.19
Counting Child Support, A-1326.2.1
Client Inquiries, B-382

 

 

A—1231.3 Individual Development Accounts (IDAs)

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Staff must use the following policy to determine whether an IDA is a countable or exempt resource.

TANF IDAs — TANF IDAs must be used for one of the following purposes:

  • paying for a college education,
  • purchasing a home, or
  • starting a business.

The household is not required to be a TANF recipient to qualify for an IDA, but the household must be financially needy and have a child living with the custodial parent or other adult relative who meets the TANF relationship criteria or the household must consist of a pregnant woman.

The household is considered financially needy if the household is eligible to receive TANF, SNAP, or any Medical Program except TP 56. For TP 56, the household is considered financially needy if its gross income is below 185 percent of the Federal Poverty Income Limit (FPIL).

Any earnings, including Earned Income Tax Credit (EIC), deposited in a TANF IDA must be excluded from resources. Any interest earned on the account must be excluded from resources. Any deposits into an IDA not made with earnings, or withdrawals from an IDA that are not made for an allowable qualifying purpose, should count as a resource.

Assets for Independence Act (AFIA) IDAs — AFIA IDAs are funded and authorized under the AFIA and must meet one of the same qualifying purposes as TANF IDAs. Any earnings, including EIC, deposited in an AFIA IDA must be excluded from resources. Any interest earned on the account must also be excluded from resources. Any deposits into an IDA not made with earnings, or withdrawals from an IDA that are not made for an allowable qualifying purpose, should count as a resource.

Other IDAs — These IDAs do not meet one of the qualifying purposes of paying for a college education, purchasing a home, or starting a business and should be counted as a resource. The interest earned on these accounts must be counted as unearned income.

For any type of IDA, matched funds are not counted as a resource, as they are not accessible to the household.

Exception: IDAs are exempted if Long Term Care certifies them as meeting the Social Security criteria for a Plan to Achieve Self-Sufficiency (PASS).

 

 

A—1231.4 Retirement Accounts

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

A retirement account is one in which an employee and/or the employer contributes money for retirement. There are several types of retirement plans.

Some of the most common plans authorized under Section 401(a) of the Internal Revenue Services (IRS) Code are the 401(k) plan, Keogh, Roth individual retirement account (IRA), and a pension or traditional benefit plan. Common plans under Section 408 of the IRS Code are the IRA, Simple IRA, and Simplified Employer Plan.

  • A 401(k) plan allows an employee to postpone receiving a portion of current income until retirement.
  • An IRA is an account in which an individual contributes money to supplement the individual’s retirement income (regardless of the individual’s participation in a group retirement plan).
  • A Keogh plan is an IRA for a self-employed individual.
  • A Simplified Employee Pension (SEP) plan is an IRA owned by an employee to which an employer makes contributions or an IRA owned by a self-employed individual who makes contributions for the individual’s self.
  • A pension or traditional defined benefit plan is employer-based and promises a certain benefit upon retirement regardless of investment performance.

The following retirement accounts or plans are excluded:

  • Accounts established under Internal Revenue Code of 1986, Sections 401(a), 403(a), 403(b), 408, 408A, 457(b), 501(c)(18);
  • Plans established under the Federal Thrift Savings Plan, Section 8439, Title 5, United States Code; and
  • Other retirement accounts determined to be tax exempt under the Internal Revenue Code of 1986.

Any other retirement accounts not established under plans or codes listed above are counted.

Related Policy

Lump-Sum Payments, A-1242

 

 

A—1231.5 Education Tuition Savings Plan

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Internal Revenue Service Code, Section 529 and 530, Coverdell Education Tuition Savings Plans, which provide special tax benefits for school tuition savings accounts, are exempt.

Section 529 qualified tuition programs allow owners to prepay a student's education expenses or contribute to an account to pay those expenses. Examples of Section 529 accounts are:

  • Texas College Savings Plan;
  • LoneStar 529 Plan; and
  • Texas Guaranteed Tuition Plan (formerly the Texas Tomorrow Fund).

A Coverdell Education Savings Account is a trust or custodial account set up in the U.S. for the sole purpose of paying qualified education expenses for the designated beneficiary of the account. There is no limit to the number of accounts that can be established for a beneficiary. The designated beneficiary must be under age 18 at the time the account is established. The plan may be for elementary school through college.

 

 

A—1231.6 Achieving a Better Life Experience (ABLE) Accounts

Revision 17-1; Effective January 1, 2017

Achieving a Better Life Experience (ABLE) programs allow individuals who become blind or disabled before age 26 to establish tax-free savings accounts for the designated beneficiary's disability-related expenses.

TANF, SNAP, Children on TP 32 and Children on TP 56

Funds held in an ABLE account are excluded from countable resources when determining eligibility.

Related Policy:

Achieving a Better Life Experience (ABLE) Accounts; A-1326.25  

 

 

A—1231.7 School-Based Savings Accounts

Revision 17-4; Effective October 1, 2017

All Programs

School-Based Savings Accounts are accounts set up by students or their parents at financial institutions that partner with school districts. The accounts are intended to help students save for higher education.

TANF, Children on TP 32 and Children on TP 56

Funds in School-Based Savings Accounts are exempt up to an amount set by the Texas Higher Education Coordinating Board (THECB) each year. The current exempt amount is $11,896. Count any excess over the exempt amount as a resource.

Note: This amount is updated annually.

SNAP

The total amount of funds in a School-Based Savings Account is exempt.

Related Policy

School-Based Savings Accounts, A-1326.26

 

 

A—1232 Government Payments

Revision 07-4; Effective October 1, 2007

 

 

A—1232.1 Crime Victim's Compensation Payments

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Crime victim's compensation payments are exempt from resources.

 

 

A—1232.2 Federal Tax Refunds and Earned Income Tax Credits (EIC)

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Federal tax refunds and EIC payments are exempt from resources for a period of 12 months after receipt.

Related Policy
Federal Tax Refunds and Earned Income Tax Credits (EIC), A-1323.5.1

 

 

A—1232.3 Energy Assistance Payments

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Payments or allowances made under any federal law for the purpose of energy assistance are exempt.

Related Policy

Energy Assistance, A-1326.3

 

 

A—1232.4 Government Disaster Payments

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Federal disaster payments and comparable disaster assistance provided by states, local governments, and disaster assistance organizations if the household is subject to legal penalties when the funds are not used as intended (including temporary employment of six months or less for disaster-related work, paid under the Workforce Innovation and Opportunity Act and funded by the National Emergency Grant) are exempt.

Examples:

  • Payments by the Individual and Family Grant Program or Small Business Administration to rebuild a home or replace personal possessions damaged in a disaster.
  • Payments from the Federal Emergency Management Agency (FEMA) to assist with rent.

Related Policy
Government Disaster Payments, A-1324.3

 

 

A—1232.5 Transitional Living Allowance

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Transitional living allowances are exempt.

Related Policy
Transitional Living Allowance, A-1324.5

 

 

A—1232.6 Native and Indian Claims

Revision 20-3; Effective July 1, 2020

TANF, SNAP, Children on TP 32 and Children on TP 56

The following payments resulting from Public Laws are exempt:

  • Payments to Grand River Band of Ottawa Indians (Public Law [PL] 94-540).
  • Payments to Passamaquoddy Tribe, the Penobscot Nation, and the Houlton Band of Maliseet Indians received according to the Maine Indian Claims Settlement Act of 1980 (PL 96-420, Section 9(c)).
  • Payments to members of the Seneca Nation (PL 101-503).
  • Payments to Confederated Tribes and Bands of the Yakima Indian Nation and the Apache Tribe of the Mescalero Reservation, received from the Indian Claims Commission (PL 95-433).
  • Payments made under the Sac and Fox Indian Claims Agreement (PL 94-189).
  • Payments received by certain Indian tribal members under PL 94-114, Section 6, for submarginal lands held in trust by the United States.
  • Payments from Indian lands held jointly with the tribe or land that can be sold only with approval of the Bureau of Indian Affairs.

SNAP and TANF

The following distributions and payments are exempt:

  • Distributions from native corporations made under the Alaska Native Claims Settlement Act (ANCSA) (PL 92-203 and Section 15 of PL 100-241), as follows:
    • cash up to $2,000 per person per calendar year;
    • stocks;
    • a partnership interest;
    • land or interest in land; or
    • an interest in a settlement trust.
  • Payments (and any initial purchases made with such funds) distributed by the Secretary of the Interior to families or individual tribal members (PL 93-134) including:
    • tribal trust funds distributed to individual members of an Indian tribe (PL 98-64);
    • judgment funds up to $2,000 per year, per person, granted to a tribe because of claims against the United States and held in trust or distributed per capita (PL 93-134 as amended by PL 97-458);
    • payments up to $2,000 per year to heirs of deceased Indians made under the Old Age Assistance Claims Settlement Act (PL 98-500); and
    • payments distributed per capita to or held in trust for members of any Indian tribe under PL 92-254.

SNAP

The following four types of property belonging to a member of a federally recognized Indian tribe are exempt:

  • Property, which may be real property and improvements, that is held in trust located on a reservation, including any federally recognized Indian tribe reservation, pueblo or colony. Property may be located on former reservations in Oklahoma, in Alaska native regions established by the Alaska Native Claims Settlement Act, and on Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs.
  • For any federally recognized tribe not listed in the previous item, property located on a past federally recognized reservation.
  • Ownership interests in rents, leases, royalties, or usage rights related to natural resources that are federally protected by the Bureau of Indian Affairs.
  • Ownership or usage rights to property not in the previous items that have unique religious, spiritual, traditional or cultural significance, or ownership or usage rights that allow the continuation of the Indian lifestyle according to tribal law or custom.

 

 

A—1232.7 Payments to Children of Vietnam Veterans

Revision 03-7; Effective October 1, 2003

 

 

 

 

A—1232.7.1 Payments to Children of Vietnam Veterans Who Are Born with Spina Bifida

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Exempt Veterans Affairs (VA) payments made under PL 104-204.

 

 

A—1232.7.2 Payments to Children of Women Vietnam Veterans Born with Certain Birth Defects (Public Law 106-419)

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Exempt VA payments made under PL 106-419.

 

 

A—1232.8 Payments to Civilians Relocated During Wartime

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Payments to civilians relocated during wartime made under Title I of PL 100-383 are exempt. These payments are made to Aleuts or individuals of Japanese ancestry (or their heirs) who were relocated during World War II.

 

 

A—1232.9 Payments to Victims of Nazi Persecution

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Payments made to individuals because of their status as victims of Nazi persecution are exempt.

 

 

A—1232.10 Radiation Exposure Compensation Act Payments

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Payments provided from the Radiation Exposure Compensation Act, PL 101-426, are exempt.

 

 

A—1232.11 Payments to World War II Filipino Veterans and Spouses

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Under the American Recovery and Reinvestment Act of 2009 (Division A, Title X, Section 1002), some World War II Filipino veterans who served in the military forces of the Government of Commonwealth of the Philippines, and their spouses, are authorized to receive one-time lump sum payments of up to $15,000.

These payments are exempt.

 

 

A—1232.12 Relocation Assistance

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Payments provided by the following are exempt:

  • The Uniform Relocation Assistance and Real Properties Acquisition Act of 1970.
  • PL 93-531 to members of the Navajo or Hopi tribes.

 

 

A—1232.13 Relative and Other Designated Caregiver Program Payments

Revision 19-1; Effective January 1, 2019

TANF, SNAP, Children on TP 32 and Children on TP 56

There are two types of Relative and Other Designated Caregiver Program Payments issued by DFPS. These include:

  • Kinship Reimbursement payments; and
  • Post-Permanent Managing Conservatorship Annual Reimbursement payments.

The remaining balance of both of these types of payments is considered a resource in the month(s) after receipt.

Related Policy
Relative and Other Designated Caregiver Program Payments, A-1324.21

 

 

A—1233 Insurance

Revision 03-5; Effective July 1, 2003

 

 

A—1233.1 Life Insurance

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

The cash value of life insurance policies is exempt.

 

 

A—1233.2 Prepaid Burial Insurance

Revision 21-2; Effective April 1, 2021

TANF and SNAP

Exempt the full cash value of a prepaid burial insurance policy, funeral plan or funeral agreement for each household member.

Children on TP 32 and Children on TP 56

Exempt up to $7,500 cash value of a prepaid burial insurance policy, funeral plan, or funeral agreement for each certified household member. Count the cash value exceeding $7,500 as a liquid resource.

The person’s statement of cash value should be accepted unless the amount is questionable or close to the maximum allowable limits.

Related Policy

General Policy, A-1210
Limits, A-1220
Vehicles, A-1238
How to Determine Fair Market Value of Vehicles, A-1238.5
General Policy, A-1310
Categorically Eligible Households, B-470

 

 

A—1234 Noneducational Loans

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Financial assistance is considered as a loan if:

there is an understanding the money will be repaid, and

the individual can reasonably explain how the loan will be repaid.

These loans are exempt from resources, but assistance that is not considered a loan, such as a contribution, is counted as unearned income.

Related Policy

Cash Gifts and Contributions, A-1326.1
Loans (Noneducational), A-1326.7

 

 

A—1235 Personal Possessions

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Exempt personal possessions.

 

 

A—1236 Property

Revision 03-1; Effective January 1, 2003

 

 

 

A—1236.1 Burial Plots

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Exempt all burial plots.

Related Policy
Prepaid Burial Insurance, A-1233.2

 

 

A—1236.2 Homestead

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

The usual residence and surrounding property not separated by property owned by others is exempt. The exemption remains in effect if public rights of way, such as roads, separate the surrounding property from the home. The homestead exemption applies to any structure the individual uses as a primary residence, including additional buildings on contiguous land, a houseboat, or a motor home, as long as the household lives in it. If the household does not live in the structure, the structure is counted it as a resource. Houseboats and motor homes count according to vehicle policy, if not considered the household's primary residence or otherwise exempt. The equity value of extra buildings counts unless the buildings are exempt for another reason.

For households that currently do not own a home, but own or are purchasing a lot on which they intend to build, the lot and partially completed home are exempt.

TANF

Households cannot claim real property outside Texas as a homestead. Exception: Migrants and itinerant workers who meet the residence requirements in A-710, General Policy, may claim an exemption for a homestead outside Texas.

SNAP

All homesteads and property are exempt.

 

 

A—1236.2.1 Homestead Temporarily Unoccupied

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

A homestead temporarily unoccupied because of employment, training for future employment, illness (including receiving medical treatment), casualty (fire, flood, state of disrepair, etc.), or natural disaster, if the household intends to return, is exempt.

 

 

A—1236.2.2 Sale of a Homestead

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Money remaining from the sale of a homestead is counted as a resource.

 

 

A—1236.3 Income-Producing Property

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Income-producing property is any real or personal property that generates income. Property is exempt if the property:

  • is essential to a household member's employment or self-employment, such as tools of a trade, farm machinery, stock, and inventory (this property continues to be exempt during temporary periods of unemployment if the individual expects to return to work);
  • annually produces income consistent with a fair market value comparable in the community, even if used only on a seasonal basis such as rental property (to determine that the income produced is comparable to the fair market value for similar usage of real property in the area, eligibility staff may contact local realtors, tax assessors, the Small Business Administration or similar sources); or
  • is necessary for the maintenance or use of a vehicle exempted as income-producing or as necessary for transporting a household member with a physical disability. The portion of the property used for this purpose is exempt.

Note: For farmers or fishermen, the value of land or equipment continues to be exempt for one year from the date that the self-employment ceases.

 

 

A—1236.4 Real Property

Revision 19-4; Effective October 1, 2019

TANF, Children on TP 32 and Children on TP 56

Equity value of real property counts unless it is otherwise exempt.

Any portion of real property directly related to the maintenance or use of a vehicle is exempt if the vehicle is:

  • necessary for self-employment; or
  • to transport a household member with a physical disability.

The equity value of any remaining portion counts unless it is otherwise exempt.

SNAP

Real property is exempt.

 

 

A—1236.4.1 Exemption Based on Good Faith Effort to Sell

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Real property is exempt if the household is making a good faith effort to sell it.

 

 

A—1236.5 Jointly Owned Property

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Property jointly owned by the household applying and other individuals not applying for or receiving benefits is exempt if the:

  • household provides proof they cannot sell or divide the property without consent of the other owners; and
  • other owners will not sell or divide the property.

SNAP

Jointly owned property is exempt.

Related Policy

Solely Owned Vehicles, A-1238.1

 

 

A—1237 Trust Funds

Revision 20-1; Effective January 1, 2020

TANF, SNAP, Children on TP 32 and Children on TP 56

Trust funds are exempt if all of the following conditions are met:

  • The trust arrangement is unlikely to end during the certification period.
  • No household member can revoke the trust agreement or change the name of the beneficiary during the certification period.
  • The trustee of the fund is either a:
    • court, institution, corporation, or organization not under the direction or ownership of a household member; or
    • court-appointed person who has court-imposed limitations placed on the use of the funds; and
  • The trust investments do not directly involve or help any business or corporation under the control, direction, or influence of a household member.
  • Trusts established from the household's own funds are exempt if the trustee uses the funds:
    • only to make investments on behalf of the trust; or
    • to pay the education or medical expenses of the beneficiary.

 

 

A—1238 Vehicles

Revision 20-1; Effective January 1, 2020

TANF, SNAP, Children on TP 32 and Children on TP 56

The total value of all licensed vehicles used for income-producing purposes is exempt. A vehicle is considered income-producing if it:

  • is used as a taxi, a farm truck or fishing boat;
  • is used to make deliveries as part of the person's employment;
  • is used to make calls on people or customers;
  • is required by the terms of employment; or
  • produces income consistent with its fair market value.

A vehicle necessary to transport a household member with a physical disability on the EDG or a person with a physical disability living in the home is exempt even if the person is disqualified and regardless of the purpose of the trip. No more than one vehicle for each household member with a physical disability may be exempt. There is no requirement that the vehicle be used primarily for the person with a physical disability. The SNAP work-registration criteria should be used to determine physical disability for this exclusion.

Note: These exemptions remain in effect when the vehicle is temporarily not in use.

SNAP

The following vehicles are exempt even when the vehicle is temporarily not in use:

  • vehicles necessary for long-distance travel for employment such as the vehicle of a traveling salesperson or of a migrant farm worker who is following the migrant stream (this does not include daily commuting);
  • vehicles used as the household's home;
  • vehicles necessary to carry fuel for heating or water when it is anticipated to be the primary source of fuel or water for the household during the certification period. Examples of situations in which a vehicle may be exempt because it is necessary to carry the household's primary source of water or fuel for heating include the following:
    • the home does not have any connected utilities; or
    • the home is connected to utilities, but the utilities cannot be used for some reason, such as:
      • a verifiable health risk exists if the household drinks the water; or
      • the utilities are disconnected because the household failed to pay its bills.

The vehicle exemption remains in effect until the above criteria no longer exist. The vehicle exemption also remains in effect for:

  • any licensed vehicle with equity value less than or equal to $1,500;
  • one vehicle with an FMV less than $4,650 for each adult household member, regardless of how the vehicle is used*; and
  • any other licensed vehicle with an FMV less than $4,650 that a minor (under age 18) drives to work, training, school, or to seek employment*.

For all other licensed and unlicensed vehicles, the FMV in excess of $4,650 is counted as a resource.

*This also applies to any person who is an ineligible alien or disqualified member of the SNAP household. The FMV of each vehicle in excess of $4,650 is counted as a resource.

Up to $15,000 of the FMV for the highest valued countable vehicle is exempt. The FMV in excess of $15,000 is counted as a resource.

TANF, Children on TP 32 and Children on TP 56

Vehicles with an FMV of less than $4,650 are excluded, regardless of the number of vehicles owned by a TANF-certified or disqualified household member. The FMV in excess of $4,650 counts toward the household's resource limit.

 

 

A—1238.1 Solely Owned Vehicles

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

A vehicle with a title registered solely in one person's name is considered an accessible resource for that person. This includes:

  • vehicles involved in community property issues when one person's name is on the title; and
  • a vehicle registered solely in the individual's name that the individual claims to have purchased for someone else.

Exceptions: The vehicle is inaccessible if the title holder verifies that:

  • the vehicle was sold but the name on the title has not been transferred to the buyer (in this situation, the vehicle belongs to the buyer);

Note: Any payments made by the buyer to the individual or the individual's creditors (directly) count as self-employment income (see A-1323.4, Self-Employment).

  • the vehicle was sold but the buyer has not transferred the title into the buyer's name;
  • the vehicle was repossessed;
  • the vehicle was stolen; or
  • the title holder filed for bankruptcy (Title 7, 11 or 13), and the individual is not claiming the vehicle as exempt from the bankruptcy estate. Note: In most bankruptcy petitions, the court will allow each adult individual to keep one vehicle as exempt for the bankruptcy estate. This vehicle is a countable resource.

A vehicle is accessible to an individual even though the title is not in the individual's name if the individual:

  • purchased or is purchasing the vehicle from the person who is the title holder; or
  • is legally entitled to the vehicle through an inheritance or divorce settlement.

 

 

A—1238.2 Jointly Owned Vehicles

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Vehicles jointly owned with another person not applying for or receiving benefits are considered inaccessible if the other owner is not willing to sell the vehicle.

Exception: See A-1247, Resources of Stepparents.

 

 

A—1238.3 Vehicles Over 20 Years Old

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

The value of a vehicle over 20 years old is exempt if the value is not available. If the applicant provides the value for a vehicle older than 20 years, the amount provided should be accepted. Note: A vehicle’s age during any month of that year should be considered.

 

 

A—1238.4 Leased Vehicles

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

A person leasing a vehicle is not generally considered the owner of the vehicle because the:

  • vehicle does not have any equity value,
  • person cannot sell the vehicle, and
  • title remains in the leasing company's name.

A leased vehicle is exempt until the individual exercises the option to purchase the vehicle. Once the individual becomes the owner of the vehicle, the vehicle counts as a resource.

The individual is the owner of the vehicle if the title is in the individual's name, even if the individual and the dealer refer to the vehicle as leased, and the vehicle counts as a resource.

 

 

A—1238.5 How to Determine Fair Market Value of Vehicles

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

The FMV of licensed vehicles is determined using the average wholesale value listed in the Vehicles Registered at Address report from the Data Broker System. After the vehicle value is verified, it does not have to be re-verified unless resources are close to the resource limit and a change in the vehicle value results in a change in eligibility status. Note: If the household claims the listed value does not apply because the vehicle is in less-than-average condition, the household must provide proof of the true value from a reliable source, such as a bank loan officer or a local licensed car dealer.

The basic value of a vehicle is not increased because of low mileage, optional equipment, or special equipment for a person with a disability.

The household's estimate of the value of vehicles no longer listed in the Data Broker System should be accepted, unless it is questionable and would affect the household's eligibility. In this case, the household must provide an appraisal from a licensed car dealer or other evidence of the car's value, such as a tax assessment or a newspaper advertisement indicating the sale value of similar vehicles.

The value of new vehicles not yet listed in the Data Broker System may be determined by asking the household to provide an estimate of the average wholesale value from a new car dealer or bank loan officer. If this cannot be done, the individual's estimate should be accepted unless it is questionable and would affect eligibility. The car's loan value should be used only if other sources are unavailable. Advisors must request proof of the value of licensed antiques and custom made or classic vehicles from the household if an accurate appraisal cannot be made.

Determining Vehicle Resource Values
Type of Vehicles SNAP TANF, Children on TP 32 and Children on TP 56
Income-producing Exempt Exempt
Vehicle for a person with a physical disability living in the home Exempt Exempt
Equity value less than or equal to $1,500 Exempt Not applicable
Long distance travel for employment Exempt Exempt up to $4,650 of FMV. Count excess.
Household's home Exempt Exempt up to $4,650 of FMV. Count excess.
Carry fuel or water Exempt Exempt up to $4,650 of FMV. Count excess.
Primary vehicle/Highest valued countable vehicle Exempt up to $15,000 of FMV. Count excess. Exempt up to $4,650 of FMV. Count excess.
One vehicle for each adult household member, regardless of use Exempt up to $4,650 of FMV. Count excess. Exempt up to $4,650 of FMV. Count excess.
Any vehicle used by a household member under age 18 for employment, training, education or to seek employment Exempt up to $4,650 of FMV. Count excess. Exempt up to $4,650 of FMV. Count excess.
Other licensed vehicles Exempt up to $4,650 of FMV. Count excess Exempt up to $4,650 of FMV. Count excess.
Unlicensed vehicles Exempt up to $4,650 of FMV. Count excess. Exempt up to $4,650 of FMV. Count excess.

 

See A-1238, Vehicles, for the specific policy for determining the countable value of a vehicle.

 

 

A—1239 Educational Assistance

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Educational assistance (including education loans, regardless of the source) is exempt during the period it is intended to cover. If the individual combines the educational assistance with other countable funds, such as a bank account, the educational assistance is exempt during the period that it is intended to cover. For example, educational assistance intended for the months of January through May is an exempt resource during the same months.

Related Policy

Educational Assistance, A-1322.1

A-1240, Determining Countable Resources in Special Situations

A—1241 Inaccessible Resources

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

The equity value of resources that are not legally available (inaccessible) to the household are exempt.

Examples: Irrevocable trust funds, property in probate, security deposits on rental property and utilities, and the balance of a note from the sale of property.

Money received from a nonmember is inaccessible if:

  • it is intended and used only for a nonmember's benefit, and
  • the individual can provide verification of the intent and use of the money.

This includes any bank account that a household member has access to. A bank account is considered inaccessible if the money in the account is used solely for the nonmember's benefit.

The household must provide verification that the bank account is used solely for the nonmember's benefit and that no household members use the money in the account for their benefit. If household members use any of the money for their benefit, the bank account must be considered accessible to the household.

A temporarily inaccessible resource is exempt until the resource is accessible. Government savings bonds are an example of a temporarily inaccessible resource. These types of savings plans are usually inaccessible for a definite time from the date the individual makes a withdrawal request. The date the household applies is used as the date of the withdrawal request, unless the household has a withdrawal request pending at the time of application. For these pending withdrawals, the date of the actual withdrawal request is used to determine the length of time the resource is inaccessible.

Related Policy

Solely Owned Vehicles,A-1238.1
Jointly Owned Vehicles, A-1238.2
Bank Accounts, A-1231.1

 

A—1241.1 Nonliquid Resources

Revision 17-1; Effective January 1, 2017

SNAP

Nonliquid resources, except vehicles, are exempt. Vehicle policy in A-1238, Vehicles, applies.

TANF, Children on TP 32 and Children on TP 56

Count the equity value of nonliquid resources.

 

A—1242 Lump-Sum Payments

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Countable lump-sum payments include, but are not limited to, retroactive lump-sum RSDI, public assistance, retirement benefits, lump-sum insurance settlements, refunds of security deposits on rental property or utilities, and lump-sum payments on child support.

Lump-sum payments received once a year or less frequently are counted as resources in the month received (unless specifically excluded by other policies).

Lump-sum payments received or anticipated to be received more often than once a year are counted as unearned income in the month received.

If a portion of a lump sum will be received as ongoing income, that ongoing portion is counted as income for that month.

Example: An individual receives a lump-sum payment in the amount of $4,950 from the Social Security Administration in the month of March. Effective that same month, the individual receives his first monthly RSDI payment of $950, which is included in the $4,950 lump-sum payment. Staff must budget the $950 RSDI payment beginning with the month of March as an ongoing payment and consider the $4,000 as a lump-sum payment.

Exceptions:

  • Federal tax refunds and EICs are exempt from resources for a period of 12 months after receipt.
  • If an individual is scheduled to receive retroactive SSI benefits
    in installment payments (up to three payments, paid every six months):
    • the payments count as a resource in the month received if the individual is not a current SSI recipient, or
    • the payments are excluded if the individual is a current SSI recipient.

Related Policy

Cash Gifts and Contributions, A-1326.1
Lump-Sum Payments, A-1331

TANF, Children on TP 32 and Children on TP 56

The One-Time Temporary Assistance for Needy Families (OTTANF) payment is exempt from resources for the month of receipt because the household is a TANF recipient that month. The remaining OTTANF benefits are considered a resource the month after receipt.

A One-Time Grandparent payment is a resource of the TANF-certified grandchild(ren) and is exempt from resources as explained in A-1248, Resources of TANF and SSI Recipients.

Related Policy

When Receipt of TANF Is Uncertain, A-161

 

A—1243 Payments Exempt as a Resource While Being Considered Income

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

If a payment or benefit counts as income for a particular month, it is not counted as a resource in the same month. If you prorate a payment as income over several months, no portion of the payment is considered a resource during that time.

Example: Income of students or self-employed persons that is prorated over several months.

If the individual combines this money with countable funds, such as a bank account, the prorated amounts are exempt for the time prorated.

 

A—1244 Reimbursements

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Reimbursements are counted as a resource in the month after receipt.

Reimbursements earmarked and used for replacing or repairing an exempt resource are exempt indefinitely.  

Related Policy

Reimbursements, A-1332

 

A—1245 Resources of an Alien's Sponsor

Revision 19-1; Effective January 1, 2019

TANF, SNAP and Children on TP 56

Resources of an alien's sponsor and spouse (if the spouse also signed an affidavit of support) must be evaluated. The sponsor's countable resources must be determined when determining the applicant's resources. The total value of these resources must be reduced by $1,500. See the Glossary for the definition of an alien sponsor.

The remainder must be added to the alien's countable resources. If someone sponsors more than one alien, the amount of countable resources is prorated evenly among all the aliens who apply for or get benefits.

This policy does not apply to sponsored aliens who:

  • are under age 18;
  • are ineligible for benefits (examples include those who are
    disqualified from getting benefits or those considered non-members, such
    as students who do not meet SNAP student eligibility criteria);
  • have become naturalized U.S. citizens;
  • have worked or can receive credit for 40 quarters of work;
  • have a deceased sponsor;
  • have a sponsor who is a member of the alien’s household or Modified Adjusted Gross Income (MAGI) household composition;
  • are refugees, parolees, asylum grantees, Amerasians, victims of severe trafficking or Cuban or Haitian entrants;
  • are battered alien spouses of U.S. citizens or of legal permanent residents, children of battered aliens, or parents of battered children, if
    • HHSC determines the battery is substantially related to the need for benefits; and
    • the battered person does not live with the batterer; or
  • are indigent.

    Notes:
    • The criterion for indigent aliens applies only if the alien does not meet one of the other exceptions noted in this list. Only the amount the sponsor will give the alien for a 12-month period starting the date HHSC makes the indigence determination should be deemed. Each determination is renewable for additional 12-month periods.
      • Each time a determination of indigence is made, a memo must be sent with the name, address, Social Security number and date of birth, of both the indigent alien and the indigent alien’s sponsor, to Texas Works Policy Section, 909 W. 45th St., Bldg. 2, Mail Code 2115, Austin , TX 78751.
      • Before sending the memo, explain to the sponsored alien that regulations require the state to report the sponsor to the United States Citizenship and Immigration Services (USCIS) for failure to give support as required on the sponsor affidavit.
      • The alien may choose to have the sponsor's resources deemed if the alien does not want the state office to send this report.
    • The sponsor's resources must not be deemed for 12 months for battered aliens, starting the month the alien is certified for any benefit. A new 12-month period must not be assigned if the alien reapplies after denial of benefits. After the first 12 months, the sponsor's resources continue to be exempt from deeming if:
      • a court or the U.S. Citizenship and Immigration Services recognize the battery;
      • HHSC determines the battery has a substantial connection to the need for benefits; and
      • the alien does not live with the batterer.
    • The following list of circumstances may be used as a guide in making the substantial connection between the battery and the need for benefits. Staff may determine whether the battered alien needs the benefits:
      • to become self-sufficient after leaving the abuser;
      • to escape the abuser, the community where the abuser lives, or both;
      • to ensure the battered alien’s safety;
      • to replace financial support lost as a result of the separation from the abuser;
      • because of the loss of a job or reduced earnings resulting from the battery or cruelty;
      • because the battered alien needs medical attention or mental health counseling or now has a disability due to the battery;
      • because the battered alien lost the home, and the separation from the abuser jeopardizes the battered alien's ability to care for the children;
      • to reduce nutritional risks;
      • to get medical care for a pregnancy resulting from sexual assault or abuse; or
      • to replace medical coverage or health care services.

TANF and Children on TP 56

This policy does not apply to:

  • sponsored aliens whose sponsors get TANF or SSI; or
  • the dependent child of a sponsor or sponsor's spouse.

SNAP

This policy does not apply to:

  • sponsored aliens whose sponsors get SNAP as a member of the same household; or
  • organizations or groups that sponsor aliens.

 

A—1246 Resources of Residents in Shelters for Battered Persons

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Resources of residents in shelters for battered persons are exempt if:

the resources are jointly owned by the household in the shelter and members of the former household; and

the shelter resident's access to the value of the resource depends on the agreement of a joint owner who still lives in the resident's former household.

 

A—1247 Resources of Stepparents

Revision 15-4; Effective October 1, 2015

TANF

All resources of a stepparent must be counted if the stepparent is included in the certified group. When the stepparent is not included in the certified group, only the legal parent's half of a jointly owned resource should be counted.

Children on TP 32 and Children on TP 56

When a stepparent is included in the child's household composition, all resources of a stepparent are counted.

Related Policy

Earnings of a New TANF Spouse, A-1249.2

 

A—1248 Resources of TANF and SSI Recipients

Revision 22-1; Effective January 1, 2022

TANF, Children on TP 32 and Children on TP 56

The resources of an SSI recipient living in the home, even when the resources are available to the TANF-certified member or Medical Programs household member, are exempt if:

  • the SSI recipient would otherwise be a certified member in the TANF or Medical Programs EDG;
  • the SSI recipient would otherwise be someone whose income is:
    • applied to the TANF budget; or
    • included in the Medical Programs household composition; or
  • a TANF-certified or disqualified person or member of the Medical Programs household composition is the SSI recipient's payee.

This policy applies to:

  • people who continue to receive SSI Medicaid when their SSI financial assistance is denied because of earnings; and
  • children who receive SSI Medicaid that the person chooses not to include in the TANF-certified group.

If other SSI recipients live in the home and contribute to a member of the TANF-certified group, disqualified group or Medical Programs household composition, follow policy for cash gifts and contributions.

SNAP

Exempt the resources of TANF and SSI recipients unless the recipient owns them with another member of the same SNAP household and that other member does not receive TANF or SSI.

Note: Consider a household member a TANF or SSI recipient, even if the benefit:

  • has not yet been received;
  • is suspended; or
  • is being recouped.

When a TANF or SSI recipient owns a resource with a member of the same SNAP household who does not receive TANF or SSI, determine countable resources as follows:

  • Nonliquid resources — Exempt the TANF or SSI recipient's portion of a nonliquid resource if the recipient jointly owns it with another member of the SNAP household.
  • Liquid resources — Exempt or count liquid resources according to the following guidelines:
    • Commingled resources — Exempt the TANF or SSI recipient's portion of commingled resources for six months from the month the person combined them. After six months, count the total amount of commingled resources as an available resource to the non-TANF or SSI recipient if it remains accessible.
    • Jointly owned resources (not commingled) — Exempt these resources if all the contributed money is from a TANF or SSI recipient and the resource is solely for:
      • expenses of the TANF or SSI recipient; or
      • common household expenses.

Related Policy 

Cash Gifts and Contributions, A-1326.1

 

A—1249 Resources Resulting from Earnings

Revision 04-1; Effective January 1, 2004

 

A—1249.1 Earnings of a Child

Revision 15-4; Effective October 1, 2015

TANF, SNAP, Children on TP 32 and Children on TP 56

Staff must exempt any liquid resources resulting from the earnings of a child (certified child for TANF or eligible child for Medical Programs) who is attending school:

  • full time, or
  • less than full time and employed less than 30 hours a week.

Note: A child who is home schooled or attends general equivalency diploma (GED) classes is eligible for the resource exclusion.

Resources of a child that are commingled with resources of other household or non-household members are excluded. The child's liquid resources are exempt for six months from the month the resources were combined. After six months, the amounts previously earned as a resource are counted.

 

A—1249.2 Earnings of a New TANF Spouse

Revision 15-4; Effective October 1, 2015

TANF

The liquid resources of a TANF recipient's new spouse are excluded for six months beginning the month after the date of the marriage if the:

  • resource results from the new spouse's earnings, and
  • total gross income of the budget group does not exceed 200 percent FPIL for the family size.

Note: This applies to both ceremonial and common law marriages. The following are included in the budget group:

  • the caretaker or payee of the TANF-certified group;
  • the new spouse of the TANF caretaker or payee;
  • each dependent of the TANF caretaker or payee and the new spouse who meets the TANF age and relationship requirements and lives in the household; and
  • anyone who would be a required member if not disqualified or ineligible such as an SSI recipient or ineligible alien.

If the household fails to provide verification of the marriage, the exclusion is not allowed. After six months, the amount previously earned is counted as a resource.

A-1250, Verification Requirements

Revision 16-2; Effective April 1, 2016

TANF, SNAP, Children on TP 32 and Children on TP 56

Staff must verify:

  • resources if:
    • they are questionable,
    • the value is within $300 of the maximum allowable limit, or
    • it is a regional requirement.
  • all checking or savings accounts at application or when a household reports a new account (except SNAP, see below).
  • that inaccessible resources, including bank accounts:
    • are used solely for the non-member's benefit, and
    • that no household members use the money for their benefit.
  • a person’s statement about the inaccessibility of a vehicle if it is within $300 of the resource limit.
  • the fair market value of licensed vehicles as explained in A-1238.5, How to Determine Fair Market Value of Vehicles.
  • an exempt trust fund that meets conditions in A-1237, Trust Funds.
  • the exempt or countable status of an education and/or retirement plan or account at application or when a household reports a new account.
  • the death of an alien's sponsor (does not apply to children on TP 32).

TANF, Children on TP 32 and Children on TP 56

Staff must verify a good faith effort to sell by verifying that the:

  • property is for sale, and
  • household has not refused a reasonable offer.

SNAP

Staff must verify:

  • the equity value of a licensed vehicle if exempting the vehicle because the equity value is less than or equal to $1,500.
  • a bank account if verification can be obtained during the interview. If verification cannot be obtained during the interview, the person’s statement may be accepted without verification if:
    • the person states that the household's total combined balance for all accounts does not exceed $1,000; and
    • the person’s statement is not questionable.

The EDG is pended only if the reported account balance exceeds $1,000 or the person’s statement is questionable.

TANF

Staff must verify:

  • the date of marriage between a TANF recipient and new spouse. The date of marriage is used to determine the six-month period in which the new spouse's earnings can be excluded as a resource.
  • the amount of liquid resources resulting from the earnings of a new TANF spouse.

 

 

A—1251 Verification Sources

Revision 21-1; Effective January 1, 2021

TANF, SNAP, Children on TP 32 and Children on TP 56

Vehicles

  • Data Broker System;
  • statements from:
    • finance company or bank;
    • insurance agent;
    • car dealers; or
    • Texas Department of Motor Vehicles (DMV);
  • city or county government records; or
  • newspapers.

Real Property

  • statements from:
    • tax appraisal or collector office;
    • county courthouse official;
    • real estate company;
    • bank or financial institution;
    • local land owners (nonrelative); or
    • county agent.

Alien Sponsor's Death

The Texas Bureau of Vital Statistics (BVS), if available, is considered the primary source of verification of death. If BVS is available but the date of death (DOD) does not match reported information, accept BVS as verification. No additional verification is required.

If BVS verification is not available, verify the DOD using two of the following sources:

  • Social Security Administration (SSA);
  • statement from guardian or authorized representative;
  • copy of death certificate;
  • statement from a doctor;
  • newspaper death notice (obituary);
  • statement from a relative or household member;
  • statement from funeral director; or
  • records from the hospital or other institution where the person died.

TANF, SNAP, Children on TP 32 and Children on TP 56

Bank Account

  • current bank statements (within last three months), or
  • statement from bank official.

Debit Account

  • Electronic Benefit Transfer (EBT) cash accounts via the:
    • EBT System; or
    • Lone Star Help Desk automated voice response system at 800-777-7328, if staff have the cardholder's 19-digit personal account number (PAN);
  • Unemployment Insurance Benefit (UIB) debit accounts via:
  • Texas Office of Attorney General (OAG) child support debit accounts online at EPPICard.com; or
  • Social Security Direct Express card (RSDI or SSI) debit accounts via:
    • online at USDirectExpress.com;
    • calling the Direct Express card help desk automated voice response system at 888-741-1115, if the advisor has the cardholder's 16-digit card number; or
    • current receipt (free of charge) from any ATM that displays the MasterCard® logo.

Other Liquid Assets/Personal Property

  • recent sales slips;
  • insurance or tax appraisals;
  • catalogs or newspaper;
  • statements from:
    • experts or other collectors;
    • bank;
    • brokers; or
    • local merchants;
  • retirement benefit letters; or
  • education plan or account benefits summary letters.

Life Insurance

  • Insurance policy; or
  • Statements from:
    • Insurance company;
    • Insurance agent; or
    • Union, employer, funeral director, organization or agency that provides insurance.

Nonrecurring Lump-sum Payments

  • statements from the company, agency or organization that provided payment;
  • checks, award letters or check stubs; or
  • bank statements or deposit slips.

TANF

Ceremonial Marriage

  • marriage license or certificate;
  • church records;
  • statement from clergy; or
  • family Bible records.

Common Law Marriage

  • Declaration of Informal Marriage filed with the county clerk;
  • sworn statement signed by both spouses; or
  • Form H1057, Declaration of Informal Marriage.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

A-1260, Documentation Requirements

Revision 21-2; Effective April 1, 2021

TANF, SNAP, Children on TP 32 and Children on TP 56

Documentation is required for the following:

  • to indicate whether a resource is countable or exempt and explain if it is questionable;
    Note: For SNAP, this requirement applies only to vehicles and liquid resources.
  • calculations used to determine the equity value for resources with allowable deductions;
  • the total value of countable resources;
  • the dates and amounts of any resources received while the EDG is active;
  • the facts surrounding a transfer of resources;
  • how resources were verified and the date of verification;
  • that information was provided to a sponsored alien who meets the indigent criteria about the requirement to report the alien’s sponsor to USCIS for failure to give support and if the alien chose to have the sponsor’s resources deemed instead;
    Note: Does not apply to children on TP 32.
  • the type of any retirement account, plan, or education tuition savings plan, or any combination, and the Internal Revenue Code provision under which the plan was established; and
  • the source used to verify the death of an alien's sponsor.

TANF, Children on TP 32 and Children on TP 56

Document the good faith effort to sell real property and the:

  • reason for exempting the property; and
  • household's efforts to sell it.

TANF

Documentation is required for the following:

  • the months of the six-month period that the earnings of a new spouse of a TANF recipient will be excluded as a liquid resource;
  • the amount of the earnings of the new spouse of a TANF recipient that will be excluded as a liquid resource; and
  • the reason for not pursuing a legally entitled resource per policy.

TANF and SNAP

Document the facts about a transfer of resources per policy.

Related Policy

Requirement to Pursue Resources, A-1211 
Transferring Resources, A-1212 
Documentation, C-940
The Texas Works Documentation Guide

A-1310, General Policy

Revision 21-2; Effective April 1, 2021

All Programs

Income is any type of payment that is of gain or benefit to a household and is either counted or exempted from the budgeting process. Earned income is related to employment. Except for MAGI medical programs, earned income entitles a household to deductions not allowed for unearned income. Unearned income is income received without performing work-related activities and includes benefits from other programs. Factors specific to the source of income and the distance it travels through the mail (weekends and holidays) may be used to determine the date income can reasonably be anticipated.

TANF and SNAP

Retirement, Survivors, and Disability Income (RSDI), Supplemental Security Income (SSI), Veterans Affairs (VA) benefits, or other such funds legally obligated to a beneficiary are not counted if a payee who is not a member of the household:

  • receives the funds; and
  • does not make the money available to the beneficiary.

In the beneficiary’s Eligibility Determination Group (EDG), the total amount of the legally obligated funds the payee makes available to the beneficiary in cash, by way of vendor payment or through items purchased for the beneficiary using the beneficiary's money (includes payments made by the payee to a third party on behalf of the beneficiary) is counted as unearned income. Any portion of the funds the payee keeps for the payee's own use is counted as unearned income in the payee's EDG.

TANF

The income of the following people must be considered for Temporary Assistance for Needy Families (TANF):

  • any person in the certified or budget group, or EDG member, including disqualified members;
  • any person living in the home who is not included in the certified or budget group but who is legally responsible for a member of the certified group; and
  • an alien's sponsor.

For TANF, if the income is not made available to the beneficiary, the person must follow the requirements for pursuing legally obligated income.

SNAP

The income of the following people must be considered for the Supplemental Nutrition Assistance Program (SNAP):

  • any member of the SNAP household, including disqualified members; and
  • an alien's sponsor.

Medical Programs

Modified Adjusted Gross Income (MAGI) rules are based on Internal Revenue Service (IRS) rules for counting income and are used to determine financial eligibility for medical programs and federal insurance affordability programs.

To determine financial eligibility, the following items must be identified for each person within the MAGI household composition:

  • earned income, excluding any pre-tax contributions;
  • unearned income;
  • self-employment income;
  • American Indian (AI)/Alaska Native (AN) disbursements;
  • overpayments; and
  • expenses.

The income of the following people must be considered for medical programs:

  • any person who is included in the person’s MAGI household composition; and
  • an alien's sponsor (if applicable).

Note: Household composition for medical programs is determined for each applicant or recipient. The income of certain people may be exempt from an applicant’s or recipient’s MAGI household income as explained in A-1341, Income Limits and Eligibility Tests, Medical Programs, Step 3.

TP 40

If a pregnant woman is determined to be eligible, the EDG must not be denied if the pregnant woman’s MAGI household composition income increases above the income limit. The budget should be adjusted to reflect the new income.

TP 45

Income is not an eligibility factor for TP 45.

Related Policy

Requirement to Pursue Income, A-1311
Income Limits and Eligibility Tests, A-1341
Alien Sponsor’s Income, A-1361
Eligibility Criteria, B-471
Special Provisions for Households with Elderly Members or Members with a Disability, B-433
Categorically Eligible Households, B-470

 

A—1311 Requirement to Pursue Income

Revision 22-1; Effective January 1, 2022

TANF and Medical Programs

Applicants and recipients are required to pursue and accept all legally entitled income. Inform applicants and recipients of this requirement and develop a plan to pursue the potential income. Allow reasonable time (at least three months) to pursue the income and do not consider the income available during this time. Inform recipients of their obligation to pursue potential income and include the allowable time to pursue the income in the comments section of Form TF0001, Notice of Case Action.

Exception: The recipient does not have to pursue income if it would be unreasonable. Consider a situation unreasonable if:

  • the cost to pursue the income exceeds the potential income or causes financial hardship; 
  • pursuing the income would endanger the recipient’s health or safety; or
  • legal action is required, but a private attorney or legal services refuses to accept the case. The recipient must make a reasonable effort to obtain legal assistance.

TANF and TP 08

Document the plan and the time allowed to pursue income. If the household refuses or fails to follow the agreed plan without good cause, deny the EDG. 

Set a special review if the anticipated change in income will occur before the next periodic redetermination. 

Related Policy  

Documentation Requirements, A-1380

 

A—1311.1 Requirement to Pursue SSI/RSDI

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Advisors must provide and explain Form H1859, Social Security Administration Benefits for People with Disabilities Receiving TANF, to households claiming a disability or caring for a child with disabilities. Staff must also document that Form H1859 was provided and explained to the individual.

Advisors are not required to set a special review when referring individuals for Social Security benefits. At the next periodic redetermination, the household must provide verification that the individual with disabilities applied for SSI/RSDI benefits.

In the comments section of Form TF0001, Notice of Case Action, the advisor must inform individuals of their obligation to pursue potential income and include the time allowed for pursuing income. The advisor must include the following appropriate statement for households claiming a disability or caring for a child with disabilities:

  • English – "You must apply for assistance with the Social Security
    Administration and provide proof of the application at your next TANF interview."
  • Spanish – "Tiene que solicitar asistencia de la Administración del Seguro
    Social y presentar prueba de la solicitud en su próxima entrevista de TANF."

If the household fails to apply for SSI/RSDI without good cause, the EDG is denied. If the household chooses to no longer claim the Choices exemption, the advisor should update the exemption code and document the decision. The individual may not claim the Choices exemption if the individual reapplies within 12 months from the denial date. If the individual claims the exemption before the 12 months, the EDG should be pended and the individual should be given the opportunity to provide verification that he or she applied for SSI/RSDI benefits.

 

A—1311.1.1 SSI/RSDI Application Assistance

Revision 15-4; Effective October 1, 2015

TANF

State office has an automated process that identifies TANF recipients with a Choices exemption for caring for a child with disabilities and unable to work due to mental or physical disability and sends referrals to the contractor who administers the Social Security Outreach Application Program (SSOAP). SSOAP outreaches the TANF household, provides information, and answers questions about the Social Security Administration (SSA) process.

If an individual states that the household applied for SSI/RSDI, but does not have verification available, the advisor should refer to the Wire Third-Party Query (WTPY)/State Online Query (SOLQ) system. If the WTPY/SOLQ system does not show that the individual applied for benefits, the advisor should request that the individual provide verification.

The EDG should not be denied if:

  • the individual is physically or mentally unable to complete the SSI/RSDI application process; and
  • SSOAP and SSA fail or are unable to provide assistance needed to complete the SSI/RSDI application process.

 

A—1311.1.2 Social Security Administration (SSA) Definitions and Guidelines

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

The SSA administers two programs that provide benefits based on disability:

  • RSDI provides disability benefits to individuals, and to their dependents with disabilities under certain conditions.
  • SSI provides benefits to individuals with disabilities (including children under age 18) who have limited income and resources.

The Social Security Act and SSA's regulations provide a definition of disability:

  • For all individuals applying for RSDI and adults applying for SSI, the definition of disability is the same. The law defines disability as the inability to engage in substantial gainful activity because of physical or mental impairment(s) which may result in death, or which has lasted or is expected to last for a continuous period of not less than 12 months.
  • For children under age 18 applying for SSI, the law defines disability as a physical or mental impairment(s) which results in marked and severe functional limitations, and which may result in death, or which has lasted or is expected to last for a continuous period of not less than 12 months.

Advisors should refer the individual to SSI if one of the following conditions is met:

  • Psychological/psychiatric problems:
    • Actual clinical diagnosis or medical documentation that indicates the individual is unable to work,
    • Odd and/or inappropriate behavior, or
    • Inability of a long-time TANF individual to get or keep a job for more than 30 days because of a mental impairment.
  • Obesity combined with any other physical problems such as arthritis, high blood pressure, heart failure, respiratory disease, or vascular disease.
  • Low intelligence:
    • Former special education student,
    • Inability to read or write even though person has been to school,
    • Basis test scores below 200,
    • Failure to comprehend even the simplest directions, or
    • Down's syndrome.
  • Serious substance abuse when combined with other related health problems.
  • Serious health problems:
    • Multiple sclerosis, cancer, stroke, multiple surgeries for the same problem, multiple trauma and other situations;
    • Chronic health problems; or
    • Newborns with low birth weight (1200 grams or less within the first few days after birth).
  • Age 50 or over with health problems, especially if combined with limited education and limited work history.

Note: A claimant, including a child, applying for SSI based on disability or blindness may receive up to six months of payments before the final determination of disability or blindness if the claimant is determined to presumptively have a disability or be blind and meets all other eligibility requirements.

Related Policy

Definition of Disability, B-432
Social Security's Criteria for Disability, B-432.1
Form H1859, Social Security Administration Benefits for People with Disabilities Receiving TANF

 

A—1320 Types of Income

Revision 15-4; Effective October 1, 2015

All Programs

There are differences between TANF, Medical Programs and SNAP in countable and exempt income.

TANF and SNAP

Income that is not specifically listed in this section must be counted.

 

A—1321 Disability Benefits

Revision 13-2; Effective April 1, 2013

 

A—1321.1 Agent Orange Settlement Payments

Revision 15-4; Effective October 1, 2015

All Programs

Agent Orange Settlement Payments disbursed by AETNA Insurance Company and paid to the following individuals are exempt:

  • veterans with disabilities exposed to Agent Orange while in Vietnam who suffer from total disabilities caused by any disease, and
  • survivors of these deceased veterans.

These veterans receive yearly payments. Survivors of these deceased veterans receive a lump-sum settlement payment.

TANF and SNAP

VA payments are counted as unearned income, including benefits paid to veterans with service-connected disabilities resulting from exposure to Agent Orange. See A-1324.20, Veterans Benefits.

Related Policy

Lump-Sum Payments, A-1331

A-1320, Types of Income

Revision 15-4; Effective October 1, 2015

All Programs

There are differences between TANF, Medical Programs and SNAP in countable and exempt income.

TANF and SNAP

Income that is not specifically listed in this section must be counted.

A—1321 Disability Benefits

Revision 13-2; Effective April 1, 2013

A—1321.1 Agent Orange Settlement Payments

Revision 15-4; Effective October 1, 2015

All Programs

Agent Orange Settlement Payments disbursed by AETNA Insurance Company and paid to the following individuals are exempt:

  • veterans with disabilities exposed to Agent Orange while in Vietnam who suffer from total disabilities caused by any disease, and
  • survivors of these deceased veterans.

These veterans receive yearly payments. Survivors of these deceased veterans receive a lump-sum settlement payment.

TANF and SNAP

VA payments are counted as unearned income, including benefits paid to veterans with service-connected disabilities resulting from exposure to Agent Orange. See A-1324.20, Veterans Benefits.

Related Policy

Lump-Sum Payments, A-1331

A—1321.2 Disability Insurance Benefits

Revision 16-4; Effective October 1, 2016

All Programs

Disability insurance benefits are normally paid to an individual who has suffered injury or impairment. These payments may be from an employer, insurance provider, or other public or private fund.
Advisors must determine the source of the benefit.

  • If the source is covered by an income type listed in A-1320, Income Types, such as RSDI [see A-1324.16, Retirement, Survivors and Disability Insurance (RSDI)], the procedures for that benefit must be used.
  • If the source is not covered by another income type listed in A-1320, the policy listed below must be used.

TANF and SNAP

Count as unearned income.

Medical Programs

Disability insurance benefits are exempt.

A—1321.3 Radiation Exposure Compensation Act Payments

Revision 15-4; Effective October 1, 2015

All Programs

Payments from the Radiation Exposure Compensation Act (the “Act”), Public Law 101-426, are exempt.

The Act established a program to pay damages to individuals for injuries or deaths caused by exposure to radiation from nuclear testing and uranium mining. When the affected individual is deceased, the surviving spouse, children, parents, grandchildren, or grandparents receive the payments.

A—1321.4 Worker's Compensation

Revision 15-4; Effective October 1, 2015

TANF and SNAP

The gross benefit is counted as unearned income, less amounts:

  • recouped for a prior worker's compensation overpayment; or
  • paid for attorney's fees. Note: The Texas Workers' Compensation Commission (TWCC) or a court sets the amount of the attorney's fee to be paid.

A deduction from the gross benefit for court-ordered child support payments is not allowed.

Exception: Worker's compensation benefits paid to the individual for out-of-pocket medical expenses are considered as reimbursements.

Medical Programs

All workers’ compensation payments are exempt.

A—1322 Education and Training

Revision 13-2; Effective April 1, 2013

 

A—1322.1 Educational Assistance

Revision 15-4; Effective October 1, 2015

All Programs

Educational assistance, including educational loans, scholarships, fellowships, grant monies, and work study, are exempt, regardless of the source. Loans for education, including loans from relatives or other people, are considered as educational assistance only if payment is deferred.

Educational assistance is:

  • any financial aid for vocational or educational courses from:
    • an organization (such as fraternal, alumni, etc.); or
    • a government program or agency (such as the U.S. Office of Education, Department of Veterans Affairs, or Texas Department of Assistive and Rehabilitative Services).
  • provided to students who are enrolled in a:
    • program that provides for completion of a secondary high school diploma or the equivalent (such as a general equivalency diploma [GED]);
    • school for people with intellectual or physical disabilities; or
    • post-secondary institution.

    Note: "Post-secondary" includes institutions of higher education and others not requiring a high school diploma (such as community colleges and vocational educational programs) authorized by the state to provide educational or training programs beyond secondary education.

The U.S. Office of Education under Title IV of the Higher Education Act administers most educational assistance programs. A few examples of the most common Title IV educational assistance grants include:

  • Pell Grants,
  • Stafford Loan Program,
  • Parent Loans for Students (PLUS Loans),
  • Supplemental Educational Opportunity Grants,
  • College Work Study, and
  • Carl D. Perkins Loans (Title IV, Part E) (formerly National Direct Student Loans).

The National Community Services Act (NCSA) program also provides educational assistance. Individuals are awarded from $1,000 to $4,000 per year of completed services to apply toward past or future educational expenses. The educational award is not counted, as it is always made payable directly to the financial institution or institution of higher learning.

The Department of Veterans Affairs administers education programs designed for veterans, reservists, members of the National Guard, and their widows and orphans. These include:

  • Montgomery GI Bill (MGIB) Active Duty Educational Assistance Program,
  • Vocational Rehabilitation,
  • Post-Vietnam Era Veterans' Educational Assistance Program (VEAP),
  • Survivor's and Dependent's Educational Assistance (DEA), and
  • MGIB - Selected Reserve Educational Assistance Program.

Related Policy

Educational Assistance, A-1239

A—1322.2 Job Training

Revision 03-7; Effective October 1, 2003

 

A—1322.2.1 Workforce Innovation and Opportunity Act (WIOA)

Revision 15-4; Effective October 1, 2015

All Programs

Temporary employment of six months or less for disaster-related work, paid under the Workforce Innovation and Opportunity Act and funded by the National Emergency Grant, is exempt.

TANF and Medical Programs

All WIOA payments are exempt.

SNAP

All WIOA payments are exempt except on-the-job training (OJT) payments funded under the Workforce Innovation and Opportunity Act. OJT payments are counted as earned income for adults.

OJT payments are exempt if received by a child who is under:

Related Policy

Government Disaster Payments, A-1324.3

A—1322.2.2 Other Job Training and Training Allowances

Revision 15-4; Effective October 1, 2015

All Programs

Portions of payments earmarked as reimbursements for training-related expenses are exempt, and any excess is counted as earned income.

A—1323 Employment and Self-Employment Income

Revision 13-2; Effective April 1, 2013

A—1323.1 Children's Earned Income

Revision 20-2; Effective April 1, 2020

TANF

A dependent child's earned income is counted unless the child (as defined in A-221, Who Is Included) is a:

  • full-time student, including a home-schooled child; or
  • part-time student employed less than 30 hours a week.

Exception: See A-1322.2.1, Workforce Innovation and Opportunity Act (WIOA).

SNAP

A child's earned income is counted unless the child:

  • is under age 18;
  • attends elementary, middle, or high school, including home schooling; or
  • attends general equivalency diploma (GED) classes; and
  • lives with natural or adoptive parents, stepparent or is under parental control of another household member.

Exception: See A-1322.2.1, Workforce Innovation and Opportunity Act (WIOA).

TANF and SNAP

Breaks in school attendance, such as summer vacation and holidays, do not change the student status of a child. Ensure that the child's enrollment will continue following the break.

If the child's earnings cannot be separated from other household members' earnings, divide the total earnings equally by the number of working members.

Medical Programs

A child's earned income may be exempted from the MAGI household income as explained in A-1341, Income Limits and Eligibility Tests, Medical Programs, Step 3.

A—1323.2 Contractual Earnings

Revision 05-5; Effective October 1, 2005

All Programs

Contractual earnings are wages and salaries only. Self-employment income, unearned income, or income received on an hourly or piecework basis are not included. The two basic types of contractual earnings are:

  • Seasonal employment — available only during certain months of the year and recurs each year. Examples: school-related employment, certain types of farm work, and summer or winter employment. Divide seasonal employment that is a household's annual means of support over 12 months. If the income supports the household for only a portion of the year and the household has income from other sources the rest of the year, average the earnings over the time they are intended to cover.
  • Contractual employment — nonseasonal employment that is contracted for a specific time and does not recur. Divide earnings over the time covered by the contract.

A—1323.2.1 Monthly Budgeting of Contractual Earnings

Revision 20-2; Effective April 1, 2020

All Programs

Budget contractual earnings monthly by:

  • dividing the total gross amount earned under the contract by the number of months the contract covers or by 12 months, whichever is applicable; and
  • adding this amount to any other income, and budgeting according to usual procedures.

    Note: If the person does not receive the income agreed to in the contract, or if income is interrupted because of participation as a striker in a work slow-down or stoppage, do not budget the contractual earnings using the steps above since the person cannot reasonably anticipate receiving the contractual income. For strikers, follow policy in A-1367.1 . If the person's employment situation changes and contractual earnings resume:
     
  • recalculate the income or adjust the benefits accordingly; and
  • document all the facts that caused the recalculation or adjustment.

Related Policy

How to Project Income, A-1355
Strikers, A-1367
Eligibility of Strikers, A-1367.1

A—1323.3 Military Pay Allotments and Allowances

Revision 15-4; Effective October 1, 2015

All Programs

Military pay and allowances for housing, food, base pay, and flight pay is counted as earned income less pay withheld to fund education under the G.I. Bill.

An allotment is a specified amount of money from each paycheck of the military wage earner that is designated to go to someone else. Military allotments are counted as unearned income.

A—1323.3.1 Family Subsistence Supplemental Allowance (FSSA)

Revision 15-4; Effective October 1, 2015

TANF and SNAP

The Family Subsistence Supplemental Allowance is a monthly payment made to certain low-income service members and their families so they will not have to depend on SNAP to meet their needs. The service members' pay statements usually include the FSSA and are counted as earned income.

Medical Programs

FSSA payments are exempt.

A—1323.3.2 Combat (Hazardous Duty) Payments

Revision 15-4; Effective October 1, 2015

TANF

All of the combat payments, also known as hazardous duty payments, received by a legal parent who is a member of the U.S. military, absent solely because the individual has been deployed to a combat zone, are counted.

SNAP

Any portion of military pay identified as combat pay, including any portion of combat pay contributed to a household from military personnel deployed to a combat zone, is excluded.

The advisor must determine whether any funds contributed to the household by military personnel, such as through joint bank accounts or military allotments, are considered combat pay. Any portion identified as combat pay is exempt from income. The following steps should be used to determine the amount of military income to exclude as combat pay:

Steps Action
1. Verify the monthly amount of combat pay received, as required in A-1370, Verification Requirements.
2.

Determine the amount of military pay the deployed individual was making available to the household before deployment to the combat zone.

If the deployed person was:

  • a household member before deployment, the amount would be the individual's net military pay.
  • not part of the household before deployment, then consider any amount made available from the individual's pay before deployment.
3. Determine the amount of military pay the deployed individual is making available to the household after deployment to the combat zone.
4. If the amount of contribution the household receives from the military personnel after deployment:
  • is equal to or less than the amount the household was receiving before deployment, then none of that contribution would be considered combat pay. Count the full amount of the contribution as unearned income.
  • exceeds the amount received before deployment, exclude the excess as combat pay (not to exceed the verified monthly amount of combat pay) and count the remainder (if any) as unearned income.

Medical Programs

Combat (hazardous duty) payments are exempt.

Related Policy

Who Is Included, A-241.1
Verification Requirements, A-1370
Glossary, Combat Pay and Combat Zone

A—1323.4 Self-Employment

Revision 12-4; Effective October 1, 2012

All Programs

Self-employment income is usually income from one's own business, trade, or profession rather than from an employer. However, some individuals may have an employer and receive a regular salary. If an employer does not withhold income taxes or FICA, even if required to do so by law, the person is considered self-employed.

Advisors must inform households in writing to keep self-employment records and receipts for verification purposes for future recertifications. Form TF0001, Notice of Case Action, contains the self-employment information.

Note: If a household has self-employment income and meets the streamlined reporting criteria, assign a six-month certification period.

A—1323.4.1 Types of Self-Employment Income

Revision 15-4; Effective October 1, 2015

All Programs

Types of self-employment include:

  • odd jobs, such as mowing lawns, babysitting, and cleaning houses;
  • owning a private business, such as a beauty salon or auto mechanic shop;
  • farm income;
  • income from property; and
  • independent contracting.

A—1323.4.2 Property Income

Revision 15-4; Effective October 1, 2015

All Programs

Income from renting, leasing, or selling property on an installment plan is self-employment income. Property includes equipment, vehicles, and real property.

TANF and SNAP

Income from property is counted as:

  • earned if the:
    • person spends an average of at least 20 hours a week in management or maintenance activities; or
    • income is from noncommercial boarding situations.
  • unearned if the person spends an average of less than 20 hours a week in management or maintenance activities.

Work-related expenses are allowed for earned income. For unearned income, only the expenses associated with producing the income should be deducted.

If the individual sells property on an installment plan, the payments are counted as income. The balance of the note is exempted as an inaccessible resource.

Medical Programs

Income from renting, leasing, or selling property on an installment plan is counted as self-employment income.

A—1323.4.3 Noncommercial Roomer/Boarder Payments

Revision 15-4; Effective October 1, 2015

TANF and SNAP

The noncommercial roomer/boarder policy is used if a noncertified household member makes payments to a certified member under a formal or informal landlord/tenant relationship. Payments made by boarders for room, meals, and other shelter expenses are counted. Payments made by roomers for room and other shelter expenses are counted.

See A-1323.4.5, Allowable Costs of Producing Income, to determine the countable amount of noncommercial roomer/boarder payments. If there is not a formal or informal landlord/tenant relationship, the policy in A-1326.1, Cash Gifts and Contributions, applies.

TANF

Roomer/boarder status should not be given to:

  • anyone whose income can be applied to the certified group; or
  • a dependent child who is an ineligible alien.

SNAP

To be considered a boarder, a person residing with the household must pay reasonable compensation for meals and lodging. Reasonable compensation is:

  • the amount of the full allotment for the number of boarders if the boarders eat an average of more than two meals a day with the household; or
  • two-thirds of the full allotment for the number of boarders if the boarders eat an average of two meals a day or less with the household.

In determining "reasonable compensation," only the amount paid for meals is counted if it can be separated from lodging.

If the individual chooses to include a boarder as a household member:

  • all of the boarder's income, resources and deductions are counted; but
  • the payment from the boarder is not counted as income since it is transferred between household members.

If the individual chooses not to include a boarder as a household member:

  • the boarder's income, resources, or deductions are not included in the household; but
  • the payment from the boarder is counted as self-employment income for the household.

Medical Programs

The noncommercial roomer/boarder policy is used when an individual in the MAGI household composition receives payments from someone in their physical household under a formal or informal landlord/tenant relationship. Payments made by boarders for room, meals, and other shelter expenses are counted as self-employment income. Payments made by roomers for room and other shelter expenses are counted as self-employment income.

See A-1323.4.5, Allowable Costs of Producing Income, to determine the countable amount of noncommercial roomer/boarder payments. If there is not a formal or informal landlord/tenant relationship, the policy in A-1326.1, Cash Gifts and Contributions, applies.

Related Policy

Nonmembers, A-232.1

A—1323.4.4 Determining the Amount of Self-Employment Income

Revision 16-4; Effective October 1, 2016

All Programs

If the household receives self-employment income monthly or more often (such as semi-monthly, bi-weekly, weekly or daily), recent self-employment pay amounts may be used to project income.

If the household had self-employment income for the past year that was received less often than monthly, the income figures from the previous year's business records or tax forms, including the IRS Schedule C-Form 1040- Profit or Loss from Business, may be used if the records are anticipated to reflect current self-employment income and expenses.

Exceptions:

  • If the previous year's records do not accurately represent the household's current self-employment income because the household has experienced a substantial increase or decrease in business, anticipate income using more current information such as updated business ledgers or day books, or contact people who have similar businesses.
  • If the business is new and there is insufficient information to make a reasonable projection based on last year's records, anticipate earnings and expenses using only the recent business records along with the individual's statements about expected income and expenses and any applicable information from collateral sources.
  • If the income terminates before completing the EDG, budget actual income and expenses for the month the income terminates.
  • For Children’s Medicaid programs (TP 43, TP 44, TP 45 and TP 48), the previous year’s business records or tax forms are acceptable, no matter the pay frequency.

When calculating self-employment income, the financial profit from a sale or transfer of capital goods, possessions (such as products, raw materials, equipment), or ownership of a business, must be considered.

Financial profit from the sale or transfer of capital goods that the household expects to receive in the next 12 months should be added and the total averaged over 12 months. This averaged amount should be used for each certification period within the next 12 months, unless a new average is computed because the person received a profit from the sale or transfer of capital goods that was unanticipated or a different amount than anticipated.

Determining the Amount of Self-Employment Income at Application

All Programs

New applicants who have not received TANF, Medical Program coverage, or SNAP for a period of three consecutive months before the application month, or new household members who have not received benefits for three months before moving into the household, may not have been keeping accurate records of self-employment income and expenses. The policy in C-932, Advisor Responsibility for Verifying Information, should be used to obtain verifications needed to determine eligibility and what types of verification are readily available to the household. Any business records that are available for use (even if this documentation is for a short period of time) should be accepted, in addition to the individual's statement and any proof that might be available from a collateral source, as sufficient proof.

The advisor must verify:

  • at least the last two recent pay amounts when determining the amount of self-employment income received monthly;
  • at least four consecutive recent pay amounts when determining the amount of self-employment income received more often than monthly, such as semi-monthly, bi-weekly or weekly; and
  • at least four consecutive weeks for self-employment income received daily.

The individual is not required to provide verification of self-employment income and expenses for more than two calendar months before the interview date for income received monthly or more often.

The applicant's statement is accepted as proof if:

  • there is a reasonable explanation why documentary evidence or a collateral source is not available; and
  • the applicant's statement does not contradict other individual statements or other information received by the Texas Health and Human Services Commission (HHSC).

Exception: If the business is new and there is insufficient information to make a reasonable projection, the income is calculated based on anticipated earnings and expenses.

The advisor must inform the household in writing to keep self-employment records and receipts for verification purposes for future recertifications. Form TF0001, Notice of Case Action, contains the self-employment information.

Medical Programs

If the individual applies for three months prior Medicaid, the following should be budgeted in each prior month:

  • actual income and expenses for self-employment income received monthly or more often, or
  • projected monthly average amount for self-employment income received annually or seasonally.

Determining the Amount of Self-Employment Income at TANF Periodic Reviews, SNAP Recertifications, and Medical Programs Renewals

All Programs

For income received less often than monthly, only information from the period of time since HHSC last requested verification of self-employment needs to be verified. Verification that was previously verified is not needed (see C-932). Verification is needed for:

  • at least the last two recent pay amounts when determining the amount of self-employment income received monthly;
  • at least four consecutive recent pay amounts when determining the amount of self-employment income received more often than monthly, such as semi-monthly, bi-weekly or weekly; and
  • at least four consecutive weeks for self-employment income received daily.

The individual is not required to provide verification of self-employment income and expenses for more than two calendar months before the interview date for income received monthly or more often.

If the advisor informed the household to maintain accurate self-employment records and receipts after certification, the household must provide them before being recertified unless:

  • the records and receipts are not available because of a reason beyond the household's control, such as being lost in a fire or flood; or
  • if due to a verified physical or mental disability, the applicant is unable to complete the task. Note: This requirement is not applicable if the self-employed person has not received TANF, SNAP, or Medical Program coverage for three consecutive months before reapplying.

Related Policy

Computation Methods, A-1323.4.6

A—1323.4.5 Allowable Costs of Producing Income

Revision 21-2; Effective April 1, 2021

All Programs

Allowable self-employment expenses are based on costs that can be deducted from federal income taxes according to the Internal Revenue Service’s (IRS) Schedule C, Form 1040 - Profit or Loss From Business. There are certain self-employment expense types that are not allowed for SNAP.

Use an automatically calculated monthly expense amount generated by TIERS to determine eligibility if the IRS Schedule C, Form 1040 - Profit or Loss From Business, is provided.

Allowable and Non-Allowable Self-Employment Expenses by Program

Expense Types TANF and MAGI Programs SNAP

Advertising

Allow

Allow

Car and truck expenses

Allow

Allow

Commissions and fees

Allow

Allow

Contract labor

Allow

Allow

Costs not related to self-employment

Non-allowed

Non-allowed

Costs related to producing income gained from illegal activities, such as prostitution and the sale of illegal drugs

Non-allowed

Allow

Depletion

Allow

Non-allowed

Depreciation

Allow

Non-allowed

Employee benefit programs

Allow

Allow

Insurance

Allow

Allow

Interest

Allow

Allow

Legal and professional services

Allow

Allow

Net loss that occurred in a previous period

Non-allowed

Non-allowed

Office expense

Allow

Allow

Pension and profit-sharing plans

Allow

Allow

Rent or lease

Allow

Allow

Repairs and maintenance

Allow

Allow

Supplies

Allow

Allow

Taxes and licenses

Allow

Allow

Travel, meals, and entertainment

Allow

Non-allowed

Travel to and from place of business

Non-allowed

Non-allowed

Utilities

Allow

Allow

Wages

Allow

Allow

Other expenses

Allow

Allow

Note: When determining transportation costs, the person may choose to use 56 cents per mile instead of keeping track of actual expenses.

Noncommercial Roomer or Boarder Payments

All Programs

If the household receives roomer or boarder payments, as explained in A-1323.4.3, Noncommercial Roomer/Boarder Payments, the cost of doing business is deducted from each monthly payment. Count the remainder as self-employment income.

For roomers, the cost of doing business is actual costs. For boarders, the cost of doing business is:

  • the amount of the monthly SNAP allotment for the number of boarders (average of more than two meals a day);
  • two-thirds of a full allotment for the number of boarders (average of two meals a day or less); or
  • the actual cost of providing room and meals if the actual cost exceeds the monthly SNAP allotment for the number of boarders.

Note: Each expense must be identified and verified when using actual costs.

Net Financial Loss

All Programs

A self-employment net financial loss must not be deducted from other types of household income. 

Exception: The loss may be deducted from other household income if:

  • the loss results from a self-employment farming operation; and
  • the household received or anticipates receiving annual gross income of $1,000 or more from the farming operation (from Step I, Line A, Page 3, Form H1049, Client's Statement of Self-Employment Income).

TANF

The farm loss amount may be deducted from other non-farm self-employment income during the budgetary (100 percent) needs test.

Any remaining farm loss amount may be deducted during the recognizable needs test.

Medical Programs

The farm loss amount may be deducted from other non-farm self-employment income during the federal poverty level (FPL) test.

Any remaining farm loss amount may be deducted after the work expense standard deduction and child or incapacitated care costs.

SNAP

The farm loss may be deducted from other non-farm self-employment income before applying the gross income test.

Any remaining farm loss may be deducted from other earned or unearned income after applying the 20 percent earned income deduction.

A—1323.4.6 Computation Methods

Revision 15-4; Effective October 1, 2015

All Programs

There are four computation methods for self-employment income that may be used to calculate monthly income amounts for budgeting purposes:

  • annual,
  • monthly,
  • daily, and
  • anticipated.

Annual Computation Method

For this method, the individual must have been self-employed for at least the past full year.

The self-employment income projection period, usually 12 months, is the period of time the household expects the income to support the family. A projection period should be established for households that receive self-employment income that is intended to support the household for:

  • the year, but is received less frequently than monthly, such as farm income that may only be received a few times per year when crops or livestock are sold; or
  • a specific period in time, but is received less frequently than monthly.

The projection period should be determined at application when the individual reports self-employment income received less often than monthly. Note: For Medicaid EDGs, if the individual is eligible for prior Medicaid, the prior months are not included in the 12-month projection period.

The following steps are used to determine the projection period for self-employment income:

  1. Determine whether the self-employment is annual or seasonal, since that will determine the length of the projection period.
    • Annual – intended to support the household for at least the next full 12 months. The projection period is 12 months whether the income is received yearly or less often than monthly.
    • Seasonal – intended to support the household for less than 12 months since it is available only during certain months of the year. The projection period is the number of months the self-employment is intended to provide support.
  2. Determine the first month of the projection period. It is always the first month the household receives benefits, unless the individual will begin working in a future month. In this situation, use the month the self-employment begins as the first month of the projection period.

Once the projection period is established, it must not be changed. The projection period remains the same until the:

  • individual no longer supports the household through self-employment;
  • 12-month or seasonal period ends; or
  • EDG is denied, and the individual misses one full month's benefits before reapplying.

Exception: When there is a new source of self-employment income received less often than monthly, and the individual expects the income to support the household for the year or a specific period of time, establish a projection period for the months that the individual states the income is intended to cover. Since this projection period covers income from a new source, at redetermination, ensure that the income and circumstances still fit with the annual computation method criteria. Until the household has 12 months of income history, the projection period is conditional and may be changed as may the type of computation method used to calculate self-employment income.

In determining the monthly figure to use for new self-employment income when calculating a budget amount:

  • the monthly computation method is used if there are two full representative months of self- employment income received less often than monthly; and
  • the daily computation method is used if there are less than two full representative calendar months of self-employment income received less often than monthly.

On an active EDG, when an individual reports a new source of self-employment, the first month of the projection period is the change effective month.

Monthly Computation Method

The monthly computation method is used in two situations:

  1. If the frequency is known and consistent, the appropriate conversion factor is used when calculating self-employment income and/or expenses. Conversion factors are not used when income is received on any other basis, such as daily or irregularly.
    If the frequency is … use the conversion factor …
    weekly 4.33
    bi-weekly 2.17
    semi-monthly 2
  2. If the individual has at least two full representative calendar months of self-employment income and the source or the frequency is unknown and inconsistent, each month's self-employment income should be totaled and deducted from the allowable expenses for each corresponding month.

Daily Computation Method

The daily computation method is used when:

  • there are less than two full representative calendar months of self-employment income; and
  • the source or frequency of the income is unknown or inconsistent (income received irregularly, not on a weekly, bi-weekly or semi-monthly basis).

The daily method is used until there are at least two representative calendar months of income. Once there are two full representative calendar months, the monthly computation method is used.

Anticipated Self-Employment Method

The anticipated method to calculate self-employment income is used when:

  • there is no income history on which to base an average, and the individual will receive the income on a known and consistent basis; or
  • there is a change that will make the current or actual self-employment income non-representative.

Anticipated means the individual knows who will pay, when they will pay, and how much will be paid. If the individual knows the source, but not the amount and/or frequency, the daily computation method in A-1323.4.7, Determining Net Self-Employment Income, should be used.

A—1323.4.7 Determining Net Self-Employment Income

Revision 15-4; Effective October 1, 2015

All Programs

Annual Computation Method

The following steps are used to determine net self-employment income when using the annual comput