A—111 Pre-Application Process

Revision 15-4; Effective October 1, 2015

TANF

Before the Application process begins, staff deliver an up-front Texas Works message to the Temporary Assistance for Needy Families (TANF) applicants explaining that:

• TANF is temporary and has time limits;
• there are other alternatives and options for the applicant instead of TANF benefits;
• an applicant should consider jobs and other resources (such as child support) before pursuing TANF;
• if an applicant chooses to apply for assistance, the individual is requesting help finding a job; and
• even if an applicant chooses not to apply for TANF, the individual still may apply for Medicaid and the Supplemental Nutrition Assistance Program (SNAP) to support employment while working toward self-sufficiency.

Staff must consider and determine which messages are appropriate for a particular applicant.

A—112 Application Assistance

Revision 15-4; Effective October 1, 2015

All Programs

If an applicant needs help completing the application packet, a volunteer or staff member must help. Anyone helping the applicant complete a paper application must initial the completed sections or sign the form showing that  a volunteer or staff person helped complete the application.

A—113 Application Requests and Submissions

Revision 15-4; Effective October 1, 2015

All Programs

Applications must be given to anyone who requests the form. Each household has the right to file an application on the same day the household contacts the office during office hours. The local office must ensure that a person can obtain an application packet within 15 minutes of coming into the office.

Staff must advise the household  that an applicant does not have to be interviewed before filing the application. The household may file an incomplete application as long as the form contains the applicant's name, address, and signature as explained in A-121, Receipt of Application.

Program	Ways to Request an Application*	Ways to Submit an Application	Applications
TANF	Online through YourTexasBenefits.com; In the local office; By mail; By fax; or By phone.	Online through YourTexasBenefits.com; In the local office; By mail; or By fax.	YourTexasBenefits.com Form H1010, Texas Works Application for Assistance — Your Texas Benefits: Staff must also provide the following forms with the application: Form H1830, Application/Review/Expiration/Appointment Notice; Form H0025, HHSC Application for Voter Registration; Form H0050, Parent Profile Questionnaire, for each absent parent; Appropriate program pamphlets; and A postage-paid return envelope.
SNAP	Online through YourTexasBenefits.com; In the local office; By mail; By fax; or By phone.	Online through YourTexasBenefits.com; In the local office; By mail; or By fax.	YourTexasBenefits.com Form H1010, Texas Works Application for Assistance — Your Texas Benefits: Staff must also provide the following forms with the application: Form H1830, Application/Review/Expiration/Appointment Notice; Form H0025, HHSC Application for Voter Registration; Appropriate program pamphlets; and A postage-paid return envelope. Note: Form H1805, SNAP Food Benefits: Your Rights and Program Rules, must be included in the application packet or given to the applicant during the interview.
Medical Programs	Online through YourTexasBenefits.com; In the local office; By mail; By fax; or By phone.	Online through YourTexasBenefits.com; In the local office; By mail; By fax; or By phone.	YourTexasBenefits.com Form H1010, Texas Works Application for Assistance — Your Texas Benefits: Staff must also provide the following forms with the application: Form H1830, Application/Review/Expiration/Appointment Notice (if applicable); Form H0025, HHSC Application for Voter Registration; Appropriate program pamphlets; and A postage-paid return envelope. Form H1205, Texas Streamlined Application: Staff must also provide the following forms with the application: Form H1830, Application/Review/Expiration/Appointment Notice (if applicable); Form H0025, HHSC Application for Voter Registration; Appropriate program pamphlets; and A postage-paid return envelope.

* Staff must give the applicant an application on the same day it is requested. If a household contacts the local office by telephone and does not wish to come to the designated office to file an application on the same day of the request and prefers receiving the application by mail, staff send an application packet on the same day of the telephone request. For written requests, including those received electronically or by fax, staff mail an application packet on the same day the request is received.

The Texas Health and Human Services Commission (HHSC) must accommodate reasonable requests to receive communications by alternative means or at alternative locations. The individual must specify in writing the alternate mailing address or means of contact, and include a statement that using the home mailing address or normal means of contact could endanger the individual.

Note: Individuals applying for Medical Programs may also use the Marketplace-only applications explained in A-113.1, Application Forms. These applications can be submitted to HHSC in person, by fax, by mail, or via an account transfer explained in A-118, Coordination with the Federal Marketplace.

Related Policy

Registering to Vote, A-1521

A—113.1 Application Forms

Revision 19-4; Effective October 1, 2019

YourTexasBenefits.com

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

YourTexasBenefits.com can be used to apply for the following benefits:

• SNAP food benefits;
• TANF cash help for families;
• health care for:
  • children;
  • adults caring for a child;
  • adults not caring for a child (if this is selected, YourTexasBenefits.com will allow applicants to identify themselves as a refugee; if they are not a refugee, they will be redirected to HealthCare.gov);
  • pregnant women;
  • people age 65 or older or with a disability; and
  • people under age 26 who were in foster care in Texas and receiving federally funded Medicaid at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an Interstate Compact on the Placement of Children (ICPC) agreement at age 18 or older;
• Medicare Savings Programs; and
• long-term services and supports for:
  • people with intellectual or developmental disabilities; and
  • people with no intellectual or developmental disabilities.

Form H1010, Texas Works Application for Assistance — Your Texas Benefits

Form H1010 integrates Texas Works programs into one single application.

The addendum to Form H1010 — Form H1010-M, Applying for or Renewing Medicaid or CHIP? — captures the information needed to make an eligibility determination for Medicaid or the Children's Health Insurance Program (CHIP).

Form H1010 can be used to apply for the following benefits:

• SNAP food benefits;
• TANF cash help for families; and
• health care for:
  • children;
  • adults caring for a child;
  • adults not caring for a child;
  • pregnant women;
  • people under age 26 who were in foster care in Texas and receiving federally funded Medicaid at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an ICPC agreement at age 18 or older.

Form H1205, Texas Streamlined Application

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

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

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

Applications Solely Used by the Marketplace

The online Marketplace application is a single interactive application based on an applicant's selections. In addition, there are three paper applications for the Marketplace:

• Application for Health Coverage — for anyone who needs health coverage, but does not need help paying for health insurance costs.
  • Used by applicants who want to purchase a Qualified Health Plan (QHP) through the Marketplace.
• Application for Health Coverage & Help Paying Costs (Short Form) — for single adults who need help paying for health care coverage (mostly for states offering Medicaid expansion coverage to single adults ages 19 through 64) and who:
  • are not married, do not claim any tax dependents, and cannot be claimed as a tax dependent on someone else's federal income tax return;
  • were not formerly in the foster care system; and
  • are not American Indian (AI)/Alaska Native (AN).
• Application for Health Coverage & Help Paying Costs — for anyone who needs help paying for health care coverage, including:
  • people who are married, have tax dependents, or can be claimed as a tax dependent on someone else's federal income tax return;
  • people with or without current health care coverage;
  • families that include immigrants; and
  • people who were formerly in the foster care system.

Since these applications do not contain additional questions that were included on Form H1205, Texas Streamlined Application, send out Form H1020, Request for Information or Action, to request any additional information necessary to make an eligibility determination. 

A—114 Applications Causing Conflicts of Interest

Revision 15-4; Effective October 1, 2015

All Programs

The advisor must avoid the appearance of impropriety or conflict of interest when determining eligibility. The advisor is not allowed to work on a case if the individual is a relative (by blood or marriage), roommate, dating companion, supervisor, or someone under the advisor's supervision. The advisor may never work on a case in which the advisor is a case participant or an authorized representative (AR).

The advisor:

• may provide anyone with an application and information about how and where to apply for benefits;
• may help a person gather any documents needed to verify eligibility; but
• must not take any other role in determining eligibility.

The advisor must consult with the supervisor if the individual is a friend, acquaintance or coworker. Generally, the advisor should not work on cases involving these individuals, but the degree and nature of the relationship should be taken into account. In remote areas where it is impractical for another person to process the application, the unit supervisor should be contacted to determine the best method to process the application.

A—114.1 Applications Submitted by Texas Works or Medicaid for the Elderly and People with Disabilities Employees

Revision 18-1; Effective January 1, 2018

All Programs

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

• A Texas Works or MEPD employee at the next higher administrative position must complete the eligibility determination for another Texas Works employee.
• A designated supervisor must complete the eligibility determination for a Texas Works or MEPD supervisor or higher position.
• The employee's immediate supervisor or someone in the direct line of supervision may not process the Texas Works or MEPD employee's application.

A—115 Applications Filed in Hospitals and Clinics

Revision 19-1; Effective January 1, 2019

All Programs

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

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

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

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

A—116 Special Application Processes

Revision 12-2; Effective April 1, 2012

A—116.1 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

A—116.2 Applications from Residents of a Homeless Shelter

Revision 22-1; Effective January 1, 2022

SNAP

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

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

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

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

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

Related Policy

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

A—116.3 Applications for Babies Born to Women in Prison

Revision 15-4; Effective October 1, 2015

Medical Programs

A pregnant woman who enters the state prison system is sent to the Texas Department of Criminal Justice women's facility. Before the baby is born, the prison social worker assists the pregnant woman to arrange for a responsible individual to pick up the baby from the hospital. The pregnant woman is sent to a prison section of the University of Texas Medical Branch (UTMB) in Galveston a few weeks before she is due to deliver, unless an emergency occurs earlier. If an emergency does occur, she will deliver at a closer facility when necessary. Before releasing the baby from the hospital, UTMB requires the individual who picks up the baby to complete an application for Medicaid. Designated Texas Works advisors ensure that the baby is certified for Medicaid using special application processing procedures and follow-up activities.

The designated advisors coordinate Medicaid certification by other advisors in special situations when the newborn needs to be added to an active case. Upon request by the designated advisors, which must be documented in the case record, an advisor must certify the newborn:

• for Medicaid (TP 43) from the date of birth (DOB), not the day the caretaker brought the baby home from the hospital; or
• after normal application time frames have passed. If needed, staff may follow procedures to request a timeliness exception.

State law requires Medicaid coverage for Texas newborns for at least 28 days after birth and possibly longer if the child is hospitalized at that time. If the hospital followed required procedures before releasing the baby, but the baby does not meet eligibility requirements for Medicaid, the designated advisor and State Office Data Integrity (SODI) staff certify the baby for TA 62, MA - State-Paid Coverage. Examples of not meeting eligibility requirements are:

• the individual caring for the child does not reside in Texas, and the baby will be taken out of state;
• the individual caring for the child refuses to apply for Medicaid; or
• the household is over the income limit.

Related Policy

Documentation Requirements, A-190
Medical Programs, A-240

A—116.4 Reserved for Future Use

Revision 20-4; Effective October 1, 2020

A—116.5 Food Distribution Program on Indian Reservation (FDPIR)

Revision 11-3; Effective July 1, 2011

For application processing related to FDPIR, refer to the policy in B-421, Food Distribution on Indian Reservation (FDPIR).

A—116.6 Joint SSI-SNAP Applications

Revision 22-3; Effective July 1, 2022

For application processing related to joint Supplemental Security Income (SSI)-SNAP applications, refer to the policy in B-476, Joint Supplemental Security Income (SSI)-SNAP Applications.

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

Revision 11-3; Effective July 1, 2011

A—116.7.1 Reserved for Future Use

Revision 22-3; Effective July 1, 2022

 

A—116.7.2 Applications for SNAP-CAP

Revision 15-4; Effective October 1, 2015

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

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

Revision 15-4; Effective October 1, 2015

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

A—116.7.4 Medicaid Coverage for Children Placed in or Released from a Juvenile Facility

Revision 20-4; Effective October 1, 2020

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

A—116.7.5 Medicaid for Breast and Cervical Cancer (MBCC)

Revision 15-4; Effective October 1, 2015

For application processing related to MBCC, staff should refer to policy in B-474.1.2, Medical Programs, 4; and Other Medical Programs, Part X, Medicaid for Breast and Cervical Cancer (MBCC).

A—116.7.6 Reserved for Future Use 

A—116.7.7 Former Foster Care in Higher Education (FFCHE) (TA77)

Revision 11-3; Effective July 1, 2011

For application processing related to FFCHE, refer to policy in Other Medical Programs, Part F, Former Foster Care in Higher Education (FFCHE).

A—116.7.8 Former Foster Care Children (FFCC)

Revision 15-4; Effective October 1, 2015

For application processing related to FFCC, refer to policy in Other Medical Programs, Part E, Former Foster Care Children (FFCC).

A—117 Applications Filed Online through YourTexasBenefits.com

Revision 15-4; Effective October 1, 2015

When the household submits an application online, a process formats the information entered on the online application and imports certain data into TIERS. The process creates the PDF file of the application that is stored in the image repository and is viewable in the State Portal.

TIERS edits the data passed by YourTexasBenefits.com. The fields must contain valid characters and be valid values to be imported into TIERS. Dates must be in the correct format, fields that are numeric must contain only numbers and data must be in accepted ranges for fields with values such as Yes or No, or ZIP codes.

Applications that do not contain required data or have data that may be invalid may be rejected. When an application is rejected for electronic processing into TIERS, the system creates a non-SSP Application Registration Task List Manager (TLM) task.

Applications that are valid and accepted as electronic input into TIERS have an Application Registration TLM task created for them. The task is routed to the appropriate office based on Type of Assistance (TOA) and individual ZIP code for the clerk to perform the Application Registration process task.

A—117.1 Application Registration

Revision 15-4; Effective October 1, 2015

Clerks select the Application Registration task and review the application. Staff will perform Application Registration using certain pre-filled data from the online application that was entered by the individual. All online applications must have Application Registration processed even if the case is approved. It is important to associate the online application to the existing case.

A logical unit of work (LUW) is in Application Registration; Self-Service Application Search. Clerks search for the self-service application using any of the fields in the search area. The search results will be displayed by the head of household name even when the search was not on the head of household.

After successful Application Registration, an appointment or process task will be created for Data Collection, depending upon the programs requested on the online application.

The Application T number is changed to a case number upon clicking Submit in Application Registration.

A—117.2 Data Collection

Revision 15-4; Effective October 1, 2015

When performing Data Collection, the data entered in the online application is displayed for the advisor either as:

• pre-filled TIERS fields and a message at the top of the page stating that the fields are pre-filled from self-service data (for new applications); or
• YourTexasBenefits.com information that must be addressed, which displays in a comparison pop-up window (existing cases).

Click on the C icon in the Details page to access the comparison pop-up.

The comparison pop-up window displays the current data in TIERS and the data from the online application to allow the advisor to select the correct data to use in Data Collection.

The advisor may choose to:

• accept all TIERS data,
• accept all YourTexasBenefits.com data, or
• select each data element to be used individually from the comparison pop-up.

These comparison windows are displayed on most Data Collection pages through Resources. There is no YourTexasBenefits.com information or comparison windows in the Program, Income or Expenses pages. The advisor must complete the Data Collection driver flow.

A screen is added in the driver flow just before Run Eligibility. This screen is a summary screen that displays each LUW with YourTexasBenefits.com comparison data and the status of that data. Once the case is disposed, all YourTexasBenefits.com comparison data that was not resolved or processed will be marked completed by the system.

A—118 Coordination with the Federal Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

HHSC and the federal Marketplace coordinate eligibility determinations for Texas Works Medicaid and CHIP. Information provided by the applicant or verified for the applicant is sent through an interface between the Marketplace and HHSC. The two systems — the Marketplace and HHSC — transfer an applicant's information from one system to the other. The transfer of application information is referred to as an account transfer. An account transfer is the way in which a client's information moves between the Marketplace and HHSC.

A—118.1 Applications Received from the Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

The Marketplace sends the individual's or household's information electronically to HHSC via an account transfer when:

• the Marketplace determines the applicant is potentially eligible for Medical Programs available through HHSC; or
• the applicant requests a final eligibility determination for Texas Works Medicaid or CHIP from HHSC. This is referred to as a "full determination."

Applications sent via account transfers from the Marketplace are received by staff in the same manner as an application from YourTexasBenefits.com. 

When an application is sent to HHSC via an account transfer, a PDF is populated with information provided by the applicant on the Marketplace application, along with a "Verifications" section that provides information on any verifications performed by the Marketplace. Advisors should enter the information provided on the PDF into TIERS.

Individuals cannot be required to provide the same information more than once, regardless of whether they apply through the Marketplace or through HHSC. This applies to any information provided on an application, as well as any verification materials provided by the applicant.

Related Policy

Verifications Provided by the Marketplace, A-118.1.2

A—118.1.1 Non-MAGI Account Transfers

Revision 15-4; Effective October 1, 2015

Medical Programs

A non-Modified Adjusted Gross Income (non-MAGI) account transfer is an account transfer that is sent from the Marketplace to HHSC when the Marketplace has identified that an applicant may be eligible for Medicaid for the Elderly and People with Disabilities (MEPD) because the applicant reported being age 65 or older, having a disability, or being blind. In order for an individual to apply for MEPD programs, they must submit an MEPD application, Form H1200, Application for Assistance — Your Texas Benefits.

Advisors must deny the application as "Filed in Error" and send the applicant Form H1200 if:

• the PDF included in the account transfer indicates "Medicaid Non-MAGI Eligibility" in the Referral Activity Eligibility Reason for an individual on the application;
• a "full determination" is not requested; and
• a determination for Texas Works Medicaid or CHIP is not listed for any other applicant on the application.

A—118.1.2 Verifications Provided by the Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

For Marketplace account transfers, the PDF also includes a "Verifications" section. Advisors should use the verification section as follows:

• If the Marketplace has verified the applicant's Social Security number (SSN) or citizenship status using data from the Social Security Administration (SSA), advisors can identify that information in TIERS as "Verified by SSA."
• If the Marketplace has verified the applicant's alien status using data from the Department of Homeland Security (DHS), advisors can identify that information in TIERS as "Verified by DHS."
• All other applicant information, such as income, must be verified by an HHSC advisor according to HHSC procedures explained in C-900, Verification and Documentation. If the Marketplace has verified the information according to HHSC procedures, then that data must be treated as verified.

A—118.2 Applications Sent to the Marketplace

Revision 15-4; Effective October 1, 2015

Medical Programs

When HHSC determines that a client is ineligible for Texas Works Medicaid or CHIP (due to Texas eligibility requirements), or that the client is only eligible for TP 56, Medically Needy with Spend Down; TP 32, Medically Needy with Spend Down-Emergency; or three months prior Medicaid, HHSC transfers that individual's account information to the Marketplace to be assessed for eligibility for other health care coverage programs. Form TF0001, Notice of Case Action, informs the client that they have been transferred to the Marketplace.

A—119 Correspondence Options

Revision 15-4; Effective October 1, 2015

A—119.1 Electronic Correspondence

Revision 15-4; Effective October 1, 2015

All Programs

The head of household or authorized representative (AR) for a case may each choose at any time to receive most eligibility correspondence electronically rather than through the mail. By selecting this option, applicable forms and notices are posted to the client's or AR's YourTexasBenefits.com case account, and the client or AR receives a cell phone text message or email reminder each time a new form or notice has been posted to their account. Clients may print a copy of the correspondence from their account or request that a paper copy be mailed to them. Any forms or notices that are not available electronically will continue to be mailed to the client. 

Once a head of household or AR has opted to receive electronic correspondence through their case account on YourTexasBenefits.com or by indicating that preference to staff through 2-1-1 (Option 2), a confirmation cell phone text message or email reminder will be sent to the client. The head of household or AR must enter the code provided in that confirmation message in their YourTexasBenefits.com case account in order to confirm their choice to receive electronic correspondence. Once confirmed, Form H1013, Electronic Correspondence Confirmation Letter, will automatically be mailed to the head of household or AR to further confirm the selection and to provide instructions about how to opt out of receiving electronic correspondence.

After a failed delivery of a text or email alert, the client is automatically unsubscribed from electronic correspondence. The eligibility system then automatically prints and mails to the client a paper copy of the correspondence that failed to reach the client with the original generation date, attached to Form H1015, Electronic Correspondence Failed Delivery. The client will receive future correspondence through the mail. However, the client may opt to subscribe again to receive electronic correspondence and start over the confirmation process.

A—119.2 Preferred Language for Correspondence

Revision 15-4; Effective October 1, 2015

All Programs

The head of household or AR for a case has the ability to choose the language in which certain forms and notices are generated from the eligibility system. The head of household or AR can select their primary household language from the following options:

• English
• Spanish
• Both English and Spanish
• Vietnamese*

* Clients who select Vietnamese as their primary household language will receive correspondence in English, and the eligibility system will automatically attach to the form or notice the Vietnamese Translation Interpreter Form, which directs clients to translation services.

Once a primary household language is selected, both the head of household and AR will receive correspondence in that language.

A—121 Receipt of Application

Revision 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:

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

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 22-3; Effective July 1, 2022

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 is not date-stamped, the application is considered invalid. Return the application with a letter and a pre-paid envelope explaining that the application must be signed before the agency can establish a file date.

If the agency accepts an application without a signature and the application is date-stamped, the date the application is received is considered a valid file date. Send Form H1020, Request for Information or Action, along with the signature page, 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: Staff cannot accept telephonic signatures.

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

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

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

Action	Correspondence
Applicant or AR signs the application by phone	Form H1031, Telephonic Signatures Cover Letter, 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 The unsigned Form H1010, Texas Works Application for Assistance - Your Texas Benefits, populated with information provided over the phone. OR Form M5021C, Cover Letter for Missing Signature Letter, which notifies the person a signature is needed to complete the application process for TW medical and MEPD programs; The unsigned Form H1010, which is populated with information provided over the phone; and The unsigned Form H1200, Application for Assistance - Your Texas Benefits, 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, use the applicant’s signature to establish a file date if the application meets application receipt requirements.

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

Medical Programs

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

If the applicant returns a signed application without Form H1010-MR, 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 22-4; Effective Oct. 1, 2022

SNAP, TANF, TP 08 and TA 31

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

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

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

Exceptions:

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

Related Policy

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

A—122.3 Registering an Application

Revision 22-3; Effective July 1, 2022

All Programs

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

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

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

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

If inquiry shows …	then …
no record,	follow established local office procedures for processing applications.
an individual record,	check case and EDG status (active or denied). If the case is active, determine if the person is currently active on another case in the same program. If the person is: not currently active in the same program, register the application. entitled to dual SNAP participation as a resident of a shelter for battered persons, follow procedures in B454.1, Duplicate Participation Procedures. currently active in the same program and is not entitled to dual benefits, take appropriate action to prevent duplicate participation. Process an overpayment, if applicable. If the case is denied, associate the old case number in File Clearance after determining that this is the same household.
a SNAP-Combined Application Project (CAP) case record,	check for CBS status in TIERS inquiry. SNAP-CAP will be listed as FS-SNAP under Current EDG Affiliations in case inquiry results and under Current Eligibility in individual inquiry results. Follow established local office procedures applicable to the specific case situation.

A—123 Withdrawal of an Application

Revision 15-4; Effective October 1, 2015

All Programs

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

SNAP

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

Related Policy

The Texas Works Message, A-1527

A—124 Processing Presumptive Eligibility Applications

Revision 15-3; Effective July 1, 2015

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

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

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

Qualified entities (QEs) determine PE for pregnant women and MBCC applicants. For MBCC applicants, only QEs that are also Texas Department of State Health Services (DSHS) Breast and Cervical Cancer Services contractors may make MBCC PE determinations, following the process outlined in X100, Application Processing.

A—124.1 Eligible Groups

Revision 15-3; Effective July 1, 2015

The following groups can receive presumptive eligibility coverage:

• Children:
  • MA-Children Under 1 Presumptive — TA 74
  • MA-Children 1–5 Presumptive — TA 75
  • MA-Children 6–18 Presumptive — TA 76
• Former Foster Care Children (MA-FFCC Presumptive — TA 83)
• Pregnant Women (MA-Pregnant Women Presumptive — TP 42)
• Parents and Other Caretaker Relatives (MA-Parents and Caretaker Relatives Presumptive — TA 86)

A—124.2 File Clearance

Revision 15-3; Effective July 1, 2015

TIERS performs automated file clearance for each individual determined presumptively eligible if the individual has a 100 percent match in TIERS or if there is no match for the individual in TIERS. For individuals for whom TIERS cannot perform automated file clearance, TIERS triggers an alert to create a TLM task for staff to manually do file clearance for the individual. TIERS routes manual file clearance tasks to the Out-stationed Worker Program (OWP) queue for assignment and processing.

A—124.3 Task List Manager

Revision 15-3; Effective July 1, 2015

When TIERS cannot automatically perform file clearance for an individual whom a QH/QE has determined to be presumptively eligible, an OWP advisor needs to take action. TIERS creates the task "Process a File Clearance Failure for Presumptive Eligibility" and sends it to an OWP advisor based on the applicant's ZIP code.

To complete the task, the advisor:

1. Selects the Work icon.
2. Selects the individual who needs file clearance from the Presumptive Eligibility Individual — Summary page.
3. Matches the PE individual to the TIERS individual on the PE File Clearance — Results page.
4. Selects Auto Process PE on the File Clearance — Results page to complete the task once the advisor has performed file clearance for all individuals on the case.  

The advisor can also manually clear the task. When an advisor searches for an application on the Self Service Application Search page, the SS Application Search Results section displays a Determine PE link if a PE individual on the case requires manual file clearance. TIERS displays the Presumptive Eligibility Individual — Summary page when the advisor clicks the link.

Once the advisor completes file clearance, TIERS notifies TLM to close the QH/QE PE task.

A—124.4 Application Processing

Revision 15-3; Effective July 1, 2015

The TLM routes applications for regular Medicaid from individuals whom a QH/QE has determined to be presumptively eligible for Medicaid to an OWP advisor for processing. If the QH has an OWP advisor, the TLM assigns the application to that advisor for processing. If the QH does not have an OWP advisor or a QE submits the application, the TLM routes the application to the regional OWP queue.

Process the applications using current policy and application processing time frames. See B112, Deadlines. If both a PE task for file clearance and a regular Medicaid application exist for the same person, clear the PE task first.

A—124.5 Verifications

Revision 15-3; Effective July 1, 2015

Use standard verification requirements when processing an application for regular Medicaid from an individual determined presumptively eligible. See C900, Verification and Documentation.

Related Policy

Verifications, C1113.4

A—124.6 Medical Effective Date

Revision 15-4; Effective October 1, 2015

The medical effective date for PE is the date that the QH or QE determines the individual is presumptively eligible for Medicaid. 

Note: An individual is not eligible for PE coverage if the individual is currently certified for Medicaid, CHIP or CHIP perinatal.  

If the individual does not apply for regular Medicaid, PE coverage ends the last day of the month after the month of the PE determination (see scenario 1 below).

If the individual submits Form H1205, Texas Streamlined Application, or Form H1010, Texas Works Application for Assistance — Your Texas Benefits, HHSC determines whether the individual is eligible for regular Medicaid. If the person is not eligible for regular Medicaid, the individual's PE coverage ends the date that HHSC determines the individual is ineligible (see scenario 2 below). If the person is eligible for regular Medicaid, the person’s PE coverage ends when HHSC makes the Medicaid eligibility determination, following cutoff rules. 

If an individual is Medicaid-eligible during the application month, the individual receives Medicaid from the first of that month through the PE MED. Regular Medicaid coverage for the ongoing period starts once the PE period ends (see scenarios 3 and 4 below). Exception: Since PE for pregnant women provides only limited prenatal services, ongoing Medicaid coverage overlays the PE coverage (see scenario 5 below).

Examples:

PE Scenarios
Individual does not apply for regular Medicaid	A child is determined eligible for MA-Children 6–18 Presumptive on February 2. Her mother does not submit an application for regular Medicaid. The child’s PE coverage ends on March 31.
Individual is ineligible for regular Medicaid	A child is determined eligible for MA-Children Under 1 Presumptive on April 4. Her father submits an application for regular Medicaid on the same date. HHSC determines on April 20 that the child is not eligible for regular Medicaid. Her PE coverage ends on April 20.
Individual is eligible for regular Medicaid (HHSC makes eligibility determination before cutoff)	A child is determined eligible for MA-Children 1–5 Presumptive on March 6. His mother submits an application for regular Medicaid on the same date. HHSC determines on March 15 (before cutoff) that the child is eligible for regular Medicaid. His PE coverage ends March 31. He is certified for regular Medicaid effective March 1 to March 5 and April 1 through ongoing.
Individual is eligible for regular Medicaid (HHSC makes eligibility determination after cutoff)	A former foster care child is determined eligible for MA-FFCC Presumptive on May 9. He submits an application for regular Medicaid on the same date. HHSC determines on May 22 (after cutoff) that the individual is eligible for regular Medicaid. His PE coverage ends June 30. He is certified for regular Medicaid effective May 1 to May 8 and July 1 through ongoing.
Pregnant woman is eligible for regular Medicaid	A woman is determined eligible for MA-Pregnant Women Presumptive on June 4. She submits an application for regular Medicaid on the same date. HHSC determines on June 10 that the woman is eligible for regular Medicaid. Her PE coverage ends on June 30. Regular Medicaid overlays her PE coverage with an effective date of June 1.

A—124.7 Periods of Presumptive Eligibility

Revision 15-3; Effective July 1, 2015

Pregnant women are allowed one PE period per pregnancy.

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

A—124.8 Fair Hearings

Revision 15-3; Effective July 1, 2015

Appeals and fair hearings do not apply to PE.

A—124.9 Questions About the Presumptive Eligibility Process

Revision 20-4; Effective October 1, 2020

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

Refer a person with questions about their PE coverage dates to the QH/QE that made the PE determination. For questions about services covered by Medicaid, tell the person to call the Medicaid help line at 800-335-8957.

A—124.10 Presumptive Eligibility Forms

Revision 15-3; Effective July 1, 2015

Qualified hospital/qualified entity staff use the following forms in the presumptive eligibility process: 

• Form H1265, Presumptive Eligibility (PE) Worksheet — Completed by the QH/QE and used to determine if an applicant is presumptively eligible.    
• Form H1266, Short-term Medicaid Notice: Approved — Completed by the QH/QE and given to an individual determined presumptively eligible. This form notifies the individual about PE coverage and lists the eligibility start and end dates. If an individual takes this form to a local eligibility determination office and requests a temporary Medicaid identification card, give the person Form H1027-A, Medicaid Eligibility Verification.
• Form H1267, Short-term Medicaid Notice: Not Approved — Completed by the QH/QE and given to an individual determined ineligible for PE coverage. This form explains the reason for ineligibility and how to apply for regular Medicaid.

Related Policy

Qualified Hospital/Qualified Entity Policy and Procedures for Presumptive Eligibility Determinations, C1113

A—125 TP 45 Provider Referral Process

Revision 16-3; Effective July 1, 2016

TP 45

State Office Data Integrity (SODI) uses the Provider Referral Process when a hospital, birthing center, or Federally Qualified Health Center (FQHC) submits a referral directly to SODI for a newborn whose mother is Medicaid eligible. The provider does not submit a claim for payment to the claims administrator for the child at this time.

SODI researches eligibility files. After verifying the mother's Medicaid coverage, which can be retroactive, SODI creates a TP 45 EDG for the newborn.

Coverage for the child begins with the child's date of birth (DOB). The last month of coverage is the month the child turns age one, unless one of the following situations occurs.

• The hospital notifies SODI using Texas Department of State Health Services Form 7484, Hospital Report (Newborn Child or Children), that the child's mother relinquishes her parental rights.
  • If Form 7484 indicates a relinquishment but the new caretaker’s information is incomplete or is not provided, SODI provides newborn Medicaid coverage from the child's DOB through the end of the month the child is relinquished.
  • If Form 7484 indicates a relinquishment and the new caretaker’s name and address are provided, SODI completes two case actions. The first action is to process an open and close newborn Medicaid EDG with the birth mother as the case name. The coverage begins with the child’s DOB and continues through the end of the month the child was relinquished. The second action is to open a newborn Medicaid case/EDG with the new caretaker as the case name. The coverage begins the first of the month after the original newborn Medicaid coverage ended and continues through the month of the child’s first birthday.
• The child's mother received TP 42 Pregnant Women Presumptive coverage at the time of the child's birth and the mother's application for regular Medicaid coverage is denied. SODI certifies the child through the birth month.

The computer generates and sends the following documents for each EDG:

• A notice of the newborn's individual number to the referring provider and other providers, if identified on the provider's referral;
• Your Texas Benefits Medicaid card to the newborn's mother; and
• A notice informing the newborn's mother/caretaker:
  • that the child is eligible to receive medical coverage through the month the child turns age one, as long as the Texas residence requirement is met, and to report any changes concerning these eligibility requirements;
  • to report if information on Form H1027-A, Medicaid Eligibility Verification, is incorrect;
  • to report if the newborn's siblings receive TANF; and
  • if the mother's Medicaid end date changes because the child was not born in the anticipated month.

A—125.1 Advisor Action in Provider Referral Process

Revision 15-4; Effective October 1, 2015

TP 45

A task is created when a TP 45 EDG is established and the TIERS case contains an active SNAP or TANF EDG. The advisor must take the following actions once the advisor claims the newborn alert task.

If ...	then ...
the newborn is a mandatory member of a TANF-certified group or SNAP household,	process to add the child to the TANF or SNAP EDG as explained in B641.1, Adding Newborns to the Case.
the child is not a mandatory member of a TANF-certified group, but the child's mother or caretaker provides additional information about the child (name, SSN, etc.),	add these changes to the TP 45 EDG.
the newborn's siblings are included in the MAGI household composition for a TP 43, 44, or 48,	take no action on the siblings' EDG until additional information is requested for the siblings. At that point, request verification of tax status and relationship for the newborn. If the mother provides verification of relationship for the newborn, add the newborn to the siblings' budget groups.
the child becomes ineligible for TP 45 before the child's first birthday,	deny TP 45 for the child, using the appropriate denial code.

A—125.2 Suspended Claim Process

Revision 15-4; Effective October 1, 2015

TP 45

The Medicaid provider sends a claim for a newborn child with the child's mother's claim to the claims administrator. If the claims administrator cannot find the child on HHSC's eligibility files, the claims administrator suspends the child's claim and sends an exception notice to State Office Data Integrity (SODI). SODI checks the child's mother's Medicaid eligibility. If the mother received Medicaid at the time of the child's birth, including a retroactive determination, SODI follows procedures in the Provider Referral Process to provide Medicaid coverage for the child.

A—125.3 Mandated TIERS Inquiry

Revision 15-4; Effective October 1, 2015

TP 45

Field staff must perform TIERS inquiry before providing coverage for a newborn when there is no evidence of SODI TP 45. Staff should inquire by the newborn's mother's individual number and look for a process date that is after the child's DOB.

A—126 Processing Children’s Insurance Applications

Revision 15-4; Effective October 1, 2015

See A-113, Application Requests and Submissions, for how to apply for Medical programs for children.  

A—126.1 Front Desk Process

Revision 15-4; Effective October 1, 2015

CHIP and TP 43, TP 44 and TP 48

When individuals come to a local eligibility office to inquire about health insurance for their child(ren), the front desk clerk must:

• explain the ways to submit an application as outlined in A-113, Application Requests and Submissions; and
• explain that the Medicaid application process provides that if a child is found ineligible for Medicaid based on income, HHSC will test the child for CHIP and, if eligible, the Enrollment Broker will send an enrollment packet to the household.

A—126.2 Inquiry

Revision 15-4; Effective October 1, 2015

CHIP and TP 43, TP 44 and TP 48

Before certifying a child for any type of Medicaid program, advisors must perform an inquiry to determine whether the child applying for Medicaid is already enrolled or pending enrollment in Medicaid, CHIP, or CHIP perinatal.

A—126.3 Advisor Action for Determining Eligibility for Children

Revision 16-2; Effective April 1, 2016

CHIP and TP 43, TP 44 and TP 48

When taking action on an application, the following procedures must be applied:

If ...	then ...
The child applying is not active in CHIP or pending CHIP enrollment,	test for Medicaid eligibility. Follow the policy for assigning the MED*.
The child applying is active in CHIP and the CHIP end date is the application month or the following month,	test for Medicaid eligibility. If eligible, and it is: before cutoff, begin Medicaid coverage the first day of the next month. after cutoff, begin Medicaid coverage the first day of the month following the next month.
The child applying is active in CHIP and the CHIP end date is later than the month following the application month,	test for Medicaid eligibility. If eligible, and processing is: before cutoff, begin Medicaid coverage the first day of the next month. after cutoff, begin Medicaid coverage the first day of the month following the next month.
The child applying is pending CHIP enrollment with a start date the first day of the next month,	test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. If eligible, and it is: before cutoff, follow the policy for assigning the MED. after cutoff, begin Medicaid coverage the first day of the month following the next month. Provide open/close coverage for the application month and/or prior months, if applicable.
The child applying is pending CHIP enrollment with a start date later than the first day of the next month,	test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. Follow the policy for assigning the MED.
The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the application month,	test for Medicaid eligibility. If eligible, begin Medicaid coverage the first day of the month following the CHIP end date.
The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the month following the application month or later,	test for Medicaid eligibility. If eligible, and it is: before cutoff, begin Medicaid coverage the first day of the next month. after cutoff, begin Medicaid coverage the first day of the month following the next month.
One child in the family applying is active in CHIP and another is not,	test for Medicaid eligibility. If eligible, follow the applicable guidelines given in the preceding scenarios, for each child.
* See A-820, Regular Medicaid Coverage, to apply the MED.

After determining a child is ineligible for Medicaid, TIERS will test eligibility for CHIP.

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

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

A—126.3.1 Neonatal Intensive Care Unit (NICU) Newborn Process

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 36, TP 43 and TP 45

Income Above the Limit for Medicaid for Pregnant Women (TP 40)

When a CHIP perinatal mother whose household income is above the income limit for TP 40 applies for Medicaid for her newborn and HHSC hospital-based staff have information from the applicant or the hospital that the newborn is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the newborn using the following process:

• Upon receipt of an application for a Medicaid NICU newborn, HHSC hospital-based staff must perform inquiry to determine if the mother is on CHIP perinatal or whether the newborn has been assigned a TIERS individual identification (ID) number and is active on Medicaid.
• If the newborn is not active on Medicaid, staff must deny the CHIP perinatal and certify the eligible newborn for TP 43, if eligible, following existing policy.
• If not eligible, test the newborn for TP 56 and do not deny the newborn’s CHIP perinatal coverage.
• If eligible, the newborn may receive TP 56 and CHIP perinatal coverage.

Income at or Below the Limit for Medicaid for Pregnant Women (TP 40)

When HHSC hospital-based staff have information from the applicant or the hospital that a newborn born to a CHIP perinatal mother whose household income is at or below the income limit for TP 40 is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the eligible mother for Emergency Medicaid and the newborn for TP 45, effective on the newborn's date of birth. The CHIP perinatal mother must submit Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification, to the hospital. HHSC hospital-based staff must process Form H3038-P.

Upon receipt of Form H3038-P, HHSC hospital-based staff must:

• perform inquiry on the Newborn Perinatal Match Interface (Interfaces – TIERS Left Navigation) to verify the CHIP perinatal household's FPIL;
• use the date Form H3038-P is provided as the file date for both the Emergency Medicaid and Medicaid for the newborn child;
• certify the CHIP perinatal mother for Emergency Medicaid and deny the CHIP perinatal Eligibility Determination Group (EDG); and
• certify the eligible newborn for TP 45, effective on the newborn's date of birth.

Related Policy

Adding a New Child, D1433.1

A—126.4 CHIP Good Cause

Revision 15-4; Effective October 1, 2015

CHIP good cause is explained in D1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

A—126.4.1 Claiming Good Cause

Revision 15-4; Effective October 1, 2015

CHIP good cause is explained in D1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

A—127 Prior Medicaid Coverage

Revision 15-4; Effective October 1, 2015

Children's Medicaid and TP 33, TP 34 and TP 35

Staff use any valid application or renewal form to determine three months prior coverage for Children's Medicaid. Do not require Form H1113, Application for Prior Medicaid Coverage, if the family provides enough information to determine eligibility for prior months. If the family does not provide enough information and cannot be reached by telephone, staff sends Form H1113 with Form H1020, Request for Information or Action, to request verification. Note: Three months prior coverage does not apply to CHIP. See D1723.5, Coverage Start Dates, to determine when CHIP coverage begins.

Staff must not delay certification of ongoing eligibility to determine if any child is eligible for prior coverage.

Related Policy

Medicaid Coverage for the Months Prior to the Month of Application, A-830

A—128 Processing Applications for Pregnant Women

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 40 and TP 36

A pregnant woman may apply for health care coverage using applications and ways to submit an application explained in A- 113, Application Requests and Submissions.

When a pregnant woman applies for health care coverage, she will first be tested for TP 40 coverage. If ineligible for TP 40, TIERS will determine whether the woman is eligible for CHIP or CHIP perinatal.

CHIP perinatal coverage provides services to unborn children of pregnant women, regardless of age, who are at or below the program income limit and are ineligible for:

• Medicaid because of immigration status or income; or
• CHIP because of age or immigration status.

CHIP perinatal households are exempt from the:

• 90-day waiting period;
• cost-sharing (enrollment fees and co-payments); and
• six-month income check.

A—128.1 Inquiry for Pregnant Women

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 40 and TP 36

Before certifying a pregnant woman for any type of health care coverage, advisors must perform inquiry to determine whether the pregnant woman is already certified for Medicaid or enrolled or pending enrollment in CHIP or CHIP perinatal.

Searching by the woman's last name and date of birth may increase the possibility for a match.

A—128.2 Staff Action for Determining Eligibility for Pregnant Women

Revision 21-2; Effective April 1, 2021

TA 85 (CHIP-P), TP 40 and TP 36

When taking action on an application, apply the following procedures.

If ...	then ...
the woman is active in CHIP perinatal and the application indicates she is due in the application month,	test for Medicaid eligibility.* If eligible, and she is: not a U.S. citizen or alien with acceptable status, certify the woman for Emergency Medicaid coverage for the birth and certify the newborn for TP 45 Medicaid coverage.
the woman is active in CHIP perinatal and the application indicates she is due in the month following the application month or later,	test for Medicaid eligibility.* If eligible, and it is: before cutoff, begin Medicaid coverage the first day of the next month. after cutoff, begin Medicaid coverage the first day of the month following the next month.

* When a woman enrolled in CHIP perinatal submits a new application, they must be tested for Medicaid coverage. When processing a change for a woman certified for CHIP perinatal, TIERS will automatically test for Medicaid eligibility. A new application is not required.

A—128.3 CHIP Perinatal Application Process

Revision 21-2; Effective April 1, 2021

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

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

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

Thirty days before the expected due date, TIERS generates and sends Form H3038-P with Form H1061, Birth Outcome Letter, to the household. If the household has not reported the child’s birth by 30 days after the expected due date, TIERS sends a Form H1062 , Birth Outcome Reminder Letter, and a second Form H3038-P with instructions for getting Form H3038-P completed and signed by the medical practitioner, along with a self-addressed postage-paid envelope. The household must return Form H3038-P to HHSC.

Upon receipt of Form H3038-P:

• the form is linked to the mother's case; and
• a task is created for Customer Care Center (CCC) staff to certify the mother for Emergency Medicaid and the newborn for TP 45.

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

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

CCC Staff Process

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

• determine whether mother and newborn are already active on Medicaid;
• if mother and newborn are not active on Medicaid, use all TP 40 eligibility policies and procedures to determine Emergency Medicaid eligibility, except when verifying income and citizenship/alien status;
• use the verified income provided to determine CHIP perinatal eligibility to determine Emergency Medicaid eligibility. Note: TIERS will not run financial rules when certifying a recipient for Emergency Medicaid and will instead use the verified income used to determine the woman’s CHIP Perinatal eligibility; 
• verify all non-financial eligibility points prior to certification using: 
  • identity verification sources; and
  • residence verification sources;
• use the date Form H3038-P is received as the file date for the Emergency Medicaid and TP 45; and
• process Form H3038-P by the 45th date after the file date.

The file date for the TP 45 is usually the date Form H3038-P is received if it includes the newborn's information. Birth outcome information can also be received via the newborn interface or from the person by phone or in writing. When birth outcome information is received after Form H3038-P has already been submitted to the HHSC, a second task is assigned to CCC to process TP 45 coverage for the newborn.

When CCC staff receive a task that includes Form H3038-P dated more than 60 days after the pregnancy due date, CCC must stamp "Received (Date) CCC" on Form H3038-P, to indicate the form was provided after the 60 days from the pregnancy due date. CCC staff must return Form H3038-P along with an application and a letter informing the person that they must apply for Medicaid. The person is instructed to complete the application and return it to the nearest HHSC office or appropriate out-stationed worker, if an out-stationed worker is housed at the hospital where the delivery took place.

Out-Stationed and HHSC Eligibility Office Staff Process

The chart below explains procedures staff must follow to determine appropriate action.

If an applicant…	then staff must:
provides Form H3038-P only, and was active on CHIP perinatal at the time of the delivery,	fax Form H3038-P to 877-447-2839.
provides an application requesting Medicaid only, provides Form H3038-P, and was active on CHIP perinatal at the time of delivery,	follow policy for receipt of duplicate or identical application and fax Form H3038-P to 877-447-2839.
provides an application requesting Medicaid and other benefits (SNAP, Medicaid, TANF), provides Form H3038-P, and was active on CHIP perinatal at the time of delivery,	certify the TP 36 coverage when determining eligibility for the other requested programs (including TP 45) following existing policy, if eligible; or fax only Form H3038-P to 877-447-2839 if the mother is ineligible for Emergency Medicaid based on the current information.
provides an application and Form H3038-P stamped with “Received (Date) CCC,”	process the request for Medicaid following normal application procedures.
was not active on CHIP perinatal at the time of delivery,	process the Emergency Medicaid request per existing policy and certify TP 45 if appropriate.

Notes:

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

Related Policy

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

A—129 Data Broker Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Staff must request Data Broker reports as required in C-820, Data Broker.

Related Policy

Permissible Purpose, C-824

A—131 Interviews

Revision 22-3; Effective July 1, 2022

TANF, SNAP, TP 08 and TA 31

Conducting Interviews for Applications and Redeterminations

Conduct the interview with the applicant or the applicant's spouse (if the spouse is a member of the household) to determine eligibility.

Exceptions:

• A household may designate an authorized representative (AR), who must also sign the application.
• For SNAP, another responsible household member may also be interviewed.
• For TSAP redeterminations, no interview is required unless the household requests an interview, the case contains earned income, or it appears the household is going to be denied.

Note: The spouse (or other responsible household member for a SNAP interview) does not have to sign the application to be interviewed. Staff must not exempt the household from any program or verification requirements due to interviewing an AR or conducting a phone interview.

Related Policy

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

A—131.1 Home Visits

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must provide notice to the household before making any home visit. Application and redetermination interviews must be scheduled in writing. Notification of other home visits may be:

• verbal,
• given or mailed to the individual, or
• by telephone contact with a responsible household member.

The notification should include the time (at least whether morning or afternoon) and date of the visit. Advisors should route the notification for imaging to add to the electronic case record or document the specific information in TIERS Case Comments. If regions have specialized staff that conduct home visits, the documentation may be maintained in a separate location as long as it is accessible if needed.

Home visits to collateral sources do not have to be scheduled in advance.

No one should be denied for refusing to agree to a home visit unless there is no other sufficient and reliable verification available.

Related Policy

Advisor Responsibility for Verifying Information, C932

A—131.2 Requirement to Provide Interpreter or Translation Service

Revision 15-4; Effective October 1, 2015

All Programs

HHSC is required to provide interpreter and translation (written or verbal) services to applicants and recipients with Limited English Proficiency (LEP). Consider an individual with LEP even if they do not request an interpreter on the application if the individual indicates they would like to speak a language other than English during the interview. HHSC is also required to provide an effective method to communicate with applicants and recipients who indicate they are deaf or hearing impaired. Applicants and recipients may indicate on an application or during an interview that they need interpreter services.

A—131.2.1 Availability of Interpreters and Translation Services

Revision 23-1; Effective Jan. 1, 2023

All Programs

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

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

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

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

• Language Line Services – This service is available to all regions. Staff can access the service by calling 888-985-2683 and using their 11-digit employee identification number.
• Applicants or recipients may provide their own interpreter if they wish to do so. Note: A minor, 15 or older, can be an interpreter at the person's request and when the minor accompanies the person to the interview. Do not use a minor under 15 as an interpreter.

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

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

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

A—131.2.2 Availability of Translated Written Material

Revision 15-4; Effective October 1, 2015

All Programs

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

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

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

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

A—131.3 Interview Requirements

Revision 15-4; Effective October 1, 2015

All Programs

During the interview, the interviewer must:

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

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

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

TANF

• Determine whether any adult household member has received TANF cash assistance from another state since October 1999. Refer to A-1920, Determining the Number of FTL Months Used.
• Determine whether any member of the household has been disqualified in another state for a felony or drug conviction.
• Determine whether any member of the household has been disqualified from participating in TANF for an intentional program violation (IPV) in another state. See B942, Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification, for policy regarding the IPV information the advisor must gather from the other state.
• Determine whether applicants must provide information on parent(s) living outside of the home to meet child and medical support requirements, or if applicants meet a good cause exemption, as explained in A-1130, Explanation of Good Cause.

SNAP

• Determine whether households qualifying for the standard medical expense want to claim actual expenses according to the policy in A-1428.3, Budgeting Options;
• Determine whether the household wants to prorate an expense or income according to policy in A-1428.3; A-1355.1, Budgeting Options for SNAP Households; and A-1358, How to Budget Expenses;
• Determine whether any household member claims an exemption to Employment and Training (E&T) work requirements;
• Provide reminders, including the household's change reporting requirement, regarding E&T requirements, able-bodied adult without dependents (ABAWD) time limit policy (if there is an ABAWD in the household), and how the household can obtain and use SNAP benefits issued via EBT;
• Determine whether an ABAWD received any countable months of benefits in another state; and
• Determine whether any member of the household has been disqualified from participating in SNAP for an IPV or a felony drug conviction in another state. Note: Data Broker displays current out-of-state IPV disqualification data.

Medical Programs

Determine whether applicants experiencing family violence are exempt from providing information about a member of their MAGI household composition because they fear physical or emotional harm by that person, as explained in A-241.4, Family Violence Exemption.

TP 08

Determine whether applicants must provide information on parent(s) living outside of the home to meet medical support requirements, or if applicants meet a good cause exemption, as explained in A-1130, Explanation of Good Cause.

A—132 Eligibility Factors

Revision 15-4; Effective October 1, 2015

All Programs

	TANF	SNAP	Medical Programs
Household Composition	X	X	All Medical Programs*
Citizenship	X	X	All Medical Programs*
Social Security number	X	X	TPs 08, 40, 43, 44, 48, 56
Age	X	-	TP 08, TA 31, TPs 32, 33, 34, 35, 43, 44, 45, 48, 56
Relationship	X	-	TP 08, TA 31, TPs 32, 33, 34, 35, 43, 44, 45, 48, 56
Identity	X	X	All Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36*
Residence	X	X	All Medical Programs*
Third-Party Resources	X	-	All Medical Programs*
Domicile	X	-	TP 08, TA 31
Deprivation	X	-
Resources	X	X	TP 56 (children) or TP 32 (children)
Income/Deductions/Budgeting	X	X	All Medical Programs*
School attendance	X	-	TP 08
Work registration	X	X
Management	X	X	TP 08, TA 31
Responsibility Agreement	X	-

* TP 08, TA 31, TPs 32, 33, 34, 35, 36, 40, 43, 44, 45, 48 and 56.

Note: For medical programs, the eligibility factors noted above do not necessarily apply in all cases.

A—132.1 Medical Programs Hierarchy

Revision 19-4; Effective October 1, 2019

Medical Programs

Texas Works Medical Programs Hierarchy

Step	Eligible Persons	With Income	Type Program Code	Type	Program
1	People ages 18 through 25 who have aged out of foster care in Texas and were enrolled in Medicaid on their 18th birthday	Not Applicable	TP 82	MA	Former Foster Care Children (FFCC)
2	People ages 18 through 20 who have aged out of foster care and: are not eligible for FFCC (were not receiving federally funded Medicaid when they aged out of foster care); or who aged out of foster care at age 18 or older, currently reside in Texas, and have had an Interstate Compact on the Placement of Children (ICPC) agreement	At or below program FPL	TP 70	MA	Medicaid for Transitioning Foster Care Youth (MTFCY)
3	Pregnant Women	At or below program FPL	TP 40	MA	Pregnant Women
4	Pregnant women who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible	At or below TP 40 FPL	TP 36	MA	Pregnant Women - Emergency
5	Newborn children of Medicaid-eligible mothers up to age 1, including mothers receiving TP 36 for the delivery	Not Applicable	TP 45	MA	Newborn Children (Deemed)
6	Children under age 1	At or below program FPL	TP 43	MA	Children Under Age One
7	Children ages 1 through 5	At or below program FPL	TP 48	MA	Children 1–5
8	Children ages 6 through 18	At or below program FPL	TP 44	MA	Children 6–18
9	Children ages 1 through 5 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible	At or below TP 48 FPL	TP 33	MA	Children 1–5 - Emergency
10	Children ages 6 through 18 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible	At or below TP 44 FPL	TP 34	MA	Children 6–18 - Emergency
11	Children under age 1 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible	At or below TP 43 FPL	TP 35	MA	Children Under Age One - Emergency
12	A parent or caretaker relative caring for a dependent child under age 18 or who meets school attendance requirements who receives Medicaid	At or below program FPL	TP 08	MA	Parents and Caretaker Relatives Medicaid
13	Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a parent or caretaker relative of a Medicaid-eligible child	At or below TP 08 FPL	TA 31	MA	Parents and Caretaker Relatives - Emergency
14	Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in earnings	Above the limits for TP 08	TP 07	MA	Earnings Transitional
15	Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in spousal support income	Above the limits for TP 08	TP 20	MA	Child Support Transitional
16	Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer and presumed eligible for Medicaid for Breast and Cervical Cancer (MBCC)	Not Applicable	TA 66	MA	MBCC Presumptive
17	Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer	Not Applicable	TA 67	MA	MBCC
18	Children under age 19 and pregnant women	Above the limits for TPs 40, 43, 44, and 48 FPL	TP 56	MA	Medically Needy with Spend Down
19	Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a pregnant woman or child under age 19	Above the limits for TPs 40, 44, or 48 FPL and at or below program limit	TP 32	MA	Medically Needy with Spend Down - Emergency
20	Children under age 19 ineligible for Medicaid due to income	Above the limits for TPs 43, 48, or 44 FPL, and at or below program limit	TA 84	CI	CHIP
21	Unborn children whose mother is ineligible for Medicaid or CHIP due to income or immigration status	Above the limits for TPs 40 and 36, and at or below program limit	TA 85	CI	CHIP - Perinatal
22	Former foster care youth ages 21 through 22 attending school of higher education who: are not eligible for FFCC; or who aged out of foster care at age 18 or older, currently reside in Texas, and have had an ICPC agreement.	At or below program FPL	TA 77	Health Care Benefits	Health Care - FFCHE
23	Children under age 1 presumed to be eligible for Medicaid as determined by a Qualified Hospital (QH)	At or below TP 43 FPL	TA 74	MA	Children Under Age One - Presumptive
24	Children ages 1 through 5 presumed to be eligible for Medicaid as determined by a QH	At or below TP 44 FPL	TA 75	MA	Children 1–5 - Presumptive
25	Children ages 6 through 18 presumed to be eligible for Medicaid as determined by a QH	At or below TP 48 FPL	TA 76	MA	Children 6–18 - Presumptive
26	Parents and caretaker relatives presumed to be eligible for TP 08 by a QH	At or below TP 08 FPL	TA 86	MA	Parents and Caretaker Relatives - Presumptive
27	Former Foster Care Children presumed to be eligible for Medicaid by a QH	Not Applicable	TA 83	MA	FFCC - Presumptive
28	Healthy Texas Women	At or below program   FPL	TA 41	MA	Healthy Texas Women
29	Pregnant women presumed to be eligible for TP 40 by a QH or Qualified Entity (QE)	At or below TP 40 FPL	TP 42		Pregnant Women - Presumptive

Notes:

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

Related Policy

Income Limits, C-131 
Qualified Hospital/Qualified Entity Procedures for Presumptive Eligibility Determinations, C-1113 
Guidelines for Providing Retroactive Coverage for Children and Medical Programs, C-1114 
Type Programs (TP) and Type Assistance (TA), C-1150 
Former Foster Care in Higher Education (FFCHE), Part F 
Medicaid for Transitioning Foster Care Youth (MTFCY), Part M 
Medicaid for Breast and Cervical Cancer (MBCC), Part X 
Healthy Texas Women, Part W

A—132.2 Guidelines for Pregnant Women

Revision 15-4; Effective October 1, 2015

See A-240, Medical Programs.

A—133 Rights and Responsibilities

Revision 15-4; Effective October 1, 2015

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

Before completing the interview, advisors must ensure that the applicant:

• provides all of the information requested on the application;
• reports any changes that occurred since filling the application; and
• reads and understands the individual's rights and responsibilities as explained on the application.

TANF and TP 08

Advisors must also ensure that:

• the applicant reads and understands the rights and responsibilities of the child support program explained on Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause;
• TANF applicants read and understand Form H2580, TANF Employment Services Notice, and receive a copy of the form; and
• TANF applicants read, understand and sign Form H1073, Personal Responsibility Agreement.

SNAP

Advisors must provide the applicant with Form H1805, SNAP Food Benefits: Your Rights and Program Rules.

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

Before completing the interview, if requested, ensure the applicant:

• completes all sections of the application; and
• reads and understands an individual's and responsibilities as explained on Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and Form H1205, Texas Streamlined Application.

A—134 Documentation Guidelines

Revision 13-2; Effective April 1, 2013

A complete list of documentation requirements for determining eligibility can be found at the conclusion of each eligibility section within the Texas Works Handbook. TIERS Data Collection pages handle a vast majority of the required documentation for case records. For the remaining small percentage of documentation still required by policy, staff must include the information in TIERS Case Comments. For documentation that is not captured within the Data Collection pages, a comprehensive guide, The Texas Works Documentation Guide, has been developed. This documentation guide outlines the requirements for documentation that must be entered in TIERS Case Comments.

A—135 Pending Information

Revision 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.

Revision 22-4; Effective Oct. 1, 2022

SNAP

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

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

• postpone all verification until after receiving the first month's benefit, except: 
  • identity; and
  • proof they meet or are currently exempt from the SNAP ABAWD work requirement if they have already received the maximum number of benefit months without meeting the work requirement; and
• get benefits the same day they apply, if possible, but no later than the next business day.

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

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

Late Determinations

Additionally, applicants may not get benefits within this time frame in late determinations for expedited service. These are households that:

• the agency did not identify as entitled to expedited service when the household filed the application. Expedited processing begins on the day the office becomes aware the applicant is entitled to this service. Do not enter a late determination date if the agency failed to properly screen the application using the expedited screening questions on Form H1010;
• meet expedited criteria and have a household member who served the minimum employment and training penalty, but the household has chosen to delay their certification until all disqualified members have signed Form H1808, SNAP Work Rules;
• require an interview, but HHSC must mail the application back to the household for signature. The late determination date is the date the applicant returns the signed application;
• mail or drop off Form H1010 or Form H1010-R, Your Texas Works Benefits: Renewal Form. Contact the applicant to conduct an interview. If the applicant cannot be contacted by phone, mail Form H1830-FA, Application/Review/Expiration/Appointment Notice, the same day the application is screened. Staff must complete the interview and provide benefits to an eligible applicant by the seventh calendar day from the file date. If the household also applies for TANF or a Medicaid program that requires an interview, schedule a regular TANF or Medicaid appointment on the same notice;
• miss their expedited appointment. If the applicant later contacts the office to complete an interview, expedited processing begins the day the applicant contacts the office for an interview;
• do not provide acceptable proof of identity, or proof of meeting or being exempt from the SNAP ABAWD work requirement, as explained in the beginning of this section. Expedited processing begins when the applicant provides the required proof;
• are not eligible for expedited processing when screened for expedited services at the time of application but meet expedited criteria later in the application month because of a change in household circumstances after the application was submitted. The late determination date is the date the eligibility for expedited processing is met; or
• submitted an application through YourTexasBenefits.com when the office was closed due to weather-related conditions, flooding or other similar situations. The late determination date is the first business day the office reopens following the office closure.

Notes:

• Enter the late determination date in TIERS for late determinations caused by the applicant, resulting from a change in the household's circumstances or due to office closures, as explained above.
• Except for delays in screening due to office closure, enter the late determination date only if HHSC, the vendor or YourTexasBenefits.com screened the application on the file date or no later than the next business day.
• The late determination date becomes day zero in determining timeliness on expedited applications.

TP 40

Expedite applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy. These applicants are entitled to:

• have their eligibility determined no later than 15 business days from the date HHSC receives the application; and
• postpone all verification, except identity, until the 30th calendar day from the application file date. Note: Postponing verification only applies to current and ongoing coverage. For prior coverage, take action 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 Drug and Alcohol Treatment (D&A) Facilities, B-441  
Residents of Group Living Arrangement (GLA) Facilities, B-442

A—141 Expedited Eligibility Criteria

Revision 15-4; Effective October 1, 2015

SNAP

Applicants are entitled to expedited service if they meet one of the following criteria:

• The household's:
  • liquid resources total $100 or less, and
  • countable gross monthly non-converted income totals less than $150. Note: When determining eligibility for expedited services, staff must count the actual amount of TANF the individual actually receives.
• The household's liquid resources plus actual, non-converted countable gross monthly income total less than the most recent monthly expenses for rent/mortgage and utilities. Staff should include the standard telephone allowance for households with a telephone expense.
• The household includes a migrant or seasonal farmworker and meets the destitute criteria listed in A-146, Expedited Policy for Migrant or Seasonal Farmworkers.

An individual who reapplies within the last month of a current certification period is not eligible for expedited service.

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy are eligible for expedited processing.

A—142 Limit on Expedited Certification

Revision 22-2; Effective April 1, 2022

SNAP

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

• completes the verification requirements postponed at the last expedited certification; or
• was certified under the usual 30-day processing standards since the last expedited certification.

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

Notes:

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

Related Policy

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

A—143 How to Determine Eligibility for Expedited Service

Revision 14-1; Effective January 1, 2014

SNAP

		Yes	No
1.	Does the applicant's Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and statement indicate eligibility for expedited service based on eligibility criteria in A-141, Expedited Eligibility Criteria?	Go to step 2.	Stop, use normal 30-day processing procedures.
2.	Did the applicant already receive SNAP this month?	Stop, use normal 30-day processing procedures.	Go to step 3.
3.	Did the applicant receive expedited service before?	Go to step 4.	Go to step 5.
4.	Did the applicant provide all postponed verifications from previous certification, or did HHSC certify the applicant under normal 30-day processing since the last expedited certification?	Go to step 5.	Stop, use normal 30-day processing procedures.
5.	Was the SNAP EDG denied at redetermination for a missed appointment or for failure to provide requested information, and is it still within 30 days of the last benefit month?	Stop, this application is a duplicate application. Follow reuse of application policy.	Go to step 6.
6.	Does the applicant or AR being interviewed have proof of identity?	Go to step 7.	Not eligible for expedited service until he provides proof.
7.	If an applicant age 18 to 50 has already received the maximum number of benefit months without meeting the work requirement, did the applicant verify that the applicant is exempt from or meets the 20-hour-per-week work requirement (even if the AR applies)?	Go to step 8.	Not eligible for expedited service until he provides proof.
8.	Issue benefits today. Postpone all other verification that is: not provided at the interview, or not acceptable.

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to pregnancy are eligible for expedited processing.

Related Policy

Receipt of Duplicate Application, A-121.2  
Reuse of an Application Form After Denial, B111  
Delays Caused by Households, B122.3  
Denied for Missed Appointments, B122.3.1  
Denied for Failure to Provide Information/Verification, B122.3.2

A—144 Expedited Verifications

Revision 15-4; Effective October 1, 2015

SNAP and TP 40

See A-140, Expedited Service.

A—144.1 Social Security Numbers (SSNs)

Revision 20-2; Effective April 1, 2020

SNAP

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

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

TP 40

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

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

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

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

Related Policy

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

A—144.2 Work Registration

Revision 15-4; Effective October 1, 2015

SNAP

Advisors should register the applicant being interviewed for work unless:

• the applicant is exempt from work registration, or
• an AR is applying for the household.

Advisors should register other household members if possible. Advisors should postpone registration for the initial month if it cannot be completed within the expedited time frames.

A—144.3 Citizenship

Revision 16-2; Effective April 1, 2016

SNAP

Household members whose citizenship/eligible alien status is questionable can receive expedited benefits with the household. These household members must provide verification of citizenship/eligible alien status before the next month's benefits are issued or be disqualified.

TP 40

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

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

Related Policy

Reasonable Opportunity, A-351.1

A—144.4 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

A—144.5 Pregnancy

Revision 18-1; Effective January 1, 2018

TP 40

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

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

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

If questionable, advisors must verify pregnancy by using:

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

The verification must be from an acceptable source such as:

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

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

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

• If the only item missing on the application form is the pregnancy start month, staff must count nine months back from the pregnancy end month to determine the pregnancy start month. The pregnancy end month is month zero.
• If the only item missing on the application form is the pregnancy end month, staff must count nine months from the pregnancy start month to determine the anticipated date of delivery. The pregnancy start month is month zero.
• If both the pregnancy start and end months are missing, attempt to obtain the information by phone. If unable to obtain the information by phone, send Form H1020, Request for Information or Action, to request the information.

Related Policy

Verification Requirements, A-870

A—145 Expedited Certification Procedures

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must assign usual certification periods even if staff postpones verifications. See A-2324, Length of Certification, for certification period policy.

Advisors must issue the second month's benefits as a combined allotment as explained in A-150, Combined Allotment Policy, if the household applies after the 15th of the month and benefits are prorated.

TP 40

If an applicant provides the minimum information required to process the application, the advisor may certify the application before the 15th workday and allow postponed verification.

Advisors must deny the application no later than 15 workdays if:

• the information provided indicates the applicant is not eligible, or
• not enough information was provided to determine eligibility.

Advisors must reopen applications denied because there was not enough information provided if the information is received within 60 days of the file date.

Advisors must use the date the information is provided as the new file date, and follow the expedited processing guidelines.

Note: An interview is not required when processing a TP 40 application.

A—145.1 Postponed Verification Procedures

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must provide Form TF0001, Notice of Case Action, stating:

• what information is needed;
• the date it is needed; and
• that the individual must provide the information before the issuance of benefits for the:
  • second month; or
  • third month, if the applicant received a combined allotment.

TIERS identifies and holds benefits for the second month for households not issued a combined allotment or the third month for combined allotment households. See A-150, Combined Allotment Policy.

A-145.1 Postponed Verification Procedures Table

If the household furnishes the postponed verification and the ...	then ...
second month is on hold,	enter the information and dispose the SNAP EDG within five days or by the first workday of the second month, whichever is later.
third month is on hold (for combined allotment situations),	enter the information and dispose the SNAP EDG.

If the household provides postponed verification that results in lowered or denied benefits, see B116.1, Information Received During Expedited Application Processing.

If the household does not provide postponed verifications within 30 days of the application date, advisors must:

• disqualify the individual when appropriate, or
• deny the SNAP EDG for failing to provide postponed information and send the individual adequate notice using Form TF0001.

A household denied for failure to provide postponed verification must submit a new application to receive benefits if the household does not provide the postponed verification by the 60th day from the file date. If the household provides the verification by the 60th day, advisors must reopen the application using the date the household provided the verification as the new file date.

An individual receiving adequate notice of adverse action as noted above cannot receive continued benefits pending appeal.

TP 40

Advisors must provide Form TF0001, stating the:

• eligibility start and end date,
• postponed verifications, and
• date the verifications are due.

If the individual does not provide verification by the 30th day following the file date, the advisor must initiate adverse action. Advance notice is required. The individual must reapply if the verification is not provided by the expiration of the adverse action.

If the individual provides verification by the 30th day following the file date but does not meet eligibility requirements, the advisor must provide advance notice of adverse action and deny ongoing coverage.

Note: Advisors must not deny the EDG if the individual is eligible in the application month or one of the three prior months.

A—146 Expedited Policy for Migrant or Seasonal Farmworkers

Revision 15-4; Effective October 1, 2015

SNAP

The expedited processing procedures apply to migrant or seasonal farmworkers except for the following:

• If verifying something other than identity and the source of verification is out of state, the advisor postpones verification until after the household receives the second month's benefit. Advisors should use this procedure for only one two-month postponement during one round-trip from home.
• Households with a migrant or seasonal farmworker are destitute if they have $100 or less countable liquid resources and meet any of the following:

  • The household's only income for the application month is from a terminated source, and the household will not receive any more payments from that source after the application date.  
    
    Advisors should consider terminated income if it is usually received:

    • monthly or more often but will not be received from that source the following month, or
    • at intervals of more than one month but will not be received from that source in the next usual payment period.

    
    Advisors should not consider terminated income in the following situations:

    • Someone changes jobs while working for the same employer;
    • A self-employed person changes contracts or has different customers without having a break in normal income cycle; or
    • Someone receives regular contributions, but the contributions are from different sources.
  • Note: When determining destitute status, advisors do not consider terminated income if a payment from the same source will be received after the file date in the month of application.
  • All household income in the application month is from a new source, and the household will receive income of $25 or less from the first of the month up to and including the 10th day after the application date (or the end of the month if there are not 10 days left in the month).  
    
    Income received monthly or more frequently is from a new source if the household did not receive $25 or more from that new source in the 30 days up to and including the application date.  
    
    Income received at intervals of more than one month is new income if the household has not received more than $25 from that source between the last usual payment month and the application date.  
    
    Advisors count new income received after the application date to determine whether the individual is destitute, but disregard it in determining eligibility and benefits for the month of application.

  • The household has a combination of terminated income through the application date and new income after the application date if:

    • there is no other income from the terminated source that month, and
    • the household will receive income of $25 or less from the new source from the first of the month through the 10th day after the application date (or the end of the month if there are not 10 days left in the month).

    At recertification, advisors disregard income from a new source in the first month of the certification period if that income will not exceed $25 within 10 days after the individual's usual issuance cycle.  
    
    Notes:

    • Advisors count an advance of wages for travel expenses as income unless it is a reimbursement.
    • Advisors do not consider the advance in determining whether the household is destitute or in determining whether later payments from the employer are from a new source.
    • Self-employed farmworkers whose income is annualized are not destitute if they do not receive income each month of the year.
    • The grower, not the crew chief, is the farmworker's source of income. An individual who follows a crew chief to a new grower is leaving a terminated source for a new source.

The policies in this section apply to income determinations for destitute applicants at initial and later certifications but only in the first month of any certification period.

A—147 Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents

Revision 15-4; Effective October 1, 2015

Medical Programs – All Except Emergency Medicaid and TP 56

All applications for Medicaid from active duty military members and their dependents applying for coverage are eligible for expedited processing.

Active duty refers to military members who currently are serving full time in their military capacity. A military member is defined as someone in the:

• U.S. Armed Forces/Reserves
  • Army
  • Marine Corps
  • Navy
  • Air Force
  • Coast Guard
• National Guard
  • Army
  • Marine Corps
  • Navy
  • Air Force
  • Coast Guard
  • Reserve/Guard
• Army National Guard
• Air National Guard
• State Military Forces/Texas State Guard
  • Texas State Guard – Unless activated by the governor and placed on paid state active duty, these personnel receive no compensation for their time.
  • Texas Army National Guard
  • Texas Air National Guard

When an application for Texas Works medical assistance is received and includes an active duty military member, staff should take the following action on or before the 15th workday of the application file date:

• Provide an interview if requested or required;
• Send/provide Form H1020, Request for Information or Action, to request missing information if no interview was requested or required and the household did not provide information with the application; and
• Send/provide Form TF0001, Notice of Case Action, if the household provided all verification with the application and no interview was requested or required.

Military status is self-declared. Additional verification is not required.

Advisors should use processing time frames stated in B-112, Deadlines, if the household did not provide all required information and verification with the application.

The expedited processing requirement does not apply to TP 56 (Medically Needy with Spend Down) or to Emergency Medicaid for ineligible aliens, and only applies to applications and untimely reviews/renewals.

A household is not eligible for expedited processing if the military member is on active duty because of training as a member of the Reserves, National Guard, or State Military Forces.

When an application consists of a pregnant member and an active duty member, advisors use TP 40 expedited application processing time frames.

Advisors provide expedited processing for a Medicaid application if the budget group includes the needs of an active duty member even if the active duty member is not included in the certified group.

Advisors must not pend an application if the household:

• fails to answer the Yes/No question and name/designation. Advisors must not process the application using expedited time frames. If the Yes/No question is left blank, advisors enter No in the system.
• fails to answer the Yes/No question but provides a name or information that can be used to determine who the active military member is. Advisors should assume that the answer is Yes and process the application using expedited time frames.
• answers Yes to the question but does not provide a name or information that can be used to determine who the active military member is. Advisors must not process the application using expedited time frames.

When an interview is scheduled timely within 15 workdays, but the applicant requests to reschedule the interview, staff should attempt to accommodate the rescheduled appointment within the 15-workday time frame. If, at the household’s request, the interview is rescheduled after the 15-workday time frame, staff should document the reason for not scheduling the appointment within the required time frame.

Note: For requested interviews, if the applicant requests to be rescheduled, staff should inform the household that an interview is not required and that the processing of the application can begin without an interview. Staff must not deny an application if the household fails to show for the appointment when an interview is not required.

Revision 15-4; Effective October 1, 2015

SNAP

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

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

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

Inform households receiving combined allotments:

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

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

Revision 13-2; Effective April 1, 2013

TANF, SNAP and TP 08

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

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

 

 

A—161 When Receipt of TANF Is Uncertain

Revision 15-4; Effective October 1, 2015

TANF and SNAP

When TANF eligibility is uncertain, advisors must:

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

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

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

Revision 21-4; Effective October 1, 2021

All Programs

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

An AR must be verified using a(n):

• applicant's or recipient's signature on one of the following HHSC applications for benefits containing the AR designation:
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
  • Form H1010-R, Your Texas Works Benefits: Renewal Form;
  • Form H1034, Medicaid for Breast and Cervical Cancer;
  • Form H1200, Application for Assistance — Your Texas Benefits;
  • Form H1200-MBI, Application for Benefits — Medicaid Buy-In;
  • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children;
  • Form H1205, Texas Streamlined Application;
  • Form H1206, Health Care Benefits Renewal;
  • Form H1840, SNAP Food Benefits Renewal Form;
  • Form H1841, SNAP-CAP Application;
  • Form H1842, SNAP-CAP Renewal Application;
  • Form H2340, Medicaid for Breast and Cervical Cancer Renewal; or
  • Form H2340-OS, Medicaid for Breast and Cervical Cancer.
• applicant's signature on a Marketplace application for health care benefits that is transferred to HHSC and contains the AR designation;
• legal document that the AR has authority to act on behalf of the applicant or recipient under state law (e.g., legal guardianship or power of attorney);
• letter designating AR authority and containing the applicant's or recipient's signature, in addition to the name, address, and signature of the AR;
• completed Form H1003, Appointment of an Authorized Representative; 
• applicant's or recipient's electronic signature designating the AR on an application, renewal, or reported change submitted through YourTexasBenefits.com.

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

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

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

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

• the applicant or recipient notifies HHSC that the AR is no longer authorized to act on their behalf;
• the AR notifies HHSC that they no longer wish to act as AR for the applicant or recipient;
• there is a change in the legal authority (i.e., legal guardianship or power of attorney) on which the AR’s designation is based; or
• the applicant or recipient designates a new AR to act on their behalf. If there is an existing AR designated on a case, the person or organization that the client most recently designated as the AR will replace the existing AR on the case.

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

Note: An AR is not automatically a personal representative.

An AR is designated at the case level to have access to all benefit information for that case. A verified AR may:

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

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

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

Mailing Address for AR

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

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

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

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

Medical Programs

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

SNAP

People disqualified for SNAP benefits because of an administrative disqualification hearing or a nonmember living with the household may serve as an AR only if:

• no other responsible household member is reasonably able to be the HOH or AR; or
• that person is the only adult living in the household.

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

Related Policy

Electronic Correspondence, A-119.1
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000
Personal Representatives, B-1212
Establishing Identity for Contact Outside the Interview Process, B-1213
Telephone Contact, B-1213.1
Confidentiality, W-2400

A—171 Protective Payee

Revision 22-3; Effective July 1, 2022

TANF

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

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

Related Policy

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

A—172 AR Applying for Household

Revision 15-4; Effective October 1, 2015

All Programs

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

The AR must be an adult.

A—173 AR for Residents of Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities

Revision 22-1; Effective January 1, 2022

SNAP

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

Residents of GLA facilities may apply:

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

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

Related Policy

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

A—174 Abuse by AR

Revision 15-4; Effective October 1, 2015

SNAP

An advisor who suspects an AR of acting against the household's interests must report the circumstances to the advisor's program manager.

Revision 22-3; Effective July 1, 2022

All Programs

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

Make the eligibility decision for each program when all verifications are received for that program.

Related Policy

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

TANF

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

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

Note: A protective payee is automatically the AR.

Related Policy

Relationship Charts, C-1440

SNAP

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

A—181 Verification Sources

Revision 22-3; Effective July 1, 2022

TANF

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

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

Revision 22-3; Effective July 1, 2022

All Programs

Document the date and method that advance notice of a home visit was provided and the date and time of the visit. An imaged copy of the appointment notice provided to the person is sufficient.

Document why a certain file date was used to determine eligibility when:

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

Document:

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

TANF, SNAP and TP 08

For all interviews, staff must document:

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

Medical Programs

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

TANF

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

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

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

SNAP

Document:

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

Related Policy

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

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—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 22-3; Effective July 1, 2022

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 a grandparent, aunt, uncle, brother or sister who is 25 or older to be the protective payee because the parent is not using the TANF payments for the child's benefit. Great-grandparents, great-aunts, and great-uncles may be designated as protective payees. Follow TANF relationship requirements.

   The protective payee is automatically the authorized representative (AR).
   
   The protective payee cannot be a:

   • Texas Health and Human Services Commission (HHSC) employee;
   • person who provides HHSC services to the family; or
   • a relative who is younger than 25 when a relative protective payee is designated by HHSC. 
   • A child’s cousin, niece or nephew.

   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, aunt, uncle, brother or sister designated by HHSC as protective payee. Investigate any alleged report of the relative not using TANF for the child's benefit.

   Note: When designating or continuing a protective payee, notify the recipient 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.

   A representative payee is automatically the AR. The representative payee may be the AR 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 (quality control) process.

   Note: A legal parent is permanently disqualified for a felony drug conviction (not deferred adjudication) for an offense 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, certify the person for 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, discuss the situation with the person. If the person claims they are not the person 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:

   • 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. If applicable, enter information in the Data Collection-Individual Demographic-Conviction/Rehabilitation page and make an overpayment referral if appropriate.
      
5. SSI Recipients

   A TANF family member is removed from the certified group when the person is certified for SSI. The Social Security Administration (SSA) notifies HHSC by 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 where 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 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
Relationship Charts, C-1440

A–223 Certifying Children on Non-Parent Caretaker EDGs

Revision 22-3; Effective July 1, 2022

TANF

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

• a separate EDG with the relative as a payee when the relative receives TANF for children who are not the child's natural, adopted or half siblings; 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.

Certify each other-related child, unless they are siblings, 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 (for example, a stepparent).

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

• deny the EDG, which includes 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 related policy for more information on the action to take when non-parent relative caretakers must be denied while the other-related children remain eligible.

Related Policy  

Stepparent Budgeting Procedures, A-1366.2
OTTANF, A-2411
One-Time TANF for Relatives, A-2412 
Documentation Requirements, A-2470
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480

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—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.

3. Intentional Program Violation (IPV)
   
   People disqualified for an IPV in Texas or another state.
    
4. Noncooperation with SNAP Employment and Training (E&T)
   
   People disqualified for failing to cooperate with E&T requirements.
    
5. Noncooperation with Social Security number (SSN) requirements
   
   People disqualified for failing to cooperate with SSN requirements.
    
6. Ineligible Alien
   
   People who do not have eligible alien status to receive benefits.
    
7. 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

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.

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

Revision 22-3; Effective July 1, 2022

TANF and TP 08

Document an explanation of people living in the home who are not included on the EDG. 

See relationship, domicile and deprivation policy for other verification and documentation requirements.  

TANF

Document:

• the specific reason for designating a representative payee or protective payee;
• the basis for giving separate household status to married minors;
• the name and phone 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;  
• the household was informed of the one-time payment at application and whether the caretaker requested it or declined it; and
• a relative caring for a related dependent child or children receiving TANF was informed of One-Time TANF for Relatives at application or periodic review if the relative is potentially eligible and whether they requested it or declined it. 

SNAP

Document:

• an explanation of the household composition;
• the basis of granting separate household status;
• the applicant’s or recipient's response to Data Broker information if the person disagrees with the information;
• the reason for an OIG referral resulting from the Data Broker criminal history record for a felony drug conviction;
• the result of OIG's findings;
• the disqualification status of any disqualified household member;
• name and phone number of the out-of-state human services employee who provides verification;
• the name of the household member currently disqualified for an intentional program violation (IPV) in another state; and
• the number of any countable months of benefits received in another state as an able-bodied adult without dependents (ABAWD).

Related Policy 

Documentation Requirements, A-540
Documentation Requirements, A-950
Disability Verification, A-1080
Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification, B-941
The Texas Works Documentation Guide

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:

• Asylee;
• Battered Alien;
• Conditional Entrant;
• Cuban or Haitian Entrant;
• Deportation (or Removal) Withheld;
• Iraqi and Afghan Special Immigrants (SIV);
• Lawful Permanent Resident (LPR);
• Parolee;
• Refugee;
• Special Immigrant Conditional Permanent Resident (SI CPR); or
• Trafficking Victims.

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

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.

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

Revision 23-2; Effective April 1, 2023

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 23-2; Effective April 1, 2023

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 Machine Readable Immigrant Visa (MRIV) or 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 or CBP, or DHS or 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. Or I-765, Employment Authorization Document (EAD), receipt notice with code SQ1, SQ2, SQ3, SQ6, SQ7 or SQ8. Or I-766, Employment Authorization Document (EAD), with code SQ1, SQ2, SQ3, SQ6, SQ7 or SQ8.   For special immigrants who are Special Immigrant Parolees (SI or SQ Parole): 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 (SI CPRs) adjusting their status to LPR status in the U.S.: Passport with a MRIV, or DHS or 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 or CBP, or DHS or 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. Or I-765, Employment Authorization Document (EAD), receipt notice with code C11. Or I-766, Employment Authorization Document (EAD), with code C11. 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 23-2; Effective April 1, 2023

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 Machine Readable Immigrant Visa (MRIV) or 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 or CBP, or DHS or 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. OR I-765, Employment Authorization Document (EAD), receipt notice with code SQ1, SQ2, SQ3, SQ6, SQ7 or SQ8. OR I-766, Employment Authorization Document (EAD), with code SQ1, SQ2, SQ3, SQ6, SQ7 or SQ8.   For special immigrants who are Special Immigrant Parolees (SI or SQ Parole): I-94 noting Special Immigrant Status (SQ or 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. OR I-765, Employment Authorization Document (EAD), receipt notice with code C11. OR I-766, Employment Authorization Document (EAD), with code C11. 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 (SI CPRs) adjusting their status to LPR status in the U.S.: Passport with a MRIV, or DHS or CBP stamp noting admission under IV Category with one of the following codes: CQ 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 or CBP, or DHS or 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. OR I-765, Employment Authorization Document (EAD), receipt notice with code C11. OR I-766, Employment Authorization Document (EAD), with code C11.   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, Section 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
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.
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.
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.
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.

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,	Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu. 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,	Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu. 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,	Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu. 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,	Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu. 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).

6. Select Submit Initial Verification. The response appears in the Initial Verification Results section of the same page.
7. 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.

8. Review the results and select Print Case Details.
9. 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

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

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 23-1; Effective Jan. 1, 2023

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 (an indication that the person has changed their 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 with SOLQ, but information given by the SSA shows 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 before disposing the case action. If the person does not provide the information needed to clear the discrepancy, either disqualify or deny the person using failure to comply policy. 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 time frames.

Note: If a person with a SOLQ verified SSN requests to change their name, date of birth or gender, the person must first update their information through the Social Security Administration.

SSN Not Verified

If the person’s SSN is not verified with 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, try 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, include the request for information to clear the SSN discrepancy on Form H1020, Request for Information or Action.
  • Manually generate the Form H1020 and attach the Form HRG-83, SSN Maintenance Memorandum, before mailing.

If the person:

• Returns all requested information and staff verify the SSN, certify the person if all other eligibility requirements are met.
• Returns all requested 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 requested information, disqualify or deny the person.

If the person’s identity is questionable, request information to clear the discrepancy. If the information is not provided or the information provided 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 the monthly interface does not validate the SSN, 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

Verification Requirements, A-440

Questionable Information, C-920

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.

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

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.

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

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

For age requirements, see household composition:

• A-220 for TANF, and
• A-240 for Medical Programs.

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:

• legal parent of a dependent child (both legal parents can be eligible);
• caretaker relative of a dependent child; or
• spouse of a caretaker relative.

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

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

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

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).

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

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

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

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.

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

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

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.

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

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

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.

Revision 22-3; Effective July 1, 2022

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 on that date.

The medical effective date (MED) may not be the first day of the application month in the following situations. 

The MED cannot precede:

• A newborn's date of birth.
• The date a child enters the home.
  
  Note: 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.
   
• For the parent or caretaker relative’s Medicaid application, the newborn’s date of birth or the date a child enters the home when the newborn or entering child is the only eligible child.
  
  TP 08 Exception: TIERS assigns an earlier MED 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 start date of the emergency condition for aliens eligible for Emergency Medicaid.
• The date a disqualified parent or caretaker relative complies.
• 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 requirements 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: Do not request verification of pregnancy if the:

• application is processed after the pregnancy terminates; and
• applicant provides proof of the 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.

Note: If a woman certified for Healthy Texas Women (HTW) reports her pregnancy, the HTW and Medicaid for Pregnant Women (TP 40) coverage may overlap because HTW does not provide prenatal or pregnancy benefits. In this situation, HTW is denied prospectively, and the woman is enrolled in TP 40 beginning the first of the month when she meets all eligibility criteria.

If a woman who was certified for expedited benefits provides postponed verifications that prove she does not meet eligibility requirements, 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.

TP 56

Medicaid coverage for children or pregnant women with spend down begins the first day the household meets spend down.

Note: A woman certified for HTW may have overlapping coverage with TP 56 if she has unpaid medical bills related to her pregnancy because HTW does not provide full coverage benefits. 

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 Texas Integrated Eligibility Redesign System (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

Provider Referral Process, A-125
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
Current Medicaid, Medicare (Part A or B) and Children's Health Insurance Program (CHIP) recipients, W-911
Pregnant Women, W-912

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.