B-110, Applications

B—111 Reuse of an Application Form After Denial

Revision 21-3; Effective July 1, 2021

All Programs

The original application form is valid for up to 60 days if an applicant reapplies after being denied for:

  • missing an appointment;
  • failing to furnish information or verification;
  • failure to provide postponed verification; or
  • failure to provide proof of U.S. citizenship.

Notes:

  • If the information on the application form has changed or is more than 45 days old, applicants and staff must update the form.
  • If the application has been denied for missing an appointment, the denied application is reopened using the contact date as the new file date.
  • Do not request more income verification when reopening a redetermination denied for failure to provide information. The original income verification the person provided at the interview date is acceptable, unless the household indicates a change in income.

TP 32 and TP 56

An application may be used more than one time for TP 56 and TP 32 applicants when both of the following conditions exist:

  • the application interview or process date is after the application month; and
  • the household states that it wishes to reapply and reuse an application form.

Related Policy

Denied for Missed Appointments, B-122.3.1
Denied for Failure to Provide Information/Verification, B-122.3.2

B—112 Deadlines

Revision 20-4; Effective October 1, 2020

TANF and Medical Programs

Provide Form TF0001, Notice of Case Action, to a certified or denied applicant by the 45th day after the file date.

Ensure that certified applicants have access to benefits by the 45th day after the file date.

Follow A-140, Expedited Service, for TP 40 expedited Eligibility Determination Groups (EDGs).

Follow Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents, policy for expedited time frames for medical program applicants with an active duty military connection.

Exceptions:

  • For applications requiring medical verification, the total processing time of the delay caused by obtaining Form H3038, Emergency Medical Services Certification, is not counted.
  • Document the date that:
    • Form H3038 was sent to the practitioner or given to the applicant; and
    • medical information was received.
  • For TANF reapplications with open Choices or school attendance penalties, a period of up to 40 days is excluded from timeliness calculations. The person must demonstrate cooperation for 30 days before staff close the penalty and process the application.

SNAP

By the 30th day after the file date:

  • deny or certify an application; and
  • ensure that a certified applicant has an opportunity to participate.

Exception: For expedited service, see A-140.

Medical Programs

Provide Form TF0001, Notice of Case Action, to a certified or denied applicant, including those with spend down by the 45th day from the file date.

Related Policy

Expedited Service, A-140
Postponed Verification Procedures, A-145.1
Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents, A-147
Eligibility Dates and Benefit Amounts, A-2320
Children’s Medicaid Redetermination Expectations, B-123.6

B—113 Delay in Processing Applications

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must follow policy below when an application is delayed until the 60th day after the file date:

If ... then ...
the agency is at fault for not completing the application process by the 60th day after the file date and was also at fault for delaying it during the first 30 days after the file date, the advisor must continue to process the original application and provide benefits retroactive to the file date (or the month the individual met all requirements, if later).

If the applicant:
  • misses a Supplemental Nutrition Assistance Program (SNAP) appointment and fails to contact the office by the 10th day as noted on Form H1020, Request for Information or Action, to request a second appointment, the application is denied the following workday. The household loses eligibility for all past months and must reapply if they still want to receive benefits.
  • fails to provide all the required verification by the 10th day noted on Form H1020, then deny the application the following workday. If the household subsequently provides the missing verification within 10 days after the Form H1020 due date, reopen the application using the original file date. Otherwise, the household must reapply if they want to receive benefits.
HHSC was at fault in the first 30 days and the individual was at fault in the second 30 days, deny the application on the 60th day after the file date and provide no benefits.
the individual was at fault the first 30 days and HHSC was at fault in the second 30 days, the advisor must continue to process the original application and provide benefits retroactive to the month following the month of application (or the month the individual met all requirements, if later).

B—113.1 Reserved for Future Use

Revision 22-4; Effective Oct. 1, 2022

 

B—114 Missed Appointment

Revision 22-4; Effective Oct. 1, 2022

TANF, SNAP, TP 08 and TA 31

Make at least two attempts to contact the applicant by phone. If staff are unable to contact the applicant or authorized representative (AR) by phone or the applicant is not available for the interview during the initial attempted phone calls, mail Form H1830-FA, Application/Review/Expiration/Appointment Notice, to the applicant. Form H1830-FA instructs the person to call the Flexible Appointment toll-free number:

  • by seven calendar days after the date of the initial attempted cold calls; and
  • during business hours, from 8:30 a.m. to 4:30 p.m.

Exception: Expedited SNAP applicants are instructed to call the Flexible Appointment toll-free number within three business days after the initial attempted phone calls.

Applicants can complete an interview with available staff by calling the Flexible Appointment toll-free number.

If the person does not contact HHSC by the date listed on Form H1830-FA, send Form H1020-MA-FA, Request for Information or Action-Missed Appointment-Flexible Appointment, to inform the person of the final date to complete their interview. The applicant has until close of business on the final due date to contact HHSC for an interview.

Exception: TANF and TP08 must be denied by the due date on Form H1830-FA if the interview has not been completed.

Notes:

  • The final due date on Form H1020-MA-FA follows timeframes in related policy, SNAP Timeliness Charts for Applications and All Redeterminations.

If a joint application is received requesting interview and non-interview required programs and the applicant misses a required interview, process the non-interview required programs.

Related Policy 

Interviews, A-131
Reuse of an Application Form After Denial, B-111
Processing Redeterminations, B-122
Denied for Missed Appointments, B-122.3.1
Children’s Medicaid Redetermination Expectations, B-123.6
SNAP Timeliness Charts for Applications and All Redeterminations, B-160

TP 36 and TP 40

No appointment is required to process an application.

Note: For requested interviews, inform the household an interview is not required. Do not deny an application if the household fails to complete an interview when an interview is not required.

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

No appointment is required to process an application or renewal unless the person non-complies with the Health Care Orientation requirement, non-complies with Texas Health Steps, or information needed to determine eligibility can only be obtained through a phone interview.

Note: For requested interviews, inform the household an interview is not required. Do not deny an application if the household fails to complete an interview when an interview is not required.

Related Policy

Scheduling Appointments, A-122.2
Interviews, A-131
Compliance Requirements, A-1531.5
Processing Children's Medicaid Redeterminations, B-123

B—115 Pending Verification on Applications

Revision 15-4; Effective October 1, 2015

All Programs

If more information/verification is required to complete an application, the household is allowed at least 10 days to provide the information/verification. The due date must be a workday.

Advisors request documents that are readily available to the household if the documents are anticipated to be sufficient verification. Each handbook section lists potential verification sources. C-900, Verification and Documentation, provides information on verification procedures.

The advisor must give the applicant Form H1020, Request for Information or Action, explaining:

  • what is required,
  • the date the verification is due, and
  • the date the application will be denied if the verification is not received.

The day Form H1020 is sent is considered day zero of the pending period.

If the applicant does not provide the verification by the 30th day after the file date, or the next workday if the 30th day is not a workday, the application is denied no earlier than the:

  • 30th day if the 30th day is a workday, or
  • following workday if the 30th day is not a workday.

The final due date on Form H1020 must correspond with the 30th day if a workday, or the following workday if the 30th day is not a workday. The advisor must take the appropriate action on the final due date.

Exceptions:

  • If necessary, the advisor may hold the application past the 30th day to allow the household at least 10 days to provide verification. If the household does not provide required verification by this deadline, the EDG is denied no earlier than the following workday. This includes situations in which the 10th day falls on the 30th day.
  • If the eligibility factor in question does not affect eligibility of the entire household, the ineligible member(s) is disqualified and the remaining members are certified.

On an application denied for failure to furnish information or failure to provide postponed verification, if the household provides the required verification by the 60th day after the file date, the application is reopened using the date the individual provided verification as the file date.

TANF

For applications in pay for performance with a noncooperation for Choices or school attendance, the final due date is the 40th day from the date of interview. See A-2151, Open Penalty at Reapplication in Pay for Performance.

Note: When an application is pended for other eligibility verification in addition to the verification of Choices or school attendance cooperation, staff should continue to pend the TANF application until the final due date (40th day from the interview) before taking appropriate action on the TANF EDG.

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

Advisors must check for any associated EDGs and use appropriate verifications from those EDGs when the applicant does not provide verification with the application form. Advisors use proof of alien status, income or deductions (if provided in the 90 days before the file date) from an associated SNAP, Medicaid or TANF EDG as verification for a child's Medicaid application or redetermination.

SNAP

If the applicant is eligible, the advisor must provide an opportunity to participate by the 30th day after the file date. If not possible, benefits are authorized with a priority issuance the day the applicant provides the required verification.

Related Policy

Expedited Service, A-140

B—115.1 Pending Verification for MA – Pregnant Women – Emergency

Revision 15-4; Effective October 1, 2015

TP 36

An application for a TP 36 is denied by the 45th day after the file date if the applicant:

  • or her representative does not provide Form H3038, Emergency Medical Services Certification; Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification; or other required verification; and
  • had at least 10 days to provide the verification.

Advisors use the following chart to process the application for the individual's emergency condition if the required verification is received:

If the emergency condition occurs... and Form H3038/H3038-P is received ... then ...
during the month of application, by the 45th day after the file date, dispose the EDG using the original file date.
during the month of application, after the EDG is denied but by the 60th day after the file date, reopen the EDG, using the same application, as specified in B-111, Reuse of Application Form After Denial. Use the date Form H3038/Form H3038-P is received as the new file date.*
after the application month but by the 60th day after the file date, by the 45th day after the file date, use the date Form H3038/H3038-P is received as the file date.*
after the application month but by the 60th day after the file date, after the EDG is denied but by the 60th day after the file date, reopen the EDG, using the same application, as specified in B-111. Use the date Form H3038/H3038-P is received as the new file date.*

* Form H1113, Application for Prior Medicaid Coverage, is not required if processing the emergency coverage for a prior month.

B—116 Information Reported During Application Processing

Revision 15-4; Effective October 1, 2015

All Programs

In determining eligibility, the advisor must consider any information the individual reports between the application date and the decision date. The advisor must include any information the individual reports in the application decision process and send Form H1020, Request for Information or Action, if verification of the reported information is required to complete the application process, following procedures in B-115, Pending Verification on Applications.

Advisors must add a new household member the month the household member joins the household. For newborns, this is the:

  • birth month for TANF and Medical Programs, and
  • month the newborn comes home from the hospital for SNAP.

If the household has an existing case and submits a new application that includes new information, such as a new job, advisors must address changes that may impact eligibility for other programs.

Related Policy

Receipt of Duplicate Application, A-121.2
Receipt of Identical Application, A-121.3

B—116.1 Information Received During Expedited Application Processing

Revision 15-4; Effective October 1, 2015

SNAP

Advisors use the following chart to determine what action to take when the advisor receives information after certifying an expedited application with postponed verifications:

If, between the certification date and the date you release the hold ... then ...
  • an individual provides postponed verification that results in lowered or denied benefits; or
  • the advisor discovers information that existed on the interview date but the household failed to report, and the information results in lowered or denied benefits,
  • determine eligibility and benefits using the new information; and
  • release the hold and deny or issue lowered benefits effective the hold month providing adequate notice of adverse action.
an individual reports a change that occurred after the certification date, release the hold and issue benefits based on the originally requested information. Work the change using change policy in B-600, Changes, allowing advance notice of adverse action, if required.

Note: Advisors must send a fraud/overpayment referral, if applicable. See B-742, Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV).

Related Policy

Expedited Service, A-140
Action on Changes, B-631

B-120, Redeterminations

Revision 17-1; Effective January 1, 2017

Redetermination is the generic term in TIERS and the State Portal used to identify:

  • periodic reviews of TANF;
  • recertification of SNAP; and
  • renewal TP 08, TP 43, TP 44, and TP 48.

Note: Certification periods and redeterminations for individuals on Medical Programs who are receiving TANF and SNAP may not align. If the household reports new information during a redetermination, such as a new job, advisors must address changes that may impact eligibility for other programs.

Redeterminations can be submitted through any of the channels explained in A-113, Application Requests and Submissions, and signed as explained in A-122.1, Application Signature.

Related Policy

Application Requests and Submissions, A-113  
Application Signature, A-122.1

TANF and SNAP

Form H1830-R, Texas Works Renewal Notice (PDF), is sent to households, along with Form H1010-R, Your Texas Benefits: Renewal Form (PDF), for redeterminations.

TP 08, TP 43, TP 44 and TP 48

The following forms are generated for clients during the automated renewal process explained in B-122.4.1, Automated Renewal Process:

  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter;
  • Form H1206, Health Care Benefits Renewal - MA*; and
  • Form M5017, Documents to Send with Your Renewal Application.*

* The system generates these forms but does not automatically mail them to the client, as explained in B-121, Notice of Redetermination/Certification Expiration.

Form H1206, Health Care Benefits Renewal - ME, is mailed to the household when the individual receiving Medicaid for the Elderly and People with Disabilities (MEPD) is eligible to renew their benefits.

B—121 Notice of Redetermination/Certification Expiration

Revision 22-4; Effective Oct. 1, 2022

TANF

TIERS Scheduling triggers the Texas Works redetermination packet mail-out date in Correspondence 60 days before the review due date for approved Eligibility Determination Groups (EDGs).

Attempt two cold calls to complete an interview after the household returns Form H1010-R, Your Texas Works Benefits: Renewal Form (PDF). Schedule an appointment for unsuccessful cold call attempts by mailing Form H1830-FA to the household.

SNAP

TIERS Scheduling triggers the Texas Works redetermination packet mail-out date in Correspondence during the first week of the month before last benefit month (LBM).

Attempt two cold calls to complete an interview after the household returns the Form H1010-R. Schedule an appointment for unsuccessful cold call attempts by mailing Form H1830-FA.

For timely redeterminations, the person must contact the Flexible Appointment toll-free number provided on Form H1830-FA early enough in the last benefit month to allow at least 13 days after the interview to ensure the EDG can be disposed by the last day of the certification period. This allows two days mail time for Form H1020, Request for Information or Action (PDF), from the central mail facility and 10 days after the Form H1020 issue date for the household to provide the information.

Note: If the 10th day falls on a non-workday, the due date is the following workday.

Related Policy

Redetermination, B-476.1.6

TP 08, TP 43, TP 44 and TP 48

The system generates renewal correspondence automatically in the ninth month of the 12-month certification period.

The system generates and sends Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter. Staff action is not required. Form H1211 is dynamic based on the eligibility outcome and program.

The system generates Form H1020 and sends it with Form H1211 when more information or verifications are needed to complete the renewal processing.

The system generates Form H1206, Health Care Benefits Renewal - MA, but does not automatically mail it. Form H1206 is pre-populated with information from the recipient’s case and may also include information from electronic data sources. There are different versions of this form depending on the type of assistance in which the recipient is currently enrolled. Recipients can access Form H1206 using the following methods:

  • logging into YourTexasBenefits.com using a case access account and selecting the “Letters and forms” tab to view or print the form;
  • dialing 2-1-1, selecting option 2, and requesting that Form H1206 be mailed to them; or
  • visiting a local office and receiving lobby assistance to access the form through YourTexasBenefits.com or having local office staff print a copy of the form.

The system generates Form M5017, Documents to Send with Your Renewal Application, to include with Form H1206.

Note: Accept Form H1010-R if it contains a person’s Modified Adjusted Gross Income (MAGI) information and a signature. The signature on Form H1010-R is considered valid if it is provided by the certified person or a person who is allowed to sign on their behalf. Enter the information provided on Form H1010-R and pend for any information that cannot be verified through electronic data sources.

When a new person is added to a case or a person is transferred to a different medical program, their review due date may be aligned with the review due date of another person in the same medical program on the case and they will be able to renew at the same time. If the review due dates are aligned after the system has initiated the automated renewal process by requesting electronic data sources, the following forms are mailed to the new person or the person who was transferred to a different type of assistance to complete the processing:

Related Policy 

Receipt of Application, A-121  
Additions to the Household, B-641

B—122 Processing Redeterminations

Revision 22-4; Effective Oct. 1, 2022

TANF

Process redeterminations before cutoff in the month:

  • the redetermination date occurs if the redetermination is due on or before cutoff; or
  • after the redetermination date if the redetermination is due after cutoff.

When the Texas Works Renewal Packet Is Returned and a Packet Received Date Is Entered

If the household must provide verification to complete the redetermination, allow at least 10 days to provide verification.

Follow the related policy about scheduling appointments and missed appointments to conduct an interview.

When the Texas Works Renewal Packet Is Not Returned, a Packet Received Date Is Not Entered, or Both

TIERS runs a Mass Update (MU) on the fifth, sixth or seventh day of each month to terminate EDGs with due dates on or before cutoff of the current month if a renewal packet is not received.

For example: On July 5, the MU terminates EDGs with a review due date on or before July cutoff.

Normal MU rules for exceptions may prevent an EDG from being terminated. Process these EDGs and verify that a Texas Works renewal packet has been sent and not returned.

When the Texas Works renewal packet is:

  • Not returned, go to Initiate Interview in Change Action mode, run eligibility and dispose the TANF EDG.
  • Returned, go to Initiate Interview in Ongoing mode and enter the packet received date in the Miscellaneous Packet Received logical unit of work (LUW).

If the household returns Form H1010–R, Your Texas Works Benefits: Renewal Form, within the adverse action period, schedule an appointment to process the complete redetermination. These EDGs must be processed as a Redetermination for correct eligibility determination and timeliness calculation.

Where to Find the Packet Received Date

In State Portal, the packet received date can be found in PT Inquiry in the EDG Details section in the column labeled Recertification Packet Date.

In TIERS, the packet received date can be found in two places in Data Collection:

  • Miscellaneous – Packet Received LUW, which can be viewed in any mode; and
  • Initiate Interview – Initiate Review page, which can be viewed only in Complete Action mode.

Related Policy

Scheduling Appointments, A-122.2  
The Texas Works Message, A-1527  
Missed Appointment, B-114  
Data Broker, C-820

SNAP

To reapply in a timely manner, the person must submit the completed application form by the 15th day of the last month of the certification period. Exception: See B-122.1, SNAP Redeterminations Following a Short Certification.

Follow the related policy for scheduled and missed appointments to conduct an interview.

If the household does not contact HHSC by the last business day of the certification period to complete an interview, the redetermination application is denied on the last business day of the certification period using adequate notice.

Process timely redeterminations by the last business day of the certification period. If the redetermination is pended for verification, the household is allowed until the last business day of the month to provide the required verification before denial action is taken. Ensure the person's normal issuance cycle is not interrupted.

Exception: The redetermination is pended past the last business day of the month when needed to allow the person at least 10 days to provide requested verification. If the person:

  • Provides verification before the end of the current certification month, then the action is processed by the last day of the month.
  • Provides verification after the end of the certification period but by the end of the 10-day period, ensure that the household receives an opportunity to participate within five business days of receipt of the verification, if eligible. If the household is not eligible, the denial is processed by the fifth business day after receipt of verification.
  • Does not provide verification by the end of the 10-day period, the redetermination is denied the next business day.

Related Policy

Scheduling Appointments, A-122.2  
Interviews, A-131  
Missed Appointment, B-114  
SNAP Redeterminations Following a Short Certification, B-122.1  
Children’s Medicaid Redetermination Expectations, B-123.6  
Redetermination, B-476.1.6

TP 08, TP 43, TP 44 and TP 48

These programs complete an administrative renewal process, explained in B-122.4, Medical Program Administrative Renewals.

TP 07 and TP 20

Retest recipients of TP 07 and TP 20 for eligibility in other medical  programs following the related policy for retesting eligibility at the end of their certification period. These people are referred to the Marketplace if they are determined ineligible for all other medical programs.

Related Policy

Retesting Eligibility, A-2342.1  
Denied for Failure to Provide Information/Verification, B-122.3.2  
Processing Untimely Redeterminations, B-124  
SNAP Timeliness Charts for Applications and All Redeterminations, B-160  
Required Verification, C-910

B—122.1 SNAP Redeterminations Following a Short Certification

Revision 13-3; Effective July 1, 2013

SNAP

Advisors must provide eligible households with benefits by the 30th day after the last monthly full benefit was provided if the individual reapplied timely and was previously certified with a short certification. A short certification is defined as a SNAP certification in which the household is certified:

  • for a one-month period; or
  • in the second month of a two-month certification.

The household must reapply within 15 days of receiving Form H1830, Application/Review/Expiration/Appointment Notice, and the application for assistance to be considered timely.

Notes:

  • This policy does not apply to households that are certified in the first month of a two-month certification. These households must continue to file their Form H1010 by the 15th of the last benefit month for a timely redetermination. Advisors must continue to process timely redeterminations on these cases by the last day of the current certification period.
  • Advisors must continue to provide Form H1830 and an application for assistance to households that are certified in the first month of a two-month certification or after cutoff in the first month of a three-month certification, because these households will not receive a redetermination packet even though they are not considered to have received a short certification.

B—122.1.1 Calculating the 30-Day Period After the Last Monthly Full Benefit

Revision 15-4; Effective October 1, 2015

SNAP

To calculate the 30-day period, the advisor considers the date the individual received the last full benefit as day zero. If the 30th day falls on a non-workday, the advisor must complete the case by the last workday preceding the 30th day.

B—122.1.2 Determining the Date the Client Must File the Application for a Timely Redetermination Following a Short Certification

Revision 15-4; Effective October 1, 2015

SNAP

To calculate the date the individual must file the application to be considered timely, the advisor must count 15 days after the individual received Form H1830, Application/Review/Expiration/Appointment Notice, and the application for assistance. This date is known as the Short Certification Timely Due Date. If the 15th day falls on a weekend or a holiday, the individual must submit the application before the 15th day in order for it to be considered a timely redetermination.

Advisors must follow the chart below in determining a timely redetermination:

If Form H1830 and Form H1010 are...then count 15 days ...
given to the individual in the office,after the date the individual is given the forms.
mailed to the individual,plus two days (17 days) after the date the forms are mailed.

To schedule timely redeterminations properly, scheduling staff need to know the due date on which the application must be submitted to be considered a timely redetermination. Therefore, when providing Form H1830 and Form H1010, Application for Assistance — Your Texas Benefits, at the time a short certification is completed, advisors must manually document the due date in the Short Cert. Timely Due Date box in the Agency Use Only section of Form H1010. Scheduling staff must then follow B-160, SNAP Timeliness Charts for Applications and All Redeterminations, to properly schedule the appointment.

B—122.1.3 Missed Appointments Following a Short Certification

Revision 22-4; Effective Oct. 1, 2022

SNAP

Send Form H1020-MA-FA, Request for Information or Action-Missed Appointment, for reapplications submitted timely after a short certification, if a person does not complete an interview on or before the date on Form H1830-FA, Application/Review/Expiration/Appointment Notice. This is to inform the household they must contact HHSC by the 30th day from the last month's full benefit issuance to complete the interview.

Hold the application past the 30th day after the last month's full benefit issuance to allow the household at least 10 days (or longer if the 10th day falls on a non-business day) to provide missing information or verification. Notify the household of the due date on Form H1020. When the 10-day due date is on or after the 30th day after the last month's full benefit issuance and the household fails to provide missing information or verification by the due date, deny the application the next business day. If the household does not contact HHSC by the 30th day to complete an interview, the redetermination application is denied on the 30th day (or the last business day before the 30th day if the 30th day is not a business day).

B—122.2 HHSC Delays in Processing All Timely Redeterminations

Revision 22-4; Effective Oct. 1, 2022

SNAP

If the redetermination process is not completed in a timely manner due to agency delays, dispose the EDG the same day the eligibility redetermination is completed to ensure benefits are available within 24 hours.

Example 1: A household's last benefit month is October. The household files the redetermination timely, but HHSC does not give the household Form H1830-FA, Application/Review/Expiration/Appointment Notice, to complete their interview until November. Dispose the EDG on the same day the eligibility redetermination is completed to ensure that benefits are available within 24 hours.

Example 2: A household's last benefit month is October. The household files the redetermination, completes the interview, and provides all requested verification timely. Staff did not dispose and recertify the EDG by the last business day in October. Due to HHSC delay, staff must dispose the EDG on the same day that the eligibility redetermination is complete to ensure household has access to benefits within 24 hours.

B—122.3 Delays Caused by Households

Revision 22-4; Effective Oct. 1, 2022

TANF

If a redetermination is denied for a missed appointment or failure to provide information, allow the household until 60 days from the file date to complete an interview or provide the missing information.

SNAP

If a timely redetermination is denied for a missed appointment or failure to provide information, allow the household an additional 30 days after the end of the last benefit month to complete an interview or to provide the missing information.

Related Policy

Verification Requirements, A-1370

B—122.3.1 Denied for Missed Appointments

Revision 22-4; Effective Oct. 1, 2022

TANF and TP 08

If an application is denied for a missed appointment, consider the date the household contacts the agency as the new file date if the household completes an interview within 60 days after the original file date.

SNAP

If an application is denied for a missed appointment, consider the date the household contacts the agency as the new file date if the household completes an interview within 30 days after the end of the last benefit month. Benefits are prorated using the new file date.

B—122.3.2 Denied for Failure to Provide Information/Verification

Revision 15-4; Effective October 1, 2015

TANF

The date the household provides the missing information is the new file date if the household provides the missing information within 60 days of the original file date. If the EDG is reopened within 30 days of the denial, a new interview is not required. For TANF, a new Form H1073, Personal Responsibility Agreement, is not required if the EDG is reopened within 30 days of the denial.

SNAP

The date the household provides the information/verification is the new file date and a new interview is not required. Benefits are prorated using the new file date.

Advisors do not request additional income verification when following reuse of application policy for a redetermination denied for failure to provide information. The original income verification the individual provided at the interview date is acceptable, unless the household indicates a change in income.

TP 08, TP 43, TP 44 and TP 48

When a renewal is denied due to failure to provide information or verification and the information or verification is provided after the date of denial but by the 90th day after the last day of the last eligibility month, staff must reopen the existing case and not require a new application from the client. The date the information or verification is provided is the new file date.

Note: This may result in a gap in coverage.

B—122.4 Medical Program Administrative Renewals

Revision 20-4; Effective October 1, 2020

TP 08, TP 43, TP 44 and TP 48

TIERS initiates administrative renewals without additional staff action. The administrative renewal process uses the automated renewal process to gather information from a person’s existing case and from electronic data sources to determine if the person remains eligible for Medical Programs. This is explained in B-122.4.1, Automated Renewal Process.

Exception: Children whose TP 44 eligibility is reinstated upon release from a juvenile facility and who are released to a household different than the one in which they were certified at the time of placement in a juvenile facility do not administratively renew. Form H1010-R, Your Texas Benefits: Renewal Form, is required to review their Medicaid eligibility. For more information about reinstatement, see B-531, Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility.

TP 08

An interview is required at redetermination. During the interview, remind the person to use YourTexasBenefits.com to:

  • create a case access account;
  • complete the renewal;
  • sign-up for email reminders and electronic correspondence; and
  • find out when the next renewal is due.

A person cannot be required to complete a face-to-face interview, but has the right to request one.

For TP 08 interviews, use the interview policy explained in A-131, Interviews (for TP 08).

Related Policy

Automated Renewal Process, B-122.4.1  
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531

B—122.4.1 Automated Renewal Process

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

The automated renewal process is the first step in an administrative renewal. The automated renewal process runs the weekend before cutoff in the ninth month of the certification period and does not require advisor action.

The process uses electronic data to automatically:

  • assess the verifications required by type program for renewals;
  • determine the eligibility outcome; and
  • send the renewal correspondence to the client.

B—122.4.1.1 Verifications Required by Type Program for Renewals

Revision 21-2; Effective April 1, 2021

During the automated renewal process, TIERS checks for the required verification by program.

Automated Renewal Process: Verifications Required by Type Program for Renewals
TP 08, Parents and Caretaker Relatives Medicaid
  • Residence
  • Income and Expenses
  • Immigration Status
  • Domicile
  • Full-time School Attendance, when the only dependent child(ren) is 18
TP 43, Children Under Age One  
TP 44, Children 6–18  
TP 48, Children 1–5
  • Income and Expenses
  • Immigration Status
  • Texas Health Steps (only for TP 44 and TP 48)
  • Health Care Orientation

The automated renewal process attempts to verify income by determining if the person’s income information is reasonably compatible  with income information available through electronic data sources.

When there are no earned income electronic data sources (TWC) available for the person, the automated renewal process checks to see if there is a New Hire Report. When a New Hire Report exists with an employer's name and hire date that is not currently included in the person's income, the person must provide verification of income from the employer shown on the New Hire Report.

Immigration status is verified during the automated renewal process only if the person’s immigration document expires during the current certification period.

Related Policy

Verification Requirements, A-1370

B—122.4.1.2 Eligibility Outcomes

Revision 15-4; Effective October 1, 2015

Once available verifications are assessed, the system runs eligibility. The following chart lists the possible eligibility outcomes of the automated renewal process.

Automated Renewal Process: Eligibility Outcomes
Eligibility Potentially Approved
  • All required eligibility information can be verified during the automated renewal process for the program.
  • No additional verification is required from a client.
  • Clients must review the information used to determine their eligibility.
  • Clients are only required to return a signed renewal Form H1206, Health Care Benefits Renewal, if the information on the renewal form is incorrect or there are changes to the client’s case.
Additional Information Needed
  • This outcome may be the result of two scenarios that require additional verification to determine whether the client remains eligible:
    • Electronic data sources indicate there is a change in income that may result in ineligibility for Medical Programs.
      • The reasonable compatibility calculation result is “Need Info because ELDS above limit” or verification required for information found on the New Hire Report.
      • The client must return a signed renewal Form H1206, Health Care Benefits Renewal, and all required verification(s) within 30 days.
    • No electronic data is available for the client.
      • The client must return a signed renewal Form H1206 and all requested verification(s).
  • SNAP or TANF benefits may be impacted if a member of the MAGI household is included in a SNAP or TANF budget group.
Eligibility Terminated*
  • This outcome may be the result of two scenarios:
    • The previous eligibility outcome was “Additional Information Needed” and eligibility was terminated because the client:
      • did not submit required verifications within 30 days to show that income is under the limit, or
      • submitted verifications that showed that income was over the limit.
    • The client reported a change in income that was over the income limit, and eligibility was terminated before the automated renewal process was triggered.

* See A-2342, Denial at Redetermination, for more information on individuals found ineligible for Medical Programs at renewal.

B—122.4.1.2.1 Determining if Verification Is Required for SNAP or TANF During an Administrative Renewal

Revision 21-2; Effective April 1, 2021

TP 08, TP 43, TP 44 and TP 48

Verification is required for SNAP and TANF during the automated administrative renewal process when:

  • the eligibility outcome of the automated renewal process is “Additional Information Needed”; and 
    • the reasonable compatibility calculation result is “Need Info because ELDS above limit”; or 
    • the person is required to provide verification of information found on a New Hire Report; and
  • a person in the MAGI household is included in a SNAP or TANF budget group.

The person has 10 days to provide verification for SNAP and TANF. Based on the income type and electronic data source used during the automated income verification process, if the person does not provide verification by the 10th day, TIERS automatically takes the following action on the 11th day:

  • Denies SNAP and TANF benefits for the following data sources:
    • quarterly wage data from Texas Workforce Commission (TWC); or
    • New Hire Report data from the Office of the Attorney General (OAG).
  • Notifies staff to adjust SNAP and TANF benefits for the following data sources:
    • unearned Retirement, Survivors and Disability Insurance (RSDI) income data from the Social Security Administration (SSA); or
    • unearned unemployment data from the Texas Workforce Commission (TWC).

Note: Unearned RSDI data from SSA and unearned unemployment data from TWC are valid verification sources for SNAP and TANF. Because New Hire Report data from OAG is not a valid verification source for SNAP and TANF, the person must provide verification of income from the employer shown on the New Hire Report.

B—122.4.1.3 Renewal Correspondence

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

The system generates client correspondence according to the eligibility outcome of the automated renewal process and the action needed by the client.

The following chart lists the correspondence generated for each eligibility outcome of the automated renewal process and the required client response.

Automated Renewal Process: Renewal Correspondence
Eligibility OutcomeCorrespondence and Required Client Response
Eligibility Potentially Approved
  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, notifies the client that they must review the information used to determine their eligibility on Form H1206, Health Care Benefits Renewal - MA.
  • The client is only required to return a signed renewal Form H1206 if the information on the form is incorrect or there are changes to the client’s case.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206.
  • No additional forms are sent with Form H1211.
  • Form TF0001, Notice of Case Action, is mailed to the client to notify him or her of the eligibility determination*.
Additional Information Needed
  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, and Form H1020, Request for Information or Action, are sent to the client.
  • Form H1211 notifies the client that they must return the following:
    • Signed renewal Form H1206, and
    • Required verification(s).
  • Form H1020 identifies all the required verification(s) needed to complete the renewal.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206.

Note: For TP 43, TP 44, and TP 48, Form H1014-A, Children's Health Care Benefits — Final Reminder, is sent if the eligibility outcome is “Additional Information Needed” and the client does not return his or her redetermination packet by the first calendar day in the 11th month of a 12-month eligibility period.

Eligibility Terminated
  • If additional information is needed and the client does not return a renewal form by the 30th day from the date Form H1211 is mailed, eligibility is auto-disposed and denied. No advisor action is needed.
  • If additional information is needed and the client does return a renewal form by the 30th day from the date Form H1211 is mailed, the form is routed to local offices for processing and the advisor manually processes the renewal.
  • Form TF0001, Notice of Case Action, is mailed to the client to notify him or her of the eligibility determination*.

* Form TF0001, Notice of Case Action, is sent when a final eligibility determination has been made. Depending on the renewal status outcome and client action, final eligibility determinations may be made by advisors manually processing renewal documents or by the system automatically. Form TF0001 identifies the dates of the new certification period for Medicaid benefits, potential CHIP eligibility, or the denial reason for not recertifying the case.

B—122.4.2 Processing a Manual Renewal

Revision 20-4; Effective October 1, 2020

TP 08, TP 43, TP 44 and TP 48

The file date is the day that any local eligibility determination office receives an acceptable Medical Program renewal form. The following are considered acceptable Medical Program renewal forms:

  • Form H1206, Health Care Benefits Renewal – MA
  • Form H1206, Health Care Benefits Renewal – ME
  • Form H1010-R, Your Texas Benefits: Renewal Form

A redetermination is considered timely if a renewal form is received by the first calendar day of the 11th month of the certification period. A redetermination is considered untimely if a renewal form is received after the first calendar day of the 11th month of the certification period and through the last day of the 12th month.

Note: If the first calendar day of the 11th benefit month falls on a weekend or a holiday and the redetermination is received on the following business day, the redetermination is considered timely.

Process redeterminations (received timely or untimely) by the 30th day from the date the renewal form is received or by cutoff of the last benefit month of the certification period, whichever is later. Follow the policy in B-123.4, Eligibility Transition from Medicaid to CHIP, when a person returns a renewal form timely and is determined ineligible for Medicaid but eligible for CHIP.

Examples:

Medicaid coverage period is January through December. If the redetermination file date is:

  • October 10, the redetermination must be completed by the December cutoff date to be considered processed timely.
  • December 1, the redetermination must be completed by December 31 to be considered processed timely.

When HHSC receives an acceptable Medical Program renewal form, review the information provided and determine whether the case needs to be updated to reflect the most recent information reported on the form.

Only request information and verification needed to determine eligibility from the household when it is not available through electronic data sources. Verification previously provided must be used to renew eligibility when the verification is still valid. Determine whether there is any verification that can be used before requesting verification from the household.

Allow at least 10 days to provide missing information. The due date must fall on a workday.

Note: Information reported during renewal processing may impact other benefit programs.

B—122.4.2.1 When a Medical Program Renewal Form Is Not Returned

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

When an acceptable Medical Program renewal form, explained in B-122.4.2, Processing a Manual Renewal, is not returned, the system automatically makes an eligibility determination through a mass update based on the eligibility outcome from the automated renewal process. This does not require the advisor to run eligibility or dispose the EDG.

Below are the eligibility outcomes during the automated process:

  • Eligibility Potentially Approved — the client is auto-disposed and approved without advisor action. The file date is the date the EDG is auto-disposed approved, and the client is granted a new 12-month certification period.
  • Additional Information Needed — the client is auto-disposed and denied without advisor action.

Note: When an individual submits income or expense verification without a signed acceptable Medical Program renewal form, advisors manually process information as a change to determine ongoing eligibility for the remainder of the certification period if the client is in a non-continuous period. A signed acceptable Medical Program renewal form is required if additional information is needed to complete the renewal during the automated renewal process.

B—123 Processing Children's Medicaid Redeterminations

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 use the correspondence and processing requirements explained in B-121, Notice of Redetermination/Certification Expiration (for TP 08, TP 43, TP 44 and TP 48), and B-122.4, Medical Program Administrative Renewals.

TP 44 and TP 48

TP 44 and TP 48 must follow the Texas Health Steps requirements explained in A-1531.5, Compliance Requirements.

Related Policy

Continuous Medicaid Coverage, A-832  
Compliance Requirements, A-1531.5  
Data Broker, C-820

B—123.1 Children's Medicaid Redetermination Due Dates

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 follow the administrative renewal process and use the timeliness guidelines explained in B-122.4, Medical Program Administrative Renewals.

Related Policy

Eligibility Transition from Medicaid to CHIP, B-123.4

B—123.2 Children's Medicaid Redetermination Processing Time Frames

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 follow the administrative renewal process and use the timeliness guidelines explained in B-122.4, Medical Program Administrative Renewals.

B—123.3 Reuse of Form H1206 After Denial

Revision 19-2; Effective April 1, 2019

TP 43, TP 44 and TP 48

TP 43, TP 44 and TP 48 follow the policy for reusing renewal forms after the date of denial explained in B-122.3.2, Denied for Failure to Provide Information/Verification.

B—123.4 Eligibility Transition from Medicaid to CHIP

Revision 17-2; Effective April 1, 2017

TP 43, TP 44 and TP 48

When a child certified on TP 43, TP 44 or TP 48 is determined eligible for CHIP at the renewal and there is a delay in CHIP enrollment because of HHSC error and the redetermination packet was received timely, TIERS extends Medicaid eligibility for one or two additional months to allow the family time to complete the process and still retain coverage. The redetermination is considered timely when the redetermination packet is received by the first day of the 11th month and processed by HHSC by the 30th day from the file date.

If the family is solely responsible for the delay, Medicaid coverage is not extended when a child is determined eligible for CHIP.

Advisors use the following chart to determine when to extend Medicaid coverage:

If a child is ineligible for Medicaid but eligible for CHIP and the family ...but HHSC ...then, provide Medicaid coverage ...
completes the redetermination process timely,*does not process the form by the 15th day of the 11th month,for one additional month.
completes the redetermination process timely,*does not process the form by the 15th day of the 12th month,for two additional months.

* Timely means the redetermination form is received from the family by the first day of the 11th month and any required verification is received within specified time frames.

Related Policy

Medicaid Termination, A-825  
Expedited CHIP Enrollment, D-1711

B—123.5 Processing a Redetermination for TP 45 - Transfer to TP 48

Revision 15-4; Effective October 1, 2015

Medical Programs

Advisors use this procedure to provide TP 45 coverage for a child whose TP 45 coverage ends and is eligible for TP 48 coverage.

If the family returns the redetermination packet and the child is eligible for TP 48, the advisor must initiate the review on the TP 45 EDG so that TIERS will build the TP 48 EDG after cutoff in the 11th month of the certification period. Children on TP 45 will be denied at the end of their certification period.

B—123.6 Children's Medicaid Redetermination Expectations

Revision 15-4; Effective October 1, 2015

Children's Medicaid

Staff must process Children's Medicaid redeterminations even if not requested on an associated SNAP application or redetermination, if the SNAP application or redetermination is received in the 10th, 11th or 12th month of a 12-month Children's Medicaid eligibility period.

Note: If the individual misses the appointment for a SNAP application or redetermination, staff must continue processing the Children’s Medicaid redetermination, even if the Children’s Medicaid program was not requested on the application.

The recipient must provide an application or redetermination application to process the Children’s Medicaid redetermination if the SNAP application or redetermination is not received within the specified time frames.

Related Policy

Receipt of Application, A-121  
Deadlines, B-112  
Missed Appointment, B-114  
Redeterminations, B-120  
Processing Redeterminations, B-122

B—124 Processing Untimely Redeterminations

Revision 22-4; Effective Oct. 1, 2022

SNAP

If an application form is not received within the processing redetermination time frames, use initial application processing time frames.

If the person submits an untimely redetermination packet and does not complete an interview, use the related processing time frames policy in the SNAP timeliness charts for applications and all redeterminations.

Note: For phone interviews, make at least two attempts to contact the person. If unable to contact the applicant, mail Form H1830-FA, Application/Review/Expiration/Appointment Notice-Flexible Appointment, to notify the applicant to call the Flexible Appointment toll-free number and complete an interview.  

Notes:

  • Benefits are not prorated if an eligible person submits an untimely reapplication because HHSC fails to provide Form H1830-FA timely. Benefits are provided from the first day of the month after the last benefit month (enter a file date of the first day of that month).
  • Do not use application verification requirements when processing untimely redeterminations. Verification requirements are the same for all redeterminations whether filed timely or untimely.

TP 08, TP 43, TP 44 and TP 48

If a renewal form is not received by the date of denial in the 12th month of the certification period, deny the EDG for failure to return a renewal packet. A renewal form received after the last day of the 12-month certification period must be treated as an application using application processing time frames. The file date is the day HHSC receives the renewal form.

If the renewal form is received after the date of denial but before the last day of the 12th month of the certification period, reopen the Medical Program EDG and process as a renewal.

Related Policy 

Missed Appointment, B-114  
Deadlines, B-112  
Processing Redeterminations, B-122  
SNAP Timeliness Charts for Applications and All Redeterminations, B-160  
Required Verification, C-910

B—125 Processing Special Reviews

Revision 15-4; Effective October 1, 2015

All Programs

Special reviews are contacts with the household outside of the redetermination process. Staff may conduct special reviews by home visits, telephone, or by mailing individuals Form H1020, Request for Information or Action, or a letter.

TANF and Medical Programs

Advisors contact the household to determine whether a change occurred. If the household confirms that no change occurred, the advisor documents the contact. To clear the special review alert task, the advisor must be in Data Collection Initiate Interview in Special Review mode. If the household confirms that a change occurred, the advisor follows policy in B-600, Changes.

If the household fails to furnish verification requested on Form H1020 or misses an appointment scheduled for the special review, the advisor must send Form TF0001, Notice of Case Action, to begin adverse action.

If the individual contacts the office during the adverse action period, the advisor must reschedule the appointment to process the review as soon as possible to avoid interruption of the benefit issuance cycle for the following month. A second Form TF0001 is not required if the individual misses the second appointment. If the individual does not keep the second appointment, the advisor uses the time frame of the original Form TF0001 to determine the effective date of the denial.

Related Policy

Setting Special Reviews, A-2330

B—125.1 Due Dates

Revision 15-4; Effective October 1, 2015

All Programs

An alert for a special review is triggered in TIERS, which generates a task in Task List Manager (TLM) for the special review.

TANF and Medical Programs

Advisors process special reviews before cutoff in the month:

  • the review date falls, if the review is due on or before cutoff; or
  • after the review date, if the review is due after cutoff.

SNAP

Advisors process special reviews by cutoff of the month the review date falls.

B—126 Processing Desk Reviews

Revision 15-4; Effective October 1, 2015

SNAP

A desk review is the processing of a timely or untimely filed SNAP redetermination application without scheduling or conducting an interview with the household. A SNAP redetermination may be completed by processing a desk review when all of the following criteria are met:

  • the household's current SNAP certification period is six months or less;
  • the current and new SNAP certification periods combined will not exceed a total of 12 months; and
  • eligibility for the current SNAP certification was determined without using the desk review process.

Exceptions: Staff must conduct an interview when the household:

  • has a member who is receiving or is applying for TANF or TP 08;
  • failed to complete the application form sufficiently enough (as determined by the local office) to process without an interview;
  • has a member with an intentional program violation (IPV) disqualification; or
  • lives in a drug/alcohol treatment center, homeless shelter, family violence shelter or group living arrangement.

Advisors begin processing a SNAP redetermination as a desk review within seven calendar days after the Packet Received Date (day zero) and issue either Form H1020, Request for Information or Action, or Form TF0001, Notice of Case Action, to the household within the same seven calendar days.

Note: When a SNAP redetermination Packet Received Date is the 10th through the 15th calendar day of the Last Benefit Month, the advisor must ensure that Form H1020 or Form TF0001 is sent to the household early enough to allow the household 10 days to provide missing information, while still allowing time for the final case action to be timely. Timeliness for Desk Reviews is calculated the same as if an interview was held.

Related Policy

Processing Redeterminations, B-122  
Processing Untimely Redeterminations, B-124

B-130, Changes

Revision 02-1; Effective January 1, 2002

See B-600, Changes, for procedures and time frames for processing changes.

B-140, Summary of Due Dates for Form H1020, Request for Information or Action

Revision 15-4; Effective October 1, 2015

All Programs

The due date and final due date entries are shown in the following table. Note: If the 10th or 30th day falls on a non-workday, the due date is the next workday. If the due date is not an HHSC workday (on a weekend or a holiday), the due date advances to the next HHSC workday.

TANF

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Complete redetermination 10 days 10 days
Incomplete redetermination (including the addition of a household member) 10 days 10 days

SNAP

EDG Action Due Date Final Due Date
Application 10 days*
  • 30 days, or
  • 10th day if 10 days end after 30th day
Untimely redetermination (including adding a person at untimely redetermination) 10 days*
  • 30 days, or
  • 10th day if 10 days end after 30th day
Timely redetermination (including adding a person at timely redetermination) 10 days*
  • last workday of last benefit month, or
  • 10th day if 10 days end after last benefit month
Incomplete redetermination (including adding a person at incomplete redetermination) 10 days 10 days

* For SNAP EDGs pended for a missed appointment, the 10-day due date is calculated from the date the form is mailed, usually two days after the H1020-MA is triggered by TIERS or TLM entries. The two additional days for mail time when sending a Form H1020-MA in TIERS is only applicable to SNAP EDGs pended for a missed appointment.

TP 08, TP 43, TP 44 and TP 48

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Complete redetermination 10 days
  • 30 days or by cutoff in the last benefit month of certification, whichever is later; or
  • 10th day if 10 days end after 30th day
Incomplete redetermination (including the addition of a household member) 10 days 10 days

TP 40

EDG Action Due Date Final Due Date
Application 10 days
  • 15 work days, or
  • 10th day if 10 days end after 15th work day

TA 31, TP 34, TP 35, TP 36, TP 56 and TP 32

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day

B-150, Avoiding Invalid Denials Related to Missing Information and Missed Appointments

Revision 23-4; Effective Oct. 1, 2023

All Programs

Ensure correspondence is sent to the person's current address. Update the person’s address if a new address is reported on an application form or if there is a pending change of address.

Deny an EDG for failure to furnish information only if:

  • the due date on Form H1020, Request for Information or Action, has expired;
  • the information was requested on Form H1020; and
  • there is confirmation that the requested information is not in the office such as the front desk, mail room, fax machine or imaged and available through the State Portal. Follow local procedures for locating submitted verifications.

Do not deny an EDG for missed appointment if:

  • the denial date falls before the final due date listed on Form H1020 for applications and timely redeterminations;
  • the agency failed to mail Form H1830-FA, Application/Review/Expiration/Appointment Notice, or Form H1020-MA-FA, Request for Information or Action-Missed Appointment-Flexible Appointment ; or
  • the person files another application after missing the initial appointment date on Form H1830-FA and before the date provided on Form H1020-MA-FA. Follow policy to determine if the new application should be considered a duplicate application. 

SNAP Denial Reminders (PDF)

Related Policy 

Receipt of Duplicate Application, A-121.2

B-160, SNAP Timeliness Charts for Applications and All Redeterminations

Revision 22-4; Effective Oct. 1, 2022

SNAP

Use the charts in this section as a guide to determine the date applicants must complete an appointment and HHSC must provide benefits for the case action to be reported as timely. The charts detail required actions and due dates in the following type situations:

  • applications and untimely redeterminations;
  • timely redeterminations after a regular certification period; and
  • timely redeterminations after a short certification period.

SNAP Applications and Untimely Redeterminations

If then
  • the household completes an interview through the initial cold call attempts; 
  • the household completes an interview on or before the date provided on Form H1830-FA, Application/Review/Expiration/Appointment Notice-Flexible Appointment; 
  • the household completes an interview on or before the 30th day, and the application is not pended for verification; or
  • the household completes an interview on or before the 30th day, and the application is pended for verification and verification is provided timely on or before the 30th day;    
  • if eligible, ensure the household has an opportunity to participate by the 30th day after the file date; or
  • if not eligible, deny the application by the 30th day after the file date. Note: If the 30th day is a non-business day, take appropriate action the following business day.
  • the household completes an interview on or before the 30th day after the file date and the application is pended for verification with a Form H1020, Request for Information or Action, due date before the 30th day and the household fails to provide verification timely; or
  • the household does not complete an interview by the date provided on Form H1830-FA and the 30th from the file date;
deny the application on the 30th day after the file date. Note: If the 30th day is a non-business day, take appropriate action the following business day.
the household does not complete an interview on or before the date provided on Form H1830-FA but completes an interview on or before the 30th day, and the application is pended for verification with a Form H1020 due on or after the 30th day and the household provides verification before the 30th day; dispose by the 30th day: 
  • if eligible, ensure the household has an opportunity to participate by the 30th day; or
if not eligible, deny the application by the 30th day.
the household does not complete an interview on or before the date provided on Form H1830-FA but completes an interview on or before the 30th day, and the application is pended for verification and the household provides it timely on or after the 30th day; dispose on the day the verification is provided. If the household is: 
  • eligible, ensure the household has an opportunity to participate on the day verification is provided; or
  • not eligible, deny the application on the day verification is provided.
the household does not complete an interview on or before the date provided on Form H1830-FA but completes an interview on or before the 30th day, and the application is pended for verification with a Form H1020 with a due date on or after the 30th day and verification is not provided timely; deny the application on the business day after the Form H1020 due date.
the household does not complete an appointment on or before the date provided on Form H1830-FA and does not complete an interview by the 30th day; deny the application on the 30th day after the file date. Note: If the 30th day is a non-business day, take appropriate action the following business day.

Timely SNAP Redeterminations After a Regular Certification Period

If then
  • the household completes an interview through the initial cold call attempts; 
  • the household completes an interview on or before the date provided on Form H1830-FA; 
  • the household completes an interview on or before the last business day of the certification period, and the application is not pended for verification; or
  • the household completes an interview on or before the last business day of the certification period, and verification is provided timely on or before the last day of the certification period;
  • if eligible, approve the redetermination application by the last business day of the certification period; or
  • •    if not eligible, deny the redetermination application by the last business day of the certification period.
Note: If the last day of the certification period is not a business day, take action the last business day before the end of the certification period.
the household does not complete an interview on or before the date provided on Form H1830-FA and does not complete an interview by the last business day of the certification period. deny the application on the last business day of the certification period.
the household does not complete an interview on or before the date provided on Form H1830-FA but completes an interview before the last business day of the certification period, and the application is not pended for verification; dispose the recertification application on the day the household completes the interview.
the household does not complete an interview on or before the date provided on Form H1830-FA but completes an interview on or before the last business day of the certification period, and the application is pended for verification with a Form H1020 and the household provides verification timely.
  • if verification was provided by the last business day of the certification period, process by the last business day of the certification period; or
  • If verification was provided by the Form H1020 due date but after the certification period: 
    • if eligible, ensure the household has an opportunity to participate within five business days after receipt of the verification; or
    • if not eligible, deny the application within five business days after receipt of the verification.
the household does not complete an interview on or before the date provided on Form H1830-FA but completes an interview on or before the last business day of the certification period, and the application is pended for verification with a Form H1020 and the household fails to provide verification by the final due date;
  • if the Form H1020 due date was before the last business day of the certification period, deny the application on the last business day of the certification period; or
  • if the Form H1020 due date was on or after the last business day of the certification period, deny the application on the business day following the due date on Form H1020.

Timely SNAP Redeterminations After a Short Certification Period

If then
  • the household completes an interview through the initial cold call attempts; 
  • the household completes an interview on or before the date provided on Form H1830-FA; 
  • the household completes an interview on or before the 30th day after the last month's full benefit issuance, and the application is not pended for verification; or
  • the household completes an interview on or before the 30th day after the last full month’s issuance, and the application is pended for verification and verification is provided timely on or before the 30th day after the last month's full benefit issuance;
  • if eligible, process the redetermination by the 30th day; or
  • if not eligible, deny the application by the 30th day.
Note: If the 30th day is not a business day, take action on the last business day before the 30th day.
 
  • the household does not complete an interview by the date provided on Form H1830-FA and does not complete an interview by the 30th day after the last month's full benefit issuance.
deny the application on the 30th day. Note: If the 30th day is a non-business day, take appropriate action the following business day.
the household does not complete an interview by the date provided on Form H1830-FA and completes an interview on or before the 30th day after the last month's full benefit issuance, and the application is pended for verification with a Form H1020 and the household provides verification timely;
  • if verification was provided by the 30th day after the last month's full benefit issuance, process by the 30th day;
  • if verification was provided by the Form H1020 due date but after the 30th day after the last month's full benefit issuance: 
    • if eligible, ensure the household has an opportunity to participate within five business days after receipt of the verification; or
    • if not eligible, deny the application within five business days after receipt of the verification.
  • the household completes an interview on or before the date provided on form H1830-FA and the application is pended for verification with a Form H1020 and the household fails to provide verification by the final due date; or
  • the household does not complete an interview on or before the date provided on Form H1830-FA but completes an interview on or before the 30th day after the last month’s full benefit issuance, and the application is pended for verification with a Form H1020 and the household fails to provide verification by the final due date;
  • if the Form H1020 due date was before the 30th day after the last month's full benefit issuance, deny the application on the 30th day; or
  • if the Form H1020 due date was on or after the 30th day, deny the application on the business day following the due date on Form H1020.

B—161 DataMart Reports

Revision 13-3; Effective July 1, 2013

All Programs

DataMart provides a series of online reports accessed through the State Portal. The reports are used as monitoring tools for various EDG action activities for cases in TIERS (including timeliness of those activities). See C-840, DataMart.

B-170, Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must document the reason(s) for delays in processing an application and advisor action as explained in B-113, Delay in Processing Applications.

For missed telephone interviews, advisors must document on the Appointment – Details page the time of each call when attempting to contact the applicant according to policy in B-114, Missed Appointment; B-122, Processing Redeterminations; and B-124, Processing Untimely Redeterminations.

Related Policy

The Texas Works Documentation Guide

B-200, Issuing Benefits

B-210, General Policy

Revision 22-3; Effective July 1, 2022

TANF

The Texas Health and Human Services Commission (HHSC) issues Temporary Assistance for Needy Families (TANF) benefits via Electronic Benefit Transfer (EBT) on a Lone Star Card or warrant. The agency issues all one-time benefits via warrant.

Related Policy

Medicaid Eligibility, A-800
Issuing OTTANF Benefits, A-2451
Issuing One-Time TANF for Relatives Payments, A-2452

SNAP

HHSC issues all Supplemental Nutrition Assistance Program (SNAP) benefits by EBT using a Lone Star Card.

B-220, Benefits

Revision 05-2; Effective April 1, 2005

B—221 Types of Benefits

Revision 23-3; Effective July 1, 2023

TANF and SNAP

There are seven types of benefits:

B—222 Mailing Addresses for Issuing Benefits

Revision 21-4; Effective October 1, 2021

TANF and Medical Programs

Staff issue benefits to the person's physical address, unless the person:

  • is temporarily living at another address;
  • has a post office box or general delivery address;
  • has a guardian; or
  • provides a good reason for a different mailing address, showing the person would suffer hardship if benefits were mailed to their physical address.

Staff should not use a local eligibility determination office address or an employee's physical address as a mailing address, unless the employee is the TANF applicant or recipient.
 

SNAP

The person's physical address is the preferred mailing address to enter in TIERS. However, the person may use another mailing address if they believe it is more secure or they have no physical address.

All Programs

Notes:

  • If a person has a post office box and physical address, both are entered in TIERS, unless they reside in a shelter for battered persons.
  • The U.S. Postal Service does not forward TANF warrants or the Your Texas Benefits Medicaid cards.

B-230, Electronic Benefit Transfer (EBT)

Revision 23-3; Effective July 1, 2023

TANF and SNAP

HHSC issues benefits by EBT and contracts with one or more vendors who perform EBT functions.

When interview staff certify a household, HHSC establishes and deposits benefits in the household's EBT account(s). EBT issuance staff issue a Lone Star Card to the recipient or their representative. These cardholders access benefits using the card with a Personal Account Number (PAN) and a Personal Identification Number (PIN).

The EBT process includes:

  • establishing a primary cardholder (PCH) and EBT account(s);
  • establishing a secondary cardholder (SCH), if requested;
  • issuing a Lone Star Card;
  • pending card registration or allowing the household to select a PIN;
  • replacing a card, if required; and
  • providing a card sleeve, Form H1184 , Here is Your Lone Star Card, and Form H1185, Important Information About Your Lone Star Card.

Related Policy

Establishing a Secondary Cardholder, B-232         
Issuing a Lone Star Card, B-233         
PIN Selection, B-234

B—231 Establishing the Primary Cardholder (PCH)

Revision 23-3; Effective July 1, 2023

TANF and SNAP

The PCH is the head of household (HOH) with the primary responsibility of security and access to the household's benefits in the EBT account. Staff establish the HOH as the PCH, even if the person is a disqualified member.

The HOH must act as the PCH except in the following situations:

  • If the TANF Eligibility Determination Group (EDG) lists a protective payee or representative payee, establish this person as the PCH.
  • If a SNAP recipient lives as a resident in a drug and alcohol (D&A) treatment or group living arrangement (GLA) facility, and the D&A or GLA facility acts as the person's authorized representative (AR), establish the facility AR as the PCH.
If the TANF and SNAP EDGs have...then...
the same EDG name,

establish the HOH as the PCH for both EDGs.

Note: Ensure that the name, date of birth, sex and Social Security number (SSN) match exactly.

different EDG names,establish each EDG name as the PCH for the EBT account associated with their EDG.

To establish an EBT account, TIERS sends the new PCH record to the EBT system using real time interface or batch file. If the EBT system receives a benefit record before the PCH record, the EBT system uses the benefit record to create a PCH record. TIERS sends PCH records to the EBT system when staff:

  • certify or pend a TANF or SNAP application; and
  • change an EDG name, including when:
    • adding, removing, or changing a TANF protective payee or representative payee; or
    • adding, removing, or changing the SNAP AR for a D&A or GLA facility. Note: Staff must update the alternate payee information in TIERS to change the PCH record for an AR in the EBT system.  

Staff complete Part II of Form H1175, EBT Change Request, to change the PCH on a denied EDG or when TIERS cannot send the record due to automation problems.

Note: Do not send a PCH record when pending the TANF or SNAP application due to a missed appointment.       
TIERS updates existing PCH records on active cases any time staff change the cardholder's biographical data or address and complete the Issuance Logical Unit of Work (LUW). The EBT system receives an overnight file from TIERS that updates the PCH record the next day.

To change the cardholder’s biographical data in the EBT system, staff complete a modify request in the EBT Details LUW in TIERS. If the TIERS system is offline and the household meets same-day service issuance criteria, staff must complete Part II of the Form H1175.

Staff complete Part IV of Form H1175 to merge PCH records via the EBT system when a household's TANF and SNAP PCH record information fails to match. 

Related Policy 

Protective Payee, A-171       
Who Is Not Included, A-222       
Splitting and Merging Primary Cardholder Records, B-261.3       
Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440

B—232 Establishing a Secondary Cardholder

Revision 23-3; Effective July 1, 2023

TANF and SNAP

The PCH can establish an SCH only after HHSC certifies the household’s application.

Exception: If staff certify a person for one program and pend the other, the person may authorize a different SCH for each program’s benefit account.

The PCH may authorize:

  • an SCH for only one benefit account;
  • a different SCH for each benefit account; or
  • the same person as the SCH for both the cash account and the food account.

After certification, the PCH can add, remove or change an SCH by calling the Lone Star Help Desk or going to an HHSC local office.

To establish an SCH in an HHSC local office, the PCH must:

  • bring the secondary cardholder to the office;
  • complete the Form SCR, Secondary Cardholder Request;
  • give the form to EBT issuance staff; and
  • provide proof of identity.

Interview staff must ensure the Form SCR is completed and signed by both the PCH and the SCH before completing the Form H1172, EBT Card, PIN and Data Entry Request, and notifying EBT issuance staff to establish an SCH record in the EBT system and complete card issuance.

With supervisory approval in emergency situations, establish account access for an SCH if:

  • the household needs to establish an SCH; and
  • the PCH cannot complete and sign Form SCR for reasons such as age, death, disability, distance to an HHSC local office or inability to appoint an AR.

After supervisory approval, staff get a completed Form SCR signed by another responsible household member. If there are no other responsible household members, staff get a completed Form SCR from the AR, if previously established. If there are no other responsible household members nor an established AR, staff and the supervisor sign below the SCH’s signature, issue the card to the SCH, and document the emergency and inability of the PCH, responsible household member and AR to sign the Form SCR in the case record.

Related Policy

Prudent Person Principle, A-137       
Questionable Information, C-920 

B—232.1 Secondary Cardholder Established by the Lone Star Help Desk

Revision 23-3; Effective July 1, 2023

TANF and SNAP

A PCH may contact the Lone Star Help Desk any time after certification to add, remove, or change an SCH.

When the Lone Star Help Desk receives a request to add or change an SCH, they mail Form SCR, Secondary Cardholder Request, to the PCH. The PCH must complete and sign the form, get  the SCH's signature, and return the form to the EBT vendor to authorize the SCH.

After receiving the completed Form SCR, EBT vendor staff mail the SCH's Lone Star Card to the PCH. The PCH must give the card to the SCH. The SCH must contact the Lone Star Help Desk to authenticate their identity and complete card registration.

When a PCH requests to remove an SCH, the Lone Star Help Desk deactivates the second card immediately.

B—233 Issuing a Lone Star Card

Revision 23-3; Effective July 1, 2023

TANF and SNAP

Staff request Lone Star Card issuance in TIERS when:

  • pending or certifying a SNAP or TANF application;
  • establishing a new PCH record; or
  • establishing an SCH in an HHSC local office.

If the household was mailed a card and instead picks up a card in an HHSC local office, cancel the mailed card. If the Lone Star Card is mailed or issued in-office to someone other than the PCH, pend card registration to require the PCH to authenticate their identity and select a PIN before using their Lone Star Card. Lone Star Cards issued directly to the cardholder in the HHSC local office do not require card registration if the PIN is selected on the PIN pad.

The cardholder should keep their Lone Star Card, even if the household no longer receives a monthly SNAP allotment. If the household meets eligibility for benefit issuance in the future, it allows them to quickly access their EBT account.

Issuing a Card When Pending the Application

When pending an application for more verification, request card issuance by vendor mail-out or in-office, as appropriate, and explain the following to the person being interviewed:

  • The household must provide the requested information and be determined eligible for SNAP or TANF before HHSC deposits benefits into their EBT account.
  • If the household does not already have a Lone Star Card, the vendor mails the card to the PCH with EBT training materials.
  • The household receiving a Lone Star Card does not mean they meet eligibility for benefits or have access to benefits in the EBT account.
  • The PCH must call the Lone Star Help Desk when they receive their Lone Star Card to complete card registration by authenticating their identity and selecting a PIN.
  • After receiving a notice of eligibility, the person should call the Lone Star Help Desk, login to their Your Texas Benefits mobile app to manage their EBT account.

Note: If staff pend the application for verification of ID, request card issuance by vendor mail-out and pend card registration to require the PCH to authenticate their identity before using their Lone Star Card.   

Issuing a Card in an HHSC Local Office

A TANF protective payee or representative payee and D&A or GLA facility PCHs must come to the office to be issued a Lone Star Card. If the TANF protective or representative payee cannot come to the office, staff may request a vendor mail-out and pend card registration.         
When issuing Lone Star Cards in the office, EBT issuance staff must:

  • verify through TIERS inquiry that staff conducted an interview;
  • verify the person meets criteria for in-office issuance, or criteria for a replacement card;
  • verify the identity of the person receiving the card;
  • issue the Lone Star Card and training materials;
  • register the Lone Star Card to the correct EDG number; and
  • follow established security and reconciliation procedures.

Issuing a Card During a Phone Interview

If the household completes the interview by phone and the EBT LUW shows no available card for the EDG, staff request card issuance using the following table.

Table: Issuing a Lone Star Card During a Phone Interview 

If the household interviews by phone and is:then:
  • eligible for expedited SNAP benefits; or
  • interviewed on or after the 25th day after the file date for SNAP benefits,
inform the person of the option to pick-up their Lone Star Card in the HHSC local office.
  • determined eligible at the interview; or 
  • pended for missing information and does not meet the criteria in the box above,
inform the person that they will receive their Lone Star Card by mail.
  • denied at the interview,
do not request card issuance.

Issuing a Card During a Home Visit

If staff complete the interview during a home visit, a Lone Star Card may be issued during or after the home visit. If issuing a card after a home visit, request card issuance by vendor mail-out and pend card registration. If issuing a card during a home visit, staff complete the steps in the following table.

Table: Lone Star Card Issuance During the Home Visit

StepAction
1Interview staff check to see if HHSC previously issued a Lone Star Card. If so, write down the PAN and provide the household with the active card’s PAN during the home visit .
2Interview staff request card issuance from HHSC local office issuance staff by completing Part I of the Form H1172 , EBT Card, PIN and Data Entry Request. 
3HHSC local office issuance staff complete Part II of the Form H1172 and log out a Lone Star Card using Form H1173, EBT Card Issuance Log, ensuring an EBT card can be provided to the household during the home visit. 
4HHSC local office issuance staff sign the Form H1172, get the interviewer’s signature on the Form H1172, and retain their own copy of the Form H1172 until the interviewer returns from the home visit.
5

During the home visit, interview staff ask the PCH, responsible household member or AR if the household has a Lone Star Card and PIN.

  • If the household has a Lone Star Card, then provide the PAN from the EBT LUW to confirm the PAN on the household’s Lone Star Card matches the PAN associated with their EBT account. 
    • If the PANs match, the household should be able to access their benefits using their existing card. If the household needs to reset their PIN, they may contact the Lone Star Help Desk or access their Your Texas Benefits account.
    • If the PANs do not match, complete Step 6.
  • If the household does not have a Lone Star Card, complete Step 6.       
     
6

If interview staff provide the household with the Lone Star Card logged out on the Form H1173 during Step 2, interview staff must:

  • explain that the PCH must select their PIN contacting the Lone Star Help Desk or accessing their Your Texas Benefits account;
  • provide the household with Form H1184, Here is your Lone Star Card, and Form H1185, Important Information About Your Lone Star Card;
  • obtain the PCH, responsible household member or AR’s signature in Part II of the Form H1172; and
  • return the completed Form H1172 to HHSC local office issuance staff.
7

If the household received a Lone Star Card during a home visit, HHSC local office issuance staff must receive a completed Form H1172 from interview staff the same day.

If the household did not receive a Lone Star Card during a home visit, HHSC local office issuance staff must:

  • ensure interview staff returned the Lone Star Card to the HHSC local office the same day;
  • confirm the PAN number on the returned card matches the PAN number on their copy of the Form H1172; and
  • use the Form H1173 to log the card back into inventory.

Related Policy

PIN Selection, B-234       
Lone Star Card Replacements, B-235       
Special Certification Situations, B-240         
Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440         
Residents in Family Violence Shelters, B-450         
Prepared Meal Services, B-460 

B—234 PIN Selection

Revision 23-3; Effective July 1, 2023

TANF and SNAP

In addition to the Lone Star Card, a cardholder must have a PIN to access benefits in the household's EBT account(s). The cardholder selects their PIN in the local office at card issuance or through the Lone Star Help Desk.

If the cardholder has a barrier that prevents them from selecting a PIN, they may request a pre-assigned PIN from the Lone Star Help Desk. The EBT vendor then mails the cardholder a PIN packet. The cardholder's statement about barriers that prevent them from self-selecting a PIN is acceptable.

After initial PIN selection or issuance, a cardholder may select a new PIN at any time by calling the Lone Star Help Desk or accessing their Your Texas Benefits mobile app.

Note: Lone Star Cards deactivated because the wrong PIN was entered five times in one day are reactivated automatically at midnight.

Related Policy

Special Certification Situations, B-240         
EBT Vendor-Produced Materials, B-280         
Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440         
Residents in Family Violence Shelters, B-450         
Prepared Meal Services, B-460

B—235 Lone Star Card Replacements

Revision 23-3; Effective July 1, 2023

TANF and SNAP

An EBT vendor or HHSC replaces a Lone Star Card when:

  • a cardholder has an open EBT account; and
  • cannot access the account because the person’s Lone Star Card was lost, stolen or does not work properly.

If a PCH or SCH reports a lost, stolen or not working Lone Star Card, the EBT vendor mails a replacement card to the PCH's TIERS address within two calendar days of the request. If the TIERS address is not current, the Lone Star Help Desk refers the person to 2-1-1 to update the household’s mailing or issuance address.

In certain situations, the HHSC local office replaces Lone Star Cards. The same policies and procedures for replacing cards for PCHs apply to the secondary cardholders, except that the PCH must go with the secondary cardholder to the HHSC local office to authorize the replacement.

When a cardholder contacts the HHSC local office to request a Lone Star Card replacement, determine the correct action using the chart below:       
 

Replacement Card Criteria 

If the card ...then ...
does not work,inquire on the EBT system to ensure the card is correctly connected to the account.
was lost or destroyed in a household disaster,replace the card only if the household needs access to their account immediately and cannot wait for a replacement by mail from the Lone Star Help Desk.
is lost or stolen, or damaged (and correctly connected to the account)refer the cardholder to the Lone Star Help Desk. The Help Desk cancels the person's Lone Star Card and sends a replacement by mail.* The cardholder can also freeze and unfreeze their Lone Star Card using their YourTexasBenefits.com account.
has unauthorized transactions,replace the card and have the household select a new PIN only if the household has not requested a replacement card by mail through the Lone Star Help Desk or their Your Texas Benefits mobile app.

*Exceptions: EBT issuance staff replace Lone Star Cards in the HHSC local office by the EBT system for cardholders, including Centralized Benefit Services (CBS) recipients, if the:

  • Household is certified for a SNAP application that requires a priority issuance. Interview staff refer the person to EBT issuance staff for an immediate replacement.
  • Person cannot get a replacement from the Lone Star Help Desk because the EBT system does not reflect the cardholder's correct biographical information or current mailing address.
  • Household does not have a secure mailing address. A local eligibility determination office is not a secure mailing address for this purpose.
  • Person has not received a requested replacement from the Lone Star Help Desk within seven calendar days after the order date reflected on the EBT system. EBT issuance staff must identify these replacements on Form H1173, EBT Card Issuance Log, by writing “VR” (Vendor Replacement) under the Replacement Column.

SNAP

To reduce trafficking, the EBT vendor tracks the number of replacement cards issued in a 12-month period. After the initial card issuance to a PCH or secondary cardholder, when a household requests four replacement cards within 12 months, the EBT vendor produces a report for the print vendor. The print vendor sends the household an excessive replacement card notice. The notice advises the household that:

  • they received four replacement cards in a 12-month period; and
  • if the household requests a fifth replacement card, the Office of Inspector General (OIG) receives notification and may investigate their household.

The notice also gives a reminder of what constitutes trafficking.

The excessive replacement card notice directs households to contact 2-1-1 for any questions about the notice. Remind households inquiring about the notice at local offices of appropriate EBT card use and the penalties for trafficking.

The EBT vendor produces a monthly report for OIG identifying households that request a fifth replacement card.

Related Policy

Establishing a Secondary Cardholder, B-232.2         
Benefit Issuance on Applications, B-252         
Destroyed Food Replacements, B-344

B—236 PIN Replacement

Revision 21-3; Effective July 1, 2021

TANF and SNAP

If the cardholder reports they forgot their PIN or that the PIN was compromised, refer the cardholder to the Lone Star Help Desk to select a PIN. If the cardholder cannot self-select a PIN after two attempts, a Lone Star Help Desk operator offers to:

  • provide training or assistance in the PIN self-selection process; or
  • mail a PIN packet to the PCH's address if the person has a barrier that prevents them from self-selecting a PIN.

If the cardholder cannot self-select a PIN because incorrect biographical data was entered, the Lone Star Help Desk refers the person to 2-1-1 to correct the biographical data.

Related Policy

EBT Vendor-Produced Materials, B-280

B—237 PCH Replacements

Revision 23-3; Effective July 1, 2023

TANF and SNAP

When benefits remain in an EBT account and the PCH, other responsible household member or AR is not able or available to access the benefits, staff may use the following table to determine when they may establish a new PCH.

Table: Determining a New PCH

StepQuestionAction
1Did the only household member with account access die, is absent temporarily, become incapacitated or abandon the child?
  • If no, stop. Take no further action.
  • If yes, go to Step 2.
2Is there another responsible household member who may be established as the PCH?
  • If no, go to Step 3.
  • If yes, establish the other responsible household member as the PCH.
3Is the child in the care of another person?
  • If no, stop. Take no further action.
  • If yes, authorize account access to the new PCH using the procedures that follow in this section.

Related Policy 

Issuing a Lone Star Card, B-233      
PIN Selection, B-234      
Lone Star Card Replacements, B-235

B—238 Reserved for Future Use

Revision 21-3; Effective July 1, 2021

 

B—239 Explaining Cardholder Responsibilities

Revision 21-3; Effective July 1, 2021

TANF and SNAP

HHSC must instruct the cardholder about their rights and responsibilities related to EBT.

B—239.1 Explanation of Cardholder Responsibilities at Interview

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Instruct the cardholder to read Form H1185, Important Information About Your Lone Star Card. Ask  the cardholder questions about any EBT issuance procedures the cardholder does not understand. Also explain:

  • Procedures for Lone Star Card issuance and PIN selection to access benefits including:
    • primary cardholder (PCH) and secondary cardholder (including how to establish a secondary cardholder);
    • how access is limited to a person with both the card and the PIN;
    • that there is no charge for using the Lone Star Card for food account purchases; and
    • that to obtain benefits they need to have a card, PIN and available benefits.
  • Timeframes for their initial benefits, if certified, explaining the availability of monthly benefits as specified in Form H1184, Here Is Your Lone Star Card.
  • Methods for how to use the Lone Star Card including how to:
    • make a purchase or cash withdrawal for TANF;
    • check the account balance;
    • identify stores accepting Lone Star Cards;
    • ask store personnel if the store provides TANF cash-back services; and
    • find the TANF cash-back policy.
  • Security for Lone Star Cards, including:
    • how to keep benefits secure;
    • what to do if a card is lost or stolen or the PIN is compromised; and
    • that HHSC will not replace benefits used before a card is reported lost or stolen to the Lone Star Help Desk.
  • A cardholder may still access benefits in their EBT account unless the benefits are expunged due to inactivity.
  • Procedures for moving out of Texas including the:
    • use of the Lone Star Card to access TANF or SNAP benefits at retailers in other states; and
    • recommendation to withdraw all available cash benefits from the cash account before leaving the state.

HHSC may mail a benefit conversion warrant (full month's TANF benefit only) to the household's new address if the:

  • cardholder cannot find a retailer that accepts the Lone Star Card; and
  • the household moved out of state on or after the first of the month but before accessing that month's TANF benefits.

Related Policy

Issuing a Lone Star Card, B-233         
Personal Identification Number (PIN) Selection, B-234         
Cancelling Benefits in EBT Accounts, B-331         
Moves Out of State, B-351         
Dormant Account Policy, B-361         
Expunged Benefits, B-370

B—239.2 Issuance Staff Requirements for Client Training

Revision 21-4; Effective October 1, 2021

TANF and SNAP

After receiving a request authorizing an initial Lone Star Card for the PCH, EBT issuance staff take the following actions:

  • Issue and briefly explain the:
    • Lone Star Card;
    • card sleeve;
    • Form H1184, Here Is Your Lone Star Card; and
    • Form SCR, Secondary Cardholder Request.
  • If issuing the Lone Star Card to someone other than the PCH, explain how to use each item to the person receiving the card.
  • Explain:
    • the importance of saving the last receipt for the current account balance(s);
    • pending card registration, if required;
    • the requirement for the PCH to sign the back of the card;
    • how to protect the card and what to do if it is lost or stolen; and
    • how to protect the PIN and what to do if it is compromised.
  • Advise the person to call the toll-free Lone Star Help Desk at 800-777-7EBT or 800-777-7328 if they have questions or problems accessing benefits.

B-240, Special Certification Situations

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Follow the procedures in this section for households with special needs.

Related Policy

Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440
Residents in Family Violence Shelters, B-450
Prepared Meal Services, B-460

B—241 Reserved for Future Use

Revision 21-4; Effective October 1, 2021

B—242 Reserved for Future Use

Revision 21-4; Effective October 1, 2021

B—243 Centralized Benefit Services (CBS) Cases

Revision 21-4; Effective October 1, 2021

SNAP

Local office staff must not attempt to:

  • issue benefits on a CBS case;
  • make other changes to a CBS case; or
  • make changes to any biographical data on a CBS case.

When local office staff dispose a case that has a SNAP-Supplemental Security Income (SNAP-SSI) or SNAP-Combined Application Project (SNAP-CAP) EDG, TIERS will not allow the disposal of the CBS EDG. A task is generated for CBS staff to dispose the CBS EDG on the same day.

Related Policy

Personal Identification Number (PIN) Selection, B-234
Lone Star Card Replacement, B-235
PIN Replacement, B-236

B—243.1 Centralized Benefit Services (CBS) Case Changes

Revision 22-3; Effective July 1, 2022

SNAP

Regional office staff must not attempt to:

  • issue benefits on a CBS case;
  • make other changes to a CBS case; or
  • make changes to the biographical data of a CBS case.

When regional staff dispose a case with an associated SNAP-Combined Application Project (SNAP-CAP) EDG, TIERS does not allow regional staff to dispose the CBS EDG. A TLM task generates for CBS staff to dispose the CBS EDG on the same day. If the person loses SSI benefits, the EDG is no longer considered a SNAP-CAP EDG and non-CBS staff can dispose the case action.

B—244 Homeless

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Staff must advise homeless households to come to the local office if they require a Lone Star Card or PIN issuance or replacement.

SNAP

Homeless households may use SNAP benefits to purchase prepared meals.

Related Policy

Prepared Meal Services, B-460

B—245 SNAP Applications Filed with the Social Security Administration (SSA)

Revision 21-4; Effective October 1, 2021

SNAP

Staff must follow procedures for phone interviews.

Related Policy

Applicants Interviewed by Phone, B-233.2.2

B-250, EBT Benefit Issuance

Revision 05-4; Effective August 1, 2005

TANF and SNAP

HHSC credits benefits to the cash or food account by sending a benefit record to the EBT system. This section describes the availability of those benefits for use by the cardholder. 

B—251 Monthly Benefit Issuance Schedule

Revision 23-4; Effective Oct. 1, 2023

TANF and SNAP

HHSC sends the files of benefit records for monthly issuances to the EBT system after cutoff each month.

TANF

TANF monthly benefits issued via EBT are available on a staggered basis over the first three days of the month, based on the last number in the EDG number.

Table: Monthly TANF Benefit Issuance Date

Last digit of TANF EDG numberDay
0, 1, 2, 31
4, 5, 62
7, 8, 93

SNAP

Based on the last two digits of the EDG number, households receive their monthly benefits on a staggered basis from the 1st through the 28th day of the month. 

If the household’s benefits are pro-rated at application, the pro-rated benefit amount and the following monthly allotment may be issued as one deposit into the household’s EBT account.

Note: SNAP benefits cannot be issued more than 40 days after the previous issuance. Households with applications certified more than 40 days before their scheduled monthly benefit issuance date have an initial issuance adjustment period until their benefits align with their scheduled monthly benefit issuance date.

SNAP households certified before May 1, 2023, keep their existing issuance schedule based on the date benefits were initially certified, unless there is a break in benefits of at least six months and the household reapplies after May 1, 2023.

Table: Monthly SNAP Benefit Issuance Date

Last two digits of the SNAP EDG numberDay
00-031
04-062
07-103
11-134
14-175
18-206
21-247
25-278
28-319
32-3410
35-3811
39-4112
42-4513
46-4914
50-5315
54-5716
58-6017
61-6418
65-6719
68-7120
72-7421
75-7822
79-8123
82-8524
86-8825
89-9226
93-9527
96-9928

B—252 Benefit Issuance on Applications

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Staff provide benefits according to timeliness standards. Benefit issuances for certified applications are available immediately upon being credited to the account. Benefits requested after cutoff for the next month are available on the first day of the next month, except for SNAP-combined allotments.

SNAP

Staff may issue EBT SNAP benefits very quickly in situations that meet the HHSC criteria for a priority issuance. Request priority issuances only for SNAP benefits in three situations:

  • expedited applications;
  • regular applications certified on or after the 25th day; and
  • benefits ordered by a hearing officer decision that requires a priority issuance to meet timeliness requirements.

The system credits benefits to the person's account in about an hour.

Related Policy

Deadlines, B-112  

B—253 Methods for Sending Benefit Records

Revision 21-4; Effective October 1, 2021

TANF and SNAP

A benefit record may be sent two ways to the EBT system. TANF benefit records are sent only from TIERS. SNAP benefit records are normally sent only from TIERS, but priority issuances may also be sent by manual EBT system entry.

Entries are sent to TIERS through:

  • Real time interface – credits the account right away; or
  • Overnight batch file – credits the account by the next day.

Note: Manual EBT system entry must have supervisor approval.

When interview staff certify an application, the EBT system credits:

  • SNAP priority issuances to the individual's account within one hour after EDG disposition; and
  • TANF benefits and SNAP benefits that are not priority issuances to the individual's account by 8 a.m. CST (Central Standard Time) the day after the EDG is disposed. 

B—254 Benefit Issuance When TIERS Is Unavailable

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Two types of “TIERS unavailable” cases are:

  • TIERS Down – TIERS is completely unavailable and the application or case cannot be accessed.
  • TIERS Read-Only – TIERS is in read-only mode and workers cannot make changes to the EBT LUW for benefit issuance.

When TIERS is Down or is Read-Only, staff must:

  • perform the interview;
  • manually complete essential information on appropriate handbook forms;
  • provide the client with manual notice;
  • enter information into TIERS  once it becomes available; and
  • issue benefits or deny the case based on the household’s eligibility. 

B—255 Priority Issuances Using the EBT System

Revision 23-3; Effective July 1, 2023

SNAP

To send the primary cardholder’s (PCH’s) benefit record by the EBT system data entry process for priority issuances if TIERS is down or read-only, interview staff must:

  • obtain the person's signature on Form H1855, Affidavit for Nonreceipt or Destroyed Supplemental Nutrition Assistance Program(SNAP) Benefits;
  • complete Form H1172, EBT Card, PIN and Data Entry Request, to provide issuance staff the PCH’s information for manual EBT system data entry; 
  • receive approval from the supervisor and the EBT regional coordinator to request manual EBT system benefit issuance; and 
  • notify issuance staff to complete the manual EBT system benefit issuance.

EBT regional coordinators must reconcile EBT system benefit record entries. 

B—256 Discrepancies on Benefit Records Sent via the EBT System

Revision 21-4; Effective October 1, 2021

SNAP

When there is a discrepancy between the benefit records in TIERS and the EBT system, staff use the following chart to determine how actions are processed in TIERS and the EBT system:

If the benefit amount reported to TIERS is ...then ...
more than the amount authorized in the EBT system,the EBT system updates the household's benefit account to reflect the amount reported in TIERS.
less than the amount authorized in the EBT system,TF-07E-01, EBT Reconciliation Exception Report, is produced and sent to management for distribution.

Related Policy

TF-07E-01, EBT Reconciliation Exception, B-262.5

B-260, EBT System

Revision 21-4; Effective October 1, 2021

TANF and SNAP

The Electronic Benefit Transfer (EBT) system is a direct access web-based program. Staff, other than the issuance staff, must request card issuance in TIERS or complete Form H1175, EBT Change Request, to authorize action in the EBT system.

B—261 EBT System Functions

Revision 21-2; Effective April 1, 2021

TANF and SNAP

Designated staff use the EBT system to perform authorized functions. Since there are multiple functions that can be performed using the EBT system, there are multiple levels of access secured by individual sign-on IDs.

B—261.1 Issuing a Lone Star Card or Enabling PIN Self-Selection

Revision 21-4; Effective October 1, 2021

TANF and SNAP

EBT issuance staff use the EBT System to issue Lone Star Cards or enable PIN self-selection when:

  • establishing a new PCH;
  • replacing a Lone Star Card or PIN; or
  • establishing a secondary cardholder in the local office.

B—261.2 Creating a Cardholder Record

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Staff request EBT card issuance in TIERS or complete Form H1172, EBT Card, PIN and Data Entry Request, to establish a primary cardholder record via the EBT system.

B—261.3 Splitting and Merging Primary Cardholder Records

Revision 21-4; Effective October 1, 2021

TANF and SNAP

EBT regional coordinators use the EBT system to split PCH records when EBT accounts are incorrectly linked.

EBT accounts may be incorrectly linked when staff fails to reassign the EDG name to the current head of household from the previous one. As a result, the EBT system links the both EDGs belonging to two different people under one account.

Staff complete Form H1175, EBT Change Request to request that a EBT regional coordinator separate the incorrectly linked accounts.

EBT site and regional coordinators use the EBT system to merge PCH records when the EBT system cannot link them because of discrepancies in the cardholder's biographical data.

Discrepancies may occur in the cardholder's biographical data when staff do not correctly match the name, date of birth (DOB), sex, or SSN on a person's TANF and SNAP EDG numbers. As a result, the EBT system cannot merge the two PCH records into one record with a link to both accounts and a merge is required to allow individual access to both benefits on the same EBT card.

If the person wants to use one card to access both accounts, staff complete Form H1175 to authorize the merge. When the cardholder has one card for the cash account and another for the food account before the merge, the EBT system user indicates which card the person wants to use. After completing the merge, the EBT system automatically disables the card not chosen, and it must be destroyed.

B—261.4 Updating a Primary Cardholder Record

Revision 21-4; Effective October 1, 2021

TANF and SNAP

EBT issuance staff use the EBT system to update the PCH record. This can happen when the current PCH passes away and the PCH record needs to be updated to the current head of household.

Staff complete Form H1175, EBT Change Request, to authorize the PCH record update via the EBT system.

B—261.5 Creating a SNAP Benefit Record

Revision 21-4; Effective October 1, 2021

SNAP

HHSC limits the direct entry of SNAP benefit authorization in the EBT system when TIERS is unavailable, preventing the timely issuance of priority SNAP benefits.

Staff must request EBT card issuance to authorize benefit data entry into the EBT system following established sign-off procedures.

EBT regional coordinators complete EBT system data entry only after receipt of Form H1175.

B—261.6 Performing EBT System Inquiry

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Designated local office staff use the EBT system to perform benefit record inquiry or to validate that a Lone Star Card is active. Staff view the EBT Card Details page to confirm if there is a previously issued Lone Star Card associated with the EDG.

EBT regional coordinators use the EBT system to perform transaction history inquiry.

B—261.7 Changing an EDG Number

Revision 18-1; Effective January 1, 2018

TANF and SNAP

EDG numbers cannot be changed, but multiple EDGs can be entered and connected to the same card.

B—261.8 Pending Card Registration

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Staff pend the Lone Star Card registration during card issuance and in the EBT system when:

  • issuing a card to someone other than the PCH; or
  • mailing a card.

B—262 Reconciliation

Revision 21-4; Effective October 1, 2021

TANF and SNAP

This section provides general information about reconciliation. For details, see the Security and Accountability Handbook and the Eligibility Operations Procedures Manual (EOPM) Appendix: EBT Procedures Manual.

B—262.1 Reconciling EBT System Benefit Records to Forms H1175

Revision 21-4; Effective October 1, 2021

SNAP

Each day EBT staff designated in Local Office Security Plan (LOSP) prints the local EBT Report. This report contains a list of benefit records manually entered on the EBT system, sorted by employee identification number. A designated person must check these entries against Form H1175, EBT Change Request, on a daily basis to ensure accuracy.

B—262.2 Reconciling Benefit Records

Revision 21-4; Effective October 1, 2021

SNAP

Each day EBT staff use the list of benefit issuances on the EBT Report to reconcile the EBT benefit record entries with Form H1175, EBT Change Request. Within five days, state office staff send exception reports (TF-07E-01/TG-37E-1) to field offices to clear within established time frames.

To avoid exception reports, EBT issuance staff must ensure that interview staff report issuances via TIERS within three working days.

B—262.3 Reconciling EBT Card Issuances

Revision 21-4; Effective October 1, 2021

TANF and SNAP

Each day, designated staff use the list of card issuances on the EBT Report to reconcile cards issued in the region.

If the office has problems reconciling these, staff report the problem to the supervisor and the EBT regional coordinator to complete reconciliation.

B—262.4 TF-36, More Than One SNAP Benefit Authorized

Revision 21-4; Effective October 1, 2021

SNAP

After all issuances for a benefit month have been reconciled, state office generates the TF-36 report to display duplicate benefit issuances. Management reviews each SNAP EDG listed on the report to determine how the duplicate issuance occurred:

•    individual error; 
•    suspected fraud; 
•    coding error; or
•    whether the household correctly completed Form H1855, Affidavit for Nonreceipt or Destroyed Food Stamp Benefits, before the duplicate issuance.
 

If there is an overpayment and ...

then...

a signed Form H1855,

submit Form H4834, Individual or Recipient Provider Fraud Referral/Status Report, with the original Form H1855 to the regional Office of Program Integrity, Claims Investigation.

no signed Form H1855,

initiate a nonfraud recovery.

Related Policy

How to File an Overpayment Referral, B-730

B—262.5 TF-07E-01, EBT Reconciliation Exception

Revision 21-4; Effective October 1, 2021

SNAP

When an EBT issuance cannot be reconciled with the TIERS database, state office staff generate and send a TF-07E-01 to the supervisor of the employee who processed the last case action. This report serves as the clearance document to report case findings and actions taken.

Staff check the case record to determine:

  • the reason for the reconciliation exception; and
  • whether the amount of benefits provided to the household is correct.

If the amount of benefits is incorrect because of an ...

then...

overpayment,

initiate recovery.

underpayment,

restore benefits.

Related Policy

How to File an Overpayment Referral, B-730
Restored Benefits, B-800

B—263 Security

Revision 21-3; Effective July 1, 2021

TANF and SNAP

Only authorized staff with special permissions can enter data in the EBT system. Staff are designated by office. They must ensure that all information remains confidential.

The level of user access is determined by the individual user's sign-on ID. Designated employees have authorizations that allow updates to all or part of the system. Other users have inquiry access only.

B-280, EBT Material Inventory/Distribution

Revision 21-4; Effective October 1, 2021

TANF and SNAP

An EBT vendor provides most EBT-related materials, including:

  • Lone Star Cards;
  • Lone Star Card mailers;
  • Lone Star Card sleeves;
  • Form H1184, Here Is Your Lone Star Card;
  • Form H1185, Important Information About Your Lone Star Card; and
  • Form SCR, Secondary Cardholder Request.

To order items produced by the EBT vendor, designated local office staff complete a request for Lone Star Cards or materials and send it to the EBT regional coordinator for secure and non-secure items.

The EBT regional coordinator or authorized regional staff submit the order request to the EBT vendor.

B-300, Account Maintenance

B-310, General Policy

Revision 13-3; Effective July 1, 2013

TANF and SNAP

After HHSC certifies an Eligibility Determination Group (EDG), the advisor uses specific procedures to maintain the Electronic Benefit Transfer (EBT) account and resolve problems.

For information about establishing accounts, see B-200, Issuing Benefits.

B-330, Cancelling Benefits

B—331 Cancelling Benefits in EBT Accounts

Revision 23-3; Effective July 1, 2023

TANF and SNAP

When a Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) household moves out of state before the end of the month, cancel the next month's benefits.

TANF

When a TANF household moves out of state on or after the first day of the month but before that month’s benefit accessibility date, the cardholder can use the Lone Star Card to access benefits at retailers in other states. 
If the cardholder cannot find a retailer that accepts the Lone Star Card, a benefit conversion warrant (full month's benefit amount only) may be mailed to the household's new address. Perform inquiry in the EBT system to determine if the household accessed that month's benefits.

When the agency receives the report of the move:

  • deny the EDG; and
  • advise the cardholder to withdraw the balance from the EBT account.

Actions for the Next Month's Benefits

If the household is ...then ...
ineligible for the next month's benefits because the household left the state before the end of the previous month,cancel the next month's benefits.
eligible for the next month's benefit but unable to use the Lone Star Card out of state,cancel the next month's benefits and reissue with a conversion warrant to the new address.

Do not consider a benefit cancelled until TIERS inquiry confirms cancellation.

Follow policy for deleting months when cancelling benefits for a person whose months count toward a time limit.

SNAP

HHSC cannot cancel benefits in a food account on or after the accessibility date.

When the agency receives a report that the person moved out of state, determine if the move is temporary or permanent. If the move is permanent, deny the EDG.

The cardholder can use the Lone Star Card to access benefits at retailers in other states.

Use the TIERS Benefit Issuance – Maintain EBT Benefits – EBT Cancellation pages to cancel the next month’s benefits.

Do not consider a benefit cancelled until TIERS inquiry confirms cancellation.

Related Policy

Moves Out of Texas, A-740 
Temporary Visits Out of Texas, A-750 
Deleting Months When TANF Benefits are Cancelled or Recouped, A-2533.1 
Explanation of Cardholder Responsibilities at Interview, B-239.1 
Cancelling Benefits Not Used by EBT, B-332 
Using Benefits Out of State, B-350 
Documentation Requirements, B-390 

B—332 Cancelling Benefits Not Issued by EBT

Revision 13-3; Effective July 1, 2013

TANF

If an individual returns a warrant,

  • give the individual the original Form H4100, Money Receipt (PDF); and
  • send the first copy of Form H4100, the warrant, and Form H1008-A, Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-receipt of Warrant (PDF), explaining the reason for the returned warrant to Fiscal Management, Mail Code 3500.

B-340, Replacing Benefits

Revision 23-3; Effective July 1, 2023

TANF and SNAP

HHSC issues benefits by  warrant or EBT. Staff replace TANF warrants, TANF EBT benefits and SNAP EBT benefits only in certain situations.

Related Policy

Agency Replacements, B-341
One-Time Payment Replacements, B-342
Destroyed Food Replacements, B-344

B—341 Agency Replacements

Revision 23-3; Effective July 1, 2023

TANF and SNAP

HHSC designs the EBT systems  and issuance procedures to minimize loss and theft of SNAP and TANF household benefits. HHSC is required to issue agency replacement benefits only if the loss occurred:

  • after the household reports the Lone Star Card lost or stolen and HHSC or an HHSC contractor failed to cancel the household’s Lone Star Card;
  • because of an HHSC local office Lone Star Card issuance error; or
  • because of an unlawful or other erroneous action on the part of HHSC or an HHSC contractor.

Related Policy 

Documentation Requirements, B-390

B—341.1 Procedures for Issuing Agency Replacements 

Revision 23-3; Effective July 1, 2023

TANF and SNAP

If a person receiving EBT reports benefits stolen or lost from the household's EBT account, refer them to the Lone Star Help Desk. Help desk staff research the account credits and debits and work with HHS AES state office staff to determine if HHSC is liable for any loss of benefits that occurred. If state office staff determine a replacement is due because of unauthorized access or card issuance error, the replacement is authorized. 

If a loss occurs because of a card issuance error, staff contact the EBT regional coordinator who notifies the HHSC AES Lone Star Business Services (LSBS) mailbox.

Related Policy 

Balance Disputes, B-382.2
 

B—342 One-Time Payment Replacements 

Revision 23-3; Effective July 1, 2023

TANF

If a person reports a One-Time TANF or One-Time TANF for Relatives warrant (check) as lost, stolen or not received, check TIERS inquiry to see if the warrant was returned to Fiscal Management Services (FMS). The most common reason for non-receipt is a mismatched address. The U.S. Postal Service (USPS) will not forward TANF warrants. If necessary, update the person’s address in TIERS.

When the USPS returns the warrant to state office, FMS staff check inquiry for a new address and immediately re-mail the check, if there is a new address.

If the person does not receive the warrant by the 10th day after HHSC mailed it, request a replacement warrant by sending the appropriate form to FMS:

  • For One-Time TANF, send Form H1008-A, Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-Receipt of Warrant. If using Form H1008-A, write "OTTANF" across the top of the form.
  • For One-Time TANF for Relatives, send Form H1084, Certification for Warrants Lost, Destroyed, Stolen, or Not Received. 

Exception: Send the form immediately if it is obvious a warrant was stolen or destroyed. For Form H1008-A, indicate under "Comments" the reason for the special processing request.

Require the recipient to sign the Form H1008-A or H1084 in the correct space to attest to their statement that they did not receive the warrant and if they receive the first warrant, they will return it to HHS.

Staff may:

  • fax Form H1008-A or H1084 to FMS at 512-487-3400; or
  • send Form H1008-A or H1084 by email by scanning and emailing to the HHSC Warrant Issuance mailbox. 

Staff may call HHS Accounting Operations within FMS at 512-487-3435 to check on the status of the replacement request.

After receiving Form H1008-A or H1084, FMS:

  • complete TIERS inquiry to verify warrant information and status; and
  • obtain the warrant payment status from the Texas Comptroller.

B—342.1 Warrant Not Cashed

Revision 22-3; Effective July 1, 2022

TANF

If the USPS has not returned the warrant to FMS or the recipient has not cashed the warrant, FMS:

  • notifies the Texas Comptroller to cancel the warrant;
  • receives notification when the Texas Comptroller cancels the warrant; and
  • issues a replacement warrant. The word "Replacement" is printed in the upper right corner above the warrant number on the face of the warrant. TIERS inquiry identifies replacement warrants in Benefits Issuance under Issuance Status as “Issued” and Benefit Type as “Replacement."

If the person reports receipt of the original warrant after staff send the replacement request form, call FMS at 512-487-3435 to discontinue the inquiry and replacement process. Instruct the person not to cash the warrant until FMS notifies staff that they have discontinued the replacement process.

B—342.2 Warrant Cashed

Revision 22-3; Effective July 1, 2022

TANF

If someone cashed the warrant, FMS sends the staff person requesting the replacement:

  • a cover memo with instructions;
  • a copy of the warrant;
  • Form 6059-A, Determination of the Validity of a Forgery Claim; and
  • Form 6059-B, Affidavit of Forgery.

Staff:

  • investigate to determine if someone forged the recipient’s signature to endorse and cash the warrant; or
  • investigate if the recipient received any amount of money or benefit from the cashed warrant by perhaps conspiring with others; and
  • complete Form 6059-A to document the determination.
If staff determine the signature endorsing the warrant was ...then staff ...
forged,
  • complete Form 6059-B;
  • request that the recipient signs the form; and
  • return Forms 6059-A and B to FMS.
not forged,send only Form 6059-A to FMS.

If it is not a forgery and the recipient is the one who endorsed the warrant, the process stops. The recipient is not eligible for a replacement warrant.

If the signature is a forgery:

  • FMS sends the completed packet to the Texas Comptroller’s office for a final determination. 
  • The Texas Comptroller requests money back from the original cashing establishment.
  • The Texas Comptroller notifies FMS that the cashing establishment has returned payment. 
  • FMS issues a replacement warrant.

Note: The cashing establishment has up to nine months to investigate and return the payment to the Texas Comptroller.

For issues or further instructions and information, staff may contact HHS Accounting Operations within FMS by:

B—343 Reserved for Future Use

Revision 22-3; Effective July 1, 2022

B—344 Destroyed Food Replacements

Revision 23-4; Effective Oct. 1, 2023

SNAP

Replacements may be issued when food purchased with SNAP benefits was destroyed in a household disaster. To report that food has been destroyed in a household disaster, the HOH, a responsible household member or AR must go to an HHSC local office to complete a destroyed food replacement benefit request.

A household disaster may:

  • impact one or more households; and 
  • be an event that results in food purchased with SNAP benefits being destroyed, such as: fire, flood, tornado, accident, power outage or other similar event.

A household disaster does not include damage or destruction resulting from events within the household’s control, such as:

  • pets or children;
  • utility disconnection; or
  • deferred household maintenance.

When a household reports destroyed food, verify the disaster and issue destroyed food replacement benefits unless the household:

  • failed to report the loss within 10 days of discovering the destroyed food; or
  • received a disaster benefit issuance in the same month as the replacement request.

Issue replacement benefits for the household’s reported loss up to a maximum of the household’s last monthly allotment. If the household’s last monthly allotment included restored benefits, include the full value of the restored benefit with the replacement. Do not impose a limit on the number of destroyed food replacement requests.

Related Policy 

Prudent Person Principle, A-137
Questionable Information, C-920 

B—344.1 Procedures for Issuing Destroyed Food Replacements

Revision 23-3; Effective July 1, 2023

SNAP

To issue destroyed  food replacement benefits, take the following steps:

StepAction
1

Require the head of household, responsible household member or AR to go to an HHSC local office and complete Form H1855, Affidavit for Nonreceipt or Destroyed Supplemental Nutrition Assistance Program (SNAP) Benefits, to request replacement of destroyed food.

or

Mail Form H1855 to get the person’s signature if a responsible household member or AR cannot come to the HHSC office because of:

  • age;
  • disability;
  • distance to the HHSC office; or
  • inability to appoint an AR.

Issue a replacement only when HHSC receives the completed and signed Form H1855 within 10 days of the request for replacement.

2

Verify the disaster and date by:

  • contacting a collateral source; 
  • receiving documentation from a community agency, such as the fire department or Red Cross; or 
  • visiting the person’s home.
3Issue a replacement benefit via TIERS – Benefit Issuance – Request Manual Issuance.

Note: Authorized staff receive a request to approve the issuance.

Related Policy

Prudent Person Principle, A-137
Questionable Information, C-920

B-350, Using Benefits Out of State

Revision 18-1; Effective January 1, 2018

TANF

Texans who leave the state should be able to use the Lone Star Card to access TANF benefits at retailers in other states.

People from other states may use EBT cards to access TANF benefits at retailers in Texas. When local office staff receive inquiries, advise the cardholder to try the card at stores that accept EBT cards in Texas. If it does not work, advise the person to contact the help desk of the state that issued the card.

SNAP

Texans who leave the state can use the Lone Star Card to access SNAP benefits at retailers in other states.

People from other states may use their EBT cards to access SNAP benefits at retailers in Texas. When local office staff receive inquiries, advise the cardholder to try the card at stores in Texas that accept SNAP benefits. If it does not work, advise the person to contact the help desk of the state that issued the card.

 

B—351 Moves Out of State

Revision 13-3; Effective July 1, 2013

TANF

If the household reports a move or temporary absence from Texas, follow the policy in A-740, Moves Out of Texas, and A-750, Temporary Visits Out of Texas, to determine whether to consider the move temporary or permanent.

The cardholder should be able to use the Lone Star Card to access benefits at retailers in other states. Advise the individual of the following:

  • Withdraw any amount of benefits remaining in the cash account before leaving.
  • Take your Lone Star Card.

Note: If the individual reports that the individual does not have a Lone Star Card, advise the individual to contact the Lone Star Help Desk.

  • In order to use cash benefits that were not accessible before the move, try the card at stores that accept EBT in other states. Ask if the store charges a fee and the amount of the fee. Verify and accept any fees before completing the cash withdrawal.
  • Call the Lone Star Help Desk at 1-800-777-7EBT (1-800-777-7328) if your Lone Star Card does not work. The Lone Star Help Desk assists the cardholder in finding an out-of-state retailer that accepts the Lone Star Card. Note: If the cardholder cannot find a retailer that accepts the Lone Star Card and moved out of state on or after the first of the month but before accessing that month's TANF benefits, HHSC may mail a benefit conversion warrant (full month's benefit amount only) to the household's new address. The Lone Star Help Desk will advise these cardholders to contact the local eligibility determination office. See B-331, Cancelling Benefits in EBT Accounts.

SNAP

If the household reports a move or temporary absence from Texas, follow the policy in A-740 and A-750 to determine whether to consider the move temporary or permanent.

The cardholder can use the Lone Star Card to access benefits at retailers in other states. Advise the individual of the following:

  • Take your Lone Star Card.

Note: If the individual reports that the individual does not have a Lone Star Card, advise the individual to contact the Lone Star Help Desk.

  • In order to use SNAP benefits, try the card at stores that accept SNAP in other states.
  • Call the Lone Star Help Desk at 1-800-777-7EBT (1-800-777-7328) if your Lone Star Card does not work. The Lone Star Help Desk assists the cardholder in finding an out-of-state retailer that accepts the Lone Star Card.

 

B—352 Households Shopping Out of State

Revision 13-3; Effective July 1, 2013

TANF and SNAP

Cardholders can use the Lone Star Card out of state. As a result, some households may continue to use benefits without reporting an out-of-state move. Households receiving benefits in Texas who shop out of state consistently, without shopping in Texas, may no longer meet residency requirements. See A-740, Moves Out of Texas, and A-750, Temporary Visits Out of Texas.

 

B—353 Out-of-State Shopping (OSS) Reports

Revision 13-3; Effective July 1, 2013

TANF and SNAP

State office produces a Non-Border OSS Report and a Border OSS Report monthly. Both reports list Lone Star Card usage for households that:

  • shopped out of state in the last 60 days;
  • did not shop in Texas during that period; and
  • have active EDGs.

The Border OSS Report lists households with Lone Star Card usage in states that border Texas (Arkansas, Louisiana, Oklahoma and New Mexico). The Non-Border OSS Report lists households with Lone Star Card use in states that do not border Texas.

State office sends the Non-Border OSS report to Eligibility Operations each month for appropriate action as a potential change in Texas residence. This data also is included in a combined Data Broker report if the OSS occurred in the prior 12 months.

The Border OSS Report is not sent to Eligibility Operations each month for clearance. The data is included in a combined Data Broker report if the OSS occurred in the prior 12 months. EDGs that appear on the Border OSS Report must be cleared at a complete action after a household submits an application or redetermination.

 

B—353.1 Advisor Action on OSS Report Activity

Revision 19-4; Effective October 1, 2019

TANF and SNAP

Clearing Non-Border OSS Report Activity at a Change Action

Send the household Form H1020, Request for Information or Action, requesting verification of the household's address.

Exception: Clearing Non-Border OSS activity as a change action is not required when the household's most recent OSS activity occurred in the:

  • month prior to the periodic review month or in the periodic review month of the household's TANF Eligibility Determination Group (EDG); or
  • next to last benefit month or last benefit month of the household's SNAP EDG.

Clearing Non-Border OSS Report Activity at a Complete Action

The household must provide verification of the household's address when:

  • the most recent OSS activity occurred within six months of the current interview/desk review month; and
  • the OSS activity listed in the report was not previously cleared.

The interview/desk review month is month zero.

Note: Act on any associated Medical Program(s) as appropriate.

After a household has been asked to provide verification of the household's address, take the following action.

If the ... then ...
household provides verification of the household’s address, determine continued eligibility for all programs based on residency requirements.
household does not provide verification of the household’s address, deny the SNAP EDG and any associated TANF/Medical Program EDGs for failure to provide information.
agency receives returned mail with no forwarding address and the household cannot be located, deny the SNAP EDG for failure to provide information and any associated TANF/Medical Program EDGs for unable to locate.

Clearing Border OSS Report Activity

The requirement to clear the Border OSS Report only applies at a complete action. This report must be cleared at a complete action when a household submits an application or redetermination and the OSS activity in the report makes the household’s address questionable.

Example: A household living in Texas near the Arkansas border and shopping in Arkansas may not be questionable. A household living in Austin and shopping in Arkansas would be questionable.

When a household’s address is questionable, follow the policy outlined above for clearing a Non-Border OSS Report Activity at a Complete Action. If necessary, send the household Form H1020, Request for Information or Action, requesting verification of the household's address.

 

B—354 Card Replacements for Cardholders Who Are Out of State

Revision 13-3; Effective July 1, 2013

TANF and SNAP

If a Texas individual who is out of state reports that the individual’s Lone Star Card was lost or stolen, advise the individual to contact the Lone Star Help Desk at 1-800-777-7EBT (1-800-777-7328).

B-370, Expunged Benefits

Revision 13-3; Effective July 1, 2013

TANF and SNAP

Expungement is a process in which HHSC removes unused TANF or SNAP benefits from an EBT account and returns them to the state or federal government.

B—371 Expungement Policy

Revision 23-1; Effective Jan. 1, 2023

TANF

HHSC expunges TANF benefits if:

  • the household does not access its cash account for one year; or
  • benefits remain in an account past their availability period.

Note: If the TANF household does not access its cash account for one year, HHSC removes the entire balance.

SNAP

HHSC expunges:

  • SNAP benefits remaining from a particular month's issuance when the:
    • household does not access the account for nine months; and
    • benefit was issued more than nine months before the expungement file is processed; or
  • the entire food account when HHSC denies an entire household because of death.

HHSC mails Form H0599, Notice of Expungement, to households 30 days before the expungement of unused benefits. Form H0599 informs the household that unused SNAP benefits will be removed from their EBT account if they do not make a purchase using their Lone Star Card before the date listed on the notice.

B—372 Advisor Procedures for Expunged Benefits

Revision 20-4; Effective October 1, 2020

TANF and SNAP

Explain expungement policy to people who inquire about these benefits.

Except for death denials, inform people who dispute the expungement or believe it was in error that their dispute will be routed to the Regional EBT Coordinator for review. Within two business days of receiving the dispute, the Regional EBT Coordinator will inform the person of the outcome.

SNAP

Staff is responsible for expungements resulting from death denials.  

If the expungement resulted from an erroneously processed denial, restore benefits within one business day of discovering the error. Using a manual issuance in TIERS:

  • round the benefits down to the nearest dollar if the balance includes 49 cents or less; or
  • round up if it includes 50 cents or more.

Related Policy

Expungement Policy, B-371

B-380, EBT Problem Resolution

Revision 23-3; Effective July 1, 2023

TANF and SNAP

HHSC staff use the following policies to handle electronic benefit transfer (EBT) related inquiries from households and retailers.

B—381 Retailer Inquiries

Revision 23-3; Effective July 1, 2023

TANF and SNAP

Refer retailers who have EBT questions or need a manual voucher authorization to the Lone Star Retailer’s Help Desk at 877-209-5339.

Refer retailers to the SNAP Retailer Service Center 877-823-4369 or the Food and Nutrition Service website for questions about the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) retailer authorization process. 

B—382 Client Inquiries

Revision 23-3; Effective July 1, 2023

TANF and SNAP

Refer a household to the Lone Star Help Desk (800-777-7EBT or 800-777-7328) or to their Your Texas Benefits mobile app if the household contacts HHSC to request information about their EBT account and the question is not about eligibility. Households can call the Lone Star Help Desk or use their Your Texas Benefits account to manage their EBT account to:

  • request replacement Lone Star Cards and personal identification numbers (PINs);
  • view account transaction history, balances and upcoming deposits;
  • freeze and unfreeze their account for theft prevention; and
  • file a dispute with the Lone Star Help Desk because of a discrepancy with a retailer.

Note: Only the primary cardholder (PCH) can view the household’s EBT account information in their Your Texas Benefits account.

A household has 90 calendar days from the date the error occurred in an EBT transaction to file a dispute with the Lone Star Help Desk and request an adjustment. The EBT vendor reviews the request and notifies the household of the vendor’s determination. Within 10 business days the EBT vendor must:

  • investigate the dispute;
  • determine the household's eligibility for an adjustment;
  • send the household a written notice informing them of the decision; and
  • make the adjustment to the household’s EBT account, if applicable.

If the household disagrees with the vendor’s decision after receiving the written notice, they may contact the HHSC Access and Eligibility Services (AES) Lone Star Business Services (LSBS) Mailbox for a second review.

The household has the right to request a fair hearing.

Related Policy

Advisor Procedures for Expunged Benefits, B-372 
Balance Disputes, B-382.2 
Fair Hearings, B-1000.

B—382.1 Cardholder Problems Accessing Benefits

Revision 22-1; Effective January 1, 2022

TANF and SNAP

Contact the EBT site coordinator when after card issuance:

  • Benefits show in TIERS, but not in the EBT system, and both the card and PIN appear to work properly.
  • Benefits show in the EBT system with no benefit number, but the benefits do not show in TIERS.

B—382.2 Balance Disputes

Revision 23-3; Effective July 1, 2023

TANF and SNAP

If the household reports a balance dispute because of unauthorized use on their EBT account, explain they need to:

  • call the Lone Star Help Desk (800-777-7EBT or 800-777-7328) to request a replacement card and PIN; and
  • go to HHSC local office to complete an unauthorized use replacement request.

If the household reports a balance dispute because of a retailer error, determine if they contacted the Lone Star Help Desk.

  • If yes, forward the complaint to the HHSC AES LSBS Mailbox .
  • If no, refer the complaint to the Lone Star Help Desk.

Related Policy 

Client Inquiries, B-382 
 

B—382.3 Client Problems with Retailers

Revision 23-3; Effective July 1, 2023

TANF and SNAP

Forward a complaint to the HHSC AES LSBS Mailbox when a person reports any problem with a retailer, other than a balance dispute .

B—382.4 Client Problems with an EBT Vendor

Revision 23-3; Effective July 1, 2023

TANF and SNAP

Forward the complaint to the HHSC AES LSBS Mailbox when a person reports a problem with an EBT vendor or the Lone Star Help Desk .

 

 

B-400, Special Households

B-410, Students in Higher Education

Revision 13-4; Effective October 1, 2013

 

B—411 General Policy

Revision 15-4; Effective October 1, 2015

SNAP

A student in higher education is one who is enrolled at least half-time (as defined by the institution) in a college or university curriculum that offers degree programs, regardless of whether a high school diploma is required for admittance, or at a business, technical, trade or vocational school that normally requires a high school diploma or equivalent for admittance.

Student higher education policy does not apply to individuals:

  • under age 18 (students are 18 the month after the student's 18th birthday);
  • age 50 or older (students are 50 the month of the student's 50th birthday);
  • enrolled in curricula (such as beauty school or auto mechanics) that do not require a diploma or the equivalent for entrance; or
  • enrolled only in English as a second language curriculum.

Enrollment begins the first day of the first school term. For example, a high school senior might be accepted by a college and register for classes before graduation; however, the Texas Health and Human Services Commission (HHSC) does not consider the student enrolled until the first day of the college term.

Once enrolled, HHSC considers the student enrolled through vacation and recess, until the student graduates, is expelled, drops out, or does not intend to register for the next usual term, excluding summer school. A student remains enrolled between terms, breaks, and during summer vacations unless the student does not intend to return to school the next term.

 

B—412 Student Eligibility Requirements

Revision 21-1; Effective January 1, 2021

SNAP

A student qualifies for the Supplemental Nutrition Assistance Program (SNAP) if the student meets at least one of the followings:

  1. Unfit for employment. If not evident, proof is required from a certified doctor or psychologist, or receipt of permanent or temporary disability benefits issued by government or private sources must be verified.
  2. Employed for pay an average of 20 hours a week. If self-employed, the student must work an average of 20 hours a week and earn at least the federal minimum hourly wage.
  3. Participating during the regular school year in a state or federally-funded work study program. The student must be working at a job for pay or for dollar credits against tuition charges. This does not include students who must work for academic requirements, such as interns and student teachers. The student exemption begins the month the school term begins or the work study is approved to begin, whichever is later. The student exemption stops:
  • if the student quits working (unless it results solely from lack of work study funds); or
  • when there is a break between terms of a full calendar month or longer unless the student continues work study during the break.
  1. Enrolled in school through one of the following programs:
  • Workforce Innovation and Opportunity Act (WIOA);
  • Choices;
  • SNAP Employment and Training (E&T);
  • Trade Adjustment Assistance (a program administered by the Texas Workforce Commission); or
  • other state and local government training programs approved by state office as equivalent to E&T.
  1. Participating in an on-the-job training program (classroom study is not considered on-the-job-training for this purpose).
  2. Approved for Temporary Assistance for Needy Families (TANF).
  3. Responsible for the care of a dependent child who is a certified household member and the child is:
  • under 6 years old;
  • at least 6 but under 12, and the student states there is no other available child care, which prevents the student from attending class and complying with work requirements in #2 or #3 above.

    Note: If both parents or caretakers are students, both cannot obtain student eligibility by caring for the same child.
  1. A single parent (natural, adoptive or stepparent in the home or other single adult with parental control) who is:
  • enrolled full-time (as determined by the school); and
  • responsible for the care of a child under 12.

 

B—413 Ineligible Students

Revision 15-4; Effective October 1, 2015

SNAP

A student who does not meet the student eligibility requirements is not a member of the household. Do not count the student's income and resources for the remaining household members. If an ineligible student is also disqualified for another reason, the student is treated as a disqualified member.

If an ineligible student is also disqualified for another reason, the student is treated as a disqualified member. Advisors follow resource policy in A-1210, General Policy, and income policy in A-1362, Disqualified Members.

 

B—414 Work Registration

Revision 13-4; Effective October 1, 2013

SNAP

Eligible students are exempt from work registration during the regular school term. This exemption continues between terms, breaks and through scheduled school vacations for students who remain enrolled.

 

B—415 Verification Requirements

Revision 16-4; Effective October 1, 2016

SNAP

Staff must verify self-employment hours of students who work at least a weekly average of 20 hours and earn at least the federal minimum hourly wage. If the student does not provide verification by the due date, the student will be denied for failure to provide and is considered an ineligible student, unless they meet another student eligibility requirement as described in B-412, Student Eligibility Requirements.

 

B—416 Documentation Requirements

Revision 16-4; Effective October 1, 2016

SNAP

Advisors must document the student's eligibility, if questionable.

B-420, Other Special Situations

Revision 13-4; Effective October 1, 2013

 

B—421 Food Distribution Program on Indian Reservations (FDPIR)

Revision 24-2; Effective April 1, 2024

SNAP

FDPIR is a food distribution program that provides commodity foods to low-income households living on an Indian reservation, and to Native American families living near reservations. The Indian tribe administers this program under approval from the Food and Nutrition Service (FNS). Households eligible for the FDPIR receive a monthly food package based on the number of household members. The following tribes are the only tribes approved to receive FDPIR in Texas:

  • Alabama-Coushatta Tribe of Texas in Polk County; and
  • Choctaw Nation of Oklahoma in Bowie, Fannin, Lamar, and Red River Counties.

A household cannot participate simultaneously in SNAP and FDPIR. An Indian Tribal Household eligible for both programs may participate in only one of the programs of its choice in a month. The household may switch from one program to the other, but benefits must be ended in one program before certifying the household for the other program. Benefits in the new program can be issued for the month after benefits end in the previous program. 

B—421.1 Duplicate Participation

Revision 24-2; Effective April 1, 2024

HHSC staff must identify household members receiving duplicate benefits with SNAP and FDPIR. The household can be denied from either program. If duplicate participation occurs, a household overpayment occurs for the program that was certified for benefits last. HHSC staff must send an overpayment referral to the Office of Inspector General (OIG) if the overpayment occurred in SNAP.

The Livingston HHSC office receives a monthly list of certified FDPIR households in Polk County from the Alabama-Coushatta Tribe of Texas.

The Paris HHSC office receives a monthly list of certified FDPIR households in Bowie, Fannin, Lamar, and Red River from the Choctaw Nation of Oklahoma.

HHSC staff must:

  • perform inquiry to identify any household members receiving benefits in both FDPIR and SNAP;
  • notify FDPIR staff about any household member with duplicate participation; and
  • deny SNAP, if appropriate, and refer the household to OIG for a SNAP overpayment.

Related Policy

How to File an Overpayment Referral, B-730 

B—421.2 Intentional Program Violation (IPV)

Revision 13-4; Effective October 1, 2013

Any member disqualified from SNAP for an IPV is also disqualified from participating in the FDPIR program. Likewise, any member disqualified from FDPIR for an IPV is also disqualified from participation in SNAP for the full length of the IPV disqualification period. Advisors follow policy in B-940, Texas Works (TW) Responsibilities. 

B—421.3 Switching from FDPIR to SNAP

Revision 24-2; Effective April 1, 2024

SNAP

Verify that the Indian Tribal Household does not receive FDPIR before determining SNAP eligibility by contacting FDPIR tribal staff.

Note: Alabama and Oklahoma are the only other states that can be entered in the Out of State Benefit Logical Unit of Work in this situation. Staff must document the facts in the Texas Integrated Eligibility Redesign System (TIERS) Case Comments.

B—421.4 Switching from SNAP to FDPIR

Revision 15-4; Effective October 1, 2015

SNAP

For Indian Tribal Households switching from SNAP to FDPIR, staff must:

  • process the switch as a verbal request for voluntary withdrawal from SNAP;
  • send Form TF0001, Notice of Case Action, allowing adequate notice;
  • terminate SNAP benefits for the household as soon as possible so the household may be certified for FDPIR; and
  • notify FDPIR staff of the SNAP denial effective date for the household.

Related Policy

Form TF0001 Required (Adequate Notice), A-2344.1 

B—421.5 Verification Requirements

Revision 24-2; Effective April 1, 2024

SNAP

Verify that the Indian Tribal Household does not receive FDPIR and if there is a current FDPIR IPV before determining SNAP eligibility by contacting FDPIR tribal staff.

FDPIR tribal staff must contact the Livingston or Paris HHSC offices to verify the household does not receive SNAP or have a current SNAP IPV disqualification before certifying the household for FDPIR. 

B—421.6 Documentation Requirements

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must document the:

  • name and telephone number of the FDPIR staff who provides verification; and
  • name of the household member currently disqualified for an IPV in FDPIR.

Related Policy

Documentation, C-940

B-430, Households with Elderly Members or Members with a Disability

Revision 13-4; Effective October 1, 2013 

B—431 Definition of Elderly

Revision 01-1; Effective January 1, 2001

SNAP

An elderly person is someone who is age 60 or older as of the last day of the month. 

B—432 Definition of Disability

Revision 15-4; Effective October 1, 2015

SNAP

The following people are considered to have a disability:

  • People approved for Supplemental Security Income (SSI), Social Security disability or blindness payments, or SSI Medicaid only.
  • Veterans who receive Veterans Affairs (VA) benefits because they are rated a 100 percent service-connected disability or who, according to the VA, need regular aid and attendance or are permanently housebound.
  • Surviving spouses of deceased veterans who meet one of the following criteria according to the VA:
    • need regular aid and attendance,
    • are permanently housebound, or
    • are approved for benefits from the VA because of the veteran's death and could be considered to have a permanent disability for Social Security purposes. (See B-432.1, Social Security's Criteria for Disability.)
  • Surviving children (any age) of a deceased veteran who the VA:
    • determines are permanently incapable of self-support, or
    • approves for benefits because of the veteran's death and could be considered to have a permanent disability for Social Security purposes. (See B-432.1.)
  • People receiving disability retirement benefits from any government agency for a disability that could be considered permanent for Social Security purposes.
  • People receiving Railroad Retirement Disability who are also covered by Medicare. 

B—432.1 Social Security's Criteria for Disability

Revision 15-4; Effective October 1, 2015

SNAP

The Social Security Administration (SSA) considers that any of the following 12 conditions result in permanent disability:

  • Permanent loss of use of both hands, both feet, or one hand and one foot.
  • Amputation of leg at hip.
  • Amputation of leg or foot because of diabetes mellitus or peripheral vascular diseases.
  • Total deafness, not correctable by surgery or hearing aid.
  • Statutory blindness, unless caused by cataracts or detached retina.
  • IQ of 59 or less, established after the person becomes age 16.
  • Spinal cord or nerve root lesions resulting in paraplegia or quadriplegia.
  • Multiple sclerosis in which there is damage to the nervous system caused by scattered areas of inflammation. The inflammation recurs and has progressed to varied interference with the function of the nervous system, including severe muscle weakness, paralysis, and vision and speech defects.
  • Muscular dystrophy with irreversible wasting of the muscles, impairing the ability to use the arms or legs.
  • Impaired renal function caused by chronic renal disease, resulting in severely reduced function which may require dialysis or kidney transplant.
  • Amputation of a limb of a person at least age 55.
  • AIDS progressed so that it results in extensive and/or recurring physical or mental impairment.

If the individual already receives SSI or Social Security blindness or disability payments, or the disability is obvious to the advisor (such as amputation of leg at hip), the advisor does not require additional verification. Other conditions may require the opinion of a physician. Advisors use Form H1836-A, Medical Release/Physician's Statement, in these instances. 

B—433 Special Provisions for Households with Elderly Members or Members with a Disability

Revision 20-3; Effective July 1, 2020

SNAP

Households containing members who are elderly or who have a disability receive special treatment. The special provisions are:

  • exemption from the gross income test;
  • allowance of a deduction for medical expenses when the medical expenses exceed a total of $35 per month for all eligible members who are elderly or who have a disability; and
  • allowance of an uncapped excess shelter deduction for the full monthly amount that exceeds 50 percent of the household's monthly income after the allowable deductions.

Exception: Households with members who are disqualified for not meeting SSN requirements, alien status requirements or for reaching ABAWD time limits are ineligible for an uncapped excess shelter deduction. Household members who are disqualified for another reason are eligible for the uncapped excess shelter deduction when there is a member of the household who is elderly or has a disability.

Related Policy

Income Limits and Eligibility Tests, A-1341 
Medical Deduction, A-1428 
Shelter Costs, A-1429 
Deduction Amounts, C-121.1 

B—434 Verification Requirements

Revision 20-3; Effective July 1, 2020

SNAP

Verify that a household member:

  • is age 60 or older; or
  • meets the disability criteria in B-432, Definition of Disability.

Related Policy

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

B—435 Documentation Requirements

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must document:

  • the reason the individual is considered to have a disability (see B-432, Definition of Disability);
  • how age was verified (see B-431, Definition of Elderly); and
  • how disability was verified (see B-432).

Related Policy

Documentation, C-940

B-440, Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities

Revision 22-1; Effective January 1, 2022

B-441 Residents of D&A Facilities

Revision 22-1; Effective January 1, 2022

SNAP

People receiving chemical dependency treatment and residing in a facility that conducts a chemical dependency program may qualify for SNAP, regardless of the number of meals the facility provides, if the treatment facility is an approved institution. A D&A facility is an approved institution, if it is:

  • certified as a retailer by the Food and Nutrition Service (FNS) to accept SNAP benefits; or
  • a private, nonprofit organization or institution or a publicly operated community mental health center. To qualify under this provision, the facility or organization must also meet one of the following requirements:
    • be licensed by the Texas Department of State Health Services (DSHS) to operate a chemical dependency treatment facility; or
    • have written verification from DSHS that it is a registered faith-based exempt chemical dependency treatment program under Texas Health and Safety Code, Chapter 464, Subchapter C, and is recognized by DSHS as operating a program that furthers the purposes of Part B of Title XIX of the Public Health Service Act, the rehabilitation of drug addicts or alcoholics. The facility does not have to receive funds from DSHS.

Residents in D&A facilities that are not approved institutions may qualify for SNAP, only if the facility provides half of their meals or less. Consider this when determining if a person who resides in a facility is institutionalized.

Note: See disqualified persons policy for people disqualified due to felony drug conviction.

Evaluate all other eligibility criteria to determine whether a resident of the treatment center is eligible for SNAP.

Determine eligibility following the same income and resource policy as other households. Processing time frames and procedures for certifying households apply to residents of treatment facilities, except the following:

  • Household size — Certify:
    • single residents of the treatment facility as separate one-person households; and
    • adult residents and their children as one household.
  • Authorized representative (AR)  — The treatment facility must act as the AR for all residents of the facility.
  • Expedited service  — Process the application to allow the resident an opportunity to participate by the seventh calendar day after the application date. The application date is day zero.
  • Adverse action — When the facility loses its status as AR or loses its certification, the resident must be given adequate notice of adverse action.
  • Work registration — The resident is exempt from work registration.

A facility that is no longer an approved institution (the facility loses its license from a state agency or the U.S. Department of Agriculture (USDA) disqualifies the facility as a retailer) cannot serve as an AR. Deny all existing SNAP Eligibility Determination Groups (EDGs) for residents in the facility. The facility may not debit residents' food accounts after the disqualification occurs.

Note: Refer the treatment center to the USDA FNS at 877-823-4369 or SNAP for inquiries about obtaining a SNAP retailer license from FNS.

Related Policy

Nonmembers, A-232.1
Disqualified Persons, A-232.2
Determining Whether a Person Who Resides in a Facility Is Institutionalized, B-490

B-442 Residents of GLA Facilities

Revision 22-1; Effective January 1, 2022

SNAP

A GLA is a public or private nonprofit residential facility that serves no more than 16 residents. People residing in a GLA facility may potentially qualify for SNAP, regardless of the number of meals the facility provides, if the GLA facility is an approved institution. A GLA is an approved institution if it is a:

  • certified SNAP retailer; or
  • nonprofit, certified by a state agency as required by Section 1616(e) of the Social Security Act.

Residents in GLA facilities that are not approved institutions may potentially qualify for SNAP, only if the facility provides half of their meals or less. Consider this when determining whether a person who resides in a facility is institutionalized.

Residents who meet disability definition criteria may be certified under group living arrangements. Determine eligibility according to the same income and resource standards as other households.

GLA residents may apply:

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

If a member of the group wants to apply separately from other GLA residents, the facility makes the decision to allow the resident to apply separately based on the resident's physical and mental ability. Accept applications from any person the facility allows to apply as a one-person household or for any group of residents applying as a household.

Processing time frames and procedures for certifying households apply to GLA residents, except:

  • Household size — If the resident applies using the facility as the AR, the resident is certified as a one-person household. If the residents apply without using the facility as AR, the largest allowable household size is 16.
  • Expedited service — Provide benefits to allow the resident an opportunity to participate by the seventh calendar day after the application date. The application date is day zero.
  • Adverse action — When the facility loses its status as AR or loses its certification, the resident is given adequate notice of adverse action.
  • Work registration — Members must be registered unless exempt.

Related Policy

Nonmembers, A-232.1
Disqualified Persons, A-232.2
Determining Whether a Person Who Resides in a Facility Is Institutionalized, B-490

B-443 HHSC Responsibilities

Revision 13-4; Effective October 1, 2013

B-443.1 Staff Responsibilities

Revision 22-1; Effective January 1, 2022

SNAP

For residents participating in D&A or GLA facilities, verify that the D&A or GLA facility meets the eligibility criteria.

D&A or GLA facility eligibility certification may be verified by contract documents or certificates of eligibility from the USDA, HHSC or DSHS. Verify nonprofit status by reviewing a current, valid Internal Revenue Service (IRS) exemption or a document from the Texas State Comptroller of Public Accounts. If the facility is a USDA-certified retailer, the facility's eligibility is verified.

Provide the facility AR a copy of Form H1851, Reference Guide for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities (PDF). The AR must acknowledge receipt of Form H1851 by signing Form H1846, Facility Authorized Representative Interview (PDF). Ensure the AR understands each of the facility's responsibilities.

Ensure the facility AR has a supply of Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP). The AR must return Form H1852 to HHSC by the fifth day of every month, or the following business day if the fifth is not a business day. Repeated failure to return this form is a program violation. Use Form H1852 to help monitor the facility's compliance with its responsibilities as AR. Complete and send Form H1847, Reminder to Submit Form H1852, when the facility report is three days past due.

Ensure the AR has a supply of Form H1019, Report of Change, and postage-paid envelopes.

On-site visits to the facility must be made at least once every six months.

During these visits, use Form H1845, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility Review (PDF), to document the:

  • date of the visit;
  • number of residents; and
  • proof the facility continues to meet eligibility requirements.

Report suspected misuse of SNAP by the facility to the Electronic Benefit Transfer (EBT) regional coordinator. Use Form H1845 or Form H1853, Documentation of Findings (PDF), to report suspected misuse after evaluating the monthly Form H1852 returned by the facility.

Ensure the facility returns the correct benefit amount to the person’s EBT account. If the facility is unable or unwilling to return the person’s benefits:

Note: If a household managed by Centralized Benefit Services (CBS) moves into a D&A or GLA facility, update the Living Arrangement record to convert the EDG back to SNAP and out of the CBS caseload.

Maintain a D&A or GLA facility case file in the local office for each facility. Keep copies of any forms, reports or supporting documentation in this file.

Related Policy

Residents of D&A Facilities, B-441
Residents of GLA Facilities, B-442
Resident Moves Out of a D&A or GLA Facility, B-447

B-443.1.1 Monitoring Facilities

Revision 22-1; Effective January 1, 2022

SNAP

Information provided each month by facilities on Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP), must be monitored to ensure certified residents receive the correct amount of SNAP benefits.

Compare the information on the current month's Form H1852 to the information on the previous month's Form H1852 and clear any discrepancies. Consider the following questions in detail:

  • Are the same residents certified?
  • Did any of the residents move out during the month? If so:
    • Did the facility report the change and return the Lone Star Card within three business days?
    • Did the Lone Star account contain the correct benefit amount?
    • Was the EBT card accessed after the residents reported move out date?

If the facility fails to report residents who move out or fails to return the Lone Star Card, deny the EDGs following the D&A or GLA facility resident moves out procedure. Remind facilities of the responsibility as an AR to report moves and return the Lone Star Card within three days of the change. Complete Form H1853, Documentation of Findings, for monthly Form H1852, to document findings. If there are no findings, document no findings. Place a copy of the findings in the facility case file and provide a copy to the EBT regional coordinator responsible for the facility case file.

Related Policy 

Resident Moves Out of a D&A or GLA Facility, B-447

B-443.2 EBT Regional and Site Coordinator Responsibilities

Revision 22-1; Effective January 1, 2022

SNAP

EBT regional coordinators report misuse of SNAP benefits in facilities certified as retailers by the USDA by sending Form H1853, Documentation of Findings for Form H1852, to:

Texas Health and Human Services Commission
Eligibility Operations – State and Regional Operations
Mail Code 992-6
909 W. 45th Street
Austin, TX 78751

State office makes referrals to the OIG. If necessary, the USDA will send a copy to the EBT regional coordinator and subsequently, notification of any action taken.

Do not take any further adverse action on a facility certified by USDA before USDA's action. Compute over-issuances for each resident, as appropriate.

If OIG staff confirms the report is valid, OIG will refer the misuse to the USDA for its information and consideration for prosecution. The OIG sends a copy of the referral to the EBT site coordinator responsible for the facility case file and notifies the EBT regional coordinator of any action taken by USDA.

B-444 Overview of EBT Processes for Residents of D&A or GLA Facilities

Revision 22-1; Effective January 1, 2022

SNAP

Establish the AR as the primary cardholder (PCH) and issue a Lone Star Card to access a resident's benefits in the food account. Allow the AR to select a PIN through the Lone Star Help Desk or receive a vendor mailed PIN packet.

Some D&A or GLA facilities are certified by the USDA as SNAP retailers, and some are not. Regardless of SNAP retailer certification, the facility serves as AR and is responsible for the use of SNAP benefits of all residents who participate in SNAP (except for some GLAs). Benefits issued by EBT for residents of these D&A or GLA facilities are handled per one of the following three methods:

  • An  EBT vendor contracts with D&A or GLA facilities certified by USDA as SNAP retailers to process EBT transactions in two ways:
    • If the D&A or GLA facility processes a minimum monthly value of SNAP transactions, an EBT vendor installs Point of Sale (POS) equipment on site. The facility, as AR and PCH, debits the residents' SNAP benefits by swiping each resident's Lone Star Card through their POS equipment and entering the associated PIN. An EBT vendor completes the financial settlement to pay the retailer the day after a SNAP transaction is completed.
    • If the retailer processes less than the minimum monthly value of SNAP transactions to receive POS equipment, an EBT vendor contracts with the retailer to use a manual voucher system to process EBT SNAP transactions from each resident's account. An EBT vendor completes the financial settlement to pay the retailer the day after a SNAP transaction is completed.
  • D&A or GLA facilities that are not USDA-certified retailers do not contract with an EBT vendor to accept SNAP benefits. However, if the facility meets the D&A or GLA eligibility criteria for non-USDA certified retailers, residents of those facilities can still participate in the SNAP program with the facility AR responsible for the residents' SNAP benefits. In this situation, the facility AR is established as the PCH, a Lone Star Card is issued, and the AR can select a PIN through the Lone Star Help Desk or receive a vendor mailed PIN packet. The facility AR may use the food account, Lone Star Card and PIN to purchase food for the resident at a SNAP certified retail store or market.
    • Note: GLAs do not always serve as AR for each resident. If the GLA employee is not listed as a GLA-AR on a resident's SNAP EDG follow normal EBT issuance procedures. The resident uses the Lone Star Card to purchase food from a regular retailer or to purchase prepared meals from the GLA if the GLA is certified as a retailer by USDA.

Related Policy

EBT Vendor-Produced Materials, B-280
Residents of D&A Facilities, B-441
Residents of GLA Facilities, B-442

B-445 D&A or GLA Facility Responsibilities as ARs

Revision 22-1; Effective January 1, 2022

SNAP

The D&A or GLA facility acting as AR must:

  • apply for and provide accurate information on behalf of a resident;
  • use the Lone Star Card to debit the resident's food account;
  • buy and prepare food for eligible residents;
  • buy meals delivered to each resident;
  • report the loss of USDA or DSHS certification or loss of nonprofit status to HHSC within 10 days;
  • report any changes, losses, over-issuances or misuse of SNAP benefits;
  • provide departing residents Form H1019, Report of Change, as appropriate, and advise the person to report their new address within 10 days;
  • report and return the Lone Star Card issued for departed residents to HHSC within three business days after the person moves out, whether announced or not;
  • ensure the security of all Lone Star Cards and PINs issued to the facility AR;
  • ensure the departing resident's Lone Star Card contains all the SNAP benefits that are unspent when the resident moves out; and
  • return Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP), by the fifth day of every month, or the following  business day if the fifth day is not a business day.

Both, the resident and facility AR must sign the application form.

The facility, acting as an AR, is liable if it knowingly commits a program violation to obtain SNAP benefits for a resident.

The facility must maintain a sufficient supply of required forms. Form H1852, Form H1019 and HHSC return envelopes may be obtained from HHSC and will be offered to the AR at each certification.

Related Policy

Use of SNAP Benefits by D&A or GLA Facilities Which Serve as SNAP Authorized Representative (AR), B-445.1

B-445.1 Use of SNAP Benefits by D&A or GLA Facilities Which Serve as SNAP ARs

Revision 22-1; Effective January 1, 2022

SNAP

HHSC restricts how the D&A and GLA facilities may use the resident's benefits. Inform the facility AR of these rules during the interview and provide them with Form H1851, Reference Guide for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities.

Related Policy 

Account Access, B-445.1.1
Returning Unspent Benefits When a Resident Moves Out, B-445.1.3
Residents Moving Out Before the 16th of a Month, B-445.1.4

B-445.1.1 Account Access

Revision 22-1; Effective January 1, 2022

SNAP

HHSC issues a Lone Star Card to the facility AR and enables the AR to select a PIN through the PIN pad in the local office or the Lone Star Help Desk. HHSC allows the AR access only to benefits issued for a month the person is a facility resident. The facility may assign one person to serve as the AR to apply for the resident and another to serve as AR or PCH and use the Lone Star Card.

Note: When the D&A or GLA facility is the AR, the facility is responsible for all benefits in an account. Therefore, security of the card and PIN is as important to them as it is to a person not in a facility.

HHSC is unable to issue benefits to the D&A or GLA facility AR for a month the resident is in the facility when that month's benefits were already issued to the resident's existing food account. If the resident wants to allow the facility access to previously issued benefits, the resident has the following options:

For facilities that are not USDA-certified retailers, the resident may:

  • use the card to purchase groceries to give to the facility; or
  • make the D&A or GLA facility AR a secondary cardholder on the existing account to access those benefits. To establish the facility AR as a secondary cardholder:
    • staff must ensure that the person made this choice and approved it; and
    • EBT issuance staff must establish the secondary cardholder, issue the card and pend card registration.

For facilities that are USDA-certified retailers, the resident can:

  • use one of the options listed above for facilities that are not USDA-certified; or
  • use the Lone Star Card to purchase meals via the facility POS device or via the EBT manual voucher process. The facility may only charge for prepared meals on a per day basis, not in advance. In addition, the facility is not allowed possession of the card previously issued to the resident, nor knowledge of the resident's PIN. 

Related Policy

Application Processing for D&A or GLA Facilities, B-446

B-445.1.2 Reserved for Future Use

Revision 22-1; Effective January 1, 2022

B-445.1.3 Returning Unspent Benefits When a Resident Moves Out

Revision 22-1; Effective January 1, 2022

SNAP

When a resident moves out of the D&A or GLA facility, the facility must return all unspent benefits issued to the AR's account regardless of when the resident moves out, even if it means returning all the resident's benefits. D&A and GLA facilities are not allowed to spend a resident's benefits after the resident moves out.

After a resident moves out, the facility must return the AR's EBT card and ensure the account contains all unspent benefits. For purposes of this policy, "spent" means the facility used the EBT Card to access the resident's benefits before the person moved out.

If the facility accesses benefits that it is not allowed to use, the facility must return the benefits to the account. USDA-certified facilities can return benefits using the POS device to process a return on the account or via communication with an EBT vendor. Facilities not certified as retailers by USDA must ask a retailer to process a return on the resident's account using the AR's EBT card on the store's POS device.

If the retailer cannot restore benefits to the EBT card, initiate a claim against the facility by sending Form H1096, Notification Letter, and sending Form H1095, Treatment Facility Fraud Referral, to the OIG Benefits Program Integrity (BPI) mailbox and restore benefits to the person.

Related Policy

Restored Benefits, B-800

B-445.1.4 Residents Moving Out Before the 16th of a Month

Revision 22-1; Effective January 1, 2022

SNAP

The D&A or GLA facility must return at least half of the monthly allotment for residents who move out before the 16th of the month. Therefore, although a facility can access more than half of the monthly allotment before the 16th, it is not a best practice to do so.

The D&A or GLA facility AR know the full allotment amount from the person's notice. If the EDG has recoupment, staff must notify the facility AR to use the Lone Star Help Desk (800-777-7EBT) to verify monthly benefits.

D&A or GLA facilities without a POS device must be cautious to ensure they do not use more than half of a resident's monthly allotment before the 16th of the month, because they have no POS device to process a return if the resident moves out before the 16th of the month.

B-446 Application Processing for D&A or GLA Facilities

Revision 22-1; Effective January 1, 2022

SNAP

Process SNAP EDGs for residents in D&A or GLA facilities using one of the following procedures, depending on the resident's situation at application.

At the time of disposition, staff must review the Issuance – Details page and the Alternate Payee – Summary page, to ensure that TIERS successfully included the PCH record for the facility AR.

Note: TIERS does not collect biographical data on D&A or GLA facility ARs, so TIERS cannot send this information to the EBT system. 

B-446.1 New Resident (or Denied Resident with No Benefits in an EBT Account) Who Moves into a D&A or GLA Facility and Applies for SNAP

Revision 22-3; Effective July 1, 2022

SNAP

  • Interview staff:
    • interview the AR;
    • advise the AR about the limitations noted on Form H1851, Reference Guide for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities;
    • provide EBT training material if the AR has not already received it;
    • send the PCH record for the facility AR to the EBT system by indicating in the TIERS issuance pages that there is an alternate payee. After the batch, complete Form H1175, EBT Change Request, to change the biographical information in the EBT system to the facility AR dispose the SNAP EDG; and
    • complete issuance.
  • EBT issuance staff must:
    • issue a card to the AR;
    • print the EDG name in the space under the signature field on the back of the Lone Star Card; and
    • enable the AR to select a PIN through the Lone Star Help Desk.
  • The facility AR uses the card and PIN to access benefits in the food account. Note: If the resident also receives TANF, the cash account is not available to the D&A or GLA facility AR. The resident has a separate card and PIN for the cash account.

Related Policy

Application Processing for D&A or GLA Facilities, B-446

B-446.2 Resident Has an Active SNAP EDG (or a Denied-Ongoing SNAP EDG), No Benefits in the Food Account, and All SNAP Household Members Move into the D&A or GLA Facility

Revision 22-1; Effective January 1, 2022

SNAP

Follow policy for a new resident who moves into a D&A or GLA facility. The D&A or GLA facility representative is added as AR for the existing SNAP EDG and the SNAP EDG is certified if it is currently denied.

Related Policy

New Resident (or Denied Resident with No Benefits in an EBT Account) Who Moves into a D&A or GLA Facility and Applies for SNAP, B-446.1

B-446.3 All Other Situations

Revision 22-1; Effective January 1, 2022

SNAP

Assign the resident a new SNAP EDG number and certify the resident using the new EDG number to establish a separate EBT food account as a resident of a D&A or GLA facility with a facility AR.

  • If the resident is on an active SNAP EDG (and all members are not moving into the facility), remove the person from the existing EDG before certifying on a new case. 
  • If the resident is currently certified as a single person household on a previous case (but has a remaining benefit balance), certify the resident for SNAP with a certification period for the remaining months using a different case number. A new Form H1010, Texas Works Application for Assistance — Your Texas Benefits, is not required. The file date is the first day of the first month of the remaining certification period. Cross reference the other case in the TIERS Case Comments section of each case.

Enter the facility AR’s information in the Authorized Representative page and indicate in the Issuance – Details page that there is an alternate payee. Complete the subsequent Alternate Payee – Summary page.

Request card issuance and provide a completed Form H1175, EBT Change Request, to EBT issuance staff. EBT issuance staff enter additional data to the PCH record for the AR through the EBT system for the new EDG number. 

Related Policy

Application Processing for D&A or GLA Facilities, B-446
New Resident (or Denied Resident with No Benefits in an EBT Account) Who Moves into a D&A or GLA Facility and Applies for SNAP, B-446.1

B-447 Resident Moves Out of D&A or GLA Facility

Revision 22-3; Effective July 1, 2022

SNAP

Follow these procedures when the resident moves out of the facility:

  • The facility AR:
    • notifies HHSC of the move; and
    • returns the Lone Star Card (in-person) for this account to the local office within three business days of the move. 
  • Check the account balance to ensure the D&A or GLA facility returned the correct benefit amount. Ensure the facility returns any benefit amount spent to the resident’s food account after the resident moved out. Monthly benefits and account balance information are available on the EBT system benefit history screen. The EBT system transaction history screens provide information to verify if the AR debited the account after the resident moved out. Transactions are listed by date and time.
  • Report violations according to staff responsibility policy.
  • After ensuring benefits are properly returned, destroy the card according to procedures for returned Lone Star Cards.
  • Follow procedure 1 or 2 below.
    1. If the facility reports the move and the former resident has not contacted HHSC:
      • Send the EDG name to the EBT system as the new PCH. Complete of Form H1175, EBT Change Request, and send to EBT issuance staff, who will use the information to update the PCH record in the EBT system.
      • Immediately remove the AR entries including any designations in the Issuance – Details and the Alternate Payee – Summary pages and update the address, if known.
      • Document in Case Comments the name of the facility and facility AR that are being removed. Do not issue a new card and PIN until requested by the former resident.
      • Follow normal adverse action procedures to deny the EDG.
         
    2. If former resident reports the move to another D&A or GLA facility:
      • Do not deny the existing active case.
      • Remove the former facility AR.
      • Document in Case Comments the name of the facility and facility AR that are being removed and the name of the new facility and facility AR that are being added and when.
      • Enter the new facility AR’s information in the Authorized Representative page and indicate in the Issuance – Details page that there is an alternate payee. Complete the subsequent Alternate Payee – Summary page.
      • Request card issuance and enable the new AR to select a PIN through the Lone Star Help Desk.
      • Complete Part II of Form H1175 and send to EBT issuance staff, who will use the information to complete the new PCH record on the new AR via the EBT system. 
      • EBT issuance staff:
        • issue a card to the AR; 
        • report the PAN; 
        • print the EDG name in the space under the signature field on the back of the Lone Star Card; and 
        • enable the AR to select a PIN through the Lone Star Help Desk.

Follow these procedures if the former resident moves in with another active SNAP household and the former resident will participate with that household:

  • Deny the active D&A or GLA case and send Form TF0001, Notice of Case Action, following regular adverse action procedures.
  • Send the case name to the EBT system to change the PCH by removing all AR-related entries in TIERS, including any designations in the Issuance – Details and the Alternate Payee – Summary pages.
  • Change the address to the resident's new address.
  • Document in Case Comments the name of the facility and facility AR removed and the date. Cross reference the other case in the Case Comments section of each case.
  • If there are still benefits in the account, complete a card issuance request to give the former resident access to the account and enable the person to select a PIN through the Lone Star Help Desk.
  • If updating PCH biographical information, complete Part II of Form H1175 and send to EBT issuance staff, who will update the PCH record in the EBT system.
  • Add the former resident to the other household's SNAP EDG effective the month after any final benefits are received.

Follow these procedures if the former resident moves and no longer lives in a D&A or GLA facility or does not participate with another active SNAP household. Move the former resident's remaining months of SNAP certification to a different case (and thus a new food account) and:

  • Send the case name to the EBT system to change the new PCH on the currently active case by removing all AR-related entries in TIERS including any designations in the Issuance – Details and the Alternate Payee – Summary pages.
  • Change the address to the resident's new address.
  • Document in Case Comments the name of the facility and facility AR that are being removed and when.
  • Deny the former resident's active SNAP EDG. Do not send notice of adverse action since benefits are not actually being denied.
  • Certify the former resident for SNAP with a certification period for the remaining months using a different case number. If the former resident has a previous denied-ongoing case, use it and associate the case number during Application Registration. Do not require a new Form H1010, Texas Works Application for Assistance — Your Texas Benefits. The file date is the first day of the first month of the remaining certification period. Cross reference the other case in the Case Comments section of each case.
  • Complete issuance request to give the former resident access to the account(s) by issuing a new card and enabling the person to select a new PIN through the Lone Star Help Desk.
  • If updating PCH biographical information, complete Form H1175 and send to EBT issuance staff, who will update the PCH record in the EBT system.

Related Policy

Staff Responsibilities, B-433.1
Application Processing for D&A or GLA Facilities, B-446

B-448 D&A or GLA Facility Replaces the AR

Revision 22-3; Effective July 1, 2022

SNAP

To replace an AR, the D&A or GLA facility must provide a written request to HHSC.

Follow these procedures if a D&A or GLA facility replaces the AR. Do not replace Lone Star Cards for residents' accounts: 

  • Interview staff:
    • change the name of the AR on all applicable TIERS cases by replacing the former facility AR with the new person in the Authorized Representative page and the Alternate Payee Summary page; 
    • document the change for each case and when the change occurred in Case Comments; and
    • complete Form H1175, EBT Change Request, for each case to update the existing PCH record with new AR name and biographical information; and 
    • complete a new Form H1846, Facility Authorized Representative Interview, at the first certification following replacement of the AR. 
  • EBT issuance staff update the PCH record for each case in the EBT system and ensure the Form H1175 is included in each case record.

Related Policy

Application Processing for D&A or GLA Facilities, B-446

B-449 Verification Requirements

Revision 22-1; Effective January 1, 2022

SNAP

Verify the facility meets the D&A or GLA facility eligibility criteria.

Related Policy

Residents of D&A Facilities, B-441
Residents of GLA Facilities, B-442
Questionable Information, C-920
Providing Verification, C-930

B-450, Residents in Family Violence Shelters

Revision 13-4; Effective October 1, 2013

B-451 Eligibility Requirements

Revision 22-1; Effective January 1, 2022

SNAP

People residing in a family violence shelter may potentially qualify for SNAP, regardless of the number of meals the shelter provides, if the family violence shelter is an approved institution. A family violence shelter is an approved institution if it is a:

  • certified SNAP retailer; or
  • public or private nonprofit facility.

Residents in family violence shelters that are not approved institutions may potentially qualify for SNAP, only if the facility provides half of their meals or less. Consider this when determining if a person who resides in a facility is institutionalized.

Residents in eligible family violence shelters may receive SNAP benefits as individual household units or as part of a group of individuals like any other household.

Residents in family violence shelters may apply for SNAP and use SNAP benefits on their own behalf. Residents may also appoint a shelter representative or another person to act as AR or secondary cardholder.

Residents in shelters must meet the same income and resource standards as other households. Resources held jointly with the abuser are considered inaccessible. Room payments to the shelter are considered shelter expenses. These households have the same rights to notices of adverse action, fair hearing, and lost benefits as other households. Residents should be registered for work unless otherwise exempt.

Normal processing standards for initial and ongoing eligibility decisions, handling reported changes and other actions and usual verification and documentation requirements apply to residents in shelters for battered persons.

Related Policy

Nonmembers, A-232.1
Determining Whether an Person Who Resides in a Facility Is Institutionalized, B-490

B-452 Approved Centers That Provide Meals

Revision 15-4; Effective October 1, 2015

SNAP

Family violence shelters that provide meals must be public or private nonprofit residential facilities that serve victims of family violence. If a facility serves other people, part of the facility must be set aside on a long-term basis to serve only family violence victims.

Advisors must verify the shelter's status as a nonprofit organization by seeing a current certificate from the IRS or a document from the Texas State Comptroller of Public Accounts. If the shelter is a USDA-certified retailer, the shelter's eligibility is verified.

B-452.1 Buying Meals

Revision 13-4; Effective October 1, 2013

SNAP

Individual households may use their SNAP benefits to buy meals prepared for them at a shelter that is a USDA-certified retailer.

B-453 Authorized Representatives

Revision 01-3; Effective April 1, 2001

SNAP

Employees of facilities that are USDA-certified retailers may not be authorized to serve as AR/secondary cardholders unless HHSC decides that there are no other representatives available.

If the shelter is not a USDA-certified retailer, the household may authorize a shelter representative as secondary cardholder.

B-454 Participation Twice in Same Month

Revision 10-4; Effective October 1, 2010

SNAP

A shelter resident can qualify for a duplicate SNAP benefit in a single month if:

  • the resident's former household already received benefits for the month; and
  • the resident's former household was based on a household size that included the resident, any children, and the person who abused or threatened to abuse them.

B-454.1 Duplicate Participation Procedures

Revision 22-1; Effective January 1, 2022

SNAP

Remove the resident from the former household's case.

Special certification procedures based on entries made on the Living Arrangements logical unit of work (LUW) allow duplicate participation until the resident is removed from the former household. Establish a new SNAP case and food account if the person is the case name or has a Lone Star Card on the previous case. The person must complete a new Form H1010, Texas Works Application for Assistance — Your Texas Benefits.

If the person has not been removed from the former case:

  • complete the certification process;
  • issue the person a new Lone Star Card;
  • pend card registration to enable the person to select a PIN through the Lone Star Help Desk; and
  • issue benefits.

Related Policy

Issuing a Lone Star Card, B-233
Personal Identification Number (PIN) Selection, B-234
Benefit Issuance on Applications, B-252

B-460, Prepared Meal Services

Revision 13-4; Effective October 1, 2013

B-461 Communal Dining or Meal Delivery Services

Revision 15-4; Effective October 1, 2015

SNAP

Eligible individuals and their spouses may use SNAP benefits to purchase prepared meals through communal dining or meal delivery services authorized by FNS.

To be eligible, a household member must:

  • be age 60 or older;
  • be housebound;
  • have a physical disability;
  • have a disability to the extent the member is unable to adequately prepare all meals; or
  • be receiving SSI.

B-462 Prepared Meals for Homeless

Revision 12-2; Effective April 1, 2012

SNAP

Homeless individuals may use SNAP benefits to purchase prepared meals from meal providers authorized by FNS.

B-463 Staff Responsibilities

Revision 21-2; Effective April 1, 2021

SNAP

The Lone Star Card does not identify people qualifying for communal dining, meal delivery, or homeless people eligible for prepared meals. Use Form H1175, EBT Change Request, to send the primary cardholder (PCH) record and indicate in the endorsement box of Form H1175 either:

  • Communal dining
  • Meal delivery
  • Homeless
  • Every service

B-464 EBT Coordinator Responsibilities

Revision 15-4; Effective October 1, 2015

SNAP

If a meal-provider representative contacts HHSC about certification procedures, the advisor should refer the meal-provider representative to the EBT coordinator to approve these providers.

The EBT coordinator must ensure through discussion with the meal provider that the establishment:

  • provides meals to homeless people, and
  • is a public or private nonprofit organization as defined by IRS. HHSC may require the provider to present documentation from IRS to verify nonprofit status under §501(c)(3) of IRS regulations.

If the meal provider meets these requirements, the EBT coordinator will:

  • obtain the meal-provider representative's signature on Form H1832, Affidavit for Meal Providers to the Homeless; and
  • refer the provider to USDA, with the original, signed Form H1832, to apply for authorization as a retailer.

B-465 Matrix of Prepared Meals, Services, Households and Codes

Revision 15-4; Effective October 1, 2015

SNAP

Prepared Meals

SNAP RecipientCommunal Dining (Public or Nonprofit Private)Meal DeliveryHomeless Meal Provider (Public or Nonprofit Private) 
Age 60 or older, not homelessXXXX  
SSI recipient who is under age 60, not homelessXXXX  
Under age 60, not an SSI recipient, housebound, a person with physical disabilities, or has disabilities to the extent they are unable to adequately prepare own meals XX  
Homeless only  XX 
Homeless age 60 or olderXXXXXX 
Homeless SSI recipient who is under age 60XXXXXX 
Endorsement status allowed to purchase from meal providerCodes C,ECodes C,M,ECodes H,E 

Codes:

C – SSI/elderly member authorized to purchase prepared meals from communal dining facilities or meal delivery services.

E – Homeless and either elderly or SSI household authorized to purchase from every service (communal dining, meal delivery services or homeless meal providers).

H – Homeless household authorized to purchase from homeless meal provider.

M – Housebound or a member with a disability authorized to purchase from meal delivery service.

B-470, Categorically Eligible Households

Revision 05-5; Effective October 1, 2005

SNAP

Categorically eligible households are subject to fewer eligibility requirements than other SNAP households. HHSC uses special procedures to process applications from persons who potentially meet the categorical eligibility criteria. Categorical eligibility does not mean the applicants automatically receive SNAP.

B-471 Eligibility Criteria

Revision 15-4; Effective October 1, 2015

SNAP

SNAP households meet categorical eligibility criteria if:

  • all members are approved for TANF cash assistance or SSI; or
  • the household:
    • meets the resource criteria to be authorized to receive TANF Non-cash (TANF-NC) services (see A-1210, General Policy); and
    • has gross income less than or equal to 165 percent of the Federal Poverty Income Limit (FPIL) for its size.

This also includes households that have:

  • active EDGs but whose benefits are being recouped; or
  • a disqualified alien member or student who does not get TANF/SSI.

The household is not categorically eligible if:

  • one or more members are disqualified from TANF or SNAP for an IPV; or
  • the entire household is ineligible because the primary wage earner (PWE) failed to comply with E&T or voluntary quit requirements; or
  • if the household is otherwise ineligible due to one or more members' disqualification for any reason.

For TANF-NC, a household is not categorically eligible if one or more members has a current SNAP IPV disqualification. If the household meets the combined resource limit of $5,000 for liquid assets and excess vehicle value, the household is still authorized to receive TANF-NC, and their remaining resources are exempt. The household is not exempt from the gross/net income limits.

B-472 Special Treatment for Households Meeting Categorical Eligibility Criteria

Revision 15-4; Effective October 1, 2015

SNAP

Categorically Eligible TANF/SSI Households

Categorically eligible households are not subject to the resource or gross/net income limits. These households are exempt from verification requirements regarding:

  • Social Security numbers (SSNs),
  • resources,
  • residence, and
  • sponsored alien information.

Categorically Eligible TANF-NC Households

TANF-NC categorically eligible households are not subject to the gross/net income limits. Once the household passes the resource criteria for TANF-NC, the remaining non-liquid resources are exempt. TANF-NC categorically eligible households must comply with all other eligibility criteria.

Related Policy

General Policy, A-1210
Limits, A-1220
Prepaid Burial Insurance, A-1233.2
Vehicles, A-1238
How to Determine Fair Market Value of Vehicles, A-1238.5
General Policy, A-1310
Special Provisions for Households with Elderly Members or Members with a Disability, B-433

B-473 Application Processing

Revision 15-4; Effective October 1, 2015

SNAP

Advisors must follow these procedures when processing a joint application for TANF and/or SSI and SNAP:

If the TANF/SSI application is pending and the household...then ...
is eligible for SNAP without meeting categorical eligibility criteria,certify the SNAP application as soon as possible. Follow normal SNAP time frames.
will not be eligible for SNAP unless the TANF or SSI application is granted,

delay denial of the SNAP EDG. Pend the SNAP application for up to 30 days awaiting the TANF/SSI decision. If the TANF/SSI application is denied on or before the 30th day, deny the SNAP application immediately.

If the TANF/SSI application is granted by the 30th day, certify for SNAP as soon as possible. Prorate from the SNAP application date.

If the TANF/SSI application is still pending by the 30th day:

  • deny the SNAP application; and
  • notify the individual on the denial notice to contact the certification office if the TANF/SSI is later granted.

If the TANF/SSI application is granted after the 30th day:

  • copy Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and return the original to the applicant (the applicant must initial any changes, re-sign Form H1010, and return it to the local eligibility determination office);
  • reopen the SNAP application when Form H1010 is returned;
  • verify and document any changes since the initial interview; and
  • prorate benefits from the original SNAP file date or the effective date of TANF/SSI benefits, whichever is later.*

* When prorating from the effective date of TANF/SSI benefits, use this date as the new SNAP file date. The effective date of benefits for TANF is the earlier of the certification date or 30 days after the file date. The effective date of benefits for SSI applicants is the:

  • SSI file date; or
  • date the individual met all eligibility criteria, if later than the file date.

Advisors must verify the SSI benefit effective date by viewing the award letter or by running Wire Third-Party Query (WTPY) or the State Online Query (SOLQ).

B-474 Centralized Benefit Services (CBS) Section

Revision 13-4; Effective October 1, 2013

SNAP and Medical Programs

CBS is a centralized section that processes certain types of cases statewide.

Related Policy

Specialized and Centralized Casework Units, C-1471

B-474.1 Programs Administered by CBS

Revision 13-4; Effective October 1, 2013

SNAP and Medical Programs

CBS administers SNAP and Medical Programs for several individual groups. For information concerning the SNAP Combined Application Project (SNAP-CAP), which is one of the programs that CBS administers, see B-475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP).

B-474.1.1 SNAP Programs

Revision 22-3; Effective July 1, 2022

SNAP

CBS administers SNAP for eligible SSI households as part of SNAP-CAP.

B-474.1.2 Medical Programs

Revision 20-4; Effective October 1, 2020

CBS administers medical programs for:

  • children placed in or released from a Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) facility;
  • former foster care children;
  • women diagnosed with breast or cervical cancer; and
  • people incarcerated in the Texas Department of Criminal Justice (TDCJ) who receive inpatient services.

Related Policy

Centralized Benefit Services, B-540

B—474.1.2.1 Reserved for Future Use

Revision 20-4; Effective October 1, 2020

B-474.1.2.2 Reserved for Future Use

Revision 20-4; Effective October 1, 2020

B-474.1.2.3 Medicaid for Transitioning Foster Care Youth

Revision 17-2; Effective April 1, 2017

Policy for TP 70 — Medicaid for Transitioning Foster Care Youth (MTFCY), is explained in Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

B-474.1.2.4 Former Foster Care in Higher Education

Revision 17-2; Effective April 1, 2017

Policy for type Assistance (TA) 77 — Former Foster Care in Higher Education (FFCHE), is explained in Part F, Former Foster Care in Higher Education (FFCHE).

B-474.1.2.5 Medicaid for Breast and Cervical Cancer

Revision 17-2; Effective April 1, 2017

Policy for TA 66 — Medicaid for Breast and Cervical Cancer (MBCC)-Presumptive, and TA 67 — MBCC, is explained in Part X, Medicaid for Breast and Cervical Cancer (MBCC).

B-474.1.2.6 Former Foster Care Children

Revision 18-1; Effective January 1, 2018

Policy for TA 82 — Medicaid for Former Foster Care Children (FFCC), is explained in Part E, Former Foster Care Children (FFCC).

B-474.2 Conversion of EDGs

Revision 22-3; Effective July 1, 2022

SNAP

EDGs are converted to CBS when a household is eligible for SNAP-CAP. 

After the local office completes an initial certification, an automated process converts EDGs that meet the criteria to CBS. The automated process occurs monthly at cutoff. HHSC mails the person a notice to inform them:

  • that the EDG is handled by CBS, and
  • to report household changes by:
    • calling 2-1-1;
    • entering the change in the Self-Service Portal; or
    • notifying HHSC via mail.

The notice includes contact information. Continue to accept changes and complete case actions until the EDG converts to CBS.

B-474.3 Methods of Reporting Changes

Revision 15-4; Effective October 1, 2015

SNAP and Medical Programs

Local office staff may fax changes to CBS. The vendor will create a task for online or mailed changes.

Related Policy

Reporting Requirements, B-620

B-474.4 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

B-474.5 Replacement of Lone Star Cards or Medical Care IDs

Revision 22-1; Effective January 1, 2022

SNAP

For recipients managed by CBS who request a replacement Lone Star Card or PIN, follow regular card and PIN replacement procedures.

Related Policy

Lone Star Card Replacement, B-235
PIN Replacement, B-236

Medical Programs

Replacement or temporary medical care ID cards (Form H1027-A, Medicaid Eligibility Verification; Form H1027-B, Medicaid Eligibility Verification - MQMB; and Form H1027-C, Medicaid Eligibility Verification - QMB) must be issued by local eligibility determination offices. The person can print an image of the medical care identification card and request a replacement online through YourTexasBenefits.com, or call 855-827-3748 to request a replacement.

B-474.6 Moving Cases Out of CBS

Revision 15-4; Effective October 1, 2015

SNAP

The CBS section:

  • moves cases out of the CBS caseload if:
    • the household no longer meets the criteria to be a CBS case (earnings, loss of SSI);
    • household composition changes; or
    • because regional staff request the transfer under special circumstances;
  • shortens the certification period as specified in B-474.6.1, Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs); and
  • documents in TIERS Case Comments the reason for return.

The CBS section also returns untimely redetermination EDGs received in the month after the last benefit month to the task queue and documents in TIERS Case Comments the reason for return.

Medical Programs

Children's Medicaid – CBS moves completed Medicaid determinations, both active and denied, out of the CBS section.

B-474.6.1 Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs)

Revision 15-4; Effective October 1, 2015

SNAP

If the household reports a change that results in the household no longer meeting CBS caseload criteria, such as the loss of SSI benefits, an addition to the household, or moving into a GLA, then CBS staff move the EDG out of the CBS caseload.

Before moving the EDG out of the CBS caseload, CBS must take appropriate action based on the following criteria:

If the household's certification period is in ...then ...
month 1-11,

if benefits:

  • will increase or decrease, send the household Form TF0001, Notice of Case Action, informing the individual that the last benefit month is month 12; and
  • shorten the certification period to a 12-month total by processing a change action with the new benefit amount and change the last benefit month to month 12.
month 12-36,

if benefits:

  • are being increased or decreased, send the household Form TF0001, Notice of Case Action, informing the household that the certification period is being shortened because it no longer meets the criteria specified in B-474, Centralized Benefit Services (CBS) Section; and
  • shorten the certification period to end on the last day of the month after the month Form TF0001 was sent.

Note: CBS staff also must include Form H1830, Application/Review/Expiration/Appointment Notice, and Form H1010, Texas Works Application for Assistance — Your Texas Benefits, advising the individual how to file future applications.

B-474.7 Denied EDGs

Revision 15-4; Effective October 1, 2015

SNAP

The local office must perform an inquiry on denied EDGs to ensure the CBS section is not in the process of certifying the EDG.

Note: Advisors must accept Form H1840, SNAP Food Benefits Renewal Form, if received at the local office and the CBS SNAP EDG certification period has expired.

Medical Programs

The local office must coordinate with CBS to determine the effective date of certification when a youth certified for TP 70, TA 82, or TP 44 (Medicaid coverage to eligible youths in the custody of or released from the Texas Juvenile Justice Department), or an adult certified for TA 67, applies for Medicaid.

B-474.8 Opportunity to Register to Vote

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must mail Form H0025, HHSC Application for Voter Registration, to households who do not have a face-to-face interview, unless Form H0025 is requested through the Voter Registration Information Individual Demographic screen.

If the individual contacts the local office to decline the opportunity to register to vote after receipt of Form H0025, the advisor should mail Form H1350, Opportunity to Register to Vote, to the individual for a signature. The advisor sends the completed Form H1350 for imaging and retains the form for 22 months.

Related Policy

Registering to Vote, A-1521

B-475 Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP)

Revision 13-4; Effective October 1, 2013

B-475.1 Overview

Revision 23-4; Effective Oct. 1, 2023

SNAP-CAP

SNAP-CAP is a demonstration project to outreach older SSI recipients not currently certified for SNAP. Single SNAP-CAP households are certified for a standard SNAP-CAP allotment of either $144 or $233 based on their reported monthly shelter expense. 

The monthly SNAP-CAP allotment is:

  • $144 for households with reported monthly shelter expenses less than or equal to $440 per month; and
  • $233 for households with reported monthly shelter expenses more than $440 per month.

To be eligible for SNAP-CAP, a person must:

  • be an SSI recipient;
  • be 50 or older;
  • live in Texas;
  • not live in an institution that causes ineligibility; and
  • not receive regular SNAP or TSAP benefits.

Additionally, a person is not eligible to participate in SNAP-CAP if the person is:

  • a fleeing felon;
  • disqualified due to an IPV; or
  • disqualified due to a felony drug conviction that occurred on or after Sept. 1, 2015.

Other regular SNAP eligibility criteria does not apply to SNAP-CAP. 

Note: An SSI recipient may elect to switch from regular SNAP to SNAP-CAP.

Related Policy

Disqualified Persons, A-232.2
Switching from the Regular SNAP Program to SNAP-Combined Application Project (CAP), B-475.2.2

B-475.2 Application Processing

Revision 23-1; Effective Jan. 1, 2023

SNAP-CAP

HHSC identifies potential SNAP-CAP recipients by the Texas State Data Exchange (SDX) match process and automatically mails Form H1841, SNAP-CAP Application (PDF), to people potentially eligible for SNAP-CAP. For people who previously received SNAP benefits in Texas, the mail-out occurs two months after the last month a person received benefits in Texas.

After Form H1841 is returned, CBS staff certify the SNAP-CAP EDG for 36 months, provide notice of eligibility, and authorize an EBT account without a face-to-face or phone interview.

If a person receives a SNAP-CAP application and also applies for SNAP at the local office, coordinate the application process with CBS staff before making an eligibility decision in the local office. This will ensure that the person can make an informed choice about their preferred program. The person may voluntarily withdraw the other application.

If the spouse of an active SNAP-CAP participant submits an application at the local office, certify the spouse separately from the active SNAP-CAP participant. If the spouse appears potentially eligible for SNAP-CAP, explain the program and requirements outlined in Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP). The SNAP application may be withdrawn if the person wants to participate in SNAP-CAP. Refer the person to 2-1-1. Document that the person was informed of the program and the SNAP application was withdrawn.

Fax a SNAP-CAP application returned to a local eligibility determination office to the non-expedited fax line at 877-447-2839 the same day it is received.

Expedited processing and benefit proration does not apply to the SNAP-CAP program. A standard allotment is issued for the month the application is returned.

Related Policy

Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP), B-475

B-475.2.1 Identifying Intentional Program Violations (IPVs) and Felony Drug Convictions 

Revision 15-4; Effective October 1, 2015

SNAP-CAP

The Data Broker vendor will receive the monthly SNAP-CAP application file and will notify state office Eligibility Operations of any clients with active out-of-state SNAP IPV disqualifications and felony drug convictions.

State office staff will forward any IPV matches to the Customer Care Center-Electronic Disqualified Recipient System (CCC-eDRS) staff using secure Voltage email at HHSC Office of Eligibility Services CCC Open Investigation (HHSC OES CCC IC) who will complete a secondary verification and then forward a completed Form H1856, SNAP Out-of-State Intentional Program Violations, to OIG at CDU@hhsc.state.tx.us, and document this action in TIERS Case Comments.

OIG Centralized Disqualification Unit (CDU) staff will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the advisor of the disqualification. The CBS advisor then takes appropriate action to deny the application/EDG. Note: If CBS staff has not yet processed the application, TIERS will ensure it is denied if the application is subsequently filed and/or processed.

State office also shares any felony drug conviction data matches with CBS. CBS staff must follow policy in A-232.2, Disqualified Persons, to take adverse action.

B-475.2.2 Switching from the Regular SNAP Program to SNAP-Combined Application Project (CAP)

Revision 15-4; Effective October 1, 2015

SNAP-CAP

If an SSI recipient receiving regular SNAP benefits wants to switch to SNAP-CAP, the individual must contact CBS staff and request to withdraw from the regular program and apply for SNAP-CAP.

Within 10 days of receipt of the request and determination that the individual meets SNAP-CAP eligibility requirements, CBS staff:

  • send the individual a notice of denial for the regular SNAP, using adequate notice procedures;
  • terminate the person's participation in the regular SNAP as soon as possible (that is, the end of the month the individual made the request if the 10th day falls before the monthly computer cutoff, and no later than the end of the next month); and
  • send the individual a SNAP-CAP application if the individual has not already filed one with CBS.

If HHSC fails to take action within 10 days to authorize denial of the regular SNAP EDG for the applicable month, HHSC restores any lost benefits as a result of untimely agency action.

HHSC does not provide a SNAP-CAP application to anyone who does not meet the SNAP-CAP eligibility criteria. CBS also certifies eligible individuals for SNAP-CAP if the individuals submit applications they obtained on their own. CBS will coordinate termination of the individual's participation in regular SNAP, if not already terminated. To avoid duplication of SNAP benefits when an eligible individual requests to switch from the regular SNAP to SNAP-CAP, CBS staff use a file date equal to the first day of the first month the individual qualifies for SNAP-CAP, if that date is later than the date the application form is actually received. CBS staff must document in TIERS Case Comments the reason for the modified file date as compared to the date on the application form.

Note: CBS staff may also cancel a month's regular SNAP issuance in order to expedite the recipient's switch to SNAP-CAP, if it is not too late to cancel that issuance. Refer to B-331, Cancelling Benefits in EBT Accounts.

B-475.3 Household Composition

Revision 15-4; Effective October 1, 2015

SNAP-CAP

A SNAP-CAP food unit consists of one person. Married individuals who are both receiving SSI are considered separate households and certified on individual SNAP-CAP EDGs. (See A-231, Who Is Included.)

A SNAP-CAP participant who resides in a household in which other members receive SNAP through the regular program is considered a separate household, regardless of how they purchase and prepare their meals. (See A-232.1, Nonmembers.)

Do not include a SNAP-CAP participant when determining regular SNAP eligibility for other household members. Follow policy in A-1326.1.1, Contributions from Noncertified Household Members.

A minor child residing with a SNAP-CAP participant may be certified as SNAP head of household. The SNAP-CAP participant must be listed as the AR on the minor child's EDG. (See A-231.)

B-475.4 Income

Revision 13-4; Effective October 1, 2013

SNAP-CAP

SSI eligibility is verified weekly via the SNAP-CAP participant's SDX record.

B-475.5 Shelter and Utility Expenses

Revision 15-4; Effective October 1, 2015

SNAP-CAP

Advisors follow policy in A-1429, Shelter Costs, for separate households sharing shelter expenses, including standard utility allowance (SUA)/basic utility allowance (BUA), if applicable.

B-475.6 Changes

Revision 15-4; Effective October 1, 2015

SNAP-CAP

SNAP-CAP participants are not required to report changes. CBS processes shelter and address changes reported by SNAP-CAP participants.

CBS will mail Form H0025, HHSC Application for Voter Registration, to the individual when the individual reports a change of address. If the individual contacts CBS to decline the opportunity to register to vote after receipt of Form H0025, CBS will mail Form H1350, Opportunity to Register to Vote, to the individual for a signature. After the household returns Form H1350, the advisor sends the form for imaging and retains the image for 22 months.

State office uses SDX records to automatically update individual information on a weekly basis. The weekly SDX update results in a SNAP-CAP EDG denial if the individual no longer receives SSI, dies or moves to a nursing home.

Related Policy

Registering to Vote, A-1521

B-475.7 Issuing Benefits

Revision 22-2; Effective April 1, 2022

SNAP-CAP

CBS staff authorize EBT accounts for SNAP-CAP participants. Replacement Lone Star Cards may be obtained from local offices if the local office replacement criteria are met. Determine whether the SNAP-CAP participant can get a replacement card locally or request it from the Lone Star Help Desk.

Related Policy

Lone Star Card Replacement, B-235

B-475.8 Fair Hearings

Revision 13-4; Effective October 1, 2013

SNAP-CAP

Follow policy in B-1000, Fair Hearings.

B-475.9 Claims

Revision 19-4; Effective October 1, 2019

SNAP-CAP

Staff file an overpayment referral when a household receives benefits it is not entitled to receive. This may occur based on agency error, applicant or recipient error or misunderstanding, through fraud or an Intentional Program Violation (IPV). OIG receives the overpayment referral and establishes a claim if the referral is valid.

SNAP-CAP households are subject to overpayment referrals and claims. Households may repay benefits through either recoupment or restitution. Recoupment is a method of recovering an overpayment claim by withholding a portion of the household's benefits. Restitution is a method of recovering an overpayment claim by the receipt of payments from the household paid to HHSC.

Related Policy

Claims, B-700
Filing an Overpayment Referral, B-770

B-475.10 Redeterminations

Revision 15-4; Effective October 1, 2015

SNAP-CAP

State office automatically mails Form H1842, SNAP-CAP Renewal Application, two months before the last benefit month. To reapply in a timely manner, the individual must submit the completed Form H1842 by the 15th day of the last benefit month.

CBS staff must process timely redeterminations by the last workday of the certification period. CBS staff certify the SNAP-CAP EDG for 36 months and provide a notice of eligibility without a face-to-face or telephone interview. Advisors must ensure that the individual's normal issuance cycle is not interrupted.

If CBS receives Form H1842 after the 15th day of the last benefit month, advisors certify or deny the application by the 30th day after the file date. Expedited processing and benefit proration do not apply to SNAP-CAP.

A Form H1842 returned to a local eligibility determination office must be faxed to CBS the same day it is received. The fax number is 1-877-447-2839.

B-475.10.1 Opting Out of SNAP-CAP

Revision 15-4; Effective October 1, 2015

SNAP-CAP

Individuals currently receiving SNAP-CAP may choose to apply for traditional SNAP because they may be eligible for a higher allotment. If an individual returns Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and chooses to opt out of SNAP-CAP, the local office must:

  • contact and confirm the applicant wants to apply for benefits under regular SNAP;
  • schedule an appointment for an interview;
  • perform Application Registration using a different SNAP EDG number than the SNAP-CAP EDG number;
  • determine if the individual would receive a higher allotment under regular SNAP;
  • notify the individual of the allotment amount under regular SNAP and confirm if the individual wishes to withdraw from SNAP-CAP;
  • contact 2-1-1 to request EDG closure because the individual wishes to withdraw from SNAP-CAP;
  • confirm the SNAP-CAP EDG has been denied; and
  • certify the individual for regular SNAP effective the first month the individual qualifies for benefits without duplicating benefits.

B-476 Joint Supplemental Security Income (SSI)-SNAP Applications

Revision 15-4; Effective October 1, 2015

B-476.1 Applications Filed in the Social Security Office

Revision 15-4; Effective October 1, 2015

SNAP

Households whose members are all applying for or receiving SSI may apply for SNAP at the SSA office unless the households already have a SNAP application pending. These individuals are not required to come to the SNAP office to complete the application or redetermination process. If more information is needed from the household, the advisor must contact the household by home visit, telephone, or mail.

SSA:

  • accepts and completes the SNAP application during the SSI interview; and
  • forwards the following items to the Document Processing Center within one workday after receiving the application:
    • the application;
    • Form SSA-4233, Social Security Administration Transmittal for Food Stamp Applications; and
    • any verification SSA has received.

The file date for the application is the date SSA receives the application. SSA notes this date on Form SSA-4233. When SSA receives additional verification after forwarding the application to the Document Processing Center, SSA sends the additional verification with Form SSA-4233.

B-476.1.1 Expedited Service

Revision 15-4; Effective October 1, 2015

SNAP

Advisors determine expedited services eligibility for SSI households the same as other households, except expedited time limits begin with the date the correct SNAP office receives the application.

SSA staff:

  • screen the application for expedited services on the day they receive it;
  • note "Expedited Processing" on the first page of Form H1010, Texas Works Application for Assistance — Your Texas Benefits, if the household appears to be eligible; and
  • fax the application within one workday to the Document Processing Center's expedited fax number.

The individual may also take the application to the SNAP office.

B-476.1.2 Work Registration

Revision 22-1; Effective January 1, 2022

SNAP

SSI household members who apply for SSI and SNAP at the Social Security office are exempt from work registration until the SSA determines their eligibility for SSI.

Related Policy

SNAP Work Requirement Exemptions, A-1822.1

B-476.1.3 Special Review

Revision 15-4; Effective October 1, 2015

SNAP

For households applying at SSA, advisors process a special review during the third month of the certification period to determine whether the individual received a decision on the SSI claim.

B-476.1.4 Notice of Expiration

Revision 13-4; Effective October 1, 2013

SNAP

TIERS sends Form H1830-R, Texas Works Renewal Notice, to the SSI household:

  • no earlier than the month before the last month of the certification period, and
  • no later than the first day of the last month of the certification period.

The notice of expiration informs the individual:

  • what programs are due for redetermination,
  • verifications needed for the redetermination,
  • when the redetermination application and verifications are due, and
  • the individual's rights and responsibilities.

B-476.1.5 Reporting Changes

Revision 15-4; Effective October 1, 2015

SNAP

These households are subject to the same change reporting requirements as other SNAP households.

HHSC receives information on whether the SSI was granted or denied through an interface with SSA. Advisors must take action on information from this or any other source.

Related Policy

Reporting Requirements, B-620

B-476.1.6 Redetermination

Revision 13-4; Effective October 1, 2013

SNAP

Households in which all members are applying for or receiving SSI may file a redetermination for SNAP at the SSA.

The SSA office sends:

  • the application,
  • transmittal sheet (Form SSA-4233), and
  • any available verification to the Document Processing Center.

B-476.2 Applications Filed in Public Institutions

Revision 22-3; Effective July 1, 2022

SNAP

A resident of a public institution may jointly apply for SSI and SNAP while in the institution if scheduled for release within 30 days.

SSA staff:

  • within one business day, send non-expedited applications to:
    • HHSC
      P.O. Box 149024
      Austin, TX 78714-9024; or
    • fax to 877-447-2839;
  • within one business day, fax expedited applications to 866-559-9628;
  • note "PRERELEASE" in red ink across the top of Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
  • send Form SSA-4233 to HHSC; and
  • give HHSC the name, address and phone number of a staff contact at the institution.

When the person does not have a post-release address, SSA holds the application for 30 days and documents its actions. SSA sends these applications and Form SSA-4233 to HHSC within one business day when:

  • SSA receives a post-release residence address;
  • release has occurred, but SSA has not received a post-release address;
  • SSA denies SSI prior to release; or
  • release from the institution is canceled.

HHSC staff:

  • register the application; and
  • pend the application until SSA notifies HHSC that the applicant has been released.

If the applicant is:

  • not released, HHSC denies the application.
  • released, HHSC determines eligibility for benefits, including expedited services. HHSC offers benefits to allow the person a chance to participate per the application processing time frames.

Note: The file date is the date the applicant is released from the institution. The file date is day zero.

Certification Period or Special Review — Process a special review during the third month of the certification period to determine whether the person receives SSI.

Related Policy

Application Processing, A-100

B-477 Texas Simplified Application Project (TSAP)

Revision 22-3; Effective July 1, 2022

B-477.1 Overview

Revision 22-3; Effective July 1, 2022

TSAP

For the TSAP caseload, Texas is operating under a waiver. The waiver allows the state to provide a simplified application and certification process for certain persons applying for SNAP. TSAP provides a 36-month certification period and does not require an interview at recertification.

B-477.2 Application Processing

Revision 22-3; Effective July 1, 2022

TSAP

Eligibility 

TSAP follows all regular SNAP policy and processes with the following differences:

To be eligible for TSAP, households must meet the following criteria:

  • All household members are 60 or older, receive disability payments, or both;
  • have no earned income; and 
  • No household member receives SNAP benefits under the SNAP-Combined Application Project (SNAP-CAP).

Applications

People can apply for TSAP using Form H0011, Texas Simplified Application Project (TSAP) for SNAP Food Benefits, Form H1010, Texas Works Application for Assistance – Your Texas Benefits, or online at YourTexasBenefits.com. 

At recertification, TSAP households are provided Form H1011-R, Texas Simplified Application Project (TSAP) for Food Benefits Renewal. They can also reapply using Form H1010, Form H1010-R, Your Texas Works Benefits: Renewal Form, or online at YourTexasBenefits.com. 

Applicants cannot select TSAP on Form H1010. However, new SNAP applicants and active SNAP households are tested for TSAP eligibility as part of the SNAP application and recertification process, regardless of the type of SNAP application submitted, and are certified for TSAP if eligible. Additionally, applicants who use the Form H0011 or H0011-R to apply for TSAP will be automatically tested for SNAP eligibility if not eligible for TSAP. 

Additionally, automated monthly screenings occur to identify Medicaid households that are potentially eligible for TSAP but are not currently receiving SNAP benefits. These Medicaid households will receive a TSAP application packet and an accompanying cover letter, Form H0011A, TSAP Outreach Cover Letter, detailing TSAP requirements and their potential eligibility.

Interviews

An interview is required at initial certification for TSAP, but waived at recertifications with the following exceptions:

  • prior to denying a TSAP recertification;
  • if information supplied by the household or authorized representative is questionable, incomplete or contradictory; or
  • if the TSAP household requests an interview.

Verification

Accept the applicant’s statement and use data matching to verify as much information as possible. Only request more information from the household to resolve questionable information. Out-of-pocket medical expenses still require verification if the person wants to claim a medical deduction.

Related Policy 

Budgeting Medical Deductions, A-1428.2
Households with Elderly Members or Members with a Disability, B-430
Questionable Information, C-920

B-477.3 SNAP Conversion

Revision 22-3; Effective July 1, 2022

TSAP

A TSAP household will convert to regular SNAP and maintain their assigned TSAP certification period if the TSAP household becomes ineligible for TSAP during their certification period (but remains eligible for SNAP) due to: 

  • the loss of disability payments;
  • an addition of a non-elderly or non-disabled member; or
  • the receipt of earned income.

B-477.4 Change Reporting

Revision 22-3; Effective July 1, 2022

TSAP

All TSAP households meet the streamlined reporting criteria and must report changes in accordance with the reporting requirements for this group. TSAP households will receive Form H0586, TSAP Change Reminder, once every 12 months during the 36-month certification period, reminding the household of what changes to report, how to report changes and the consequences of not reporting required information. TSAP households are not required to return Form H0586.

Related Policy

Streamlined Reporting Households, A-2350
Reporting Requirements, B-620

B-480, A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20

Revision 15-4; Effective October 1, 2015

TANF

When household members on a TANF EDG that includes other-related children become ineligible, and the other-related children remain eligible for TANF, advisors must ensure the other-related children continue to receive TANF.

Advisors must:

  • deny the TANF or TANF-SP EDG; and
  • continue the TANF for the other-related children.

TP 08

If a caretaker relative who receives TP 08 based on caring for (an) other-related child(ren) receiving Medicaid becomes ineligible for TP 08 due to new or increased earnings or spousal support and begins receiving TP 07 or TP 20, the other-related child(ren) will also transition from their TP 43, TP 44, or TP 48 EDG to a TP 07 or TP 20 EDG.

B-481 EDGs That Include an Other-Related Child

Revision 15-4; Effective October 1, 2015

B-481.1 At Initial Certification

Revision 15-4; Effective October 1, 2015

TANF or TANF-SP

When a TANF EDG includes an other-related child, advisors must:

  • explain to the household that the other-related child, if eligible alone, can continue receiving TANF even if the TANF for the other members of the household is denied. Denials include, but are not limited to, those because of:
    • resources,
    • earnings, or
    • child support.
  • advise households that have an other-related child included in the TANF EDG to contact HHSC immediately if they receive a notice in the mail stating that their TANF or TANF-SP will be denied because they are no longer eligible for the 90 percent earned income deduction.
  • set a special review to contact the household and continue TANF for an eligible other-related child when the EDG is expected to be denied because the 90 percent earned income deduction will be removed.

B-481.2 Before a TANF or TANF-SP EDG Is Denied

Revision 15-4; Effective October 1, 2015

TANF

Advisors determine whether an other-related child is eligible for TANF on a separate EDG before the household's TANF is denied. Advisors must contact the household to ensure that the household wants the child's TANF to continue.

Advisors provide TANF to the other-related child without a break in benefits, if the other-related child is eligible alone and the household:

  • wants the other-related child's TANF to continue, or
  • cannot be contacted.

If more than one other-related child is in the household, other-related children who are not siblings are certified on separate EDGs. Exception: The individual may choose to combine EDGs if one EDG is ineligible separately but would be eligible if the members were combined.

The other-related child is kept in the original household group if the:

  • child is not eligible alone, or
  • the household does not want the child to receive TANF.

B-482 Separating Household Members

Revision 15-4; Effective October 1, 2015

TANF

The eligibility system creates an EDG for the other-related child's TANF. Advisors must verify that each certified group contains the correct members. Advisors also must ensure that a new Lone Star Card is issued for the other-related child's new EDG. A new application is not required.

Note: These procedures ensure that TANF-SP EDG numbers follow the SP members.

B-490, Determining Whether a Person Who Resides in a Facility Is Institutionalized

Revision 22-1; Effective January 1, 2022

SNAP

People residing in institutions that are not approved are potentially eligible for SNAP, only if the person is not considered institutionalized. Approved institutions include homeless shelters, Drug and Alcohol Treatment (D&A), Group Living Arrangement (GLA) Facilities, and family violence shelters.

Additionally, people who reside together and receive residential services from nonprofit organizations or for-profit providers who contract with HHSC to provide residential services may participate in SNAP, only if the person is not considered institutionalized.

Residential services providers may:

  • manage a resident's personal funds at the request of the resident; or
  • be the payee on the resident's SSI benefit check.

If the person requests the residential services provider to manage the resident's personal account, the provider must maintain a financial account for the person and a separate detailed record of all deposits and expenditures for each resident.

Residential services providers may not commingle the resident's personal funds with the provider's funds.

For people residing in a facility or receiving residential services, staff must determine whether a person is institutionalized for SNAP eligibility following the steps below:

StepYesNo
  1. Does the person do their own shopping and preparation for more than 50 percent of their meals, or do the facility staff manage the resident's personal account (which can include SNAP benefits) and use those funds to purchase a majority of the person's meals and prepare them for the resident?
The resident is not considered institutionalized. The person is eligible for SNAP if all other SNAP eligibility requirements are met. Go to Step 3.Go to Step 2.
  1. Does the facility:
  • contract with HHSC to furnish a majority of the resident's meals along with other services;
  • provide a majority of the resident's meals from food purchased with money other than the person's funds; or
  • charge the resident a standard fee for a majority of the person's meals?
The resident is considered "institutionalized" for purposes of SNAP eligibility since the contractor is providing most meals for the person. The resident can only qualify if the person meets the requirements for a resident of a nonprofit GLA.The resident is not considered institutionalized. The person is eligible for SNAP if all other SNAP eligibility requirements are met. Go to Step 3.
  1. Does the resident purchase and prepare their meals separately from others (including situations in which an attendant purchases food for the person with the person’s money and prepares the person's meals separately from other people’s), or does the resident intend to purchase and prepare separately after certification for SNAP?
The person can apply as a one-person household following regular policy.People who purchase or prepare their food together must be included on the SNAP application. HHSC determines eligibility for all those purchasing or preparing together. Example: The facility uses every resident’s specific SNAP funds to purchase groceries and prepare meals for everyone together. In this example, all the residents must be certified together for SNAP.

Verify and document the answers to the questions in the chart. If the person designates provider staff as the AR and the AR states the attendant purchases meals or food using the person's funds, the AR must provide a detailed record of deposits and expenditures for these people.

Related Policy 

Applications from Residents of a Homeless Shelter, A-116.2
General Policy, A-210
Drug and Alcohol (D&A) or Group Living Arrangement (GLA) Facilities, B-440
Residents of GLA Facilities, B-442
Residents in Family Violence Shelters, B-450

B-491 Documentation Requirements

Revision 22-1; Effective January 1, 2022

SNAP

For households receiving residential assistance, document responses to the questions when determining if a person who resides in a facility is institutionalized.

Related Policy

Determining Whether a Person Who Resides in a Facility Is Institutionalized, B-490

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

B-510, Termination of Medical Coverage for People Confined in a Public Institution

Revision 20-4; Effective October 1, 2020

All Medical Programs

Medical coverage is terminated for people confined in a public institution, except as provided in Section B-520, Medicaid Suspension, and Section B-541, Inpatient Services Provided to Inmates of the Texas Department of Criminal Justice (TDCJ). When a report of confinement is received, follow policy in B-631, Actions on Changes, to terminate the person’s eligibility.

Related Policy

Medicaid Suspension, B-520
Inpatient Services Provided to Inmates of the Texas Department of Criminal Justice (TDCJ), B-541
Actions on Changes, B-631
Child Leaves the Home, D-1433.2
General Policy, W-910
Medicaid Termination, X-923

B-520, Medicaid Suspension

Revision 24-2; Effective April 1, 2024

Suspend Medicaid in the following circumstances:

People Certified for TA 82, TP 40, TP 44 and TP 70 Confined in a Texas County Jail

Suspend Medicaid if the person is confined in a Texas county jail for more than 30 days and the county jail chooses to report the person’s confinement to HHSC. The person’s Medicaid suspension is effective the day after the confinement is reported by the county jail.

If notified of the person’s confinement from a source other than a Texas county jail, terminate the person’s Medicaid.  

If notified of a child’s confinement from a source other than a Texas county jail, sustain the child’s Medicaid.

Children Certified for TP 44 Confined in a Secured Juvenile Facility

Suspend Medicaid when a child is placed in a secured juvenile facility. The Texas Juvenile Justice Department (TJJD) or a Juvenile Probation Department (JPD) makes the report to HHSC within 30 calendar days of a child’s placement. The child's TP 44 suspension is effective the day after TJJD or a JPD notifies HHSC that the child is placed in a juvenile facility.

If notified of the person’s confinement from a source other than a Texas county jail, terminate the person’s Medicaid.  

The following are scenarios for a child certified on Medicaid who is reported as placed in a juvenile facility.

Child is certified for…and HHSC receives notification of the child's placement in a juvenile facility from...then the child's…
TP 44 from Dec. 1, 2014 – Nov. 30, 2025TJJD on Feb. 7, 2024,TP 44 eligibility is suspended effective Feb. 8, 2024.
TP44 from Oct. 1, 2024 – Sept. 30, 2025the child’s mother on Dec. 1, 2024.TP44 is sustained. 

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Persons Confined in a Texas County Jail, B-542
Child Placed in a Secured Juvenile Facility, B-543
General Policy, E-1010
Three Months Prior Coverage, M-1010

B-530, Medicaid Reinstatement

Revision 20-4; Effective October 1, 2020

B-531 Medicaid Reinstatement for Children Certified for TP 44 Who Are Released from a Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

Upon receiving notification from the Texas Juvenile Justice Department (TJJD) or a Juvenile Probation Department (JPD) that a child whose Medicaid is suspended has been released and the child has months remaining on their original certification period:

  • reinstate the child's eligibility effective the date of their release, and
  • certify the child for any remaining months of the child’s original certification period.

Add the child back to any associated active TANF, SNAP, Medicaid, CHIP, or Medicaid for the Elderly and People with Disabilities (MEPD) EDGs if the child is a required member of the household.

The child's eligibility is reinstated even if the child is released to a household that is different than the one in which the child resided at the time of their placement.

If the child is not eligible for reinstatement but is released to a home in which a sibling is receiving Medicaid or CHIP, add the child to the sibling’s case.

If the child is released to the same household and the case is…Then…
Active or deniedThe child's TP 44 eligibility is reinstated for the remainder of the child's original certification period on the same EDG.
If the child is released to a different household…Then…
With an existing denied caseThe child's TP 44 eligibility is reinstated for the remainder of the original certification period on a new EDG.
Without an existing caseThe child's TP 44 eligibility is reinstated for the remainder of the child's original certification period on a new case.
For a child released to a different household, any changes to the child's circumstances should be addressed at the next scheduled renewal. A child released to a different household may not administratively renew.
If the child is released as an independent child with…Then…
An existing denied caseThe child's TP 44 eligibility is reinstated for the remainder of the child's original certification period on a new EDG.
Without an existing caseThe child's TP 44 eligibility is reinstated for the remainder of the child's original certification period on a new case.
For a child released as an independent child, any changes to the child's circumstances should be addressed at the next scheduled renewal. A child released to a different household may not administratively renew.

TIERS will automatically reinstate the child’s eligibility for the remainder of the certification period and add the child to any associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS staff must manually process the reinstatement or add the child to an existing case following B-545, Notification of Actual Release.

Related Policy

Medicaid Suspension, B-520
Child Placed in a Secured Juvenile Facility, B-543
Child Placed in a Non-Secure Facility, B-544
Notification of Actual Release, B-545

B-532 Medicaid Reinstatement for Persons Released from Texas County Jails

Revision 20-4; Effective October 1, 2020

TA 82, TP 40, TP 44 and TP 70

When notified by any source that a person has been released from a Texas county jail, perform individual inquiry to determine if the person:

  • has suspended or terminated health care coverage due to county jail confinement; and
  • was included in the budget or certified group of any other EDGs at the time their health care coverage was suspended or terminated.

If inquiry shows that the person’s health care coverage was suspended at confinement, perform a County Jail Release - Search to determine if the person has an active suspension (months remaining on their original certification). If so, create a Process a County Jail Confinement/Release task for all active cases on which the person was included prior to suspension and enter the release information into TIERS on the County Jail Release - Details page.

When the health care coverage EDG is disposed:

  • The person’s health care coverage is reinstated for the remaining months of the original certification period, effective the date the person is released from the county jail.
  • The Individual - Medicaid History page is updated to indicate the person’s eligibility has been reinstated.
  • A TF0001, Notice of Case Action, is generated notifying the person of reinstatement.

Reinstatement must occur within two business days of receiving the notification of the person’s release.

Consider the report of release as a change report for all other types of assistance and follow policy in B-641, Additions to the Household, to determine if the person needs to be added to the other types of assistance.

If inquiry shows that the person’s health care coverage was terminated at confinement or that the person’s original certification has ended and is not eligible for reinstatement, send an application to the person’s last known address.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Additions to the Household, B-641
General Policy, E-1010
Action on Changes, E-2220
General Policy, M-1010
Action on Changes, M-2220

B-533 Reasonable Opportunity After a Medicaid Suspension and Reinstatement

Revision 20-4; Effective October 1, 2020

TA 82, TP 40, TP 44 and TP 70

If a person’s reasonable opportunity period expires while their Medicaid is suspended, a new reasonable opportunity period is provided when their Medicaid coverage is reinstated. The new reasonable opportunity period is the earlier of the following:

  • 95 days from the date the reinstatement is disposed; or
  • the last day of their current certification period.

If the person’s Medicaid coverage is reinstated before the original reasonable opportunity period end date, their original reasonable opportunity due date is retained.

A TF0001, Notice of Case Action, is generated at reinstatement and will include the reasonable opportunity information to remind the person to submit documentation of citizenship or alien status.

Related Policy

Reasonable Opportunity, A-351.1

B-540, Centralized Benefit Services

Revision 20-4; Effective October 1, 2020

B-541 Inpatient Services Provided to Inmates of the Texas Department of Criminal Justice (TDCJ)

Revision 20-4; Effective October 1, 2020

TP 44 and TP 40

This section applies only to people confined in a Texas Department of Criminal Justice (TDCJ) facility. This policy does not apply to any other state, county, or city jails. Applications are submitted to HHSC only by The University of Texas Medicaid Branch at Galveston.

A person confined in a public institution is eligible for Medicaid coverage if the following conditions are met:

  • the confined person meets Medicaid eligibility requirements (pregnant women and children through age 18 could meet current Medicaid eligibility requirements);
  • the confined person receives inpatient services; and
  • the inpatient services are provided by a hospital that is not on the premises of a prison, jail, detention center, or other penal setting, including a facility run by a private health care entity.

Medicaid coverage is limited to the specific days the confined person is admitted as a patient and receives inpatient services as verified by the medical provider using Form H1046, Inpatient Medical Services Certification. Inpatient services are those provided on the recommendation of a physician or dentist and received in a medical institution. The confined person must receive or expect to receive room, board, and professional services in the institution for a 24-hour period or longer.

If the confined person is ineligible due to U.S. citizenship or alien status, the medical provider must also complete Form H3038, Emergency Medical Services Certification. The ineligible person is eligible only for those dates verified as an emergency, even if the inpatient treatment continues after the verified emergency dates.

The confined person is eligible for prior coverage only.

The TDCJ or its designee submits the following documents to HHSC via fax:

  • Form H1205, Texas Streamlined Application, on behalf of the confined person the month following the month the eligible hospital bill was incurred;
  • Form H1046, Inpatient Medical Services Certification;
  • Form H3038, Emergency Medical Services Certification, if applicable; and
  • all required verification, such as verification of citizenship, alien status, etc.

Note: If the required information or verification is not received, call or send secure email to the designated TDCJ contact.

Upon disposition of the application, send Form TF0001, Notice of Case Action, to the representative’s address provided on Form H1205, Texas Streamlined Application.

Related Policy

Applications for Babies Born to Women in Prison, A-116.3

B-542 Persons Confined in a Texas County Jail

Revision 20-4; Effective October 1, 2020

All Medical Programs

A county jail may choose to report people who receive health care coverage from HHSC and are confined in their facility for more than 30 days. If applicable, within two business days of the confinement report, Centralized Benefit Services (CBS) staff must review the report of confinement and determine the appropriate action needed.

CBS staff:

  • Suspend the following types of health care coverage:
    • TA 82, MA – Former Foster Care Children
    • TP 40, MA – Pregnant Women
    • TP 44, MA – Children 6–18
    • TP 70 - Medicaid for the Transitioning Foster Care Youth (MTFCY)
  • Terminate the following types of health care coverage:
    • TA 41, Health Care – Healthy Texas Women (HTW)
    • TA 66, MA – MBCC – Presumptive
    • TA 67, MA – MBCC
    • TA 76, MA – Children 6–18 Presumptive
    • TA 77, Health Care – FFCHE
    • TA 83, MA – FFCC Presumptive
    • TA 84, CI – CHIP
    • TA 85, CI – CHIP perinatal
    • TA 86, MA – Parents and Caretaker Relatives Presumptive
    • TP 07, MA – Earnings Transitional
    • TP 08, MA – Parents and Caretaker Relatives
    • TP 20, MA – Alimony/Spousal Support Transitional
    • TP 42, MA – Pregnant Women Presumptive

Do not act on other types of health care coverage.

When the Eligibility Determination Group (EDG) is disposed, if applicable:

  • The person’s health care coverage is suspended or terminated effective the day after HHSC receives the notification. The person receives Medicaid through the date of the confinement notification.
  • The Individual – Medicaid History page is updated to indicate the person’s eligibility is suspended or terminated.
  • The person is removed from other EDGs in which they are included, and benefits are adjusted accordingly for the remaining household members following current policies and procedures.
  • A TF0001, Notice of Case Action, is generated at suspension/termination and reinstatement (TWH Section A-2310, Notice to Applicants).

Note: Terminate the person’s eligibility following policy in B-631, Actions on Changes, if a report of confinement in a county jail is received from a source other than a participating county jail.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Actions on Changes, B-631
General Policy, E-1010
General Policy, M-1010

B-543 Child Placed in a Juvenile Facility

Revision 24-2; Effective April 1, 2024

TP 44

The TJJD or a JPD notify HHSC within 30 days of a child's placement in a juvenile facility. When notified of the placement:

  • suspend the child's Medicaid eligibility effective the day after HHSC receives the notification if the child is certified for TP 44;
  • sustain the child's Children's Health Insurance Program (CHIP) eligibility;
  • sustain the child's Medicaid eligibility, if the child is certified on a Medicaid type other than TP 44; and
  • remove the child from other Eligibility Determination Groups (EDGs) in which the child is included.

The child receives TP 44 eligibility through the date of the notification of placement.

The following are scenarios for a child certified on Medicaid who is reported as placed in a juvenile facility.

Child is certified forand HHSC receives notification of the child's placement in a juvenile facility fromthen the child's
TP 44 from Dec. 1, 2024 – Nov. 30, 2025TJJD on Feb. 7, 2025,TP 44 eligibility is suspended effective Feb. 8, 2025.
TP 44 from Oct. 1, 2024 – Sept. 30, 2025the child's mother on Dec. 1, 2024,TP 44 eligibility is sustained.

Exceptions:

  • Children certified on a Supplemental Security Income (SSI) or a Department of Family and Protective Services (DFPS) type of Medicaid are not terminated by HHSC.
  • Children placed in a non-secure facility may receive TP 44 as an independent child. Therefore, these EDGs are not suspended or denied when a notification of placement is received.

TIERS will automatically suspend or sustain the child’s eligibility and remove the child from associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS must manually suspend, sustain, or remove the child from associated EDGs.

Related Policy

Termination of Medical Coverage for People Confined in a Public Institution, B-510
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531
Child Placed in a Non-Secure Facility, B-544

B-544 Child Placed in a Non-Secure Facility

Revision 24-1; Effective Jan. 1, 2024

TP 44

When reporting that a child has been placed in a juvenile facility, Texas Juvenile Justice Department (TJJD) or a Juvenile Probation Department (JPD) notifies HHSC if the facility is a secure or non-secure facility. 

Non-secure TJJD or JPD halfway house facilities with more than 16 beds and non-secure juvenile facilities with 16 or fewer beds may apply for medical assistance on behalf of the children under their care. Independent children residing in a TJJD or a JPD halfway house with more than 16 beds may be eligible for Medicaid if the child meets all other eligibility criteria and the half-way house meets the federally required children’s living arrangement criteria.

These facilities have limited power of attorney and are considered alternate payees for the children’s Medicaid EDG. A facility submits an application listing the child as a case name and a representative from the facility as an authorized representative (AR). If the representative is no longer affiliated with the facility, the facility must name a new representative to serve as the child’s AR. When a child moves out of the facility, it is the responsibility of the facility’s AR to report the change of address and to end the AR designation.

Medical Effective Date

To determine the correct medical effective date (MED) for children in a non-secure facility, follow the chart below:

If the child isthen
not active on Medicaid or Children's Health Insurance Program (CHIP) and the file date is within the same month as the placement date of the child,the MED is the date the child was placed in the non-secure facility.
not active on Medicaid or CHIP and the file date is not within the same month as the placement date of the child (the application is filed the month after the placement date),the MED is the first day of the application month. Note: For unpaid medical bills before the file date, follow policy in How to Apply for Three Months Prior Coverage.
active on CHIP,test for Medicaid eligibility following procedures in Advisor Action for Determining Eligibility for Children.
receiving SSI or Foster Care Title IV-E any time during application month or within same month child is placed,deny the application.
Related Policy

Advisor Action for Determining Eligibility for Children, A-126.3   
Children's Living Arrangement, A-241.3.1
How to Apply for Three Months Prior Coverage, A-831.1 
Reporting Requirements, B-620

B-545 Notification of Anticipated Release from Juvenile Facility

Revision 20-4; Effective October 1, 2020

TP 44

At least 30 days prior to a child's release, TJJD or a JPD notifies HHSC of the child's anticipated release date. Upon receipt of the information, CBS staff determines whether the child:

  • is eligible for reinstatement of TP 44 eligibility;
  • can be added to an existing case if not eligible for reinstatement; or
  • must reapply.

If the child cannot be reinstated because their original certification period has ended or their TP 44 was not suspended or cannot be added to an existing case, CBS staff are notified in the HHSC Action Status field on the TIERS TJJD/JPD Release page, to send the household an application packet. The application packet includes the following:

  • Form H1205, Texas Streamlined Application;
  • a pre-paid envelope addressed to CBS;
  • a cover letter that provides information and instructions for submitting the application and obtaining help in completing the application; and
  • a list of Community Partners in the household’s area that provide application assistance upon request.

Related Policy

Notification of Actual Release from a Juvenile Facility, B-546

B-546 Notification of Actual Release from a Juvenile Facility

Revision 24-2; Effective April 1, 2024

TP 44

After TJJD or a JPD provide notification of the child's actual release, reinstate eligibility for a child who has suspended eligibility, if there are months remaining on the child's original certification period.

Medicaid coverage will be reinstated if there are any months left in the child’s 12-month certification period. The child will receive continuous eligibility (CE) for the remaining months. 

The child is automatically added to an existing case if they are not eligible for reinstatement but have a sibling receiving Medicaid or CHIP. The child is also added to any other EDGs on the case that require the child to be a household member.

TIERS will automatically reinstate the child’s eligibility and add the child to associated active EDGs upon notification from TJJD or a JPD. When an exception to the automated process occurs, CBS must manually process the reinstatement or add the child to an existing case.

CBS staff must process and dispose any pending applications in two business days of notification of the child's release.

CBS accepts applications up to and including the 14th calendar day after the confirmed release date. Any applications received after the 14th calendar day are routed to the local office for processing.

CBS reports the following to TJJD through the Juvenile Medicaid Tracker:

  • the child has Medicaid or CHIP;
  • the child was denied;
  • the CBS unit never received the application; or
  • the application was sent to the local office.

If the child is eligible for Medicaid, the MED cannot be any earlier than the release date.

Related Policy

Regular Medicaid Coverage, A-820
Adverse Actions Not Requiring Advance Notice, A-2344
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Who Are Released from a Juvenile Facility, B-531  
Additions to Household, B-641

B-547 Inpatient Services Provided to Juvenile Inmates

Revision 22-3; Effective July 1, 2022

TP 40 and TP 44

This section only applies to people confined in Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) facilities. This policy does not apply to any other state, county or city jails. Applications are only submitted to HHSC by TJJD.

A person confined in a juvenile public institution is eligible for Medicaid coverage if:

  • the confined person meets all other Medicaid eligibility requirements (pregnant women and children through 18 could meet current Medicaid eligibility requirements);
  • the confined person receives inpatient services; and
  • the inpatient services are provided by a hospital, including a facility run by a private health care entity, that is not on the premises of a prison, jail, detention center or other penal setting.

Medicaid coverage is only available for the specific days the confined person is admitted as a patient and receives inpatient services as verified by the medical provider using Form H1046, Inpatient Medical Services Certification. Inpatient services are those services provided on the recommendation of a physician or dentist and received in a medical institution. The confined person must receive or expect to receive room, board and professional services in the institution for a 24-hour period or longer.

If the confined person is ineligible due to U.S. citizenship or immigration status, the medical provider must also complete Form H3038, Emergency Medical Services Certification. The person is eligible only for dates verified as an emergency, even if the inpatient treatment continues after the verified emergency dates identified on Form H3038.

The confined person is only eligible for prior Medicaid coverage.

TJJD submits the following documents to HHSC via YourTexasBenefits.com:

  • YourTexasBenefits.com online application on behalf of the confined person the month following the month the person incurred the eligible hospital bill;
  • Form H1046;
  • Form H3038, if applicable; and
  • all required verification for the applicable Medical assistance program, such as verification of citizenship, immigration status, etc.

Note: If TJJD does not provide the required information or verification with the application, call or send a secure email to the designated TJJD contact to request the necessary information.

If the child has an existing case as part of a household with other members in TIERS, perform Application Registration to certify the prior Medicaid coverage on a separate case number from the existing household’s case. Upon disposition of the application, send Form TF0001, Notice of Case Action, to the representative’s address provided on the application.

Related  Policy

Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Who Are Released from a Juvenile Facility, B-531

B-600, Changes

B-610, General Policy

Revision 15-4; Effective October 1, 2015

All Programs

Changes are situations that occur in a household that may affect eligibility or the amount of benefits. The advisor must take action on reported changes to ensure that:

  • individual benefits are issued timely and accurately;
  • the Texas Health and Human Services Commission (HHSC) is not sanctioned for failure to provide correct benefits for the correct month; and
  • Quality Control (QC) initiatives are met.

B-620, Reporting Requirements

Revision 05-4; Effective August 1, 2005

B-621 What to Report

Revision 23-3; Effective July 1, 2023

All Programs

Inform all households of their responsibility to report changes in residence.

TANF and SNAP except SNAP Streamlined Reporting (SR) Households

Inform all households of their responsibility to report the following changes:

  • source of income;*
  • household composition;
  • ownership of a licensed vehicle; and
  • wage rate or status (full-time to part-time or vice versa as defined by the employer) for employed household members.*

* SR households must report any change that causes the ongoing income to exceed the 130 percent of the federal poverty level (FPL) including a new household member.

TANF

Staff must inform all households of their responsibility to report the following changes:

  • the amount of non-exempt unearned income of any household member;
  • circumstances other than employment that affect a person's amount of benefits or employment services exemption status;
  • address, job, or other information related to the absent parent; and
  • available cash, stocks, bonds, or money in a bank or savings account if the total is over $1,000.

SNAP

Streamlined Reporting 1 households meet the SR criteria described in the related streamlined reporting household policy and have income below 130 percent of the FPL. These households are required to report:

  • residence and associated changes in shelter cost such as rent or mortgage and utilities;
  • when the ongoing gross monthly income exceeds 130 of the FPL for the household's size. Consider the income ongoing if it exceeds 130 percent of the FPL for two consecutive months. Example: A new household member who is required to be included in the SNAP Eligibility Determination Group (EDG) moves into an SR household and the new member has income that causes the household's income to exceed the current 130 percent of the FPL. The household must report the change. Issue a Form TF0001, Notice of Case Action, notifying the household of the requirement to report changes in residence and associated changes in shelter costs; and
  • when the work or participation hours of an ABAWD decrease below an average of 20 hours per week. Work and participation hours include employment, self-employment and any participation hours that count toward the work requirement.

Streamlined Reporting 2 households meet the SR criteria described in the related streamlined reporting household policy and have income above 130 percent of the FPL. These households are required to report changes in residence and associated changes in shelter costs such as rent or mortgage and utilities and when the work or participation hours of an ABAWD decrease below an average of 20 hours per week.

Streamlined Reporting 3 households do not meet the SR criteria. These households are required to report:

  • gross monthly household unearned income if the amount changes by more than $50 during the certification period;
  • residence and associated changes in shelter costs such as rent or mortgage and utilities;
  • legal obligation of child support paid to or for nonmembers; and
  • available cash, stocks, bonds or money in a bank or savings account if the combined resources total is $5,000 or more.

When an SR 1 household reports a change that occurs after certification and the change causes their ongoing income to exceed their gross monthly income limit (130 percent of the FPL) for two consecutive months, the household has met the SR reporting requirement. If the household remains eligible for an allotment, the household is not required to report additional income changes during the certification period. They are only required to report changes in residence. However, if staff later processes a reported change and income is again below 130 percent of the FPL (due to decreased income or fewer household members), issue Form TF0001 advising the household they are again responsible for reporting if their income exceeds 130 percent of the FPL.

SR 1 and SR 2 households:

  • must respond as directed to all notices and letters from employment services;
  • are not required to report any other changes. If the household reports a change, staff take the appropriate action and continue to act on all agency-generated changes; and
  • are not required to report when a child turns 18 during the certification period. If an SR household contains a child who will turn 18 during the certification period, time limits do not apply to anyone until the next redetermination.

Inform SR 1 and SR 2 households with associated TANF or Medical Program (MP) EDGs of the TANF/MP reporting requirements. A status of SR 1 or SR 2 on a SNAP EDG does not alter the change reporting requirements for associated TANF or MP EDGs.

If the SR 1 or SR 2 household reports that a minor child is no longer in the home and the household contains a person 18 to 50 who is now an Able Bodied Adult without Dependents (ABAWD), process the household composition change and registers the person for SNAP Employment and Training (E&T), if not already registered. Send the household a TF0001 that includes the SNAP Work Rules informing the person about the work rules and the ABAWD time limits. 

If the person:

  • does not meet the SNAP ABAWD work requirement, set a special review for the month before the end of the ABAWD's time limit to disqualify the ABAWD or deny the EDG.
  • meets the SNAP ABAWD work requirement, the ABAWD's months do not count toward the ABAWD’s time limit. A special review is not required.

When an SR1 or SR2 household reports that an ABAWD is working or participating less than an average of 20 hours per week and no longer meeting the work requirement, the household will be subject to non-streamlined reporting criteria and designated as SR3.

Medical Programs except TP 45

Inform all households of their responsibility to report the following changes:

  • address;
  • intent to live in Texas;
  • the people living in the home;
  • income, including sources of income, regular hours worked and pay rate;
  • Modified Adjusted Gross Income (MAGI) expenses;
  • a child being institutionalized or dying; and
  • medical insurance coverage.

TP 08 and TA 31

Staff Inform all households of their responsibility to report changes in residential address, job or other information related to the absent parent.

TP 40

Households must report the termination of a pregnancy.

TP 45

Households must report if the child no longer live in Texas.

Related Policy

General Reminders, A-1510
Monitoring Questionable Management, A-1731
E&T Procedures, A-1822
Length of Certification, A-2324
Streamlined Reporting Households, A-2350

B-622 When to Report

Revision 05-4; Effective August 1, 2005

All Programs

During the interview or application processing, households must report changes that occurred since the application was filed. See B-116, Information Reported During Application Processing.

After the interview, the household must report changes listed in B-621, What to Report, within 10 days after the household knows about the change.

For special reviews, see the requirements in B-125, Processing Special Reviews.

B-623 How to Report

Revision 15-4; Effective October 1, 2015

All Programs

Household members or someone acting on the household's behalf may report changes:

Notes:

  • When a change is reported by telephone, the advisor must verify that the person speaking has the authority to report a change.
  • When a signed Form H1019 is not on file, the individual's signature on Form H1028, Employment Verification, is acceptable as a written, signed report of income change for adequate notice purposes.
  • When a change is reported on an application form, staff do not have to act on the change within 10 days. The file date is considered the report date for purposes of determining the effective date of the change. The date the advisor begins working the EDG and becomes aware of the change is day zero for purposes of taking action on the change for the associated EDGs. The individual must provide any requested verification by the Form H1020, Request for Information or Action, due date to be considered timely verification.
  • If the household reports a change of address in person, the advisor must provide the individual with the opportunity to complete Form H0025, HHSC Application for Voter Registration, to register to vote based on their new address. If the individual declines to register to vote, the advisor should ask the individual to sign Form H1350, Opportunity to Register to Vote. The advisor must send Form H1350 for imaging when the individual returns the form and retain the form for 22 months.
  • If the household reports a change of address online through YourTexasBenfits.com, or via mail, fax, telephone, or through an authorized representative, the advisor must mail the individual Form H0025 to register to vote based on the new address. If the individual contacts the local office to decline the opportunity to register to vote after receipt of Form H0025, the advisor must mail Form H1350 to the individual for a signature. The advisor must send Form H1350 for imaging when the individual returns the form and retain the form for 22 months.
  • When a household requests to make a new person or organization their authorized representative, the advisor must verify the change using the client’s signature or documentation explained in A-170, Authorized Representatives (AR).

Related Policy

Form TF0001 Required (Adequate Notice), A-2344.1
Receipt of Duplicate Application, A-121.2
Receipt of Identical Application, A-121.3
Registering to Vote, A-1521

B-623.1 Determining Whether New Income Information Is a Reported Change

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and SNAP

When an advisor works a Children's Medicaid application/redetermination during a TANF/Medicaid/SNAP certification period, and a household member's source of income currently budgeted on the other active EDG has not changed, the advisor must determine whether the member is reporting a change in income. To do this, the advisor must determine whether the income verification the household provided with the Children's Medicaid application/redetermination is:

  • a more recent payment than previously verified; and
  • within the range of payments previously verified that are currently used in the budget for the associated active EDG(s), whether the individual provides only one or more than one. "Range of payment" is the highest to the lowest representative pay amounts used to determine the current ongoing budget.

Advisors may follow the guidelines below:

If ...then ...

any of the payment amounts provided as verification for the Children's Medicaid application/redetermination are:

  • more recent; and
  • at least $25 outside the range of payment currently used as "representative income" in the budget for the active EDG,
treat this as a reported change for the active EDG and take action following B-631, Actions on Changes (including additional verification of income, if necessary). If the individual fails to provide timely verification, follow policy in B-642, Changes Increasing Benefits (Other than Additions to the Household), and B-643, Changes Decreasing Benefits.

all of the payment amounts provided as verification for the Children's Medicaid application/redetermination are:

  • older than those currently used, or
  • less than $25 outside the range of payment currently used as "representative income" in the budget for the active EDG,
do not treat this as a reported change for the active EDG (unless the individual reports that the source of income or amount of income has changed).

Example: The lowest representative check used for the current certification period is $175 and the highest representative check used is $200. The individual provides a check stub for the Children's Medicaid EDG in the amount of $210. This check is less than $25 outside the range of payments and is not considered a change.

If a change is reported during the Children's Medicaid application/redetermination, the advisor processing the Medicaid EDG must either take action on the associated TANF/Medicaid/SNAP EDG or notify the local office of the reported change. The file date is considered the report date for purposes of determining the effective date of the change. The date the advisor works the Children's Medicaid EDG and becomes aware of the change is day zero for purposes of taking action on the change for the associated EDG. The individual must provide any requested verification by the due date on Form H1020, Request for Information or Action, to be considered timely verification.

B-624 Receipts for Reported Changes

Revision 15-4; Effective October 1, 2015

All Programs

Households may request a receipt to acknowledge the change report. The receipt includes the type of change(s) and the date reported. If an individual requests a receipt, the advisor must issue:

  • a copy of the individual's completed Form H1019, Report of Change; or
  • Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change.

B-630, Processing Requirements

Revision 05-5; Effective October 1, 2005 

B-631 Actions on Changes

Revision 20-4; Effective October 1, 2020

All Programs

Customer Care Center (CCC) staff is responsible for processing most client-reported changes.

Upon receipt of a change report in the local office:

  • Accept the change.
  • Date stamp the written change report.
  • Enter the change into the State Portal — Report a TIERS Change portlet if the change is received without verification and verification is required.
  • Complete an MI/Change Routing Cover Sheet and fax the change to the vendor at 877-236-4123 if the change is received with verification. Do not enter the information in the State Portal — Report a TIERS Change portlet.

Note: Provide Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change, upon request.

To reduce the potential for quality control (QC) errors when the household reports a change in person or by phone, attempt to collect enough information to determine if the change will decrease benefits. For new or increased income, this includes the following information:

  • date of the change;
  • date of the first payment;
  • source of the income;
  • expected pay amounts (or weekly hours and rate of pay for earnings); and
  • pay frequency.

Note: Do not verify income if the amount reported makes the household ineligible.

Provide the household with Form H1020, Request for Information or Action, and Form H1020-A, Sources of Proof, on the day of the report (no later than the next workday) if more information or verification is required to complete the change action. The household is allowed 10 full days to provide the requested information or verification.

Note: When a SNAP household reports a change during the last certification month, do not send the household Form H1020/Form H1020-A, if the effective date of the change is after the certification period expires. Send the change for imaging and address it with the person at the redetermination interview.

  • Document the:
    • reported change;
    • date the change occurred; and
    • date the change was reported.
  • Calculate the budget (if applicable).

Exception: Take the following steps when a person reports a change in annual or seasonal self-employment income or expenses during their certification period:

StepYesNo
  1. Does the current budget already include fluctuations as significant as the change reported?
Stop — the change is part of the normal fluctuation of the business; do not rebudget.Re-evaluate, go to Step 2.
  1. Does the re-evaluation result in a change of more than $25 to the average monthly net self-employment income?
Rebudget the EDG(s) using new average monthly net self-employment income.Stop — do not rebudget.
  • Send Form TF0001, Notice of Case Action:
    • Following policy in B-642, Changes Increasing Benefits (Other than Additions to the Household); B-642.1, Verification Provided Timely; and B-642.2, Verification Not Provided Timely, if benefits increase or remain the same.
    • Following policy in B-643, Changes Decreasing Benefits, if benefits decrease. See A-2343.1, How to Take Adverse Action if Advance Notice Is Required.
  • Provide the household with a new Form H1019, Report of Change, and a pre-paid envelope to report future changes.

The Texas Department of Family and Protective Services (DFPS) notifies HHSC through an interface when a child receiving TANF, Medicaid or SNAP has been placed in foster care. Mass Update is triggered, and the child is automatically removed from the EDG(s). If Mass Update fails because the case is not in ongoing mode, take action to remove the child from the EDG(s).

For this type of change, advance notice of adverse action is required for SNAP, but not for TANF or Medicaid.

The Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) notifies HHSC via the TJJD/JPD Placement Logical Unit of Work in the Texas Integrated Eligibility Redesign System (TIERS) when a child certified for Medicaid has been placed in a juvenile facility and when a child has been released. Follow policy in B-520, Medicaid Suspension, and B-546, Notification of Actual Release from a Juvenile Facility, regarding action taken on a case that includes a child placed in or released from a juvenile facility.  

Related Policy

Change in Medical Expenses During Certification, A-1428.4
How to Take Adverse Action if Advance Notice Is Required, A-2343.1
Adverse Actions Not Requiring Advance Notice, A-2344
Form TF0001 Required (Adequate Notice), A-2344.1
Information Received During Expedited Application Processing, B-116.1
Medicaid Suspension, B-520
Notification of Actual Release from a Juvenile Facility, B-546  
Changes Increasing Benefits (Other than Additions to the Household), B-642
Verification Provided Timely, B-642.1
Verification Not Provided Timely. B-642.2
Changes Decreasing Benefits, B-643 

B-631.1 Multiple Changes

Revision 15-4; Effective October 1, 2015

All Programs

Multiple changes reported on the same day must be processed as one occurrence. If required, the advisor must send Form H1020, Request for Information or Action, with the corresponding pending period and list the verifications needed for all changes.

Multiple changes reported on different days must be processed as separate occurrences. If required, the advisor sends Form H1020 for each reported change with the corresponding pending period and lists only the verification needed for that change.

Each change could affect the benefits for different months. Advisors refer to B-640, Changes Affecting Benefits, to determine the correct month for each change.

Exception: All changes associated with an individual at the time the individual joins a household affects the benefits for the same month, even if the report of change is on a different day.

Example A – A household consists of a mother and son who receive SNAP, TANF and Medicaid (TP 08 for the mother and Children's Medicaid for the son). On January 10, the mother reports the birth of her daughter on January 4 and that she and the newborn went home from the hospital on January 6. The EDGs are pended for more information with a due date of January 20. The mother provides the requested information on January 20, reports she has gone to work, and provides verification of her new employer. She reports her first day of work was January 16 and that she is paid semimonthly. She will receive her first check January 30, and it is not a partial payment. The advisor must:

  • Add the newborn to the SNAP and TANF certified group effective February and request supplements for both programs;
  • Adjust the TANF benefit amount, counting the income effective for March benefits, since adverse action must first expire — apply the 90 percent earned income deduction if the mother is eligible; and
  • Adjust the SNAP budget to include the new TANF grant amount and the new earned income effective for March, since adverse action must first expire.

Example B – A household consists of a father, mother, and three children who receive SNAP and Children's Medicaid. The father is employed, and the mother receives Unemployment Insurance Benefits (UIB). On January 5, the mother reports that the father left the household on October 31 and that she received her last UIB check November 16. She also reports she started working December 3 and provides verification.

  • Remove the father from the household and terminate his income effective for February SNAP benefits.
  • Terminate the mother's UIB using either the Texas Workforce Commission inquiry system or the verification provided, effective for February SNAP benefits.
  • Add the mother's new income effective for February.
  • Children's Medicaid is continuously eligible for the first six months. The income change will be processed during a PIC, as explained in B-637, Periodic Income Checks.
  • There is no overissuance because this is a streamlined reporting household.

Example C – On March 7, the household in Example B reports that the mother's sister has moved in, and the sister wants to be added to the SNAP EDG. The EDG is pended for the sister's Social Security number (SSN) with a due date of March 17. The sister provides a current pay stub from her employer that includes her SSN on March 17. On the same day, the SNAP EDG is pended again for verification of income that was not previously reported, with a new due date of March 27. On March 25, the sister provides Form H1028, Employment Verification, that states she has worked for her employer for one year and includes all other needed information.

  • The sister is not added to the certified group for April SNAP benefits. Advance notice of adverse action for the addition of the sister's income will not expire in March.
  • The sister is added to the certified group and her income counts, effective for May benefits. 

B-631.2 Actions on Office of Inspector General (OIG) Match Action Alert Changes

Revision 19-4; Effective October 1, 2019

All Programs

OIG staff help with clearing computer matches for the following reports:

  • Public Assistance Reporting Information System (PARIS) Interstate Matches;
  • Texas Department of Criminal Justice (TDCJ);
  • Social Security Administration Prisoner Verification System (PVS);
  • Income and Eligibility Verification Systems (IEVS); and
  • Social Security Administration (SSA) Deceased Individual Report.

PARIS Interstate Matches

When OIG staff receive an Interstate Match through PARIS that shows a person on an active TIERS EDG is receiving benefits in another state, OIG informs HHSC staff by creating a task within the Task List Manager (TLM). Take the appropriate action to process the task based on the information provided by OIG.

TDCJ and PVS Matches

When OIG staff find a match through TDCJ or PVS that shows a person on an active TIERS EDG is incarcerated, OIG informs HHSC staff by creating a task within TLM. Take the appropriate action to process the task based on the information provided by OIG.

When staff request a Data Broker report, TDCJ information is displayed on the combined report for an incarcerated person. See C-825.17, Inmate/Parolee Match, for staff instructions for processing Prisoner Matches viewed in Data Broker.

Income and Eligibility Verification Systems (IEVS)

The procedures for clearing IEVS reports are documented in C-1000, Procedures for Clearance of Income and Eligibility (IEVS) Reports and Internal Revenue (IRS) Federal Tax Information (FTI).

Date of Death Matches

TIERS matches recipients on active EDGs with records from the Office of Inspector General (OIG), Social Security Administration (SSA), Texas Bureau of Vital Statistics (BVS), the Centers for Medicaid and Medicare Services (CMS), and DADS Webservice to find deceased persons.

The BVS, if available is considered the primary source of verification of death.  If BVS is available but the date of death (DOD) does not match reported information, accept BVS as verification. No additional verification is required.

If BVS verification is not available, verify the DOD using two of the following sources:

  • Social Security Administration (SSA);
  • statement from guardian or authorized representative;
  • copy of death certificate;
  • statement from a doctor;
  • newspaper death notice (obituary);
  • statement from a relative or household member;
  • statement from a funeral director; or
  • records from hospital or other institution where the person died.

TIERS attempts to update the DOD information for all active and inactive persons and automatically removes them from active EDGs. If unable to process the death data automatically, TIERS creates a task for staff to research and confirm the validity of the computer match.

Take action to clear any discrepancies when DOD data is received on an active or inactive person within TIERS and TIERS is unable to automatically dispose the case. When TIERS cannot dispose the case, a series of alerts are created for staff to explore and request additional verification.

To clear discrepancies, gather additional verification on the DOD data received. Do not require the household to provide the verification if the verification is available through one of the sources listed above.

Related Policy

Verification Sources, A-1081
Inmate/Parolee Match, C-825.17
Procedures for Clearance of Income & Eligibility IEVS, Reports & Internal Revenue IRS, Federal Tax Information FTI, C-1000 

B-632 Mass Changes

Revision 15-4; Effective October 1, 2015

All Programs

The state or federal government initiates changes that can affect all individuals or large numbers of individuals. Individuals are not required to report mass changes. These changes occur in the:

  • income eligibility standards;
  • shelter and dependent care maximum deductions;
  • Thrifty Food Plan and standard deductions;
  • utility standard;
  • cost-of-living adjustments for Social Security, Supplemental Security Income (SSI) and other federal benefits;
  • TANF grants; and
  • other eligibility criteria based on legislative or regulatory actions.

When these changes occur, HHSC automatically adjusts eligibility or benefits for most individuals and notifies the households via Form TF0001, Notice of Case Action. The adjustments are effective the date of the change. Advisors do not send Form TF0001.

HHSC generates an exception report for EDGs that are not adjusted during the state office conversion. Advisors must review the EDGs, adjust benefits if necessary, and send the individual Form TF0001, allowing advance notice of adverse action if required. 

B-633 Changes in Eligibility Test

Revision 15-4; Effective October 1, 2015

All Programs except TP 45

If a household's circumstances change and the household is subject to a new income/resource test, the advisor must determine eligibility by applying the new test when the change is reported. 

B-634 Changes in SNAP EDGs Jointly Processed with Supplemental Security Income (SSI)

Revision 15-4; Effective October 1, 2015

SNAP

Individuals whose SNAP and SSI applications have been jointly processed must report changes like other SNAP individuals. 

B-635 Shortening Certification Periods as a Result of a Change

Revision 15-4; Effective October 1, 2015

SNAP

In the following situations, the advisor may shorten a non-public assistance (NPA) SNAP certification period:

  • A change occurs that makes the case circumstances unstable, and the advisor cannot readily determine the effect of the change on the household's eligibility or benefits. This includes:
    • receipt of the discrepancy report Alert 254, Employer New Hire Data;
    • new listings of information on Data Broker that are inconsistent with information previously reported by the household; and
    • situations in which a public assistance household's TANF is denied for some administrative reason, such as missed appointment, voluntary withdrawal, or failure to provide information requested to redetermine TANF eligibility, and the individual's SNAP EDG becomes questionable.
  • The household's eligibility becomes questionable as described in special reviews for known changes. See B-125.1, Due Dates.

Exception: Do not shorten the certification period if the household is designated SR. The advisor must send Form H1020, Request for Information or Action, requesting specific verification. If the SR household does not provide the verification, the EDG is denied and the advisor sends Form TF0001, Notice of Case Action. See A-2330, Setting Special Reviews, to determine when to set a special review on SR EDGs.

Centralized Benefit Services (CBS) staff shorten certification periods when a household reports a change that results in the household being transferred out of CBS. See B-474.6.1, Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs).

In all of the situations where advisors may shorten an NPA SNAP certification period, the advisor must use the following procedures before shortening the certification period:

  • Send the household Form H1020 and list the specific verification needed to process the case. If the household responds, take appropriate action.
  • If the household fails to provide verification, deny the EDG using denial reason failure to provide information and send Form TF0001.
  • Send Form H1830, Application/Review/Expiration/Appointment Notice, and Form H1010, Texas Works Application for Assistance – Your Texas Benefits, to the household along with Form TF0001. Mark the first box on Form H1830 that begins, "Attached is an application for ..." and mark "SNAP." When the individual returns Form H1010, follow normal application time frames.

Related Policy

Data Broker, C-820
Questionable Information, C-920 

B-636 Change in Head of Household (HOH)

Revision 21-4; Effective October 1, 2021

All Programs

When the current HOH dies or leaves the home, change the HOH to another responsible adult household member without requiring the remaining household members to reapply for benefits. If there are children in the household, a responsible adult household member is:

If there is no responsible adult member identified in the household, and a child in the household is receiving benefits, send Form H1020, Request for Information or Action, to notify the household that a responsible adult who is caring for the child must apply for benefits for the child to continue to receive assistance. If an application is not submitted by the Form H1020 due date, deny benefits since the whereabouts of the household are unknown.

SNAP and TANF

If the HOH who left the home was the Electronic Benefit Transfer (EBT) primary cardholder (PCH), update the PCH information with the new HOH and issue a new Lone Star Card to allow the household access to SNAP and TANF benefits. Do not update the information if a new HOH has not been identified.

Related Policy

When to Send a PCH Record, B-231.1
Issuing a Lone Star Card, B-233 

B-637 Periodic Income Checks

Revision 24-2; Effective April 1, 2024

TP 08

Initiating a PIC requires no staff action. It uses the automated income check process to determine if there has been a change in the household’s income that makes the household potentially ineligible for Medicaid for Parents or Caretaker Relatives.

A PIC is initiated in months three through eight of the certification period when the following conditions are met:

  • any of the following is true for at least one person in the MAGI household for at least one countable income or expense source:
    • an income or expense is not verified;
    • one of the following income types uses “Verified by Reasonable Compatibility” as the verification source:
      • employment income;
      • unemployment compensation income; or
      • RSDI income; or
    • the verification source is anything other than “Verified by Reasonable Compatibility” and the verification received date is more than 60 days old; and
  • the case is in Approved Ongoing mode; and
  • there are no pending TLM tasks for the case. 

The household’s income information in the eligibility system is compared with income data available through electronic data sources (ELDS) as part of the automated income check process. This is to determine if it is reasonably compatible, as explained in A-1370, Verification Requirements, Medical Programs.

The eligibility system may be able to complete the entire PIC process without any staff action or correspondence sent to the client. This is if the PIC does not find an indication that there has been a change in the household’s income that makes them potentially ineligible.

Electronic income data is requested one month before the eligibility system uses it. If the household’s income is not determined to be reasonably compatible with electronic data, the household must provide other acceptable verification as explained in A-1371, Verification Sources.

Electronic Data Hierarchy for Earned Income

  1. TIERS checks electronic data from the Texas Workforce Commission (TWC).
  2. If earned income electronic data is not available, TIERS checks to see if there is a New Hire Report. When a New Hire Report exists that does not match the household’s income information in TIERS, the household must provide verification of the information on the New Hire Report.

TIERS also checks SOLQ to verify RSDI income (unearned income).

Process verifications returned as the result of a PIC following changes policy. If the person does not provide the requested verification by the 10th day, TIERS automatically sends Form TF0001 on the 11th day for failure to provide.

SNAP and TANF

Verification is required for SNAP and TANF during the automated income check process when:

  • The reasonable compatibility calculation result is Need Info because ELDS above limit or the person is required to provide verification of information found on a New Hire Report for a Medical Program.
  • A person in the MAGI household is included in a SNAP or TANF budget group.

The person has 10 days to provide the verification for SNAP and TANF. If the person does not provide verification by the 10th day, TIERS will automatically take the following action on the 11th day based on the income type and electronic data source used during the automated income verification process:

  • Deny SNAP and TANF benefits for the following data sources:
    • quarterly wage data from the TWC; or
    • New Hire Report data from the Office of the Attorney General (OAG).
  • Create a task to notify staff to adjust SNAP and TANF benefits for the following data sources:
    • unearned Retirement, Survivors, and Disability Insurance (RSDI) income data from the Social Security Administration Social Security Administration (SSA); or
    • unearned unemployment data from TWC.

Note: Unearned RSDI data from SSA, or unearned unemployment data from TWC are valid forms of verifications for SNAP and TANF. Since quarterly wage data from TWC and New Hire Report data from OAG are not valid sources of verification for SNAP and TANF, the person must provide verification of the income.

Related Policy

Medicaid Termination, A-825
Advance Notice, A-2343
Actions on Changes, B-631
Employer New Hire Report (ENHR) and National Directory of New Hires (NDNH) Report, C-825.12
Texas Workforce Commission (TWC) Wages/Benefits, C-825.13
Expedited CHIP Enrollment, D-1711

B-638 Returned Mail

Revision 16-4; Effective October 1, 2016

All Programs

Advisors must take the following action when returned mail is received:

If the case includes an active SNAP EDG:

  1. Review the address indicated on the returned mail, the case record, and the State Portal to determine whether the household has reported a new address. If a new address was reported, process the address change and any related changes in shelter expenses. Otherwise, go to Step 2.
  2. If the new address was not reported and a forwarding address was not provided, make one attempt to contact the household via telephone to confirm the address and document the attempt. If able to contact the household and the household provides a new address, process the change and any related changes in shelter expenses. Otherwise, go to Step 3.
  3. If the returned mail is a SNAP redetermination packet and there are no other active EDGs, document these facts in Texas Integrated Eligibility Redesign System (TIERS) Case Comments and take no further action. Otherwise, go to Step 4.
  4. For households with:
    • no individuals receiving Retirement, Survivors, and Disability Insurance (RSDI) or Supplemental Security Insurance (SSI), go to Step 5; or
    • individuals receiving RSDI or SSI, use the State Online Query (SOLQ) to verify the household's address. If the address in SOLQ:
      • is different from the address in the TIERS case record, use the information in SOLQ to update the address and explore shelter expenses as necessary; and
      • matches the address in the TIERS record, document in TIERS Case Comments that the SOLQ inquiry address matches the TIERS address and take no further action. Otherwise, go to Step 5.
  5. If unable to contact the household via telephone to obtain an update on their address and no household member receives RSDI or SSI, send Form H1020, Request for Information or Action, to the TIERS address to request verification of address and any change in shelter expenses. To pend for address information:
    • in Change Action mode, go to "Individual Demographics";
    • edit the head of household's record;
    • change the effective begin date appropriately;
    • on the "Residency" page, select "not verified" from the residency verification drop down menu;
    • complete the Logical Unit of Work (LUW);
    • document all attempts to contact the household by telephone; and
    • run eligibility.
  6. If the household fails to provide information as requested on Form H1020, deny the household for failure to provide information. Send Form TF0001, Notice of Case Action, to deny the case using the denial reason "Failed to Provide Information."
  7. If the household is denied for failure to provide information and provides a correct address within the advance notice of adverse action period, reopen the EDG using the original certification period and process any related changes in shelter expenses. Please refer to the TIERS Advance Notice of Adverse Action Reference Guide in the ASK iT Knowledge Base for instructions.

If the case does not include an active SNAP EDG:

  1. Review the address on the returned mail, the case record, and the State Portal to determine whether the household has reported a new address. If a new address has been reported, process the address change. Otherwise, go to Step 2.
  2. If a new address has not been reported and a forwarding address was not provided, make one attempt to contact the household via telephone to obtain an update on their address and document the attempt. If the household provides a new address, process the change. Otherwise, go to Step 3.
  3. For households with individuals receiving RSDI or SSI, use SOLQ to verify the household's address. If the address in SOLQ is different from the address on file, use the address in SOLQ to update the address. If the address in SOLQ matches the address in the TIERS record, document in TIERS Case Comments that the SOLQ inquiry address matches the TIERS address and take no further action. Otherwise, go to Step 4.
  4. If unable to contact the household by telephone to obtain an updated address and no household member receives RSDI or SSI, use the following steps to deny the EDG using the denial reason “Unable to Locate” as stated in TWH A-2344.1, Form TF0001 Required (Adequate Notice):
    • in Change Action Mode, go to "Household Information" and select "Yes" for the question "Is the worker unable to locate the household?";
    • document all attempts to contact the household by telephone; and
    • run eligibility.

Related Policy

Actions on Changes, B-631
Returned Mail, E-2221
Returned Mail, M-2221

B-640, Changes Affecting Benefits

Revision 09-3; Effective July 1, 2009

B—641 Additions to the Household

Revision 20-4; Effective October 1, 2020

TANF and SNAP

Determine household eligibility when a member must be added to the household. If the addition to the household causes benefits to increase or remain the same, send Form TF0001, Notice of Case Action, by the 10th day after the change is reported. If additional information or verification is required, send Form TF0001 the next business day, but no later than the business day after the Form H1020, Request for Information or Action, due date. Request supplemental benefits, if required, no later than the last day of the month in which the verification is received.

If the household addition is a member of another active EDG, remove the person from the other EDG before adding the person to the new EDG. Restore benefits if adding the person increases benefits and the person was not removed from the active EDG in a timely manner. Take overpayment action on the old EDG.

Medical Programs except TP 45

Under MAGI household composition rules, explained in A-240, Medical Programs, a person joining or leaving the home may or may not affect eligibility depending on that person’s tax status, tax relationships, and family relationships.

TP 08

If the household requests Medicaid for an additional legal parent or caretaker relative, the new person is given a separate EDG and the system aligns the certification period of the newly created EDG with the existing TP 08 certification period.

Assign a Medicaid eligibility date as early as three months before the month the person reports the change for applicants who have unpaid medical bills and meet the criteria described in A-830, Medicaid Coverage for the Months Prior to the Month of Application. When applying the criteria in A-830, the application month is the month the person reports the change.

TP 43, TP 44 and TP 48

When a household requests Medicaid for a child (sibling or non-sibling) who lives with a child currently receiving TP 43, TP 44, or TP 48 Medicaid coverage, the household does not need to complete a new application. Follow policy in A-240, Medical Programs, to determine the new child’s household composition and A-1300, Income, to determine if the new child has any countable income.

If the household does not provide all the information needed to make an eligibility determination when requesting Medicaid for the new child, follow current policy and processes to request the additional information by issuing the Form H1020, Request for Information or Action.

When all the requested information is provided, the new child is given a separate EDG and the system aligns the certification period of the newly created EDG with the existing child’s Medicaid certification period.

Exception: Do not add additional children or siblings to a case in which a denied EDG is being reinstated because another child in the household or a sibling was released from a juvenile facility or a county jail. The household must submit a new application for the additional children or siblings.

If there is not an existing TP 43, TP 44, TP 48 or CHIP EDG, a separate application is required to initiate benefits for a new child being added to the case, as explained in A-121, Receipt of Application. 

TA 82, TP 40, TP 44 and TP 70

If a person’s Medicaid is suspended because the person was incarcerated in a Texas county jail, determine if they can be added to an existing case for reinstatement of all previous benefits when the person’s Medicaid is reinstated.

Related Policy

Medical Programs, A-240
Regular Medicaid Coverage, A-820
Medicaid Coverage for the Months Prior to the Month of Application, A-830
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531
Medicaid Reinstatement for Persons Released from Texas County Jails, B-532

B—641.1 Adding Newborns to the Case

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Before adding a newborn child, advisors use inquiry to determine whether a TP 45 EDG has been opened. This helps prevent the assignment of duplicate coverage and individual numbers.

To locate the TP 45 EDG, the advisor must perform inquiry using the newborn's mother's individual number or demographic information.

Newborns are added to the household even if they are still hospitalized as long as the parent(s) exercises care and control and intends to bring the newborn home.

SNAP

The TP 45 certification date is considered the change report date for the birth of the child. This is considered a reported change whether the case is SR or non-SR, and the agency is required to take action on this reported change.

Before adding the newborn to the EDG, the agency must confirm that the child was released from the hospital to the individual's home. The advisor must attempt to contact the household by phone to confirm whether the newborn child has moved into the home (and the date that occurred) and to obtain any information not already available on the TP 45 EDG that is needed to add the child. If the advisor is not able to reach the individual by phone, the advisor must send Form H1020, Request for Information or Action, requesting the necessary information. The advisor must not pend for verification of an SSN application at change action to add a child age six months or younger. Advisors follow policy in B-641.2, Steps for Adding New Members, to determine the effective date of the change. If the individual does not respond by the Form H1020 due date:

  • the child is not added to the SNAP EDG; and
  • the advisor must document that the individual failed to provide required information to add the child.

If the household later provides information and verification related to the newborn, the child is added, effective the month after verification is received.

Related Policy

General Policy, A-410 

B—641.2 Steps for Adding New Members

Revision 23-3; Effective July 1, 2023

All Programs

When the household reports a new member,  send Form H1020, Request for Information or Action, and Form H1020-A, Sources of Proof, the day of the report or no later than the next business day to request any more necessary information or verification.

If the change is:

  • Timely reported and verified, add the new member to the case the month after the change occurred, unless benefits decrease. If benefits decrease, send Form TF0001, Notice of Case Action, and decrease or deny benefits effective the month after notice of adverse action expires.
  • Untimely reported with timely verification, add the new member effective the month after the change is reported. If the change decreases benefits, send Form TF0001 and decrease or deny benefits effective the month after notice of adverse action expires.
  • Timely or untimely reported with a delay in verification of eligibility points that results in individual disqualification (e.g., SSN or alien status) and verification is not provided by the Form H1020 due date, take the following actions:
    • For TANF, if the new member is a required member of the certified group, disqualify the new member following applicable policy. Notify the household on Form TF0001 as appropriate. Exception: See TANF policy for household members who are not required members of the certified group.
    • For SNAP, disqualify the new member following applicable policy. Notify the household of the disqualification on Form TF0001 as appropriate.
    • For Medical Programs, see reasonable opportunity policy.
  • Timely or untimely reported with enough information to determine benefits will decrease, but verification is delayed, send Form TF0001 and decrease or deny benefits based on the person's unverified statement effective the month after notice of adverse action expires.
  • Timely or untimely reported lacking enough information about income, resources, or other factors necessary to determine eligibility or benefits,  sends Form H1020 and Form H1020-A to request verification the same day the change was reported or no later than the next business day and attempts to contact the household by phone within 10 days after the change is reported to obtain enough information to determine the effect of the change.
    • If information is obtained, policies for changes apply as described in this section.
    • If information is not obtained, the impacted EDGs are kept pending until the Form H1020 due date.
    • If verification is not received by the Form H1020 due date,  send Form TF0001 the next business day to deny the EDG for failure to provide information.

Notes:

  • There may be situations in which verification is provided to establish eligibility for one program and not the other.
  • When the household reports a new member using an application or redetermination form, the file date is considered the report of change date. The person must provide the verification by the Form H1020 due date to be considered timely verification.

TANF

Delays in verification of other legal requirements for required members: If the new member is a required member of the certified group and the household does not provide proof of age, relationship, or domicile by the Form H1020 due date:

  • because it is not available, send Form TF0001 to notify the household that the person cannot be added without required verification.
  • but it is available, send Form TF0001 to deny the EDG for failure to provide information.

Delays in verification for persons who are not required members of the certified group: If the new member is not a required member of the certified group and the person fails to provide requested proof by the Form H1020 due date, send Form TF0001 to notify the household that the new person cannot be added without required verification. If the household later provides verification, the member is added the month after the verification is received.

SNAP

Request a combined Data Broker report for a new adult member.

When a new household member is added:

  • determine each person's Employment & Training (E&T) registration or participation exemption status;
  • determine a primary wage earner (PWE);
  • ensure the household receives the SNAP Work Rules information that is included within their TF0001 as explained in related policy about action in full-service choices counties or E&T counties; 
  • use the SNAP Work Rules — Verbal Informing Script in the related policy section for E&T procedures to verbally inform the person interviewed about each E&T registrant’s and ABAWD’s rights and responsibilities; and
  • inform households with members exempt from E&T and of age to participate that they may voluntarily participate in the E&T Program as described in the related policy about exempt members volunteering to participate in E&T.

Related Policy

Reasonable Opportunity, A-351.1
E&T Procedures, A-1822
Voluntary E&T Participants, A-1822.2
Action in Full-Service Choices Counties or E&T Counties, A-1831
Changes Decreasing Benefits, B-643 

B—641.3 Adding Disqualified Members

Revision 15-4; Effective October 1, 2015

TANF and SNAP

If the member being added was disqualified, the new member is added effective the month after the disqualification ends. See A-1800, Employment Services, for adding household members disqualified for noncompliance with employment services requirements.

SNAP

See A-1362, Disqualified Members, for special budgeting of TANF benefits.

B—642 Changes Increasing Benefits (Other than Additions to the Household)

Revision 15-4; Effective October 1, 2015

All Programs

Advisors determine the effective dates of a change based on the date the change is reported and the date the verification is provided, as explained in B-642.1, Verification Provided Timely, and B-642.2, Verification Not Provided Timely. If supplemental benefits are necessary, the advisor must request the issuance no later than the last day of the month in which the verification is received.

Note: If verification is not required, the change is treated the same as if verification was received timely (see B-642.1).

B—642.1 Verification Provided Timely

Revision 15-4; Effective October 1, 2015

All Programs

If the household provides verification of a reported change by the Form H1020, Request for Information or Action, due date, benefits are increased, effective the month after the change is reported, regardless of whether the change was reported timely. The advisor sends Form TF0001, Notice of Case Action, the next workday, but no later than the workday after the Form H1020 due date.

If the household reports a change on an application form, the file date is considered the report of change date. The individual must provide the verification by the Form H1020 due date to be considered timely verification.

B—642.2 Verification Not Provided Timely

Revision 15-4; Effective October 1, 2015

All Programs

If the household fails to provide timely verification, benefits are not increased until verification is received. The advisor sends Form TF0001, Notice of Case Action, by the next workday after the Form H1020, Request for Information or Action, due date to explain that benefits remain the same. If the household later provides verification untimely, benefits are increased, effective the month after verification is received.

If the household fails to provide verification before the next SNAP, TANF, or TP 08 redetermination, request it again during the interview process and deny the EDG if verification is not received.

SNAP

If decreased or denied TANF or Refugee Cash Assistance (RCA) benefits result in an increase in SNAP benefits, benefits are increased the same month the TANF or RCA is decreased, with some exceptions (see A-1324.18, Temporary Assistance for Needy Families [TANF]).

If the household appeals the TANF or RCA decision and receives continued TANF or RCA benefits, the advisor continues to budget the TANF or RCA grant in the SNAP EDG.

B—643 Changes Decreasing Benefits

Revision 23-4; Effective Oct. 1, 2023

TANF and SNAP

Staff must take action on changes as indicated in the chart below. Benefits are decreased or denied, effective the month after the notice of adverse action expires. If applicable, process an overpayment claim. To determine the first month of an overpayment, staff refer to the TANF and SNAP Overpayment Determination Chart.

If a household reports a change ...then ...
and provides all verification,send Form TF0001, Notice of Case Action, by the 10th day after the change was reported* to decrease or deny benefits.
with enough information to determine eligibility or benefit issuance but does not provide verification,

send Form H1020, Request for Information or Action, and Form H1020-A, Sources of Proof, the same day the change was reported or no later than the next business day to request verification.**

Send Form TF0001 to decrease or deny benefits based on the individual's unverified statement at the time the change was reported:

  • by the 10th day after the change was reported;* or
  • with Forms H1020 and H1020-A if the change was reported untimely.

Require verification of the change at the next TANF or SNAP redetermination.

Note: Verify income even if the amount reported makes the household ineligible.

without enough information to determine eligibility or benefit issuance,

send Form H1020 and Form H1020-A the same day the change was reported or no later than the next business day to request verification.**

Attempt to contact the household by phone to obtain enough information to send Form TF0001 by the 10th day after the change was reported.*

Note: The regional director may opt out of the requirement to make a phone contact.

If information is not obtained to redetermine eligibility, keep the EDG pending until the Form H1020 due date. If verification is not received by the Form H1020 due date, send Form TF0001 the next business day to deny the EDG for failure to furnish information. Exception: If the household fails to provide verification of a deductible expense that requires verification, do not deny the EDG, instead, disallow the deduction. Follow verification requirement policy to determine if any deduction is allowable for the expense.

* If the due date for sending Form TF0001 falls on a non-business day, send it the preceding business day to meet the 10-day requirement.

** Allow the person 10 days to provide the verification requested on Form H1020. If the 10th day falls on a non-business day, use the following business day as the due date.

Note: Use change policy for situations where the Texas Department of Family and Protective Services (DFPS) places a TANF or Medicaid child in foster care.

TP 08

If a person reports or electronic data sources indicate new or increased earned income, alimony or spousal support that makes the person ineligible for TP 08, staff must request verification of the income. If the person fails to provide verification of the earned income, alimony or spousal support, staff must deny the TP 08 EDG and open the appropriate Transitional Medicaid EDG if:

  • the information is not questionable; and
  • they meet the eligibility requirements for the applicable Transitional Medicaid program (TP 07 or TP 20).

In addition, staff must deny the Medicaid EDG and open the appropriate Transitional Medicaid EDG (TP 07 or TP 20) for each associated parent or caretaker and dependent child.

If the EDG is denied for failure to provide verification that does not cause Medicaid ineligibility, staff must determine the household's eligibility for other medical programs.

Related Policy

General Eligibility Information, A-841
TP 07 Transitional Medicaid, A-842
TP 20 Alimony/Spousal Support Transitional Medicaid Coverage, A-850
General Eligibility Information, A-851
Verification Requirements, A-1440
Denial at Redetermination, A-2342
Actions on Changes, B-631
Claims, B-700
TANF and SNAP Overpayment Determination Chart, C-1140

B-650, Correcting Incorrect Information

Revision 15-4; Effective October 1, 2015

All Programs

Individuals have a right to correct any information that HHSC has about the individual and any other individual on the individual's case.

Advisors follow policies in A-2300, Case Disposition; B-100, Processes and Processing Time Frames; and B-600, Changes, for the time frames and procedures to correct or update information when processing:

  • applications,
  • redeterminations, and
  • other actions on active cases.

 

B—651 Correction Request

Revision 15-4; Effective October 1, 2015

All Programs

A request for correction must be in writing and:

  • identify the individual asking for the correction;
  • identify the disputed information about the individual;
  • state why the information is wrong;
  • include any proof that shows the information is wrong;
  • state what correction is requested; and
  • include a return address, telephone number, or email address at which HHSC can contact the individual.

During application, redetermination, and other actions on active EDGs, individuals are not required to request correction of incorrect information in writing. (Refer to B-116, Information Reported During Application Processing; B-124, Processing Untimely Redeterminations; and B-623, How to Report.)

 

 

B—652 Action on Denied EDGs or During the Last Month of Certification and the Client Has Not Reapplied

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must respond according to the following chart:

When an individual requests that the agency correct their information ... then ...
at application, redetermination, or anytime when an EDG is active, follow policies in A-2300, Case Disposition; B-100, Processes and Processing Time Frames; and B-600, Changes.
on a denied EDG or during the last month of certification, and the individual has not reapplied,
  • review the request,
  • contact third parties if necessary, and
  • send the correct information for imaging.

The advisor notifies the individual in writing within 60 days (using current HHSC letterhead without the board members' names) that the information is corrected or will not be corrected and the reason. The advisor informs the individual if HHSC needs to extend the 60-day period by an additional 30 days to complete the correction process or obtain additional information.

If HHSC makes a correction to individually identifiable health information, the advisor must ask the individual for permission before sharing with third parties. HHSC will make a reasonable effort to share the correct information with persons who received the incorrect information from HHSC if they may have relied or could rely on it to the disadvantage of the individual. Advisors follow regional procedures to contact the HHSC privacy officer for a record of disclosures.

Note: Advisors follow procedures to establish a claim or restore benefits if an overissuance or underissuance occurred. Advisors make a referral to the Office of Inspector General for intentional program violation occurrences.

 

 

B—653 Different Review Process

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must not follow procedures in B-600, Changes, when the accuracy of information provided by an individual is determined by another review process such as a:

  • fair hearing,
  • civil rights hearing, or
  • other appeal process.

The decision in that review process is the decision on the request to correct information.

B-660, Documentation Requirements

Revision 15-4; Effective October 1, 2015

All Programs

According to B-631, Actions on Changes, advisors must document the:

  • reported change,
  • date the change occurred,
  • date the change was reported, and
  • date the verification is provided.

For new income changes, advisors document the date of the first payment.

For address changes, advisors document the actions taken to provide the individual with Form H0025, HHSC Application for Voter Registration, and Form H1350, Opportunity to Register to Vote.

Refer to A-1380, Documentation Requirements, for further requirements related to income.

SNAP

Advisors must document:

  • the reason for shortening certification as a result of a change. See B-635, Shortening Certification Periods as a Result of a Change.
  • that the individual failed to provide required information to add a newborn when based on the TP 45 certification according to B-641.1, Adding Newborns to the Case.

Medical Programs

Clients are not required to report a change in tax status or tax relationship during the certification period because tax status and tax relationships are self-declared based on what the client expects to happen on their federal income taxes. If a change is reported, advisors should document the change in case comments and it will be addressed at the time of redetermination.

However, if multiple individuals self-declare to claiming the same person as a tax dependent, the advisor must clear the discrepancy with all individuals attempting to claim the same person as a tax dependent and update the tax statuses as a change in the eligibility system if necessary. For example, a change is reported that a child certified on Children’s Medicaid will no longer be claimed as a tax dependent. This change will be addressed at redetermination.

TP 08

Advisors must document the reason for denying a TP 08 EDG and opening a TP 07 EDG when new or increased income makes the household ineligible.

Related Policy

Documentation Requirements, A-1380
Documentation, C-940
Registering to Vote, A-1521
The Texas Works Documentation Guide

B-700, Claims

B-710, General Policy

Revision 11-1; Effective January 1, 2011

All Programs

An overpayment is the amount of benefits issued in excess of what should have been issued.

A claim is an amount owed by an individual for an overpayment of benefits or owed by an individual for benefits that are trafficked.

The date of discovery is the date the Office of Inspector General (OIG) substantiates that an overpayment occurred.

B—711 Types of Overpayment Claims

Revision 15-4; Effective October 1, 2015

All Programs

There are three types of overpayment claims:

  • agency error,
  • inadvertent household error/misunderstanding, or
  • fraud or intentional program violation (IPV).

OIG staff process overpayment referrals, determine the overpayment amount, and submit as a claim to the Texas Health and Human Services Commission (HHSC) Fiscal Management Services (FMS) to collect.

Related Policy

Referrals for Intentional Program Violation (IPV), B-900

B-720, When to File an Overpayment Referral

Revision 19-4; Effective October 1, 2019

All Programs

Staff must file an overpayment referral when a household receives benefits the household is not entitled to receive. When an overpayment occurs, OIG establishes the claim. The household must repay any type of overpayment claim.

If the household reports a change and staff does not take the appropriate action or fail to act on an agency-generated change, an overpayment referral must be filed.

Do not file an overpayment referral if the overpayment was due to:

  • a change the household is not required to report; or
  • an overpayment that occurred more than six years before the date of discovery.

SNAP

Changes for categorically eligible households, except for changes in net income, household size or both, do not cause an overpayment.

Exception: This does not apply to households who are categorically eligible based on receipt of Temporary Assistance for Needy Families - Non-Cash (TANF-NC).

OIG files a claim when an intentional program violation (IPV) is established against a person for trafficking Supplemental Nutrition Assistance Program (SNAP) benefits or accessing devices such as Electronic Benefit Transfer (EBT) cards.

B-730, How to File an Overpayment Referral

Revision 15-4; Effective October 1, 2015

All Programs

When an overpayment occurs, advisors determine the type of overpayment and enter an overpayment referral using the Automated System for Office of Inspector General (ASOIG) or the Texas Integrated Eligibility Redesign System (TIERS) referral interface. See B-770, Filing an Overpayment Referral, for overpayment referral instructions.

B-740, Texas Works Responsibilities

Revision 23-1; Effective Jan. 1, 2023

All Programs

Texas Works staff:

  • identify overpayments;
  • enter all agency error, inadvertent household error or misunderstanding, and fraud overpayment referrals using ASOIG or the TIERS referral interface, within 30 days of the date a potential overpayment is identified;
  • process fair hearing requests about claims establishment or collection using the TIERS interface; and
  • forward any payments or warrants received at the local office, along with a copy of Form H4100, Money Receipt, within 24 hours of receipt to:

    Texas Health and Human Services Commission
    Fiscal Management Services
    ARTS Billing
    P.O. Box 149055
    Austin, TX 78714-9055

The Accounts Receivable Tracking System (ARTS) is administered by FMS staff who monitor and process payments from people who receive HHSC services. The ARTS Hotline number is 800-666-8531.

B—741 Texas Works Action on Agency Errors

Revision 11-1; Effective January 1, 2011

TANF and SNAP

When an agency error overpayment occurs, Texas Works staff:

  • correct the ongoing benefits, as needed, using adverse action procedures; and
  • enter an electronic overpayment referral using ASOIG or the TIERS referral interface within 30 days of the date a claim is identified.

Note: See B-770, Filing an Overpayment Referral, for instructions about how to complete and send an overpayment referral.

B—742 Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV)

Revision 15-4; Effective October 1, 2015

All Programs

When an overpayment is due to an inadvertent household error/misunderstanding or a potential IPV, Texas Works staff:

  • correct the ongoing benefits, as needed, using adverse action procedures; and
  • enter an overpayment referral using ASOIG or the TIERS interface within 30 days of the date a claim is identified.

Note: See B-770, Filing an Overpayment Referral, for instructions about how to complete and send an overpayment referral.

When an alien and the alien's sponsor are liable for an overpayment, both individuals are referred to the OIG.

The alien and the alien's sponsor are not referred for an overpayment claim if the sponsor also receives benefits in the same program in which the alien’s overpayment occurred.

B-750, Office of Inspector General (OIG) Responsibilities

Revision 23-1; Effective Jan. 1, 2023

All Programs

The OIG Benefits Program Integrity (BPI) department investigates allegations of recipient non-fraud overpayment and fraud. The BPI department consists of the claims investigation and field investigation units located throughout the state.

B-751 Office of Inspector General (OIG) Investigation Staff

Revision 19-4; Effective October 1, 2019

All Programs

OIG staff:

  • screen all types of referrals and investigate valid agency error, inadvertent household error or misunderstanding, fraud, IPV, individual or retailer EBT trafficking, and employee fraud;
  • process referrals including initiation of demand letters and establishment of claims;
  • set restitution or recoupment amounts for active Eligibility Determination Groups (EDGs);
  • respond to follow-up questions from people who receive benefits and staff about the validity of claims;
  • coordinate with Texas Works staff to process fair hearing requests related to claims establishment or collection; and
  • initiate the process to debit an EBT food account to repay a SNAP claim when the request is made.

Related Policy

Texas Works Responsibilities, B-740
Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV), B-742
Texas Works Action on Agency Errors, B-741

B-752 Determining Claim Amounts

Revision 15-4; Effective October 1, 2015

All Programs

OIG staff take the following steps when determining claim accounts:

  • determine the first month of overpayment (see B-752.1, Determining the First Month of Overpayment);
  • exclude any months in which the household did not receive benefits or benefits were expunged;
  • follow applicable policy in A-1300, Income, to budget the overpayment months;
  • budget each month of an overpayment by using actual income amounts received for the month (the income is not converted);

    Exceptions: OIG staff:
    • budget the income originally projected at certification/redetermination when the income does not involve a required change; and
    • budget earned income as reported quarterly to the Texas Workforce Commission (TWC) to determine the overpayment amount when all efforts to verify earned income amounts have been exhausted; allow the household the opportunity to provide verification of actual gross pay per pay period; and recompute the overpayment if the individual provides the verification. Note: For cases sent to an administrative disqualification hearing, staff must verify the employment hire date when computing an overpayment based on TWC wage information.
  • do not allow earned income deductions for any earned income that the household failed to report timely as required and this failure caused an overpayment (deductions for overpayment months caused by an agency error are allowed);
  • for excess resource overpayment EDGs, compute earned interest income to estimate an account balance for the tax year, as reported annually by the Internal Revenue Service (IRS) through the Income and Eligibility Verification System (IEVS), to determine the overpayment amount when all efforts to verify an unreported financial institution account have been exhausted; allow the household the opportunity to provide verification of the interest income and the resource; and recompute the overpayment if the individual provides the verification;
  • subtract the amount the household was entitled to receive from the amount the household actually received before recoupment;

    Exception: There is no recoupment for Medical Programs.
     
  • total all the monthly amounts of overpayment; and
  • when the household is due unpaid restored benefits, offset the amount to be restored against the overpayment amount and document the offset according to B-831, Procedures for Counting Restored Benefits Toward a Claim.

Related Policy

Computing Benefits by EDG Action Type, A-1357
Reporting Requirements, B-620

TANF

When a child support payment was made during the overpayment month, the total income, less the $75 disregard, is counted to determine the overpayment amount.

B-752.1 Determining the First Month of Overpayment

Revision 11-1; Effective January 1, 2011

B-752.1.1 Errors at Certification

Revision 11-1; Effective January 1, 2011

All Programs

The first month of overpayment is the first month the household received more benefits than it was entitled to receive.

B-752.1.2 Errors After Certification

Revision 15-4; Effective October 1, 2015

All Programs

The first month of overpayment for non-streamlined reporting (SR) households is the month in which the change would have been effective had it been reported and acted on in a timely manner. However, the first month of overpayment can be no later than two months from the month the change occurred. Staff may use the following chart to determine the first month of overpayment.

If a change was...then the first month of overpayment is the month that begins more than...
reported timely,23 days after the date the change was reported. (Example: Change occurred January 5 and was reported January 10. Count 23 days to February 2. March is the first month of overpayment.)
not reported timely,33 days after the date the change occurred. (Example: Change occurred January 5. Count 33 days to February 7. March is the first month of overpayment.)

Exception: The first month of overpayment may be earlier for errors caused by moves out of state. The first month of overpayment may be as early as the month after all members of the household leave the state and there is duplicate participation in that month.

Charts in C-1140, TANF and SNAP Overpayment Determination Chart, provide help for determining the first month of overpayment for both timely and untimely change reports.

SNAP

An overpayment does not exist on a streamlined reporting EDG unless:

  • the household fails to timely report a required change, or
  • the agency fails to timely act on a reported change.

Note: The 10-day reporting requirement for SR EDGs is from the first payment that exceeds the 130 percent Federal Poverty Income Limit (FPIL) threshold. For example, an individual receives a pay raise effective May 15. The individual's gross monthly income exceeds the 130 percent FPIL with the June 27 paycheck. The household must report the change within 10 days of June 27 to be timely.

The first month of overpayment is the month after the second month the income exceeds the 130 percent FPIL for the household size. For example, income exceeds the 130 percent FPIL on June 27 and for the month of July. August is the first month of overpayment.

Related Policy

Reporting Requirements, B-620

B-753 Establishing Claims

Revision 13-3; Effective July 1, 2013

B-753.1 Identifying Liable Members

Revision 22-3; Effective July 1, 2022

TANF, One-Time TANF and One-Time TANF for Relatives

Determine the liable household member responsible for repayment of a claim in the following order:

  • Caretaker or payee.
  • Second parent, spouse, or stepparent who was an adult household member at the time of the overpayment.

SNAP

Determine the liable household member responsible for repayment of a claim in the following order:

  • The head of household.
  • Any household member who was an adult at the time of overpayment.

TANF and SNAP

An authorized representative (AR) is liable for paying a claim when the AR causes an overpayment or traffics in SNAP benefits.

Sponsors and eligible aliens are jointly liable for overpayments resulting from incorrect information provided by the sponsor unless the sponsor:

  • can show good cause;
  • can show the eligible alien or sponsor was not at fault for the error; or
  • receives benefits in the same program in which the overpayment occurred.

The sponsor, alien or both may appeal the amount or fault of an overpayment.

B-753.2 Demand Notices

Revision 19-4; Effective October 1, 2019

TANF and SNAP

OIG staff send either Form OIG 5034, Notice of SNAP Overpayment Claim, or Form OIG 5039, Notice of TANF Overpayment Claim or both, along with Form OIG 5027, Repayment Agreement, to the household.

To be timely, OIG staff must send the notice no later than 180 calendar days from the date the investigation was created in the Automated System for Office of Inspector General (ASOIG).

When the case involves an alien with a sponsor, OIG staff send separate demand notices to the alien and the alien's sponsor. The demand notice informs the sponsor that the sponsor is not responsible for the person when:

  • the sponsor has good cause for the error;
  • is not at fault; or
  • receives benefits in the same program that the alien's overpayment occurred.

Note: Calls about overpayment demand notices are referred to the local OIG unit for clearance. Local office contacts can be found by clicking on this link: OIG Facilities Local Office Contacts.

After navigating to the website, click on "OIG Facilities Local Office Contacts" on the right side of the page.

B-753.3 Claim Disposition

Revision 19-4; Effective October 1, 2019

TANF and SNAP

OIG staff mail a household a repayment agreement notice and an overpayment claim notice. A claim in the Accounts Receivable Tracking System (ARTS) is then established the same date of the notice.

The claim notice provides:

  • an explanation of how the overpayment claim amount was calculated;
  • repayment options (either restitution or recoupment); and
  • information about the person's right to request a fair hearing within 90 days of the effective date of claim notice.

The person indicates whether they prefer to repay the claim by restitution or recoupment on the repayment agreement notice and must return the agreement within 30 days of receipt.

Repayment of the claim is delayed only when the person requests a fair hearing.

B-760, Fiscal Management Services - Accounts Receivable Responsibilities

Revision 19-3; Effective July 1, 2019

All Programs

HHSC Accounts Receivable staff:

  • maintain the Accounts Receivable Tracking System (ARTS);
  • manage the billing and collection process;
  • manage delinquent claims;
  • renegotiate methods of collection;
  • modify existing claims;
  • respond to inquiries from individuals or staff from the date the claim is established, including:
    • delinquent notices;
    • collection efforts;
    • federal payment intercepts through the Treasury Offset Program; and
    • license suspensions;
  • process fair hearing requests related to claims establishment or collection (if the request is past 90 days from the claim origination date); and
  • initiate the process for one-time debits of an EBT food account to repay a SNAP claim when the request is made after the claim is established.

B—761 Claims Collection

Revision 11-1; Effective January 1, 2011

B—761.1 Recoupment

Revision 19-3; Effective July 1, 2019

TANF and SNAP

Recoupment, also known as allotment reduction, is a method of recovering an overpayment claim by withholding a portion of the household's benefits.

B—761.1.1 Action on Recoupment Cases

Revision 20-2; Effective April 1, 2020

TANF and SNAP

Recoupment is initiated when Office of Inspector General (OIG) staff enter a claim against a household into the Accounts Receivable Tracking System (ARTS). ARTS interfaces with TIERS to automatically reduce the household's benefit allotment if any liable household member is currently receiving benefits.

Overpayments are recouped from all identified liable household members. When persons liable for an overpayment currently reside in separate households, overpayments are recouped from all liable household members until all claims are paid in full. When a liable household member is currently disqualified but on an active case, overpayments are recouped from the household benefit allotment received by the other certified members.

Follow policy in B-761.2.1, Action on Restitution Cases, if there is no liable household member currently receiving benefits to recoup from.

If a liable household member begins receiving benefits, TIERS automatically begins the recoupment process from the new benefit allotment. TIERS continues to recoup the newly certified benefits until the claim is paid in full.

Notes:

  • HHSC Accounts Receivable staff may negotiate a repayment agreement with the household. However, if a claim is being recouped or has been sent to the U.S. Treasury for collection, HHSC Accounts Receivable will not enter into a new repayment plan.
  • HHSC Accounts Receivable staff are authorized to make corrections to the recoupment records in ARTS.

Recoupment information is available through TIERS inquiry, ARTS inquiry, or by calling the Accounts Receivable Customer Service Hotline at 800-666-8531.

Related Policy

Identifying Liable Members,  B-753.1
Recoupment Amount, B-761.1.3
Action on Restitution Cases, B-761.2.1

B—761.1.2 Recoupment Hierarchy

Revision 15-4; Effective October 1, 2015

TANF and SNAP

Claims are recouped by error type in the following order.

  1. Type A — IPVs (fraud)
  2. Type J — inadvertent household error/misunderstanding
  3. Type L — agency error

All three claim types can be simultaneously stored on ARTS. Recoupment of a Type A claim places Type J and L claims on hold status until the Type A recoupment is completed. ARTS automatically resumes recoupment of the Type J or L claim when all of the individual's Type A claims have been paid in full.

B—761.1.3 Recoupment Amount

Revision 15-4; Effective October 1, 2015

TANF

HHSC recoups Type A, J, and L claims at 10 percent of the household's maximum grant, rounded down to the nearest dollar.

Once a TANF claim is recouped in full, TIERS will automatically rebudget any active SNAP EDG to include the appropriate ongoing TANF grant amount. See A-1324.18, Temporary Assistance for Needy Families (TANF).

SNAP

For Type A claims, HHSC recoups at 20 percent of the household allotment or $20, whichever is greater. When calculating a dollar amount using the percentage, TIERS rounds 49 cents down and 50 cents up to the next whole dollar.

For Types J and L claims, HHSC recoups at 10 percent of the household allotment or $10, whichever is greater. When calculating a dollar amount using the percentage, TIERS rounds 49 cents down and 50 cents up to the next whole dollar.

Notes:

  • When benefits are $10 or less, no benefits are issued.
  • When a current household member is disqualified for an IPV, recoupment is computed using the allotment the household would receive if the disqualified member was included in the household size.

B—761.2 Restitution

Revision 19-3; Effective July 1, 2019

TANF and SNAP

Restitution is a method of recovering an overpayment claim by receiving payments in the form of a cashier's check, certified or personal check, money orders made payable to the Texas Health and Human Services Commission, or credit or debit card payments through the Texas.gov HHSC Online Overpayment System (HOOPS).

B—761.2.1 Action on Restitution Cases

Revision 20-2; Effective April 1, 2020

TANF and SNAP

When OIG establishes an overpayment claim, Form OIG 5027, Repayment Agreement is sent to the primary liable household member along with Form OIG 5034, Notice of SNAP Overpayment Claim, or Form OIG 5039, Notice of TANF Overpayment Claim.

The primary liable household member has 30 days from the date on the repayment agreement to agree to restitution by signing the agreement and returning it to the OIG investigator. The repayment agreement provides the household with both the signature and first payment due date.

OIG staff are responsible for sending the repayment agreement, signed or unsigned, to HHSC Accounts Receivable for processing as soon as it is received. For the household to avoid delinquency, all payments must be sent to HHSC Accounts Receivable on or before the 30th day from the date on the repayment agreement.

If a household has delinquent restitution payments and TIERS is unable to match an overpayment claim to a liable household member currently receiving benefits, then the overpayment claim is eligible for referral to the:

  • Federal Treasury Offset Program (TOP) for an intercept of federal payments (only applicable to SNAP claims once the payment is 120 days delinquent);
  • Texas Comptroller of Public Accounts for interception of any state payments, including lottery winnings; or
  • appropriate agencies to request suspension of licenses.

Restitution payments cannot be made in lieu of mandatory recoupment. If a liable household member is making restitution payments and becomes certified on an active case, then the liable household member is switched from a restitution payment plan to a recoupment payment plan. Recoupment begins after the first month of certification. Once ARTS receives notification from TIERS of the first recoupment payment from the active case, ARTS automatically switches the payment plan from restitution to recoupment.

If the household was on a restitution payment plan and receiving bills, all billing will stop until the household stops receiving benefits or when the claim is paid in full.

In order to pay down their overpayment balance, households may make extra restitution payments in addition to their mandatory repayment or recoupment payments.

Related Policy

Identifying Liable Members, B-753.1
Action on Recoupment Cases, B-761.1.1
Restitution Amount, B-761.2.2

B—761.2.2 Restitution Amount

Revision 19-3; Effective July 1, 2019

TANF and SNAP

The repayment agreement reflects a 36-month amortized schedule for the claim to be repaid within three years. If the amortized monthly payment is less than $25, then the agreement is generated with $25 as the minimum payment.

Only HHSC Accounts Receivable staff can renegotiate a payment plan differing from the one on the repayment agreement. Accounts receivable staff sends all subsequent monthly bills or repayment agreements to households after OIG sends the initial repayment agreement.

B—762 Action on Receipt of Payments

Revision 19-3; Effective July 1, 2019

TANF and SNAP

When staff receive restitution payments, staff:

  • complete Form H4100, Money Receipt; and
  • submit the payment or warrants with a copy of Form H4100 within 24 hours of receipt to:

    Texas Health and Human Services Commission
    Accounts Receivable
    P.O. Box 149055
    Austin, TX 78714-9055

Note: Staff must mark each TANF warrant void when received.

B—763 Debit of SNAP EBT Accounts

Revision 13-3; Effective July 1, 2013

SNAP

Debit of an EBT food account is a method of recovering an overpayment claim by electronically removing benefits from the household's EBT account. The value of the debit is applied to the SNAP claim.

B—763.1 One-Time Debit of an Active EBT Account

Revision 20-2; Effective April 1, 2020

SNAP

A household member liable for an overpayment with an active EBT food account may request a one-time debit of the EBT food account as payment toward a SNAP overpayment claim instead of making separate recoupment payments. When this occurs OIG or HHSC Accounts Receivable staff:

  • use the EBT System to verify the:
    • status of the EBT food account; and
    • balance of the account;
  • complete Form H1021, Payment Agreement — Verbal Authorization for One-Time Debit of an Active Lone Star Food Account to document the verbal authorization to repay the claim by removing benefits from the active EBT food account;
  • inform the liable household member:
    • that the amount of the one-time payment must be maintained in the EBT account until the debit is completed; and
    • that it takes approximately 14 days for the debit transaction to be completed.
    • the person will receive a receipt of the debit within 10 days of the debit transaction; and
  • submit the original of Form H1021 by:
    • Mail:
      HHSC Lone Star Business Services
      State Office
      Mail Code 2033; or
    • Fax: 512-206-5961; and
  • Maintain a copy of Form H1021 in the OIG or ARTS file.

Lone Star Business Services staff remove the SNAP benefits from the food account and submit Form H1021 to Accounts Receivable to pay the claim.

Note: When the liable household member contacts HHSC and disagrees with the debit transaction, they may request a fair hearing to request the return of the benefits to their account.

Related Policy

Identifying Liable Members, B-753.1
Fair Hearings, B-764

B—763.2 Offset Expunged Benefits

Revision 19-3; Effective July 1, 2019

SNAP

When staff become aware that a household has expunged SNAP benefits, OIG or HHSC Accounts Receivable staff must offset the balance of a SNAP claim by the amount of the expungement.

B—764 Fair Hearings

Revision 20-4; Effective October 1, 2020

TANF and SNAP

When it is unclear whether the household wishes to appeal an action taken by eligibility staff or an action taken by OIG staff, eligibility staff and OIG review the request for an appeal to determine what action the household is appealing. If a household disputes the establishment of a claim or collection action initiated by OIG and requests an appeal, OIG will take the lead and begin processing the appeal. Eligibility staff must attend the hearing along with OIG if the appeal includes the eligibility staff's action that was not part of the establishment of the claim.

Note: Form H4800, Fair Hearing Request Summary, is not used to submit an appeal request when the household disputes the establishment of a claim or action initiated by OIG. If Form H4800 is sent directly to the hearings division, it will be returned to staff with instructions to correctly submit the information.

OIG Staff

OIG staff use the Automated System for the Office of Inspector General (ASOIG) to submit appeal requests on claims or collection actions.  

OIG staff use the State Portal Appeals tab and the Hearing Evidence Packets Upload tab to send evidence documents related to an appeal request.

Exception: When ASOIG is not available or an investigation is not found in ASOIG, OIG staff process the appeal through the TIERS Hearings and Appeal function located in the left navigation menu.

Eligibility Staff Working in TIERS

When a person verbally requests an appeal, process the fair hearing request by selecting the Hearing and Appeal option found on the left-navigation menu in TIERS and choose Create Appeal.

When a fair hearing request is received in writing by fax or mail, fax the appeal request, using the fair hearing cover sheet, through the expedited fax line (866-559-9628) for processing. The fair hearing request is not entered in the State Portal.

Whether the TIERS appeal request is received verbally or in writing, the Centralized Representation Unit (CRU) continues to process the appeal, including creating and submitting the evidence packet. Copies of the evidence packet are mailed to the appellant and any authorized or legal representative.

Related Policy

Appeal Procedures, B-1030
Local Office Procedures for Hearing Requests, B-1031
Providing Form H4800-A, Fair Hearing Request Summary (Addendum), to Hearings Division, B-1031.2

B-770, Filing an Overpayment Referral

Revision 12-2; Effective April 1, 2012

B—771 Filing an Overpayment Referral Using Automated System for the Office of Inspector General (ASOIG)

Revision 15-4; Effective October 1, 2015

All Programs

Staff create referrals for overpayments caused by agency error, individual error/misunderstanding, or suspected IPV or fraud in ASOIG.

ASOIG is accessed at the following website: https://hhsportal.hhs.state.tx.us/asoig.

Users log in using a unique sign on. A disclaimer page explaining IRS Federal Tax Information requirements must be agreed to before proceeding with the referral. Agreement takes the user to the ASOIG home page.

Investigation is selected from the left navigation menu to proceed to the Referral and Investigation search page. Users must enter identifying information and select Create Referral.

Identifying information may consist of one or more of the following:

  • Suspect name,
  • Individual (client) number,
  • Social Security number, or
  • EDG or case number.

The Create Referral tab takes the user to the Create Referral screen group. This consists of the Referral, Suspects, Reasons, Contacts, Comments and Assignment tabs. The user must go through all tabs, enter information as appropriate, and save the referral.

The Referral tab is the first tab in creating a referral. The tab has two areas. The top part, Alleged Information, is for entering biographical information. The bottom portion, EDG Types, is used to enter whatever program type information is known.

The New button at the bottom of the tab is used when adding types to the EDG Types portion of the tab. If the referral is associated with more than one EDG, users must click the New button to add additional types. The user must continue to click the New button until all EDGs associated with the referral are added. Once all types have been entered, the user must click the Next button to proceed to the next tab, Suspects.

The Suspects tab is used to enter information on suspects as well as household members associated with the referral. The top portion of the screen, Suspect, allows for the entry of any known biographical information. The bottom portion, Address, is for entering any known address(es).

At least one suspect screen with a name and type of suspect is required for a referral. Although children are not "suspects," entering all household members is recommended as that information will be required if an investigation is merited.

If an automated interface finds information in TIERS, users may select from a list of names. If a name is chosen from the list in this field, the ASOIG populates applicable biographical and EDG information such as date of birth, Social Security number and address. If TIERS information is not found, users must enter all known information.

The New button on the tab is to allow the user to include all household members in the referral. Once all members are entered, the user must click the Next button to advance to the next tab, Reasons.

The Reasons tab is used to establish the basis for the referral. The screen is divided into three sections, Reason, Source Information and Source Detail. One reason type and name is required for each referral.

Multiple reasons may be entered on a single referral. If there are multiple reasons, users enter the information for the first reason and then click the New button to enter information for the next reason. Once all applicable reasons are entered, the user must click the Next button to move to the next tab, Contacts.

The Contacts tab is used to enter sources of information such as another employee, agency or other person with information about the referral. The screen is divided into two sections. The Contact portion is for information on the source of information while the Address portion is for documenting any address information for the contact.

A Contacts entry is not required for a referral, but multiple entries may be made by clicking the New button. Clicking on the Next button takes the user to the next tab, Comments.

The Comments tab is used to enter information on the referral. It is used to document information not otherwise captured by ASOIG. At least one comment is required and multiple comments may be entered. Comments are listed by subject, and users should enter a concise statement in the subject to describe the contents of the comment.

Comments may be linked to a Contact by clicking the Related Contact checkbox.

Once a comment is saved by clicking the New or Next button, it cannot be modified. Care must be exercised in completing this tab. Clicking the Next button takes the user to the final tab, Assignment.

The Assignment tab allows the assignment of the referral based on predefined rules. Once the Save Referral button is clicked, the referral is saved and all information is locked, except for the ability of the user to include additional comments.

Saving the referral takes the user back to the Referral tab; however, it is only for viewing, and the user now has the ability to attach any electronic documents saved on the user's computer to the referral. Attach documents by clicking the paper clip icon next to the tabs, browse to select the document, give a name to the document, describe the contents of the document and click Save. Multiple documents may be attached using the New button.

Note: Logging out of the referral before it is saved on the Assignment tab will result in loss of information entered, requiring the user to start over.

B—772 Filing an Overpayment Referral Using TIERS

Revision 15-4; Effective October 1, 2015

SNAP and TANF

When eligibility staff discover that an overpayment exists, either by advisor knowledge or because it is identified in the TIERS Eligibility Summary, the following steps must be taken to enter the referral in TIERS:

  • From the left navigation menu, the user must go to Data Collection > Initiate Interview and enter the case number and case mode. If a case is already in ongoing mode, the user may enter the referral.
  • From the left navigation menu, the user must select Data Collection > Miscellaneous > Referral. The TIERS referral summary page will display. If an overpayment claim exists for the EDG, there will be an entry for the advisor to review on this page. To review the claim, the user must click on the edit icon.
  • To enter a new referral, the user must click the red Add button.
  • On the Details page, the user must enter the following information:
    • Name – From the drop-down menu, select the name of the individual causing the overpayment.
    • Effective Begin Date – Enter the date the overpayment began.
    • Discovery Code – From the drop-down menu, select the most appropriate entry to describe how the overpayment was discovered. If no entry is appropriate, select "other."
    • Error Referral Type – From the drop-down menu, select an entry based on the entity causing the error. For errors caused by the agency's error or failure to take action in a timely manner, select "agency." For errors caused by individuals without the intent to commit fraud, select "client." For errors where eligibility staff believe the individual intentionally committed fraud to receive additional benefits, select "fraud."
    • Overpayment Reason – From the drop-down menu, select the most appropriate reason for the overpayment. If no entry is appropriate, select "other."
    • Overpayment Discovery Date – Enter the date HHSC discovered the overpayment.
    • Benefit Type – From the drop-down menu, make the appropriate selection based on the type of benefit overpaid.
    • Financial Penalty Code – For overpayments caused by TANF Personal Responsibility Agreement (PRA) noncompliance, select the area with which the individual noncomplied.
    • Destination Unit – Select the appropriate unit by region and by the type of referral (CI – Claims Investigation/FI – Fraud Investigation).
    • Referral Benefit Restored Amount – If the overpayment was caused by the issuance of restored benefits, enter the overpayment amount in this field. If the overpayment was not caused by the issuance of restored benefits, a zero entry remains in this field.
    • Form 1898 Completion Date – This field is used for overpayment claims caused by the issuance of restored benefits only. Enter the date Form 1898, Restored Benefits Documentation, was completed at the time the restored benefits were authorized.
    • First Month and Year of Overpayment – Enter the month and year the overpayment began. Estimate only.
    • Last Month and Year of Overpayment – Enter the month and year the overpayment ended. Estimate only.
    • Overpayment Amount – Enter the dollar amount of the overpayment for all referrals except referrals based on restored benefits. If the overpayment was caused by the issuance of restored benefits, this field should contain a zero entry. Estimate only.
    • EDG Participation – For the individual causing the overpayment, select whether or not the individual was a member of the certified group.
    • Participation Change Date – For claims based on household changes, enter the date the participation status changed for the individual causing the overpayment.
    • Participation Change Report Date – For claims based on household changes, enter the date HHSC learned of the household change.
    • Enter comments you wish OIG to receive by entering page-level comments on this page – Click on the center icon next to the Referral – Details title to enter page-level comments.
  • On the Income page (for overpayments caused by income only), if known, the user enters the following information:
    • Source Type – From the drop-down menu, select "earned income" or "unearned income" depending on the type of income causing the overpayment.
    • Source Name – Enter the name of the entity that provided the income that caused the overpayment. This may be the name of an individual, company or government agency.
    • Verification Source – From the drop-down menu, make the appropriate verification source selection. If the source used to verify the income is not available on the menu, select "none" and document the source in page-level comments on the details tab.
    • Source Hire Date – For earned income overpayments, enter the hire date for the individual.
    • First Check Date – Enter the date the individual received the first payment that caused the overpayment. Note: This could be a check or cash payment, and the payment could be for earned and unearned income.
    • Source Report Date – Enter the date the individual informed HHSC of the income change.
    • Source Amount – Type the monthly amount of the income received from the source.
    • Income Source Address – If known, enter the address of the income source.
  • On the Resources page (for overpayments caused by resources only), if known, the user enters the following information:
    • Resource Type – From the drop-down menu, select the most appropriate entry for the type of resource causing the overpayment. If no selection is appropriate, select "other."
    • Resource Change Date – Enter the date the individual obtained possession of the resource.
    • Resource Report Date – Enter the date HHSC learned of the resource change.
    • Resource Amount – Enter the countable value of the resource.
  • The user must document the overpayment referral and reason in TIERS Case Comments.

B-780, Documentation Requirements

Revision 15-4; Effective October 1, 2015

TANF and SNAP

Advisors must document in TIERS Case Comments:

  • that an overpayment referral was made via ASOIG or through the TIERS interface, according to B-730, How to File an Overpayment Referral; and
  • a brief description of the overpayment, and how and when the overpayment was discovered, according to B-711, Types of Overpayment Claims.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

B-800, Restored Benefits

B-810, Entitlement to Restored Benefits

Revision 10-2; Effective April 1, 2010

TANF and SNAP

Households are entitled to restored benefits when:

  • legislation, federal regulations or court actions require restoration;
  • the Health and Human Services Commission (HHSC) makes an error in the household's amount of benefits and the household was not at fault;
  • an individual is disqualified for an intentional program violation, which is later reversed by a court; or
  • the Supplemental Nutrition Assistance Program (SNAP) or an authorized representative of a drug and alcohol facility improperly accesses and fails to return the benefits to the individual's EBT account.

Households are not entitled to restored benefits for unreported changes or household errors.

Households are entitled to restored benefits regardless of whether they are currently eligible for or receiving benefits.

B-820, Time Frames for Qualifying for Restored Benefits

Revision 10-2; Effective April 1, 2010

TANF and SNAP

Restore benefits as directed by a court or if the loss occurred within 12 months of the date:

  • the household:
    • contests an adverse decision,
    • attends a disqualification hearing, or
    • notifies HHSC that it believes it has lost benefits.
  • HHSC discovers that the household may be entitled to a restoration.

The month the agency discovers the household is entitled to a restoration is counted as month zero.

B-830, How to Determine the Amount of Restored Benefits

Revision 13-3; Effective July 1, 2013

TANF and SNAP

Texas Integrated Eligibility Redesign System (TIERS) Eligibility performs the steps to calculate restored benefits in most instances. The advisor may be required to manually calculate the restored benefit, record the restored benefit and offset information, and issue benefits using the Benefit Issuance – Manual Issuance functional area in TIERS.

  1. Determine the month the loss began.
  2. Exclude months before the 12-month time limit.
  3. Determine if the household was eligible for each month the household lost benefits.
  4. Obtain needed information to determine eligibility for any restored benefit month in question.
  5. For each month, compute the amount of benefits the household should have received.
  6. Determine the restored benefit amount by subtracting the correct benefits from the amount of benefits actually issued. If there is a claim, subtract the restored benefit amount from the amount due on the claim. Issue any remainder to the household.

Note: When initial benefits are paid retroactively, do not reduce the retroactive payment to offset previous claims.

Issue restored benefit(s) within 30 days of the date the agency discovers the underpayment.

 

B—831 Procedures for Counting Restored Benefits Toward a Claim

Revision 13-3; Effective July 1, 2013

TANF and SNAP

  1. Document the amount of restored benefits owed on the Restored Benefits Details page or Request Manual Issuance page.
  2. Determine if there is a claim, as noted in A-832, How to Verify a Claim Amount. Refer to B-761.1.1, Action on Recoupment Cases.
  3. The nightly interface between TIERS and the Accounts Receivable Tracking System (ARTS) will report the offset.
  4. Notify the individual on Form H1825, Entitlement to Restored Benefits.

 

B—832 How to Verify a Claim Amount

Revision 13-3; Effective July 1, 2013

TANF and SNAP

Advisors must go to Benefits Issuance on the left navigation bar and click on View Overpayments to verify a claim amount. TIERS users can search for overpayment information by entering a Social Security number, an Eligibility Determination Group (EDG) number or claim number. The Search Results display columns are: Social Security number, EDG number, EDG Name, Claim number and Individual number. Clicking on the Social Security number hyperlink will display overpayment information, which includes the remaining overpayment balance.

B-840, Notice to the Household

Revision 01-3; Effective April 1, 2001

TANF and SNAP

Notify the household by Form H1825, Entitlement to Restored Benefits, of

  • their entitlement to restored benefits,
  • the amount and method of restoration,
  • any claim offset, and
  • the right to appeal.

B-850, Disputed Benefits

Revision 13-3; Effective July 1, 2013

TANF and SNAP

If the household disagrees with the amount of restored benefits, or any other action the advisor takes to restore them, the household may request a hearing within 90 days of the notice date. The advisor continues the restoration while waiting for the hearing decision and adjusts the benefits according to the hearing officer's decision.

The household may request a hearing if the household believes it is entitled to restored benefits but the advisor does not agree. Document on the appropriate worksheet the request for restored benefits, the justification to deny them, and the date.

B-860, Method of Restoration

Revision 13-3; Effective July 1, 2013

TANF

Restore all benefits owed to the household at the same time. Issue a separate benefit for each month the household is owed benefits.

SNAP

Restore all benefits owed the household at the same time.

Issue a separate EBT benefit for each month the household is owed restored benefits.

B-870, Changes in Household Composition

Revision 01-3; Effective April 1, 2001

TANF and SNAP

If household membership changes, issue restored benefits to the household containing a majority of the persons who were household members when the loss occurred.

If the worker cannot locate an individual or determine which household contains a majority of members, restore benefits to the household that includes the person who was the head of the household when the loss occurred.

B-880, Procedure for Authorizing Restored Benefits

Revision 13-3; Effective July 1, 2013

TANF and SNAP

Authorize the restoration within 30 days of the date the agency discovers the underpayment.

A Second Level Review (SLR) is required when, in TIERS Eligibility:

  • Restored benefits are being issued for more than three months prior to the current date.
  • The total restored benefit amount (prior to offset) for TANF is equal to or greater than $50.
  • The total restored benefit amount (prior to offset) for SNAP is equal to or greater than $125.

An SLR is required for all restored benefits requested in Manual Issuance.

B-890, Documentation Requirements

Revision 13-3; Effective July 1, 2013

TANF and SNAP

Advisors are required to document

  • why the household is entitled to restored benefits;
  • the month the loss of benefits began;
  • the time frames for benefits owed;
  • computations;
  • if there is a claim against the household; and
  • the amount of restoration approved if the household has an offset.

Note: The documentation requirements will be met if appropriate entries are made on the Restored Benefits Details page or Request Manual Issuance page.

Document in the case record the:

  • request for restored benefits;
  • justification to deny the request; and
  • date according to B-850, Disputed Benefits.

 

Related Policy

Documentation, C-940
The Texas Works Documentation Guide

B-900, Referrals for Intentional Program Violation

B-910, General Policy

Revision 15-4; Effective October 1, 2015

All Programs

An IPV occurs when a person intentionally makes a false or misleading statement, or misrepresents, conceals, or withholds facts for the purpose of receiving assistance under Texas Health and Human Services Commission (HHSC) benefit programs.

Note: A person may be charged with an IPV, even if benefits the person was not entitled to receive have not actually been received.

SNAP

An IPV occurs when a person commits an act that constitutes a violation of the Food and Nutrition Act, the Supplemental Nutrition Assistance Program (SNAP) regulations, or any state statute for the purpose of using, presenting, transferring, acquiring, receiving, possessing, or trafficking of benefits, authorization cards, or reusable documents used as part of an electronic benefit delivery system (Electronic Benefit Transfer [EBT]).

B—911 Elements of an IPV

Revision 11-4; Effective October 1, 2011

All Programs

An IPV must contain at least one or more of the following elements:

  • a falsified document,
  • a falsified statement,
  • a falsified interview,
  • a continuing scheme, or
  • trafficking of benefits.

See Glossary for definitions of the above terms.

B—912 IPV Disqualification Penalties

Revision 20-4; Effective October 1, 2020

General Policy

The Office of Inspector General (OIG) may establish an overpayment claim for a person found guilty of committing fraud in the SNAP and TANF programs. There is no IPV disqualification or disqualification penalty imposed for Medicaid or the Children's Health Insurance Program (CHIP).

SNAP and TANF

A person found guilty of an IPV by a court will be disqualified as specified by the court. If the court fails to specify a disqualification, OIG will impose the appropriate IPV disqualification penalty as listed below.

TANF

A person found guilty of an IPV by an administrative disqualification hearing (ADH) or who signs an ADH waiver for an IPV that occurred on or after Sept. 1, 2003, will be disqualified:

  • for 12 months for the first offense; and
  • permanently for the second offense.

A person convicted of a state or federal IPV and granted deferred adjudication, or placed on community supervision for conduct that constitutes an IPV, will be permanently disqualified from receiving TANF assistance.

Exception: A person found guilty of an IPV in federal court, state court, or in an ADH for making a fraudulent statement or representation with respect to the identity or residence of the person to receive multiple benefits simultaneously, will be disqualified for 10 years.

SNAP

A person found to have committed an IPV either through an ADH or by a federal, state, or local court, or to have signed either a waiver of right to an ADH or a disqualification consent agreement in cases referred for prosecution, will be disqualified:

  • for 12 months for the first offense;
  • for 24 months for the second offense; and
  • permanently for the third offense.

SNAP Specified Offenses

A person found guilty of an IPV in a federal court, state court or in an ADH for making a fraudulent statement or representation with respect to the identity or residence of the person to receive multiple benefits simultaneously, will be disqualified for 10 years.

A person found guilty of an IPV in federal, state, or local court of having used or received SNAP benefits in a transaction involving the sale of a controlled substance will be disqualified:

  • for 24 months for the first occasion; and
  • permanently for the second occasion.

A person convicted by a federal, state or local court of an IPV due to trafficking in SNAP benefits or program access devices, such as EBT cards, with a conviction for an aggregate amount of $500 or more, will be permanently disqualified.

A person found guilty of an IPV in federal, state, or local court of having used or received benefits in a transaction involving the sale of firearms, ammunition, or explosives will be permanently disqualified.

B-920, When to File an IPV Referral

Revision 15-4; Effective October 1, 2015

All Programs

Staff are responsible for reporting to OIG any acts of fraud, waste, abuse, or misconduct in the following HHSC benefit programs:

  • Temporary Assistance for Needy Families (TANF),
  • SNAP,
  • Medicaid, and
  • CHIP.

B-930, How to File an IPV Referral

Revision 15-4; Effective October 1, 2015

All Programs

Staff submit a fraud or IPV referral using either the:

  • Automated System for Office of Inspector General (ASOIG), or
  • Texas Integrated Eligibility Redesign System (TIERS) referral interface.

Note: If the fraud allegation contains confidential information and/or the person making the allegation requests to remain anonymous, the referral is submitted using ASOIG. Any supporting information and/or evidence should be attached to the referral using ASOIG. The TIERS referral interface does not allow attachments.

Staff must follow instructions in B-770, Filing an Overpayment Referral, for submitting a referral using either ASOIG or the TIERS referral interface.

B-940, Texas Works Responsibilities

Revision 20-4; Effective October 1, 2020

All Programs

Identify potential fraud or IPVs to OIG.

Submit fraud or IPV referrals using ASOIG or the TIERS referral interface, within 30 days of the date the IPV is identified.

Process fair hearing requests related to claims or collections following instructions in B-1035, Appeals Related to Accounts Receivable Tracking System (ARTS), in TIERS.

Forward any payments received in the local office to:

Texas Health and Human Services Commission
Fiscal Management Services
ARTS Billing
P.O. Box 149055
Austin, TX 78714-9055

Refer questions regarding collections on established claims to Fiscal Management Services (FMS).

Note: The FMS hotline number is 800-666-8531. ARTS is administered by FMS staff who monitor and process payments from HHSC claims.

Report fraud or violations of SNAP rules by drug and alcohol treatment (D&A) and group living arrangement (GLA) facilities by emailing Form H1095, Treatment Facility Fraud Referral, along with Form H1096, Notification Letter, and if applicable, Form H1853, Documentation of Findings for Form H1852, to the OIG Benefits Program Integrity (BPI) mailbox at OIG_GI@hhsc.state.tx.us.

Report retail stores allowing unauthorized purchases and accepting benefits for previous purchases to Lone Star Business Services at LoneStar@hhsc.state.tx.us.

B-941 Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification

Revision 22-3; Effective July 1, 2022

SNAP

When out-of-state SNAP IPV disqualification data from the SNAP federal Electronic Disqualified Recipient System (eDRS) is identified on Data Broker, discuss the IPV with the member to determine whether the member agrees with or disputes the information. Complete as much of the application process as possible and dispose the application for other programs, if applicable. Follow the procedures below for SNAP.

Exception: This policy does not impact SNAP Combined Application Project (SNAP-CAP) Eligibility Determination Groups (EDGs) administered by Centralized Benefit Services (CBS), with one exception in SNAP-CAP circumstances related to Intentional Program Violations (IPVs) and Felony Drug Convictions.

Procedures When Data Broker Identifies an eDRS Match

If the situation is ...then ...
A. an expedited SNAP application, and the household does not dispute the IPV data,
  • complete Form H1856, SNAP Out-of-State Intentional Program Violations, indicating it is for an expedited application;
  • send a copy for imaging;
  • email the form to Customer Care Center (CCC)-eDRS eligibility staff at HHSC OES CCC IC, indicating Expedited in the email subject line; and
  • document this action in case comments.

CCC-eDRS staff will review the form for accuracy and immediately email it to OIG-Central Disqualification Unit (CDU).

If the email is received by 4:30 p.m. Central Standard Time, OIG -CDU staff take action the same day. They enter the IPV disqualification data from Form H1856 into TIERS, create a reported change task to notify staff to complete and dispose the SNAP EDG, and email staff notice of the change. Exception: Out-of-state IPVs with non-standard penalty periods are noted on Data Broker and require secondary verification as described in Box D.

B. an expedited SNAP application, and the household disputes the IPV disqualification,
  • postpone verification of the IPV penalty and certify the application without the penalty;
  • complete Form H1856, indicating it is for an expedited application;
  • send a copy for imaging;
  • email Form H1856 to CCC-eDRS eligibility staff at HHSC OES CCC IC to obtain secondary verification of the out-of-state IPV data; and
  • document this action in case comments.

If the out-of-state IPV verification is:

  • received by the final due date, CCC-eDRS staff forward Form H1856 to OIG, who will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the local office staff to complete and dispose the SNAP EDG.
  • not received by the final due date, the local office staff must dispose the application without imposing the IPV disqualification.

When the secondary verification is received, CCC-eDRS staff forward Form H1856 to OIG-CDU staff at HHSC CDU. OIG-CDU staff enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify CCC to dispose the penalty as a change and create an overpayment claim referral back to OIG.

C. a SNAP non-expedited application, household addition or redetermination,

Staff must discuss the out-of-state IPV disqualification with the household to confirm the IPV data if possible. If the household does not dispute the IPV data:

  • complete Form H1856;
  • send a copy for imaging;
  • email Form H1856 to CCC-eDRS eligibility staff at HHSC OES CCC IC; and
  • document this action in case comments.

CCC-eDRS staff review the form for accuracy and immediately forward it to OIG-CDU at HHSC CDU.

OIG-CDU staff enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify staff to complete and dispose the EDG. Exception: Out-of-state IPVs with non-standard penalty periods are noted on Data Broker and require secondary verification as described in Box D.

If not possible to contact the household or the household disputes the IPV, then:

  • manually pend the SNAP EDG action until the final due date for CCC-eDRS staff to complete secondary verification;
  • complete Form H1856;
  • send a copy for imaging;
  • email Form H1856 to CCC-eDRS staff at HHSC OES CCC IC for a secondary verification as described above; and
  • document this action in case comments.

If the secondary verification is not received and OIG has not entered the IPV disqualification by the:

  • final due date on an application or redetermination, process it without imposing the IPV disqualification.
  • 20th day after sending Form H1856 on a requested household addition, process the change without imposing the IPV disqualification.

When CCC-eDRS staff subsequently receive the out-of-state IPV verification, staff forward it to OIG. OIG-CDU staff will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify staff to dispose the EDG and create an overpayment claim referral back to OIG.

D. the IPV data on a Data Broker report is marked as “non-standard” (i.e., the penalty period listed is not a standard length),
  • manually pend the SNAP EDG action until the final due date for CCC-eDRS staff to complete secondary verification;
  • complete Form H1856;
  • send a copy for imaging;
  • email Form H1856 to CCC-eDRS eligibility staff at HHSC OES CCC IC to obtain secondary verification of the IPV before imposing the disqualification in Texas; and
  • document this action in case comments.

Note: Postpone verification if expedited. If not expedited, process the application as explained in Box C.

Note: If the person is not active on a SNAP EDG or the application has already been denied, OIG will enter this out-of-state IPV data into TIERS since the person is known to TIERS. No staff action is required in this situation.

Related Policy

Identifying Intentional Program Violations (IPVs) and Felony Drug Convictions, B-475.2.1

B-942 Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification

Revision 15-4; Effective October 1, 2015

TANF

When the advisor discovers that an individual has an out-of-state TANF IPV disqualification, the advisor must discuss the IPV with the individual to determine whether the individual disputes the information.

If the household does not dispute the IPV data …the advisor must …
 
  • complete as much of the application process as possible and dispose the application for other programs if applicable,
  • pend the TANF EDG until OIG notifies the advisor to complete and dispose the EDG, and
  • send a secure email referral to OIG-CDU staff at CDU@hhsc.state.tx.us containing the following information:

    Subject: TANF Out-of-State IPV

    Out-of-state IPV information:

    • TANF EDG number
    • Originating state where IPV occurred
    • Disqualified individual's:
      • Name
      • Social Security number (SSN)
      • Date of birth (DOB)
    • Client number in originating state
    • Number of disqualified months
    • Disqualified begin date
    • Disqualified end date
    • Offense occurrence
    • Offense description
    • Federal or state court or administrative hearing decision date

Document the IPV information and the email sent to OIG in TIERS Case Comments.

OIG-CDU staff will enter the IPV disqualification data from the email into TIERS and create a reported change task to notify the advisor to complete and dispose the EDG.

If unable to contact the household or the household disputes the IPV data …the advisor must …
 
  • complete as much of the application process as possible and dispose the application for other programs if applicable,
  • pend the TANF EDG until OIG notifies the advisor to complete and dispose the EDG*, and
  • send a secure email referral to CCC-eDRS staff at HHSC OES CCC IC containing the following information:

    Subject: TANF Out-of-State IPV – Pending Secondary Verification

    Out-of-state IPV information:
    • TANF EDG number
    • Originating state where IPV occurred
    • Disqualified individual's:
      • Name
      • SSN
      • DOB
    • Client number in originating state
    • Number of disqualified months
    • Disqualified begin date
    • Disqualified end date
    • Offense occurrence
    • Offense description
    • Federal or state court or administrative hearing decision date
    • Whether the individual was/wasn’t contacted
    • If the individual disputes the IPV, details regarding why the claim is disputed

      Document the IPV information and the email sent to CCC-eDRS in TIERS Case Comments.

      CCC-eDRS staff will obtain secondary verification of the IPV and immediately forward the secondary verification to OIG. OIG will enter the IPV information into TIERS.

      * If OIG has not entered the IPV disqualification by the final due date, process the application or redetermination without imposing the IPV disqualification.

B-943 Expiration of an IPV Disqualification Penalty

Revision 15-4; Effective October 1, 2015

TANF and SNAP

Once the IPV disqualification penalty begins, it continues even when benefits expire or the EDG is denied. If the person reapplies for benefits, advisors must ensure that the person has served the IPV disqualification penalty before certifying the person for benefits.

Example: A person reapplies for TANF and SNAP on April 4, 2011, for herself and her three children.

The advisor checks the person's IPV disqualification status by viewing the person's Individual-Summary using the hover menu IPV Sanctions page. The person was found guilty of committing an IPV offense on February 4, 2011, resulting in a 12-month SNAP IPV disqualification beginning March 1, 2011, through February 28, 2012. Since the disqualification period has not expired, the advisor must continue the person's disqualification.

Notes:

  • Form OIG5042, Notice of Disqualification Enforcement, may be viewed under Case Data Search.
  • To determine eligibility for the remaining household members, advisors use the budgeting procedures in:
    • A-1362.2, 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; and
    • A-1362.4, SNAP — Budgeting for Persons Disqualified for Intentional Program Violations, SNAP Employment Services Noncompliances, Felony Drug Convictions or Being a Fugitive.
B—944 Reinstatement of an IPV Disqualified Person

Revision 14-1; Effective January 1, 2014

TANF and SNAP

When the IPV disqualification penalty period expires on an active EDG, TIERS automatically adds the formerly IPV disqualified person to the household and adjusts benefits accordingly.

B—945 Request for New Administrative Disqualification Hearing (ADH)

Revision 15-4; Effective October 1, 2015

TANF and SNAP

When a person disqualified for an IPV contacts the local office and claims that the individual did not receive an ADH notice and requests a new hearing, staff must notify the Office of Social Services (OSS) – Eligibility Services Support (ESS) Centralized Representation Unit (CRU). CRU coordinates with OIG in processing new ADH requests.

Staff provide CRU the following information:

  • person's name,
  • EDG number,
  • date of disqualification, and
  • status of the person's EDG (active, denied, pending).

Note: If the ADH officer grants a person's request for a new hearing, the CDU:

  • removes the IPV disqualification, and
  • contacts Texas Works to re-run the budget to allow for the person’s continued benefits pending the new ADH.

B-950, OIG Responsibilities

Revision 20-4; Effective October 1, 2020

All Programs

OIG Benefits Program Integrity (BPI) is organized as follows:

  • Research Analysis and Policy Training (RAPT) unit;
  • Central Disqualification Unit (CDU);
  • Claims Investigations (CI) units; and
  • Field Investigations (FI) units.

The EBT Trafficking unit is also part of the OIG Investigations division and works closely with BPI.

OIG staff:

  • review allegations of HHSC benefit program recipient fraud, including employee, recipient or retailer EBT trafficking fraud;
  • investigate allegations of recipient or employee fraud to determine whether fraud exists and, if applicable, the amount of an overpayment;
  • establish fraud claims through the Fiscal Management Services Accounts Receivable Tracking System (ARTS);
  • coordinate with the HHSC Fair and Fraud Hearings Division for investigations submitted for ADH;
  • coordinate with the local district attorney office for investigations submitted for prosecution;
  • coordinate with U.S. Department of Agriculture (USDA) EBT trafficking investigations;
  • dispose investigations based on the results of either prosecution or ADH;
  • impose an IPV disqualification penalty, if applicable; and
  • coordinate with the HHSC-OSS – Eligibility Operations Customer Care Center (CCC) to adjust active HHSC program benefit amounts, if appropriate.

B—951 Facts Do Not Support an IPV

Revision 15-4; Effective October 1, 2015

All Programs

The facts do not support an IPV when:

  • OIG staff review and determine that the facts do not support the allegation,
  • a court determines the person is not guilty, or
  • an ADH hearing officer determines that no IPV was committed.

OIG staff may process these claims as inadvertent household errors/misunderstandings.

B—952 Facts Support an IPV

Revision 15-4; Effective October 1, 2015

All Programs

When OIG determines that the facts support an IPV allegation, OIG submits the case to either the:

  • local district attorney for prosecution, or
  • Fair and Fraud Hearings Division for an ADH.

Note: A person may waive the right to an ADH by signing Form OIG5040, which allows OIG to establish a fraud claim and impose an IPV disqualification.

B—953 Enforcement of IPV Disqualification

Revision 15-4; Effective October 1, 2015

TANF and SNAP

OIG-CDU staff enforce the IPV Disqualification and associated disqualification penalty.

B—953.1 Notice of an IPV Disqualification

Revision 15-4; Effective October 1, 2015

TANF and SNAP

CDU staff receive the following notices that a household member has been disqualified due to an IPV:

  • Form H1856, SNAP Out-of-State Intentional Program Violations. TW staff submit this form to CDU upon discovery of a person's current IPV disqualification that was administered by another state. See B-941, Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification, for directions.
  • Form OIG5038, Notice of Disqualification Decision. OIG staff submit this form to CDU indicating when a court finds a person guilty of an IPV, or a court defers adjudication and the person voluntarily signs Form OIG5036, Disqualification Consent Agreement.
  • Form OIG5040/5040S, Waiver of Disqualification Hearing. OIG staff submit this form to CDU indicating when a person waives the right to an ADH.
  • Form H4857, Notice of Decision, Administrative Disqualification Hearing. ADH hearing officers submit this form to CDU indicating the ADH decision that a person committed an IPV.

B—953.2 Imposing an IPV Disqualification

Revision 15-4; Effective October 1, 2015

TANF and SNAP

CDU staff has primary responsibility for enforcing IPV disqualifications upon receipt of:

  • Form H1856, SNAP Out-of State Intentional Program Violations;
  • Form OIG5040, Waiver of Disqualification Hearing, signed by the person;
  • Form H4857, Notice of Decision, Administrative Disqualification Hearing; or
  • Form OIG5038, Notice of Disqualification Decision.

CDU imposes the IPV disqualification penalty:

  • by the court-specified date (as indicated on Form OIG5038);
  • within 45 days of the court disqualification decision date (as indicated on Form OIG5038) if the court did not specify a disqualification date;
  • within 45 days of the date the person signs Form OIG5036, Disqualification Consent Agreement;
  • the first month after the date the local OIG office receives a signed Form OIG5040; or
  • the month after the date the person receives Form H4857.

CDU enters the IPV disqualification details in the disqualified individual's IPV Sanction screen and:

  • sends an email request to the OSS - Eligibility Operations CCC to rebudget the household's future SNAP EDG benefit amount when the interface record exceptions out of a mass update or the IPV was manually entered by OIG staff; and
  • sends Form OIG5042, Notice of Disqualification Enforcement, notifying:
    • the household of:
      1. the begin and end dates of the IPV disqualification penalty period; and
      2. its new benefit amount (if applicable); and
    • TW staff of the enforcement of the IPV disqualification penalty.

When an IPV disqualification is not imposed in a timely manner, CDU staff initiate an overpayment referral to establish an agency error overpayment claim for any months the household received benefits to which it was not entitled.

B—953.3 Amendment of IPV Disqualification Penalties

Revision 15-4; Effective October 1, 2015

All Programs

CDU staff are authorized to modify IPV disqualification information if applicable. TW staff should contact CDU if TW staff believe IPV information is incorrect. CDU will research and respond to the problem.

B-960, Fiscal Management Services Responsibilities

Revision 11-4; Effective October 1, 2011

B—961 IPV Claim Collection

Revision 15-4; Effective October 1, 2015

All Programs

FMS establishes repayment agreements and collects on IPV claims including court-deferred adjudications.

TANF

When the person fails to comply with its repayment agreement, FMS initiates recoupment at 10 percent of the household's recognizable needs.

SNAP

When the person fails to comply with its repayment agreement, FMS initiates recoupment at 20 percent of the household's allotment or $10, whichever is greater. When a current household member is disqualified for an IPV, recoupment is computed using the allotment the household would receive if the disqualified member were included in the household size.

B-970, HHSC Employee Fraud

Revision 20-4; Effective October 1, 2020

All Programs

Staff are responsible for reporting allegations of fraud involving HHSC benefit program certification procedures by HHSC employees to the unit supervisor. The supervisor forwards the report to the program manager.

Program managers report serious violations of HHSC employee fraud to the Office of Inspector General (OIG) Benefits Program Integrity (BPI). The information is reviewed and referred to the OIG Internal Affairs division, as appropriate.

Note: Allegations of employee fraud must be reported by sending a secure email or a fax to 512-833-6484.

B-980, Documentation Requirements

Revision 15-4; Effective October 1, 2015

 All Programs

Staff must document the reason(s) for creating a fraud or IPV referral in the case comments.

Note: If the reason contains confidential information and/or the person making the allegation requests to remain anonymous, the referral must be submitted using ASOIG. Any supporting information and/or evidence should be attached to the referral using ASOIG. The TIERS referral interface does not allow for attachments. Staff must follow instructions in B-771, Filing an Overpayment Referral Using Automated System for the Office of Inspector General (ASOIG).

Related Policy

Documentation, C-940
The Texas Works Documentation Guide

B-1000, Fair Hearings

B-1010, Right to Appeal

Revision 15-4; Effective October 1, 2015

All Programs

A request for a hearing is a clear expression, oral or written, by the household or its representative that indicates that the household wishes to appeal a decision. The freedom to make a request for a hearing must not be limited or interfered with in any way.

If any member of a household or the household's representative expresses dissatisfaction with a decision regarding benefits or services, the advisor takes the following actions:

  • Explain the basis for the decision and the applicable policies;
  • Provide the household an opportunity to have a conference with the supervisor;
  • Provide the household an opportunity to request a fair hearing;
  • Provide the individual with copies of all documents before the hearing that will be entered into evidence during the fair hearing; and
  • Consult with the supervisor if the individual requests information the advisor considers confidential. Note: The individual is entitled to any information that was used to determine suspension, reduction or termination of benefits. See B-1210, Disclosure of Information, for information that is considered to be confidential.

The household or the household's representative must make a request to withdraw an appeal in writing. Staff must fax the written withdrawal request to the designated hearings office. If a written withdrawal request is not obtained, staff must notify the hearings officer via email. If email is not an option, staff must notify the hearings officer via fax or phone.

SNAP

If the household requests a conference with the supervisor after a denial for expedited service, the advisor must schedule the conference within two workdays of the request, unless the household prefers a later date. The advisor must document that the household requested a later date.

B-1020, Time Period for Requesting Fair Hearing

Revision 15-4; Effective October 1, 2015

All Programs

Individuals have the right to appeal within 90 days from the effective date of any Texas Health and Human Services Commission (HHSC) action. The individual's request may be oral or in writing.

Advisors may not prevent an individual from filing an appeal, even if the appeal was not requested within 90 days from the effective date of the action. Only the hearings officer has the authority to decide the timeliness of filed appeals and can accept untimely filed appeals in order to determine whether there was good cause for the delay in filing the appeal.

SNAP

The household may appeal the denial of a request to restore benefits that were lost within one year before the request. In addition, a household may appeal its current level of benefits during a certification period.

B-1030, Appeals Procedure

Revision 15-4; Effective October 1, 2015

All Programs

All fair hearing requests are processed in the State Portal. The local office staff (including Customer Care Center [CCC] staff) and Centralized Representation Unit (CRU) staff have separate responsibilities and must follow the following procedures when processing fair hearing requests and appeals.

B—1031 Local Office Procedures for Hearing Requests

Revision 15-4; Effective October 1, 2015

When any member of a household or the household's representative expresses dissatisfaction with a decision regarding benefits or services, the local office staff takes the following actions:

  • Review the Eligibility Determination Group (EDG) to determine accuracy of the action;
  • Take action to correct any agency error that results in an increase in benefits;
  • Clearly document any discovered error and the action taken to correct the error;
  • Explain the basis for the decision and the applicable policies to the individual;
  • Provide the individual an opportunity to have a conference with the supervisor (including a conference within two workdays for an individual who wants to contest an expedited services decision); and
  • Provide the individual an opportunity to request a fair hearing.

The same day a fair hearing request is received:

  • in person, over the telephone or in writing — the advisor/supervisor enters the fair hearing request with the Add New Appeal tab in the State Portal Appeals/RFR (Request for Revision). These entries automatically create an Appeal Request for (Program/TOA) for CRU staff.
  • by fax or mail — the advisor/supervisor faxes or mails the appeal using the fair hearing cover sheet to the expedited fax line (1-866-559-9628) for processing. The advisor must not:
    • complete and submit Form H4800, Fair Hearing Request Summary;
    • enter the fair hearing request in State Portal; or
    • enter the fair hearing request through left navigation in the Texas Integrated Eligibility Redesign System (TIERS).
  • advisors must consult with the supervisor if the individual requests information staff considers confidential.

B—1031.1 Office of Attorney General (OAG) Child Support Division Region Contacts

Revision 15-4; Effective October 1, 2015

OAG Region Primary Contact Secondary Contact Physical Mailing and Centralized Email Addresses
1
Lubbock
Angelia Gregg
806-761-4715
Fax: 806-763-7579
Renee DeLaRosa
806-761-4704
Fax:
806-763-7579
4630 50th Street, Ste 500
Lubbock, TX 79414-3521
OAGarea1.FairHearing@texasattorneygeneral.gov
2
San Antonio
Vanessa Vasquez
210-804-6488
Fax:
210-930-3625
Martin Martinez
210-804-6489
Fax: 210-930-3625
3460 Northeast Parkway
San Antonio, TX 78218-3304
OAGarea2.FairHearing@texasattorneygeneral.gov
3
McAllen
Anna Rangel
956-926-4524
Fax: 956-631-2451
Vacant 3331 N. McColl Road
McAllen, TX 78501-5536
OAGarea3.FairHearing@texasattorneygeneral.gov
4
Dallas
Nancy Hernandez
214-915-3721
Fax:
214-915-3750
Oscar Sanchez
214-915-3720
Fax:
214-915-3750
400 South Zang Blvd. Ste. 1100
Dallas, TX 75208-6646
OAGarea4.FairHearing@texasattorneygeneral.gov
5
Tyler
Christy Cates
903-533-4005
Fax:
903-592-5732
Glen Elliott
903-533-4009
Fax:
903-592-5732
200 N. Broadway Avenue, Ste 355
Tyler, TX 75702-5747
OAGarea5.FairHearing@texasattorneygeneral.gov
6
Houston
Mark Jones
713-948-7673
Fax:
713-910-4806
Melissa Jimenez
713-787-7146
Fax:
713-789-7665
8866 Gulf Freeway, Ste 200
Houston, TX 77017-6529
OAGarea6.FairHearing@texasattorneygeneral.gov
7
Austin
Patricia Roark
512-358-3242
Fax:
512-892-8967
Annette Hernandez
512-358-3249
Fax:
512-892-8967
2512 S IH 35 Ste 200
Austin, TX 78704-5751
OAGarea7.FairHearing@texasattorneygeneral.gov
8
El Paso
Lorraine Sanchez-Rayas
915-782-4211
Fax:
915-782-4276
Barbara Ramirez
915-782-4236
Fax:
915-782-4276
6090 Surety Dr., Ste 250
El Paso, TX 79905-2062
OAGarea8.FairHearing@texasattorneygeneral.gov
9
Ft. Worth
Elizabeth House
817-834-7048
Fax:
817-834-7066
Kelly Robison
817-834-7038
Fax:
817-834-7066
2001 Beach St. Ste 700
Ft. Worth, TX 76103
Regional email not yet established

OAG – Counties Served by Each Area

 

Region Counties Served
1
Lubbock
Archer, Armstrong, Bailey, Baylor, Briscoe, Brown, Callahan, Carson, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Fisher, Floyd, Foard, Gaines, Garza, Grey, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Hutchinson, Irion, Jack, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Lubbock, Lynn, Mason, McCulloch, Menard, Mitchell, Montague, Moore, Motley, Nolen, Ochiltree, Oldham, Parmer, Potter, Randall, Reagan, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Wheeler, Wichita, Wilbarger, Yoakum, Young
2
San Antonio
Atascosa, Bandera, Bexar, Comal, Dewitt, Dimmit, Edwards, Frio, Gillespie, Gonzales, Guadalupe, Karnes, Kendall, Kerr, Kinney, LaSalle, Maverick, McMullen, Medina, Real, Uvalde, Val Verde, Wilson, Zavala
3
McAllen
Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Nueces, Starr, Webb, Zapata
4
Dallas
Collin, Cooke, Dallas, Denton, Ellis, Erath, Hood, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somerville, Tarrant
5
Tyler
Anderson, Angelina, Bowie, Camp, Cass, Chambers, Cherokee, Delta, Fannin, Grayson, Gregg, Hardin, Harrison, Henderson, Hopkins, Houston, Hunt, Jasper, Jefferson, Lamar, Liberty, Marion, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Wood
6
Houston
Austin, Brazoria, Ft Bend, Galveston, Harris, Matagorda, Montgomery, Waller, Wharton
7
Austin
Aransas, Bastrop, Bee, Bell, Blanco, Bosque, Brazos, Burleson, Burnett, Caldwell, Calhoun, Colorado, Coryell, Falls, Fayette, Freestone, Goliad, Grimes, Hamilton, Hays, Hill, Jackson, Lampasas, Lavaca, Lee, Leon, Limestone, Live Oak, Llano, Madison, McLennan, Milam, Mills, Refugio, Robertson, San Patricio, San Saba, Travis, Victoria, Walker, Washington, Williamson
8
El Paso
Andrews, Borden, Brewster, Crane, Culberson, East El Paso, Ector, Glasscock, Howard, Hudspeth, Jeff Davis, Loving, Martin, Midland, Pecos, Presidio, Reeves, Terrell, Upton, Ward, Winkler

B—1031.2 Providing Form H4800-A, Fair Hearing Request Summary (Addendum), to Hearings Division

Revision 17-1; Effective January 1, 2017

Form H4800-A, Fair Hearing Request Summary (Addendum), provides a method to send documents or evidence used in a hearing that were not sent with the original submission and to report changes of address or other corrections to the appropriate hearings officer.

B—1032 Centralized Representation Unit (CRU)

Revision 15-4; Effective October 1, 2015

The CRU is a staff unit within Eligibility Services Support (ESS) that represents HHSC in fair hearings and implements hearing officers' decisions.

B—1032.1 Centralized Representation Unit (CRU) Staff Responsibilities

Revision 15-4; Effective October 1, 2015

CRU staff completes the following actions:

  • claim the Appeal Request for (Program/TOA) task from the Task List Manager (TLM) Global Queue;
  • review the EDG to determine if any correction is needed and take appropriate action;
  • prepare the evidence packet and mail to the Document Processing Center (DPC) for imaging;
  • ensure the hearing procedures are explained in a language the individual understands;
  • mail a copy of the evidence packet to the individual, legal representative, authorized representative and any other witnesses participating in the hearing;
  • create and send a fair hearing request in TIERS;
  • enter in TIERS any necessary accommodations; and
  • mark the task as Task Completed.

Once the fair hearings request has been scheduled by Hearings Division staff, a Fair Hearing Appointment for a (Program) Case task will be routed to the Fair Hearings Centralized Representation Unit TLM Global Queue.

CRU will:

  • assign an agency representative for each hearing;
  • attend the fair hearing as the agency representative; and
  • present the agency's case by explaining the action being appealed, the documents submitted and how the agency policy applies to the issue(s) on appeal.

B—1033 Appeals Related to Decisions/Actions of an Electronic Benefit Transfer (EBT) Vendor

Revision 14-2; Effective April 1, 2014

All Programs

When an EBT vendor cannot resolve an account balance dispute or error resolution related to benefits to an individual's satisfaction, the vendor refers the individual to Lone Star Business Services (LSBS) for a second review. The individual may contact LSBS staff to request a fair hearing if still not satisfied with the results of the second review. CRU processes the appeal following the policy and procedures outlined in this section.

B—1034 Appeals Related to Services for Medicaid Recipients

Revision 15-4; Effective October 1, 2015

All Programs

The Texas Department of State Health Services (DSHS) handles appeals concerning specific services for Medicaid recipients including:

  • lock-in;
  • medical necessity for prior authorization of services; and
  • denial, termination, suspension or reduction of covered services, or payment for services rendered.

For individuals who want to appeal service-related issues, staff must refer them to DSHS. DSHS individual notification letters include an address and telephone number for requesting appeals. Individuals who do not have a notification letter should be referred to the Medicaid Hotline at 1-800-252-8263.

Note: DSHS does not allow individuals to appeal decisions made by the Health Insurance Premium Payment (HIPP) program. To obtain assistance in resolving problems or issues with the HIPP contractor:

  • individuals must contact the Medicaid Hotline at 1-800-252-8263.
  • staff must contact the Third-Party Resource (TPR) Unit at 1-800-846-7307.

B—1035 Appeals Related to Accounts Receivable Tracking System (ARTS)

Revision 15-4; Effective October 1, 2015

All Programs

For all individual requests for appeals related to ARTS collection notices, the advisor must make the following entries on Form H4800, Fair Hearing Request Summary:

  1. In the From box, if the appeal is regarding a:
    • Claims Investigation (CI) collection notice, enter the CI unit supervisor, mail code, and phone number.
    • Treasury Offset Program (TOP) collection notice, enter ARTS Hearing Representative, 512-406-3800, at mail code E-411.

    Note: If the individual does not know if the collection notice is a result of a CI claim or TOP, enter the CI unit supervisor.

  2. In Section 1, Program, check the appropriate program box.
  3. In Section 2, Agency Action Resulting in a Hearing Request, check D, Not Benefit Amount Related. This will indicate to the hearing officer that the appeal does not affect current benefits.
  4. In Section 8, Summary of Agency Action and Applicable Handbook Reference(s) or Rules, enter the following message: "Collection Notice - Overpayment Claim" (See B-700, Claims).

The advisor must notify the appropriate Claims Investigations Unit supervisor and ARTS supervisor of the hearing request. The advisor sends a copy of Form H4800 to the local Claims Investigation Unit supervisor or the ARTS supervisor, as appropriate, and faxes a copy of Form H4800 to ARTS at 512-438-3061.

B-1040, Timely Action on Fair Hearings

Revision 15-4; Effective October 1, 2015

All Programs

Hearing decisions must comply with federal law and regulations and be based on the evidence and testimony of the hearing.

Once the fair hearing has been held and a decision rendered, the hearings officer records the decision in TIERS, and a TLM task is created and routed to the Fair Hearings Centralized Representation Unit TLM Global Queue for processing.

  1. If the decision is reversed, a Process Fair Hearings Reversal Decision for (Program/TOA) TLM task is created and routed to the CRU TLM Global Queue.
  2. If the decision is sustained, a Fair Hearings Sustain Decision for (Program/TOA) task will be created and routed to the CRU TLM Global Queue for processing.
  3. A Fair Hearings Decision Issued for (Program/TOA) task will be created for issued decisions that do not typically require an agency action.

CRU will follow these procedures to timely implement the hearing officer's instructions:

If the hearing decision results in restored benefits, an increase in benefits for the current month and/or future months, and ... then ...
no additional information or verification is needed, ensure within 10 days from the date the decision task is received that:
  • benefits for future months are increased, and
  • all benefits the household is entitled to are provided.

Authorize restored Temporary Assistance for Needy Families (TANF) benefits in Eligibility or by manual issuance within 10 days from the date Form H4807, Action Taken on Hearing Decision, is received.

additional information or verification is needed, send the individual Form H1020, Request for Information or Action, within 10 days from the date the decision task is received. List on Form H1020 the specific information/verification needed in order to provide benefits.
 

If the individual:

  • provides all of the requested information and verification, then increase benefits for future months and/or provide benefits for the current/past months within three workdays from receipt of the information/verification;
  • provides part but not all of the requested information and verification, then increase benefits for future months and/or provide benefits for each month for which information/verification is provided within three workdays of receipt of the remaining information/verification; or
  • fails to provide the requested information and/or verification, then follow the normal eligibility determination process in B-600, Changes, and complete/deny the EDG without the missing information/verification.

 

Notes:

  • Upon the individual's request, CRU will offer reasonable assistance in obtaining the necessary verification. The individual's statement is acceptable as verification if no other documentary or collateral information is available.
  • Restored benefits are not denied for any months solely because a person outside the household refuses to cooperate in providing verification.

SNAP

  • Benefits are not restored for any months more than 12 months prior to the date a fair hearing was requested.
  • If the hearing officer authorized restored benefits, TIERS sends Form H1825, Entitlement to Restored Benefits, to the household, along with a copy to the hearing officer, when benefits are approved either in Eligibility or by manual issuance.

 

B—1041 Completing and Reporting Timely Action on Fair Hearings

Revision 15-4; Effective October 1, 2015

SNAP

Once all restored and/or supplemental benefits have been issued, the advisor must:

  • enter all decision implementation information in TIERS in the Decision Implementation page;
  • clear any delays entered in the Implementation Delay page; and
  • enter all necessary information in the Implementation Details page and submit for supervisor review.

The supervisor must:

  • review the EDG information and all supporting documentation in accordance with agency procedures and time frames; and
  • approve the Implementation Details page.

B-1050, Handling of Benefits During the Appeal Process

Revision 01-3; Effective April 1, 2001

 

 

B—1051 Continued Benefits

Revision 15-4; Effective October 1, 2015

All Programs

Households previously certified for ongoing benefits are entitled to continued benefits if they make a timely request for a fair hearing after receiving Form TF0001, Notice of Case Action. A request is timely if it is made within 13 days of the adverse action notice (including a mailed request postmarked during the 13-day period). If a household fails to make a timely request for a hearing, but has good cause for the failure, benefits are reinstated at the previous level if the household did not waive its right to continue benefits.

TANF and Medical Programs

Households receiving an adequate notice of adverse action are not entitled to continued benefits when benefits are lowered or denied because of reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice).

Exception: If the household received a notice of adverse action based on noncompliance with child support or Choices, continued benefits are allowed if the individual timely requests a fair hearing.

SNAP

Households receiving a notice of adverse action are not entitled to continued benefits when benefits are lowered or denied because of:

  • a verbal request to voluntarily withdraw, conducted in the advisor's presence;
  • verification provided by the household that was previously postponed during expedited services;
  • the household's failure to provide verification postponed during expedited services; or
  • the expiration of the certification period.

 

B—1052 Waiver of Continued Benefits

Revision 13-3; Effective July 1, 2013

All Programs

The household may waive its right to continued benefits by providing a signed and dated statement to this effect. If the household waives this right, TIERS will reduce or deny benefits when the 13-day notice period (plus 2 days mail time) expires in advance notice situations.

 

B—1053 Reducing or Ending Benefits Before the Hearing Decision

Revision 15-4; Effective October 1, 2015

All Programs

Continued or reinstated benefits must not be reduced or denied during the appeal period before the official hearing decision unless:

  • another change adversely affects the household and the household does not appeal the adjustment for the later change. Benefits are reduced based on the change, and the advisor sends Form TF0001, Notice of Case Action.
  • a mass change affects the household's eligibility. Benefits should be adjusted accordingly.

SNAP

When a certification period expires and the household reapplies, the EDG is certified at the appropriate level of benefits.

If the hearing officer determines the only issue being appealed is federal law or regulation and there are no computation errors or misapplied law, the hearing officer instructs the advisor to reduce or deny benefits as required by the policy change.

 

B—1054 Time Frame to Stop Providing Continued Benefits

Revision 15-4; Effective October 1, 2015

All Programs

When a hearing officer’s decision sustains the agency action, CRU must take action to stop continued benefits and file a claim for any overpayment within 10 days of receiving the hearing decision and order. Advance notice is not provided. If the hearing decision and order are received within 10 days before cutoff, CRU must make every attempt to process the EDG action before cutoff to prevent issuing continued benefits in the next month.

B-1060, Fair Hearings Held by Telephone

Revision 15-4; Effective October 1, 2015

All Programs

Fair hearings may be conducted by telephone. However, an appellant may still request a face-to-face hearing. Upon requesting a face-to-face hearing, the appellant is notified of the date, time and location of the hearing using Form H4803, Notice of Hearing.

There are two versions of Form H4803 that indicate how a fair hearing is conducted:

If the fair hearing is scheduled using ...then ...
Form H4803-T/H4803-TS, Notice of Hearing,the hearing officer calls the appellant, the agency representative and all other fair hearing participants at the time, date and telephone number indicated on the form.
Form H4803-P, Notice of Hearing,the appellant, agency representative and all other fair hearing participants must call the Fair Hearing 1-800-Call-In number, using the toll-free number and access code at the scheduled time indicated on the form.

B-1070, Administrative and Judicial Reviews

Revision 15-4; Effective October 1, 2015

All Programs

Effective September 1, 2007, if an individual expresses dissatisfaction with a decision rendered by the fair hearings officer, the individual may have the right to have the decision reviewed. The types of review to which the individual may be entitled are an administrative review and a judicial review, depending on which program is appealed.

If the individual or individual's authorized representative is dissatisfied with a … then the individual is entitled to an administrative review. then the individual is entitled to a judicial review.
Supplemental Nutrition Assistance Program (SNAP) or Medicaid fair hearing decision, Yes Yes
TANF fair hearing decision, Yes No
SNAP administrative disqualification hearing (ADH) decision, Yes Yes
TANF ADH decision, No Yes

 

B—1071 Administrative Review

Revision 15-4; Effective October 1, 2015

All Programs

An administrative review is a review of the hearing record conducted by an agency attorney to determine if the hearing officer's decision was correct. The agency attorney issues a new decision, which includes the hearings officer's signature in all administrative reviews, and this decision is the agency's final action. Administrative reviews apply to SNAP, TANF and Medicaid fair hearing decisions and SNAP ADH decisions.

If the individual or individual's authorized representative is dissatisfied with a fair hearing decision issued on or after September 1, 2007, an administrative review may be requested but must be submitted in writing within 30 calendar days from the date of the hearing officer's decision. The request for an administrative review must be mailed to the following address:

Hearings Administrator
P.O. Box 149030, Mail Code W-613
Austin, TX 78714-9030

Notes:

  • For TANF fair hearings, the individual's request for an administrative review only requires that the agency attorney review the hearing record for procedural and programmatic accuracy. The case is returned to the fair hearing officer for the final decision.
  • An administrative review of the fair hearing or ADH decision by an agency attorney must be requested and completed before a judicial review is allowed. Exception: There is no prerequisite for an administrative review for a TANF ADH before a judicial review is requested.

 

B—1071.1 Centralized Representation Unit (CRU) Staff Responsibilities Following an Administrative Review

Revision 15-4; Effective October 1, 2015

All Programs

CRU Staff

When a fair hearing decision is reversed because of an administrative review, the agency must take action on the agency attorney's decision, as described in B-1040, Timely Action on Fair Hearings.

CRU:

  • completes actions as required by the administrative review decision; and
  • notifies the agency attorney and hearing officer that the required action has been completed.

Note: Continued benefits are not provided if the hearing officer sustains the agency action.

CRU Supervisory Staff

The CRU supervisor reviews the actions taken on the reversal and ensures all actions are complete and correct.

 

B—1072 Judicial Reviews

Revision 15-4; Effective October 1, 2015

All Programs

A judicial review is a review of the hearing decision by the court to determine whether the decision taken by the agency was correct. ADH decisions must be filed by the individual in a district court in Travis County. The court will determine whether the decision of the agency is correct. The individual must file a petition for a judicial review within 30 calendar days after the date the administrative review decision is rendered. The individual must complete the administrative review process before filing a petition for a judicial review.

An individual dissatisfied with a TANF ADH decision has the right to file for a judicial review in the district court in the county in which the violation occurred no later than the 30th calendar day after the date the hearing officer makes the determination.

Exception: There are no judicial review rights for a TANF fair hearing decision, but the appellant may still request a procedural review of the hearing officer's decision. A procedural review is a review of the hearing record by an agency attorney to ensure procedural and programmatic accuracy.

 

B—1072.1 Agency Staff Responsibilities Following a Judicial Review

Revision 15-4; Effective October 1, 2015

All Programs

Local Office and CCC Staff

If the agency's decision is reversed as a result of a judicial review, staff must implement the decision within the time frames as specified within the final orders of the court.

Note: Continued benefits are not provided due to a request for a judicial review.

B-1080, Verification Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must verify that the household waived its right to continued benefits according to B-1052, Waiver of Continued Benefits.

Related Policy

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

B-1100, Reserved for Future Use

B-1200, Confidentiality

B-1210, Disclosure of Information

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must disclose information to applicants or individuals who want to review their case records for information used in the eligibility determination. Advisors must withhold confidential information from the case record, such as:

  • names of persons who disclosed information about the household without the household's knowledge, and
  • the nature or status of pending criminal prosecution.

TANF and Medical Programs

Advisors must disclose information about applicants or individuals to federal, state, or local agencies, if the information is directly connected with:

  • administration of a program approved under any of the following titles of the Social Security Act:
    • Title IV-A (Temporary Assistance for Needy Families [TANF]/Choices)
    • Title IV-B (Child Protective Services [CPS])
    • Title IV-D (Child Support)
    • Title IV-E (Foster Care and Adoption Assistance)
    • Title XVI (Supplemental Security Income [SSI])
    • Title XIX (Medicaid)
    • Title XX (Social Services/Child Care)

Disclosure of information is permitted for any case audits, reviews of expenditure reports, financial reviews, investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of these programs.

  • administration of any other federal or federally assisted program that provides assistance directly to individuals on the basis of need.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

Advisors must disclose information about applicants or individuals to Medicaid providers or their contractors that is needed for the providers to submit claims for reimbursement of Medicaid services provided to individuals. See the list of releasable data items in B-1230, Releasable Information for Medicaid Providers and Their Contractors.

SNAP

Advisors must disclose information about applicants or individuals to persons or agencies directly connected to the administration or enforcement of:

  • the Supplemental Nutrition Assistance Program (SNAP);
  • food distribution programs for households on Indian reservations; or
  • other federal assistance programs or federally aided programs that base assistance on an individual's income and resources.

    Such programs include, but are not limited to: Women, Infants, and Children (WIC); TANF; Medicaid; Child Protective Services; and SSI.

Advisors must disclose information about applicants or individuals to employees of the U.S. Comptroller General's Office for audit purposes.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

 

B—1211 Reporting Abuse and Neglect

Revision 15-4; Effective October 1, 2015  

All Programs

Policies on confidentiality do not prohibit reporting abuse or neglect that threatens the health or welfare of a child or an elderly adult or adult with disabilities. Advisors must report instances of suspected:

  • physical or mental injury,
  • sexual abuse,
  • exploitation, and
  • neglect.

Exception: Advisors are not required to report family violence.

Advisors must inform adults or their personal representative (PR) when reporting abuse or neglect of an adult, unless the advisor believes that informing the individual or PR would place the individual at risk of serious harm.

 

B—1212 Personal Representatives

Revision 15-4; Effective October 1, 2015  

All Programs

Only the individual's PR can exercise the individual's rights with respect to individually identifiable health information. Therefore, only an individual's PR may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of an individual. Individually identifiable health information is information that identifies or could be used to identify an individual and that relates to the:

  • past, present, or future physical or mental health or condition of the individual;
  • provision of health care to the individual; or
  • past, present, or future payment for the provision of health care to the individual.

Note: An authorized representative (AR) is not automatically a PR.

 

B—1212.1 Adults and Emancipated Minors

Revision 15-4; Effective October 1, 2015  

All Programs

If the individual is an adult or emancipated minor, including married minors, the individual's personal representative is a person who has the authority to make health care decisions about the individual and includes a:

  • person the individual has appointed under a medical power of attorney, a durable power of attorney with the authority to make health care decisions, or a power of attorney with the authority to make health care decisions;
  • court-appointed guardian for the individual; or
  • person designated by law to make health care decisions when the individual is in a hospital or nursing home and is incapacitated or mentally or physically incapable of communication. Advisors follow regional procedures to contact the regional attorney for approval.

 

B—1212.2 Unemancipated Minors

Revision 15-4; Effective October 1, 2015  

All Programs

A parent is the personal representative for a minor child except when:

  • the minor child can consent to medical treatment by him or herself. Under these circumstances, do not disclose to a parent information about the medical treatment to which the minor child can consent. A minor child may consent to medical treatment by him or herself when the:
    • minor is on active duty with the US military;
    • minor is age 16 or older, lives separately from the parents and manages his own financial affairs;
    • consent involves diagnosis and treatment of disease that must be reported to the local health officer or the Texas Department of State Health Services;
    • minor is unmarried and pregnant and the treatment (other than abortion) relates to the pregnancy;
    • minor is age 16 or older and the consent involves examination and treatment for drug or chemical addiction, dependency or use at a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • consent involves examination and treatment for drug or chemical addiction, dependency or use by a physician or counselor at a location other than a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • minor is unmarried, is the parent of a child, has actual custody of the child and consents to treatment for the child; or
    • consent involves suicide prevention or sexual, physical or emotional abuse.
  • a court is making health care decisions for the minor child or has given the authority to make health care decisions for the minor child to an adult other than a parent or to the minor child. Under these circumstances, the advisor must not disclose to a parent information about the health care decisions not made by the parent.

 

B—1212.3 Deceased Individuals

Revision 15-4; Effective October 1, 2015  

All Programs

The PR for a deceased individual is an executor, administrator, or other person with authority to act on behalf of the individual or the individual's estate. These individuals include:

  • an executor, including an independent executor;
  • an administrator, including a temporary administrator;
  • a surviving spouse;
  • a child;
  • a parent; and
  • an heir.

Advisors may consult the regional attorney with questions about whether a particular person is the PR of an applicant or individual.

 

B—1213 Establishing Identity for Contact Outside the Interview Process

Revision 15-4; Effective October 1, 2015  

All Programs

All information the Texas Health and Human Services Commission (HHSC) has about an individual or any person on the individual's case must be kept confidential. Confidential information includes, but is not limited to, individually identifiable health information.

Before discussing or releasing information about an individual or any person on the individual's case, steps must be taken to reasonably ensure that the person receiving the confidential information is either the individual or a person the individual authorized to receive confidential information (such as an attorney or personal representative).

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.1 Telephone Contact

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must establish a person's identity when contacting the individual, AR or PR by telephone. Refer to A-2020, Authenticating a Caller, for identity authentication policy.

Advisors must establish the identity of attorneys or legal representatives by asking the individual to provide Form H1826, Case Information Release, completed and signed by the individual. Advisors refer to B-1220, Specific Information That May Be Released, for authorization requirements.

Establish the identity of legislators or their staff by following regional procedures.

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.2 In-Person Contact

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must establish the identity of a person who presents himself as an individual or individual's representative at a local eligibility determination office by:

  • driver's license,
  • date of birth,
  • Social Security number (SSN), or
  • other identifying information.

Advisors must establish the identity of other staff, federal agency staff, researchers, or contractors by:

  • employee badge, or
  • government-issued identification card with a photograph.

Advisors must identify the need for other staff, federal staff, research staff, or contractors to access confidential information through:

  • official correspondence or phone call from state or regional offices, or
  • contact with a regional attorney.

Advisors must contact appropriate regional or state office staff when federal agency staff, contractors, researchers, or other staff, etc., come to the office without prior notification or adequate identification and request permission to access HHSC records.

B-1220, Specific Information That May Be Released

Revision 23-2; Effective April 1, 2023

All Programs

Staff must only give individual addresses or other case information to a person with written permission from the applicant to obtain the information. 

Note: If a general release is authorized, the advisor must provide the information that can be disclosed to the individual described in B-1210, Disclosure of Information, under All Programs.

The applicant authorizes the release of information by completing and signing: 

  • Form H1826, Case Information Release; or
  • a document containing all of the following information:
    • the applicant or individual's full name including middle initial and case number or full name including middle initial and either the date of birth or Social Security number; 
    • a description of the information to be released;
    • statement specifically authorizing HHSC to release the information;
    • the name of the person or agency to whom the information will be released;
    • purpose of the release;
    • an expiration event that is related to the individual, the purpose of the release, or an expiration date of the release;
    • statement about whether refusal to sign the release affects eligibility for or delivery of services;
    • a statement describing the applicant's or individual's right to revoke the authorization to release information;
    • the date the document is signed; and
    • the signature of the applicant or individual.

If the case information being released includes individually identifiable health information, the document must also inform the applicant or individual that the information released under the document may no longer be private and may be further released by the person receiving the information.

Note: Advisors must not include Form H1826 or other information release authorization documents in application packets.

Advisors must give information to government agencies conducting case audits, reviewing expenditure reports, or conducting financial reviews.

Advisors must give an applicant or individual's most recent address and place of employment to Parent Locator services in state or local offices.

Advisors must refer all requests from federal, state, or local law enforcement officials for case information to the local investigation division office.

Reasonable efforts must be made to limit the use, request, or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program.

The disclosure of individual medical information from agency records must be limited to the minimum necessary to accomplish the requested disclosure. For example, if a person authorizes release of income verification, including disability income, related case medical information must not be released unless specifically authorized by the person.

TANF and Medical Programs

Advisors must release identifying information such as the name and address of the person's friends and relatives to funeral homes, police, or agencies trying to find friends or relatives of deceased people.

Advisors reply to inquiries and complaints about the status of a person’s case from public officials or interested citizens who are acting as an agent for and have the consent of the person. The case status includes whether an application was filed, action taken by HHSC and the reason for the agency's action.

Advisors provide only the specific information stated in a summons on an Internal Revenue Service (IRS) Form 2039 to the IRS representative.

Advisors provide the following information only to the Armed Forces:

  • whether a person is receiving TANF; and
  • the amount of the TANF grant.

Advisors provide only the information in B-1230, Releasable Information for Medicaid Providers and Their Contractors, to Medicaid providers and their contractors. Note: Advisors must verify the contract with the Medicaid provider by obtaining:

  • the contract with the provider; or
  • a written document from the provider confirming the contract.

SNAP

Advisors release the names and addresses of participating individuals to people or agencies directly connected with nutrition education.

B-1230, Releasable Information for Medicaid Providers and Their Contractors

Revision 19-3; Effective July 1, 2019

All Programs

Applicant Data
  • Name
  • SSN*
  • Social Security Claim Number (SSCN or PCN)*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Category Code
  • Application Number
  • Application Disposition Date
  • Application Status
  • Client Number
Client Data
  • Name
  • Client Number
  • SSN*
  • SSCN*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Certification Date
  • Claims Administrator Update Date (Ins Sub Date)
  • Last Medical Update Date
  • Code for Type Change in Medical Coverage
  • Medicaid:
    • Open Date
    • Close Date
    • Type Coverage
    • Category
    • Type Program
    • Qualified Medicare Beneficiary (QMB) Indicator, if applicable
    • Medically Needy Indicator, if applicable
    • Client Medical Record
    • Case Numbers (active)
  • Third-Party Resource (TPR) Policy Occurs (most recent three):
    • Ins. Policy Number
    • Ins. Policy Sequence
    • Ins. Information Status
    • Type Coverage
    • Company Number
    • Group Number
    • Ins. Begin Date
    • Ins. End Date
    • Ins. Policy Holder
    • Ins. Employer
  • Medicare (Yes or No)
  • Texas Health Steps Data:
    • Texas Health Steps Decision Date
    • Dental Treatment Date
    • Medical Screen Date
  • Lock-in Data (most recent six):
    • Provider Type
    • Provider Name
    • Start Date
    • Through Date
Public Assistance (PA) Case Data
  • Case Number
  • Eligibility Determination Group (EDG) Number
  • Case Name
  • Case Status
  • Three Month Prior Date
  • End Date (For Medically Needy)
  • Denial Reasons **
  • Type Program
  • Active Clients List:
    • Client Number
    • Name
    • Date of Birth
    • Sex
  • Three Months Prior with Spend Down (not the spend down amount)

 

* Staff must confirm that the number given by the requestor is correct. Staff do not release Social Security numbers.

** Only the following denial reasons can be released:

Reason
Refusal to furnish information
Failure to furnish information
Appointment not kept (application/review)
Unable to locate
Voluntary withdrawal

B-1240, Preventing Disclosure of Information

Revision 15-4; Effective October 1, 2015  

All Programs

If the advisor receives a request for information which cannot be released, the advisor must inform the person requesting the information about the confidentiality of case records based on federal and state laws.

If the advisor receives a subpoena to appear in court with an individual's record, the advisor must notify the supervisor about the hearing. The advisor must take the case record and appear in court. When asked to disclose information from the case record, the advisor must ask the judge to be excused from disclosing information because of the laws concerning confidentiality. The advisor must abide by the judge's ruling.

See Part I, Section 3000, Health Insurance Portability and Accountability (HIPPA), in the Texas Department of Aging and Disability Services Operational Handbook for more information on disclosure of information laws.

 

B—1241 Destruction of Confidential Material

Revision 07-3; Effective July 1, 2007  

Confidential material that includes identifying information such as name, address or Social Security number must be disposed of according to local office procedures.

B-1250, Reporting Unauthorized Inspection or Disclosure of Social Security Administration-Provided Information

Revision 14-4; Effective October 1, 2014  

All Programs

Staff who become aware of an incident of unauthorized access to or disclosure of restricted information (i.e., IRS Federal Tax Information and verified SSA information) or confidential information must immediately contact the HHSC IRS coordinator by sending a secure email to HHSC IRS_FTI_Safeguards@hhsc.state.tx.us.

The HHSC IRS coordinator will report the incident by contacting the information security officer (ISO).

If a person is responsible for a security breach or a person’s employment is terminated, the user's access to all information must be removed. Supervisors must follow agency procedures for removing access for employees, contractors, vendors or trainees.

Related Policy

Reporting a Security Incident Regarding Internal Revenue Service (IRS) Federal Tax Information (FTI), C-1060

B-1260, Verification Requirements

Revision 15-4; Effective October 1, 2015  

All Programs

Advisors must verify the identity of the person who contacts the advisor with a request to disclose individually identifiable health information, using sources found in A-621, Verification Sources. In addition, Form H1826, Case Information Release, presented by a legal representative or with an employee badge, may be used to identify the person.

B-1270, Documentation Requirements

Revision 15-4; Effective October 1, 2015  

All Programs

If disclosing individually identifiable health information, the advisor must document how the identity of the person was verified when contact occurs outside of the interview.

Advisors must document:

  • the name of the personal representative (see B-1212, Personal Representatives);
  • the reason why a parent is not considered a PR for an unemancipated minor (see B-1212.2, Unemancipated Minors);
  • that the inquiring agency will agree to keep information confidential; and
  • that the information is limited to the purpose of the disclosure.

Related Policy

Documentation, C-940
The Texas Works Documentation Guide

B-1300, Nondiscrimination

B-1310, Nondiscrimination Policy

Revision 15-4; Effective October 1, 2015

All Programs

The Texas Health and Human Services Commission (HHSC) does not discriminate against any applicant or participant in any aspect of program administration. All eligible households receive benefits without regard to age, race, color, sex, disability, religious creed, national origin, or political beliefs.

HHSC must:

  • inform the public of this nondiscrimination policy and the applicable complaint procedures, and
  • provide access to nondiscrimination information within 10 days of a request.

Individuals should be referred to the Civil Rights Office toll-free at 1-888-388-6332. Staff can email the individual’s request to HHSCivilRightsOffice@hhsc.state.tx.us.

SNAP

Each certification office must display the nondiscrimination poster provided by the United States Department of Agriculture (USDA).

B-1320, Racial and Ethnic Data Collection

Revision 15-4; Effective October 1, 2015

All Programs

HHSC obtains racial and ethnic information about all individuals. The racial or ethnic categories are: American Indian or Alaskan Native, Asian or Pacific Islander, black (not of Hispanic origin), Hispanic, and white (not of Hispanic origin). Individuals are requested to voluntarily identify their race or ethnicity on the applications for HHSC assistance. If this information is not voluntarily provided on the application form, the advisor must determine the category by asking an individual to self-identify the individual’s race. The individual’s racial identity is self-declared. If the individual does not want to provide the information, the individual’s race is listed as “unknown.” In the Individual Household logical unit of work (LUW) on the individual’s Add New Individual Information, Edit Existing Individual ID Information or Edit New Individual Information page, the advisor must select the appropriate ethnicity and race from the drop-down menus.

B-1400, Complaints

B-1420, Office of the Ombudsman

Revision 19-2; Effective April 1, 2019

All Programs

Office of the Ombudsman operates a toll-free customer service hotline during normal office hours. The Office of the Ombudsman assists the public with issues or complaints about health and human services programs that have not been resolved under the agency's normal resolution process. If a person has a problem or complaint, they are encouraged to first discuss it with the person, program staff or office staff involved. They can often explain a specific policy or resolve the concern immediately.

People who need assistance or information about local resources or programs are encouraged to call 2-1-1 for access to information about health and human services in their community, including information on the location and phone number of local HHSC offices.

If a person has problems with or complaints about a health and human services program, service, or benefit that has not been resolved to their satisfaction, the person has four ways to send a question or file a complaint:

  1. Call: Toll-free phone, relating to:
    1. A consumer, call 877-787-8999 (8 a.m. to 5 p.m., Central Standard Time, Monday through Friday).
    2. A consumer needing help with accessing services under a managed care plan, call 866-566-8989.
    3. A foster youth, call 844-286-0769.
    4. A consumer seeking behavioral health services, call 800-252-8154.
    5. A resident of a nursing facility or an assisted living facility, call 800-252-2412.
    6. A person who has a hearing or speech disability, call 7-1-1 or 800-735-2989.
  2. Online: hhs.texas.gov/ombudsman
  3. Fax: 888-780-8099 (toll-free)
  4. Mail: Texas Health and Human Services Commission
    Office of the Ombudsman, MC H-700
    P.O. Box 13247
    Austin, Texas 78711-3247

Ombudsman staff:

  • provide dispute resolution services;
  • perform consumer protection and advocacy functions;
  • collect consumer contact data;
  • conduct reviews of complaints concerning HHSC policy or practices;
  • ensure case actions related to complaints are consistent with applicable HHS policies;
  • provide information to people about their rights and responsibilities;
  • coordinate the resolution of complaints or requests for information with appropriate agency staff;
  • refer people who request other state health and human services to the appropriate area;
  • screen, document and track all complaints and inquiries received using the HHS Enterprise Administrative Report and Tracking System (HEART);
  • compile and share various weekly, monthly and quarterly reports with designated executive, state and regional staff, providing complaint and inquiry volume and trend analysis.

Note: Ombudsman staff cannot determine eligibility or make changes to cases.

Medicaid Managed Care Helpline

The Medicaid Managed Care Helpline is designed to help people who receive Medicaid and need help accessing health care services. The HHSC Medicaid Managed Care Helpline helps people who receive Medicaid benefits:

  • navigate the managed care system (STAR, STAR+PLUS, STAR Kids and STAR Health);
  • understand their Medicaid coverage;
  • understand their rights;
  • advocate for themselves; and
  • resolve problems, including access to care.

The Medicaid Managed Care Helpline also provides general information about managed care programs to providers, health plans, community based organizations and other stakeholders. People may contact the Medicaid Managed Care Helpline at 866-566-8989.

Related Policy

Managed Care, A-821.2
Managed Care Plans, C-1116