Texas Works Handbook

C-1410, Legal Aid

Revision 13-3; Effective July 1, 2013

All Programs

Staff are required to include the address and phone number of legal services available in the area on individual notices.

C-1420, SSA Claim Number Suffixes

Revision 21-2; Effective April 1, 2021

A Primary Claimant 
B Wife, 62 or over (1st claimant)
B1 Husband, 62 or over (1st claimant)
B2 Young wife with a child in her care (1st claimant)
B3 Wife, 62 or over (2nd claimant)
B4 Husband, 62 or over (2nd claimant)
B5 Young wife with a child in her care (2nd claimant)
B6 Divorced wife, 62 or over (1st claimant)
B7 Young wife with a child in her care (3rd claimant)
B8 Wife, 62 or over (3rd claimant)
B9 Divorced wife, 62 or over (2nd claimant)
BA Wife, 62 or over (4th claimant)
BD Wife, 62 or over (5th claimant)
BG Husband, 62 or over (3rd claimant)
BH Husband, 62 or over (4th claimant)
BJ Husband, 62 or over (5th claimant)
BK Young wife with a child in her care (4th claimant)
BL Young wife with a child in her care (5th claimant)
BN Divorced wife, 62 or over (3rd claimant)
BP Divorced wife, 62 or over (4th claimant)
BQ Divorced wife, 62 or over (5th claimant)
BR Divorced husband, 62 or over (1st claimant)
BT Divorced husband, 62 or over (2nd claimant)
BW Young husband with a child in his care (2nd claimant)
BY Young husband with a child in his care (1st claimant)
C1-C9* Child (minor, disabled or student)
CA-CK Child (minor, disabled or student) CA = C11, CB = C12, etc.
D Widow, 60 or over (1st claimant)
D1 Widower, 60 or over (1st claimant)
D2 Widow, 60 or over (2nd claimant)
D3 Widower, 60 or over (2nd claimant)
D4 Widow (remarried after turning 60) (1st claimant)
D5 Widower (remarried after turning 60) (1st claimant)
D6 Surviving divorced wife, 60 or over (1st claimant)
D7 Surviving divorced wife, 60 or over (2nd claimant)
DB Widow, age 60 or over (3rd claimant)
D9 Widow (remarried after turning 60) (2nd claimant)
DA Widow (remarried after turning 60) (3rd claimant)
DC Surviving divorced husband, 60 or over (1st claimant)
DD Widow, 60 or over (4th claimant)
DG Widow, 60 or over (5th claimant)
DH Widower, 60 or over (3rd claimant)
DJ Widower, 60 or over (4th claimant)
DK Widower, 60 or over (5th claimant)
DL Widow (remarried after turning 60) (4th claimant)
DM Surviving divorced husband, 60 or over (2nd claimant)
DN Widow (remarried after turning 60) (5th claimant)
DP Widower (remarried after turning 60) (2nd claimant)
DQ Widower (remarried after turning 60) (3rd claimant)
DR Widower (remarried after turning 60) (4th claimant)
DS Surviving divorced husband, 60 or over (3rd claimant)
DT Widower (remarried after turning 60) (5th claimant)
DV Surviving divorced wife, 60 or over (3rd claimant)
DW Surviving divorced wife, 60 or over (4th claimant)
DX Surviving divorced husband, 60 or over (4th claimant)
DY Surviving divorced wife, 60 or over (5th claimant)
DZ Surviving divorced husband, 60 or over (5th claimant)
E  Mother (widow) (1st claimant)
E1 Surviving divorced mother (1st claimant)
E2 Mother (widow) (2nd claimant)
E3 Surviving divorced mother (2nd claimant)
E4 Father (widower) (1st claimant)
E5 Surviving divorced father (1st claimant)
E6 Father (widower) (2nd claimant)
E7 Mother (widow) (3rd claimant)
E8 Mother (widow) (4th claimant)
E9 Surviving divorced father (2nd claimant)
EA Mother (widow) (5th claimant)
EB Surviving divorced mother (3rd claimant)
EC Surviving divorced mother (4th claimant)
ED Surviving divorced mother (5th claimant)
EF Father (widower) (3rd claimant)
EG Father (widower) (4th claimant)
EH Father (widower) (5th claimant)
EJ Surviving divorced father (3rd claimant)
EK Surviving divorced father (4th claimant)
EM Surviving divorced father (5th claimant)
F1 Father
F2 Mother
F3 Stepfather
F4 Stepmother
F5 Adopting father
F6 Adopting mother
F7 Second alleged father
F8 Second alleged mother
G1 – G9 Claimants of lump-sum death payments
J1 Primary PROUTY entitled to HIB (less than 3 Q.C.) (General Fund) **
J2 Primary PROUTY entitled to HIB (over 2 Q.C.) (RSI Trust Fund)
J3 Primary PROUTY not entitled to HIB (less than 3 Q.C.) (General Fund)
J4 Primary PROUTY not entitled to HIB (over 2 Q.C.) (RSI Trust Fund)
K1 PROUTY wife entitled to HIB (less than 3 Q.C.) (General Fund)
K2 PROUTY wife entitled to HIB (over 2 Q.C.) (RSI Trust Fund)
K3 PROUTY wife not entitled to HIB (less than 3 Q.C.) (General Fund)
K4 PROUTY wife not entitled to HIB (over 2 Q.C.) (RSI Trust Fund)
K5 PROUTY wife entitled to HIB (less than 3 Q.C.) (2nd claimant) (General Fund)
K6 PROUTY wife entitled to HIB (over 2 Q.C.) (2nd claimant) (RSI Trust Fund)
K7 PROUTY wife not entitled to HIB (less than 3 Q.C.) (2nd claimant) (General Fund)
K8 PROUTY wife not entitled to HIB (over 2 Q.C.) (2nd claimant) (RSI Trust Fund)
K9 PROUTY wife entitled to HIB (less than 3 Q.C.) (3rd claimant) (General Fund)
KA PROUTY wife entitled to HIB (over 2 Q.C.) (3rd claimant) (RSI Trust Fund)
KB PROUTY wife not entitled to HIB (less than 3 Q.C.) (3rd claimant) (General Fund)
KC PROUTY wife not entitled to HIB (over 2 Q.C.) (3rd claimant) (RSI Trust Fund)
KD PROUTY wife entitled to HIB (less than 3 Q.C.) (4th claimant) (General Fund)
KE PROUTY wife entitled to HIB (over 2 Q.C.) (4th claimant) (RSI Trust Fund)
KF PROUTY wife not entitled to HIB (less than 3 Q.C.) (4th claimant) (General Fund)
KG PROUTY wife not entitled to HIB (over 2 Q.C.) (4th claimant) (RSI Trust Fund)
KH PROUTY wife entitled to HIB (less than 3 Q.C.) (5th claimant) (General Fund)
KJ PROUTY wife entitled to HIB (over 2 Q.C.) (5th claimant) (RSI Trust Fund)
KL PROUTY wife not entitled to HIB (less than 3 Q.C.) (5th claimant) (General Fund
KM PROUTY wife not entitled to HIB (over 2 Q.C.) (5th claimant) (RSI Trust Fund)
LM Black lung miner (1st claimant)
LW Black lung miner's widow (1st claimant)
M Beneficiary not entitled to Title II or monthly benefits (Not qualified for automatic free Part A – HIB)
M1 Similar to M, but qualified for automatic free Part A – HIB, but elects to file for Part B – SMIB only
T
  • Fully insured beneficiaries who have elected entitlement only to HIB (usually but not always along with SMIB)
  • End Stage Renal Disease (ESRD) filing for Medicare only
  • Deemed insured (hospital insurance only)
T2-T9 Multiple eligible children (Medicare Qualified Government Employment (MQGE)) childhood disability benefits)
TA MQGE primary beneficiary
TB MQGE aged spouse (1st claimant) spouse
TC MQGE childhood disability benefits (1st claimant)
TD MQGE aged widow or widower (1st claimant)
TF MQGE father
TG, TH, TJ, TK Multiple eligible MQGE aged spouses
TL, TM, TN, TP Multiple eligible MQGE aged widow(er)s
TQ MQGE mother
TE, TR, TS, TT, TU Multiple eligible MQGE young widow(ers)
TV, TW, TX, TY, TZ Multiple eligible MQGE disabled widow(er)s
W Disabled widow, 50 or over (1st claimant)
W1 Disabled widower, 50 or over (1st claimant)
W2 Disabled widow, 50 or over (2nd claimant)
W3 Disabled widower, 50 or over (2nd claimant)
W4 Disabled widow, 50 or over (3rd claimant)
W5 Disabled widower, 50 or over (3rd claimant)
W6 Disabled surviving divorced wife (1st claimant)
W7 Disabled surviving divorced wife (2nd claimant)
W8 Disabled surviving divorced wife (3rd claimant)
W9 Disabled widow, 50 or over (4th claimant)
WB Disabled widower, 50 or over (4th claimant)
WC Disabled surviving divorced wife (4th claimant)
WF Disabled widow, 50 or over (5th claimant)
WG Disabled widower, 50 or over (5th claimant)
WJ Disabled surviving divorced wife (5th claimant)
WR Disabled surviving divorced husband (1st claimant)
WT Disabled surviving divorced husband (2nd claimant)
* Youngest child is assigned suffix "1." When there are more than nine children in an Eligibility Determination Group (EDG), the 10th child is coded with an A rather than 10, the 11th child is coded with a B, etc.

** Quarters of covered employment.

C-1430, SNAP Allotment Charts

C-1431 Whole Monthly Allotments by Household Size

Revision 24-4; Effective Oct. 1, 2024

SNAP Allotment Chart (PDF)

The shaded portions on the table in this section show monthly, not prorated allotments available to categorically eligible households, which can be $1 or more.

The minimum monthly, not prorated Supplemental Nutrition Assistance Program (SNAP) allotment for a one-or two-person household is $23.

Related Policy

How to Determine Monthly SNAP Allotments, C-122

C-1432 Prorated SNAP Allotments by Application Date

Revision 19-1; Effective January 1, 2019

Prorated Food Snap Allotments

Do not issue prorated benefit allotments of less than $10.

Related Policy

How to Determine Monthly SNAP Allotments, C-122
How to Prorate Benefits, C-123
Whole Monthly Allotments by Household Size, A-2321

C-1440, Relationship Charts

 

C—1441 Guide for Determining Relationship

Revision 13-3; Effective July 1, 2013

TANF and Medical Programs

This guide provides more detailed information about the eligibility requirements for relationship discussed in A-200, Household Composition, and A-520, Relationship. This guide is not all-inclusive.

ABC
When the child no longer lives with the relative listed below ...and the child now lives with ...can the person listed in Column B be a caretaker/payee for the child?
1. Mother1. Stepfather1. Yes
2. Father2. Stepmother2. Yes
3. Stepfather3. Stepfather's Spouse3. Yes
4. Stepmother4. Stepmother's Spouse4. Yes
5. Stepfather's Spouse5. New Spouse5. No
6. Stepmother's Spouse6. New Spouse6. No
*7. Grandmother7. Step Grandfather7. Yes
*8. Grandfather8. Step Grandmother8. Yes
*9. Step Grandfather9. New Spouse9. No
*10. Step Grandmother10. New Spouse10. No
11. Brother11. Sister-in-law11. Yes
12. Sister12. Brother-in-law12. Yes
13. Brother-in-law13. New Spouse13. No
14. Sister-in-law14. New Spouse14. No
15. Stepbrother15. Stepbrother's Spouse15. Yes
16. Stepbrother's Spouse16. New Spouse16. No
17. Stepsister17. Stepsister's Spouse17. Yes
18. Stepsister's Spouse18. New Spouse18. No
*19. Aunt19. Aunt's Spouse19. Yes
*20. Uncle20. Uncle's Spouse20. Yes
21. Aunt's Spouse21. New Spouse21. No
22. Uncle's Spouse22. New Spouse22. No
**23. First Cousin23. First Cousin's Spouse23. Yes
**24. First Cousin's Spouse24. New Spouse24. No
*25. Niece25. Niece's Spouse25. Yes
26. Niece's Spouse26. New Spouse26. No
*27. Nephew27. Nephew's Spouse27. Yes
28. Nephew's Spouse28. New Spouse28. No
*Extends to the degree of "Great-great" for items 19, 20, 25, and 27 and to the degree of "Great-great-great" for items 7, 8, 9 and 10.

**Extends to the first cousin once removed.

 

 

C—1442 Guide for Determining Extended Relationships

Revision 06-1; Effective January 1, 2006

Extended Relationships Chart

C-1450, Guidelines for Clearing Quality Control (QC) Findings

C—1451 Dropped – Subject to Review but Not Completed

Revision 20-4; Effective October 1, 2020

All Programs

Form H1025, Report of Quality Control Assessment Findings Penalty What to do ...
Not reviewed (reason):

 

Refusal to Cooperate1		 Yes Issue Form TF0001, Notice of Case Action, entering the comments for the appropriate program: "Your SNAP or TANF benefits are denied due to your refusal to cooperate with the Quality Control (QC) review. You will incur this penalty through Feb. 2, 20YY, 2 or until you decide to cooperate with the QC review process, whichever occurs first. You will need to contact (insert the QC contact designated by QC State Office) at (insert the QC contact’s phone number) to complete the QC review process." Include the Texas Health and Human Services Commission's (HHSC's) Spanish translation: "Sus beneficios de SNAP o TANF se negaron porque usted se negó a cooperar con la revisión de Control de Calidad (QC). Esta sanción se le aplicaráá hasta el 2 de febrero de [Año] o hasta que decida cooperar con el proceso de revisión de la QC, lo que ocurra primero. Para completar el trámite de revisión de la Valoración de Control de Calidad (QC), tiene que comunicarse con (insert the QC contact designated by State Office) al (insert the QC contact’s telephone number)."

Allow advance notice of adverse action and deny only the EDG for which Form H1025 was received. Do not deny associated EDGs. (See A-2343, Advance Notice.) Call the Texas Integrated Eligibility Redesign System (TIERS) helpdesk before disposing the denied EDG to ensure only the appropriate EDG is denied.

Notes:

  • Refusal to cooperate with QC does not affect Medicaid.
  • The Temporary Assistance for Needy Families (TANF) denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF EDG for refusal to cooperate with QC. (Refer to policy in A-1324.18, Temporary Assistance for Needy Families (TANF).)

When the EDG is denied for any other reason before the time Form H1025 is received (for example, the person failed to return pending information and the EDG is denied effective Sept. 30, the QC review month was September, and Form H1025 is received in October), continue to send Form TF0001 to the household notifying them of the penalty for refusal to cooperate with the QC review..
Not reviewed (reason):


Failure to Cooperate3		 No Analyze any information provided by QC and adjust the EDG, if necessary.

Notes:

1 Refusal to cooperate indicates the person has refused to cooperate with the QC review process by refusing to provide information or refusing to be interviewed.

2 The penalty period always expires 125 days after the reporting period. The reporting period ends Sept. 30 each year. The penalty period for federal fiscal year (FFY) is October through September of the following year. QC refusal to cooperate penalties expire Feb. 2, 20YY. Example: The person's sample month is October 2019. The person refuses to cooperate and is penalized. The penalty period expires Feb. 2, 2021 (125 days after Sept. 30, 2020).

3 Failure to cooperate indicates the person has provided all the information and cooperated with the QC review process; however, the QC analyst is unable to complete the review due to an aspect beyond the person's control (for example, the employer or landlord refused to provide information).

 

C—1452 Dropped – Not Subject to Review

Revision 15-4; Effective October 1, 2015

All Programs

Form H1025, Report of Quality Control Assessment Findings Penalty What to do ...
Not reviewed (reason):


Moved Out of State		 No If the individual reports in advance of moving, issue Form TF0001, Notice of Case Action, and deny the EDG simultaneously allowing adequate notice. See A-2344.1, Form TF0001 Required (Adequate Notice). Deny the EDG for which Form H1025 was received.

When the individual reports after they move out of state or it is determined by QC, deny the EDG following A-2344.2, No Form TF0001 Required.

Adjust/deny any other EDGs in which the individual/household members are included.
Not reviewed (reason):


Referred to Fraud, Under Active Fraud Investigation or Intentional
Program Violation (IPV) EDG		 No No action is required.

 

If, as of the date the EDG is selected for QC sampling, the EDG meets one of the following:

  • has been referred for investigation to the state's fraud investigation unit, and the investigation is scheduled to begin within five months of sampling;
  • is under active fraud investigation; or
  • has a pending administrative or judicial IPV hearing,

the IPV EDG is not subject to review.
Not reviewed (reason):


Retroactive Benefits		 No No action is required. The sample month benefits were issued retroactively; therefore, the EDG is not subject to review. Example: The file date is November 15 and the certification date is December 15. Benefits for November are issued (retroactively) in December; if November is the sample month, the EDG is not subject to review.
Not reviewed (reason):


Unable to Locate		 No When Form H1025 indicates that returned mail has been received by QC, the advisor must send Form TF0001 and deny the EDG simultaneously to allow adequate notice. (See A-2344.1.)

When Form H1025 does not indicate that returned mail has been received but that the individual has not been located, advisors must send Form TF0001 to deny for unable to locate allowing advance notice of adverse action. (See A-2343, Advance Notice.)

Adjust/deny any other EDGs in which the individual/household members are included.
Not reviewed (reason):


All Individuals Who Could Be Interviewed Are Hospitalized, Incarcerated or Placed in a Mental Institution		 No Information discovered by QC is forwarded to the advisor via this format. The advisor needs to analyze the information and adjust the EDG appropriately, including denial.

Adjust/deny any other EDGs in which the individual/household members are included.
Not reviewed (reason):


EDG Pending a Hearing		 No No action is required.
Not reviewed (reason):


Household Did Not Receive Benefits for Sample Month		 No No action is required.

TANF

 

Form H1025 QC Findings Penalty What to do ...
Not reviewed (reason):

 

Death of All Available Adult Household Members		 No Deny the EDG, allow adequate notice and send Form TF0001 simultaneously. Adjust/deny any other EDGs in which the individual/household members are included. (See A-2344.1.)

The child(ren) may be certified as independent children on appropriate Medicaid EDGs (see A-241.1, Who Is Included) or they may be determined eligible in a new TANF household when all other eligibility requirements are met.
Not reviewed (reason):

 

Dormant Electronic Benefit Transfer (EBT) Account		 No No action is required.

SNAP

Form H1025 QC Findings Penalty What to do ...
Not reviewed (reason):


Death of All Household Members		 No Deny the EDG. Adjust/deny any other EDGs in which the individual/household members are included. (See A-2344.2.)
Not reviewed (reason):

 

Dormant Account, No Activity in EBT Account, Sample Month and Two Following Months Up To and Including Transmission to Food and Nutrition Services		 No No action is required.

 

C—1453 Completed QC Reviews

Revision 20-4; Effective October 1, 2020

TANF and SNAP

Form H1025, Report of Quality Control Assessment Findings Penalty What to do ...
Completed – Person Refused to Cooperate 1 Yes Issue Form TF0001, Notice of Case Action, with the following message: "Your SNAP/TANF benefits are denied due to your refusal to cooperate with the Quality Control (QC) review. You will incur this penalty through Feb. 2, 20YY, 2 or until you decide to cooperate with the QC review process, whichever occurs first. You will need to contact (insert the QC contact designated by QC State Office) at (insert the QC contact’s phone number) to complete the QC review process." Include HHSC's Spanish translation: "Sus beneficios de SNAP o TANF se negaron porque usted se negó a cooperar con la revisión de Control de Calidad (QC). Esta sanción se le aplicará hasta el 2 de febrero de [YEAR] o hasta que decida cooperar con el proceso de revisión de la QC, lo que ocurra primero. Para completar el trámite de revisión de la Valoración de Control de Calidad (QC), tiene que comunicarse con (insert the QC contact designated by State Office) al (insert the QC contact’s telephone number)."

 

Allow advance notice of adverse action and deny only the EDG for which Form H1025 was received. Do not deny associated EDGs. (See A-2343, Advance Notice.)

Notes:

  • Refusal to cooperate with QC does not affect Medicaid.
  • The TANF denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF EDG for refusal to cooperate with QC. (Refer to policy in A-1324.18, Temporary Assistance for Needy Families (TANF).)
Information(al) Only No Information discovered by the QC analyst is forwarded to eligibility staff via this form. Eligibility staff need to analyze the information and adjust the EDG appropriately, including denial, if necessary.

 

Refer all instances of SNAP over issuance identified during the QC review process to the Office of Inspector General (OIG), regardless of the dollar amount. (See policy in B-720, When to File an Overpayment Referral, prior to sending the referral to OIG.)
Amount Correct: No No action is required.

Notes:

1 Refusal to cooperate indicates the person has refused to cooperate with the QC review process by refusing to provide information or refusing to be interviewed.

2 The penalty period always expires 125 days after the reporting period. The reporting period ends Sept. 30th each year. The penalty period for the FFY is October through September of the following year. QC reviews expire Feb. 2, 20YY. Example: The person's sample month is March 2020. The person refuses to cooperate and is penalized. The penalty period expires Feb. 2, 2021 (125 days after Sept. 30, 2020).

TANF

Form H1025 QC Findings Penalty What to do ...
Underpayment No

Adjust the EDG accordingly (See B-800, Restored Benefits) and issue supplemental benefits for the current month if the person is currently eligible.

Note: Consider all reported changes when determining the amount of supplemental or restored benefits. The dollar amount listed is not necessarily the amount of the underpayment.

Adjust or deny any other EDGs in which the person or household members are included.
Overpayment No

Adjust the EDG accordingly and enter the overpayment referral in TIERS.

Note: Consider all reported changes when determining the amount of the overpayment claim, including changes reported to QC during the exclusionary period and any other information listed by QC as “information only.” The dollar amount listed is not necessarily the amount of the overpayment.

Adjust or deny any other EDGs in which the person or household members are included.

SNAP

Form H1025 QC Findings Penalty What to do ...
Underissuance No

Adjust the EDG accordingly. (See B-800, Restored Benefits.)

Issue supplemental benefits for the current month if the person is currently eligible.

For agency errors only, issue restored benefits for past months regardless of whether the person is currently eligible. Do not restore benefits for unreported changes or household errors.

Note: Consider all reported changes when determining the amount of supplemental or restored benefits. The dollar amount listed is not necessarily the amount of the underissuance.

Adjust or deny any other EDGs in which the person or household members are included.
Overissuance No

Adjust the EDG accordingly and enter the overissuance referral in TIERS. Refer all SNAP overissuances identified during the QC review process to OIG, regardless of the dollar amount. (See policy in B-720, When to File an Overpayment Referral, prior to sending the referral to OIG.)

Note: Consider all reported changes when determining the amount of the overissuance claim, including changes reported to QC during the exclusionary period and any other information listed by QC as “information only.” The dollar amount listed is not necessarily the amount of the overissuance.

Adjust or deny any other EDGs in which the person or household members are included.

 

C—1454 Reapplying for Benefits after a Quality Control Penalty

Revision 15-4; Effective October 1, 2015

All Programs

When the penalized individual comes in to reapply for benefits after the EDG is closed and the penalty period has ... and the penalized individual is applying with ... then the advisor ...
not expired, the same household composition as was on the EDG reviewed by QC, checks with the QC State Office staff who issued Form H1025, Report of Quality Control Assessment Findings. If the individual has cooperated with the QC review, the advisor proceeds with the application process. When the individual has not cooperated with the QC review, the advisor denies the application and informs the individual to reapply after they comply with the QC review process. Form TF0001, Notice of Case Action, must include the following: "You will need to contact (insert the QC contact designated by QC State Office) at (insert the QC contact designated by QC State Office) to complete the QC review process." Include HHSC's Spanish translation: "Para completar el trámite de revisión de la Valoración de Control de Calidad (QC), tiene que comunicarse con (insert QC contact designated by State Office) al (insert QC contact designated by State Office)."
not expired, another household or moved into another household and is a required member of that household, checks with the QC State Office staff who issued Form H1025. The penalty follows the penalized individual, and the new household is not eligible until the individual complies with QC. When the individual has cooperated with the QC review, the advisor proceeds with the application process. When the individual has not cooperated with the QC review, the advisor denies the application and imposes the disqualification until the individual cooperates or the penalty period expires, whichever comes first, informing the individual to reapply after they comply with the QC review process. Form TF0001 must include the following: "You will need to contact (insert the QC contact designated by QC State Office) at (insert the QC contact designated by QC State Office) to complete the QC review process." Include HHSC's Spanish translation: "Para completar el trámite de revisión de la Valoración de Control de Calidad (QC), tiene que comunicarse con (insert QC contact designated by State Office) al (insert QC contact designated by State Office)".

Do not disqualify other adults or children who were members of the original penalized household when they apply with or enter another household and the penalized individual(s) is not applying with or entering the new household with them.

 

C—1455 Frequently Asked Questions

Revision 20-4; Effective October 1, 2020

All Programs

1. Q: What is the difference between refusal to cooperate and failure to cooperate?
    "Refusal to cooperate" is a QC response used when the person has refused to cooperate with the QC review process, by refusing to provide information or refusing to be interviewed. "Failure to cooperate" is used when the person has provided all the information and cooperated with the QC review process. However, QC is unable to complete the review because of something beyond the person's control. For example, the person’s employer or landlord refused to provide information. A penalty is incurred when the person refuses to cooperate. A penalty is not incurred for failure to cooperate.
2. Q: How do I know if a penalty has been imposed on a case?
    The Data Broker Combined Report displays active QC penalties, including the name and phone number of the QC contact designated by QC State Office.

Additionally, QC maintains a list of sampled cases with imposed penalties. The list can be viewed from the Eligibility Services portal to view the list

  • Enter your user name and password.
  • Select Report Manager.
  • Select QCDW/Case Review List in the Select Report Group.
  • Select the appropriate Drop Case List Report.
  • Enter the criteria for the report.
3. Q: Are staff required to send Form TF0001 with the appropriate penalty wording for people who are no longer receiving benefits by the time Form H1025, Report of Quality Control Assessment Findings, is received? Example: The EDG is denied in March 2020, and staff receive Form H1025 information June …. 2020. The person is not receiving benefits when Form H1025 is received. The penalty period expires Feb. 2, 2021.
    Yes. The person must be notified of the penalty period. Form TF0001 must advise the person that the person cannot receive benefits through Feb. 2, 2021, or until the person cooperates with the QC analyst, whichever is earlier as noted in #3 above.
4. Q: Does the penalty period ever change? If so, how does it change?
    The penalty period is always 125 days after the reporting period ends. The reporting period ends each federal fiscal year on Sept. 30. One hundred twenty-five days from Sept. 30 is Feb. 2. These are for the prior federal fiscal year.
5. Q: Do we deny the entire EDG or just the person listed on Form H1025?
    Deny the entire EDG reviewed by QC. Note: When denying a TANF EDG for refusal to cooperate, the associated SNAP benefits should not be increased (the TANF grant should not be removed from the budget) as the person failed to cooperate with a QC review (see A-1324.18, Temporary Assistance for Needy Families [TANF]).
6. Q: Can the person appeal the denial of the EDG when it has been denied for refusal to cooperate?
    Yes, the decision may be appealed. (Refer to B-1000, Fair Hearings.)

TANF

1. Q: Is the person entitled to restored benefits when QC discovers an underpayment?
    When the household is currently eligible for and receiving TANF, then the answer is yes. (See B-810, Entitlement to Restored Benefits.)
2. Q: What happens when we restore benefits and the person has an overpayment claim filed?
    The restored benefits must be used to offset the claim first. (See B-810.)

SNAP

1. Q: Is the person entitled to restored benefits when QC discovers an underissuance?
    When the QC error was caused by the agency, then the answer is yes. When the QC error was caused by the person due to unreported changes or other personal errors, no, they are not entitled to restored benefits. (See B-840, Notice to the Household.)
2. Q: What happens when we restore benefits and the person has an overissuance claim filed?
    The restored benefits must be used to offset the claim first. (See B-810.)

C-1460, Helpful Toll-Free Numbers

Revision 19-2; Effective April 1, 2019

All Programs

Use the following list of toll-free phone numbers for reference purposes, or print the list and provide it to applicants or recipients.

Question or ConcernOrganizationTelephone No.
Questions about social services or community resources in Texas, including the location and phone number of local agency offices.2-1-1 Texas Information and Referral Network2-1-1 or
877-541-7905 (after selecting a language, press 1)
Provides households with information about EDG status such as active, on hold or denied; benefit amounts; and availability dates of current benefits.Automated Voice Response (AVR) system hotline2-1-1 or
877-541-7905 (after selecting a language, press 2)
Assists the public with issues or complaints about health and human services programs that have not been resolved under the agency's normal complaint process.Texas Health and Human Services Office of the Ombudsman877-787-8999
To report suspicions of the abuse or neglect of children, or the abuse, neglect or exploitation of people age 65 or older or adults with disabilities.Texas Department of Family and Protective Services800-252-5400
Questions about Social Security Administration benefits or the maintenance of an individual's record.Social Security Administration800-772-1213
TTY number
800-325-0778
For claims of discrimination experienced by either individuals or applicants.HHSC Civil Rights Office888-388-6332
Concerns about fraud, waste or abuse of SNAP, Medicaid, TANF or Children's Health Insurance Program (CHIP) services or benefits.Office of Inspector General800-436-6184
The Children with Special Health Care Needs Services Program, within the Division for Family and Community Health Services, which provides services to children with extraordinary medical needs, disabilities and chronic health conditions.Texas Department of State Health Services800-252-8023
For child support services including the collection of court-ordered child support, information about the Crime Victims Compensation Fund and enforcement of the state's consumer protection laws.Office of Attorney General800-252-8011
For information on early intervention services for children with disabilities and developmental delays, services for people who are deaf or hard of hearing or children who are blind or visually impaired.Texas Health and Human Services

Main number:
512-424-6500

TTY number:
512-424-6597

For information on vocational rehabilitation for persons with disabilities, and services for adults who are blind or visually impaired.Texas Workforce Commission800-628-5115
For information on disability determination services.Social Security Administration

800-772-1213

TTY number:
800-325-0778

Information and assistance concerning family violence.National Domestic Violence 24-hour hot line

800-799-SAFE (7233)

TTY number
800-787-3224

Medicaid

Question or ConcernOrganizationTelephone Number
Help finding or questions about a doctor, dentist or case manager for a person age 20 or younger.Texas Health Steps877-847-8377
For transportation assistance to a doctor's appointment.Medical Transportation (HHSC)877-633-8747
Helps people enrolled in STAR, STAR+PLUS, STAR Health or STAR Kids with Medicaid managed care issues.HHSC Medicaid Managed Care Helpline866-566-8989
Questions about services covered by Medicaid, or help when a bill is received from a Medicaid provider, or questions about Medically Needy with Spend Down cases.Statewide Medicaid help line800-335-8957
Questions about enrolling in the STAR Managed Care Program or help changing a health plan.State of Texas Access Reform (STAR)800-964-2777

C-1470, Eligibility Environments

Revision 15-4; Effective October 1, 2015

All Programs

Texas Works serves applicants and recipients in Texas through a variety of eligibility environments. The following is a brief summary of each type.

Local eligibility offices: HHSC staff conduct business in a face-to-face environment with people seeking information or applying for health and human services programs. Interviewing tasks are performed at the local eligibility office either in person or by telephone.

The eligibility staff in local offices provide information and application assistance, receive applications, perform Data Broker and other third-party inquiries, collect data, assess missing information, determine eligibility, issue benefits, and perform other tasks associated with eligibility services operations. Work is processed by eligibility staff in local offices in TIERS. Individuals are assigned to specific offices and a single eligibility worker processes an EDG until it is disposed as approved or denied.

Eligibility staff in a local office process multiple types of assistance: SNAP, Medicaid, CHIP, and TANF. Eligibility staff in the offices work all types of EDGs/cases; however, some offices may have specialized staff based on workload. Clerical staff handle front desk and lobby-area tasks, telephones, mail, faxes, scheduling and other support duties.

Vendor staff creates and routes tasks for applications received via mail or fax to staff in the local eligibility offices or changes received via telephone, mail or fax to staff in the Customer Care Centers (CCCs). The vendor may register a new application or reschedule an appointment, then route the interviewing tasks to local eligibility offices. Applications, redeterminations and changes submitted online through YourTexasBenefits.com are routed to the appropriate areas by the State Portal.

Centralized units: These units are able to specialize in certain programs or tasks and conduct eligibility work through the mail and by telephone without face-to-face contact. The centralized units help balance the workload of local eligibility offices. In a centralized unit, tasks are assigned based on due dates. Centralized functions have centralized mail, centralized telephone systems and do not require lobby space as eligibility offices do. Centers also have staff to answer telephones and provide status information, in addition to the staff working the cases.

C—1471 Specialized and Centralized Casework Units

Revision 22-4; Effective Oct. 1, 2022

The following chart details various specialized and centralized casework units.

Centralized Units That Serve Both Texas Works (TW) Programs and Medicaid for the Elderly and People with Disabilities (MEPD) Programs

Unit Name Description
Centralized Representation Unit (CRU) The CRU files appeal requests and assembles EDG information in preparation for hearings for TIERS cases. The CRU represents the agency at fair hearings and implements all decisions for EDGs statewide. Members of this unit are housed across the state in local eligibility offices. HHSC created the unit in September 2007, and the unit initially processed EDG actions resulting from TIERS fair hearings for both Texas Works and MEPD. More details are available in the Eligibility Services State Processes document. Staff must file all appeal requests using the Hearings and Appeal — Create Appeal functionality in TIERS, accessed through the left navigation menu. Form H4800, Fair Hearing Request Summary, which is sent directly to the hearings division, is returned to staff with instructions to enter the information in TIERS.
Customer Care Centers (CCCs) The CCC office locations are in Athens, Austin, El Paso, Houston, Midland and San Antonio. State staff, along with vendor staff, conduct business using the 2-1-1 Texas phone system. CCC staff handle inquiries and concerns that vendor staff cannot resolve. The vendor creates tasks and routes non-interview changes received by phone, mail, fax or the Self-Service Portal to state staff in the CCCs. The CCCs are supported by TIERS and by eligibility supporting technologies, such as the Task List Manager and the State Portal. CCC state staff perform Data Broker and other third-party inquiries, collect data, assess missing information, determine eligibility, issue benefits, process individual and agency generated changes, perform other non-interview tasks, and process six-month income check task. CCC performs these functions, as applicable, for TW and MEPD.

The CCC operates Monday to Friday from 8 a.m. to 6 p.m. Central time (excluding state holidays).

Below are some helpful toll-free numbers:
  • 800-645-7164 — CHIP provider toll-free phone line
  • 877-543-7669 (877-KIDS-NOW) — CHIP and Children’s Medicaid toll-free phone line
  • 800-735-2988 or 7-1-1 — TDD/TTY users (Relay Texas)
Effective Jan. 15, 2013, HHSC centralized the clearance of Income Eligibility and Verification System (IEVS) Internal Revenue Service (IRS) data matches for TW and MEPD. Data matches that OIG identifies for each program are processed by CCC staff.

HHSC set up CCCs with the Integrated Eligibility and Enrollment pilot rollout in January 2006.
Assistance Response Team (ART) ART staff housed throughout the state serve as on-site support to regional staff. These state staff offer TIERS technical support for Texas Works and MEPD on-the-job trainings (OJT), conduct clerical OJTs, offer TIERS technical support to eligibility staff (offer pre-ticket support to all regions to mitigate unneeded tickets), process Texas Works cases based on MEPD email box referrals and Health Insurance Portability and Accountability Act of 1996 (HIPAA) referrals for all regions, and assist State Office Data Integrity (SODI) with merging assignments. HHSC set up ART with the Integrated Eligibility and Enrollment pilot rollout in January 2006.

Centralized Units That Serve Only MEPD Programs

Unit Name Description

MEPD

HHSC created a special statewide eligibility unit in January 2007 to process eligibility for MEPD programs. Statewide staff specialize in MEPD eligibility programs to help make sure MEPD casework is evenly distributed. Members of this unit are housed across the state in local eligibility offices.

Centralized Units That Serve Only Texas Works Programs

Unit Name Description
Centralized Benefit Services (CBS) Staff in this centralized Austin location process SNAP EDGs for households in which all members get Supplemental Security Income (SSI), using specialized automation that supports the modified eligibility requirements for these households. In addition, the unit also processes applications, redeterminations and changes for:
  • SNAP Combined Application Project (SNAP-CAP) EDGs;
  • Medicaid for Breast and Cervical Cancer (MBCC);
  • Medicaid for children under the jurisdiction of the juvenile court and for youth under 19 in non-secure facilities;
  • Medicaid for Transitioning Foster Care Youth (MTFCY);
  • Former Foster Care Children (FFCC);
  • Medicaid for inmates of a public institution; and
  • qualified aliens admitted as refugees.
and applications for:
  • Former Foster Care in Higher Education (FFCHE) health care benefits program.
Appointed staff process Medicaid requests for babies born to mothers incarcerated in Texas. Most babies receive ongoing Medicaid, but factors such as with whom the baby will reside or if the baby will remain in Texas may affect eligibility.

When the baby cannot be certified for ongoing newborn Medicaid, the EDG is referred to Data Integrity to add coverage for the birth of the baby under a state-paid medical program.
Children's Medicaid Center (CMC) Centralized CMCs process applications and renewals for Children's Medicaid and CHIP. They do not process other associated-program case actions, to ensure a streamlined, timely approach. The CMC office locations are in regions across the state:
  • Region 3 (Dallas Metroplex)
  • Region 6 (Houston)
  • Region 8 (San Antonio)
  • Region 11 (Rio Grande Valley)
Currently, Regions 3, 6 and 8 have CMCs to process applications and renewals for Children's Medicaid and CHIP for their respective regions.
Healthy Texas Women (HTW) This center, located in San Antonio, processes statewide HTW applications, changes and renewals. The HTW center also process Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification, for CHIP perinatal mothers.