3100, General Principles

Revision 23-4; Effective Sept. 22, 2023

Use the application, documentation and verification procedures established by HHSC or a less restrictive application, documentation or verification procedure.

  • A program shall use the application Form 3064, Application for Health Care Assistance, documentation, and verification procedures established by HHSC. A country may use a less restrictive application, documentation, or verification procedure after review and approval by HHSC to ensure it captures all necessary information included in the HHSC established processes. The county should have a written policy that outlines the procedure they will use for eligibility documentation and verification no later than the beginning of a state fiscal year. 
  • The program shall provide an application for assistance to the applicant or their representative on the same date that the request is received and accept an identifiable application.
  • The program shall assist the applicant with accurately completing Form 3064 and getting all needed verifications and information if the applicant requests help in completing the application process. Anyone who helps fill out the Form 3064 must sign and date it.
  • If the applicant lacks the ability to complete the application, is incapacitated or deceased, someone acting responsibly for the client (a representative) may represent the applicant in the application and the review process, including signing and dating the application on the applicant’s behalf. This representative must be knowledgeable about the applicant and their household. Document the specific reason for designating this representative.

The Program shall determine eligibility based on residence, household, resources and income.

  • The program shall allow at least 14 days for requested information to be provided from an applicant or household, unless the applicant or household agrees to a shorter time frame, when issuing Form 3068, Request for Information, or similar document.
  • Use any information received from the provider of service when making the eligibility determination, but counties, public hospitals and hospital districts may require further eligibility information from the potentially eligible resident, if necessary.
  • The date that a complete application is received is the application completion date, which counts as Day 0.
  • Determine eligibility no later than the 14th day after the application completion date. If eligibility is not determined within this 14-day period, the applicant is considered eligible and the provider must be notified.
  • Issue written notice of the program’s decision on Form 3077, Notice of Eligibility, or Form 3082, Notice of Ineligibility. If the county denies health care assistance, the written notice shall include the reason for the denial and an explanation of the procedure for appealing the denial.
  • Review each eligible case record at least once every six months.
  • Use the “Prudent Person Principle” in situations where there are unusual circumstances in which an applicant’s statement must be accepted as proof if there is a reasonable explanation why documentary evidence or a collateral contact is not available, and the applicant’s statement does not contradict other client statements or other information received by staff.
  • Current eligibility continues until a change resulting in ineligibility occurs and Form 3082 is issued to the household.
  • Consult the county’s legal counsel to develop procedures regarding disclosure of information.
  • The applicant has the right to:
    • have their application assessed in a non-discriminatory manner;
    • request a review of the decision made on their application or recertification for health care assistance; and
    • request, orally or in writing, a fair hearing about actions affecting receipt or termination of health care assistance.
  • The applicant is responsible for:
    • completing Form 3064 accurately;
    • signing and dating Form 3064;
    • providing all needed information requested by staff.  If information is not available or is not sufficient, the applicant may designate a collateral contact for the information. A collateral contact could be any objective third party who can provide reliable information. A collateral contact does not need to be separately and specifically designated if that source is named either on Form 3064 or during the interview; and
    • reporting changes, which affect eligibility, within 14 days after the date that the change occurred.