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 Not Held – Agency Fault

Revision 15-4; Effective October 1, 2015

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

If the advisor has not contacted the household for the interview either by telephone or for a face-to-face interview by the close of business on the scheduled appointment date, the advisor must mark the Task List Manager (TLM) "Check-In" task associated with the appointment as "Not Held-Agency Fault." This creates a subsequent reschedule task. The advisor must not mark the appointment as "Show" or "No Show" when the advisor has not been able to contact the household for the interview.

Note: This policy applies to applications and redeterminations for all programs that require an interview.

 

B—114 Missed Appointment

Revision 15-4; Effective October 1, 2015

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

For telephone interviews, the advisor must make at least two attempts to contact the applicant via telephone. Both attempts must be conducted within the time period listed on Form H1830, Application/Review/Expiration/Appointment Notice. Each attempt must be conducted at least 10 minutes apart. If no contact is made with the applicant after two attempts, the telephone interview is considered a missed appointment. The advisor must document the time of each attempt on the Appointment – Details page.

TANF and Medical Programs except TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44 and TP 48

If the applicant misses the first appointment and does not contact the office on the appointment day, the application is denied no later than the next workday.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule and keep the original file date.

If the applicant contacts the office by the 30th day after the file date to reschedule, the application is reopened using the date of contact as the new file date.

When a requested or required interview is scheduled within the 15-workday active duty military member policy but the applicant requests to reschedule the interview, staff must try to accommodate the rescheduled appointment within the 15-workday time frame. If, at the household's request, the interview is rescheduled after the 15-workday time frame, the advisor must document the reason for not scheduling the appointment within the required time frame.

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

SNAP

If the applicant misses the first appointment, the advisor must send the applicant Form H1020, Request for Information or Action, on the same day and pend the application. The advisor must inform the applicant that it is the applicant's responsibility to request a second appointment.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule.

If the household misses an appointment and contacts the office on or before the 30th day after the file date, the advisor must reschedule the household for another appointment before the 30th day, if possible. If there are no appointment slots available, the advisor must schedule another appointment after the 30th day, but by the 45th day, and the application is kept pending. If the household keeps that appointment and is determined eligible, the original file date is used to provide benefits.

Note: When a household misses a scheduled appointment and subsequently submits another application, the advisor must consider the second application as a household's request to reschedule the missed appointment.

If the 30th day after the file date is a non-workday, the advisor takes the appropriate action on the following workday. This also must be the final due date on Form H1020.

Additionally, if necessary, hold the application past the 30th day to allow the household at least 10 days to contact the office for a second appointment. If the household does not contact the office by this deadline, the EDG is denied no earlier than the following workday.

Notes:

  • The individual has until close of business (COB) on the final due date listed on Form H1020, Request for Information or Action, to contact the office (COB for the vendor if calling 2-1-1) to request another appointment.
  • If a second or subsequent appointment is scheduled because the individual missed the appointment, the advisor must ensure that second and subsequent appointments have been correctly recorded on the Appointment – Details page.

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

Related Policy

Interviews, A-131
Processing Redeterminations, B-122
Children’s Medicaid Redetermination Expectations, B-123.6

TP 36 and TP 40

No appointment is required to process an application.

Note: For requested interviews, if the applicant requests to be rescheduled, the household must be informed that an interview is not required and the processing of the application can begin without an interview. An application must not be denied if the household fails to show for the appointment when 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 individual non-complies with the Health Care Orientation requirement or Texas Health Steps (THSteps) or information needed to determine eligibility can only be obtained through a telephone interview.

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