An official State of Texas website.
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, is sent to households, along with Form H1010-R, Your Texas Benefits: Renewal Form, 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 H1020, Request for Information or Action, may be included with Form H1211;
- 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. 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, 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 |
|
| TP 43, Children Under Age One TP 44, Children 6–18 TP 48, Children 1–5 |
|
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 |
|
| Additional Information Needed |
|
| Eligibility Terminated* |
|
* 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 Outcome | Correspondence and Required Client Response |
| Eligibility Potentially Approved |
|
| Additional Information Needed |
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 |
|
* 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