B-120, Redeterminations

Revision 17-1; Effective January 1, 2017

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

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

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

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

Related Policy

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

TANF and SNAP

Form H1830-R, Texas Works Renewal Notice, 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 16-4; Effective October 1, 2016

TANF

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

Advisors must schedule an appointment after the household returns Form H1010-R, Your Texas Works Benefits: Renewal Form.

SNAP

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

Advisors must schedule an appointment after the household returns Form H1010-R, Your Texas Works Benefits: Renewal Form. Advisors schedule the appointment no sooner than five days after the Form H1830-I, Interview Notice (Applications or Reviews), mail date, if possible.

For timely redeterminations, advisors schedule the first appointment 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 for Form H1020, Request for Information or Action, to be mailed from the central mail facility; 10 days after the H1020 issue date for the household to provide the information; and one additional day to process a denial for missed appointment, if applicable, in order to be timely.

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, to the client with no advisor action. Form H1211 is dynamic based on the eligibility outcome and program.

The system generates Form H1020, Request for Information or Action, and sends it with Form H1211 when additional information or verifications are needed from the client to complete the renewal processing.

The system generates Form H1206, Health Care Benefits Renewal - MA, but does not automatically mail it to the client. Form H1206 is pre-populated with information from the client’s case and may also include information from electronic data sources. There are different versions of this form depending on the type program in which the recipient is currently enrolled. Clients 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 the client; 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: Form H1010-R, Your Texas Benefits: Renewal Form, must be accepted if it contains Modified Adjusted Gross Income (MAGI) client information and a signature. The signature provided on Form H1010-R is considered valid as long as it is provided by the certified client or an individual who is allowed to sign for the client, as explained in A-121, Receipt of Application. The advisor should enter the information provided on Form H1010-R and pend for any information that cannot be verified through electronic data sources.

When a new individual is added to a case, as described at B-641, Additions to the Household, or an individual is transferred to a different medical program, their review due date may be aligned with the review due date of another individual in the same medical program on the case and 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 new individual or the individual who was transferred to a different type program will be mailed the following forms to complete the processing:

  • H1830-R, Texas Works Renewal Notice; and
  • H1010-R, Your Texas Works Benefits - Renewal Form.

 

B—122 Processing Redeterminations

Revision 20-4; Effective October 1, 2020

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.

For phone interviews, make at least two attempts to contact the applicant by phone. Conduct both attempts within the time listed on Form H1830-I, Interview Notice (Applications or Reviews). Conduct each attempt at least 10 minutes apart. If no contact is made with the applicant after two attempts, the phone interview is considered a missed appointment. Document the time of each attempt on the Appointment – Details page.

If a household fails to keep a face-to-face or phone interview appointment, send Form TF0001, Notice of Case Action, to deny the EDG the business day following the scheduled appointment date.

If the person contacts the office during the adverse action period, reschedule the appointment to process the redetermination as soon as possible to avoid interruption of the benefit issuance cycle for the following month. The EDG is not reactivated, and the EDG remains denied until the person keeps the second appointment. A second Form TF0001 is not required if the person misses the second appointment. If the person keeps the appointment, the EDG must be processed as a Reactivation/Redetermination for correct eligibility determination and timeliness calculation.

When the Texas Works Renewal Packet Is Not Returned and/or a Packet Received Date Is Not Entered

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.

For example: On July 5, the MU will terminate 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 online 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 Reactivation/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

Not Held – Agency Fault, B-113.1
The Texas Works Message, A-1527
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.

When a person misses a timely redetermination appointment, send Form H1020, Request for Information or Action, on the day of the missed appointment but no later than the next business day. Form H1020 advises the household to contact the Texas Health and Human Services Commission (HHSC) before the end of the certification period to request a second appointment, or the application will be denied.

If the household contacts the office on or before the last business day of the last month of the certification period, reschedule the household for a second appointment before the end of the certification period, if possible. If there are no appointment slots available, a second appointment should be scheduled no later than the 15th day of the following month and the application kept pending. If the household keeps the second appointment and is determined eligible, the original file date is used and a full month's benefits are provided for the first month of the new certification period.

If the household does not contact HHSC by the last business day of the certification period to request a second appointment, the redetermination application is denied on the last business day of the certification period using adequate notice.

For phone interviews, make at least two attempts to contact the person by phone. Both attempts must be conducted within the specified time period listed on Form H1830-I. Each attempt must be conducted at least 10 minutes apart. If no contact is made with the person after two attempts, the phone interview is considered a missed appointment. Document the time of each attempt on the Appointment – Details page.

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

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 if necessary 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.

For households that miss the first appointment but keep the second appointment scheduled before the 15th day of the following month, if additional information is requested, the household is allowed at least 10 days to provide the requested verification. If the household:

  • provides the verification on or before the due date on Form H1020, ensure that the household receives an opportunity to participate within five business days of receipt of the verification.
  • does not provide the verification by the due date on Form H1020, the redetermination is denied the next business day.

Situations in Which HHSC Fails to Timely Schedule the Redetermination Appointment

If the person misses an appointment for a timely redetermination scheduled without enough time to allow the household 10 days to respond to the missed appointment notice before the end of the certification period, send Form H1020 on the day of the missed appointment. The Form H1020 will inform the person to contact the office by the 10th day (or the following business day) to schedule a second appointment.

If the person:

  • fails to contact the office by the due date, the application is denied on the business day after the Form H1020 due date; or
  • contacts the office by the due date to request another appointment, schedule a second appointment within 10 days and keep the application pending for the second appointment.

Notes for SNAP policies in B-122:

  • For missed appointments, TIERS notices are mailed from the central mail facility two days after being requested in TIERS, so the Form H1020 due date is 12 days after the request date.
  • The person has until close of business on the final due date listed on Form H1020 to contact the office (close of business day for the vendor if calling 2-1-1) to request another appointment.

Related Policy

Interviews, A-131
Not Held – Agency Fault, B-113.1
Missed Appointment, B-114
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 policy explained in A-2342.1, 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 15-4; Effective October 1, 2015

SNAP

For timely filed reapplications after a short certification, if an individual misses the appointment, the advisor must send the household Form H1020, Request for Information or Action, advising the household that the household must contact HHSC by the 30th day from the last month's full benefit issuance to request a second appointment.

If the household contacts HHSC on or before the 30th day after the last month's full benefit issuance, the advisor must reschedule the household for a second appointment before the end of the 30th day, if possible. If there are no appointment slots available, the second appointment is scheduled no later than the 45th day after the last month's full benefit issuance and the application is kept pending. If the household keeps the second appointment and is determined eligible, the original file date is used and full month's benefits are provided for the first month of the new certification period.

The advisor must 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-workday) to contact the office for a second appointment or to provide missing information/verification. The advisor must notify the household of the due date on Form H1020. When this 10-day due date is on or after the 30th day after the last month's full benefit issuance and the household fails to contact the office or provide missing information/verification by the due date, the application is denied the next workday. If the household does not contact HHSC by the 30th day to request a second appointment, the redetermination application is denied on the 30th day (or the last workday before the 30th day if the 30th day is not a workday).

If the household does not contact HHSC by the 30th day to request a second appointment, the redetermination application is denied on the 30th day (or the last workday before the 30th if the 30th day is not a workday).

 

B—122.2 HHSC Delays in Processing All Timely Redeterminations

Revision 13-3; Effective July 1, 2013

SNAP

If HHSC is at fault for not completing the redetermination process in a timely manner, staff must dispose the EDG the same day the advisor completes the eligibility redetermination. This ensures that 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 an appointment until November. The advisor must 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 timely and provides all requested verification timely. Due to HHSC delay, the advisor does not complete the recertification process timely. The advisor must dispose the EDG on the same day that the eligibility redetermination is completed to ensure that benefits are available within 24 hours.

 

B—122.3 Delays Caused by Households

Revision 15-4; Effective October 1, 2015

TANF

When a redetermination is denied for a missed appointment or failure to provide information, the household is allowed until 60 days after the file date to schedule a second appointment or provide the missing information.

SNAP

When a timely redetermination is denied for a missed appointment or for failure to provide information, the household is allowed an additional 30 days after the end of the last benefit month to reschedule a missed appointment or to provide information or verification.

Related Policy

Verification Requirements, A-1370

 

B—122.3.1 Denied for Missed Appointments

Revision 15-4; Effective October 1, 2015

TANF and TP 08

The date the household requests another appointment is considered the new file date if the household requests a second appointment within 60 days after the original file date.

SNAP

The date the household requests another appointment is considered the new file date if the household requests to reschedule a missed appointment within 30 days after the end of the last benefit month. Benefits are prorated using the new file date.

 

B—122.3.2 Denied for Failure to Provide Information/Verification

Revision 15-4; Effective October 1, 2015

TANF

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

SNAP

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

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

TP 08, TP 43, TP 44 and TP 48

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

Note: This may result in a gap in coverage.

 

B—122.4 Medical Program Administrative Renewals

Revision 20-4; Effective October 1, 2020

TP 08, TP 43, TP 44 and TP 48

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

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

TP 08

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

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

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

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

Related Policy

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

 

B—122.4.1 Automated Renewal Process

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

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

The process uses electronic data to automatically:

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

 

B—122.4.1.1 Verifications Required by Type Program for Renewals

Revision 21-2; Effective April 1, 2021

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

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

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

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

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

Related Policy

Verification Requirements, A-1370 

 

B—122.4.1.2 Eligibility Outcomes

Revision 15-4; Effective October 1, 2015

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

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

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

 

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

Revision 21-2; Effective April 1, 2021

TP 08, TP 43, TP 44 and TP 48

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

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

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

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

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

 

B—122.4.1.3 Renewal Correspondence

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

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

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

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

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

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

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

 

B—122.4.2 Processing a Manual Renewal

Revision 20-4; Effective October 1, 2020

TP 08, TP 43, TP 44 and TP 48

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

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

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

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

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

Examples:

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

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

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

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

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

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

 

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

Revision 15-4; Effective October 1, 2015

TP 08, TP 43, TP 44 and TP 48

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

Below are the eligibility outcomes during the automated process:

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

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

 

B—123 Processing Children's Medicaid Redeterminations

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

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

TP 44 and TP 48

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

Related Policy

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

 

B—123.1 Children's Medicaid Redetermination Due Dates

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

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

Related Policy

Eligibility Transition from Medicaid to CHIP, B-123.4

 

B—123.2 Children's Medicaid Redetermination Processing Time Frames

Revision 15-4; Effective October 1, 2015

TP 43, TP 44 and TP 48

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

 

B—123.3 Reuse of Form H1206 After Denial

Revision 19-2; Effective April 1, 2019

TP 43, TP 44 and TP 48

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

 

B—123.4 Eligibility Transition from Medicaid to CHIP

Revision 17-2; Effective April 1, 2017

TP 43, TP 44 and TP 48

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

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

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

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

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

Related Policy

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

 

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

Revision 15-4; Effective October 1, 2015

Medical Programs

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

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

 

B—123.6 Children's Medicaid Redetermination Expectations

Revision 15-4; Effective October 1, 2015

Children's Medicaid

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

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

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

Related Policy

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

 

B—124 Processing Untimely Redeterminations

Revision 15-4; Effective October 1, 2015

SNAP

If an application form is not received by the time frames in B-122, Processing Redeterminations, the advisor uses the initial application processing time frames in B-112, Deadlines.

If the individual submits an untimely reapplication and misses a scheduled appointment, the advisor uses the charts in B-160, SNAP Timeliness Charts for Applications and All Redeterminations, for processing time frames. The advisor must inform the individual that it is the individual's responsibility to request a second appointment. Form H1020, Request for Information or Action, must be sent no later than the next workday, notifying the individual of the missed appointment and pending the application.

Note: If the individual misses an appointment that the agency scheduled untimely, a second appointment is scheduled if the individual contacts the office by the 10th day after the missed appointment date to request another appointment. Otherwise, the individual must reapply with a new file date.

For telephone interviews, advisors must make at least two attempts to contact the individual via telephone.  Both attempts must be conducted within the specified time period listed on Form H1830-I, Interview Notice (Applications or Reviews). Each attempt must be conducted at least 10 minutes apart. If no contact is made with the individual after two attempts, the telephone interview is considered a missed appointment. Advisors must document the time and date of each attempt on the Appointment – Details page.

At the individual's request, HHSC must reschedule a second appointment even if it cannot be scheduled until after the 30th day. The individual does not have to show good cause for missing the first 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.

Notes:

  • 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 – Detail page.

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

  • Benefits are not prorated if an eligible individual submits an untimely reapplication because HHSC fails to provide Form H1830 timely. Benefits are provided from the first day of the month after the last benefits month (enter a file date of the first day of that month).

See A-2323, Proration, and an exception for seasonal and migrant farm workers.

  • Advisors do not use application verification requirements when processing untimely redeterminations. Verification requirements are the same for all redeterminations whether filed timely or untimely. See C-912, Required Verification for SNAP.

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, the EDG is denied 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 that any local eligibility determination office 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, the advisor reopens the Medical Program EDG and processes as a renewal.

Related Policy

Missed Appointment, B-114

 

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