B-630, Processing Requirements

Revision 24-3; Effective July 1, 2024

All Programs

When a change is reported, determine:

• the type of change reported;
• the date the change occurred;
• the date the change was reported;
• if the change is considered as verified upon receipt based on the source of the report;
• if additional verification is required to determine how the reported changes affect the eligibility determination;
• the date the verification was received, if applicable; and
• the effective date of the change.

When income is new or increases, also determine:

• the date of the first payment;
• the source of the income;
• any expected variation in pay amounts, including the number of hours and rate of pay; and
• pay frequency.

When a household requests to select a new authorized representative (AR), determine the appropriate case action using AR policy.

When a change is reported on an application form, the date HHSC staff become aware of the change is considered the date the change was reported.

TANF

If a household reports that a minor child is no longer in the home, determine if the change makes the household ineligible or requires a second parent to participate in CHOICES.

SNAP

When adding a household member, determine the primary wage earner and if the new person is subject to the Employment and Training (E&T) work requirement and the ABAWD work requirement. Ensure the Form TF0001, Notice of Case Action, informs the household about their SNAP work rules.

When adding a newborn child, determine the date the newborn joined the SNAP household after being released from the hospital.

When a person is removed from household, determine if any remaining household members become subject to the E&T work requirement and the ABAWD work requirement. Ensure the Form TF0001 informs the household about their SNAP work rules.

TP 45

Before adding a newborn child, determine if there is an existing Medicaid EDG by querying the mother’s individual number or demographic information. This helps prevent duplicate medical coverage and individual numbers.

TP 43, TP 44 and TP 48

When a household with a child ,1 to 18, on an active Children’s Medicaid EDG reports a new child, who is a sibling or non-sibling, the household does not need to complete a new application. Determine the new child’s household composition and if the new child has any countable income.

TA 82, TP 40, TP 44 and TP 70

If a person’s Medicaid is suspended because the person was incarcerated in a Texas county jail, determine if they can be added to an existing case for reinstatement of all previous benefits when the person’s Medicaid is reinstated.

Related Policy

Authorized Representatives, A-170
Choices, A-1821
E&T Procedures, A-1822
Federal Time Limits, A-1900
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531
Medicaid Reinstatement for Persons Released from Texas County Jails, B-532
Effective Date Requirements, B-640

B-631 Actions on Changes

Revision 24-3; Effective July 1, 2024

All Programs

Determine eligibility for multiple programs independently of each other. Do not deny a type of assistance based solely on the denial of another type of assistance. When the agency receives information, it can be used to meet verification requirements for multiple programs.

If additional verification is required, send the household a Form H1020, Request for Information or Action (PDF), and a Form H1020-A, Sources of Proof (PDF). The household is allowed 10 calendar days to provide the requested information or verification. The date on the Form H1020 is day zero of the 10 calendar day period.

If unverified income is reported that makes the household ineligible, request additional income verification.

After determining eligibility:

• send a new Form H1019, Report of Change, with a prepaid envelope to report future changes; and
• send a Form TF0001, Notice of Case Action. If the household fails to provide the required additional verification by the due date on the Form H1020, send the Form TF0001 by the next business day.

If a change of address is reported, send the household a Form H0025, HHSC Application for Voter Registration.

TANF and Medical Programs

Regardless of if the household must report the change, staff must take action on all household-reported and agency-generated changes.

TANF and SNAP

If the reported change increases the household’s monthly benefit allotment, issue supplemental benefits. If additional verification is received, issue supplemental benefits by the last day of the month the verification was received.

SNAP

Staff must take action on all household-reported and agency-generated changes when the available information is sufficient to process the change. Take action even when the change is not required to be reported because of the household’s SR designation.

If additional verification is needed to process the change, only send Form H1020 when:

• the household’s SR designation requires them to report the change, and the information is less than 60 days old from the first day of the month the change was reported;
• the reported information conflicts with the information used to certify the household at the most recent application, redetermination, interview, or previous report of change; or
• electronic data sources identify a household member may be deceased.

If a household or agency-generated change is reported and Form H1020 is not required, document the reported change in the case record and verify the information reported at the next redetermination.

At redetermination, consider information the household reported during the last benefit month which is effective after the certification period ends.

If a household member is subject to the E&T work requirement or the ABAWD work requirement, call the household to verbally explain their rights and responsibilities. Inform households with exempt members of their option to voluntarily participate in the SNAP E&T Program. Ensure Form TF0001 informs the household about their SNAP work rules.

When a child on an active EDG is placed in foster care, send Form TF0001 to give the household advance notice of adverse action.

Related Policy

Change in Medical Expenses During Certification, A-1428.4
Registering to Vote, A-1521
Adverse Action, A-2340
Streamlined Reporting Households, A-2350
Information Received During Application Processing, B-116
Actions on Agency-Generated Changes, B-631.2
Changes Increasing Benefits (Other than Additions to the Household), B-642
Changes Decreasing Benefits, B-643
Questionable Information, C-920

B-631.1 Actions Known to the Agency

Revision 24-3; Effective July 1, 2024

All Programs

When information is reported to HHSC, consider the information known to the agency. If required, take action on all active EDGs. Multiple changes reported on the same day must be processed as one occurrence. If required, send Form H1020, Request for Information or Action (PDF), with the corresponding pending period and list the verifications needed for all changes.

Multiple changes reported on different days must be processed as separate occurrences. Each change could affect the benefits for different months. If required, send Form H1020 for each reported change with the corresponding pending period and list only the verification needed for that change.

TANF

When a newborn is reported on an active TP 40 EDG and a TP 45 EDG is established, consider the information as known to the agency. Staff then takes action on the associated TANF EDG.

SNAP

When a newborn is reported on an active TP 40 EDG and a TP 45 EDG is established, consider the information as known to the agency and take action on the associated SNAP EDG. Before adding a newborn, the household must confirm the date the newborn joined the household.

Related Policy

Effective Date Requirements, B-640

B-631.2 Actions on Agency-Generated Changes

Revision 24-3; Effective July 1, 2024

All Programs

The Texas Department of Family and Protective Services (DFPS) notifies HHSC through an interface when a child receiving TANF, Medicaid or SNAP has been placed in foster care. The eligibility system automatically removes the child from the EDG(s). If the eligibility system does not remove a child placed in foster care, take action to manually remove the child from the EDG(s).

Do not add other children or siblings to a household when reinstating a denied EDG because a child was released from a juvenile facility or a county jail. The household must submit a new application to add other children or siblings.

The Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) notifies HHSC through an interface when a child certified for Medicaid is placed in a juvenile facility and when a child is released.

OIG staff help with clearing computer matches for the following reports:

• Public Assistance Reporting Information System (PARIS) Interstate Matches;
• Texas Department of Criminal Justice (TDCJ);
• Social Security Administration Prisoner Verification System (PVS);
• Income and Eligibility Verification Systems (IEVS); and
• Social Security Administration Deceased Individual Report.

PARIS Interstate Matches

When OIG staff receive an Interstate Match through PARIS that shows a person on an active TIERS EDG is receiving benefits in another state, OIG informs HHSC staff by creating a task within the Task List Manager (TLM). Take the appropriate action to process the task based on the information provided by OIG.

TDCJ and PVS Matches

When OIG staff find a match through TDCJ or PVS that shows a person on an active TIERS EDG is incarcerated, OIG informs HHSC staff by creating a task within TLM. Take the appropriate action to process the task based on the information provided by OIG.

When staff request a Data Broker report, TDCJ information is displayed on the combined report for an incarcerated person.

Income and Eligibility Verification Systems (IEVS)

The procedures for clearing IEVS reports are documented in C-1000, Procedures for Clearance of Income & Eligibility Reports & Internal Revenue Federal Tax Information.

Date of Death Matches

TIERS matches recipients on active EDGs with records from the Office of Inspector General (OIG), Social Security Administration (SSA), Texas Bureau of Vital Statistics (BVS), the Centers for Medicaid and Medicare Services (CMS), and DADS Webservice to find deceased persons.

The BVS, if available is considered the primary source of verification of death. If BVS is available but the date of death (DOD) does not match reported information, accept BVS as verification. No additional verification is required.

If BVS verification is not available, verify the DOD using two of the following sources:

• SSA;
• statement from guardian or authorized representative;
• copy of death certificate;
• statement from a doctor;
• newspaper death notice (obituary);
• statement from a relative or household member;
• statement from a funeral director; or
• records from hospital or other institution where the person died.

TIERS attempts to update the DOD information for all active and inactive people and automatically removes them from active EDGs. If unable to process the death data automatically, TIERS creates a task for staff to research and confirm the validity of the computer match.

Take action to clear any discrepancies when DOD data is received on an active or inactive person within TIERS and TIERS is unable to automatically dispose the case. When TIERS cannot dispose the case, a series of alerts are created for staff to explore and request additional verification.

To clear discrepancies, request additional verification of the DOD data received. Do not require the household to provide the verification if the verification is available through one of the sources listed above.

Related Policy

Verification Sources, A-1081
Inmate/Parolee Match, C-825.17
Procedures for Clearance of Income & Eligibility IEVS, Reports & Internal Revenue IRS, Federal Tax Information FTI, C-1000

B-632 Mass Changes

Revision 15-4; Effective October 1, 2015

All Programs

The state or federal government initiates changes that can affect all individuals or large numbers of individuals. Individuals are not required to report mass changes. These changes occur in the:

• income eligibility standards;
• shelter and dependent care maximum deductions;
• Thrifty Food Plan and standard deductions;
• utility standard;
• cost-of-living adjustments for Social Security, Supplemental Security Income (SSI) and other federal benefits;
• TANF grants; and
• other eligibility criteria based on legislative or regulatory actions.

When these changes occur, HHSC automatically adjusts eligibility or benefits for most individuals and notifies the households via Form TF0001, Notice of Case Action. The adjustments are effective the date of the change. Advisors do not send Form TF0001.

HHSC generates an exception report for EDGs that are not adjusted during the state office conversion. Advisors must review the EDGs, adjust benefits if necessary, and send the individual Form TF0001, allowing advance notice of adverse action if required.

B-633 Changes in Eligibility Test

Revision 15-4; Effective October 1, 2015

All Programs except TP 45

If a household's circumstances change and the household is subject to a new income/resource test, the advisor must determine eligibility by applying the new test when the change is reported.

B-634 Changes in SNAP EDGs Jointly Processed with Supplemental Security Income (SSI)

Revision 15-4; Effective October 1, 2015

SNAP

Individuals whose SNAP and SSI applications have been jointly processed must report changes like other SNAP individuals.

B-635 Shortening Certification Periods as a Result of a Change

Revision 24-3; Effective July 1, 2024

SNAP

Shorten a certification period for a household designated as SR 3 when:

• A change occurs that makes the household’s circumstances unstable, and the effect of the change on the household's eligibility or benefits cannot be determined. This includes:
  • receipt of the discrepancy report Alert 254, Employer New Hire Data;
  • new listings of information on Data Broker that are inconsistent with information previously reported by the household; and
  • situations where a public assistance household's TANF is denied for an administrative reason, such as missed appointment, voluntary withdrawal or failure to provide information requested to redetermine TANF eligibility, and the household’s SNAP EDG becomes questionable.
• The household's eligibility becomes questionable as described in special reviews for known changes.

Send Form H1020, Request for Information or Action (PDF), requesting specific verification. If the SR 3 household does not provide the verification, deny the household for failure to provide information and send Form TF0001, Notice of Case Action.

Do not shorten the certification period if the household is designated as SR1 or SR 2.

Centralized Benefit Services (CBS) staff shorten certification periods when a household reports a change that results in the household being transferred out of CBS.

Related Policy

Setting Special Reviews, to determine when to set a special review on SR EDGs, A-2330
Due Dates, B-125.1
Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs), B-474.6.1
Data Broker, C-820
Questionable Information, C-920

B-636 Change in Head of Household (HOH)

Revision 24-3; Effective July 1, 2024

All Programs

When the current HOH dies or leaves the home, change the HOH to another responsible adult household member without requiring the remaining household members reapply for benefits. If there are children in the household, a responsible adult household member is:

• a parent with minor children living in the household; or
• an adult who has parental control over minor children living in the household.

If there is no responsible adult member identified in the household, and a child in the household is receiving benefits, send Form H1020, Request for Information or Action (PDF), to notify the household that a responsible adult who is caring for the child must apply for benefits for the child to continue to receive assistance. If an application is not submitted by the Form H1020 due date, deny benefits since the whereabouts of the household are unknown.

SNAP and TANF

If the HOH who left the home was the Electronic Benefit Transfer (EBT) primary cardholder (PCH), update the PCH information with the new HOH and issue a new Lone Star Card to allow the household access to SNAP and TANF benefits. Do not update the information if a new HOH has not been identified.

Related Policy

Establishing the Primary Cardholder, B-231
Issuing a Lone Star Card, B-233
PCH Replacements, B-237

B-637 Periodic Income Checks

Revision 24-2; Effective April 1, 2024

TP 08

Initiating a PIC requires no staff action. It uses the automated income check process to determine if there has been a change in the household’s income that makes the household potentially ineligible for Medicaid for Parents or Caretaker Relatives.

A PIC is initiated in months three through eight of the certification period when the following conditions are met:

• any of the following is true for at least one person in the MAGI household for at least one countable income or expense source:
  • an income or expense is not verified;
  • one of the following income types uses “Verified by Reasonable Compatibility” as the verification source:
    • employment income;
    • unemployment compensation income; or
    • RSDI income; or
  • the verification source is anything other than “Verified by Reasonable Compatibility” and the verification received date is more than 60 days old; and
• the case is in Approved Ongoing mode; and
• there are no pending TLM tasks for the case.

The household’s income information in the eligibility system is compared with income data available through electronic data sources (ELDS) as part of the automated income check process. This is to determine if it is reasonably compatible, as explained in A-1370, Verification Requirements, Medical Programs.

The eligibility system may be able to complete the entire PIC process without any staff action or correspondence sent to the client. This is if the PIC does not find an indication that there has been a change in the household’s income that makes them potentially ineligible.

Electronic income data is requested one month before the eligibility system uses it. If the household’s income is not determined to be reasonably compatible with electronic data, the household must provide other acceptable verification as explained in A-1371, Verification Sources.

Electronic Data Hierarchy for Earned Income

1. TIERS checks electronic data from the Texas Workforce Commission (TWC).
2. If earned income electronic data is not available, TIERS checks to see if there is a New Hire Report. When a New Hire Report exists that does not match the household’s income information in TIERS, the household must provide verification of the information on the New Hire Report.

TIERS also checks SOLQ to verify RSDI income (unearned income).

Process verifications returned as the result of a PIC following changes policy. If the person does not provide the requested verification by the 10th day, TIERS automatically sends Form TF0001 on the 11th day for failure to provide.

SNAP and TANF

Verification is required for SNAP and TANF during the automated income check process when:

• 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 for a Medical Program.
• A person in the MAGI household is included in a SNAP or TANF budget group.

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

• Deny SNAP and TANF benefits for the following data sources:
  • quarterly wage data from the TWC; or
  • New Hire Report data from the Office of the Attorney General (OAG).
• Create a task to notify 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 Social Security Administration (SSA); or
  • unearned unemployment data from TWC.

Note: Unearned RSDI data from SSA, or unearned unemployment data from TWC are valid forms of verifications for SNAP and TANF. Since quarterly wage data from TWC and New Hire Report data from OAG are not valid sources of verification for SNAP and TANF, the person must provide verification of the income.

Related Policy

Medicaid Termination, A-825
Advance Notice, A-2343
Actions on Changes, B-631
Employer New Hire Report (ENHR) and National Directory of New Hires (NDNH) Report, C-825.12
Texas Workforce Commission (TWC) Wages/Benefits, C-825.13
Expedited CHIP Enrollment, D-1711

B-638 Returned Mail

Revision 24-3; Effective July 1, 2024

All Programs

Staff must take the following action when returned mail is received:

If the case includes an active SNAP EDG:

1. Review the address shown on the returned mail, the case record, and the State Portal to determine if the household has reported a new address. If a new address was reported, process the address change and any related changes in shelter expenses. Otherwise, go to Step 2.
2. If the new address was not reported and a forwarding address was not provided, make one attempt to contact the household by phone to confirm the address and document the attempt. If able to contact the household and the household provides a new address, process the change and any related changes in shelter expenses. Otherwise, go to Step 3.
3. If the returned mail is a SNAP redetermination packet and there are no other active EDGs, document these facts in Texas Integrated Eligibility Redesign System (TIERS) Case Comments and take no further action. Otherwise, go to Step 4.
4. If unable to contact an SR 1 or SR 2 household by phone to get an updated address, document the returned mail in the case record and verify the household’s address and any change in shelter expenses at the next redetermination. If unable to contact an SR 3 household by phone to get an update on their address, send Form H1020, Request for Information or Action (PDF), to the TIERS address to request verification of address and any change in shelter expenses.
5. If the returned mail shows a new out-of-state address for the SR3 household, send Form H1020 to request additional verification of physical address, residency, and duplicate participation.
6. If the SR 3 household fails to provide the requested information on Form H1020, send Form TF0001, Notice of Case Action, and deny the household for failure to provide information.
7. If the SR 3 household is denied for failure to provide information and provides a correct address within the advance notice of adverse action period, reopen the EDG using the original certification period and process any related changes in shelter expenses.

If the case does not include an active SNAP EDG:

1. Review the address on the returned mail, the case record, and the State Portal to determine if the household has reported a new address. If a new address has been reported, process the address change. Otherwise, go to Step 2.
2. If a new address has not been reported and a forwarding address was not provided, make one attempt to contact the household by phone to get an update on their address and document the attempt. If the household provides a new address, process the change. Otherwise, go to Step 3.
3. If unable to contact the household by phone to get an updated address, send Form TF0001 and deny the EDG for being unable to locate.

Related Policy

Form TF0001 Required (Adequate Notice), A-2344.1
Actions on Changes, B-631
Returned Mail, E-2221
Returned Mail, M-2221