C-1450, Guidelines for Clearing Quality Control (QC) Findings

Allow advance notice of adverse action and deny only the EDG for which Form H1025 was received. Do not deny associated EDGs. (See A-2343, Advance Notice.) Call the Texas Integrated Eligibility Redesign System (TIERS) helpdesk before disposing the denied EDG to ensure only the appropriate EDG is denied.

Notes:

• Refusal to cooperate with QC does not affect Medicaid.
• The Temporary Assistance for Needy Families (TANF) denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF EDG for refusal to cooperate with QC. (Refer to policy in A-1324.18, Temporary Assistance for Needy Families (TANF).)

When the EDG is denied for any other reason before the time Form H1025 is received (for example, the person failed to return pending information and the EDG is denied effective Sept. 30, the QC review month was September, and Form H1025 is received in October), continue to send Form TF0001 to the household notifying them of the penalty for refusal to cooperate with the QC review..

When the individual reports after they move out of state or it is determined by QC, deny the EDG following A-2344.2, No Form TF0001 Required.

Adjust/deny any other EDGs in which the individual/household members are included.

If, as of the date the EDG is selected for QC sampling, the EDG meets one of the following:

• has been referred for investigation to the state's fraud investigation unit, and the investigation is scheduled to begin within five months of sampling;
• is under active fraud investigation; or
• has a pending administrative or judicial IPV hearing,

the IPV EDG is not subject to review.

When Form H1025 does not indicate that returned mail has been received but that the individual has not been located, advisors must send Form TF0001 to deny for unable to locate allowing advance notice of adverse action. (See A-2343, Advance Notice.)

Adjust/deny any other EDGs in which the individual/household members are included.

Adjust/deny any other EDGs in which the individual/household members are included.

The child(ren) may be certified as independent children on appropriate Medicaid EDGs (see A-241.1, Who Is Included) or they may be determined eligible in a new TANF household when all other eligibility requirements are met.

Allow advance notice of adverse action and deny only the EDG for which Form H1025 was received. Do not deny associated EDGs. (See A-2343, Advance Notice.)

Notes:

• Refusal to cooperate with QC does not affect Medicaid.
• The TANF denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF EDG for refusal to cooperate with QC. (Refer to policy in A-1324.18, Temporary Assistance for Needy Families (TANF).)

Refer all instances of SNAP over issuance identified during the QC review process to the Office of Inspector General (OIG), regardless of the dollar amount. (See policy in B-720, When to File an Overpayment Referral, prior to sending the referral to OIG.)

Adjust the EDG accordingly (See B-800, Restored Benefits) and issue supplemental benefits for the current month if the person is currently eligible.

Note: Consider all reported changes when determining the amount of supplemental or restored benefits. The dollar amount listed is not necessarily the amount of the underpayment.

Adjust or deny any other EDGs in which the person or household members are included.

Adjust the EDG accordingly and enter the overpayment referral in TIERS.

Note: Consider all reported changes when determining the amount of the overpayment claim, including changes reported to QC during the exclusionary period and any other information listed by QC as “information only.” The dollar amount listed is not necessarily the amount of the overpayment.

Adjust or deny any other EDGs in which the person or household members are included.

Adjust the EDG accordingly. (See B-800, Restored Benefits.)

Issue supplemental benefits for the current month if the person is currently eligible.

For agency errors only, issue restored benefits for past months regardless of whether the person is currently eligible. Do not restore benefits for unreported changes or household errors.

Note: Consider all reported changes when determining the amount of supplemental or restored benefits. The dollar amount listed is not necessarily the amount of the underissuance.

Adjust or deny any other EDGs in which the person or household members are included.

Adjust the EDG accordingly and enter the overissuance referral in TIERS. Refer all SNAP overissuances identified during the QC review process to OIG, regardless of the dollar amount. (See policy in B-720, When to File an Overpayment Referral, prior to sending the referral to OIG.)

Note: Consider all reported changes when determining the amount of the overissuance claim, including changes reported to QC during the exclusionary period and any other information listed by QC as “information only.” The dollar amount listed is not necessarily the amount of the overissuance.

Adjust or deny any other EDGs in which the person or household members are included.

Do not disqualify other adults or children who were members of the original penalized household when they apply with or enter another household and the penalized individual(s) is not applying with or entering the new household with them.