C-1470, Eligibility Environments

C—1470 Eligibility Environments

Revision 15-4; Effective October 1, 2015

All Programs

Texas Works serves applicants and recipients in Texas through a variety of eligibility environments. The following is a brief summary of each type.

Local eligibility offices: HHSC staff conduct business in a face-to-face environment with people seeking information or applying for health and human services programs. Interviewing tasks are performed at the local eligibility office either in person or by telephone.

The eligibility staff in local offices provide information and application assistance, receive applications, perform Data Broker and other third-party inquiries, collect data, assess missing information, determine eligibility, issue benefits, and perform other tasks associated with eligibility services operations. Work is processed by eligibility staff in local offices in TIERS. Individuals are assigned to specific offices and a single eligibility worker processes an EDG until it is disposed as approved or denied.

Eligibility staff in a local office process multiple types of assistance: SNAP, Medicaid, CHIP, and TANF. Eligibility staff in the offices work all types of EDGs/cases; however, some offices may have specialized staff based on workload. Clerical staff handle front desk and lobby-area tasks, telephones, mail, faxes, scheduling and other support duties.

Vendor staff creates and routes tasks for applications received via mail or fax to staff in the local eligibility offices or changes received via telephone, mail or fax to staff in the Customer Care Centers (CCCs). The vendor may register a new application or reschedule an appointment, then route the interviewing tasks to local eligibility offices. Applications, redeterminations and changes submitted online through YourTexasBenefits.com are routed to the appropriate areas by the State Portal.

Centralized units: These units are able to specialize in certain programs or tasks and conduct eligibility work through the mail and by telephone without face-to-face contact. The centralized units help balance the workload of local eligibility offices. In a centralized unit, tasks are assigned based on due dates. Centralized functions have centralized mail, centralized telephone systems and do not require lobby space as eligibility offices do. Centers also have staff to answer telephones and provide status information, in addition to the staff working the cases.

 

C—1471 Specialized and Centralized Casework Units

Revision 18-1; Effective January 1, 2018

The following chart details various specialized and centralized casework units.

Centralized Units That Serve Both Texas Works (TW) Programs and Medicaid for the Elderly and People with Disabilities (MEPD) Programs

Unit Name Description
Centralized Representation Unit (CRU) The CRU files appeal requests and assembles EDG information in preparation for hearings for TIERS cases. The CRU represents the agency at fair hearings and implements all decisions for EDGs statewide. Members of this unit are housed across the state in local eligibility offices. HHSC created the unit in September 2007, and the unit initially processed EDG actions resulting from TIERS fair hearings for both Texas Works and MEPD. More details are available in the Eligibility Services State Processes document. Staff must file all appeal requests using the Hearings and Appeal — Create Appeal functionality in TIERS, accessed through the left navigation menu. Form H4800, Fair Hearing Request Summary, which is sent directly to the hearings division, will be returned to staff with instructions to enter the information in TIERS.
Customer Care Centers (CCCs) The CCCs are located in Athens, Austin, El Paso, Houston and San Antonio. State staff, along with vendor staff, conduct business using the 2-1-1 Texas telephone system. CCC staff handle inquiries and concerns that vendor staff cannot resolve. The vendor creates tasks and routes non-interview changes received via telephone, mail, fax or the Self-Service Portal to state staff in the CCCs. The CCCs are supported by TIERS and by Eligibility Supporting Technologies, such as the Task List Manager and the State Portal. CCC state staff perform Data Broker and other third-party inquiries, collect data, assess missing information, determine eligibility, issue benefits, process individual- and agency-generated changes, perform other non-interview tasks, and process six-month income check task. CCC performs these functions, as applicable, for TW and MEPD.

The CCC operates Monday to Friday from 8 a.m. to 6 p.m. Central time (excluding state holidays).

Below are some helpful toll-free numbers:
  • 800-645-7164 — CHIP provider toll-free telephone line
  • 877-543-7669 (877-KIDS-NOW) — CHIP and Children’s Medicaid toll-free telephone line
  • 800-735-2988 or 7-1-1 — TDD/TTY users (Relay Texas)

Effective Jan. 15, 2013, HHSC centralized the clearance of Income Eligibility and Verification System (IEVS) Internal Revenue Service (IRS) data matches for TW and MEPD. Data matches that OIG identifies for each program are processed by CCC staff.

HHSC set up CCCs with the Integrated Eligibility and Enrollment pilot rollout in January 2006.

Assistance Response Team (ART) ART staff housed throughout the state serve as on-site support to regional staff. These state staff offer TIERS technical support for Texas Works and MEPD on-the-job trainings (OJT), conduct clerical OJTs, offer TIERS technical support to eligibility staff (offer pre-ticket support to all regions to mitigate unneeded tickets), process Texas Works cases based on MEPD email box referrals and Health Insurance Portability and Accountability Act of 1996 (HIPAA) referrals for all regions, and assist State Office Data Integrity with merging assignments. HHSC set up ART with the Integrated Eligibility and Enrollment pilot rollout in January 2006.

Centralized Units That Serve Only MEPD Programs

Unit Name Description

MEPD

HHSC created a special statewide eligibility unit in January 2007 to process eligibility for MEPD programs. Statewide staff specialize in MEPD eligibility programs to help make sure MEPD casework is evenly distributed. Members of this unit are housed across the state in local eligibility offices.

Centralized Units That Serve Only Texas Works Programs

Unit Name Description
Centralized Benefit Services (CBS) Staff in this centralized Austin location process SNAP EDGs for households in which all members get Supplemental Security Income (SSI), using specialized automation that supports the modified eligibility requirements for these households. In addition, the unit also processes applications and redeterminations for:
  • SNAP Combined Application Project (SNAP-CAP) EDGs;
  • Medicaid for Breast and Cervical Cancer (MBCC);
  • Medicaid for children under the jurisdiction of the juvenile court and for youth under age 19 in non-secure facilities;
  • Medicaid for Transitioning Foster Care Youth (MTFCY);
  • Former Foster Care Children (FFCC); and
  • Medicaid for inmates of a public institution;
and applications for:
  • Former Foster Care in Higher Education (FFCHE) health care benefits program.
Appointed staff process Medicaid requests for babies who are born to mothers incarcerated in Texas. Most babies receive ongoing Medicaid, but factors such as with whom the baby will reside or if the baby will remain in Texas may affect eligibility.

When the baby cannot be certified for ongoing newborn Medicaid, the EDG is referred to Data Integrity to add coverage for the birth of the baby under a state-paid medical program.
Children's Medicaid Center (CMC) Centralized CMCs process applications and/or renewals for Children's Medicaid and CHIP, but do not process other associated-program case actions, to ensure a streamlined, timely approach. The CMCs are located in regions across the state:
  • Region 3 (Dallas Metroplex)
  • Region 6 (Houston)
  • Region 8 (San Antonio)
  • Region 11 (Rio Grande Valley)
Currently, Regions 3, 6 and 8 have CMCs to process applications and renewals for Children's Medicaid and CHIP for their respective regions.
Region 8 Central Processing Unit Staff in this centralized Region 8 location process applications and redeterminations for all SNAP-interviewed applications from the Community Partners Interviewer (CPI) Project. This single regional structure simplifies reporting and data gathering; centralizes EBT activities under one EBT coordinator, which streamlines record keeping and adds integrity to the EBT accounting and audit functions; adds efficiency to training activities since there is one location for staff; and enhances accountability as all regional activities will be under one management structure.

The five CPI project food banks as of June 2011 were:
  • Houston Food Bank
  • North Texas Food Bank
  • San Antonio Food Bank
  • Tarrant Area Food Bank
  • South Plains Food Bank (limited to six counties in Region 1 — Bailey, Crosby, Floyd, Hockley, Lamb and Lubbock)
Healthy Texas Women (HTW) This center, located in San Antonio, processes statewide HTW applications, changes and renewals. The HTW center also process Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification, for CHIP perinatal mothers.