E—2161 How to Process a Renewal

Revision 15-4; Effective October 1, 2015

FFCC completes an administrative renewal process. An administrative renewal is initiated by the system and requires no advisor action. The administrative renewal process uses the automated renewal process, explained in E-2161.1, Automated Renewal Process, to gather information from a client’s existing case and from electronic data sources to determine whether the client remains potentially eligible for Medical Programs.

E—2161.1 Automated Renewal Process

Revision 15-4; Effective October 1, 2015

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.

E—2161.1.1 Verifications Required for Renewals

Revision 15-4; Effective October 1, 2015

During the automated renewal process, the system verifies:

  • Residency
  • Immigration status

E—2161.1.2 Eligibility Outcomes

Revision 15-4; Effective October 1, 2015

Once available verifications are assessed during the automated renewal process, 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 and no additional verification is needed from the 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 - FFCC, if the information on the renewal form is incorrect or there are changes to the client’s case.
Additional Information Needed
  • All required eligibility information cannot be verified during the automated renewal process and additional verification is needed from the client.
  • The client must return a signed renewal form, Form H1206-FFCC, and all requested verification(s).

E—2161.1.3 Renewal Correspondence

Revision 15-4; Effective October 1, 2015

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 Outcomes 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 - FFCC.
  • The client is only required to return a signed renewal form, Form H1206 - FFCC, 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.
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, Form H1206 - FFCC; and
    • Required verification(s).
  • Form H1020 identifies all the required verification(s) needed to complete the renewal and a statement that the signed renewal form is required.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206 - FFCC.

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 or the denial reason for not recertifying the case.

E—2161.2 Processing a Manual Renewal

Revision 20-4; Effective October 1, 2020

If a person is required to return a renewal form and returns a paper Form H1206, Health Care Benefits Renewal - FFCC, the form is routed to CBS for processing. If an FFCC renewal is submitted to a local office, it may be processed by the local office advisor but only CBS staff may dispose the FFCC EDG. If an FFCC renewal needs to be disposed, a Task List Manager (TLM) task will be generated for CBS instructing them to dispose the renewal.

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

  • Form H1206, Health Care Benefits Renewal - FFCC
  • Form H1010-R, Your Texas Works 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 12th month of the certification period, whichever is later.

When an acceptable FFCC renewal form is received, review the information provided and determine if the case needs to be updated to reflect the most recent information reported by the person on the form.

Only request information and verification needed to determine eligibility from the person 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 if there is any verification that can be used before requesting verification from the person. Allow the household at least 10 days to provide missing information. The due date must fall on a workday.

E—2161.2.1 When a Renewal Form Is Not Returned

Revision 15-4; Effective October 1, 2015

When an acceptable FFCC renewal form 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 CBS 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.

E—2161.2.2 Information or Renewal Form Returned After Termination

Revision 15-4; Effective October 1, 2015

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 benefit month, CBS staff must reopen the EDG. The date the information or verification is provided is the new file date.

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 FFCC renewal form.

Note: 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 EDG and process as a renewal.