W-1900, Case Disposition

Body

Revision 21-3; Effective July 1, 2021

 

W—1910 Notice to Applicants

Revision 21-3; Effective July 1, 2021

 

Case disposition is the woman’s notice of eligibility status. At the end of the interview or during the processing of the woman’s application, give her one or more of the following notices as appropriate. If the case is:

  • pended;
  • certified;
  • sustained; or
  • denied.

Form H1020, Request for Information or Action, which informs the woman of the:

  • reason the case is pending;
  • action she or HHSC staff must take;
  • date by which she or HHSC staff must take action; and
  • date staff must deny the application or case if she does not take action, if applicable; or

Form TF0001, Notice of Case Action, which informs the woman of the:

  • date benefits begin;
  • date of denial;
  • right to appeal; and
  • address and phone number of free legal services available in the area.

Women who transition to Healthy Texas Women (HTW) from another Medicaid program or the Children’s Health Insurance Program (CHIP) receive Form H1872, HTW Opting Out and Reporting Confidential Address, along with Form TF0001. The Form H1872 informs the woman of the:

  • options to voluntary withdraw from HTW; and
  • process to report a confidential address.

HTW recipients turning 18 years old receive Form H1871, HTW Client Turning 18 Years Old, ten days prior to their 18th birthday. This informs the woman of:

  • the process to report a confidential address; and
  • their responsibility to manage their HTW benefits.

Note: For women who only speak Spanish, ensure that all comments provided are in Spanish.

 

 

W—1920 Eligibility Begin Dates

Revision 21-3; Effective July 1, 2021

 

The applicant is eligible the first day of the file date month or, if ineligible the month of application for certain reasons, the first day of the month following the month of application.

Women who transition into HTW from another Medicaid program or CHIP have an effective date of the first day of the month following the end of their previous certification period.

Example: If the TP 40, Medicaid for Pregnant Women, certification end date is Sept. 30, then the HTW effective date is Oct. 1.

A woman is ineligible to receive HTW benefits if she applies the month after her 45th birthday.

Related Policy

Current Medicaid, Medicare (Part A or B) and Children's Health Insurance Program (CHIP) Recipients, W-911

 

W—1930 Length of Certification

Revision 17-2; Effective April 1, 2017

 

The Texas Integrated Eligibility Redesign System (TIERS) calculates an end date from the date the advisor certifies the application/renewal as follows:

  • Applications — initial certification month plus 11 months.
  • Renewals — 12 months from the last certification month.

Women are continuously eligible for Healthy Texas Women benefits for 12 months or through the month of the woman's 45th birthday, whichever is earlier.

Exception: A woman does not receive her 12 months of continuous eligibility if she:

  • is found eligible for Medicaid, Medicare (Part A or B) or the Children's Health Insurance Program;
  • dies;
  • voluntarily withdraws; or
  • moves out of Texas.

 

W—1940 Setting Special Reviews

Revision 07-0; Effective July 1, 2007

Do not set a special review even if a known change is to occur during the woman's 12-month continuous eligibility period. Document the known change and use the information at the next renewal. Follow current procedures and report the known change if the applicant has other active Eligibility Determination Group cases.

 

W—1950 Adverse Action

Revision 15-4; Effective October 1, 2015

 

Any household receiving a notice of adverse action has the right to request a fair hearing. In some situations, households may continue benefits pending an appeal. After certification, give households advance notice of adverse actions to deny benefits except for reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice), and A-2344.2, No Form TF0001 Required.

For adverse action, use current policy in A-2340, Adverse Action.