Revision 21-2; Effective April 1, 2021

 

 

D—1410 General Policy

Revision 20-4; Effective October 1, 2020

 

CHIP and CHIP Perinatal

Changes are situations in a household that may affect eligibility. Action must be taken on reported changes to ensure program integrity.

Cost share adjustments are handled by the Enrollment Broker at application, redetermination and the six-month income check.

When a change is processed that is missing required information, send Form H1020, Request for Information or Action, within one business day from the report date. Allow 10 full days to provide the requested information or verification. Action must be taken on the change within one business day of receipt of the missing information.

 

 

D—1420 Reporting Requirements

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

Households must report the following changes to:

  • address;
  • intent to reside in Texas;
  • the individuals living in the home;
  • income, including sources of income, regular hours worked, and pay rate;  
  • Modified Adjusted Gross Income (MAGI) expenses;
  • pregnancy termination;
  • a child being institutionalized or dying; and
  • medical insurance coverage.

Exceptions: A child is disenrolled if the child reapplies and becomes eligible for Medicaid or at the end of the month of the child’s 19th birthday.

Process all other changes, including agency-generated changes, at the time of report.

 

 

D—1421 How to Report

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

Persons with case authority may report changes by one of the following means:

  • online through YourTexasBenefits.com;
  • in person at a Texas Health and Human Services Commission Benefits Office;
  • telephone;
  • mail;
  • fax;
  • Form H1019, Report of Change, and;
  • signed Form H1028, Employment Verification.

A person with case authority is an individual who has the authority to apply on the child’s behalf, as explained in A-121, Receipt of Application, for Medical Programs.

 

 

D—1422 Receipts for Reported Changes

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

Households may request a receipt to acknowledge the change report. The receipt includes the type of change(s) and the date reported. If an individual requests a receipt, issue Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change.

 

 

D—1430 Processing Requirements

Revision 08-1; Effective January 1, 2008

 

 

 

 

D—1431 Address Change Processing

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

The case address is updated when the household reports an address change.

If the household reports a change of address, the individual is mailed Form H0025, HHSC Application for Voter Registration, to register to vote based on the new address. If the individual declines the opportunity to register to vote after receipt of Form H0025, mail Form H1350, Opportunity to Register to Vote, to the individual for their signature. Send Form H1350 for imaging when the individual returns Form and retain Form for at least 22 months.

Related Policy
Registering to Vote, A-1521

 

 

D—1432 Moves

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

For moves within Texas, the case is updated to reflect the newly reported address.

For moves outside of Texas, the case is updated to reflect the:

  • temporary address, if the move is temporary.
  • address and disenrolls the child as soon as possible, if the move is permanent.

 

 

D—1433 Household Composition Changes

Revision 15-4; Effective October 1, 2015

 

CHIP Perinatal

No action is taken on a request to add or remove a non-certified person from an existing perinatal Eligibility Determination Group (EDG).

 

 

D—1433.1 Adding a New Child

Revision 21-2; Effective April 1, 2021

 

CHIP, CHIP Perinatal

A separate application is required to start benefits for a new child being added if there is not an existing Medicaid or Children's Health Insurance Program (CHIP) EDG on the case. A separate application is also required if a household requests benefits for a sibling of a child released from a juvenile facility whose TP 44 eligibility is reinstated to a denied or newly created case.

CHIP

When a household reports a new child in the household, determine if the new child and other children in the household that are certified for CHIP meet Medicaid eligibility criteria. Certify the children for Medicaid if they are eligible. A new application is not required. Note: When a household reports a new child in the household, determine if the new child and other children in the household that are certified for CHIP meet Medicaid eligibility criteria. Certify the children for Medicaid if they are eligible. A new application is not required. 

Note: If the Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) reports via the TJJD/JPD Released Logical Unit of Work that a child was released from a juvenile facility and is now living in the household, TIERS automatically tests the child's eligibility for Medicaid. 

If the new child is ineligible for Medicaid but eligible for CHIP and has siblings or a parent currently enrolled in the program, they are considered to meet good cause. TIERS calculates the new child's effective date of coverage for the next possible month following cutoff. The new child will receive the remaining months of coverage with the siblings or parent. The coverage end date is the same date as the child's currently enrolled siblings or parent. The new child may not receive the full 12 months of coverage and is required to renew coverage along with the child’s siblings or parent on the scheduled renewal date.

Once the new child is determined eligible for CHIP, TIERS notifies the Enrollment Broker via an interface. The Enrollment Broker generates and mails a welcome letter to the household.

CHIP Perinatal

Income Above the Limit for Medicaid for Pregnant Women (TP 40)

A child born to a CHIP perinatal mother whose household income is above 198 percent of the federal poverty level (FPL), which is the applicable income limit for Pregnant Women Medicaid (TP 40), will have an effective date beginning with the date of birth and continuing through the remainder of the 12-month CHIP perinatal enrollment segment. The mother's perinatal coverage ends the last day of the child's birth month or the pregnancy's termination month. The mother will receive two postpartum visits even if they are beyond the birth month.

Example: A pregnant mother is approved for CHIP perinatal effective June 1. The child is born on Oct. 4. The newborn's effective date of coverage is Oct. 4, and the end date is May 30. The mother's perinatal coverage ends Oct. 31.

A perinatal child whose coverage ends, and who has siblings currently enrolled in CHIP, meets good cause upon determination of CHIP eligibility. The child's enrollment start date is the first day of the month following the perinatal end date. The child's CHIP end date is the end date of the existing CHIP enrollment segment. The child may not receive the 12 months of CHIP coverage and must renew eligibility in accordance with the existing CHIP redetermination date.

Income at or Below the Limit for Medicaid for Pregnant Women (TP 40)

A child born to a CHIP perinatal mother whose household income is at or below 198 percent of the FPL, which is the applicable income limit for Pregnant Women Medicaid (TP 40) and who receives Emergency Medicaid to cover the labor with delivery charges will be enrolled in TP 45 coverage effective the date of birth. The mother's perinatal coverage ends the last day of the child's birth month or the pregnancy's termination month. The mother will receive two postpartum visits even if they are beyond the birth month.  

Related Policy
Receipt of Application, A-121
CHIP Perinatal Application Process, A-128.3
Neonatal Intensive Care Unit (NICU) Newborn Process, A-126.3.1
Federal Poverty Level (FPL), C-131.1

 

 

D—1433.2 Child Leaves the Home

Revision 20-4; Effective October 1, 2020

 

CHIP

Under MAGI household composition rules, explained in A-240, Medical Programs, a certified child leaving the home may or may not affect their continued eligibility for CHIP based on their tax status, tax relationships, and family relationships.

When a child dies, terminate the child’s eligibility effective the last day of the month the child died.

Follow policy in B-510, Termination of Medical Coverage for People Confined in a Public Institution, if the child is confined in any public institution, including a juvenile facility.

Related Policy
Termination of Medical Coverage for People Confined in a Public Institution, B-510
Persons Confined in a Texas County Jail, B-542
Child Placed in a Juvenile Facility, B-543

 

 

D—1433.3 Child Institutionalized

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

When a certified child enters a state hospital or institution for a temporary absence, the child remains enrolled for the remainder of the 12-month period. See A-920, Temporary Absence From the Home, to determine if stay is considered a temporary absence.

 

 

D—1433.4 Head of Household

Revision 20-1; Effective January 1, 2020

 

CHIP, CHIP Perinatal

Under MAGI household composition rules, explained in A-240, Medical Programs, a head of household leaving the home may or may not affect eligibility depending on that person’s tax status, tax relationships, and family relationships.

When the current head of household dies or leaves the home, change the head of household to another responsible adult household member without requiring the remaining household members to reapply for benefits. An adult household member is someone 19 years or older.

If there is no responsible adult member identified in the household, and a child in the household is receiving benefits, send Form H1020 to notify the household that a responsible adult who is caring for the child must apply for benefits if the child continues to need assistance. If an application is not submitted by the Form H1020 due date, deny benefits since the whereabouts of the child is unknown.

Related Policy
Who Is Included, D-321
New Head of Household, D-1632.1

 

 

D—1434 Demographic Changes

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

A demographic change is a change to a person's identifying information, such as date of birth, Social Security number (SSN), gender or name.

Process these changes and do not interrupt the child’s continuous coverage.

 

 

D—1435 Pregnancy Reports

Revision 15-4; Effective October 1, 2015

 

CHIP

When a household reports a CHIP child's pregnancy before her CHIP end date, the child is tested for Pregnant Women Medicaid (TP 40) and verification of the pregnancy is requested. A verbal or written statement of pregnancy from the pregnant child, case name or authorized representative that includes the pregnancy start month, number of children expected and the anticipated date of delivery is an acceptable verification source. If potentially eligible and the household provides the pregnancy verification, the child is terminated from CHIP and certified for Medicaid.

If the pregnant child is determined ineligible for Pregnant Women Medicaid (TP 40), she remains in CHIP up to two months beyond the original CHIP end date if the pregnancy due date is in the 11th or 12th month of her CHIP coverage, unless the:

  • pregnant child reports pregnancy termination,
  • household reports she has other insurance,
  • pregnant child no longer lives in Texas, or
  • pregnant child turns age 19.

Before the pregnancy ends, extend coverage for:

  • one month if the pregnancy due date is in the 11th month of the CHIP certification; or
  • two months if the pregnancy due date is in the 12th month of the CHIP certification.

If the household does not report a CHIP child’s pregnancy until she gives birth or later, the child remains in CHIP, and the CHIP child’s newborn is tested for Medicaid eligibility. If eligible, the newborn is certified for Children Under Age One Medicaid (TP 43). If not eligible, the newborn is enrolled in the mother’s CHIP health plan. The effective date of CHIP coverage is the next possible month following cutoff. The newborn’s CHIP coverage ends with the household’s current enrollment segment.

Related Policy
Adding a New Child, D-1433.1

 

 

D—1436 Income and Deduction Changes

Revision 21-2; Effective April 1, 2021

 

CHIP

When a household reports a change in income, test the child or children for Medicaid eligibility. A new application is not required. If the child is still eligible for CHIP and the household requests that its cost share responsibilities be recalculated, refer the household to the Enrollment Broker. 

 

 

D—1437 Third Party Resources Changes

Revision 15-4; Effective October 1, 2015

 

CHIP

If a household reports that they have obtained health insurance during the continuous enrollment period, document the change and process the change at the next redetermination.

Related Policy
Health Insurance, D-1632.2

CHIP Perinatal

Do not take any action if a woman reports private health insurance coverage during her certification period.