B-630, Processing Requirements

Revision 05-5; Effective October 1, 2005

 

B—631 Actions on Changes

Revision 20-4; Effective October 1, 2020

All Programs

Customer Care Center (CCC) staff is responsible for processing most client-reported changes.

Upon receipt of a change report in the local office:

  • Accept the change.
  • Date stamp the written change report.
  • Enter the change into the State Portal — Report a TIERS Change portlet if the change is received without verification and verification is required.
  • Complete an MI/Change Routing Cover Sheet and fax the change to the vendor at 877-236-4123 if the change is received with verification. Do not enter the information in the State Portal — Report a TIERS Change portlet.

Note: Provide Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change, upon request.

To reduce the potential for quality control (QC) errors when the household reports a change in person or by phone, attempt to collect enough information to determine if the change will decrease benefits. For new or increased income, this includes the following information:

  • date of the change;
  • date of the first payment;
  • source of the income;
  • expected pay amounts (or weekly hours and rate of pay for earnings); and
  • pay frequency.

Note: Do not verify income if the amount reported makes the household ineligible.

Provide the household with Form H1020, Request for Information or Action, and Form H1020-A, Sources of Proof, on the day of the report (no later than the next workday) if more information or verification is required to complete the change action. The household is allowed 10 full days to provide the requested information or verification.

Note: When a SNAP household reports a change during the last certification month, do not send the household Form H1020/Form H1020-A, if the effective date of the change is after the certification period expires. Send the change for imaging and address it with the person at the redetermination interview.

  • Document the:
    • reported change;
    • date the change occurred; and
    • date the change was reported.
  • Calculate the budget (if applicable).

Exception: Take the following steps when a person reports a change in annual or seasonal self-employment income or expenses during their certification period:

Step Yes No
  1. Does the current budget already include fluctuations as significant as the change reported?
 Stop — the change is part of the normal fluctuation of the business; do not rebudget. Re-evaluate, go to Step 2.
  1. Does the re-evaluation result in a change of more than $25 to the average monthly net self-employment income?
 Rebudget the EDG(s) using new average monthly net self-employment income. Stop — do not rebudget.

 

  • Send Form TF0001, Notice of Case Action:
    • Following policy in B-642, Changes Increasing Benefits (Other than Additions to the Household); B-642.1, Verification Provided Timely; and B-642.2, Verification Not Provided Timely, if benefits increase or remain the same.
    • Following policy in B-643, Changes Decreasing Benefits, if benefits decrease. See A-2343.1, How to Take Adverse Action if Advance Notice Is Required.
  • Provide the household with a new Form H1019, Report of Change, and a pre-paid envelope to report future changes.

The Texas Department of Family and Protective Services (DFPS) notifies HHSC through an interface when a child receiving TANF, Medicaid or SNAP has been placed in foster care. Mass Update is triggered, and the child is automatically removed from the EDG(s). If Mass Update fails because the case is not in ongoing mode, take action to remove the child from the EDG(s).

For this type of change, advance notice of adverse action is required for SNAP, but not for TANF or Medicaid.

The Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) notifies HHSC via the TJJD/JPD Placement Logical Unit of Work in the Texas Integrated Eligibility Redesign System (TIERS) when a child certified for Medicaid has been placed in a juvenile facility and when a child has been released. Follow policy in B-520, Medicaid Suspension, and B-546, Notification of Actual Release from a Juvenile Facility, regarding action taken on a case that includes a child placed in or released from a juvenile facility.  

Related Policy

Change in Medical Expenses During Certification, A-1428.4
How to Take Adverse Action if Advance Notice Is Required, A-2343.1
Adverse Actions Not Requiring Advance Notice, A-2344
Form TF0001 Required (Adequate Notice), A-2344.1
Information Received During Expedited Application Processing, B-116.1
Medicaid Suspension, B-520
Notification of Actual Release from a Juvenile Facility, B-546  
Changes Increasing Benefits (Other than Additions to the Household), B-642
Verification Provided Timely, B-642.1
Verification Not Provided Timely. B-642.2
Changes Decreasing Benefits, B-643

 

 

B—631.1 Multiple Changes

Revision 15-4; Effective October 1, 2015

All Programs

Multiple changes reported on the same day must be processed as one occurrence. If required, the advisor must send Form H1020, Request for Information or Action, with the corresponding pending period and list the verifications needed for all changes.

Multiple changes reported on different days must be processed as separate occurrences. If required, the advisor sends Form H1020 for each reported change with the corresponding pending period and lists only the verification needed for that change.

Each change could affect the benefits for different months. Advisors refer to B-640, Changes Affecting Benefits, to determine the correct month for each change.

Exception: All changes associated with an individual at the time the individual joins a household affects the benefits for the same month, even if the report of change is on a different day.

Example A – A household consists of a mother and son who receive SNAP, TANF and Medicaid (TP 08 for the mother and Children's Medicaid for the son). On January 10, the mother reports the birth of her daughter on January 4 and that she and the newborn went home from the hospital on January 6. The EDGs are pended for more information with a due date of January 20. The mother provides the requested information on January 20, reports she has gone to work, and provides verification of her new employer. She reports her first day of work was January 16 and that she is paid semimonthly. She will receive her first check January 30, and it is not a partial payment. The advisor must:

  • Add the newborn to the SNAP and TANF certified group effective February and request supplements for both programs;
  • Adjust the TANF benefit amount, counting the income effective for March benefits, since adverse action must first expire — apply the 90 percent earned income deduction if the mother is eligible; and
  • Adjust the SNAP budget to include the new TANF grant amount and the new earned income effective for March, since adverse action must first expire.

Example B – A household consists of a father, mother, and three children who receive SNAP and Children's Medicaid. The father is employed, and the mother receives Unemployment Insurance Benefits (UIB). On January 5, the mother reports that the father left the household on October 31 and that she received her last UIB check November 16. She also reports she started working December 3 and provides verification.

  • Remove the father from the household and terminate his income effective for February SNAP benefits.
  • Terminate the mother's UIB using either the Texas Workforce Commission inquiry system or the verification provided, effective for February SNAP benefits.
  • Add the mother's new income effective for February.
  • Children's Medicaid is continuously eligible for the first six months. The income change will be processed during a PIC, as explained in B-637, Periodic Income Checks.
  • There is no overissuance because this is a streamlined reporting household.

Example C – On March 7, the household in Example B reports that the mother's sister has moved in, and the sister wants to be added to the SNAP EDG. The EDG is pended for the sister's Social Security number (SSN) with a due date of March 17. The sister provides a current pay stub from her employer that includes her SSN on March 17. On the same day, the SNAP EDG is pended again for verification of income that was not previously reported, with a new due date of March 27. On March 25, the sister provides Form H1028, Employment Verification, that states she has worked for her employer for one year and includes all other needed information.

  • The sister is not added to the certified group for April SNAP benefits. Advance notice of adverse action for the addition of the sister's income will not expire in March.
  • The sister is added to the certified group and her income counts, effective for May benefits.

 

 

B—631.2 Actions on Office of Inspector General (OIG) Match Action Alert Changes

Revision 19-4; Effective October 1, 2019

All Programs

OIG staff help with clearing computer matches for the following reports:

  • Public Assistance Reporting Information System (PARIS) Interstate Matches;
  • Texas Department of Criminal Justice (TDCJ);
  • Social Security Administration Prisoner Verification System (PVS);
  • Income and Eligibility Verification Systems (IEVS); and
  • Social Security Administration (SSA) Deceased Individual Report.

PARIS Interstate Matches

When OIG staff receive an Interstate Match through PARIS that shows a person on an active TIERS EDG is receiving benefits in another state, OIG informs HHSC staff by creating a task within the Task List Manager (TLM). Take the appropriate action to process the task based on the information provided by OIG.

TDCJ and PVS Matches

When OIG staff find a match through TDCJ or PVS that shows a person on an active TIERS EDG is incarcerated, OIG informs HHSC staff by creating a task within TLM. Take the appropriate action to process the task based on the information provided by OIG.

When staff request a Data Broker report, TDCJ information is displayed on the combined report for an incarcerated person. See C-825.17, Inmate/Parolee Match, for staff instructions for processing Prisoner Matches viewed in Data Broker.

Income and Eligibility Verification Systems (IEVS)

The procedures for clearing IEVS reports are documented in C-1000, Procedures for Clearance of Income and Eligibility (IEVS) Reports and Internal Revenue (IRS) Federal Tax Information (FTI).

Date of Death Matches

TIERS matches recipients on active EDGs with records from the Office of Inspector General (OIG), Social Security Administration (SSA), Texas Bureau of Vital Statistics (BVS), the Centers for Medicaid and Medicare Services (CMS), and DADS Webservice to find deceased persons.

The BVS, if available is considered the primary source of verification of death.  If BVS is available but the date of death (DOD) does not match reported information, accept BVS as verification. No additional verification is required.

If BVS verification is not available, verify the DOD using two of the following sources:

  • Social Security Administration (SSA);
  • statement from guardian or authorized representative;
  • copy of death certificate;
  • statement from a doctor;
  • newspaper death notice (obituary);
  • statement from a relative or household member;
  • statement from a funeral director; or
  • records from hospital or other institution where the person died.

TIERS attempts to update the DOD information for all active and inactive persons and automatically removes them from active EDGs. If unable to process the death data automatically, TIERS creates a task for staff to research and confirm the validity of the computer match.

Take action to clear any discrepancies when DOD data is received on an active or inactive person within TIERS and TIERS is unable to automatically dispose the case. When TIERS cannot dispose the case, a series of alerts are created for staff to explore and request additional verification.

To clear discrepancies, gather additional verification on the DOD data received. Do not require the household to provide the verification if the verification is available through one of the sources listed above.

Related Policy:

Verification Sources, A-1081
Inmate/Parolee Match, C-825.17
Procedures for Clearance of Income & Eligibility IEVS, Reports & Internal Revenue IRS, Federal Tax Information FTI, C-1000

 

 

B—632 Mass Changes

Revision 15-4; Effective October 1, 2015

All Programs

The state or federal government initiates changes that can affect all individuals or large numbers of individuals. Individuals are not required to report mass changes. These changes occur in the:

  • income eligibility standards;
  • shelter and dependent care maximum deductions;
  • Thrifty Food Plan and standard deductions;
  • utility standard;
  • cost-of-living adjustments for Social Security, Supplemental Security Income (SSI) and other federal benefits;
  • TANF grants; and
  • other eligibility criteria based on legislative or regulatory actions.

When these changes occur, HHSC automatically adjusts eligibility or benefits for most individuals and notifies the households via Form TF0001, Notice of Case Action. The adjustments are effective the date of the change. Advisors do not send Form TF0001.

HHSC generates an exception report for EDGs that are not adjusted during the state office conversion. Advisors must review the EDGs, adjust benefits if necessary, and send the individual Form TF0001, allowing advance notice of adverse action if required.

 

 

B—633 Changes in Eligibility Test

Revision 15-4; Effective October 1, 2015

All Programs except TP 45

If a household's circumstances change and the household is subject to a new income/resource test, the advisor must determine eligibility by applying the new test when the change is reported.

 

 

B—634 Changes in SNAP EDGs Jointly Processed with Supplemental Security Income (SSI)

Revision 15-4; Effective October 1, 2015

SNAP

Individuals whose SNAP and SSI applications have been jointly processed must report changes like other SNAP individuals.

 

 

B—635 Shortening Certification Periods as a Result of a Change

Revision 15-4; Effective October 1, 2015

SNAP

In the following situations, the advisor may shorten a non-public assistance (NPA) SNAP certification period:

  • A change occurs that makes the case circumstances unstable, and the advisor cannot readily determine the effect of the change on the household's eligibility or benefits. This includes:
    • receipt of the discrepancy report Alert 254, Employer New Hire Data;
    • new listings of information on Data Broker that are inconsistent with information previously reported by the household; and
    • situations in which a public assistance household's TANF is denied for some administrative reason, such as missed appointment, voluntary withdrawal, or failure to provide information requested to redetermine TANF eligibility, and the individual's SNAP EDG becomes questionable.
  • The household's eligibility becomes questionable as described in special reviews for known changes. See B-125.1, Due Dates.

Exception: Do not shorten the certification period if the household is designated SR. The advisor must send Form H1020, Request for Information or Action, requesting specific verification. If the SR household does not provide the verification, the EDG is denied and the advisor sends Form TF0001, Notice of Case Action. See A-2330, Setting Special Reviews, to determine when to set a special review on SR EDGs.

Centralized Benefit Services (CBS) staff shorten certification periods when a household reports a change that results in the household being transferred out of CBS. See B-474.6.1, Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs).

In all of the situations where advisors may shorten an NPA SNAP certification period, the advisor must use the following procedures before shortening the certification period:

  • Send the household Form H1020 and list the specific verification needed to process the case. If the household responds, take appropriate action.
  • If the household fails to provide verification, deny the EDG using denial reason failure to provide information and send Form TF0001.
  • Send Form H1830, Application/Review/Expiration/Appointment Notice, and Form H1010, Texas Works Application for Assistance – Your Texas Benefits, to the household along with Form TF0001. Mark the first box on Form H1830 that begins, "Attached is an application for ..." and mark "SNAP." When the individual returns Form H1010, follow normal application time frames.

Related Policy

Data Broker, C-820
Questionable Information, C-920

 

 

B—636 Change in Head of Household (HOH)

Revision 21-4; Effective October 1, 2021

All Programs

When the current HOH dies or leaves the home, change the HOH to another responsible adult household member without requiring the remaining household members to reapply for benefits. If there are children in the household, a responsible adult household member is:

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

SNAP and TANF

If the HOH who left the home was the Electronic Benefit Transfer (EBT) primary cardholder (PCH), update the PCH information with the new HOH and issue a new Lone Star Card to allow the household access to SNAP and TANF benefits. Do not update the information if a new HOH has not been identified.

Related Policy

When to Send a PCH Record, B-231.1
Issuing a Lone Star Card, B-233

 

 

B—637 Periodic Income Checks

Revision 20-1; Effective January 1, 2020

TP 08, TP 43, TP 44 and TP 48

Initiating a PIC requires no staff action and uses the automated income check process to determine whether there has been a change in the household’s income that makes the household potentially ineligible for medical programs.

As part of the automated income check process, the household’s income information in the eligibility system is compared with income data available through electronic data sources (ELDS) to determine whether it is reasonably compatible, as explained in A-1370, Verification Requirements, Medical Programs.

The eligibility system may be able to complete the entire PIC process without any staff action or correspondence sent to the client if the PIC does not find an indication that there has been a change in the household’s income that makes them potentially ineligible.

Electronic income data is requested one month before the eligibility system uses it. If the household’s income is not determined to be reasonably compatible with electronic data, the household must provide other acceptable verification as explained in A-1371, Verification Sources.

Electronic Data Hierarchy for Earned Income

  1. TIERS checks electronic data from the Texas Workforce Commission (TWC).
  2. If earned income electronic data is not available, TIERS checks to see whether there is a New Hire Report. When a New Hire Report exists that does not match the household’s income information in TIERS, the household must provide verification of the information on the New Hire Report.

TIERS also checks SOLQ to verify RSDI income (unearned income).

Process verifications returned as the result of a PIC following B-631, Actions on Changes. If the person does not provide the requested verification by the 10th day, TIERS automatically sends Form TF0001 on the 11th day for failure to provide.

SNAP and TANF

Verification is required for SNAP and TANF during the automated income check process when:

  • The reasonable compatibility calculation result is “Need Info because ELDS above limit” or the person is required to provide verification of information found on a New Hire Report for a Medical Program.
  • A person in the MAGI household is included in a SNAP or TANF budget group.

The person has 10 days to provide the verification for SNAP and TANF. If the person does not provide verification by the 10th day, TIERS will automatically take the following action on the 11th day based on the income type and electronic data source used during the automated income verification process:

  • Deny SNAP and TANF benefits for the following data sources:
    • quarterly wage data from the TWC; or
    • New Hire Report data from the Office of the Attorney General (OAG).
  • Create a task to notify staff to adjust SNAP and TANF benefits for the following data sources:
    • unearned Retirement, Survivors, and Disability Insurance (RSDI) income data from the Social Security Administration (SSA); or
    • unearned unemployment data from TWC.

Note: Unearned RSDI data from SSA, or unearned unemployment data from TWC are valid forms of verifications for SNAP and TANF. Since quarterly wage data from TWC and New Hire Report data from OAG are not valid sources of verification for SNAP and TANF, the person must provide verification of the income.

TP 08

A PIC is initiated in months three through eight of the certification period when the following conditions are met:

  • Any of the following is true for at least one person in the MAGI household for at least one countable income or expense source:
    • an income or expense is not verified;
    • one of the following income types uses “Verified by Reasonable Compatibility” as the verification source:
      • employment income;
      • unemployment compensation income; or
      • RSDI income; or
    • The verification source is anything other than “Verified by Reasonable Compatibility” and the verification received date is more than 60 days old.
  • The case is in Approved Ongoing mode; and
  • There are no pending TLM tasks for the case.

TP 43, TP 44 and TP 48

A PIC is initiated in months five through eight of the certification period when the following conditions are met:

  • The person will not age out before or during the PIC review month;
  • Any of the following is true for at least one person in the MAGI household for at least one countable income or expense source:
    • an income or expense is not verified;
    • one of the following income types uses “Verified by Reasonable Compatibility” as the verification source:
      • employment income;
      • unemployment compensation income; or
      • RSDI Income; or
    • The verification source is anything other than “Verified by Reasonable Compatibility” and the verification received date is over 60 days old.
  • The case is in Approved Ongoing mode; and
  • There are no pending TLM tasks for the case.

The first time the result of a PIC could impact eligibility is the seventh month of the 12-month certification period because the first six months are continuous.

Exception: A PIC is not initiated when a TP 44 child released from placement in a juvenile facility is reinstated to a different household than the one in which they were residing at the time of their placement or is reinstated as an independent child.

When taking action on the result of a PIC due to excess income, a household may be eligible for expedited CHIP enrollment if the household:

  • is determined to be ineligible for Medicaid during the eligibility period but before the end of their certification period;
  • is determined eligible for Children's Health Insurance Program (CHIP); and
  • owes a CHIP enrollment fee.

An appeal and reactivation due to a change or PIC is an eligible case action for expedited CHIP enrollment.

Related Policy

Medicaid Termination, A-825
Advance Notice, A-2343
Actions on Changes, B-631
Employer New Hire Report (ENHR) and National Directory of New Hires (NDNH) Report, C-825.12
Texas Workforce Commission (TWC) Wages/Benefits, C-825.13
Expedited CHIP Enrollment, D-1711

 

 

B—638 Returned Mail

Revision 16-4; Effective October 1, 2016

All Programs

Advisors must take the following action when returned mail is received:

If the case includes an active SNAP EDG:

  1. Review the address indicated on the returned mail, the case record, and the State Portal to determine whether the household has reported a new address. If a new address was reported, process the address change and any related changes in shelter expenses. Otherwise, go to Step 2.
  2. If the new address was not reported and a forwarding address was not provided, make one attempt to contact the household via telephone to confirm the address and document the attempt. If able to contact the household and the household provides a new address, process the change and any related changes in shelter expenses. Otherwise, go to Step 3.
  3. If the returned mail is a SNAP redetermination packet and there are no other active EDGs, document these facts in Texas Integrated Eligibility Redesign System (TIERS) Case Comments and take no further action. Otherwise, go to Step 4.
  4. For households with:
    • no individuals receiving Retirement, Survivors, and Disability Insurance (RSDI) or Supplemental Security Insurance (SSI), go to Step 5; or
    • individuals receiving RSDI or SSI, use the State Online Query (SOLQ) to verify the household's address. If the address in SOLQ:
      • is different from the address in the TIERS case record, use the information in SOLQ to update the address and explore shelter expenses as necessary; and
      • matches the address in the TIERS record, document in TIERS Case Comments that the SOLQ inquiry address matches the TIERS address and take no further action. Otherwise, go to Step 5.
  5. If unable to contact the household via telephone to obtain an update on their address and no household member receives RSDI or SSI, send Form H1020, Request for Information or Action, to the TIERS address to request verification of address and any change in shelter expenses. To pend for address information:
    • in Change Action mode, go to "Individual Demographics";
    • edit the head of household's record;
    • change the effective begin date appropriately;
    • on the "Residency" page, select "not verified" from the residency verification drop down menu;
    • complete the Logical Unit of Work (LUW);
    • document all attempts to contact the household by telephone; and
    • run eligibility.
  6. If the household fails to provide information as requested on Form H1020, deny the household for failure to provide information. Send Form TF0001, Notice of Case Action, to deny the case using the denial reason "Failed to Provide Information."
  7. If the household is denied for failure to provide information and provides a correct address within the advance notice of adverse action period, reopen the EDG using the original certification period and process any related changes in shelter expenses. Please refer to the TIERS Advance Notice of Adverse Action Reference Guide in the ASK iT Knowledge Base for instructions.

If the case does not include an active SNAP EDG:

  1. Review the address on the returned mail, the case record, and the State Portal to determine whether the household has reported a new address. If a new address has been reported, process the address change. Otherwise, go to Step 2.
  2. If a new address has not been reported and a forwarding address was not provided, make one attempt to contact the household via telephone to obtain an update on their address and document the attempt. If the household provides a new address, process the change. Otherwise, go to Step 3.
  3. For households with individuals receiving RSDI or SSI, use SOLQ to verify the household's address. If the address in SOLQ is different from the address on file, use the address in SOLQ to update the address. If the address in SOLQ matches the address in the TIERS record, document in TIERS Case Comments that the SOLQ inquiry address matches the TIERS address and take no further action. Otherwise, go to Step 4.
  4. If unable to contact the household by telephone to obtain an updated address and no household member receives RSDI or SSI, use the following steps to deny the EDG using the denial reason “Unable to Locate” as stated in TWH A-2344.1, Form TF0001 Required (Adequate Notice):
    • in Change Action Mode, go to "Household Information" and select "Yes" for the question "Is the worker unable to locate the household?";
    • document all attempts to contact the household by telephone; and
    • run eligibility.

Related Policy

Actions on Changes, B-631
Returned Mail, E-2221
Returned Mail, M-2221