B-640, Changes Affecting Benefits

Revision 09-3; Effective July 1, 2009

B—641 Additions to the Household

Revision 20-4; Effective October 1, 2020

TANF and SNAP

Determine household eligibility when a member must be added to the household. If the addition to the household causes benefits to increase or remain the same, send Form TF0001, Notice of Case Action, by the 10th day after the change is reported. If additional information or verification is required, send Form TF0001 the next business day, but no later than the business day after the Form H1020, Request for Information or Action, due date. Request supplemental benefits, if required, no later than the last day of the month in which the verification is received.

If the household addition is a member of another active EDG, remove the person from the other EDG before adding the person to the new EDG. Restore benefits if adding the person increases benefits and the person was not removed from the active EDG in a timely manner. Take overpayment action on the old EDG.

Medical Programs except TP 45

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

TP 08

If the household requests Medicaid for an additional legal parent or caretaker relative, the new person is given a separate EDG and the system aligns the certification period of the newly created EDG with the existing TP 08 certification period.

Assign a Medicaid eligibility date as early as three months before the month the person reports the change for applicants who have unpaid medical bills and meet the criteria described in A-830, Medicaid Coverage for the Months Prior to the Month of Application. When applying the criteria in A-830, the application month is the month the person reports the change.

TP 43, TP 44 and TP 48

When a household requests Medicaid for a child (sibling or non-sibling) who lives with a child currently receiving TP 43, TP 44, or TP 48 Medicaid coverage, the household does not need to complete a new application. Follow policy in A-240, Medical Programs, to determine the new child’s household composition and A-1300, Income, to determine if the new child has any countable income.

If the household does not provide all the information needed to make an eligibility determination when requesting Medicaid for the new child, follow current policy and processes to request the additional information by issuing the Form H1020, Request for Information or Action.

When all the requested information is provided, the new child is given a separate EDG and the system aligns the certification period of the newly created EDG with the existing child’s Medicaid certification period.

Exception: Do not add additional children or siblings to a case in which a denied EDG is being reinstated because another child in the household or a sibling was released from a juvenile facility or a county jail. The household must submit a new application for the additional children or siblings.

If there is not an existing TP 43, TP 44, TP 48 or CHIP EDG, a separate application is required to initiate benefits for a new child being added to the case, as explained in A-121, Receipt of Application. 

TA 82, TP 40, TP 44 and TP 70

If a person’s Medicaid is suspended because the person was incarcerated in a Texas county jail, determine if they can be added to an existing case for reinstatement of all previous benefits when the person’s Medicaid is reinstated.

Related Policy

Medical Programs, A-240
Regular Medicaid Coverage, A-820
Medicaid Coverage for the Months Prior to the Month of Application, A-830
Medicaid Suspension, B-520
Medicaid Reinstatement for Children Certified for TP 44 Released from a Juvenile Facility, B-531
Medicaid Reinstatement for Persons Released from Texas County Jails, B-532

B—641.1 Adding Newborns to the Case

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Before adding a newborn child, advisors use inquiry to determine whether a TP 45 EDG has been opened. This helps prevent the assignment of duplicate coverage and individual numbers.

To locate the TP 45 EDG, the advisor must perform inquiry using the newborn's mother's individual number or demographic information.

Newborns are added to the household even if they are still hospitalized as long as the parent(s) exercises care and control and intends to bring the newborn home.

SNAP

The TP 45 certification date is considered the change report date for the birth of the child. This is considered a reported change whether the case is SR or non-SR, and the agency is required to take action on this reported change.

Before adding the newborn to the EDG, the agency must confirm that the child was released from the hospital to the individual's home. The advisor must attempt to contact the household by phone to confirm whether the newborn child has moved into the home (and the date that occurred) and to obtain any information not already available on the TP 45 EDG that is needed to add the child. If the advisor is not able to reach the individual by phone, the advisor must send Form H1020, Request for Information or Action, requesting the necessary information. The advisor must not pend for verification of an SSN application at change action to add a child age six months or younger. Advisors follow policy in B-641.2, Steps for Adding New Members, to determine the effective date of the change. If the individual does not respond by the Form H1020 due date:

• the child is not added to the SNAP EDG; and
• the advisor must document that the individual failed to provide required information to add the child.

If the household later provides information and verification related to the newborn, the child is added, effective the month after verification is received.

Related Policy

General Policy, A-410 

B—641.2 Steps for Adding New Members

Revision 23-3; Effective July 1, 2023

All Programs

When the household reports a new member,  send Form H1020, Request for Information or Action, and Form H1020-A, Sources of Proof, the day of the report or no later than the next business day to request any more necessary information or verification.

If the change is:

• Timely reported and verified, add the new member to the case the month after the change occurred, unless benefits decrease. If benefits decrease, send Form TF0001, Notice of Case Action, and decrease or deny benefits effective the month after notice of adverse action expires.
• Untimely reported with timely verification, add the new member effective the month after the change is reported. If the change decreases benefits, send Form TF0001 and decrease or deny benefits effective the month after notice of adverse action expires.
• Timely or untimely reported with a delay in verification of eligibility points that results in individual disqualification (e.g., SSN or alien status) and verification is not provided by the Form H1020 due date, take the following actions:
  • For TANF, if the new member is a required member of the certified group, disqualify the new member following applicable policy. Notify the household on Form TF0001 as appropriate. Exception: See TANF policy for household members who are not required members of the certified group.
  • For SNAP, disqualify the new member following applicable policy. Notify the household of the disqualification on Form TF0001 as appropriate.
  • For Medical Programs, see reasonable opportunity policy.
• Timely or untimely reported with enough information to determine benefits will decrease, but verification is delayed, send Form TF0001 and decrease or deny benefits based on the person's unverified statement effective the month after notice of adverse action expires.
• Timely or untimely reported lacking enough information about income, resources, or other factors necessary to determine eligibility or benefits,  sends Form H1020 and Form H1020-A to request verification the same day the change was reported or no later than the next business day and attempts to contact the household by phone within 10 days after the change is reported to obtain enough information to determine the effect of the change.
  • If information is obtained, policies for changes apply as described in this section.
  • If information is not obtained, the impacted EDGs are kept pending until the Form H1020 due date.
  • If verification is not received by the Form H1020 due date,  send Form TF0001 the next business day to deny the EDG for failure to provide information.

Notes:

• There may be situations in which verification is provided to establish eligibility for one program and not the other.
• When the household reports a new member using an application or redetermination form, the file date is considered the report of change date. The person must provide the verification by the Form H1020 due date to be considered timely verification.

TANF

Delays in verification of other legal requirements for required members: If the new member is a required member of the certified group and the household does not provide proof of age, relationship, or domicile by the Form H1020 due date:

• because it is not available, send Form TF0001 to notify the household that the person cannot be added without required verification.
• but it is available, send Form TF0001 to deny the EDG for failure to provide information.

Delays in verification for persons who are not required members of the certified group: If the new member is not a required member of the certified group and the person fails to provide requested proof by the Form H1020 due date, send Form TF0001 to notify the household that the new person cannot be added without required verification. If the household later provides verification, the member is added the month after the verification is received.

SNAP

Request a combined Data Broker report for a new adult member.

When a new household member is added:

• determine each person's Employment & Training (E&T) registration or participation exemption status;
• determine a primary wage earner (PWE);
• ensure the household receives the SNAP Work Rules information that is included within their TF0001 as explained in related policy about action in full-service choices counties or E&T counties; 
• use the SNAP Work Rules — Verbal Informing Script in the related policy section for E&T procedures to verbally inform the person interviewed about each E&T registrant’s and ABAWD’s rights and responsibilities; and
• inform households with members exempt from E&T and of age to participate that they may voluntarily participate in the E&T Program as described in the related policy about exempt members volunteering to participate in E&T.

Related Policy

Reasonable Opportunity, A-351.1
E&T Procedures, A-1822
Voluntary E&T Participants, A-1822.2
Action in Full-Service Choices Counties or E&T Counties, A-1831
Changes Decreasing Benefits, B-643 

B—641.3 Adding Disqualified Members

Revision 15-4; Effective October 1, 2015

TANF and SNAP

If the member being added was disqualified, the new member is added effective the month after the disqualification ends. See A-1800, Employment Services, for adding household members disqualified for noncompliance with employment services requirements.

SNAP

See A-1362, Disqualified Members, for special budgeting of TANF benefits.

B—642 Changes Increasing Benefits (Other than Additions to the Household)

Revision 15-4; Effective October 1, 2015

All Programs

Advisors determine the effective dates of a change based on the date the change is reported and the date the verification is provided, as explained in B-642.1, Verification Provided Timely, and B-642.2, Verification Not Provided Timely. If supplemental benefits are necessary, the advisor must request the issuance no later than the last day of the month in which the verification is received.

Note: If verification is not required, the change is treated the same as if verification was received timely (see B-642.1).

B—642.1 Verification Provided Timely

Revision 15-4; Effective October 1, 2015

All Programs

If the household provides verification of a reported change by the Form H1020, Request for Information or Action, due date, benefits are increased, effective the month after the change is reported, regardless of whether the change was reported timely. The advisor sends Form TF0001, Notice of Case Action, the next workday, but no later than the workday after the Form H1020 due date.

If the household reports a change on an application form, the file date is considered the report of change date. The individual must provide the verification by the Form H1020 due date to be considered timely verification.

B—642.2 Verification Not Provided Timely

Revision 15-4; Effective October 1, 2015

All Programs

If the household fails to provide timely verification, benefits are not increased until verification is received. The advisor sends Form TF0001, Notice of Case Action, by the next workday after the Form H1020, Request for Information or Action, due date to explain that benefits remain the same. If the household later provides verification untimely, benefits are increased, effective the month after verification is received.

If the household fails to provide verification before the next SNAP, TANF, or TP 08 redetermination, request it again during the interview process and deny the EDG if verification is not received.

SNAP

If decreased or denied TANF or Refugee Cash Assistance (RCA) benefits result in an increase in SNAP benefits, benefits are increased the same month the TANF or RCA is decreased, with some exceptions (see A-1324.18, Temporary Assistance for Needy Families [TANF]).

If the household appeals the TANF or RCA decision and receives continued TANF or RCA benefits, the advisor continues to budget the TANF or RCA grant in the SNAP EDG.

B—643 Changes Decreasing Benefits

Revision 23-4; Effective Oct. 1, 2023

TANF and SNAP

Staff must take action on changes as indicated in the chart below. Benefits are decreased or denied, effective the month after the notice of adverse action expires. If applicable, process an overpayment claim. To determine the first month of an overpayment, staff refer to the TANF and SNAP Overpayment Determination Chart.

* If the due date for sending Form TF0001 falls on a non-business day, send it the preceding business day to meet the 10-day requirement.

** Allow the person 10 days to provide the verification requested on Form H1020. If the 10th day falls on a non-business day, use the following business day as the due date.

Note: Use change policy for situations where the Texas Department of Family and Protective Services (DFPS) places a TANF or Medicaid child in foster care.

TP 08

If a person reports or electronic data sources indicate new or increased earned income, alimony or spousal support that makes the person ineligible for TP 08, staff must request verification of the income. If the person fails to provide verification of the earned income, alimony or spousal support, staff must deny the TP 08 EDG and open the appropriate Transitional Medicaid EDG if:

• the information is not questionable; and
• they meet the eligibility requirements for the applicable Transitional Medicaid program (TP 07 or TP 20).

In addition, staff must deny the Medicaid EDG and open the appropriate Transitional Medicaid EDG (TP 07 or TP 20) for each associated parent or caretaker and dependent child.

If the EDG is denied for failure to provide verification that does not cause Medicaid ineligibility, staff must determine the household's eligibility for other medical programs.

Related Policy

General Eligibility Information, A-841
TP 07 Transitional Medicaid, A-842
TP 20 Alimony/Spousal Support Transitional Medicaid Coverage, A-850
General Eligibility Information, A-851
Verification Requirements, A-1440
Denial at Redetermination, A-2342
Actions on Changes, B-631
Claims, B-700
TANF and SNAP Overpayment Determination Chart, C-1140