Part E, Former Foster Care Children (FFCC)

E-100, Application Processing

Revision 17-1; Effective January 1, 2017

 

 

E—110 Medicaid for Former Foster Care Children (FFCC)

Revision 15-4; Effective October 1, 2015

 

The Patient Protection and Affordable Care Act (Public Law 111-148) and the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), commonly referred to together as the Affordable Care Act (ACA), requires states to extend Medicaid coverage to the population of youth who are between ages 18 and 26 and aged out of foster care at age 18 or older.

The process to cover these individuals is coordinated between the Texas Department of Family and Protective Services (DFPS), which administers the foster care program, and the Texas Health and Human Services Commission (HHSC). When a child ages out of foster care, Medicaid eligibility for these youths is transferred from Foster Care Medicaid to FFCC. DFPS certifies initial FFCC eligibility for youths aging out of foster care and HHSC is then responsible for determining their future Medicaid eligibility.

Note: There may be situations in which HHSC processes the initial certification.

 

E—111 Type of Assistance (TA) 82 – Medical Assistance – FFCC

Revision 15-4; Effective October 1, 2015

 

In order to be eligible for FFCC, individuals must:

  • have aged out of foster care or the Unaccompanied Refugee Minor Resettlement Program in the state of Texas at age 18 or older;
  • be ages 18 up to 26;
  • have received federally funded Medicaid when they aged out of foster care; and
  • meet all other Medicaid eligibility criteria such as U.S. citizenship, alien status, and Texas residency.

Centralized Benefit Services (CBS) staff is responsible for processing all FFCC applications and redeterminations, along with any other associated active Eligibility Determination Groups (EDGs). The FFCC program is identified in the Texas Integrated Eligibility Redesign System (TIERS) as TA 82, Medicaid for Former Foster Care Children.

Customer Care Center (CCC) staff is responsible for processing changes for FFCC.

Note: Federal regulations require states to provide Unaccompanied Refugee Minors (URMs) with the same range of medical benefits and services as those available to children who were in foster care. CBS is responsible for ensuring URMs continue to receive medical services through the end of their 26th birthday if they meet all eligibility criteria.

 

E—112 Application Processing

Revision 17-1; Effective January 1, 2017

 

Centralized Benefit Services (CBS) receives:

  • a new FFCC case/Eligibility Determination Group (EDG) via an interface with the Texas Department of Family and Protective Services (DFPS); or
  • an application completed by an individual who aged out of foster care.

Note: DFPS provides a notice of eligibility to each individual.

CBS staff are notified by DFPS or HHSC Quality Assurance when a referral/interface is not completed. In cases where a DFPS referral/interface is not completed or processed, CBS staff must contact DFPS to determine the reason why the individual was not sent to HHSC via the interface and confirm whether eligibility criteria is met for FFCC. If the individual meets the eligibility criteria in Section E-111 , Type of Assistance (TA) 82 - Medical Assistance - FFCC, CBS staff certify the individual for FFCC without requiring an application.

There are instances when an individual is denied ongoing FFCC coverage and must submit a new application for benefits. An individual may be denied ongoing FFCC coverage if the individual:

  • voluntary withdraws;
  • moves out of state; or
  • fails to return verification during a renewal.

Individuals denied ongoing FFCC benefits may experience gaps in coverage. When there is a gap in coverage, individuals must apply using any of the Medical Programs application channels explained in A-113, Application Requests and Submissions.

One of the following questions must be marked Yes on the application for eligibility to be considered for FFCC.

  • Were you in foster care at age 18 or older?
  • Were you in an approved Unaccompanied Refugee Minor’s Resettlement Program at age 18 or older?

If ineligible for FFCC, the individual will be considered for eligibility under other Medical Programs.

 

E—113 Requesting an Application

Revision 15-4; Effective October 1, 2015

 

Applicants may request to apply for FFCC as explained in A-113, Application Requests and Submissions.

Related Policy
Registering to Vote, A-1521

 

E—114 Authorized Representatives (AR)

Revision 15-4; Effective October 1, 2015

 

An individual may designate an individual or organization as an AR, following the policy explained in A-170, Authorized Representatives (AR).

 

E—120 Office Procedures

Revision 15-4; Effective October 1, 2015

 

 

E—121 Filing an Application

Revision 17-1; Effective January 1, 2017

 

individuals who wish to apply for FFCC, can;

  • submit an application as explained in A-113, Application Requests and Submissions; and
  • sign an application as explained in A-121, Application Signature.

 

 

E—122 File Date

Revision 17-1; Effective January 1, 2017

 

The file date is the day an application is received in one of the following ways:

  • by an HHSC eligibility determination office;
  • online through YourTexasBenefits.com;
  • by telephone through 2-1-1; or
  • through an account transfer from the Marketplace.

The file date for cases received through the DFPS interface is the date the interface is received. To be a valid application, it must contain the applicant's name, address, and appropriate signature/electronic signature. This is day zero in the application process. 

Advisors must document why a certain file date was used to determine eligibility when:

  • The file date used differs from the received date on the application, or
  • The application has two received dates (stamp dates).

Note: For applications received outside of normal business hours, the file date is the next business day.

Related Policy
Application Signature, A-122.1

 

E—130 Interviews

Revision 15-4; Effective October 1, 2015

 

 

E—131 General Policy

Revision 15-4; Effective October 1, 2015

 

An interview is not required when applying for or renewing an application for the FFCC program. Schedule a phone interview only if the individual requests an interview. The State Portal Scheduler does not support scheduling for the FFCC program. Any requests for an interview must be scheduled manually.

Note: Advisors must continue determining eligibility, rather than denying the application, if the applicant misses the interview.

E-200, Household Composition

Revision 15-4; Effective October 1, 2015

 

 

E—210 General Policy

Revision 15-4; Effective October 1, 2015

 

The certified group consists of only the individual.

 

E—220 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

There are no verification requirements for household composition. Advisors must accept the individual's statement as verification.

E-300, Citizenship

Revision 15-4; Effective October 1, 2015

 

E—310 General Policy

Revision 15-4; Effective October 1, 2015

 

Verify citizenship and alien status following the Medical Programs policy for citizenship and alien status eligibility in A-300, Citizenship. Applicants who are U.S. citizens and certain legally admitted alien residents are eligible for Medicaid for Former Foster Care Children (FFCC) if they meet all other eligibility criteria.

The alien status policy for FFCC follows Chart D in Section A-342, TANF and Medical Programs Alien Status Eligibility Charts. Individuals are no longer eligible for FFCC the month after their 21st birthday if they no longer qualify under Chart D. For individuals age 21 and older, continue eligibility if they are otherwise eligible based on Charts A, B, and C.

Allow applicants and recipients a period of reasonable opportunity, if applicable, to verify their citizenship or alien status, as explained in A-351.1, Reasonable Opportunity.

 

E—320 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

The Texas Department of Family and Protective Services (DFPS) interface provides the following information pre-populated into the Texas Integrated Eligibility Redesign System (TIERS) for individuals with an alien status:

  • Document Type — I-551 orI-94
  • Annotation/Category (conditionally based on documenttype)
  • U.S. Citizenship and Immigration Services (USCIS) Documented US EntryDate
  • Alien Status ExpirationDate
  • Alien Registration Number (the “A”number)

Verification of alien status is required when the information received via the interface does not match the information in TIERS or when the document type is marked "other." Do not request verification from the individual until efforts to verify alien status through DFPS have been attempted. Staff must request an image of the alien status documentation from DFPS to verify the alien status.

Within 10 days of receiving the task, staff must email the DFPS FC-ADO mailbox at fcadomedex@dfps.state.tx.us and copy tonya.eason@dfps.state.tx.us to request the image of the alien documentation. The email must include the individual's name, date of birth, and Social Security number (SSN) and must be encrypted. Do not include any client information in the subject line of the email. DFPS should reply to this request within five workdays.

If the DFPS image does not provide sufficient information to verify alien status, then FFCC applicants must receive a period of reasonable opportunity, explained in A-351.1, Reasonable Opportunity, to verify their alien status.

 

E-400, Social Security Number (SSN)

Revision 15-4; Effective October 1, 2015

 

 

E—410 General Policy

Revision 15-4; Effective October 1, 2015

 

Applicants must provide an SSN or apply for one through the Social Security Administration (SSA) before certification. Advisors use policy in A-411, Determining Advisor Action at Application, listed under the All Programs heading when an applicant does not have an SSN.

E-500, Age

Revision 15-4; Effective October 1, 2015

 

 

E—510 General Policy

Revision 15-4; Effective October 1, 2015

 

Applicants are eligible to receive Medicaid for Former Foster Care Children (FFCC) benefits from age 18 through the month of their 26th birthday.

Exception: An individual is no longer eligible for FFCC the month after the individual’s 21st birthday if the individual no longer qualifies due to alien status, as explained in E-310, General Policy.

 

E—520 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

Advisors accept self-declaration as verification of age.

 

E—530 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

Document the individual's self-declaration establishing the age.

E-600, Relationship

Revision 15-4; Effective October 1, 2015

 

 

Relationship requirements are not applicable in the Former Foster Care Children (FFCC) program.

E-700, Identity

Revision 15-4; Effective October 1, 2015

 

 

E—710 General Policy

To establish identity, follow Medical Programs policy in A-600, Identity.

E-800, Residence

Revision 15-4; Effective October 1, 2015

 

 

E—810 General Policy

Revision 15-4; Effective October 1, 2015
 

To determine residence eligibility, follow the Medical Programs policy in A-700, Residence.

 

 

E-900, Adequate Health Coverage (Third-Party Resource)

Revision 15-4; Effective October 1, 2015

 

 

E—910 General Policy

Revision 15-4; Effective October 1, 2015

 

Former Foster Care Children (FFCC) recipients may have adequate health coverage. Adequate health coverage is also known as a third-party resource (TPR). FFCC follows TPR policy in A-860, Third-Party Resources (TPR). FFCC recipients with TPR must cooperate in providing details of the TPR.

 

E—920 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

The TPR information has been verified when the “NHIC” box is checked and greyed out. Staff cannot end/terminate the coverage. If the individual has TPR and the “NHIC” box is greyed out, this information has already been verified by the Office of Inspector General – Third Party Liability area. 

Request verification if:

  • the individual indicates the individual has TPR, and
  • required TPR information has not been verified.

Some former foster care individuals’ parents may have TPR coverage for the applicant without the individual being aware of this coverage. If the individual states they are not aware of the TPR or do not know the details of the TPR, but the TPR has been verified by the claims administrator, advise the applicant to call the claims administrator’s Third Party Liability Customer Service Line at 1-800-846-7307 and select option 2. This will allow the individual to obtain information regarding the TPR.

If the TPR information in the Texas Integrated Eligibility Redesign System (TIERS) has been verified by the claims administrator but needs to be updated, fax the completed Form H1039, Medical Insurance Input, to the claims administrator at 512-514-4215.

E-1000, Medicaid Eligibility

Revision 18-1; Effective January 1, 2018

 

 

E—1010 General Policy

Revision 15-4; Effective October 1, 2015

 

To determine the correct eligibility begin dates, follow policy in A-820, Regular Medicaid Coverage. The applicant is continuously eligible the first day of the application month if all eligibility criteria are met. Certified applicants are eligible to receive benefits beginning the month of their 18th birthday through the end of the month of their 26th birthday. 

The Medical Effective Date (MED) cannot precede:

  • January 1, 2014, the program effective date; or
  • the month of the individual’s 18th birthday.

 

E—1011 Three Months Prior Coverage

Revision 15-4; Effective October 1, 2015

 

Applicants for Medicaid for Former Foster Care Children (FFCC) are eligible for three months prior coverage.

Three months prior coverage under FFCC cannot precede January 1, 2014. If eligible under another Medicaid program, an individual can receive three months prior coverage for months requested prior to January 1, 2014, on the Medicaid program for which the individual would have qualified prior to January 1, 2014. Coverage from January 1, 2014, forward will be under the FFCC program.

 

E—1012 Types of Coverage

Revision 18-1; Effective January 1, 2018

 

FFCC recipients are automatically enrolled in STAR Health through the month of their 21st birthday. STAR Health provides a full range of Medicaid-covered medical and behavioral health services for Texas Department of Family and Protective Services (DFPS) individuals. Individuals may opt out of STAR Health for STAR, which allows for a choice of health plans.

People under age 21 who receive Supplemental Security Income (SSI) or reside in a nursing facility have the choice of staying in STAR Health or opting into STAR Kids if they meet one of the following criteria:

  • receive Medicaid and Medicare; or
  • receive services under one of the following 1915(c) waiver programs:
    • Home and Community-based Services (HCS);
    • Community Living Assistance and Support Services (CLASS);
    • Texas Home Living (TxHmL);
    • Deaf Blind with Multiple Disabilities (DBMD);
    • Medically Dependent Children Program (MDCP); or
    • Youth Empowerment Services (YES).

Once an FFCC recipient attains age 21, coverage will transfer to STAR. STAR provides a full range of Medicaid-covered medical and other services for many children and adults. Exception: Individuals ages 21 up to age 26 who meet the STAR+PLUS criteria must enroll in the STAR+PLUS managed care program. 

Related Policy
Managed Care, A-821.2
Managed Care Plans, C-1116

E-1100, Domicile

Revision 15-4; Effective October 1, 2015


Domicile requirements do not apply to the Former Foster Care Children (FFCC) program.

E-1200, Deprivation

Revision 15-4; Effective October 1, 2015

 

 

Deprivation requirements do not apply to the Former Foster Care Children (FFCC) program.

E-1300, Child Support

Revision 15-4; Effective October 1, 2015

 

 

Child and medical support requirements do not apply to the Former Foster Care Children (FFCC) program.

E-1400, Resources

Revision 15-4; Effective October 1, 2015

 

 

Resources are not considered as a factor in determining eligibility for the Former Foster Care Children (FFCC) program.

E-1500, Income

Revision 15-4; Effective October 1, 2015

 

 

Income is not considered as a factor in determining eligibility for the Former Foster Care Children (FFCC) program.

E-1600, Deductions

Revision 15-4; Effective October 1, 2015

 

 

Since there is no income test, deductions are not considered as a factor in determining eligibility for the Former Foster Care Children (FFCC) program.

E-1700, School Enrollment

Revision 15-4; Effective October 1, 2015

 

 

School attendance requirements do not apply to the Former Foster Care Children (FFCC) program.

E-1800, Management

Revision 15-4; Effective October 1, 2015

 

 

Management requirements do not apply to the Former Foster Care Children (FFCC) program.

E-1900, Reminders

Revision 15-4; Effective October 1, 2015

 

 

E—1910 General Policy

Revision 15-4; Effective October 1, 2015

 

Before certifying applicants and recertifying recipients, advisors must:

  • Ensure the applicant completes each question and signs and dates the application.
  • Give the applicant Form H1019, Report of Change. Explain that changes must be reported within 10 days after knowing about the change. Indicate the appropriate reporting requirement on Page 1.
  • Refer the applicant to other programs the individual might be eligible for such as the Supplemental Nutrition Assistance Program (SNAP); Temporary Assistance for Needy Families (TANF); Medicaid; Supplemental Security Income (SSI); or Retirement, Survivors and Disability Insurance (RSDI). Refer individuals with a disability who are ineligible for Medical Programs for families and children to the Texas Health and Human Services Commission (HHSC) Medicaid for the Elderly and People with Disabilities (MEPD) programs.
  • Inform the applicant of the right to appeal any HHSC action that affects the individual’s eligibility.
  • Inform the applicant that the information the applicant provides is subject to verification by third parties.

 

E—1920 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

Advisors must document that Form H0025, HHSC Application for Voter Registration, was given to the applicant, authorized representative or representative payee in the Agency Use Only section of the application.

Related Policy
Registering to Vote, A-1521

E-2000, Case Disposition

Revision 15-4; Effective October 1, 2015

 

 

E—2010 Notice to Applicants

Revision 15-4; Effective October 1, 2015

 

When processing an application, redetermination or change, advisors are required to inform the individual if their request is pended, certified, sustained, or denied. Eligibility Determination Group (EDG) disposition is the end result of processing the request for assistance and will generate Form TF0001, Notice of Case Action. However, if the EDG cannot be disposed because it is pending for additional information/verification, the advisor must provide the individual with Form H1020, Request for Information or Action.

Form H1020, Request for Information or Action

Form H1020 informs the individual the:

  • reason the case is pending;
  • action the individual or advisor must take;
  • date by which the individual or advisor must take action; and
  • date the advisor must deny the application/case if the individual does not take action, if applicable.

Note: For Spanish-speaking only individuals, ensure that all comments provided are in Spanish.

Form TF0001, Notice of Case Action

Form TF0001 informs the individual:

  • the date benefits begin,
  • the date of denial and right to a fair hearing to appeal a case action, and
  • address and telephone number of free legal services available in the area.

Note: For Spanish-speaking only individuals, ensure that all comments provided are in Spanish.

 

E—2020 Length of Certification

Revision 15-4; Effective October 1, 2015

 

The Texas Integrated Eligibility Redesign System (TIERS) calculates the eligibility end date from the date the advisor disposes the EDG as follows:

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

Individuals are continuously eligible for Former Foster Care Children (FFCC) benefits for 12 months or through the month of their 26th birthday, whichever is earlier.

Exception: An individual is not eligible to receive 12 months of continuous eligibility if the individual:

  • reaches age 26,
  • dies,
  • voluntarily withdraws, or
  • moves out-of-state.

 

E—2030 Setting Special Reviews

Revision 15-4; Effective October 1, 2015

 

Use Medical Programs policy in A-2330, Setting Special Reviews, to set special reviews.

 

E—2040 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 receiving benefits pending an appeal. After certification, advisors 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, advisors use current policy in A-2340, Adverse Action.

E-2100, Processing Time Frames

Revision 15-4; Effective October 1, 2015

 

E—2110 Applications

Revision 15-4; Effective October 1, 2015

 

Advisors must make an eligibility determination by the 45th day from the file date.

Reopen an application denied for failing to furnish information/verification if the missing information is provided by the 60th day from the file date. Use the date the missing information/verification was provided as the new file date.

Use the original application, until it is 60 days old.

If the information on the form has changed or is more than 45 days old, the individual and advisor must update the form.

 

E—2120 Deadlines

Revision 15-4; Effective October 1, 2015

 

Provide Form TF0001, Notice of Case Action, the same day eligibility is determined for an application but no later than 45 days from the file date.

 

E—2130 Missed Interviews

Revision 15-4; Effective October 1, 2015

 

No interview is required to process an application or renewal unless requested by the applicant/individual. If an interview is requested, advisors provide the applicant/individual a telephone interview. If the individual fails to keep the interview, advisors must not deny the application or renewal but continue to process the request for assistance.

 

E—2140 Pending Information on Applications

Revision 15-4; Effective October 1, 2015

 

Advisors may not request additional information or documentation from clients unless such information is not available electronically or the information obtained electronically is not consistent with the information provided by the client.

If additional information is needed, advisors must request documents that are readily available to the household and are considered to be sufficient verification. Each handbook section lists potential verification sources. C-900, Verification and Documentation, gives information on verification procedures.

In determining eligibility, advisors must consider any information the individual reports between the application date and the decision date. Include any information the individual reports during the application decision process.

 

E—2150 Notice of Renewal/Expiration

Revision 15-4; Effective October 1, 2015

 

The system generates and sends renewal correspondence to individuals enrolled in Medicaid for Former Foster Care Children (FFCC) following the process explained in B-121, Notice of Redetermination/Certification Expiration, for TP 08 and Children's Medicaid (TP 43, TP 44 and TP 48).

Note: The system will generate Form H1206, Health Care Benefits Renewal - FFCC, rather than Form H1206, Health Care Benefits Renewal - MA, for individuals renewing FFCC.

 

E—2160 Processing Renewals

Revision 15-4; Effective October 1, 2015

 

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 15-4; Effective October 1, 2015

 

If an individual is required to return a renewal form and returns a paper Form H1206, Health Care Benefits Renewal - FFCC, the form is routed to Centralized Benefit Services (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 advisors may dispose the FFCC Eligibility Determination Group (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.

Advisors must 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 the Texas Health and Human Services Commission (HHSC) receives an acceptable FFCC renewal form, the advisor must review the information provided and determine whether the case needs to be updated to reflect the most recent information reported by the client on the form.

The advisor may only request information and verification needed to determine eligibility from the client when it is not available through electronic data sources. Verification previously provided must be used to renew eligibility when the verification is still valid. The advisor must determine whether there is any verification that can be used before requesting verification from the client. The household must be allowed at least 10 days to provide missing information, and 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.

 

E—2170 Renewal Time Frames

Revision 15-4; Effective October 1, 2015

 

For individuals required to return a renewal packet, CBS advisors must process the manual renewal following the time frames explained in E-2161.2, Processing a Manual Renewal.

 

E—2180 Pending Information

Revision 15-4; Effective October 1, 2015

 

Advisors must allow the household at least 10 days to provide missing information/verification. The due date must be a workday. Advisors must request documents that are readily available to the household if the documents are anticipated to be sufficient verification. If the applicant has any active or inactive EDGs, check to see if any verification previously provided for the other EDGs can be used to determine eligibility for FFCC.

Advisors use verifications accepted for the Temporary Assistance for Needy Families (TANF) program, Medical Programs or the Supplemental Nutrition Assistance Program (SNAP).

Exception: Only Medical Programs sources of verification of U.S. citizenship for applicants can be used.

Note: Advisors must not use verification that is over 90 days old from the FFCC file date.

 

E—2181 Summary of Due Dates for Form H1020, Request for Information or Action

Revision 15-4; Effective October 1, 2015

 

Case Action Due Date Final Due Date
Application 10 days
  • 30th day, or
  • 10th day if the household's Form H1020 due date extends beyond the 30th day
Renewal 10 days
  • 30th day or by cutoff in the last benefit month of certification, whichever is later; or
  • 10th day if the household's Form H1020 due date extends beyond the last day of the last benefit month
Incomplete review 10 days 10th day

Note: Staff have until the 45th day from the file date to determine eligibility for applications.

E-2200, Changes

Revision 16-4; Effective October 1, 2016

 

 

E—2210 How to Report a Change

Revision 15-4; Effective October 1, 2015

 

Customer Care Center (CCC) staff process all changes for Former Foster Care Children (FFCC) recipients. FFCC recipients can report changes:

  • online through YourTexasBenefits.com;
  • by visiting a local eligibility office;
  • in writing by mail or fax;
  • by completing Form H1019, Report of Change; or
  • by calling 2-1-1.

Note: When a change is reported by telephone, staff must verify that the person speaking is the individual or an authorized representative as explained in A-2000, Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation.

An individual must report the following changes:

  • if the individual moves out state,
  • an address change, or
  • enrollment in health insurance.

Advisors process all other changes, including agency-generated changes, at the next renewal.

Exception: If the individual failed to report required information at the time of the application that causes the individual to be ineligible for FFCC, advisors must deny the benefits and send a fraud referral to the Office of the Inspector General.

 

E—2220 Action on Changes

Revision 15-4; Effective October 1, 2015

 

If an individual reports a change or the advisor receives an agency-generated change during the 12-month continuous eligibility period and has:

  • no associated Eligibility Determination Group (EDG) — the advisor documents the change and handles at renewal, unless it is a change of address, the certified individual dies, a voluntary withdrawal, receipt of health insurance, or the individual moves out of Texas;
  • an associated EDG — the advisor documents the change and handles at renewal, unless it is a change of address, the certified individual dies, a voluntary withdrawal, receipt of health insurance, or the individual moves out of Texas; or
  • a change of address — the advisor mails the individual Form H0025, HHSC Application for Voter Registration, to register to vote based on the new address. If the individual contacts Centralized Benefit Services (CBS) or 2-1-1 to decline the opportunity to register to vote after receipt of Form H0025, the advisor mails Form H1350, Opportunity to Register to Vote, to the individual for a signature, files Form H1350 in the case record when the individual returns the form, and retains the form for at least 22 months.

Advisors follow Medical Programs policy in B-600, Changes, for verification and documentation requirements.

Related Policy
Registering to Vote, A-1521

 

E—2221 Returned Mail

Revision 16-4; Effective October 1, 2016

 

When returned mail is received, the vendor creates and assigns a Returned Mail (RTML) task to Centralized Benefit Services (CBS) staff for processing. 

 

Upon receipt of the RTML task, CBS staff must take the following actions: 

 

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 and, if there is a Supplemental Nutrition Assistance Program (SNAP) Eligibility Determination Group (EDG), any related changes in shelter expenses.

2. If a new address has not been reported and a forwarding address was not provided, attempt to contact the household via telephone to obtain an updated address and document the attempt. If the household provides a new address, process the address change and, if there is a SNAP EDG, any related changes in shelter expenses. Otherwise go to Step 3.

3. If there is an individual(s) in the household who receives Retirement, Survivor's and Disability Insurance (RSDI) or Supplemental Security Income (SSI), use the State Online Query (SOLQ) to verify the household's address. Use the address in SOLQ to update the address if the address in SOLQ differs from the address on file and, if there is a SNAP EDG, explore shelter expenses.

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.

If unable to contact the individual by phone and there is not an individual(s) in the household who receives RSDI or SSI for the:

  • FFCC EDG, go to Step 4; or
  • SNAP EDG, follow Step 5 under the process for a case that includes a SNAP EDG in B-638 , Returned Mail.

 

4. If unable to update the address, simultaneously send emails using the following CBS email box to:

 

HPO Process

  • Send an email to the Medicaid CHIP Division (MCD) Health Plan Operations (HPO) at HPO_Star_Plus@hhsc.state.tx.us . 
  • Include in the subject line Returned Mail – [last four digits of the client's case number].
  • Include the following information in the email:
  • case name;
  • case number;
  • individual’s date of birth (DOB), Social Security Number (SSN), and Medicaid Individual Identification Number; and
  • date the response is needed.
    • Leave the RTML task pending.

 

PAL Process

 

  • Use the link below to identify the Lead Regional PAL staff covering the region of the client's last known address.
  • Send an email to the identified Lead Regional PAL staff.
  • Include in the subject line Returned Mail -- [last four digits of the client's case number].
  • Include the following information in the email:
    • case name;
    • case number;
    • individual's DOB, SSN, and Medicaid Individual Identification Number; and
    • date the response is needed.
  • Leave the RTML task Pending.

 

Note:

For an individual who aged out of the Unaccompanied Refugee Minor (URM) Resettlement program, contact the following agencies and individuals to determine if the agency or individual has an updated address for the former URM:

 

  • the URM's former Voluntary Agency (VolAg); and
  • the two agencies in Texas that have URM programs:

 

5. The MCD HPO and DFPS PAL staff have ten calendar days to respond. It is important that staff make the request as soon as possible. The response will include either:

 

  • the known address on file for the individual; or
  • no known address on file for the individual.

 

MCD HPO responds to the CBS email mailbox (cbs_ffche-mtfcy@hhsc.state.tx.us ) and copies the original requestor with information from the plan by the tenth calendar day from when the email is sent, either confirming or denying that they have an address on file for the client. If they confirm, the response will include the address on file.

 

The DFPS PAL program responds to the email box (OES_FFCC@hhsc.state.tx.us ) and copies the original requestor with information from the Lead Regional PAL staff by the tenth calendar day from when the email is sent, either confirming or denying that they have an address on file for the client. If they confirm, the response will include the address on file.

 

Note: If the MCD HPO and DFPS PAL both respond and provide different addresses, use the address received from the MCD HPO (unless the individual has already provided an address).

6. For cases with a SNAP EDG, if by the Form H1020 due date, the household:

 

  • provides the requested information, process the address change for all active EDGs, including the FFCC EDG, and address any related changes in shelter expenses for the SNAP EDG; or
  • fails to provide the requested information, deny the SNAP EDG for failure to provide information. Send Form TF0001, Notice of Case Action, using the denial reason, "Failed to Provide Information".

 

For the FFCC EDG, if by the 10th calendar day due date the HPO/PAL information:

 

  • is provided, use the information to update the address in the TIERS record;
  • is not provided, use the following steps to deny the EDG(s) using the denial reason "Unable to Locate" as stated in 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?"
    • Run eligibility.

 

Note: The HPO/PAL information cannot be used to verify residence for SNAP EDGs.

 

7. If MCD HPO or DFPS PAL provide an updated address within 30 days of the EDG's denial due to "Unable to Locate,” reopen the EDG.

 

For the SNAP EDG, if the household is denied for failure to provide information and provides a correct address within the advance notice 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. 

 

Notes:

  • If an address provided by MCD HPO or the DFPS PAL program differs from an address provided by the household, contact the household to resolve the discrepancy.
  • For SNAP EDGs, if the household provides verification of residence, but does not provide information regarding shelter expenses, re-budget eligibility without the shelter expense and notify the household, according to policy in A-631, Actions on Changes.

Related Policy

Actions on Changes, B-631
Returned Mail, B-638

E-2300 Fair Hearings

Revision 15-4; Effective October 1, 2015

 

E—2310 Appeals Procedures

Revision 15-4; Effective October 1, 2015

 

Individuals on Medicaid for Former Foster Care Children (FFCC) have the right to appeal within 90 days from the effective date of any Texas Health and Human Services Commission (HHSC) action. The individual's request may be oral or in writing.
See B-1000, Fair Hearings, for specific appeals policy and procedures.

E-2400, Automated Support

Revision 15-4; Effective October 1, 2015

 

 

E—2410 Electronic Data Sources (ELDS) and Data Broker

Revision 15-4; Effective October 1, 2015

 

Advisors must follow the policy explained in C-817, Electronic Data Sources (ELDS), and C-820, Data Broker.

Exception: The consent policy explained in C-817 does not apply to individuals who are transferred to the Texas Health and Human Services Commission (HHSC) via the Texas Department of Family and Protective Services (DFPS) interface.