Part M, Medicaid for Transitioning Foster Care Youth (MTFCY)

M-100, Application Processing

Revision 19-4; Effective October 1, 2019

 

 

M—110 Medicaid for Transitioning Foster Care Youth (MTFCY)

Revision 15-4; Effective October 1, 2015

 

The Chafee Foster Care Independence Act of 1999 gave states the option to extend Medicaid coverage to the population of youth who are between ages 18 and 21 and have aged out of foster care. Senate Bill 51, 77th Texas Legislature, Regular Session, 2001, was passed and signed into law effective September 1, 2001. This law allows the state to provide Medicaid coverage to youths who are aging out of foster care until they reach their 21st birthday.

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 who is not eligible for Former Foster Care Children (FFCC) ages out of foster care in Texas, Medicaid eligibility is transferred from Foster Care Medicaid to Medicaid for Transitioning Foster Care Youth (MTFCY). DFPS certifies initial MTFCY 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.

 

M—111 Type of Assistance (TP) 70 – Medical Assistance – MTFCY

Revision 19-4; Effective October 1, 2019

 

To be eligible for MTFCY, a person must:

  • be ineligible for FFCC (see Part E, Former Foster Care Children [FFCC]);
  • be ages 18 up to 21;
  • have been in foster care in Texas on their 18th birthday, or have had an Interstate Compact on the Placement of Children (ICPC) agreement*;
  • meet medical programs citizenship and Social Security number requirements;
  • be a Texas resident;
  • not have adequate health coverage as defined by HHSC; and
  • have countable income equal to or less than the applicable income limit for TP 70, defined in C-131.1, Federal Poverty Income Limits (FPIL). Exception: Persons who have had an ICPC agreement do not need to meet the income requirement.

* Centralized Benefit Services (CBS) staff must contact DFPS to determine whether the person had an ICPC agreement. DFPS has three business days to respond.

Specialized staff process all MTFCY case actions.

 

M—112 Application Processing

Revision 17-1; Effective January 1, 2017

 

Centralized Benefit Services (CBS) receives:

  • a new MTFCY 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 MTFCY. If the individual meets the eligibility criteria in M-111, Type of Assistance (TP) 70 - Medical Assistance - MTFCY, CBS staff certify the individual for MTFCY without requiring an application.

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

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

Individuals denied ongoing MTFCY benefits may experience a gap 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 MTFCY.

  • 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 MTFCY, the individual will be considered for eligibility under other Medical Programs.

 

M—113 Requesting an Application

Revision 15-4; Effective October 1, 2015

 

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

If an applicant requests help completing an application, a volunteer or staff member must provide assistance. Anyone assisting the applicant in completing a paper application must initial the part completed, or sign the form indicating assistance was provided.

Related Policy
Registering to Vote, A-1521

 

M—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).

 

M—120 Office Procedures

Revision 10-2; Effective April 1, 2010

 

 

 

M—121 Filing an Application

Revision 17-1; Effective January 1, 2017

 

Individuals who wish to apply for MTFCY can:

  • submit an application as explained in A-113, Application Requests and Submissions; and
  • sign an application as explained in A-122, Application Signature.

 

M—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 is the day any HHSC eligibility determination office or call center vendor accepts an application containing the applicant's name, address, and appropriate signature. This is day zero in the application process.

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

 

M—130 Interviews

Revision 10-2; Effective April 1, 2010

 

 

 

M—131 General Policy

Revision 10-2; Effective April 1, 2010

 

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

Note: Do not deny the application if the applicant misses the interview; continue determining eligibility.

M-200, Household Composition

Revision 15-4; Effective October 1, 2015

 

 

M—210 General Policy

Revision 15-4; Effective October 1, 2015

To determine the Modified Adjusted Gross Income (MAGI) household composition for Medicaid for Transitioning Foster Care Youth (MTFCY), the advisor follows the policy explained in A-240, Medical Programs.

Exception: An individual received via the Texas Department of Family and Protective Services (DFPS) interface will continue to have a MAGI household size of one. MAGI household size may change at the time of redetermination if additional information is received indicating that additional people should be included in the MAGI household composition.

 

 

M—220 Verification Requirements

Revision 15-4; Effective October 1, 2015

There are no verification requirements for household composition. Accept the individual’s statement as verification.

M-300, Citizenship

Revision 15-4; Effective October 1, 2015

 

M—310 General Policy

Revision 15-4; Effective October 1, 2015

For most Medicaid for Transitioning Foster Care Youth (MTFCY) applications received via the Texas Department of Family and Protective Services (DFPS) interface, citizenship and alien status has been verified. For MTFCY applications not received via the DFPS interface, a period of reasonable opportunity may be granted if necessary, 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 MTFCY if they meet all other eligibility criteria.

 

M-400, Social Security Number (SSN)

Revision 10-2; Effective April 1, 2010

 

 

M—410 General Policy

Revision 10-2; Effective April 1, 2010

 

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

 

 

M-500, Age

Revision 10-2; Effective April 1, 2010

 

 

M—510 General Policy

Revision 10-2; Effective April 1, 2010

 

To receive Medicaid for Transitioning Foster Care Youth benefits, individuals must be at least age 18 and younger than age 21. Applicants are eligible to receive benefits from age 18 through the month of their 21st birthday.

 

M—520 Verification Requirements

Revision 10-2; Effective April 1, 2010

 

Accept self-declaration as verification of age.

 

M—530 Documentation Requirements

Revision 10-2; Effective April 1, 2010

 

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

M-600, Relationship

Revision 10-2; Effective April 1, 2010

 

 

Relationship requirements are not applicable in the Medicaid for Transitioning Foster Care Youth program.

 

 

M-700, Identity

Revision 10-2; Effective April 1, 2010

 

 

M—710 General Policy

Revision 10-2; Effective April 1, 2010

 

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

M-800, Residence

Revision 15-4; Effective October 1, 2015

 

 

M—810 General Policy

Revision 15-4; Effective October 1, 2015

 

To determine residence eligibility, follow TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48 policy in A-700, Residence.

 

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

Revision 15-4; Effective October 1, 2015

 

 

M—910 General Policy

Revision 15-4; Effective October 1, 2015

 

An applicant or recipient is not eligible to receive Medicaid for Transitioning Foster Care Youth (MTFCY) benefits if the individual currently has adequate health coverage. Adequate health coverage is also known as a third-party resource (TPR). Adequate health coverage is defined as receiving coverage under:

  • group health insurance,
  • health insurance coverage,
  • Medicare (Part A or Part B),
  • Medicaid (with the exception of the Texas Women's Health Program, Medicaid with Spend Down, and Community Attendant),
  • Armed Forces insurance, or
  • a state health risk pool.

Deny an application for an individual who has adequate health coverage.

Do not consider a plan with a limited scope of coverage such as dental, vision, long-term care, etc., or for only a specific illness/disease such as drug/substance abuse as adequate health coverage.

Consider an applicant/recipient as having adequate health coverage even if it has limits on benefits or high deductibles.

If staff receive a task with information that the individual has TPR and the "NHIC" box is greyed out, advisors deny rather than pend the EDG. This information has already been verified by the Office of Inspector General – Third Party Liability area. 

When an MTFCY applicant is denied due to adequate health care coverage, Form TF0001, Notice of Case Action, will read:

"We found that you already have private health insurance. To learn more about the insurance you already get, call toll-free 1-800-846-7307 (after you pick a language, press 2)."

In some instances, the parents of MTFCY recipients have TPR coverage for them without the individual knowing. If the individual states they are not aware of the TPR, staff should advise them 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 their 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, staff should fax the completed Form H1039, Medical Insurance Input, to the claims administrator at 512-514-4215.

 

M—920 Verification Requirements

Revision 10-2; Effective April 1, 2010

 

Accept self-declaration of adequate health coverage.

Exception: If an applicant is denied due to receiving adequate health coverage and the applicant calls to notify HHSC that the medical insurance is not adequate health coverage, staff would need to verify if the coverage is considered adequate health coverage.

 

M—930 Documentation Requirements

Revision 10-2; Effective April 1, 2010

 

Staff must document in case comments the existence of adequate health coverage.

M-1000, Medicaid Eligibility

Revision 15-4; Effective October 1, 2015

 

 

M—1010 General Policy

Revision 10-2; Effective April 1, 2010,

 

The applicant is continuously eligible for 12 months beginning the first day of the application month if all eligibility criteria are met. Applicants are eligible to receive benefits beginning the month of their 18th birthday through the end of the month of their 21st birthday.

The medical effective date cannot precede the month of the applicant’s 18th birthday.

 

M—1011 Three Months Prior Coverage

Revision 10-2; Effective April 1, 2010

 

Follow policy in A-830, Medicaid Coverage for the Months Prior to the Month of Application, to provide Medicaid coverage if the individual meets eligibility criteria.

 

M—1012 Types of Coverage

Revision 15-4; Effective October 1, 2015

 

The type of coverage determines how recipients access Medicaid services. There are two types of coverage. They are fee-for-service and managed care.

Fee-for-Service — Also known as traditional Medicaid, allows access to any Medicaid provider and self-referral to specialists. The provider submits claims directly to the claims administrator for reimbursement of Medicaid-covered services.

Managed Care — A service delivery program that provides medical care in a managed care setting. The state pays a monthly premium to the health maintenance organization (HMO) for each recipient enrolled in the plan. The plan processes all provider claims.

Medicaid for Transitioning Foster Care Youth recipients have the option to enroll in either type of coverage. See A-821.2, Managed Care.

Related Policy
Types of Coverage, A-821

M-1100, Domicile

Revision 10-2; Effective April 1, 2010

 

 

Domicile requirements do not apply to the Medicaid for Transitioning Foster Care Youth program.

 

 

M-1200, Deprivation

Revision 10-2; Effective April 1, 2010

 

 

Deprivation requirements do not apply to the Medicaid for Transitioning Foster Care Youth program.

 

 

M-1300, Child Support

Revision 10-2; Effective April 1, 2010

 

 

Child and medical support requirements do not apply to the Medicaid for Transitioning Foster Care Youth program.

 

 

M-1400, Resources

Revision 15-4; Effective October 1, 2015

 

 

Resources are not considered in determining eligibility for Medicaid for Transitioning Foster Care Youth (MTFCY).

 

 

M-1500, Income

Revision 15-4; Effective October 1, 2015

 

 

M—1510 General Policy

Revision 15-4; Effective October 1, 2015

 

Medicaid for Transitioning Foster Care Youth (MTFCY) individuals must have income less than or equal to the applicable income limit for TP 70, defined in C-131.1, Federal Poverty Income Limits (FPIL).

Advisors must use Modified Adjusted Gross Income (MAGI) rules to determine financial eligibility for MTFCY following the Medical Programs policy, explained in A-1300, Income.

Exception: Individuals who have had an Interstate Compact on the Placement of Children (ICPC) agreement do not need to meet the income requirement.

 

M-1600, Deductions

Revision 10-2; Effective April 1, 2010

 

 

M—1610 General Policy

Revision 10-2; Effective April 1, 2010

 

Use Medical Programs policy in A-1400, Deductions, to determine which deductions a household is eligible to receive.

 

 

M-1700, School Enrollment

Revision 10-2; Effective April 1, 2010

 

 

School attendance requirements are not applicable for the Medicaid for Transitioning Foster Care Youth program.

 

 

M-1800, Management

Revision 10-2; Effective April 1, 2010

 

 

Management requirements are not applicable for the Medicaid for Transitioning Foster Care Youth program.

 

 

M-1900, Reminders

Revision 15-4; Effective October 1, 2015

 

 

M—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 for which the individual might be eligible 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.

There is no requirement to inform individuals to report accidents.

 

M—1920 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

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

M-2000, Case Disposition

Revision 15-4; Effective October 1, 2015

 

 

M—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

TF0001 informs the individual:

  • the date benefits begin,
  • the date of denial,
  • about his/her right to appeal, 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.

 

M—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 Medicaid for Transitioning Foster Care Youth benefits for 12 months or through the month of their 21st birthday, whichever is earlier.

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

  • starts receiving adequate health coverage,
  • reaches age 21,
  • dies,
  • voluntarily withdraws, or
  • moves out-of-state.

 

M—2030 Setting Special Reviews

Revision 10-2; Effective April 1, 2010

 

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

 

M—2040 Adverse Action

Revision 10-2; Effective April 1, 2010

 

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, give households advance notice of adverse actions to deny benefits except for reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice), and A-2344.2, No Form TF0001 Required.

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

M-2100, Processing Time Frames

Revision 15-4; Effective October 1, 2015

 

 

M—2110 Applications

Revision 15-4; Effective October 1, 2015

 

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

Advisors 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.

Advisors 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.

 

M—2120 Deadlines

Revision 10-2; Effective April 1, 2010

 

Provide Form TF-0001, Notice of Case Action, the same day eligibility is determined for an application but no later than 45 days from the file date.

 

M—2130 Missed Interviews

Revision 10-2; Effective April 1, 2010

 

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

 

M—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.

 

M—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 Transitioning Foster Care Youth (MTFCY) 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 – MTFCY, rather than Form H1206, Health Care Benefits Renewal – MA, for individuals renewing MTFCY.

 

M—2160 Processing Renewals

Revision 10-2; Effective April 1, 2010
 

 

M—2161 How to Process a Renewal

Revision 15-4; Effective October 1, 2015

 

MTFCY recipients complete the administrative renewal process explained in B-122.4, Medical Program Administrative Renewals.   

Note: If an individual is required to return a renewal form and returns a paper Form H1206, Health Care Benefits Renewal – MTFCY, the form is routed to Centralized Benefit Services (CBS) for processing.

 

M—2170 Renewal Time Frames

Revision 15-4; Effective October 1, 2015

 

For individuals required to return a renewal packet, advisors must process the manual renewal as explained in B-122.4.2, Processing a Manual Renewal.

 

M—2180 Pending Information

Revision 15-4; Effective October 1, 2015

 

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 Eligibility Determination Groups (EDGs), check to see if any verification previously provided for the other EDGs can be used to determine eligibility for MTFCY.

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

For example, if you accept wage verification for a SNAP case, that same verification is acceptable for TANF, Medical Programs or MTFCY.

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

Note: Do not use verification that is over 90 days old from the MTFCY file date.

 

M—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.

M-2200, Changes

Revision 16-4; Effective October 1, 2016

 

 

M—2210 How to Report a Change

Revision 15-4; Effective October 1, 2015

 

Centralized Benefit Services (CBS) staff process all changes for Medicaid for Transitioning Foster Care Youth (MTFCY) recipients. MTFCY recipients can report changes:

  • online through YourTexasBenefits.com;
  • by visiting a local eligibility determination office (which will forward the change to CBS);
  • by calling 2-1-1; or
  • in writing, by mail or fax, or by completing Form H1019, Report of Change. The individual may mail or fax the change to:
    • Document Processing Center:

HHSC
P.O. Box 149024
Austin, TX 78714-9024
Toll-free fax: 1-877-447-2839

  • A local eligibility determination office (which will send the change to CBS).

 

Note: When a change is reported by telephone, staff must verify that the person speaking is the individual or an authorized representative.

An individual is continuously eligible for MTFCY for 12 months or through the month of his 21st birthday, whichever is earlier.

An individual must report the following changes:

  • an address change;
  • income, including sources of income, regular hours worked, and pay rate;
  • Modified Adjusted Gross Income (MAGI) expenses;
  • voluntary withdrawal of the individual;
  • receipt of health insurance; or
  • if the individual moves out of state.

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 MTFCY, advisors must deny the benefits and send a fraud referral to the Office of the Inspector General.

 

M—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) – document the change and handle 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 – document the change and handle 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.
  • a change of address – mail the individual Form H0025, HHSC Application for Voter Registration, to register to vote based on the new address. If the individual contacts CBS or 2-1-1 to decline the opportunity to register to vote after receipt of Form H0025, mail Form H1350, Opportunity to Register to Vote, to the individual for a signature. File Form H1350 in the case record when the individual returns the form and retain the form for at least 22 months.

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

Related Policy
Registering to Vote, A-1521

 

M—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:

  • MTFCY EDG, go to Step 4; and
  • SNAP EDG, follow Step 5 under the process for a case that includes a SNAP EDG in B-638, Returned Mail.
  1. 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:
    • Catholic Charities Diocese of Fort Worth
  • Catholic Charities Diocese of Galveston-Houston
  1. 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).

  1. 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 MTFCY 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 MTFCY EDG, if by the tenth calendar day due date the HPO/PAL information:

  • is provided, use the information to update the address in the TIERS record; or
  • 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.

  1. 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

M-2300, Fair Hearings

Revision 10-2; Effective April 1, 2010

 

 

M—2310 Appeals Procedures

Revision 10-2; Effective April 1, 2010

 

Medicaid for Transitioning Foster Care Youth applicants or recipients receiving a notice of adverse action are not entitled to continued benefits when benefits are denied for any reason if doing so would extend the 12-month continuous eligibility period or benefits past their 21st birthday.

See B-1000, Fair Hearings, for specific appeals policy and procedures.

 

 

M-2400, Automated Support

Revision 15-4; Effective October 1, 2015

 

 

M—2410  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 that are transferred to the Texas Health and Human Services Commission (HHSC) via the Texas Department of Family and Protective Services (DFPS) interface.