Texas Works Handbook

 


 

Other Medical Programs

Revision 17-2; Effective April 1, 2017

 

Effective February 1, 2017, HHSC no longer determines eligibility for Refugee Medical Assistance (RMA) and benefits provided to Unaccompanied Refugee Minors (URM's) under Former Foster Care Children (FFCC) or Medicaid for Transitioning Foster Care Youth (MTFCY).

Part A, Determining Eligibility

A-100, Application Process

Revision 18-4; Effective October 1, 2018

 

 

A—110 Application Procedures

Revision 11-2; Effective April 1, 2011

 

 

A—111 Pre-Application Process

Revision 15-4; Effective October 1, 2015

 

TANF

Before the Application process begins, staff deliver an up-front Texas Works message to the Temporary Assistance for Needy Families (TANF) applicants explaining that:

  • TANF is temporary and has time limits;
  • there are other alternatives and options for the applicant instead of TANF benefits;
  • an applicant should consider jobs and other resources (such as child support) before pursuing TANF;
  • if an applicant chooses to apply for assistance, the individual is requesting help finding a job; and
  • even if an applicant chooses not to apply for TANF, the individual still may apply for Medicaid and the Supplemental Nutrition Assistance Program (SNAP) to support employment while working toward self-sufficiency.

Staff must consider and determine which messages are appropriate for a particular applicant.

 

 

A—112 Application Assistance

Revision 15-4; Effective October 1, 2015

 

All Programs

If an applicant needs help completing the application packet, a volunteer or staff member must help. Anyone helping the applicant complete a paper application must initial the completed sections or sign the form showing that  a volunteer or staff person helped complete the application.

 

 

A—113 Application Requests and Submissions

Revision 15-4; Effective October 1, 2015

 

All Programs

Applications must be given to anyone who requests the form. Each household has the right to file an application on the same day the household contacts the office during office hours. The local office must ensure that a person can obtain an application packet within 15 minutes of coming into the office.

Staff must advise the household  that an applicant does not have to be interviewed before filing the application. The household may file an incomplete application as long as the form contains the applicant's name, address, and signature as explained in A-121, Receipt of Application.

Program Ways to Request an Application* Ways to Submit an Application Applications
TANF
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail; or
  • By fax.
  • YourTexasBenefits.com
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice;
      • Form H0025, HHSC Application for Voter Registration;
      • Form H0050, Parent Profile Questionnaire, for each absent parent;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.
SNAP
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail; or
  • By fax.
  • YourTexasBenefits.com
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice;
      • Form H0025, HHSC Application for Voter Registration;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.
Note: Form H1805, SNAP Food Benefits: Your Rights and Program Rules, must be included in the application packet or given to the applicant during the interview.
Medical Programs
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • Online through YourTexasBenefits.com;
  • In the local office;
  • By mail;
  • By fax; or
  • By phone.
  • YourTexasBenefits.com
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice (if applicable);
      • Form H0025, HHSC Application for Voter Registration;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.
  • Form H1205, Texas Streamlined Application:
    • Staff must also provide the following forms with the application:
      • Form H1830, Application/Review/Expiration/Appointment Notice (if applicable);
      • Form H0025, HHSC Application for Voter Registration;
      • Appropriate program pamphlets; and
      • A postage-paid return envelope.

* Staff must give the applicant an application on the same day it is requested. If a household contacts the local office by telephone and does not wish to come to the designated office to file an application on the same day of the request and prefers receiving the application by mail, staff send an application packet on the same day of the telephone request. For written requests, including those received electronically or by fax, staff mail an application packet on the same day the request is received.

The Texas Health and Human Services Commission (HHSC) must accommodate reasonable requests to receive communications by alternative means or at alternative locations. The individual must specify in writing the alternate mailing address or means of contact, and include a statement that using the home mailing address or normal means of contact could endanger the individual.

Note: Individuals applying for Medical Programs may also use the Marketplace-only applications explained in A-113.1, Application Forms. These applications can be submitted to HHSC in person, by fax, by mail, or via an account transfer explained in A-118, Coordination with the Federal Marketplace.

Related Policy
Registering to Vote, A-1521

 

 

A—113.1 Application Forms

Revision 15-4; Effective October 1, 2015

 

YourTexasBenefits.com

The online application on YourTexasBenefits.com integrates HHSC programs into one single application flow. Applicants only see the questions applicable to the programs they request. A PDF copy of the application information is created for applicants and advisors to view. 

Individuals use YourTexasBenefits.com to apply for the following benefits:

  • SNAP food benefits;
  • TANF cash help for families;
  • Health care for:
    • Children;
    • Adults caring for a child;
    • Adults not caring for a child (if this is selected, YourTexasBenefits.com will allow applicants to identify themselves as a refugee; if they are not a refugee, they will be redirected to HealthCare.gov);
    • Pregnant women;
    • Persons age 65 or older or persons with a disability; and
    • Persons under age 26 who were in foster care or who were unaccompanied refugee minors at age 18 or older;
  • Medicare Savings Programs; and
  • Long-term services and supports for:
    • Persons with intellectual or developmental disabilities; and
    • Persons with no intellectual or developmental disabilities.

Form H1010, Texas Works Application for Assistance — Your Texas Benefits

Form H1010 integrates Texas Works programs into one single application.

The addendum to Form H1010 — Form H1010-M, Applying for or Renewing Medicaid or CHIP? — captures the information needed to make an eligibility determination for Medicaid or the Children’s Health Insurance Program (CHIP).

Individuals use Form H1010 to apply for the following benefits:

  • SNAP food benefits;
  • TANF cash help for families; and
  • Health care for:
    • Children;
    • Adults caring for a child;
    • Adults not caring for a child;
    • Pregnant women; and
    • Persons under age 26 who were in foster care or who were unaccompanied refugee minors at age 18 or older. 

Form H1205, Texas Streamlined Application

Form H1205 can only be used to apply for health care benefits.

Individuals use Form H1205 to apply for the following benefits:

  • Health care for:
    • Children;
    • Adults caring for a child;
    • Adults not caring for a child;
    • Pregnant women; and
    • Persons under age 26 who were in foster care or who were unaccompanied refugee minors at age 18 or older. 

Applications Solely Used by the Marketplace

The online Marketplace application is a single interactive application that is based on an applicant’s selections. In addition, there are three paper applications for the Marketplace:

  • Application for Health Coverage — for anyone who needs health coverage, but does not need help paying for health insurance costs.
    • Used by applicants who want to purchase a Qualified Health Plan (QHP) through the Marketplace.
  • Application for Health Coverage & Help Paying Costs (Short Form) — for single adults who need help paying for health care coverage (mostly for states offering Medicaid expansion coverage to single adults ages 19 through 64) and who:
    • are not married, do not claim any tax dependents, and cannot be claimed as a tax dependent on someone else’s federal income tax return;
    • were not formerly in the foster care system; and
    • are not American Indian (AI)/Alaska Native (AN).
  • Application for Health Coverage & Help Paying Costs — for anyone who needs help paying for health care coverage, including:
    • individuals who are married, have tax dependents, or can be claimed as a tax dependent on someone else’s federal income tax return;
    • individuals with or without current health care coverage;
    • families that include immigrants; and
    • individuals who were formerly in the foster care system.

Since these applications do not contain additional questions that were included on Form H1205, Texas Streamlined Application, advisors must send out Form H1020, Request for Information or Action, to request any additional information necessary to make an eligibility determination. 

 

 

A—114 Applications Causing Conflicts of Interest

Revision 15-4; Effective October 1, 2015

 

All Programs

The advisor must avoid the appearance of impropriety or conflict of interest when determining eligibility. The advisor is not allowed to work on a case if the individual is a relative (by blood or marriage), roommate, dating companion, supervisor, or someone under the advisor's supervision. The advisor may never work on a case in which the advisor is a case participant or an authorized representative (AR).

The advisor:

  • may provide anyone with an application and information about how and where to apply for benefits;
  • may help a person gather any documents needed to verify eligibility; but
  • must not take any other role in determining eligibility.

The advisor must consult with the supervisor if the individual is a friend, acquaintance or coworker. Generally, the advisor should not work on cases involving these individuals, but the degree and nature of the relationship should be taken into account. In remote areas where it is impractical for another person to process the application, the unit supervisor should be contacted to determine the best method to process the application.

 

 

A—114.1 Applications Submitted by Texas Works or Medicaid for the Elderly and People with Disabilities Employees

Revision 18-1; Effective January 1, 2018

 

All Programs

Give special handling to applications and redeterminations submitted by Texas Works and Medicaid for the Elderly and People with Disabilities employees.

  • A Texas Works or MEPD employee at the next higher administrative position must complete the eligibility determination for another Texas Works employee.
  • A designated supervisor must complete the eligibility determination for a Texas Works or MEPD supervisor or higher position.
  • The employee's immediate supervisor or someone in the direct line of supervision may not process the Texas Works or MEPD employee's application.

 

 

A—115 Applications Filed in Hospitals and Clinics

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff in these outstationed facilities are responsible for processing work from end-to-end and routing completed work to the vendor as Image Only.

When a Texas Works application is received, Texas Works outstationed staff:

  • date stamp the document; and
  • perform inquiry and complete Application Registration in the Texas Integrated Eligibility Redesign System (TIERS), if necessary.

If the individual requests a program that requires an interview or the individual requests an interview, the appointment will be scheduled through the State Portal Scheduler to the appropriate outstationed facility location listed in the State Portal Scheduler.

If an appointment is not required or requested, staff must manually create the appropriate Process task via the State Create Task page.

Once an appointment is scheduled in the State Portal Scheduler, an appointment task is created for the designated outstationed facility based on the interview type.

If an application/redetermination received in an outstationed facility meets the SNAP Desk Review criteria, staff should follow the Desk Review process.

SNAP and TANF

For SNAP or TANF applications filed at hospitals or clinic sites, staff must make arrangements for the household to obtain a Lone Star Card and personal identification number (PIN) at a nearby local office, if they are not available at the hospital or clinic site.

Medical Programs

If an individual is admitted to a hospital and the individual has a pending Medicaid application in a local eligibility determination office, the outstationed advisor must coordinate with the local office to assist in providing missing information, so the local office can complete the case.

TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

The file date is the date a contracted facility accepts the application. If the application is not forwarded to HHSC within three business days, the file date is the date the local eligibility determination office receives the application.

 

 

A—116 Special Application Processes

Revision 12-2; Effective April 1, 2012

 

 

A—116.1 Reserved

Revision 15-4; Effective October 1, 2015

 

 

A—116.2 Applications from Residents of a Homeless Shelter

Revision 16-3; Effective July 1, 2016

 

SNAP

Individuals residing in a homeless shelter may be potentially eligible for SNAP, regardless of the number of meals the facility provides, if the homeless shelter is an approved institution. A homeless shelter is an approved institution if it is either:

  • a public or private, non-profit shelter for the homeless; or
  • a certified SNAP retailer.

Staff must verify if the homeless shelter is an approved institution, if questionable.

Individuals residing in homeless shelters that are not approved institutions are potentially eligible for SNAP only if the facility provides half of their meals or less as described in B490, Determining Whether an Individual Who Resides in a Facility Is Institutionalized.

Homeless households must meet the same household composition, income, and resource standards as other households. If the household pays for room in a shelter, staff must consider the payments as shelter expenses.

Related Policy
Nonmembers, A-232.1
Prepared Meals for Homeless, B-462
Homeless Shelter Standard, A-1427
Determining Whether an Individual Who Resides in a Facility Is Institutionalized, B-490

 

 

A—116.3 Applications for Babies Born to Women in Prison

Revision 15-4; Effective October 1, 2015

 

Medical Programs

A pregnant woman who enters the state prison system is sent to the Texas Department of Criminal Justice women's facility. Before the baby is born, the prison social worker assists the pregnant woman to arrange for a responsible individual to pick up the baby from the hospital. The pregnant woman is sent to a prison section of the University of Texas Medical Branch (UTMB) in Galveston a few weeks before she is due to deliver, unless an emergency occurs earlier. If an emergency does occur, she will deliver at a closer facility when necessary. Before releasing the baby from the hospital, UTMB requires the individual who picks up the baby to complete an application for Medicaid. Designated Texas Works advisors ensure that the baby is certified for Medicaid using special application processing procedures and follow-up activities.

The designated advisors coordinate Medicaid certification by other advisors in special situations when the newborn needs to be added to an active case. Upon request by the designated advisors, which must be documented in the case record, an advisor must certify the newborn:

  • for Medicaid (TP 43) from the date of birth (DOB), not the day the caretaker brought the baby home from the hospital; or
  • after normal application time frames have passed. If needed, staff may follow procedures to request a timeliness exception.

State law requires Medicaid coverage for Texas newborns for at least 28 days after birth and possibly longer if the child is hospitalized at that time. If the hospital followed required procedures before releasing the baby, but the baby does not meet eligibility requirements for Medicaid, the designated advisor and State Office Data Integrity (SODI) staff certify the baby for TA 62, MA - State-Paid Coverage. Examples of not meeting eligibility requirements are:

  • the individual caring for the child does not reside in Texas, and the baby will be taken out of state;
  • the individual caring for the child refuses to apply for Medicaid; or
  • the household is over the income limit.

Related Policy
Documentation Requirements, A-190
Medical Programs, A-240

 

 

A—116.4 SNAP Applications from a Contracted Community Partner (CP)

Revision 18-1; Effective January 1, 2018

 

SNAP

In March 2010, HHSC began a pilot program to allow CP staff from certain food banks to conduct the SNAP eligibility interview and collect as much information and verification as possible. A specially designed interview worksheet — Form H0901, HHSC Enhanced Data Gathering Worksheet — guides the CP interviewer through the interview process. Five specific CP food banks are taking part in the pilot program. HHSC contracts with the following food banks to provide application assistance:

  • Houston Food Bank;
  • North Texas Food Bank;
  • San Antonio Food Bank;
  • Tarrant Area Food Bank; and
  • South Plains Food Bank (limited to six counties in Region 1 — Bailey, Crosby, Floyd, Hockley, Lamb and Lubbock).

The file date of the interviewed application is the date the contracted CP receives the application for SNAP assistance and any other type of Texas Works benefits requested on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. For assistance beyond Texas Works programs, such as Medicaid for the Elderly and People with Disabilities program requests, advisors follow local office procedures to send the information through the appropriate channels.

If the CP accepts the application after traditional HHSC business hours or on a day that is not an HHSC workday (on a weekend or a holiday), the CP must advance the file date to the next HHSC workday. If the CP uses a date that is not an HHSC workday as the file date, the Texas Works advisor must correct the file date, enter the next HHSC workday as the file date, and document the reason for using the corrected file date. The advisor must also advance the interview date to the same date since the interview date cannot be any earlier than the file date.

CPs interview expedited and regular status households. The CP must send applications screened as potentially eligible for emergency benefits to HHSC on the day of receipt. The CP must send CP-interviewed applications with regular status, not expedited, to HHSC no later than three workdays from the date the CP receives the applications.

CPs maintain the interviewed applications on an electronic list for tracking purposes. The CP then emails the interviewed applications to a designated secure regional HHSC Outlook mailbox using Voltage Encryption. The CP places Form H0901, used exclusively by the CP interviewers, at the beginning of each application packet for which the CP conducted an interview. Since there will still be some households who only receive application assistance from the CP, Form H0901 will serve as the flag to notify HHSC staff that the CP has interviewed the household for SNAP.

TANF and Medical Programs

There is no deviation from normal processing for TANF or Medical Program requests that the CP submits with SNAP applications. For those households interviewed for SNAP by the CP, the advisor processing the TANF or Parents and Caretaker Relatives Medicaid must still conduct the TANF/Parents and Caretaker Relatives Medicaid interview. The advisor  may conduct this interview without first scheduling the appointment, but in order to meet the timeliness requirement, if the advisor is not able to contact the household to conduct the TANF/Parents and Caretaker Relatives Medicaid interview within three workdays after receiving the application, the office must schedule an appointment.

Assistance-Only Applications — All Programs

The CP routes assistance-only application packets to the Austin Document Processing Center for distribution to the proper local HHSC eligibility office (by applicant ZIP code) for normal processing. The file date of the assistance-only application is the date the contracted CP receives the application for SNAP assistance and for any other type of Texas Works assistance requested on Form H1010, Texas Works Application for Assistance — Your Texas Benefits.

While most CPs submit electronic applications online through YourTexasBenefits.com, some CPs use different computer systems that screen eligibility for various programs and services, including some services outside of HHSC programs. Two of these systems currently are able to submit electronic applications via an interface with HHSC, including applications for SNAP, Texas Works Medicaid and TANF. HHSC considers these applications e-signed the same as applications filed online. These applications display “E-signed” on all client signature lines and display the CP organization’s name in the People Helping You section. The Community-Based Organization (CBO) portal page does not report these applications, and the advisor does not need to complete the CBO Logical Unit of Work (LUW) with the CP’s information.

Pending Information

If the CP interviewer notes that more information is needed to complete the case, the CP interviewer will give a request for information form to the household.

The CP interviewer will give the applicant Form H0920, Notice from the Community Organization Helping You, explaining:

  • what is needed;
  • the due date for receipt of the information; and
  • the address and telephone number of the HHSC eligibility office where the information listed on Form H0920 should be returned.

The household has the option of returning requested information to the HHSC eligibility office or the CP. If the household chooses to return the requested information to the CP, the CP will send the pending information to the local HHSC eligibility office. The CP logs the pending information received from the household and forwards it to the proper eligibility office by encrypted email within three workdays of receipt.

Eligibility Decision

If the CP interviewer believes that all of the information to complete the case is present, the CP interviewer gives the household Form H0920 and indicates by marking the appropriate check box on Form H0920 that the CP will send the information and verification to HHSC for the final eligibility decision.

Form H0920 also informs the household that HHSC may determine whether additional information is needed to complete the case.

Rights and Responsibilities

Before completing the interview, CP interviewers will:

  • inform the household of their rights and responsibilities, using Form H1805, SNAP Food Benefits: Your Rights and Program Rules, including the right to appeal;
  • explain the difference between streamlined reporting and non-streamlined reporting; and
  • inform the household that HHSC will send them Form H1019, Report of Change, indicating the household's specific reporting requirements.

The CP interviewer addresses the following forms and activities:

  • Form H0025, HHSC Application for Voter Registration;
  • Lone Star Card training and materials; and
  • referrals for additional resources, if known, or to 2-1-1 Texas—Finding Help In Texas, if not known.

HHSC Action on CP-Interviewed SNAP Applications

The local HHSC office records receipt of all interviewed applications from the CP on an electronically maintained list. The Texas Works advisor reviews the application and the supporting documentation. If the supporting documentation and application are complete, the Texas Works advisor processes and disposes the application and sends the primary cardholder record to the Electronic Benefit Transfer (EBT) clerk for the CP-provided Lone Star Card. The HHSC advisor sends an eligibility notice and issues benefits.

If HHSC denies the application, HHSC notifies the individual about the denial action and the household's right to appeal the decision.

CP SNAP Interviews — Verification of Identity

CP staff who interview an applicant for SNAP and indicate on Form H0901 that staff verified the applicant's identity must include a copy of the document used to verify identity in the data collection packet that the CP sends to HHSC for eligibility determination and processing.

If the CP interviewer fails to send a copy of the document used to verify identity, was unable to verify the identity of the applicant, or the advisor determines that verification is questionable, the advisor must pend the applicant for verification of identity and obtain the verification before certifying the SNAP application.

Pending Information

If HHSC needs information to complete the case, the advisor sends Form H1020, Request for Information or Action, to the household and allows at least 10 days for the household to provide the information, following regular policy.

Advisors must send Form H1020:

  • to restate the same information requested by the CP; and
  • to request additional information, if any, not noted by the CP.

The advisor must then dispose the application following regular policy for pended applications. See A-136, Eligibility Decision.

If the household does not provide the needed information and the 30-day SNAP processing time frame expires, or if the information is not provided by the last workday of the last benefit month for redeterminations, the advisor denies the request for benefits and notifies the individual about the denial action and the household's right to appeal the decision.

Advisors must:

  • transfer all pertinent information gathered on Form H0920 to TIERS;
  • document that CP staff conducted the interview; and
  • document the specific food bank entity that conducted the interview.

Fair Hearings

HHSC staff represent the agency at all fair hearings. CP staff should refer individuals to the local HHSC eligibility office that serves them to submit a request for a fair hearing either by phone, in person, or by mail. If CP staff accepts a request for a fair hearing, they must send it to HHSC. The date of receipt for the fair hearing request is the date HHSC receives the request.

Scheduling a CP-Interviewed Appointment

Appropriate Office of Access and Eligibility Services (AES) staff must schedule appointments using the Portal Scheduler for cases interviewed by a CP. This allows for tracking via the Task List Manager (TLM). In many cases, the CP interview date will precede the date the HHSC eligibility office actually receives the application; therefore, OES staff use the Select Appointment option to locate a past appointment slot that corresponds to the CP interview date. To make sure that the appointment task is routed to the proper location handling the application, staff must overwrite the individual's ZIP code, which automatically displays once the case number is entered into the Portal Scheduler, with the ZIP code of the office that is processing the application.

Interview slots must be published in order to use the Select Appointment option. If there are no appointment slots published for a past date, AES staff note the appointment date in TIERS on the Appointment Details page. If AES staff do not specify an appointment date, the SNAP Eligibility Determination Group (EDG) will be pended. The TLM will not track appointments that are not scheduled in the Portal Scheduler. Note: Assistance-only applications (applications not interviewed by a CP) should follow normal scheduling procedures.

Once the case is completed, send the supporting documents used for eligibility decisions to the vendor for Image-Only processing.

Related Policy
Application Processing, A-100

Electronic Benefit Transfer (EBT)

Each CP is assigned a specific local HHSC eligibility office to facilitate Lone Star Card distributions and security activities. A list of each local HHSC office assigned to a particular CP is part of the local office security plan, and each CP must comply with the HHSC security plan. Regional EBT coordinators must audit the HHSC eligibility offices and the offices' related community partners.

If it appears that the household could be eligible for benefits, the CP provides an EBT Educational and Information Packet for Clients Applying for Supplemental Nutrition Assistance (SNAP) to the household. The packet includes the Lone Star Card, information explaining the EBT process, and contact information. The household will not be able to register the card or select a PIN until an HHSC staff member enters a primary cardholder record for the individual and associates the correct card to the individual.

If it appears the household is not eligible, the CP interviewer does not give the household a Lone Star Card or related materials, but still must process the request for benefits and submit the application online at YourTexasBenefits.com or send securely to the HHSC Centralized Processing Unit for an eligibility determination.

The CP interviewer gives households that appear to be eligible:

  • Form H1184, Here Is Your Lone Star Card; and
  • Form H1185, Important Information About Your Lone Star Card.

The CP interviewer must discuss the issuance-related items as explained in B239.1, Advisor Interview Requirements for Client Training, with potentially eligible applicants during the interview, even if the application is pended. In addition, CP interviewers must also tell the applicant about the:

  • benefits of keeping receipts to monitor one's SNAP EBT account balance;
  • expunged benefits policy (benefits that are not accessed after a year are expunged – see B371, Expungement Policy); and
  • procedures for using the Lone Star Card to access SNAP benefits in other states as explained in B351, Moves Out of State.

CP issuance staff give households that appear to be eligible a card sleeve.

The CP completes Form H1172, EBT Card, PIN and Data Entry Request, and the individual signs this form as acknowledgement of having received the EBT card. Form H0901, HHSC Enhanced Data Gathering Worksheet, also has a space to enter an existing cardholder's personal account number (PAN). CP interviewers must ask whether the household currently has a Lone Star Card. If the household says that there is an existing Lone Star Card, the CP interviewer must record the PAN on the last page of the data collection worksheet if the card is available. HHSC EBT staff must ensure that the card is linked to the proper case.

Form H1172 becomes part of the application package that the CP returns to the HHSC local office for eligibility determination. If HHSC determines the applicant is eligible, the advisor asks the EBT clerk (by sending Form H1172) to officially issue the card by linking the primary cardholder record with the card's PAN at the Administrative Terminal.

If applicants wish to add a secondary cardholder to their EBT card, applicants must contact the Lone Star Help Desk at 800-777-7328 (800-777-7EBT).

If the CP did not issue a Lone Star Card to a household eligible for SNAP benefits, the advisor must treat this situation like a certification following a telephone interview. The advisor must attempt to contact the household by telephone to give the household the choice of coming to the HHSC eligibility office to pick up the card or having the card mailed to the applicant's address.

Related Policy
Advisor Interview Requirements for Client Training, B239.1
Issuance Staff Requirements for Client Training, B239.2
Issuing Lone Star Cards for PCHs, B233.2
Applicants Interviewed by Phone, B233.2.2

 

 

A—116.5 Food Distribution Program on Indian Reservation (FDPIR)

Revision 11-3; Effective July 1, 2011

 

For application processing related to FDPIR, refer to the policy in B421, Food Distribution on Indian Reservation (FDPIR).

 

 

A—116.6 Joint SSI-SNAP Applications

Revision 11-3; Effective July 1, 2011

 

For application processing related to joint Supplemental Security Income (SSI)-SNAP applications, refer to the policy in B420, Joint SSI-SNAP Applications.

 

 

A—116.7 Types of Assistance Administered by Centralized Benefit Services (CBS)

Revision 11-3; Effective July 1, 2011

 

 

A—116.7.1 SNAP-CAP and SNAP-SSI

Revision 15-4; Effective October 1, 2015

 

For application processing related to SNAP-Combined Application Project (CAP) and SNAP-SSI, refer to the policy in B475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP), and B474.1.1.1, SNAP-Supplemental Security Income (SSI) Caseload.

 

 

A—116.7.2 Applications for SNAP-CAP

Revision 15-4; Effective October 1, 2015

 

For application processing related to SNAP-CAP, refer to the policy in B475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP).

 

 

A—116.7.3 Medicaid for Transitioning Foster Care Youth (MTFCY) (TP 70)

Revision 15-4; Effective October 1, 2015

 

For application processing related to MTFCY, staff should refer to policy in B474.1.2, Medical Programs, 2; and Other Medical Programs, Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

 

 

A—116.7.4 Medicaid Coverage for Children Placed in or Released from a Juvenile Facility

Revision 17-2; Effective April 1, 2017

 

For application processing related to Medicaid for children placed in the custody of or released from the Texas Juvenile Justice Department or Juvenile Probation Department, staff should refer to policy in B474.1.2.1, Child Placed in a Juvenile Facility, and B474.1.2.2, Child Released from a Juvenile Facility.

 

 

A—116.7.5 Medicaid for Breast and Cervical Cancer (MBCC)

Revision 15-4; Effective October 1, 2015

 

For application processing related to MBCC, staff should refer to policy in B474.1.2, Medical Programs, 4; and Other Medical Programs, Part X, Medicaid for Breast and Cervical Cancer (MBCC).

 

 

A—116.7.6 Reserved for Future Use 

 

 

 

A—116.7.7 Former Foster Care in Higher Education (FFCHE) (TA77)

Revision 11-3; Effective July 1, 2011

 

For application processing related to FFCHE, refer to policy in Other Medical Programs, Part F, Former Foster Care in Higher Education (FFCHE).

 

 

A—116.7.8 Former Foster Care Children (FFCC)

Revision 15-4; Effective October 1, 2015

 

For application processing related to FFCC, refer to policy in Other Medical Programs, Part E, Former Foster Care Children (FFCC).

 

 

A—117 Applications Filed Online through YourTexasBenefits.com

Revision 15-4; Effective October 1, 2015

 

When the household submits an application online, a process formats the information entered on the online application and imports certain data into TIERS. The process creates the PDF file of the application that is stored in the image repository and is viewable in the State Portal.

 

TIERS edits the data passed by YourTexasBenefits.com. The fields must contain valid characters and be valid values to be imported into TIERS. Dates must be in the correct format, fields that are numeric must contain only numbers and data must be in accepted ranges for fields with values such as Yes or No, or ZIP codes.

Applications that do not contain required data or have data that may be invalid may be rejected. When an application is rejected for electronic processing into TIERS, the system creates a non-SSP Application Registration Task List Manager (TLM) task.

Applications that are valid and accepted as electronic input into TIERS have an Application Registration TLM task created for them. The task is routed to the appropriate office based on Type of Assistance (TOA) and individual ZIP code for the clerk to perform the Application Registration process task.

 

 

A—117.1 Application Registration

Revision 15-4; Effective October 1, 2015

 

Clerks select the Application Registration task and review the application. Staff will perform Application Registration using certain pre-filled data from the online application that was entered by the individual. All online applications must have Application Registration processed even if the case is approved. It is important to associate the online application to the existing case.

 

A logical unit of work (LUW) is in Application Registration; Self-Service Application Search. Clerks search for the self-service application using any of the fields in the search area. The search results will be displayed by the head of household name even when the search was not on the head of household.

After successful Application Registration, an appointment or process task will be created for Data Collection, depending upon the programs requested on the online application.

The Application T number is changed to a case number upon clicking Submit in Application Registration.

 

 

A—117.2 Data Collection

Revision 15-4; Effective October 1, 2015

 

When performing Data Collection, the data entered in the online application is displayed for the advisor either as:

 

  • pre-filled TIERS fields and a message at the top of the page stating that the fields are pre-filled from self-service data (for new applications); or
  • YourTexasBenefits.com information that must be addressed, which displays in a comparison pop-up window (existing cases).

Click on the C icon in the Details page to access the comparison pop-up.

The comparison pop-up window displays the current data in TIERS and the data from the online application to allow the advisor to select the correct data to use in Data Collection.

The advisor may choose to:

  • accept all TIERS data,
  • accept all YourTexasBenefits.com data, or
  • select each data element to be used individually from the comparison pop-up.

These comparison windows are displayed on most Data Collection pages through Resources. There is no YourTexasBenefits.com information or comparison windows in the Program, Income or Expenses pages. The advisor must complete the Data Collection driver flow.

A screen is added in the driver flow just before Run Eligibility. This screen is a summary screen that displays each LUW with YourTexasBenefits.com comparison data and the status of that data. Once the case is disposed, all YourTexasBenefits.com comparison data that was not resolved or processed will be marked completed by the system.

 

 

A—118 Coordination with the Federal Marketplace

Revision 15-4; Effective October 1, 2015

 

Medical Programs

HHSC and the federal Marketplace coordinate eligibility determinations for Texas Works Medicaid and CHIP. Information provided by the applicant or verified for the applicant is sent through an interface between the Marketplace and HHSC. The two systems — the Marketplace and HHSC — transfer an applicant’s information from one system to the other. The transfer of application information is referred to as an account transfer. An account transfer is the way in which a client’s information moves between the Marketplace and HHSC.

 

 

A—118.1 Applications Received from the Marketplace

Revision 15-4; Effective October 1, 2015

 

Medical Programs

The Marketplace sends the individual’s or household’s information electronically to HHSC via an account transfer when:

  • the Marketplace determines the applicant is potentially eligible for Medical Programs available through HHSC; or
  • the applicant requests a final eligibility determination for Texas Works Medicaid or CHIP from HHSC. This is referred to as a “full determination.”

Applications sent via account transfers from the Marketplace are received by staff in the same manner as an application from YourTexasBenefits.com

When an application is sent to HHSC via an account transfer, a PDF is populated with information provided by the applicant on the Marketplace application, along with a “Verifications” section that provides information on any verifications performed by the Marketplace. Advisors should enter the information provided on the PDF into TIERS.

Individuals cannot be required to provide the same information more than once, regardless of whether they apply through the Marketplace or through HHSC. This applies to any information provided on an application, as well as any verification materials provided by the applicant.

Related Policy
Verifications Provided by the Marketplace, A-118.1.2

 

 

A—118.1.1 Non-MAGI Account Transfers

Revision 15-4; Effective October 1, 2015

 

Medical Programs

A non-Modified Adjusted Gross Income (non-MAGI) account transfer is an account transfer that is sent from the Marketplace to HHSC when the Marketplace has identified that an applicant may be eligible for Medicaid for the Elderly and People with Disabilities (MEPD) because the applicant reported being age 65 or older, having a disability, or being blind. In order for an individual to apply for MEPD programs, they must submit an MEPD application, Form H1200, Application for Assistance — Your Texas Benefits.

Advisors must deny the application as “Filed in Error” and send the applicant Form H1200 if:

  • the PDF included in the account transfer indicates “Medicaid Non-MAGI Eligibility” in the Referral Activity Eligibility Reason for an individual on the application;
  • a “full determination” is not requested; and
  • a determination for Texas Works Medicaid or CHIP is not listed for any other applicant on the application.

 

 

A—118.1.2 Verifications Provided by the Marketplace

Revision 15-4; Effective October 1, 2015

 

Medical Programs

For Marketplace account transfers, the PDF also includes a “Verifications” section. Advisors should use the verification section as follows:

  • If the Marketplace has verified the applicant's Social Security number (SSN) or citizenship status using data from the Social Security Administration (SSA), advisors can identify that information in TIERS as "Verified by SSA."
  • If the Marketplace has verified the applicant's alien status using data from the Department of Homeland Security (DHS), advisors can identify that information in TIERS as "Verified by DHS."
  • All other applicant information, such as income, must be verified by an HHSC advisor according to HHSC procedures explained in C900, Verification and Documentation. If the Marketplace has verified the information according to HHSC procedures, then that data must be treated as verified.

 

 

A—118.2 Applications Sent to the Marketplace

Revision 15-4; Effective October 1, 2015

 

Medical Programs

When HHSC determines that a client is ineligible for Texas Works Medicaid or CHIP (due to Texas eligibility requirements), or that the client is only eligible for TP 56, Medically Needy with Spend Down; TP 32, Medically Needy with Spend Down-Emergency; or three months prior Medicaid, HHSC transfers that individual’s account information to the Marketplace to be assessed for eligibility for other health care coverage programs. Form TF0001, Notice of Case Action, informs the client that they have been transferred to the Marketplace.

 

 

A—119 Correspondence Options

Revision 15-4; Effective October 1, 2015

 

 

 

 

 

A—119.1 Electronic Correspondence

Revision 15-4; Effective October 1, 2015

 

All Programs

The head of household or authorized representative (AR) for a case may each choose at any time to receive most eligibility correspondence electronically rather than through the mail. By selecting this option, applicable forms and notices are posted to the client’s or AR’s YourTexasBenefits.com case account, and the client or AR receives a cell phone text message or email reminder each time a new form or notice has been posted to their account. Clients may print a copy of the correspondence from their account or request that a paper copy be mailed to them. Any forms or notices that are not available electronically will continue to be mailed to the client. 

Once a head of household or AR has opted to receive electronic correspondence through their case account on YourTexasBenefits.com or by indicating that preference to staff through 2-1-1 (Option 2), a confirmation cell phone text message or email reminder will be sent to the client. The head of household or AR must enter the code provided in that confirmation message in their YourTexasBenefits.com case account in order to confirm their choice to receive electronic correspondence. Once confirmed, Form H1013, Electronic Correspondence Confirmation Letter, will automatically be mailed to the head of household or AR to further confirm the selection and to provide instructions about how to opt out of receiving electronic correspondence.

After a failed delivery of a text or email alert, the client is automatically unsubscribed from electronic correspondence. The eligibility system then automatically prints and mails to the client a paper copy of the correspondence that failed to reach the client with the original generation date, attached to Form H1015, Electronic Correspondence Failed Delivery. The client will receive future correspondence through the mail. However, the client may opt to subscribe again to receive electronic correspondence and start over the confirmation process.

 

 

A—119.2 Preferred Language for Correspondence

Revision 15-4; Effective October 1, 2015

 

All Programs

The head of household or AR for a case has the ability to choose the language in which certain forms and notices are generated from the eligibility system. The head of household or AR can select their primary household language from the following options:

  • English
  • Spanish
  • Both English and Spanish
  • Vietnamese*

* Clients who select Vietnamese as their primary household language will receive correspondence in English, and the eligibility system will automatically attach to the form or notice the Vietnamese Translation Interpreter Form, which directs clients to translation services.

Once a primary household language is selected, both the head of household and AR will receive correspondence in that language.

 

 

A—120 Office Procedures

Revision 08-1; Effective January 1, 2008
 

 

 

A—121 Receipt of Application

Revision 17-2; Effective April 1, 2017

 

All Programs

If the agency receives an application without a signature, follow the policy in A-122.1, Application Signature.

TANF

An application is valid as long as it contains the applicant's name, the applicant’s address, and the signature of:

  • the applicant; or
  • an authorized representative (AR) if the applicant is incapacitated or incompetent.

SNAP

An application is valid as long as it contains the applicant's name, the applicant’s address, and the signature of:

  • the applicant;
  • other responsible household member; or
  • the AR of an applicant.

Medical Programs

An application is valid as long as it contains the applicant's name, the applicant’s address, and the signature of:

  • the applicant;
  • the AR of  an applicant; 
  • an individual age 19 or older who:
    • is included in the applicant’s household composition; or
    • has a tax relationship with the applicant; or
  • an individual who satisfies the definition of caretaker when the applicant is under age 19.

Note: Individuals are not required to live at the same physical address in order to apply for each other if they have a tax relationship as explained in A-240, Medical Programs. For example, a non-custodial parent may apply for Medicaid and CHIP on behalf of his or her child if the parent expects to claim the child as a tax dependent on his or her federal income tax return.

TP 43, TP 44 and TP 48

A new application is not required when an individual has an active Medicaid type program and requests to add another child for whom a new EDG is needed. Add the child to the case as explained in B-641, Additions to the Household. Exception: Staff must not add additional children/siblings to a case where a denied EDG was reinstated due to the release from a juvenile facility. The household must submit an application for the additional children/siblings. To identify these EDGs, view the Individual – Medicaid History page for the active child. If the Juvenile Placement History field has "Yes", the EDG has been reinstated.

This policy does not apply when there is no existing Children's Medicaid EDG. For example, advisors do not add a child when the only other child is certified for Medicaid because the certified child receives SSI. A separate application is required to initiate benefits for the child being added. Also, advisors do not add an "other-related" child to an existing Medicaid case. This situation requires a separate application for Children's Medicaid.

Related Policy
Application Requests and Submissions, A-113
Filing the Application, A-122
Application Signature, A-122.1
Authorized Representatives (AR), A-170
Children's Medicaid Redetermination Expectations, B123.6
Denied EDGs, B-474.7

 

 

A—121.1 Receipt of Application from Residential Child Care Facility

Revision 15-4; Effective October 1, 2015

 

Medical Programs

When a representative from a licensed residential child care facility applies for an independent child who does not live in the county, staff should accept and process the application.

 

 

A—121.2 Receipt of Duplicate Application

Revision 15-4; Effective October 1, 2015

 

All Programs

 

A duplicate application:

  • is an application filed after another application has already been filed;
  • does not include a request for programs different from programs requested on the initial application submitted;
  • does not include a request for programs different from programs currently received by the applicant; and
  • is not needed for a redetermination of any active program.

Example:  If a household submits an application for SNAP on January 2 and later submits one or more additional applications for SNAP that are different from the one the household filed on January 2, and are not needed for a redetermination of any active program, the additional application submitted is considered a duplicate application.

Duplicate Application Received While Original Application Is Being Processed

If an office receives a duplicate application while staff are in the process of making an eligibility determination (an application or redetermination) based on the original application submitted, staff must:

  • treat the duplicate application as a report of change; and
  • assign the duplicate application as a change to the advisor currently processing the case.

The advisor processing the original application must:

  • review the duplicate application for reported changes;
  • document the duplicate application was reviewed for changes;
  • document the type of changes, if changes were reported on the duplicate application; and
  • use information provided by the household on both the original application and the duplicate application when determining eligibility for the household.

Duplicate Application Received After Original Application Is Processed

If an office receives a duplicate application and the applicant has already been certified for assistance based on another application previously submitted, staff must review the duplicate application to determine if the household is applying for programs other than what the household is currently receiving and if any redeterminations are due.

If the household is applying for different types of programs, the application is not a duplicate application and must be processed as a new application for assistance.

If the household is not applying for a different type of program and there are no redeterminations, office staff must:

  • treat the duplicate application as a report of change; and
  • assign the duplicate application as a change indicating "duplicate application."

Staff are not required to create a T number for TIERS cases and/or dispose of a duplicate application as "filed in error." If staff erroneously create a T number, staff must deny/dispose the T number as filed in error, in addition to other required actions listed above.

Note: If the office that receives the duplicate application does not normally process reported changes, staff may mark the application form as a duplicate application and route it to appropriate staff following local office procedures.

Advisors who process the duplicate application as a reported change must review the application to determine if any changes are indicated and take the following action. If no change is indicated on the duplicate application, the advisor must:

  • document receipt of the duplicate application in TIERS Case Comments;
  • route the duplicate application to be imaged as part of the electronic case record;
  • sustain the benefits for each Texas Works program the household receives; and
  • send an individual notice to the household that eligibility for benefits has not changed.

If a change is indicated on the duplicate application, staff must follow the procedures outlined in B600, Changes, when processing changes reported on the duplicate application.

 

 

A—121.3 Receipt of Identical Application

Revision 15-4; Effective October 1, 2015

 

All Programs

 

An identical application is one or more exact copy of an application previously filed by an applicant.

Example: If a household faxes in an application on January 2 and later submits an exact copy of the same application, which includes the same signature and date of the application the household previously submitted, the newly submitted application is considered an identical application.

Required Action on Identical Application Received

If an identical application is received, staff must write "Identical Application" on the front page of the application and route the application for imaging. The vendor will image the identical application and add it to the electronic case record. No other action is needed.

 

 

A—122 Filing the Application

Revision 15-4; Effective October 1, 2015

 

All Programs

 

Staff should encourage households to file an application the same day the household or its representative contacts the office in person, by telephone, fax, or mail, and expresses interest in obtaining assistance. Staff should explain how to file an application. Application forms are also available at YourTexasBenefits.com and can be downloaded, printed, and electronically submitted.

The file date is the day HHSC receives an application form containing the applicant's name, address, and appropriate signature. This is day zero in the application process. Staff use this as the file date to determine eligibility for the programs the household requests upon filing the application through the time of the interview.

For electronically filed applications, the file date is the date the applicant clicks the “Submit Application” button in YourTexasBenefits.com.

Exception: For all applications received outside of business hours when HHSC is closed, including weekends and holidays, the file date is the next business day.

The household must file another application form to apply for additional programs after the interview is held, even if the case was pended and is not completed at the time of the request for a new program. Exception: If the household requests three months prior Medicaid coverage according to policies in A-831.2, Eligibility for Three Months Prior Coverage, staff use a previously filed application with a file date that corresponds with the three-month prior period as a basis for determining eligibility.

Once an application is filed, staff must take the following actions:

  • enter the file date in the appropriate section on the application form, if received as a paper document;
  • for SNAP and TP 40, screen the application for expedited service eligibility;
  • upon request, give the household Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change;
  • register the application when required; and
  • schedule an interview appointment for the applicant when required as soon as possible.

See special procedures in this section to determine the file date for TP 40, TP 40 Continuous Coverage and TP 45 Retroactive Coverage.

Related Policy
Application Requests and Submissions, A-113
Receipt of Application, A-121
Documentation Requirements, A-190

TP 40 Continuous Coverage

The file date is the date the advisor determines eligibility, if an application form is not used.

Related Policy
Continuous Medicaid Coverage, A-832

TP 45 Retroactive Coverage

The file date is the date the advisor is notified about the child's unpaid medical bills.

Related Policy
TP 45 Retroactive Coverage, A-833

TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

The file date is the date a contracted facility accepts the application. If the application is not forwarded to HHSC within three business days, the file date is the date the HHSC office receives the application.

The file date is the date an individual submits an application to any HHSC office. The application must be faxed or mailed to the correct office the same day it is returned.

For electronically filed applications, the file date is the date the applicant clicks the “Submit Application” button in YourTexasBenefits.com. For applications received outside of business hours when HHSC is closed, including weekends and holidays, the file date is the next business day.

 

 

A—122.1 Application Signature

Revision 17-2; Effective April 1, 2017

 

All Programs

The applicant is required to provide a signed application form before being certified.

If the agency receives an application without a signature and the application has not been date stamped, the application is considered invalid. Staff must return the application with a letter and a self-addressed return envelope explaining that the application must be signed before the agency can establish a file date.

If the agency accepts an application without a signature and the application has been date stamped, the date the application is received is considered a valid file date. Staff must send Form H1020, Request for Information or Action, along with the signature page requesting a signature. If the applicant fails to provide a signed application by the final due date, staff must deny the application for failure to provide information.

 

Eligibility Support Vendor Action on Unsigned Applications

If the Eligibility Support vendor receives an unsigned application and takes action on that application within one business day, the application is invalid and is returned to the household with a letter and a self-addressed return envelope explaining that the application must be signed before a file date can be established.

If the Eligibility Support vendor accepts an application without a signature, and it is not identified as such before data entry or the data entry date is more than one business day after the receipt date of the application, the file date is protected. The file date is the receipt date of the application. The missing signature is treated as missing information.

 

Electronically Filed Applications

All Programs

For applications submitted online through YourTexasBenefits.com by the applicant or AR, staff must consider the application electronically signed.

Exception: Staff must not consider the application electronically signed when a non-client or non-AR completes and submits the online application for the household. In this situation, a pre-populated application is mailed to the household requesting a written signature from the applicant.

 

Applications Filed by Telephone

For certain programs, an applicant or AR may complete and sign an application by telephone:

Program

Complete Application by Telephone

Sign Application by Telephone

SNAP

No

No

TANF

Yes

No

Medical Programs

Yes

Yes

 

An applicant or AR who requests to apply for all programs by telephone is informed that the option to complete and sign an application for all programs by telephone is not available. The customer care representative directs the applicant or AR to submit an application online through YourTexasBenefits.com, by mail, by fax, or at a local office.

TANF

The applicant or AR completes an application over the telephone by providing their information to the customer care representative. However, the applicant or AR does not have the option to sign the application by telephone. The customer care representative enters the information provided by the applicant or AR through YourTexasBenefits.com and a pre-populated application is mailed to the household requesting a written signature from the applicant.

 

SNAP

The applicant or AR does not have the option to complete or sign the application by telephone.

 

Medical Programs

The applicant or AR may complete and sign an application over the telephone by:

  • providing their information over the telephone to the customer care representative; and
  • signing the application over the telephone by stating their name and agreeing to a penalty of perjury statement read by the customer care representative.

The customer care representative enters and submits the information provided by the applicant or AR through YourTexasBenefits.com.

Note: TW Advisors, MEPD Specialists, and other HHSC staff cannot accept telephonic signatures.

For applications signed and submitted over the telephone by the applicant or AR, staff must consider the application signed by telephone except in the following situation:

  • the applicant or AR declines to sign the application by telephone; or
  • a non-client or non-AR completes and signs the application by telephone for the household.

Correspondence is sent based on the following actions taken by the applicant or AR:

Action

Correspondence

Applicant or AR signs the application by telephone
  • Form H1031, Telephonic Signatures Cover Letter, which notifies the individual they submitted a telephonically-signed application or renewal. 

Applicant or AR declines to sign the application by telephone

  • Form M5021A, Request for Missing Signature Cover Letter, which notifies the individual a signature is needed to complete the application process for TW medical programs; and
  • Form H1010, Texas Works Application for Assistance - Your Texas Benefits, the unsigned application for TW medical programs, which is populated with information provided over the phone.

OR

  • Form M5021C, Cover Letter for Missing Signature Letter, which notifies the individual a signature is needed to complete the application process for TW medical and MEPD programs;
  • Form H1010, Texas Works Application for Assistance - Your Texas Benefits, the unsigned application for TW medical programs which is populated with information provided over the phone; and
  • Form H1200, Application for Assistance (Aged and Disabled), the unsigned application for MEPD, which is populated with information provided over the phone.

 

Notes:

  • Individuals that sign a renewal by telephone receive the same correspondence, Form H1031, Telephonic Signatures Cover Letter, as individuals that sign an application by telephone.
  • Individuals that decline to sign a renewal by telephone receive the following correspondence:
    • Form H1032, Cover Letter for Unsigned Your Texas Benefits Renewal Form, which notifies the individual a signature is needed to complete the renewal process; and
    • Form H2020-YTB, Your Texas Benefits Renewal Form, the unsigned renewal populated with information provided over the phone.

Related Policy

Application Requests and Submissions, A-113 

Authorized Representatives (AR), A-170

 

Signatures Elsewhere

All Programs

If the applicant signs the first page of Form H1010, Texas Works Application for Assistance - Your Texas Benefits, but not the last page, the application can still be used to establish a file date. The applicant must still provide a signature for the last page to be certified.

If a signed first page of Form H1010 is received, staff must send Form H1020 requesting a signature on the last page of Form H1010 by the final due date. Applicants who fail to provide a signed last page of Form H1010 must be denied for failure to furnish information.

Note: If the applicant only provides a signed last page of Form H1010, staff does not require an additional signature for the first page of Form H1010.

 

Medical Programs

If an applicant only signs and returns Form H1010-MR, MAGI Renewal Addendum, without a corresponding application, the application is considered invalid.

If the applicant returns a signed application without Form H1010-MR, the application is considered incomplete. The advisor must send Form H1020, Request for Information or Action, with Form H1010-MR requesting the necessary information to make a determination based on Modified Adjusted Gross Income (MAGI) rules. If the applicant fails to provide a completed Form H1010-MR by the final due date, staff must deny the request for failure to provide information.

Related Policy
Application Requests and Submissions, A-113
Receipt of Application, A-121

 

 

 

A—122.2 Scheduling Appointments

Revision 15-4; Effective October 1, 2015

 

All Programs except TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44, TP 45 and TP 48

 

Provide the individual with an appointment on Form H1830, Application/Review/Expiration/Appointment Notice, on the same day the individual submits an application unless the individual is interviewed on the same day. An appointment is required even if the application is filed with only a name, address and signature.

Exception: Staff sends Form H1830 no later than the next business day if the individual submits the application by mail or in an office drop box.

This policy applies to all new applications and untimely SNAP applications that are filed after the last day of the last benefit month.

Note: Staff should attempt to schedule the interview on a date and time that accommodates the needs of the household, such as after working hours if the only adult is working.

When scheduling a telephone interview, staff enters the individual’s telephone number and the appropriate time, using one-hour increments. For example, a telephone interview will be conducted between 1 p.m. and 2 p.m. Local offices may choose to establish a shorter time increment.

TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44, TP 45 and TP 48

There is no interview requirement for Children's Medicaid or Medicaid for Pregnant Women. Staff must process the application unless the individual requests an office appointment.  

Exceptions:

  • If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice, or for missing an appointment related to Health Care Orientation (HCO) or THSteps, staff should schedule a telephone appointment and deliver the HCO, or remind the individual about the importance of the THSteps checkup at that time.
  • Staff conducts a telephone interview for an initial application or renewal when HHSC receives conflicting information related to household composition or income that affects eligibility and the information cannot be verified through other means, such as an associated EDG.

Related Policy
Interviews, A-131
Explanation of Benefits, A-1531.4

 

 

A—122.3 Registering an Application

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff must perform Application Registration (App Reg) within one workday after the file date when application registration is required.

To prevent overpayments or incorrectly providing benefits, staff must take the following action before registering an application:

  • screen each application filed; and
  • associate the old case number in File Clearance when appropriate.

Perform inquiry on all household members applying for benefits listed on the application for assistance. Use Social Security numbers (SSNs), case name search, and/or available case or EDG numbers to determine case status.

If inquiry shows … then …
no record, follow established local office procedures for processing applications.
an individual record, check case/EDG status (active or denied). If the case is active, determine if the individual is currently active on another case in the same program. If the individual is:
  • not currently active in the same program, register the application.
  • entitled to dual SNAP participation as a resident of a shelter for battered persons, follow procedures in B454.1, Duplicate Participation Procedures.
  • currently active in the same program and is not entitled to dual benefits, take appropriate action to prevent duplicate participation. Process an overpayment, if applicable.
If the case is denied, associate the old case number in File Clearance after determining that this is the same household.
a SNAP-CAP or SNAP-SSI case record, check for CBS status in TIERS inquiry. SNAP-CAP will be listed as FS-SNAP under Current EDG Affiliations in case inquiry results and under Current Eligibility in individual inquiry results. SNAP-SSI will be listed as FS-SSI under Current EDG Affiliations in case inquiry results and under Current Eligibility in individual inquiry results. Follow established local office procedures applicable to the specific case situation.

 

SNAP

Staff must review the application for assistance to determine if the household is requesting a telephone interview due to a hardship.

Note: Staff use Form H1000-A, Notice of Application, to register applications and to obtain a unique EDG number when:

  • TIERS is down for an extended period;
  • the household is not known to TIERS;
  • the household is eligible for expedited services; and
  • the Administrative Terminal Application (ATA) must be used to assign the EDG number and issue benefits.

 

 

A—123 Withdrawal of an Application

Revision 15-4; Effective October 1, 2015

 

All Programs

The individual may voluntarily withdraw an application any time before certification.

 

SNAP

If someone other than the head of household, spouse, a responsible household member, or an AR requests a withdrawal, staff should contact the household to confirm the withdrawal.

Related Policy
The Texas Works Message, A-1527

 

 

A—124 Processing Presumptive Eligibility Applications

Revision 15-3; Effective July 1, 2015

 

TA 66, TA 74, TA 75, TA 76, TA 83, TA 86 and TP 42

Presumptive eligibility (PE) provides short-term medical coverage to pregnant women, MBCC applicants, children under age 19, parents and caretaker relatives of dependent children under age 19, and former foster care children. PE provides full fee-for-service Medicaid with the exception of pregnant women. Pregnant women receive ambulatory prenatal care only.

Qualified hospitals (QHs) determine PE for all groups except MBCC.

Qualified entities (QEs) determine PE for pregnant women and MBCC applicants. For MBCC applicants, only QEs that are also Texas Department of State Health Services (DSHS) Breast and Cervical Cancer Services contractors may make MBCC PE determinations, following the process outlined in X100, Application Processing.

 

 

A—124.1 Eligible Groups

Revision 15-3; Effective July 1, 2015

 

The following groups can receive presumptive eligibility coverage:

  • Children:
    • MA-Children Under 1 Presumptive — TA 74
    • MA-Children 1–5 Presumptive — TA 75
    • MA-Children 6–18 Presumptive — TA 76
  • Former Foster Care Children (MA-FFCC Presumptive — TA 83)
  • Pregnant Women (MA-Pregnant Women Presumptive — TP 42)
  • Parents and Other Caretaker Relatives (MA-Parents and Caretaker Relatives Presumptive — TA 86)

 

 

A—124.2 File Clearance

Revision 15-3; Effective July 1, 2015

 

TIERS performs automated file clearance for each individual determined presumptively eligible if the individual has a 100 percent match in TIERS or if there is no match for the individual in TIERS. For individuals for whom TIERS cannot perform automated file clearance, TIERS triggers an alert to create a TLM task for staff to manually do file clearance for the individual. TIERS routes manual file clearance tasks to the Out-stationed Worker Program (OWP) queue for assignment and processing.

 

 

A—124.3 Task List Manager

Revision 15-3; Effective July 1, 2015

 

When TIERS cannot automatically perform file clearance for an individual whom a QH/QE has determined to be presumptively eligible, an OWP advisor needs to take action. TIERS creates the task "Process a File Clearance Failure for Presumptive Eligibility" and sends it to an OWP advisor based on the applicant's ZIP code.

To complete the task, the advisor:

  1. Selects the Work icon.
  2. Selects the individual who needs file clearance from the Presumptive Eligibility Individual — Summary page.
  3. Matches the PE individual to the TIERS individual on the PE File Clearance — Results page.
  4. Selects Auto Process PE on the File Clearance — Results page to complete the task once the advisor has performed file clearance for all individuals on the case.  

The advisor can also manually clear the task. When an advisor searches for an application on the Self Service Application Search page, the SS Application Search Results section displays a Determine PE link if a PE individual on the case requires manual file clearance. TIERS displays the Presumptive Eligibility Individual — Summary page when the advisor clicks the link.

Once the advisor completes file clearance, TIERS notifies TLM to close the QH/QE PE task.

 

 

A—124.4 Application Processing

Revision 15-3; Effective July 1, 2015

 

The TLM routes applications for regular Medicaid from individuals whom a QH/QE has determined to be presumptively eligible for Medicaid to an OWP advisor for processing. If the QH has an OWP advisor, the TLM assigns the application to that advisor for processing. If the QH does not have an OWP advisor or a QE submits the application, the TLM routes the application to the regional OWP queue.

Process the applications using current policy and application processing time frames. See B112, Deadlines. If both a PE task for file clearance and a regular Medicaid application exist for the same person, clear the PE task first.

 

 

A—124.5 Verifications

Revision 15-3; Effective July 1, 2015

 

Use standard verification requirements when processing an application for regular Medicaid from an individual determined presumptively eligible. See C900, Verification and Documentation.

Related Policy
Verifications, C1113.4

 

 

A—124.6 Medical Effective Date

Revision 15-4; Effective October 1, 2015

 

The medical effective date for PE is the date that the QH or QE determines the individual is presumptively eligible for Medicaid. 

Note: An individual is not eligible for PE coverage if the individual is currently certified for Medicaid, CHIP or CHIP perinatal.  

If the individual does not apply for regular Medicaid, PE coverage ends the last day of the month after the month of the PE determination (see scenario 1 below).

If the individual submits Form H1205, Texas Streamlined Application, or Form H1010, Texas Works Application for Assistance — Your Texas Benefits, HHSC determines whether the individual is eligible for regular Medicaid. If the person is not eligible for regular Medicaid, the individual's PE coverage ends the date that HHSC determines the individual is ineligible (see scenario 2 below). If the person is eligible for regular Medicaid, the person’s PE coverage ends when HHSC makes the Medicaid eligibility determination, following cutoff rules. 

If an individual is Medicaid-eligible during the application month, the individual receives Medicaid from the first of that month through the PE MED. Regular Medicaid coverage for the ongoing period starts once the PE period ends (see scenarios 3 and 4 below).  Exception: Since PE for pregnant women provides only limited prenatal services, ongoing Medicaid coverage overlays the PE coverage (see scenario 5 below). 

Examples: 

PE Scenarios
  1. Individual does not apply for regular Medicaid
A child is determined eligible for MA-Children 6–18 Presumptive on February 2. Her mother does not submit an application for regular Medicaid. The child’s PE coverage ends on March 31. 
  1. Individual is ineligible for regular Medicaid
A child is determined eligible for MA-Children Under 1 Presumptive on April 4. Her father submits an application for regular Medicaid on the same date. HHSC determines on April 20 that the child is not eligible for regular Medicaid. Her PE coverage ends on April 20.
  1. Individual is eligible for regular Medicaid (HHSC makes eligibility determination before cutoff)
A child is determined eligible for MA-Children 1–5 Presumptive on March 6. His mother submits an application for regular Medicaid on the same date. HHSC determines on March 15 (before cutoff) that the child is eligible for regular Medicaid. His PE coverage ends March 31. He is certified for regular Medicaid effective March 1 to March 5 and April 1 through ongoing. 
  1. Individual is eligible for regular Medicaid (HHSC makes eligibility determination after cutoff)
A former foster care child is determined eligible for MA-FFCC Presumptive on May 9. He submits an application for regular Medicaid on the same date. HHSC determines on May 22 (after cutoff) that the individual is eligible for regular Medicaid. His PE coverage ends June 30. He is certified for regular Medicaid effective May 1 to May 8 and July 1 through ongoing. 
  1. Pregnant woman is eligible for regular Medicaid
A woman is determined eligible for MA-Pregnant Women Presumptive on June 4. She submits an application for regular Medicaid on the same date. HHSC determines on June 10 that the woman is eligible for regular Medicaid. Her PE coverage ends on June 30. Regular Medicaid overlays her PE coverage with an effective date of June 1.

 

 

A—124.7 Periods of Presumptive Eligibility

Revision 15-3; Effective July 1, 2015

 

Pregnant women are allowed one PE period per pregnancy.

For all other PE groups, an individual is allowed no more than one period of PE per two calendar years. Example: An individual receives PE for children ages 6–18 in June 2015. He cannot receive another period of PE until January 2017.

 

 

A—124.8 Fair Hearings

Revision 15-3; Effective July 1, 2015

 

Appeals and fair hearings do not apply to PE.

 

 

A—124.9 Questions About the Presumptive Eligibility Process

Revision 15-3; Effective July 1, 2015

 

Refer hospitals and entities that are interested in becoming qualified to make PE decisions to the PE website at www.TexasPresumptiveEligibility.com.

Refer individuals with questions about their PE coverage dates to the QH/QE that made the PE determination. For questions about services covered by Medicaid, tell the person to call the Medicaid help line at 1-800-335-9857.

 

 

A—124.10 Presumptive Eligibility Forms

Revision 15-3; Effective July 1, 2015

 

Qualified hospital/qualified entity staff use the following forms in the presumptive eligibility process: 

  • Form H1265, Presumptive Eligibility (PE) Worksheet — Completed by the QH/QE and used to determine if an applicant is presumptively eligible.    
  • Form H1266, Short-term Medicaid Notice: Approved — Completed by the QH/QE and given to an individual determined presumptively eligible. This form notifies the individual about PE coverage and lists the eligibility start and end dates. If an individual takes this form to a local eligibility determination office and requests a temporary Medicaid identification card, give the person Form H1027-A, Medicaid Eligibility Verification.
  • Form H1267, Short-term Medicaid Notice: Not Approved — Completed by the QH/QE and given to an individual determined ineligible for PE coverage. This form explains the reason for ineligibility and how to apply for regular Medicaid.

Related Policy
Qualified Hospital/Qualified Entity Policy and Procedures for Presumptive Eligibility Determinations, C1113

 

 

A—125 TP 45 Provider Referral Process

Revision 16-3; Effective July 1, 2016

 

TP 45

State Office Data Integrity (SODI) uses the Provider Referral Process when a hospital, birthing center, or Federally Qualified Health Center (FQHC) submits a referral directly to SODI for a newborn whose mother is Medicaid eligible. The provider does not submit a claim for payment to the claims administrator for the child at this time.

SODI researches eligibility files. After verifying the mother's Medicaid coverage, which can be retroactive, SODI creates a TP 45 EDG for the newborn.

Coverage for the child begins with the child's date of birth (DOB). The last month of coverage is the month the child turns age one, unless one of the following situations occurs.

  • The hospital notifies SODI using Texas Department of State Health Services Form 7484, Hospital Report (Newborn Child or Children), that the child's mother relinquishes her parental rights.
    • If Form 7484 indicates a relinquishment but the new caretaker’s information is incomplete or is not provided, SODI provides newborn Medicaid coverage from the child's DOB through the end of the month the child is relinquished.
    • If Form 7484 indicates a relinquishment and the new caretaker’s name and address are provided, SODI completes two case actions. The first action is to process an open and close newborn Medicaid EDG with the birth mother as the case name. The coverage begins with the child’s DOB and continues through the end of the month the child was relinquished. The second action is to open a newborn Medicaid case/EDG with the new caretaker as the case name. The coverage begins the first of the month after the original newborn Medicaid coverage ended and continues through the month of the child’s first birthday.
  • The child's mother received TP 42 Pregnant Women Presumptive coverage at the time of the child's birth and the mother's application for regular Medicaid coverage is denied. SODI certifies the child through the birth month.

The computer generates and sends the following documents for each EDG:

  • A notice of the newborn's individual number to the referring provider and other providers, if identified on the provider's referral;
  • Your Texas Benefits Medicaid card to the newborn's mother; and
  • A notice informing the newborn's mother/caretaker:
    • that the child is eligible to receive medical coverage through the month the child turns age one, as long as the Texas residence requirement is met, and to report any changes concerning these eligibility requirements;
    • to report if information on Form H1027-A, Medicaid Eligibility Verification, is incorrect;
    • to report if the newborn's siblings receive TANF; and
    • if the mother's Medicaid end date changes because the child was not born in the anticipated month.

 

 

A—125.1 Advisor Action in Provider Referral Process

Revision 15-4; Effective October 1, 2015

 

TP 45

A task is created when a TP 45 EDG is established and the TIERS case contains an active SNAP or TANF EDG. The advisor must take the following actions once the advisor claims the newborn alert task.

If ... then ...
the newborn is a mandatory member of a TANF-certified group or SNAP household, process to add the child to the TANF or SNAP EDG as explained in B641.1, Adding Newborns to the Case.
the child is not a mandatory member of a TANF-certified group, but the child's mother or caretaker provides additional information about the child (name, SSN, etc.), add these changes to the TP 45 EDG.
the newborn's siblings are included in the MAGI household composition for a TP 43, 44, or 48, take no action on the siblings' EDG until additional information is requested for the siblings. At that point, request verification of tax status and relationship for the newborn. If the mother provides verification of relationship for the newborn, add the newborn to the siblings' budget groups.
the child becomes ineligible for TP 45 before the child's first birthday, deny TP 45 for the child, using the appropriate denial code.

 

 

A—125.2 Suspended Claim Process

Revision 15-4; Effective October 1, 2015

 

TP 45

The Medicaid provider sends a claim for a newborn child with the child's mother's claim to the claims administrator. If the claims administrator cannot find the child on HHSC's eligibility files, the claims administrator suspends the child's claim and sends an exception notice to State Office Data Integrity (SODI). SODI checks the child's mother's Medicaid eligibility. If the mother received Medicaid at the time of the child's birth, including a retroactive determination, SODI follows procedures in the Provider Referral Process to provide Medicaid coverage for the child.

 

 

A—125.3 Mandated TIERS Inquiry

Revision 15-4; Effective October 1, 2015

 

TP 45

Field staff must perform TIERS inquiry before providing coverage for a newborn when there is no evidence of SODI TP 45. Staff should inquire by the newborn's mother's individual number and look for a process date that is after the child's DOB.

 

 

A—126 Processing Children’s Insurance Applications

Revision 15-4; Effective October 1, 2015

 

See A-113, Application Requests and Submissions, for how to apply for Medical programs for children.  

 

 

A—126.1 Front Desk Process

Revision 15-4; Effective October 1, 2015

 

CHIP and TP 43, TP 44 and TP 48

When individuals come to a local eligibility office to inquire about health insurance for their child(ren), the front desk clerk must:

  • explain the ways to submit an application as outlined in A-113, Application Requests and Submissions; and
  • explain that the Medicaid application process provides that if a child is found ineligible for Medicaid based on income, HHSC will test the child for CHIP and, if eligible, the Enrollment Broker will send an enrollment packet to the household.

 

 

A—126.2 Inquiry

Revision 15-4; Effective October 1, 2015

 

CHIP and TP 43, TP 44 and TP 48

Before certifying a child for any type of Medicaid program, advisors must perform an inquiry to determine whether the child applying for Medicaid is already enrolled or pending enrollment in Medicaid, CHIP, or CHIP perinatal.

 

 

A—126.3 Advisor Action for Determining Eligibility for Children

Revision 16-2; Effective April 1, 2016

 

CHIP and TP 43, TP 44 and TP 48

When taking action on an application, the following procedures must be applied:

If ... then ...
The child applying is not active in CHIP or pending CHIP enrollment, test for Medicaid eligibility. Follow the policy for assigning the MED*.
The child applying is active in CHIP and the CHIP end date is the application month or the following month, test for Medicaid eligibility. If eligible, and it is:
  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.
The child applying is active in CHIP and the CHIP end date is later than the month following the application month, test for Medicaid eligibility. If eligible, and processing is:
  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.
The child applying is pending CHIP enrollment with a start date the first day of the next month, test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. If eligible, and it is:
  • before cutoff, follow the policy for assigning the MED.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month. Provide open/close coverage for the application month and/or prior months, if applicable.
The child applying is pending CHIP enrollment with a start date later than the first day of the next month, test for Medicaid eligibility for the three months prior, if the application indicates unpaid medical bills. Test for ongoing Medicaid eligibility. Follow the policy for assigning the MED.
The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the application month, test for Medicaid eligibility. If eligible, begin Medicaid coverage the first day of the month following the CHIP end date.
The child is active in CHIP, the application indicates she is pregnant, and the CHIP end date is in the month following the application month or later, test for Medicaid eligibility. If eligible, and it is:
  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.
One child in the family applying is active in CHIP and another is not, test for Medicaid eligibility. If eligible, follow the applicable guidelines given in the preceding scenarios, for each child.
* See A-820, Regular Medicaid Coverage, to apply the MED.

After determining a child is ineligible for Medicaid, TIERS will test eligibility for CHIP.

When the head of household does not provide their date of birth (DOB) and/or Social Security number (SSN), the following steps are taken to obtain the information:

  • Call the household to try to obtain the correct DOB and/or SSN. Let the household know this information is voluntary and is not required to make an eligibility determination for the child; however, it will help expedite the process.
  • If unable to obtain the DOB and/or SSN by telephone, continue to process the child's application for Medicaid.
  • Select a random DOB for the caretaker/second parent, with a year between 1965 and 1975. Using randomly selected DOBs reduces or eliminates the problem of duplicate individual numbers.
  • The SSN field is left blank if the correct number is not available.
  • Staff ensure that all other demographic information is correct and include the individual's middle name, when available.

 

 

A—126.3.1 Neonatal Intensive Care Unit (NICU) Newborn Process

Revision 15-4; Effective October 1, 2015

 

CHIP Perinatal, TP 36, TP 43 and TP 45

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

When a CHIP perinatal mother whose household income is above the income limit for TP 40 applies for Medicaid for her newborn and HHSC hospital-based staff have information from the applicant or the hospital that the newborn is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the newborn using the following process:

  • Upon receipt of an application for a Medicaid NICU newborn, HHSC hospital-based staff must perform inquiry to determine if the mother is on CHIP perinatal or whether the newborn has been assigned a TIERS individual identification (ID) number and is active on Medicaid.
  • If the newborn is not active on Medicaid, staff must deny the CHIP perinatal and certify the eligible newborn for TP 43, if eligible, following existing policy.
  • If not eligible, test the newborn for TP 56 and do not deny the newborn’s CHIP perinatal coverage.
  • If eligible, the newborn may receive TP 56 and CHIP perinatal coverage.

 

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

When HHSC hospital-based staff have information from the applicant or the hospital that a newborn born to a CHIP perinatal mother whose household income is at or below the income limit for TP 40 is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the eligible mother for Emergency Medicaid and the newborn for TP 45, effective on the newborn's date of birth. The CHIP perinatal mother must submit Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification, to the hospital. HHSC hospital-based staff must process Form H3038-P.

Upon receipt of Form H3038-P, HHSC hospital-based staff must:

  • perform inquiry on the Newborn Perinatal Match Interface (Interfaces – TIERS Left Navigation) to verify the CHIP perinatal household's FPIL;
  • use the date Form H3038-P is provided as the file date for both the Emergency Medicaid and Medicaid for the newborn child;
  • certify the CHIP perinatal mother for Emergency Medicaid and deny the CHIP perinatal Eligibility Determination Group (EDG); and
  • certify the eligible newborn for TP 45, effective on the newborn's date of birth.

Related Policy
Adding a New Child, D1433.1

 

 

A—126.4 CHIP Good Cause

Revision 15-4; Effective October 1, 2015

 

CHIP good cause is explained in D1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

 

 

A—126.4.1 Claiming Good Cause

Revision 15-4; Effective October 1, 2015

 

CHIP good cause is explained in D1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

 

 

A—127 Prior Medicaid Coverage

Revision 15-4; Effective October 1, 2015

 

Children's Medicaid and TP 33, TP 34 and TP 35

Staff use any valid application or renewal form to determine three months prior coverage for Children's Medicaid. Do not require Form H1113, Application for Prior Medicaid Coverage, if the family provides enough information to determine eligibility for prior months. If the family does not provide enough information and cannot be reached by telephone, staff sends Form H1113 with Form H1020, Request for Information or Action, to request verification. Note: Three months prior coverage does not apply to CHIP. See D1723.5, Coverage Start Dates, to determine when CHIP coverage begins.

Staff must not delay certification of ongoing eligibility to determine if any child is eligible for prior coverage.

Related Policy
Medicaid Coverage for the Months Prior to the Month of Application, A-830

 

 

A—128 Processing Applications for Pregnant Women

Revision 15-4; Effective October 1, 2015

 

CHIP Perinatal, TP 40 and TP 36

A pregnant woman may apply for health care coverage using applications and ways to submit an application explained in A- 113, Application Requests and Submissions.

When a pregnant woman applies for health care coverage, she will first be tested for TP 40 coverage. If ineligible for TP 40, TIERS will determine whether the woman is eligible for CHIP or CHIP perinatal.

CHIP perinatal coverage provides services to unborn children of pregnant women, regardless of age, who are at or below the program income limit and are ineligible for:

  • Medicaid because of immigration status or income; or
  • CHIP because of age or immigration status.

CHIP perinatal households are exempt from the:

  • 90-day waiting period;
  • cost-sharing (enrollment fees and co-payments); and
  • six-month income check.

 

 

A—128.1 Inquiry for Pregnant Women

Revision 15-4; Effective October 1, 2015

 

CHIP Perinatal, TP 40 and TP 36

Before certifying a pregnant woman for any type of health care coverage, advisors must perform inquiry to determine whether the pregnant woman is already certified for Medicaid or enrolled or pending enrollment in CHIP or CHIP perinatal.

Searching by the woman's last name and date of birth may increase the possibility for a match.

 

 

A—128.2 Advisor Action for Determining Eligibility for Pregnant Women

Revision 15-4; Effective October 1, 2015

 

CHIP Perinatal, TP 40 and TP 36

When taking action on an application, apply the following procedures.

If ... then ...
The woman is active in CHIP perinatal and the application indicates she is due in the application month, test for Medicaid eligibility.* If eligible, and she is:
  • not a U.S. citizen or alien with acceptable status, certify for Emergency Medicaid coverage for the birth.
  • certify the newborn for TP 45 Medicaid coverage.
The woman is active in CHIP perinatal and the application indicates she is due in the month following the application month or later, test for Medicaid eligibility.* If eligible, and it is:
  • before cutoff, begin Medicaid coverage the first day of the next month.
  • after cutoff, begin Medicaid coverage the first day of the month following the next month.

 

* When an individual enrolled in CHIP perinatal submits a new application, they must be tested for Medicaid coverage. Otherwise, staff do not interrupt the continuous eligibility coverage.

 

 

A—128.3 CHIP Perinatal Application Process

Revision 18-4; Effective October 1, 2018

 

CHIP Perinatal, TP 36 and TP 45

Labor with delivery charges are covered by CHIP perinatal for households with income above the income limit for Medicaid for Pregnant Women (TP40), but not for households who qualify for Emergency Medicaid coverage (women who do not meet citizenship requirements and whose household income is at or below the income limit for Medicaid for Pregnant Women [TP40]). These Medicaid-eligible individuals must submit Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification, to apply for Emergency Medicaid to pay for all these charges.

A child born to a CHIP perinatal mother whose household income is at or below the income limit for Medicaid for Pregnant Women (TP40) and who receives Emergency Medicaid to cover labor with delivery charges will be enrolled in Medicaid instead of CHIP perinatal. The Central Processing Center (CPC) processes both the Emergency Medicaid coverage for the mother and the TP 45 for the newborn when the newborn is not admitted to NICU. See A-126.3.1, Neonatal Intensive Care Unit (NICU) Process.

Thirty days prior to the due date, TIERS generates Form H3038-P with Form H1061, Birth Outcome Letter, for the individual. If the birth outcome has not been reported by 30 days after the due date, a second Form H3038-P is mailed along with a self-addressed postage-paid envelope and Form H1062, Birth Outcome Reminder Letter, which includes instructions for getting Form H3038-P completed and signed by the medical practitioner. The individual must return Form H3038-P to HHSC.

Upon receipt of Form H3038-P:

  • the form is linked to the mother's case; and
  • a task is created for CPC staff to certify the mother for Emergency Medicaid and the newborn for TP 45.

If Form H3038-P is not returned within 60 days from the date of the pregnancy due date, then CPC will not certify the mother for Emergency Medicaid or the baby for TP 45. See A-831.2.1, Reopening Three Months Prior Applications, for individuals who return Form H3038-P after 60 days from the pregnancy due date.

 

CPC Staff Process

CPC is assigned a task to process Form H3038-P. CPC staff must:

  • perform an inquiry to determine whether mother and child are already active on Medicaid;
  • if mother and child are not active on Medicaid, use all TP 40 eligibility policies and procedures to determine Emergency Medicaid eligibility with the exception of verifying income and citizenship/alien status;
  • use the verified income provided to determine CHIP perinatal eligibility to determine Emergency Medicaid eligibility;
  • verify all non-financial eligibility points prior to certification such as:
    • identity – see A-621, Verification Sources; and
    • residence – see A-761, Verification Sources;
  • use the date Form H3038-P is received as the file date for the Emergency Medicaid and TP 45; and
  • process Form H3038-P by the 45th date after the file date as explained in B112, Deadlines.

The file date for the TP 45 is usually the date Form H3038-P is received if it includes the newborn's information. Birth outcome information can also be received via an interface or from the individual by telephone or in writing. When this information is received after Form H3038-P has already been submitted to the CPC, a second task is assigned to CPC to process TP 45 for the newborn.

When CPC staff receive a task that includes Form H3038-P dated more than 60 days after the pregnancy due date, CPC will stamp "Received (Date) CPC" on Form H3038-P, which indicates the form was provided after the 60 days from the pregnancy due date. CPC staff return Form H3038-P to the individual along with an application and a letter informing the individual that she will be required to apply for Medicaid. Individuals are instructed to complete the application and return it to the nearest HHSC office or appropriate out-stationed worker if an out-stationed worker is housed at the hospital where the delivery took place.

 

Out-Stationed and HHSC Eligibility Office Staff Process

The chart below explains procedures staff must follow to determine appropriate action.

If an applicant … then staff must:
provides Form H3038-P only, and was active on CHIP perinatal at the time of the delivery, fax Form H3038-P to 877-447-2839.
provides an application requesting Medicaid only, provides Form H3038-P, and was active on CHIP perinatal at the time of delivery, follow policy as explained in A-121.2, Receipt of Duplicate Application, or A-121.3, Receipt of Identical Application, and fax Form H3038-P to 877-447-2839.
provides an application requesting Medicaid and other benefits (SNAP, Children's Medicaid, Medicaid, TANF), provides Form H3038-P, and was active on CHIP perinatal at the time of delivery,
  • certify the TP 36 coverage when determining eligibility for the other requested programs (including TP 45) following existing policy, if eligible; or
  • fax only Form H3038-P to 877-447-2839 if the mother is ineligible for Emergency Medicaid based on the current information.
provides an application and provides Form H3038-P stamped with “Received (Date) CPC,” process the request for Medicaid following normal application procedures.
was not active on CHIP perinatal at the time of delivery, process the Emergency Medicaid request according to existing policy, and provide TP 45 if appropriate.

 

Notes:

  • Staff fax the bar coded Form H3038-P to 877-447-2839. If Form H3038-P is not bar coded, staff must write the mother's CHIP perinatal case and EDG number on the top of the form.
  • If the client requests the fax number for Form H3038-P, staff should instruct the client to fax the form to 877-447-2839.

 

 

A—129 Data Broker Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff must request Data Broker reports as required in C-820, Data Broker.

Related Policy
Permissible Purpose, C-824

 

 

A—130 Interview Procedures

Revision 13-2; Effective April 1, 2013


 

A—131 Interviews

Revision 15-4; Effective October 1, 2015

 

TANF, SNAP, TP 08 and TA 31

Conducting Interviews for Applications and Redeterminations

Conduct the interview with the applicant or the applicant’s spouse (if the spouse is a member of the household) to determine eligibility.

Exceptions:

  • A household may designate an AR, who must also sign the application, as explained in A-170, Authorized Representatives (AR).
  • For SNAP, another responsible household member may also be interviewed.
  • For SNAP, a contracted Community Partner food bank participating in a pilot program with HHSC may conduct the interview and gather pertinent information and verification (see A-116.4, SNAP Applications from a Contracted Community Partner [CP]).
  • For SNAP-SSI redeterminations conducted by CBS, no interview is required unless the household requests an interview, the case contains earned income or it appears the household is going to be denied (see B474.1.1, SNAP Programs, for more detailed information).

Note: The spouse (or other responsible household member for a SNAP interview) does not have to sign the application to be interviewed. Staff must not exempt the household from any program or verification requirements due to interviewing an AR or conducting a telephone interview.

 

SNAP and TANF

Staff must conduct a telephone interview if the household meets any of the following criteria:

  • All adult members of the household are elderly or have a disability and have no earned income;
  • The applicant resides in a family violence shelter and would be in danger if the individual left the shelter; or
  • The household meets the telephone interview hardship criteria below and staff accepts the individual's statement regarding the hardship.

A household meets the hardship criteria if no responsible household member is able to come to the office for any of the following reasons:

  • Residence is more than 30 miles away from the certification office (even if an itinerant office is less than 30 miles from the individual's home);
  • Work or training schedule;
  • Transportation difficulties;
  • Prolonged severe weather;
  • Illness;
  • Care of a household member (the household member does not have to be part of the certified household); or
  • Victims of family violence.

Advisors may conduct a telephone interview for all households who provide a contact telephone number (including households with a member disqualified for an intentional program violation [IPV]), unless the household requests a face-to-face interview.

 

TP 08 and TA 31

Applicants and clients are required to complete a telephone interview, unless the client requests a face-to-face interview. Clients cannot be required to complete a face-to-face interview.

 

TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

No interview is required to apply for or renew Children's Medicaid. Process the application or renewal form by mail or telephone. Schedule an office interview only if the individual requests a face-to-face interview.

When a family contacts HHSC to request an application for Children's Medicaid, offer the option to start the application process by phone. The family can complete the application process by phone, but must provide or return a signed Form H1205, Texas Streamlined Application, with any other required verification to complete the process.

Exceptions:

  • If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice, or for missing an appointment related to Health Care Orientation (HCO) or THSteps, schedule a face-to-face appointment. Deliver the HCO or remind the individual about the importance of the THSteps checkup at that time. See A-122.2, Scheduling Appointments, and B-123, Processing Children’s Medicaid Redeterminations.
  • Conduct a face-to-face interview for an initial application or renewal when HHSC receives conflicting information related to household composition, income or resources that affects eligibility and the information cannot be verified through other means, such as an associated case.

Related Policy
Scheduling Appointments, A-122.2
General Reminders, A-1510
Compliance Requirements, A-1531.5
Processing Children's Medicaid Redeterminations, B-123

 

TP 40 and TP 36

Interviews are not required at application for TP 40 or TP 36. Advisors should schedule an interview only if the household requests an interview.

Advisors must provide continuous coverage for a pregnant woman without Form H1010 or an interview if she meets the criteria in A-832, Continuous Medicaid Coverage.

 

Additional Policy Related to Telephone Interviews

If the office initially schedules a telephone interview and the individual subsequently requests a face-to-face interview before the telephone interview appointment time, staff must allow the household to receive a face-to-face interview and must not treat it as a missed appointment.

To avoid conflicts with an individual's work schedule, staff should be as flexible as possible when scheduling telephone interviews for households in which all adults are working. This could mean scheduling an appointment at a certain time of day or allowing the individual to call in from work at an appointed time for the interview. If a household does not have a home phone but prefers a telephone interview, staff should also attempt to schedule a telephone interview by allowing the individual to call in at an appointed time using someone else's telephone.

Staff must ensure that an interpreter or translation service is available if the applicant/recipient indicates the need for such services on an application.

When conducting a telephone interview, staff must offer the applicant reasonable assistance in obtaining any required verification.

Staff must indicate in TIERS, in the Voter Registration Information section of the Individual Demographics page, to mail Form H0025, HHSC Application for Voter Registration, to applicants who are interviewed by telephone, if a voter registration application is requested. If the request checkbox is marked Yes, TIERS automatically mails Form H0025 to the household.

If the individual declines to register to vote, staff must mail Form H1350, Opportunity to Register to Vote, and ask the individual to sign and return the form. Staff must also indicate in TIERS, in the Voter Registration Information section of the Individual Demographics page, that the client declined, and document that H1350 was mailed to the individual.

Related Policy
Joint TANF-SNAP Applications, A-160
Missed Appointment, B114
Processing Redeterminations, B122
Advisor Responsibility for Verifying Information, C932
Registering to Vote, A-1521

 

TP 45 Retroactive Coverage

Retroactive TP 45 coverage must be provided for the newborn child without Form H1010 or an interview with the child's mother if the household meets the criteria in A-833, TP 45 Retroactive Coverage.

 

 

A—131.1 Home Visits

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must provide notice to the household before making any home visit. Application and redetermination interviews must be scheduled in writing. Notification of other home visits may be:

  • verbal,
  • given or mailed to the individual, or
  • by telephone contact with a responsible household member.

The notification should include the time (at least whether morning or afternoon) and date of the visit. Advisors should route the notification for imaging to add to the electronic case record or document the specific information in TIERS Case Comments. If regions have specialized staff that conduct home visits, the documentation may be maintained in a separate location as long as it is accessible if needed.

Home visits to collateral sources do not have to be scheduled in advance.

No one should be denied for refusing to agree to a home visit unless there is no other sufficient and reliable verification available.

Related Policy
Advisor Responsibility for Verifying Information, C932

 

 

A—131.2 Requirement to Provide Interpreter or Translation Service

Revision 15-4; Effective October 1, 2015

 

All Programs

HHSC is required to provide interpreter and translation (written or verbal) services to applicants and recipients with Limited English Proficiency (LEP). Consider an individual with LEP even if they do not request an interpreter on the application if the individual indicates they would like to speak a language other than English during the interview. HHSC is also required to provide an effective method to communicate with applicants and recipients who indicate they are deaf or hearing impaired. Applicants and recipients may indicate on an application or during an interview that they need interpreter services.

 

 

A—131.2.1 Availability of Interpreters/Translation Services

Revision 17-4; Effective October 1, 2017

 

All Programs

Local offices must set up procedures to ensure that interpreters and translators are available for applicants or recipients who indicate the need for such services on an application.

To meet the requirement for applicants and recipients who indicate they are Limited English Proficiency (LEP), offices can use:

  • Bilingual advisors – when it is reasonably possible to do so, schedule LEP applicant/recipient interviews with bilingual advisors.
  • Bilingual clerical staff – use bilingual clerical staff as interpreters whenever possible.
  • Local community interpreter providers.

Advisors use the following methods for interpretation only after exhausting all local and regional resources:

  • Language Line Services – This service is available to all regions. Staff can access the service by calling 1-800-375-1184 and using their 11-digit employee identification number.
  • Applicants/recipients may provide their own interpreter (only if they wish to do so). Note: Advisors may use minors, age 15 or older, as interpreters only at the individual's request and when the minor accompanies the individual to the interview. Advisors must not use a minor under age 15 as an interpreter.

To meet this requirement for applicants and recipients who indicate they are deaf or hearing impaired, offices can:

  • Schedule a telephone interview if the applicant indicates the contact phone on the application is a TDD/TTY line, unless the applicant requests a face-to-face interview. Note: Relay Texas can be reached at these numbers:
    • 7-1-1, 1-800-RELAYTX (1-800-735-2989), Spanish to English (Spanish speaking callers to English speaking HHSC staff) at 1-888-777-5861;
    • and Spanish to Spanish at 1-800-662-4954.
  • If unable to reach the applicant by phone, advisors must schedule a face-to-face interview and arrange for interpreter services at the interview location.

Note: In situations where an interpreter services vendor is not available, staff may use handwritten notes back and forth with the hearing-impaired individual as long as the notes are an effective means of communication with the individual.

 

 

A—131.2.2 Availability of Translated Written Material

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff must inform applicants/recipients about the availability of translation (written or verbal) services regarding written materials HHSC sends to them by following the two processes below, when applicable.

When staff verbally communicate with LEP applicants/recipients at application, redetermination (including desk reviews) and change actions, staff  must ensure that applicants/recipients understand the eligibility action (Form H1020, Request for Information or Action, and Form TF0001, Notice of Case Action) being taken and the requirements for the  application process (including any missing information being requested). Providing a verbal explanation to all LEP applicants/recipients in their preferred language regarding the eligibility action being taken and/or missing information being requested meets this requirement.

Note: This requirement is not applicable for desk reviews and change actions when staff process the case action without talking with the applicants/recipients.

The Vietnamese Translation Interpreter Form is automatically attached to applicable eligibility notices when clients select Vietnamese as their primary household language.

 

 

A—131.3 Interview Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

During the interview, the interviewer must:

  • protect the applicant's confidentiality and conduct the interview as a confidential discussion of household circumstances;
  • review the application and resolve unclear and incomplete information with the household;
  • advise the household of their rights and responsibilities, including the right to appeal;
  • advise the household of the application processing time frames;
  • advise the household of their responsibility to report changes;
  • ensure that the address on TIERS reflects the individual's current address; and
  • explain the various policies, rights, and responsibilities as required in A-1500, Reminders.

Advisors must take the following actions and provide the following referrals and information during the interview:

  • Verify that the household agrees that the information is complete and correct on the application form and in the case documentation for household composition, income, and expenses;
  • Verify that the income and expense information obtained for past periods (including self-employment) accurately reflect the amounts that can be anticipated for future income and expenses, according to policy in A-1355, How to Project Income. If the information is inaccurate, the advisor must determine why it is inaccurate;
  • Determine whether households with questionable or negative management, as described in A-1710, General Policy, are able to explain how the household’s bills are paid;
  • Determine whether households with other discrepancies in information that could affect eligibility are able to provide information to resolve those discrepancies;
  • Determine whether there is a reason for households who have not provided all verification requested on Form H1020, Request for Information or Action, beyond the household's control that prevents the household from providing verifications. If the advisor designates a collateral source, the advisor should accept the individual statement or use other forms of verification for the missing verifications as required by policy in A-1370, Verification Requirements;
  • Determine whether income verification may be calculated based on year-to-date information from other paychecks provided by the household when income verification is missing for a particular pay period(s), rather than requesting it on Form H1020; and
  • Refer the household to other state or local resources for types of assistance the household requested on the application form, such as child care, child support, utilities, or rent, that are provided by other agencies.

TANF

  • Determine whether any adult household member has received TANF cash assistance from another state since October 1999. Refer to A-1920, Determining the Number of FTL Months Used.
  • Determine whether any member of the household has been disqualified in another state for a felony or drug conviction.
  • Determine whether any member of the household has been disqualified from participating in TANF for an intentional program violation (IPV) in another state. See B942, Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification, for policy regarding the IPV information the advisor must gather from the other state.
  • Determine whether applicants must provide information on parent(s) living outside of the home to meet child and medical support requirements, or if applicants meet a good cause exemption, as explained in A-1130, Explanation of Good Cause.

SNAP

  • Determine whether households qualifying for the standard medical expense want to claim actual expenses according to the policy in A-1428.3, Budgeting Options;
  • Determine whether the household wants to prorate an expense or income according to policy in A-1428.3; A-1355.1, Budgeting Options for SNAP Households; and A-1358, How to Budget Expenses;
  • Determine whether any household member claims an exemption to Employment and Training (E&T) work requirements;
  • Provide reminders, including the household's change reporting requirement, regarding E&T requirements, able-bodied adult without dependents (ABAWD) time limit policy (if there is an ABAWD in the household), and how the household can obtain and use SNAP benefits issued via EBT;
  • Determine whether an ABAWD received any countable months of benefits in another state; and
  • Determine whether any member of the household has been disqualified from participating in SNAP for an IPV or a felony drug conviction in another state. Note: Data Broker displays current out-of-state IPV disqualification data.

Medical Programs

Determine whether applicants experiencing family violence are exempt from providing information about a member of their MAGI household composition because they fear physical or emotional harm by that person, as explained in A-241.4, Family Violence Exemption.

TP 08

Determine whether applicants must provide information on parent(s) living outside of the home to meet medical support requirements, or if applicants meet a good cause exemption, as explained in A-1130, Explanation of Good Cause.

 

 

A—132 Eligibility Factors

Revision 15-4; Effective October 1, 2015

 

All Programs

  TANF SNAP Medical Programs
Household Composition X X All Medical Programs*
Citizenship X X All Medical Programs*
Social Security number X X TPs 08, 40, 43, 44, 48, 56
Age X - TP 08, TA 31, TPs 32, 33, 34, 35, 43, 44, 45, 48, 56
Relationship X - TP 08, TA 31, TPs 32, 33, 34, 35, 43, 44, 45, 48, 56
Identity X X All Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36*
Residence X X All Medical Programs*
Third-Party Resources X - All Medical Programs*
Domicile X - TP 08, TA 31
Deprivation X -  
Resources X X TP 56 (children) or TP 32 (children)
Income/Deductions/Budgeting X X All Medical Programs*
School attendance X - TP 08
Work registration X X  
Management X X TP 08, TA 31
Responsibility Agreement X -  

 

* TP 08, TA 31, TPs 32, 33, 34, 35, 36, 40, 43, 44, 45, 48 and 56.

Note: For medical programs, the eligibility factors noted above do not necessarily apply in all cases.

 

 

A—132.1 Medical Programs Hierarchy

Revision 18-1; Effective January 1, 2018

 

Medical Programs

 

Texas Works Medical Programs Hierarchy
Step Eligible Persons With Income Type Program Code Type Program
1 Individuals ages 18 through 25 who have aged out of foster care in Texas and were enrolled in Medicaid on their 18th birthday Not Applicable TP 82 MA Former Foster Care Children (FFCC)
2 Individuals ages 18 through 20 who have aged out of foster care and:
  • are not eligible for FFCC (were not receiving federally funded Medicaid when they aged out of foster care); or
  • who aged out of foster care at age 18 or older, currently reside in Texas, and have had an Interstate Compact on the Placement of Children (ICPC) agreement
At or below program FPIL TP 70 MA Medicaid for Transitioning Foster Care Youth (MTFCY)
3 Pregnant Women At or below program FPIL TP 40 MA Pregnant Women
4 Pregnant women who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 40 FPIL TP 36 MA Pregnant Women - Emergency
5 Newborn children of Medicaid-eligible mothers up to age 1, including mothers receiving TP 36 Not Applicable TP 45 MA Newborn Children (Deemed)
6 Children under age 1 At or below program FPIL TP 43 MA Children Under Age One
7 Children ages 1 through 5 At or below program FPIL TP 48 MA Children 1–5
8 Children ages 6 through 18 At or below program FPIL TP 44 MA Children 6–18
9 Children ages 1 through 5 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 48 FPIL TP 33 MA Children 1–5 - Emergency
10 Children ages 6 through 18 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 44 FPIL TP 34 MA Children 6–18 - Emergency
11 Children under age 1 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 43 FPIL TP 35 MA Children Under Age One - Emergency
12 A parent or caretaker relative caring for a dependent child under age 18 or who meets school attendance requirements who receives Medicaid At or below program FPIL TP 08 MA Parents and Caretaker Relatives Medicaid
13 Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a parent or caretaker relative of a Medicaid-eligible child At or below TP 08  FPIL TA 31 MA Parents and Caretaker Relatives - Emergency
14 Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in earnings Above the limits for TP 08 TP 07 MA Earnings Transitional
15 Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in spousal support income Above the limits for TP 08 TP 20 MA Child Support Transitional
16 Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer and presumed eligible for Medicaid for Breast and Cervical Cancer (MBCC) Not Applicable TA 66 MA MBCC Presumptive
17 Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer Not Applicable TA 67 MA MBCC
18 Children under age 19 and pregnant women Above the limits for TPs 40, 43, 44, and 48 FPIL TP 56 MA Medically Needy with Spend Down
19 Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a pregnant woman or child under age 19 Above the limits for TPs 40, 44, or 48 FPIL and at or below program limit  TP 32 MA Medically Needy with Spend Down - Emergency
20 Children under age 19 ineligible for Medicaid due to income Above the limits for TPs 43, 48, or 44 FPIL, and at or below program limit  TA 84 CI CHIP
21 Unborn children whose mother is ineligible for Medicaid or CHIP due to income or immigration status Above the limits for TPs 40 and 36, and at or below program limit  TA 85 CI CHIP - Perinatal
22 Former foster care youth ages 21 through 22 attending school of higher education who:
  • are not eligible for FFCC; or
  • who aged out of foster care at age 18 or older, currently reside in Texas, and have had an ICPC agreement.
At or below program FPIL TA 77 Health Care Benefits Health Care - FFCHE
23 Children under age 1 presumed to be eligible for Medicaid as determined by a Qualified Hospital (QH) At or below TP 43 FPIL TP 74 MA Children Under Age One - Presumptive
24 Children ages 1 through 5 presumed to be eligible for Medicaid as determined by a QH At or below TP 44 FPIL TP 75 MA Children 1–5 - Presumptive
25 Children ages 6 through 18 presumed to be eligible for Medicaid as determined by a QH At or below TP 48 FPIL TP 76 MA Children 6–18 - Presumptive
26 Parents and caretaker relatives presumed to be eligible for TP 08 by a QH  At or below TP 08 FPIL TP 86 MA Parents and Caretaker Relatives - Presumptive
27 Former Foster Care Children presumed to be eligible for Medicaid by a QH Not Applicable TP 83 MA FFCC - Presumptive
28 Healthy Texas Women At or below program   FPIL TA 41 MA Healthy Texas Women
29 Pregnant women presumed to be eligible for TP 40 by a QH or Qualified Entity (QE) At or below TP 40 FPIL TP 42   Pregnant Women - Presumptive

 

Notes:

  • TIERS will test for TP 56, Medically Needy with Spend Down, for prior coverage or coverage for the application month if medical expenses are indicated in data collection for:
    • Pregnant women who are ineligible for Medicaid because of income or alien status.
    • Children ages 0 to 18 who are ineligible for medical programs because of income will be tested for CHIP.
  • Foster Care and Adoption Assistance Medicaid programs are above FFCC in the Medical Programs hierarchy.

Related Policy
Income Limits, C-131
Qualified Hospital/Qualified Entity Procedures for Presumptive Eligibility Determinations, C-1113
Guidelines for Providing Retroactive Coverage for Children and Medical Programs, C-1114
Type Programs (TP) and Type Assistance (TA), C-1150
Former Foster Care in Higher Education (FFCHE), Part F
Medicaid for Transitioning Foster Care Youth (MTFCY), Part M
Medicaid for Breast and Cervical Cancer (MBCC), Part X
Healthy Texas Women, Part W

 

 

A—132.2 Guidelines for Pregnant Women

Revision 15-4; Effective October 1, 2015

 

See A-240, Medical Programs.

 

 

A—133 Rights and Responsibilities

Revision 15-4; Effective October 1, 2015

 

All Programs except TP 33, TP 34, TP 35, TP 43, TP 44, TP 45 and TP 48

Before completing the interview, advisors must ensure that the applicant:

  • provides all of the information requested on the application;
  • reports any changes that occurred since filling the application; and
  • reads and understands the individual's rights and responsibilities as explained on the application.

 

TANF and TP 08

Advisors must also ensure that:

  • the applicant reads and understands the rights and responsibilities of the child support program explained on Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause;
  • TANF applicants read and understand Form H2580, TANF Employment Services Notice, and receive a copy of the form; and
  • TANF applicants read, understand and sign Form H1073, Personal Responsibility Agreement.

 

SNAP

Advisors must provide the applicant with Form H1805, SNAP Food Benefits: Your Rights and Program Rules.

 

TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

Before completing the interview, if requested, ensure the applicant:

  • completes all sections of the application; and
  • reads and understands an individual's and responsibilities as explained on Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and Form H1205, Texas Streamlined Application.

 

 

A—134 Documentation Guidelines

Revision 13-2; Effective April 1, 2013

 

A complete list of documentation requirements for determining eligibility can be found at the conclusion of each eligibility section within the Texas Works Handbook. TIERS Data Collection pages handle a vast majority of the required documentation for case records. For the remaining small percentage of documentation still required by policy, staff must include the information in TIERS Case Comments. For documentation that is not captured within the Data Collection pages, a comprehensive guide, The Texas Works Documentation Guide, has been developed. This documentation guide outlines the requirements for documentation that must be entered in TIERS Case Comments.

 

 

A—135 Pending Information

Revision 15-4; Effective October 1, 2015

 

All Programs except TP 40

If the applicant cannot furnish all required proof during the interview or with the application, advisors must allow the household at least 10 days to provide the information. The due date must be a workday. Advisors must determine what sources of proof are readily available to the household and request that information first as sufficient proof. B-115, Pending Verification on Applications, includes more information on verification procedures.

Advisors must provide the applicant Form H1020, Request for Information or Action, explaining:

  • what is needed,
  • the due date for receipt of the information, and
  • the date the advisor
  •  must deny the application if the advisor does not receive the information.

Advisors should attach to Form H1020 the page of Form H1020-A, Sources of Proof, that corresponds to the verification requested.

 

Medical Programs

The advisor must not request additional verification if verification is available through electronic data sources.

TP 40

Advisors should not allow 10 days for the applicant to provide verification if doing so exceeds the 15-workday processing time frame and verification can be postponed.

 

 

A—136 Eligibility Decision

Revision 15-4; Effective October 1, 2015

 

All Programs

After obtaining all required proof, the advisor must dispose the application and give the applicant Form TF0001, Notice of Case Action, detailing the decision.

Advisors must provide the individual with the HIPAA — Notice of Privacy Practices or HIPAA — Notice of Privacy Practices (Spanish) at initial certification and after breaks in certification of one or more months.

 

 

A—137 Prudent Person Principle

Revision 15-4; Effective October 1, 2015

 

All Programs

The policies and procedures included in the handbook are rules for determining eligibility. It is impossible to provide examples for all policy situations. When staff encounter rare and unusual situations, HHSC encourages them to use reason and apply good judgment in making eligibility decisions. The "prudent person" principle allows staff to make reasonable decisions based on the best available information using:

  • common sense,
  • program knowledge,
  • experience, and
  • expertise.

Staff should document the rationale used to make a decision and any applicable handbook references.

 

 

A—140 Expedited Service

Revision 16-2; Effective April 1, 2016

 

SNAP

All expedited applications are screened using the expedited screening questions on page 1 of the application. HHSC staff screen applications received in the local office. Vendor staff screen applications sent to Austin by fax or mail, and an automated system screens applications submitted online.

Applicants who meet the test for expedited service are entitled to:

  • postpone all verification until after receiving the first month's benefit, except:
    • identity, and
    • proof they meet or are exempt from the SNAP ABAWD work requirement if they have already received the maximum number of benefit months without meeting the work requirement; and
  • get benefits the same day they apply, if possible, but no later than the next workday.

    Exception: In the following situations, applicants may not get benefits in this time frame.
    • Applicants in drug and alcohol treatment/group living arrangement facilities. Staff must give benefits so the individual has an opportunity to participate by the seventh day after the application date.
    • Joint SNAP/SSI applicants released from public institutions. The CBS unit gives benefits so the individual can participate by the fifth day after release from the institution.
    • Late determinations for expedited service. These are households that:
      • the agency did not identify as entitled to expedited service when the household filed the application. Expedited processing begins on the day the office becomes aware the applicant is entitled to this service. Advisors cannot enter a late determination date if the agency failed to properly screen the application using the expedited screening questions on Form H1010, Texas Works Application for Assistance — Your Texas Benefits.
      • meet expedited criteria and have an individual who served the minimum employment and training penalty, but have chosen to delay their certification until all disqualified individuals have signed Form H1808, SNAP Work Rules.
      • qualify for a telephone interview, but HHSC must mail the application back to the household for signature. The late determination date is the date the applicant returns the signed application.
      • mail or drop off Form H1010 or Form H1010-R, Your Texas Works Benefits: Renewal Form. Staff must contact the applicant and schedule an appointment the earliest day the applicant is available. If HHSC cannot contact the applicant by phone, staff must mail Form H1830-I, Interview Notice (Applications or Reviews), the same day the application is screened, notifying the applicant of possible eligibility for expedited service and instructing the applicant to contact the office. If the household also applies for TANF or Medicaid, staff should schedule a regular TANF/Medicaid appointment on the same notice. Expedited processing begins the day the applicant returns to the office for an interview.
      • miss their expedited appointment. If the applicant subsequently contacts the office, staff must conduct an interview the earliest date the individual is available. Expedited processing begins the day the applicant returns to the office for an interview.
      • do not provide acceptable proof of identity, or proof of meeting or being exempt from the SNAP ABAWD work requirement, as explained in the beginning of this section. Expedited processing begins when the applicant provides the required proof.
      • are not eligible for expedited processing when screened for expedited services at the time of application, but meet expedited criteria later in the application month as a result of a change. The late determination date is the date the eligibility for expedited processing is met.
      • submitted an application through the HHSC online system when the office was closed due to weather-related conditions, flooding or other similar situations. The late determination date is the first workday the office reopens following the office closure.

    Notes:
    • Staff can enter the late determination date in TIERS for late determinations caused by the applicant, resulting from a change in the household's circumstances, or due to office closures, as explained above.
    • Except for delays in screening due to office closure, staff can enter the late determination date only if HHSC, the vendor or the automated system screened the application on the file date or no later than the next workday.
    • The late determination date becomes day zero in determining timeliness on expedited applications.

TP 40

Expedite applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy. These applicants are entitled to:

  • have their eligibility determined no later than 15 workdays from the date HHSC receives the application; and
  • postpone all verification, except identity, until the 30th calendar day from the application file date. Note: Postponing verification only applies to current and ongoing coverage. For prior coverage, take action no later than the 15th workday. Staff must deny the application if the applicant does not provide verification and reopen denied applications within two years at the applicant's request.

Note: An interview is not required when processing a TP 40 application.

Related Policy
Medicaid Coverage for the Months Prior to the Month of Application, A-830
ABAWD Referral Process, A-1831.1.2
Counting Months Toward Time-Limited Eligibility, A-1950
Regaining Eligibility, A-1960

 

 

A—141 Expedited Eligibility Criteria

Revision 15-4; Effective October 1, 2015

 

SNAP

Applicants are entitled to expedited service if they meet one of the following criteria:

  • The household's:
    • liquid resources total $100 or less, and
    • countable gross monthly non-converted income totals less than $150. Note: When determining eligibility for expedited services, staff must count the actual amount of TANF the individual actually receives.
  • The household's liquid resources plus actual, non-converted countable gross monthly income total less than the most recent monthly expenses for rent/mortgage and utilities. Staff should include the standard telephone allowance for households with a telephone expense.
  • The household includes a migrant or seasonal farmworker and meets the destitute criteria listed in A-146, Expedited Policy for Migrant or Seasonal Farmworkers.

An individual who reapplies within the last month of a current certification period is not eligible for expedited service.

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy are eligible for expedited processing.

 

 

A—142 Limit on Expedited Certification

Revision 15-4; Effective October 1, 2015

 

SNAP

A household may receive expedited certification any number of times if the household:

  • completes the verification requirements postponed at the last expedited certification; or
  • was certified under the usual 30-day processing standards since the last expedited certification.

Exceptions:

  • If an expedited application with postponed verification is denied for failure to provide requested information/verification, the household may re-apply without submitting a new application until the 60th day after the file date, as explained in B-111, Reuse of an Application Form After Denial. If the household submits another application, staff must consider the second application a duplicate application. Staff must not allow SNAP expedited services.
  • If a redetermination is denied for failure to provide requested information or for a missed appointment, the household may re-apply without submitting a new application until the 30th day following the last benefit month (see B-122.3, Delays Caused by Households). If the household submits another application, staff considers the application a duplicate application. Staff must not allow SNAP expedited services.

 

 

A—143 How to Determine Eligibility for Expedited Service

Revision 14-1; Effective January 1, 2014

 

SNAP

- - Yes No
1. Does the applicant's Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and statement indicate eligibility for expedited service based on eligibility criteria in A-141, Expedited Eligibility Criteria? Go to step 2. Stop, use normal 30-day processing procedures.
2. Did the applicant already receive SNAP this month? Stop, use normal 30-day processing procedures. Go to step 3.
3. Did the applicant receive expedited service before? Go to step 4. Go to step 5.
4. Did the applicant provide all postponed verifications from previous certification, or did HHSC certify the applicant under normal 30-day processing since the last expedited certification? Go to step 5. Stop, use normal 30-day processing procedures.
5. Was the SNAP EDG denied at redetermination for a missed appointment or for failure to provide requested information, and is it still within 30 days of the last benefit month? Stop, this application is a duplicate application. Follow reuse of application policy. Go to step 6
6. Does the applicant or AR being interviewed have proof of identity? Go to step 7. Not eligible for expedited service until he provides proof.
7. If an applicant age 18 to 50 has already received the maximum number of benefit months without meeting the work requirement, did the applicant verify that the applicant is exempt from or meets the 20-hour-per-week work requirement (even if the AR applies)? Go to step 8. Not eligible for expedited service until he provides proof.
8.

Issue benefits today. Postpone all other verification that is:

  • not provided at the interview, or
  • not acceptable.

 

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to pregnancy are eligible for expedited processing.

Related Policy
Receipt of Duplicate Application, A-121.2
Reuse of an Application Form After Denial, B111
Delays Caused by Households, B122.3
Denied for Missed Appointments, B122.3.1
Denied for Failure to Provide Information/Verification, B122.3.2

 

 

A—144 Expedited Verifications

Revision 15-4; Effective October 1, 2015

 

SNAP and TP 40

See A-140, Expedited Service.

 

 

A—144.1 Social Security Numbers (SSNs)

Revision 18-3; Effective July 1, 2018

 

SNAP

Staff must include household members for the initial month, or initial two months if household members are receiving a combined allotment. This is true even if the household members fail to provide or apply for an SSN at the interview or if State Online Query (SOLQ) does not validate a member’s SSN at the interview. Follow policy outlined in A-413.2, SSN Not Validated, if the SSN does not validate at the interview.   

Staff must disqualify individuals who fail to provide or apply for an SSN without good cause or if SOLQ does not validate the person's SSN before the next monthly issuance. See A-410, General Policy, for rules for children age six months or younger and good cause.

TP 40

Staff must certify a pregnant woman even if she fails to provide or apply for an SSN or if SOLQ does not validate her SSN by the 15th working day from the application file date in order to meet expedited processing timeframes.  Follow policy outlined in A-413.2, SSN Not Validated, if the SSN does not validate by the 15th workday.

Staff must deny the woman’s eligibility if she fails to provide or apply for an SSN or if SOLQ does not validate the SSN by the postponed verification due date.  

Related Policy

Postponed Verification Procedures, A-145.1
Social Security Number (SSN) Validation Through State Online Query (SOLQ), A-413
SSN Validated, A-413.1
SSN Not Validated, A-413.2
 

 

A—144.2 Work Registration

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors should register the applicant being interviewed for work unless:

  • the applicant is exempt from work registration, or
  • an AR is applying for the household.

Advisors should register other household members if possible. Advisors should postpone registration for the initial month if it cannot be completed within the expedited time frames.

 

 

A—144.3 Citizenship

Revision 16-2; Effective April 1, 2016

 

SNAP

Household members whose citizenship/eligible alien status is questionable can receive expedited benefits with the household. These household members must provide verification of citizenship/eligible alien status before the next month's benefits are issued or be disqualified.

 

TP 40

Citizenship/eligible alien status must be verified using policy in A-350, Verification Requirements, for pregnant women who declare to be a U.S. citizen or declare to have an eligible alien status. If a pregnant woman does not provide proof of citizenship or alien status and:

  • no other information is required to determine eligibility, she is provided a period of reasonable opportunity as explained in A-351.1, Reasonable Opportunity.
  • other information is required to determine eligibilty, she is allowed to postpone verification (except identity) until the 30th calendar day from the application file date, as explained in A-145.1, Postponed Verification Procedures. If during that time she returns the other information, but not proof of citizenship or alien status, she is certified, sent Form TF0001, Notice of Case Action, and provided a period of reasonable opportunity at that time.

Related Policy
Reasonable Opportunity, A-351.1

 

 

A—144.4 Reserved

Revision 12-1; Effective January 1, 2012

 

 

A—144.5 Pregnancy

Revision 18-1; Effective January 1, 2018

 

TP 40

Accept the individual’s (pregnant woman’s, case name’s or AR’s) verbal or written statement of pregnancy as verification, unless questionable. The woman’s statement would be questionable if the information provided regarding the due date is discrepant, such as the pregnancy start month and pregnancy end month are less than or more than nine months apart or if the woman reports a pregnancy with overlapping start and end months.   

The individual’s statement of pregnancy must provide the following information:

  • Name of woman who is pregnant
  • Pregnancy start month and/or anticipated date of delivery
  • Number of expected children

If questionable, advisors must verify pregnancy by using:

  • Form H3037, Report of Pregnancy; or
  • other documentation containing the same information as Form H3037.

The verification must be from an acceptable source such as:

  • a physician;
  • a hospital;
  • a family planning agency; or
  • a social service agency.

A physician, nurse, advanced nurse practitioner or other medical professional must sign Form H3037 or another document for it to be considered verification from a medical source. If another medical professional completes the form, the advisor must ensure that information about the supervising physician is provided.

Staff must use the following procedures when certain information regarding pregnancy is not provided on an application for benefits.

  • If the only item missing on the application form is the pregnancy start month, staff must count nine months back from the pregnancy end month to determine the pregnancy start month. The pregnancy end month is month zero.
  • If the only item missing on the application form is the pregnancy end month, staff must count nine months from the pregnancy start month to determine the anticipated date of delivery. The pregnancy start month is month zero.
  • If both the pregnancy start and end months are missing, attempt to obtain the information by phone.  If unable to obtain the information by phone, send Form H1020, Request for Information or Action, to request the information.

Related Policy
Verification Requirements, A-870

 

A—145 Expedited Certification Procedures

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must assign usual certification periods even if staff postpones verifications. See A-2324, Length of Certification, for certification period policy.

Advisors must issue the second month's benefits as a combined allotment as explained in A-150, Combined Allotment Policy, if the household applies after the 15th of the month and benefits are prorated.

 

TP 40

If an applicant provides the minimum information required to process the application, the advisor may certify the application before the 15th workday and allow postponed verification.

Advisors must deny the application no later than 15 workdays if:

  • the information provided indicates the applicant is not eligible, or
  • not enough information was provided to determine eligibility.

Advisors must reopen applications denied because there was not enough information provided if the information is received within 60 days of the file date.

Advisors must use the date the information is provided as the new file date, and follow the expedited processing guidelines.

Note: An interview is not required when processing a TP 40 application.

 

 

A—145.1 Postponed Verification Procedures

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must provide Form TF0001, Notice of Case Action, stating:

  • what information is needed;
  • the date it is needed; and
  • that the individual must provide the information before the issuance of benefits for the:
    • second month; or
    • third month, if the applicant received a combined allotment.

TIERS identifies and holds benefits for the second month for households not issued a combined allotment or the third month for combined allotment households. See A-150, Combined Allotment Policy.

If the household furnishes the postponed verification and the ... then ...
second month is on hold, enter the information and dispose the SNAP EDG within five days or by the first workday of the second month, whichever is later.
third month is on hold (for combined allotment situations), enter the information and dispose the SNAP EDG.

 

If the household provides postponed verification that results in lowered or denied benefits, see B116.1, Information Received During Expedited Application Processing.

If the household does not provide postponed verifications within 30 days of the application date, advisors must:

  • disqualify the individual when appropriate, or
  • deny the SNAP EDG for failing to provide postponed information and send the individual adequate notice using Form TF0001.

A household denied for failure to provide postponed verification must submit a new application to receive benefits if the household does not provide the postponed verification by the 60th day from the file date. If the household provides the verification by the 60th day, advisors must reopen the application using the date the household provided the verification as the new file date.

An individual receiving adequate notice of adverse action as noted above cannot receive continued benefits pending appeal.

 

TP 40

Advisors must provide Form TF0001, stating the:

  • eligibility start and end date,
  • postponed verifications, and
  • date the verifications are due.

If the individual does not provide verification by the 30th day following the file date, the advisor must initiate adverse action. Advance notice is required. The individual must reapply if the verification is not provided by the expiration of the adverse action.

If the individual provides verification by the 30th day following the file date but does not meet eligibility requirements, the advisor must provide advance notice of adverse action and deny ongoing coverage.

Note: Advisors must not deny the EDG if the individual is eligible in the application month or one of the three prior months.

 

 

A—146 Expedited Policy for Migrant or Seasonal Farmworkers

Revision 15-4; Effective October 1, 2015

 

SNAP

The expedited processing procedures apply to migrant or seasonal farmworkers except for the following:

  • If verifying something other than identity and the source of verification is out of state, the advisor postpones verification until after the household receives the second month's benefit. Advisors should use this procedure for only one two-month postponement during one round-trip from home.
  • Households with a migrant or seasonal farmworker are destitute if they have $100 or less countable liquid resources and meet any of the following:
    • The household's only income for the application month is from a terminated source, and the household will not receive any more payments from that source after the application date.

      Advisors should consider terminated income if it is usually received:
      • monthly or more often but will not be received from that source the following month, or
      • at intervals of more than one month but will not be received from that source in the next usual payment period.

      Advisors should not consider terminated income in the following situations:
      • Someone changes jobs while working for the same employer;
      • A self-employed person changes contracts or has different customers without having a break in normal income cycle; or
      • Someone receives regular contributions, but the contributions are from different sources.

    • Note: When determining destitute status, advisors do not consider terminated income if a payment from the same source will be received after the file date in the month of application.
    • All household income in the application month is from a new source, and the household will receive income of $25 or less from the first of the month up to and including the 10th day after the application date (or the end of the month if there are not 10 days left in the month).

      Income received monthly or more frequently is from a new source if the household did not receive $25 or more from that new source in the 30 days up to and including the application date.

      Income received at intervals of more than one month is new income if the household has not received more than $25 from that source between the last usual payment month and the application date.

      Advisors count new income received after the application date to determine whether the individual is destitute, but disregard it in determining eligibility and benefits for the month of application.
       
    • The household has a combination of terminated income through the application date and new income after the application date if:
      • there is no other income from the terminated source that month, and
      • the household will receive income of $25 or less from the new source from the first of the month through the 10th day after the application date (or the end of the month if there are not 10 days left in the month).

      At recertification, advisors disregard income from a new source in the first month of the certification period if that income will not exceed $25 within 10 days after the individual's usual issuance cycle.

      Notes:

      • Advisors count an advance of wages for travel expenses as income unless it is a reimbursement.
      • Advisors do not consider the advance in determining whether the household is destitute or in determining whether later payments from the employer are from a new source.
      • Self-employed farmworkers whose income is annualized are not destitute if they do not receive income each month of the year.
      • The grower, not the crew chief, is the farmworker's source of income. An individual who follows a crew chief to a new grower is leaving a terminated source for a new source.

The policies in this section apply to income determinations for destitute applicants at initial and later certifications but only in the first month of any certification period.

 

 

A—147 Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents

Revision 15-4; Effective October 1, 2015

 

Medical Programs – All Except Emergency Medicaid and TP 56

All applications for Medicaid from active duty military members and their dependents applying for coverage are eligible for expedited processing.

Active duty refers to military members who currently are serving full time in their military capacity. A military member is defined as someone in the:

  • U.S. Armed Forces/Reserves
    • Army
    • Marine Corps
    • Navy
    • Air Force
    • Coast Guard
  • National Guard
    • Army
    • Marine Corps
    • Navy
    • Air Force
    • Coast Guard
    • Reserve/Guard
  • Army National Guard
  • Air National Guard
  • State Military Forces/Texas State Guard
    • Texas State GuarD – Unless activated by the governor and placed on paid state active duty, these personnel receive no compensation for their time.
    • Texas Army National Guard
    • Texas Air National Guard

When an application for Texas Works medical assistance is received and includes an active duty military member, staff should take the following action on or before the 15th workday of the application file date:

  • Provide an interview if requested or required;
  • Send/provide Form H1020, Request for Information or Action, to request missing information if no interview was requested or required and the household did not provide information with the application; and
  • Send/provide Form TF0001, Notice of Case Action, if the household provided all verification with the application and no interview was requested or required.

Military status is self-declared. Additional verification is not required.

Advisors should use processing time frames stated in B-112, Deadlines, if the household did not provide all required information and verification with the application.

The expedited processing requirement does not apply to TP 56 (Medically Needy with Spend Down) or to Emergency Medicaid for ineligible aliens, and only applies to applications and untimely reviews/renewals.

A household is not eligible for expedited processing if the military member is on active duty because of training as a member of the Reserves, National Guard, or State Military Forces.

When an application consists of a pregnant member and an active duty member, advisors use TP 40 expedited application processing time frames.

Advisors provide expedited processing for a Medicaid application if the budget group includes the needs of an active duty member even if the active duty member is not included in the certified group.

Advisors must not pend an application if the household:

  • fails to answer the Yes/No question and name/designation. Advisors must not process the application using expedited time frames. If the Yes/No question is left blank, advisors enter No in the system.
  • fails to answer the Yes/No question but provides a name or information that can be used to determine who the active military member is. Advisors should assume that the answer is Yes and process the application using expedited time frames.
  • answers Yes to the question but does not provide a name or information that can be used to determine who the active military member is. Advisors must not process the application using expedited time frames.

When an interview is scheduled timely within 15 workdays, but the applicant requests to reschedule the interview, staff should attempt to accommodate the rescheduled appointment within the 15-workday time frame. If, at the household’s request, the interview is rescheduled after the 15-workday time frame, staff should document the reason for not scheduling the appointment within the required time frame.

Note: For requested interviews, if the applicant requests to be rescheduled, staff should inform the household that an interview is not required and that the processing of the application can begin without an interview. Staff must not deny an application if the household fails to show for the appointment when an interview is not required.

 

 

A—150 Combined Allotment Policy

Revision 15-4; Effective October 1, 2015

 

SNAP

 

Advisors must issue benefits for the month of application and the following month at the same time if:

  • an applicant files the application after the 15th of the month (including reapplications filed after the 15th of the month following the last benefit month);
  • the household is eligible for the application month and the following month (including applicants eligible but not receiving an allotment for the application month because benefits prorate to less than $10); and
  • advisors must prorate the initial month's benefits.

Note: For applicants who meet expedited criteria, advisors issue a combined allotment within expedited time frames, even if postponing verification.

Inform households receiving combined allotments:

  • when the benefits will be available;
  • that no additional benefits will be available until the third month; and
  • that the third month’s benefits will be available on the regular issuance schedule.

TIERS identifies and issues benefits to households eligible for a combined allotment and holds the third month's benefits if the combined allotment certification has postponed verification.

 

 

A—160 Joint TANF-SNAP Applications

Revision 13-2; Effective April 1, 2013

 

TANF, SNAP and TP 08

A household in which all members are applying for or receiving TANF and/or TP 08 may apply for SNAP at the same time the household applies for TANF and/or TP 08. The advisor then conducts a single interview.

Exception: Conduct the unfinished TANF and/or TP 08 interview later if necessary to meet the SNAP expedited processing time limits.

 

 

A—161 When Receipt of TANF Is Uncertain

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When TANF eligibility is uncertain, advisors must:

  • certify the household for Non-Public Assistance (NPA) SNAP benefits if eligible. Note: If the TANF members have resources, advisors do not exclude the resources for SNAP until the household’s TANF EDG is certified (see A-1248, Resources of TANF and SSI Recipients); and
  • assign an NPA certification period (see A-2324, Length of Certification).

If TANF is approved later, advisors should process it as a reported change and add the TANF benefit to the SNAP budget as soon as possible. (See A-1324.18, Temporary Assistance for Needy Families [TANF].) Advisors should adjust the certification period to expire when the next TANF periodic review is due. Advisors should send or give the applicant Form TF0001, Notice of Case Action, with the new certification period stated. Exception: One-Time Temporary Assistance for Needy Families (OTTANF), A-1324.11.

If the TANF application is denied later, the advisor should continue SNAP eligibility based on the original application.

 

 

A—170 Authorized Representatives (AR)

Revision 15-4; Effective October 1, 2015

 

All Programs

An applicant, head of household, or someone with legal authority to act for the individual (i.e., legal guardian or power of attorney) may designate an individual or organization as an AR.

An AR must be verified using one of the following:

  • Client’s signature on one of the following HHSC applications for benefits containing the AR designation:
    • Form H1010, Texas Works Application for Assistance — Your Texas Benefits
    • Form H1010-R, Your Texas Works Benefits: Renewal Form
    • Form H1014-R, Renewing Children’s Health-care Benefits
    • Form H1034, Medicaid for Breast and Cervical Cancer
    • Form H1200, Application for Assistance — Your Texas Benefits
    • Form H1200-MBI, Application for Benefits — Medicaid Buy-In
    • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children
    • Form H1205, Texas Streamlined Application
    • Form H1206, Health Care Benefits Renewal
    • Form H1840, SNAP Food Benefits Renewal Form
    • Form H1841, SNAP-CAP Application
    • Form H1842, SNAP-CAP Renewal Application
    • Form H2340, Medicaid for Breast and Cervical Cancer Renewal
    • Form H2340-OS, Medicaid for Breast and Cervical Cancer
  • Client’s signature on a Marketplace application for health care benefits that is transferred to HHSC.
  • Legal documentation that the AR has authority to act on behalf of the client under state law (i.e., legal guardianship or power of attorney).
  • Letter from a client designating AR authority and containing the client’s signature, in addition to the name, address, and signature of the AR.
  • Completed Form H1003, Appointment of an Authorized Representative. 
  • Client’s electronic signature designating the AR through their case account on an application, renewal, or reported change submitted through YourTexasBenefits.com.

If a person or organization has submitted an application on behalf of a client and indicates that they wish to be the client’s AR, and the client has not signed the application, then the AR must be verified before the client’s eligibility for benefits can be determined. Correspondence will be sent to both the unverified AR and the head of household on the case to request the verification.

  • The head of household for the case will be sent:
    • Form H1020, Request for Information or Action, listing what missing information is needed before eligibility can be determined.
    • Form H1003, to capture the client’s and AR’s signatures designating the AR.
  • The AR will be sent:
    • Form H1004, Cover Letter: Authorized Representative Not Verified, to describe what is needed to verify the AR.
    • Form H1003, to capture the client’s and AR’s signatures designating the AR.

In order for the AR to be verified, either the AR or the head of household will need to return the completed Form H1003 within 10 days (or 30 days from the file date) in order for the application to be considered valid. If other missing information was listed on the Form H1020 that was sent to the client, that information must also be returned timely. If the AR verification is not received by the due date, then the application is denied.

Note: During the interview, the advisor must obtain the AR’s complete mailing address, if the AR’s address is not included on the application form. The advisor must record the AR’s address on the corresponding TIERS Data Collection page, Household - Authorized Representative. If the individual cannot provide a complete mailing address for the AR or no interview is required for the program type, the advisor should not pend the case. The advisor must record the household’s mailing address as the AR’s address in TIERS.

The AR designation is effective from the date the AR is verified until:

  • the client notifies HHSC that the AR is no longer authorized to act on his or her behalf;
  • the AR notifies HHSC that they no longer wish to act as the client’s AR;  

    Note: The AR will not be able to do this during the redetermination process if the AR is completing the redetermination.
  • there is a change in the legal authority (i.e., legal guardianship or power of attorney) on which the AR’s designation is based; or
  • the client designates a new AR to act on their behalf. If there is an existing AR designated on a case, the person or organization that the client most recently designated as the AR will replace the existing AR on the case.

Notices ending the designation of the AR must include the client’s or AR’s signature as appropriate. 

Note: An AR is not automatically a personal representative (PR).

An AR is designated at the case level to have access to all benefit information for that case. A verified AR may:

  • sign an application on an applicant’s behalf;
  • complete and submit a renewal form;
  • receive copies of an applicant’s/client’s notices in the preferred language selected on the application, and other communications from HHSC;
  • designate a health plan; and
  • act on an applicant’s/client’s behalf in all other matters with HHSC.

The client or AR may also request that the AR receive the client’s Medicaid or CHIP ID card and enrollment-related agency correspondence.

Related Policy
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000
Personal Representatives, B-1212
Establishing Identity for Contact Outside the Interview Process, B-1213
Telephone Contact, B-1213.1

 

SNAP

People disqualified for SNAP benefits because of an administrative disqualification hearing or a nonmember living with the household may serve as an AR only if:

  • no other responsible household member is reasonably able to be an AR, or
  • that person is the only adult living in the household.

HHSC employees involved in certification or issuance and retailers authorized to accept SNAP benefits may serve as an AR only if the unit supervisor gives written approval.

 

 

A—171 Protective Payee

Revision 15-4; Effective October 1, 2015

 

TANF

A grandparent (including great- or great-great- grandparent) may represent the household in the application and review process upon the grandparent's request and when the advisor determines that the incompetent or incapacitated individual is not using TANF for the child's benefit. In these situations, the individual's signature and designation of the grandparent as AR in writing is not required on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. If the grandparent is designated AR, the grandparent is also designated protective payee.

Related Policy
Receipt of Application, A-121
Receipt of Application from Residential Child Care Facility , A-121.1
Verification Requirements, A-180
Documentation Requirements, A-190
Children Residing in General Residential Operations Facilities, A-923

 

 

A—172 AR Applying for Household

Revision 15-4; Effective October 1, 2015

 

All Programs

The AR must be informed about the household circumstances. The individual is liable for any overissuance resulting from inaccurate information that the AR gives, except in situations when drug/alcohol treatment centers or group living facilities act as AR for a SNAP household.

The AR must be an adult.

 

 

A—173 AR for Residents of Drug and Alcohol Treatment/Group Living Arrangement (GLA) Facilities

Revision 15-4; Effective October 1, 2015

 

SNAP

For these residents, a facility employee must serve as an AR to apply for the household and to use the benefits. See B-440, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities. The AR designated to use SNAP benefits may be a different person from the AR who applies for the household.

 

 

A—174 Abuse by AR

Revision 15-4; Effective October 1, 2015

 

SNAP

An advisor who suspects an AR of acting against the household's interests must report the circumstances to the advisor's program manager.

 

 

A—180 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

When an eligibility determination has been requested for multiple programs and the programs allow the same verification sources, the advisor must use the same verifications for all applicable programs. For example, if an individual is applying for SNAP, TANF, and Medical Programs, and the advisor accepts a wage verification for SNAP, the advisor must not request additional verification of the wage for TANF or Medical Programs if the source used was an acceptable form of verification for TANF or Medical Programs.

Advisors make the eligibility decision in each program when all verifications are received for that program.

Related Policy
Data Broker, C-820
Questionable Information, C-920
Providing Verification, C-930

 

TANF

Staff must verify that the caretaker is not using TANF benefits for the child's needs when the grandparent requests to be designated AR. If the caretaker requests the grandparent's removal as AR, staff must verify that the caretaker intends to use TANF benefits for the child's needs.

 

SNAP

Staff must verify the nonprofit status of homeless shelters, if questionable. See IRS documentation that proves the nonprofit status under Section 501(c)(3) of IRS regulations.

 

 

A—181 Verification Sources

Revision 15-4; Effective October 1, 2015

 

TANF

Advisors use the following sources to verify when a grandparent requests to be designated as an AR or when the caretaker requests that the grandparent be removed as AR:

  • non-related landlord,
  • non-related neighbor,
  • school officials,
  • Child Protective Services worker, and
  • a person without vested interest in outcome of decision.

 

 

A—190 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must document the date and method by which advance notice of a home visit was provided and the date and time of the visit. An imaged copy of the appointment notice provided to the individual is sufficient.

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.

When a household requests additional programs after filing an application, advisors must document the requested program and the date of the request.

Advisors must document the rationale used to make a prudent person principle decision and any applicable handbook references.

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

Advisors must document on the application and on Form H1350, Opportunity to Register to Vote, in the Agency Use Only section the actions taken when an applicant or individual notifies the local office of the decision to decline the opportunity to register to vote after receipt of Form H0025.

Advisors must document information to support the eligibility decision in enough detail that others can understand all computations and advisor decisions explained in C940, Documentation.

 

All Programs except TP 33, TP 34, TP 35, TP 43, TP 44, TP 45 and TP 48

For all interviews, staff must document:

  • whether the individual met telephone interview criteria and a telephone interview was not done for TANF and SNAP;
  • how interpreter services were provided when the application indicates the individual requested these services, including when the advisor conducted the interview and acted as an interpreter.

 

Medical Programs

Advisors must document when a designated Texas Works advisor requests that a child born to a woman in prison be certified for TP 43.

 

TANF

Advisors must document the specific reason for designating an AR.

When the grandparent requests to be the AR, the following information must be documented:

  • information the grandparent gives to support the claim that the parent is not using the TANF benefit for the child's needs;
  • information obtained from collateral contacts and/or documents; and
  • decision whether or not to designate the grandparent as the AR and protective payee.

 

SNAP

The following information must be documented:

  • the name and address of the AR;
  • that no one else is available, if a person disqualified for IPV or a nonmember living with the household is appointed as AR;
  • the tax-exempt status [Section 501(c)(3)] for public or private homeless shelters, if applicable;
  • expedited service eligibility by marking the appropriate box on Form H1010 and explain if eligibility is questionable;
  • the decision on the length of certification and reporting requirements for expedited service EDG;
  • whether a migrant is in or out of the workforce;
  • the reason for entering a late determination date; and
  • the reason why an appointment for an expedited applicant is not scheduled for an interview within the expedited time frame.

Related Policy
Documentation, C-940
Registering to Vote, A-1521
The Texas Works Documentation Guide

A-200, Household Composition

Revision 18-1; Effective January 1, 2018

 

A—210 General Policy

Revision 15-4; Effective October 1, 2015

 

TANF

The composition of a Temporary Assistance for Needy Families (TANF) certified group:

  • is a person or group of relatives whose needs are included in one Eligibility Determination Group (EDG).
  • must include an eligible child, unless the eligible relative cares for a child who receives:
    • Supplemental Security Income (SSI), Foster Care with Cash or Adoption Assistance with Cash; or
    • ME - SSI Medicaid (TP 19) and the relative chooses not to apply for TANF for the child.

Some persons are required members of the TANF certified group. The individual may not choose to exclude a required member from the certified group. If the individual fails to provide available verifications for a required member, assistance is denied for the entire certified group.

A TANF-State Program (SP) certified group must contain both an eligible:

  • caretaker/parent; and
  • second parent.

Note: Households are eligible for TANF-SP if the budget group contains:

  • two parents who are eligible and certified for TANF;
  • one parent who is certified for TANF and the other parent is disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements; or
  • two parents who are disqualified for one of the reasons listed in A-222, No. 4, unless that disqualification is due to not meeting citizenship requirements.

Related Policy
Alien Sponsor's Income, A-1361
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480

 

SNAP

A Supplemental Nutrition Assistance Program (SNAP) unit is one person or a group of people who live:

  • together and who usually purchase and prepare their food together; or
  • with others and intend to purchase and prepare food separately after certification.

Exception: A separate household status is allowed to a person (along with the person's spouse) age 60 or over who lives with others but cannot purchase and prepare food separately because of permanent incapacity, provided that required household members are not excluded. To allow separate household status, the gross income of the other household members (without the elderly person and spouse) must be less than 165 percent of the Federal Poverty Income Limit for the number of other persons.

The elderly person must:

  • prove that he or she meets the Social Security disability criteria in B-432, Definition of Disability, if questionable; and
  • provide verification of the other household member's income.

Note: All required members are always included, as described in A-231, Who Is Included, in the elderly person’s household. For example, the elderly person’s spouse or children under age 22 are always included in the same household unless elderly members have their own SNAP Combined Application Project (SNAP-CAP) EDGs.

Related Policy
Who Is Included, A-231
Noncommercial Roomer/Boarder Payments, A-1323.4.3
Disqualified Members, A-1362
Alien Sponsor's Income, A-1361
Students in Higher Education, B-410
Joint Supplemental Security Income (SSI)-SNAP Applications, B-476
Categorically Eligible Households, B-470

 

Medical Programs

Modified Adjusted Gross Income (MAGI) household composition is used to determine whose needs, income, and expenses are considered in determining an individual’s eligibility for medical programs. Each MAGI household composition is determined on the individual level. Individuals living at the same physical address may have a different MAGI household composition. MAGI household composition is based on federal income tax rules.

Exception: Medically Needy with Spend Down has certain exceptions for determining MAGI household composition and income explained in A-1359, How to Determine Spend Down.

An individual does not have to file a federal income tax return to apply for Medical Programs.

 

 

A—211 Relationships Resulting from Termination of Parental Rights

Revision 15-4; Effective October 1, 2015

 

All Programs

When a court terminates the relationship between a biological or adoptive parent and child, a legal parent/child relationship does not exist between the two individuals.

If a biological or adoptive parent’s parental rights to a child are terminated, that parent no longer has a legal parent/child relationship to that child, nor to any of the child’s children who are born after the date the parental rights were terminated.

Example: Amy’s parental rights to her child Julie are terminated when Julie is 16. Julie already has one child, Jill, at the time Amy’s parental rights are terminated. Subsequently, Julie has a second child, Bill. As a result, Amy no longer has a legal relationship with Julie or Bill, but she retains her grandparent relationship to Jill.

Note: A parent whose parental rights have been terminated is not considered the natural parent of their biological child.

Relationships that existed between the child and other relatives of the biological parent are not interrupted or terminated. The only relationship terminated is that of the parent that relinquished his or her parental rights. Example: The child's biological or adoptive grandparents, siblings, aunts, uncles, and cousins still have the same relationship to the child they had before the parental rights were terminated.

Related Policy
Child Support and Medical Support Referrals, A-1122.2

 

A—212 Relationships Resulting from Adoption Procedures

Revision 15-4; Effective October 1, 2015

 

All Programs

A legal parent/child relationship is created when an individual adopts a child. The adoptive parent/child relationship creates the same relationships with the adoptive parent's relatives that are created with a biological parent/child relationship. Example: When a grandparent adopts a biological grandchild, the:

  • grandparent becomes the child's adoptive parent, and
  • the biological parent becomes the child's adoptive sibling.

 

A—213 Adoption Household Composition Situations

Revision 15-4; Effective October 1, 2015

 

TANF

Adoption household composition is determined by the advisor using the following steps:

Step 1

Identify all eligible children for the applicant/recipient.

Step 2

Include all eligible children in the certified group.

Step 3

Include all siblings of the children included in Step 2 if they are eligible children and cannot be certified separately from their sibling. Include a minor's child at the caretaker/payee's request.

Example 1

If a household consists of the applicant, the applicant’s two biological children, ages 15 and 17, the 15-year-old's baby (age 1) that the applicant has adopted, and the 17-year-old's 2-year-old baby, the advisor must:

Step 1 Identify eligible children:
  • 15-year-old (daughter of applicant)
  • 17-year-old (daughter of applicant)
  • 1-year-old (adopted daughter)
  • 2-year-old (applicant's grandchild – include at applicant's request)
Step 2 Include in certified group:
  • applicant
  • 15-year-old
  • 17-year-old
  • 1-year-old
Step 3 Include in certified group at the applicant's request:
  • 2-year-old

Example 2

If a household consists of the applicant, adopted child (biological grandchild), and the adopted child's half-sibling, not related to the applicant, the advisor must:

Step 1

Identify eligible children:

  • adopted child
Step 2 Include in certified group:
  • applicant
  • adopted child
Step 3 N/A – there are no optional eligible children.

Note: For TP 32, TP 33, TP 34, TP 35, TP 43, TP 44, TP 48 or TP 56, the half-sibling can be considered an independent child when determining the child’s eligibility for Medicaid. See A-910, General Policy.

 

A—220 TANF

Revision 08-1; Effective January 1, 2008

 

 

 

A—221  Who Is Included

Revision 18-1; Effective January 1, 2018

 

TANF

The following are always included in the TANF certified group:

  1. Eligible Child

    An eligible child is a person who meets TANF requirements, is not married according to Texas state law, and is:
    • under age 18; or
    • age 18 and:
      • is a full-time student (as defined by the school) in high school, attends an accredited general equivalency diploma (GED) class, or regularly attends vocational or technical training as an equivalent to high school attendance; and
      • expects to graduate before or during the month of the child’s 19th birthday.

    Notes:
    • GED is approved only if the class is administered by an accredited institution.
    • When removing a child age 18 or 19 from the grant, A-1424, Diversions, Alimony, and Payments to Dependents Outside the Home, is used to determine whether to divert for the child's needs.
    • A child certified for foster care Medicaid only or adoption assistance Medicaid only is a potentially eligible child.

    An emancipated minor is an eligible child if the:
    • child meets the TANF age criteria;
    • child is not married in accordance with Texas state law; and
    • caretaker/payee exercises parental control of the child.

  2. Eligible Legal Parent

    An eligible legal parent is a legal parent who meets TANF requirements and lives with an eligible child. This includes a parent who is absent solely because of employment or active duty in the U.S. military. See A-1040, Deprivation Based on Absence from the Home. This includes parents receiving foster care or adoption assistance services for themselves, but not the child(ren).

    Exception: See No. 6, Minor Parents, below.
     
  3. Siblings

    A sibling is a brother or sister of an eligible child, including legally adopted and half-brothers and sisters. Siblings must be certified together if they meet all TANF requirements. If an unborn child will be a required member of the certified group, a special review is set for the first day of the month after the expected delivery month.

    Note: Half-brothers/sisters who do not meet the degree of relationship to the caretaker are not eligible to receive TANF benefits but can be certified as an independent child on a separate Medicaid EDG. See A-910, General Policy.

    Example: The household consists of a grandparent, two grandchildren and a half-sibling to the grandchildren. The two grandchildren can be certified for TANF and Medicaid because they meet the required degree of relationship to the caretaker. The half-sibling does not meet the required degree of relationship to the caretaker and cannot be certified for TANF. The half-sibling can be certified as an independent child on a separate Medicaid EDG.

    Exception: See No. 6, Minor Parent, below.
     
  4. Caretaker

    A caretaker is any specified relative who:
    • is present in the home; and
    • supervises and cares for the TANF child(ren).

    A caretaker must be the child's:
    • father or mother;
    • grandfather or grandmother;
    • brother or sister;
    • uncle or aunt;
    • first cousin;
    • nephew or niece;
    • stepfather or stepmother;
    • stepbrother or stepsister; or
    • first cousin once removed.

    Relationship extends to the:
    • Spouse of the listed relatives, even after the marriage has ended in death or divorce, regardless of when the child's birth occurred.
    • Degree of "great-great" for uncles/aunts and nephews/nieces.
    • Degree of "great-great-great" for grandparents.

    A caretaker meets the relationship requirement even if a court has jurisdiction over the child or an agency is the child's managing conservator. If a child lives with a managing conservator, the conservator must meet the relationship requirement.

    If a child lives with a married relative (not a parent) who wants to be considered the caretaker, eligibility and benefits are determined using:
    • normal budgeting procedures for the applicant's income, and
    • stepparent budgeting for the income of the applicant's spouse.

    Note: See A-1366, Stepparent EDGs, for budgeting.

    If the person applying for the child cannot qualify to receive TANF, the individual’s needs are not included in the certified group. If no one qualifies as caretaker, only the needs of the eligible children are included.

    No one else is included as caretaker if the legal parent is:
    • in the home; and
    • physically and mentally able to provide care.

    Exception: The stepparent may be certified as caretaker if the stepparent wants to be included and the legal parent has a disability. The stepparent and legal parent who has a disability are certified for TANF-SP when the stepparent is included in the certified group.

    Related Policy
    Relationship, A-520
    Relationship Charts, C-1440

  5. Second Parent

    When a child lives with both legal parents, both parents are included in the certified group. The parent who is not the caretaker is the second parent. The second parent must meet all TANF requirements.

    The household may be certified for TANF-SP when:
    • both parents are eligible and certified for TANF;
    • one parent is eligible and certified for TANF and the other parent is disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements; or
    • both parents are disqualified for one of the reasons listed in A-222, No. 4, unless that disqualification is due to not meeting citizenship requirements.

    Related Policy
    General Policy, A-1310
     
  6. Minor Parent

    A minor parent and child(ren) living with the minor parent's parent(s) and/or siblings may:
    • be certified separately if the:
      • minor parent's parent(s)/sibling(s) is not a TANF applicant/recipient; or
      • minor parent cannot be included in his parent(s)'/sibling(s)' TANF EDG because he is not an eligible child; or
    • continue to receive TANF on a separate EDG if the minor parent's EDG was certified before the:
      • month the parent(s)/sibling(s) applied for TANF; or
      • day the minor parent moved into the home with the parent(s)/sibling(s).

    Otherwise, the minor parent must be included as a child with the:
    • legal parent(s) who receives TANF/TANF-SP; or
    • sibling certified for TANF/TANF-SP as a child.

    If the caretaker or payee in the EDG requests TANF for the minor parent's child, the child is included in the EDG with the caretaker/payee and the minor parent.

    Exception: A married minor parent is an eligible legal parent and must be certified separately from the minor parent’s parents. See No. 1, Eligible Child, above.

    Related Policy
    Requirement for Unmarried Minor Parents to Live with an Adult or in an Adult-Supervised Setting, A-930
    Unmarried Minor Parent Income, A-1365
    Stepparent Budgeting Procedures, A-1366.2
     
  7. Stepparents

    A stepparent is not a child's legal parent but is the legal parent's spouse. Stepchildren are deprived of parental support because one legal parent is absent.

     

    Include the stepparent in the certified group only if the stepparent wants to be included and:
    • the stepparent is the only parent in the home; or
    • both the legal parent and the stepparent are in the home and the legal parent has a disability according to policy in A-1051, Determining Incapacity.

     

    Certify the stepparent and legal parent with disabilities for TANF-SP when the stepparent is included in the certified group.

     

    If the legal parent and stepparent live in the home and have mutual children, they must all be included in the same certified group.

     

    Related Policies
    Resources of Stepparents, A-1247
    Stepparent EDGs, A-1366
    A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480  
     
  8. People in Nursing Homes

    If a member of the TANF-certified group temporarily enters a nursing facility, the individual’s needs are left in the TANF budget during the nursing facility stay or until the individual is certified for Supplemental Security Income (SSI). The individual should be referred to the Social Security Office for an SSI eligibility determination.

 

A—222 Who Is Not Included

Revision 15-4; Effective October 1, 2015

 

TANF

The following are not included in the TANF-certified group:

  1. Payee

    A payee is a relative who meets relationship requirements in A-220, TANF, and lives with, supervises and cares for an eligible child. The payee is authorized to receive the TANF benefits for an eligible child but is not a member of the certified group because the individual is a:

    • legal parent who would be a caretaker but is ineligible due to receipt of SSI.
    • relative other than the legal parent who qualifies as a caretaker except the individual:
      • chooses not to be included as caretaker;
      • receives SSI, Foster Care with Cash or Adoption Assistance with Cash payments;
      • is disqualified for an intentional program violation (IPV); or
      • fails to comply with a program requirement that would disqualify a legal parent. See No. 4, Disqualified Members, below.

    Note: A payee who chooses not to be included as a caretaker on one EDG may be a caretaker on another TANF EDG for other related children.

  2. Protective Payee

    A protective payee must be selected to receive and manage the TANF benefit if the caretaker is not using the TANF payments for the children's benefit. See A-1553, Use of TANF Benefits.

    The protective payee must be someone who can help the individual spend the household'sTANF benefits properly. The individual must agree to the person designated as the protective payee unless the:

    • Texas Department of Family and Protective Services (DFPS) designates a protective payee, or
    • advisor designates the grandparent (including great- or great-great-grandparent) as authorized representative and protective payee, because the parent is not using the TANF payments for the child's benefit. See A-170, Authorized Representatives (AR).

    The protective payee cannot be a:

    • Texas Health and Human Services Commission (HHSC) employee, or
    • person who provides HHSC services to the family.

    The protective payee situation must be re-evaluated at each complete redetermination. For EDGs with a:

    • DFPS-requested protective payee, DFPS must be contacted at each complete redetermination to determine whether the protective payee should continue; and
    • grandparent designated as protective payee and authorized representative, any reports alleging that the grandparent is not using TANF for the child's benefit must be investigated.

    When designating or continuing a protective payee, the individual is notified and allowed an opportunity to appeal.

  3. Representative Payee

    A representative payee is designated if an individual is unable to receive and manage the household's TANF or Medicaid benefits because of incapacity or incompetence. The representative payee must be knowledgeable about the family members and interested in the family’s welfare. The individual must designate this representative in writing if physically or mentally capable of doing so.

    The representative payee may be the authorized representative who assisted in the eligibility process.

  4. Disqualified Members

    A legal parent is disqualified from the certified group if the individual:

    • does not meet citizenship requirements;
    • refuses to comply with Medicaid third-party resource (TPR) requirements;
    • does not comply with Social Security number requirements;
    • is found guilty of an intentional program violation;
    • fails to timely report the temporary absence of a certified child (see A-920, Temporary Absence from the Home, for disqualification procedures);
    • is a fugitive fleeing to avoid prosecution of or confinement for a felony criminal conviction, or found by a court to be violating federal or state probation or parole;
    • is convicted of a felony drug offense (not deferred adjudication) for the possession, use or distribution of a controlled substance as defined in 102(6) of the Controlled Substances Act [U.S. Code (USC) 802(6)] that was committed on or after April 1, 2002, in Texas or another state;
    • has received benefits for the total months allowed by the state time limit;
    • is a minor parent who fails to comply with the unmarried minor parent domicile requirement; or
    • is denied for refusal to cooperate with the program integrity assessment (that is, quality control) process.

    Note: A legal parent is permanently disqualified for a felony drug conviction (not deferred adjudication) for an offense that was committed on or after April 1, 2002.

    A child is disqualified from the certified group if the child:

    • is a fugitive;
    • fails to comply with Social Security number requirements;
    • is a minor parent and fails to report the temporary absence of the minor parent's child; or
    • is convicted of a felony drug offense that was committed on or after April 1, 2002.

    Notes:

    • If the disqualified member wishes to apply for Medicaid, the advisor must determine which medical program applies to the disqualified household member. If all eligibility requirements are met, the member is certified on the appropriate medical program.
    • When the criminal history report in the Data Broker system indicates the individual has been convicted of an offense involving a controlled substance, the situation should be discussed with the individual. If the individual claims not to be the individual indicated on the criminal history report but the identifying information on the report (name, date of birth, physical description) leads the advisor to believe the report is correct, or the individual is in disagreement with other information provided in the report (for example, the type of conviction or whether it was a felony or misdemeanor), the advisor must:
      • document the client’s response in Case Comments;
      • proceed with the appropriate EDG action without acting on the criminal history report;
      • contact the Office of Inspector General (OIG) by emailing the OIG General Investigations Policy and Quality Control Unit at oig_gi@hhsc.state.tx.us; and
      • document the reason for contacting OIG in Case Comments. Once OIG obtains information to clear the discrepancy, the assigned OIG investigator provides the response/finding by creating a task within the Task List Manager (TLM) system. The assigned advisor clearing this task documents the results of the OIG's findings in case comments and, if applicable, enters information in the Data Collection-Individual Demographic-Conviction/Rehabilitation page. Make an overpayment referral if appropriate. (See B-770, Filing an Overpayment Referral.)

Related Policies
Disqualified Members, A-1362
General Policy, A-1210
When the Client Signs Form H1073, A-2128.1

  1. SSI Recipients

    A TANF family member is removed from the grant when the person is certified for SSI. The Social Security Administration notifies HHSC via an interface when a TANF recipient is determined eligible for SSI.

    Exception: Children whose SSI financial benefits were denied because of changes in the SSI disability definition in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 receive TP 19, SSI Denied Children. Individuals may choose to include or exclude these children from the TANF certified group.

  2. Residents in State Supported Living Centers for Individuals with Intellectual Disabilities

    If a TANF recipient enters a state supported living center for individuals with intellectual disabilities, the individual’s needs are removed from the TANF grant. If the recipient is the caretaker or payee, the grant continues for the remaining eligible children in another eligible person's name.

  3. Strikers

    A household's application or ongoing benefits are denied for any month in which a certified or disqualified legal parent is participating in a strike.

  4. Foster Care with Cash Payment, Adoption Assistance with Cash Payment, and Permanency Care Assistance (PCA) with Cash Payment recipients.

A person receiving these cash benefits is not included in the TANF EDG.

Note: An individual potentially may receive Texas Department of Family and Protective Services foster care through the individual's 22nd birthday month. Adoption assistance and PCA are only received through the 18th birthday month unless the family signs an agreement after the youth turns age 16. When this occurs, the youth may receive adoption assistance or PCA through their 22nd birthday month.

  1. A child who is ineligible, such as an ineligible alien child or a child who is not within the required degree of relationship to the adult caretaker/payee, is not included.

 

A—223 Certifying Children on Non-Parent Caretaker EDGs

Revision 16-3; Effective July 1, 2016

 

TANF

When an eligible child lives with a relative other than the legal parent, the child is certified on:

  • a separate EDG when the relative receives TANF for children who are not the child's natural, adopted, or half siblings (designate the relative as a payee); or
  • the same EDG with the non-parent caretaker when the relative:
    • requests it and is not receiving TANF for any other children; or
    • is receiving TANF for children who are the child's natural, adopted, or half siblings.

Each other-related child (other than siblings) is certified on a separate EDG.

Exception: Other-related children are certified on the same EDG if:

  • at least one EDG is ineligible separately;
  • the members would be eligible if the EDGs were combined; and
  • the relative requests that they be combined.

A child's TANF must not be denied because of the income or resources of a:

  • child who is not the child’s natural, adopted, or half sibling; or
  • caretaker who is not the child’s parent (see A-1366.2, Stepparent Budgeting Procedures).

When an EDG is denied because of the income or resources of a non-parent relative caretaker:

  • process the denial for the EDG including the caretaker's request for aid; and
  • process a separate EDG to determine the child's eligibility without the caretaker.

Note: Households that include a non-parent caretaker are not eligible for TANF-SP.
See B-480, A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, for more information on the action to take when some members must be denied while others remain eligible.

Related Policy OTTANF, A-2411 Grandparent Payments, A-2412 Documentation Requirements, A-2470

 

A—224 Special Household Composition Situations

Revision 02-8; Effective October 1, 2002

 

 

 

A—224.1 TANF-SP EDGs with Stepchildren or a Parent's Child from a Previous Relationship

Revision 15-4; Effective October 1, 2015

TANF

The following must be included in the TANF-SP EDG:

  • a child who lives with a natural/adoptive parent, a stepparent, and a sibling who is the parent and stepparent’s mutual child.
  • parents and all children, when:
    • the legal parents of a mutual child are not married to each other, and
    • one or both have a child living in the home who is not a mutual child.

If the household is ineligible for TANF-SP because they do not meet other TANF eligibility requirements such as income or resources, the family unit must remain as one filing unit even when stepchildren are included. In this situation, the advisor must determine whether the household meets eligibility requirements for the Medical Programs.

If an active TANF-SP EDG is denied because of earnings or the removal of the 90 percent earned income deduction and the household is receiving TP 08, the Texas Integrated Eligibility Redesign System (TIERS) will deny both the TANF-SP and TP 08 EDGs and create:

  • a transitional Medicaid EDG if the certified group meets the eligibility criteria; or
  • another Medical Program type of assistance EDG for eligible members if they are not eligible for transitional Medicaid and are otherwise eligible for medical coverage.

Related Policy
Transitional Medicaid Coverage, A-840
General Eligibility Information, A-841
TP 07 Transitional Medicaid, A-842

 

A—224.2 TANF-SP EDGs with an Other-Related Child

Revision 15-4; Effective October 1, 2015

 

TANF

Each other-related child living in the family (see A-223, Certifying Children on Non-Parent Caretaker EDGs) is certified on a separate EDG unless the child or other members are ineligible separately. If the child or other members are ineligible separately, the other-related child in the TANF-SP EDG is included. The advisor must ensure that the other-related child has the opportunity to continue receiving TANF when the TANF-SP EDG is denied.

 

A—230 Supplemental Nutrition Assistance Program (SNAP)

Revision 08-1; Effective January 1, 2008

 

 

 

A—231 Who Is Included

Revision 16-4; Effective October 1, 2016

 

SNAP

The following people must be certified as a Supplemental Nutrition Assistance Program (SNAP) household if they live together:

  1. Parents and children (natural, adopted or step) age 21 or younger. Parents and children living together when the parent or child is away from home for employment or educational purposes only, and returns home at least one day a month are considered. This includes college students who are eligible for SNAP, as explained in B-410, Students in Higher Education.

    Notes:
    • Consider the individual’s age as 22 beginning the month they turn age 22.
    • Do not consider a parent whose parental rights were terminated as the natural parent of a child.
    • The relationship between a stepparent and stepchild terminates when the marriage between the parent and stepparent terminates, either by death or divorce.
    • When DFPS places a child in foster care, the foster child is considered under parental control of the foster parent. If the foster child's parent moves into the home, the parent, child and foster parent must all be included in the SNAP household.
    • If the parents of a child do not live together and the child lives with each parent part of the month, the child can be certified with either parent as long as both parents do not apply. If both parents apply, then certify the parent who provides the majority of meals for the child.
  2. A child under age 18 and any nonparent adult household member with parental control over the child. A child not under parental control may apply separately if the child purchases and prepares food separately. Individuals age 18 are considered beginning the month they turn age 18.

    Exceptions: Even if under parental control of a nonparent household member:
     
    • A foster parent or caregiver has the option to include or exclude a foster/Permanency Care Assistance (PCA) child/adult as a household member in the SNAP-certified group. Households with more than one child/adult can opt to include some foster/PCA children/adults while excluding others, even if the foster/PCA children/adults are related to each other or related to the foster parent or caregiver. A foster/PCA child/adult who is excluded from the foster/PCA family's SNAP-certified group is not eligible to participate in SNAP alone as a separate household or as a certified member on another household's SNAP EDG. See A-1326.4, Foster Care and Permanency Care Assistance (PCA) Payments, for information on how to budget foster care/PCA payments.
    • The household may consider a foster child as a boarder instead of a household member. See A-1323.4.3, Noncommercial Roomer/Boarder Payments.
    • A child under age 18 who purchases and prepares food separately can apply separately if the child is:
      • married and living with the spouse; or
      • the parent of a minor child living in the home.
    • A child under age 18 residing with a SNAP-CAP participant can apply separately. The minor child is certified as the SNAP head of household. See B-475.3, Household Composition.
  3. Spouses. Spouses are people who:
    • are married to each other; or
    • live together and represent themselves to the community as married. This definition may differ from state laws governing common-law marriage.
      • A same-sex marriage that occurred before June 26, 2015, is considered valid effective June 26, 2015.
      • A same-sex marriage that occurred on or after June 26, 2015, is considered valid on the date it occurred.

Note: Spouses are considered to be living together even when one spouse:

  • is away from home for employment or educational purposes only; and
  • returns home at least one day a month.

Exception: SNAP-CAP participants are certified on separate EDGs.

 

A—232 Who Is Not Included

Revision 15-4; Effective October 1, 2015


 

 

A—232.1 Nonmembers

Revision 16-3; Effective July 1, 2016

 

SNAP

The following are not included in a Supplemental Nutrition Assistance Program (SNAP)-certified group:

  1. Roomers — A roomer who pays for lodging but not food as a separate household is certified unless the individual meets one of the three categories in A-231, Who Is Included.
  2. Live-in attendants — A live-in attendant is certified as a separate household unless the individual meets one of the three categories in A-231.
  3. Boarders — Boarders in noncommercial boarding houses cannot receive SNAP separate from the household they are living with. Boarders who live in a commercial boarding house cannot participate in SNAP. See A-1323.4.3, Noncommercial Roomer/Boarder Payments.

    Note: The household has the option to include or exclude a foster child/adult as a household member in the SNAP-certified group.
     
  4. Ineligible students — These are students who do not meet the student criteria in B-410,Students in Higher Education.
  5. Institutional residents  Residents who are offered more than half their meals from an institution that is not an approved institution. (See examples of approved institutions in the note below).

    Common examples of institutions are hospitals, nursing homes, public or private homes for persons with a disability, establishments for delinquents and young offenders, group homes for children, penal and correctional institutions, jails, homeless shelters, and students living in a school dormitory where the majority of meals are provided.

    Some foster children/adults are placed by foster placement agencies in homes or facilities other than a foster parent home and are cared for by individuals who are employees of, or contract with, placement agencies. There usually are multiple foster children/adults residing in such facilities. Foster children/adults who reside at these facilities or locations instead of at the foster parent’s home address are considered institutionalized and cannot receive SNAP.

    Note: Residents of approved institutions can receive SNAP as explained in A-116.2, Applications from Residents of a Homeless Shelter; B-440, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities; B-450, Residents in Family Violence Shelters.

    Residents of a homeless shelter, drug and alcohol treatment center, or a shelter for battered persons can apply and be certified separately, regardless of how they purchase and prepare meals with other residents. The SNAP household would consist of the mandatory household members found in A-231, Who Is Included.

  6. New household members who are certified in another household. These people are not added to the new EDG until they are removed from the old one. Exception: Residents in shelters for battered persons may receive two allotments in one month if the original benefits were issued to the former household that included the woman and children and the abusive person. See B-454, Participation Twice in Same Month.
  7. Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP) participants. Household members are certified separately from an active SNAP-CAP participant. See B-475.3, Household Composition.

Related Policy
Foster Care and Permanency Care Assistance (PCA) Payments, A-1326.4
Prepared Meal Services, B-460
Determining Whether an Individual Who Receives Residential Assistance Is Institutionalized, B-490

 

A—232.2 Disqualified Persons

Revision 16-3; Effective July 1, 2016

 

SNAP

These are people who would be required SNAP household members but are disqualified. They cannot participate during their period of disqualification. The disqualified individual’s circumstances, however, including income and resources, do affect the household's benefits.

  1. Fugitives are people who are fleeing to avoid prosecution of or confinement for a felony criminal conviction, or are found by a court to be violating federal or state probation or parole. The individual's statement is accepted as verification and the individual is treated as a disqualified person for the period they remain a fugitive.
  2. Individuals with a felony conviction. An individual with a felony drug conviction (not deferred adjudication) in Texas or another state occurring on or after September 1, 2015, for the possession, use or distribution of a controlled substance as defined in 102(6) of the Controlled Substance Act [21 USC 802(6)]:
  • incurs a two-year SNAP disqualification if the individual violates a condition of parole or community supervision: or
  • incurs a permanent disqualification if the individual has a subsequent felony drug conviction while receiving SNAP.

The individual's statement is accepted as verification of a felony drug conviction.

When the criminal history report in the Data Broker System indicates the individual has been convicted on or after September 1, 2015 of an offense involving a controlled substance, discuss the situation with the individual. If the individual claims not to be the individual indicated on the criminal history report but the identifying information on the report (name, date of birth, physical description) leads the advisor to believe the report is correct, or the individual disagrees with other information provided in the report (such as the type of conviction or whether it was a felony or misdemeanor), the advisor must:

  • document the individual's response in Case Comments;
  • proceed with the appropriate EDG action without acting on the criminal history report;
  • contact the OIG by emailing the OIG General Investigations Policy and Quality Control Unit at oig_gi@hhsc.state.tx.us; and
  • document the reason for contacting OIG in Case Comments. Once OIG obtains information to clear the discrepancy, the assigned OIG investigator provides the response/finding by creating a task within the Task List Manager (TLM) system. The assigned advisor clearing this task documents the results of the OIG's findings in Case Comments and, if applicable, enters information in the Data Collection-Individual Demographic-Conviction/Rehabilitation page. Make an overpayment referral if appropriate. (See B-770, Filing an Overpayment Referral.)
  1. IPV. These are people disqualified for an intentional program violation in Texas or another state.
  2. Noncooperation with SNAP Employment and Training (E&T). These are people disqualified for failing to cooperate with E&T requirements.
  3. Noncooperation with Social Security number (SSN) requirements. These are people disqualified for failing to cooperate with SSN requirements.
  4. Ineligible Alien. These are people who do not have eligible alien status to receive benefits.
  5. SNAP ABAWD Work Requirement. These are people who are age 18 up to age 50 who have received their initial three months of SNAP benefits and who do not meet the work requirement.

Related Policy Disqualified Members, A-1362

 

A—240 Medical Programs

Revision 16-4; Effective October 1, 2016

 

Medical Programs

The following individuals may be certified for medical coverage if they meet all eligibility criteria:

  • children under age 19;
  • other-related children under age 19;
  • independent children under age 19;
  • pregnant women;
  • legal parent(s);
  • caretaker relatives; or
  • spouse of caretaker relatives.

MAGI rules are used to determine financial eligibility for certain Medical Programs. MAGI rules are based on Internal Revenue Service tax rules.

The following criteria are considered when determining the MAGI household composition for Medical Programs:

  • tax status;
  • tax relationships;
  • living arrangements; and
  • family relationships.

Tax Status

An individual’s tax status must be designated before their MAGI household composition can be determined.

Tax status is based on the individual’s self-declaration for what he or she plans to report on his or her federal income tax return for the taxable year in which eligibility for Medical Programs is requested.

Individuals must be designated as one of the following:

  • A taxpayer – an individual who plans to file a federal income tax return for the taxable year in which eligibility for Medical Programs is requested and who is not claimed by another taxpayer. Spouses who plan to file a joint or separate federal income tax return are both considered taxpayers.

Note: For MAGI household composition purposes, an unmarried individual who intends to file a joint tax return is considered a taxpayer filing separately. An individual who is unmarried is not considered a taxpayer filing jointly.

  • A tax dependent – an individual who plans to be claimed as a tax dependent by a taxpayer.

Note: An individual who is both a taxpayer and tax dependent is considered a tax dependent. Example: A college student who plans to file his or her own federal income tax return and expects to be claimed by his or her parents will be considered a tax dependent.

  • A non-taxpayer/non-tax dependent – an individual who does not plan to file a federal income tax return in the taxable year in which eligibility for Medical Programs is requested and does not plan to be claimed by a taxpayer. 

Tax Relationships

Individuals have a tax relationship to one another if they:

  • plan to file a joint federal income tax return;
  • are the taxpayer that plans to claim specific tax dependent(s); or
  • are a tax dependent of a specific taxpayer.

Individuals do not have a tax relationship to anyone if they:

  • do not plan to file a federal income tax return;
  • are not the taxpayer planning to claim the specified tax dependent(s); or
  • are not a tax dependent of a specified taxpayer.

Living Arrangements

Individuals are not required to live at the same physical address in order to apply for each other if they have a tax relationship, as explained in A-121, Receipt of Application.

Domicile requirements explained in A-900, Domicile, apply to TP 08, Parents and Caretaker Relatives Medicaid. A parent/caretaker relative must reside with a dependent child to receive TP 08 benefits.

A child entering a state hospital may qualify as an independent child. The child may qualify even if ordered by the court into a state hospital. A child is considered an independent child if court ordered into a state hospital because the parent/caretaker relative no longer has care and control. If the parent/caretaker relative admitted the child voluntarily into a state hospital, verification of whether the parent/caretaker relative still has care and control to determine independent child status is required.

An inquiry should be performed prior to certifying an independent child. The child is certified as an independent child if all eligibility criteria are met. The coverage continues for 12 months, even if the child is released from the state hospital. If a child is released from the facility prior to the end of the 12-month period, the address change is processed and coverage is continued.

Determining Custodial Parent

A custodial parent is established based on physical custody and who has legal authority to claim a child as a tax dependent specified in a court order, binding separation agreement, divorce agreement, or custody agreement.

  • If there is no order or agreement, or in the event of a shared custody agreement without specifications for filing federal income tax returns, the custodial parent is the parent with whom the child spends most nights. In the event that the child spends an equal amount of nights with both parents, the advisor must make a prudent person decision regarding which parent should be considered the custodial parent.
  • If both a custodial parent and a non-custodial parent declare that they plan to claim the same child as a tax dependent on their federal income tax return, the advisor should build the child’s MAGI household composition as a tax dependent of the custodial parent. 

Family Relationships

Family relationships that impact household composition include:

  • marriage;
  • parents of children under age 19; and
  • siblings under age 19 or a child under age 19.

The tax status of the individual impacts how the family relationship is used in determining MAGI household composition.

Notes:

  • For MAGI only applications and renewals, a relationship and tax status of unmarried and intending to file jointly is not an indication that the individual is currently married or that there is a discrepancy in the individual's marital status.
  • For integrated applications and renewals that include SNAP or TANF, a relationship and tax status of unmarried and intending to file jointly should be treated as a case clue if marital status is questionable.
  • For all applications and renewals, if the client provides a tax document with an indication of marital status that is inconsistent with the marital status that was reported on an application, the discrepancy in the marital status must be resolved.

A household cannot choose to exclude a child from the budget group when determining eligibility for Medical Programs. 

The policy in A-241, Budget Group, and A-242, Certified Group, is used to determine whom to include in the budget and certified group.

Related Policy
Children Admitted into State Hospitals, A-922
Verification Requirements, A-940
Documentation Requirements, A-950
Applications for Babies Born to Women in Prison, A-116.3
Eligibility Requirements, A-521

 

A—241 Budget Group

Revision 12-1; Effective January 1, 2012

 

 

A—241.1 Who Is Included

Revision 15-4; Effective October 1, 2015

 

 

A—241.1.1 Taxpayer’s MAGI Household Composition

Revision 15-4; Effective October 1, 2015

 

Medical Programs

The following individuals are included in the taxpayer’s MAGI household composition:

  • The taxpayer;
  • The taxpayer’s spouse, if the taxpayer and the spouse live together;
  • The taxpayer’s spouse, if the taxpayer and spouse file a joint federal income tax return; and
  • Any individual the taxpayer plans to claim as a tax dependent.

 

A—241.1.2 Tax Dependent Exceptions

Revision 15-4; Effective October 1, 2015

 

Medical Programs

If a tax dependent meets any one of the following exceptions, staff must use the non-taxpayer/non-tax dependent rules explained in A-241.1.4, Non-Taxpayer/Non-Tax Dependent’s or Tax Dependent with an Exception MAGI Household Composition, (not the tax dependent rules) to build the tax dependent’s MAGI household composition:

  • The tax dependent is not the taxpayer’s spouse or the taxpayer’s child under age 19;
  • The tax dependent is a child under age 19 who lives with both parents who do not plan to file a joint federal income tax return and the child was claimed by one parent; or
  • The tax dependent is a child under age 19 who is claimed as a tax dependent only by a non-custodial parent.

For a child claimed as a tax dependent by both parents who are filing jointly, with one parent living outside the home, the child does not meet the third tax dependent exception. Staff must build the child’s MAGI household composition using the tax dependent rules explained in A-241.1.3, Tax Dependent’s MAGI Household Composition.

 

A—241.1.3 Tax Dependent’s MAGI Household Composition

Revision 15-4; Effective October 1, 2015

 

Medical Programs

If an individual is a tax dependent and does not meet a tax dependent exception previously listed, the following individuals must be included in the tax dependent’s MAGI household composition:

  • The tax dependent;
  • The individuals in the MAGI household composition of the taxpayer who is planning to claim the tax dependent; and
  • The tax dependent’s spouse, if the tax dependent and the spouse live together.

 

A—241.1.4 Non-Taxpayer/Non-Tax Dependent’s or Tax Dependent with an Exception MAGI Household Composition

Revision 15-4; Effective October 1, 2015

 

Medical Programs

If an individual does not plan to file a tax return nor plans to be claimed as a tax dependent, the individual is considered a non-taxpayer/non-tax dependent. All tax dependents who meet an exception – Tax Dependent Exceptions­ – will build his or her MAGI household composition using the non-taxpayer/non-tax dependent rules.

The following individuals must be included in the non-taxpayer/non-tax dependent’s or tax dependent with exception’s MAGI household composition if living together

  • The individual,
  • The individual’s spouse,
  • The individual’s children under age 19, and
  • If the individual is a child under age 19:
    • The individual’s parents, and
    • The individual’s siblings under age 19.

 

A—241.1.5 Inclusion of the Unborn

Revision 16-4; Effective October 1, 2016

 

Medical Programs

The expected number of unborn children are included in the MAGI household composition of:

  • a pregnant woman; and
  • any individual whose MAGI household composition includes a pregnant woman.

Note: When including the expected number of unborn children in the MAGI household composition, the pregnant woman is not required to be certified on a medical program.

Related Policy
General Policy, A-910
Income Limits and Eligibility Tests, A-1341
Who Is Included, D-321
Who Is Not Included, D-322

 

A—241.2 Who Is Not Included

Revision 15-4; Effective October 1, 2015

 

Advisors must use the MAGI household composition policy explained in A-241.1, Who Is Included, when determining eligibility for Medical Programs. 

 

A—241.3 Household Composition Situations (Minor Parents, Independent Children, Etc.)

Revision 15-4; Effective October 1, 2015

 

Advisors must use MAGI household composition policy explained in A-241.1, Who Is Included, when determining eligibility for Medical Programs.

 

A—241.3.1 Children's Living Arrangements

Revision 18-1; Effective January 1, 2018

 

Medical Programs

A child is considered institutionalized if the child is residing in a facility:

  • that is an organizational part of a governmental entity, such as a county holding facility for juveniles; or
  • over which a government unit exercises final administrative control.

A child is not considered institutionalized if the child is residing in a facility that is a:

  • publicly operated community residence that serves no more than 16 residents, such as a county emergency shelter;
  • non-public facility, such as a group or foster home or a general residential operations facility;
  • state hospital; or
  • halfway house operated by the Texas Juvenile Justice Department or Juvenile Probation Department that meets the following federally required criteria:
    • the halfway house must operate in such a way that individuals living there have freedom of movement and association according to the following tenets;
    • residents are not precluded from working outside the facility in employment available to individuals who are not under justice system supervision;
    • residents can use community resources at will; and
    • residents can seek health care treatment in the community to the same or similar extent as other Medicaid enrollees.

Related Policy

Children Placed in a Non-Secure Facility, B-474.1.2.1.1

 

A—241.4 Family Violence Exemption

Revision 15-4; Effective October 1, 2015

 

Medical Programs

Individuals may not be able to or may not want to provide information about a member of their MAGI household composition because they fear physical or emotional harm by that person. Individuals who are pended for missing information about a MAGI household composition member who may be a family violence offender can contact HHSC to request the family violence exemption by calling 2-1-1 or visiting a local office.  

Advisors must ask the individual requesting the family violence exemption, at the time the exemption is requested, if they want to be designated as the head of household for the case. Advisors must also confirm the address that should be used for agency correspondence and offer to set up an alternate address if needed. Individuals experiencing family violence must be allowed to provide an address for agency correspondence other than the address on the case with the offender.

If the individual wants to pursue the family violence exemption, advisors must determine whether the individual has existing approved Office of the Attorney General (OAG) good cause for TANF or TP 08 as explained in A-1130, Explanation of Good Cause. 

  • If the individual has existing OAG good cause, no further action is required for the individual. The advisor must select “OAG Good Cause” as the verification source in TIERS.
  • If the individual does not have existing OAG good cause, the advisor must make a referral to a family violence specialist at a nearby family violence service provider, following the process explained in A-241.4.1, Referral to a Family Violence Specialist. 

 

A—241.4.1 Referral to a Family Violence Specialist

Revision 15-4; Effective October 1, 2015

 

Advisors must send the contact information for the nearest family violence shelter to the individual pursuing the family violence exemption using Form H1071, Family Violence Exemption for Medicaid and CHIP. Form H1071 informs the individual how they can claim the family violence exemption and is sent along with Form H1020, Request for Information or Action. 

The individual must contact the family violence specialist and explain the need to claim the family violence exemption. After the family violence specialist makes the recommendation, the family violence specialist completes Form H1706, Good Cause Recommendation and Family Violence Exemption, and may mail or fax the form to HHSC, or send the form back with the individual to HHSC. Only a family violence specialist can recommend the exemption using Form H1706. Form H1706 is due 10 days from the date Form H1020 was sent (or 30 days from the file date, whichever is later).

  • If the family violence specialist recommends the family violence exemption, the exemption is granted and will affect all MAGI EDGs on the case by removing the offender from their MAGI household composition. 
  • If the family violence specialist does not recommend the family violence exemption, the exemption is denied. The advisor must re-pend the MAGI EDGs to give the individual additional time to provide the information that was originally requested for the MAGI household member.
  • If Form H1706 is not returned by the due date, the exemption is denied. All pending MAGI EDGs are denied for failure to provide information that was originally requested for the MAGI household member.
  • If the client withdraws the request for the family violence exemption, the client must provide the information that was originally requested for the MAGI household member by the due date, or the pending MAGI EDGs are denied.

Once the family violence exemption has been established by a family violence specialist, advisors do not need to re-evaluate the exemption. If the individual contacts HHSC to indicate that they no longer wish to receive the family violence exemption, advisors should update the page by indicating that the exemption has been withdrawn by the client.

The individual continues to receive the family violence exemption until there is a break in eligibility for all MAGI EDGs on the case. If an individual wants to pursue the family violence exemption again after a break in eligibility, advisors must follow the referral process explained in this section.

 

A—242 Certified Group

Revision 17-1; Effective January 1, 2017

 

Medical Programs

Each EDG will have one individual in the certified group.

TP 08

Parents and caretaker relatives caring for a dependent child who receives Medicaid.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Pregnant women, children under age 19, and parents and caretaker relatives who are ineligible for ongoing Medicaid because they are non-immigrants, undocumented aliens, or certain legal permanent resident aliens who do not meet the citizenship eligibility requirement but meet all other eligibility requirements. Only a person with an emergency medical condition is certified.

TP 40

Minor or adult pregnant woman unless disqualified from Medical Programs for not complying with TPR or SSN requirements.

TP 43

Children under age 1.

If the child is hospitalized on the child’s first birthday, eligibility is continued through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 44

Children age 6 to 18. Children are eligible through the month of their 19th birthday.

Note: A child should be certified for TP 48 rather than TP 44 the month of the child’s sixth birthday.

If the child is hospitalized on his 19th birthday, eligibility is continued through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 45

Children under 12 months old whose mother was eligible for and receiving Medicaid at the time of the child's birth. The mother's eligibility for the child's birth month can be determined retroactively.

TP 48

Children age 1 to 5. Children are eligible through the month of their sixth birthday.

Note: A child should be certified for TP 45 (or 43) rather than TP 48 the month of the child’s first birthday.

If the child is hospitalized on the child’s sixth birthday, eligibility continues through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 56

The following individuals should be certified for TP 56 if they meet all other eligibility criteria:

  1. A pregnant woman with household income that exceeds the income limits for TP 40 unless disqualified from Medical Programs for not complying with:
    • TPR requirements; or
    • SSN requirements.
  2. Children under age 19 with household income that exceeds the income limits for TP 43, TP 44 and TP 48 unless disqualified from Medical Programs for not complying with:
    • TPR requirements; or
    • SSN requirements.

 

A—250 Verification Requirements

Revision 16-3; Effective July 1, 2016

 

TANF

There are no verification requirements for household determination. See A-500, Age/Relationship; A-900, Domicile; and A-1000, Deprivation.

Out-of-state disqualifications for felony drug convictions must be verified.

SNAP

The following must be verified:

  • household size, if questionable, or if a regional requirement;
  • out-of-state disqualifications for intentional program violations;
  • out-of-state disqualifications for felony drug convictions;
  • compliance with parole or community supervision for individuals with a felony drug conviction on or after September 1, 2015 at each application, renewal, and when adding a new individual with a felony drug conviction at a change; and
  • whether a felony drug conviction is:
    • subsequent to another felony drug conviction on or after September 1, 2015; and
    • received while the individual was receiving SNAP.

The individual's statement is acceptable about who buys and prepares meals, unless questionable.

An elderly and person with disabilities claiming separate household status must provide verification of:

  • meeting criteria in B-432.1, Social Security's Criteria for Disability, if questionable; and
  • other household members' income.

Medical Programs

In order for an advisor to determine an individual’s MAGI household composition, each individual on the application must provide his or her tax status, which will identify the individual as a taxpayer, tax dependent, or a non-taxpayer/non-tax dependent. Additionally, applicants must provide the following information on their tax relationships to one another:

  • a taxpayer who plans to claim one or more dependents must provide the name(s) of the dependent(s);
  • a taxpayer who plans to file a joint federal income tax return with a spouse must provide the spouse’s name;
  • a taxpayer who plans to file a separate federal income tax return from his or her spouse must provide the name and filing status of the spouse; and
  • a tax dependent must provide the name of the taxpayer(s) who expects to claim him or her.

Note: For a pregnant woman, if tax status information is not available and the client cannot be reached, the advisor can create a Medicaid for Pregnant Women (TP 40) EDG and certify the pregnant woman by postponing verification of tax status, as explained in A-145.1, Postponed Verification Procedures. TIERS will use the non-tax payer/non-tax dependent household rules to build and pend the TP 40 EDG for the tax status information. Advisors must verify tax status for a TP 40 EDG after certification if the tax status was not verified by the client during the eligibility determination.

 

A—251 Verification Sources

Revision 17-2; Effective April 1, 2017

 

SNAP and TANF

  • Current school record showing the same address as the specified relative
  • Visual observation of the child
  • Statement from non-relative landlord
  • Statement from non-relative neighbor
  • Hospital, clinic, health department or private doctor's record
  • Statement from clergy
  • Court child support order
  • Juvenile court records
  • Child welfare records
  • Marriage license/certificate
  • Juvenile Medicaid Tracker (only for those placed or released by the Texas Juvenile Justice Department/Juvenile Probation Department)

An out-of-state human services agency can verify intentional program violations and felony drug convictions.

 

TANF

An out-of-state human services agency can verify time limits.

 

SNAP

Compliance with parole or community supervision for individuals with a felony drug conviction on or after September 1, 2015 can be verified using:

  • Form H1806, Parole/Community Supervision Report; or
  • answers to the parole or community supervision compliance questions submitted online through YourTexasBenefits.com or the Your Texas Benefits Mobile App when the individual who has the felony drug conviction is the same individual who:
    • signed the online application;
    • signed the renewal; or
    • submitted the change. 

Subsequent felony drug convictions while receiving SNAP can be verified using:

  • Criminal history in Data Broker
  • Out-of-state human services agency
  • TIERS inquiry

Medical Programs

The client’s statement is an acceptable verification source for MAGI household composition, including an individual’s tax status and tax relationships.

Related Policy
Questionable Information, C-920
Providing Verification, C-930

 

A—260 Documentation Requirements

Revision 16-3; Effective July 1, 2016

 

TANF and TP 08

An explanation of persons living in the home who are not included on the EDG must be documented for TANF and TP 08. See A-540, Documentation Requirements; A-950, Documentation Requirements; and A-1080, Disability Verification, for documentation requirements for relationship, domicile and deprivation.

TANF

The following must be documented:

  • specific reason for designating a representative payee;
  • basis for giving separate household status to married minors;
  • name and telephone number of the out-of-state human services employee;
  • months of TANF cash assistance received in other states since October 1999 by an adult household member;  
  • that the household was informed of the one-time payment at application and whether the caretaker requested it or declined it; and
  • that a grandparent was informed of the one-time grandparent payment at application or periodic review if the grandparent is potentially eligible and whether they requested it or declined it.

 

SNAP

The following must be documented:

  • explanation of the household composition;
  • basis of granting separate household status;
  • individual's response to Data Broker information if the individual disagrees with the information;
  • reason for an OIG referral resulting from the Data Broker criminal history record for a felony drug conviction;
  • the result of OIG's findings;
  • disqualification status of any disqualified household member;
  • name and telephone number of the out-of-state human services employee who provides verification;
  • name of the household member currently disqualified for an intentional program violation in another state (see B-941, Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification, for additional documentation requirements); and
  • number of any countable months of benefits received in another state as an able bodied adult without dependents (ABAWD).

Related Policy
The Texas Works Documentation Guide

A-300, Citizenship

Revision 18-4; Effective October 1, 2018

 

 

A-310 General Policy

Revision 13-2; Effective April 1, 2013

 

All Programs

U.S. citizens and certain legally-admitted alien residents are
eligible for benefits if they meet all other eligibility criteria.

A person born in the 50 states, District of Columbia, Puerto Rico,
Guam, the U.S. Virgin Islands, America Samoa, Swain's Island or Northern
Marianna Islands is considered a U.S. citizen.

A person born abroad to at least one U.S. citizen parent may claim derivative citizenship. See How to Verify Citizenship, A-351.4.

Exception: Undocumented aliens applying for Emergency Medicaid do not have to meet citizenship status eligibility requirements.


 

A—311 Alien Status Policies

Revision 18-1; Effective January 1, 2018

 

All Programs

Before certifying any alien resident, the advisor must ensure that the individual is legally admitted by the U.S. Citizenship and Immigration Services (USCIS) to reside in the United States and meets the definition of a "qualified immigrant" as specified in A-311.1, Definition of Qualified Immigrant. See A-352, Verification of Alien Status.

The advisor must use the alien's USCIS document(s) and the charts in A-340, Qualified Alien Status Eligibility Charts, to determine the programs for which the alien is potentially eligible.  The advisor may check USCIS documents for expiration dates. An expired document is not acceptable. Advisors must disqualify aliens who do not have acceptable alien status.

Exception: If the individual’s USCIS document is expired and the Systematic Alien Verifications for Entitlements (SAVE) response shows the individual is a Lawful Permanent Resident – Employment Authorized and the Date Admitted To response is Indefinite, the individual meets alien status criteria. These individuals must not be disqualified.

Notes:

  • See A-342, TANF and Medical Programs Alien Status Eligibility Charts, for Emergency Medicaid eligibility for aliens who do not have acceptable status.
  • Before disqualifying an alien with an expired document, check the expiration date of the document on the SAVE Program.USCIS automatically extends certain I-766s, Employment Authorization Documents, for up to 180 days when USCIS receives a renewal application for the document. When this occurs, SAVE will display the new expiration date.Do not disqualify the individual if SAVE shows that the I-766 is current.

Related Policy
Verifying Alien's USCIS Documents, A-355

 

A—311.1 Definition of Qualified Immigrant

Revision 13-2; Effective April 1, 2013

 

All Programs

The USCIS defines a qualified immigrant as an alien in one of the following categories:

Lawful Permanent Resident (LPR) — lawfully admitted for legal permanent residence in the U.S. This category also includes Amerasians admitted under Section 584 of the Foreign Operations, Export Financing and Related Programs Appropriation Act of 1988.

Asylee — granted asylum under Section 208 of the Immigration and Nationality Act (INA).

Refugee — admitted to the U.S. under Section 207 of the INA.

Parolee — paroled into the U.S. under Section 212(d)(5) of the INA for at least one year.

Deportation (or Removal) Withheld — deportation is being withheld under Section 243(h) of the INA, or removal is withheld under Section 241(b)(3) of the INA.

Conditional Entrant — granted conditional entry under Section 203(a)(7) of the INA as in effect before April 1, 1980.

Battered Alien — a battered spouse, battered child or parent, or child of a battered person with a petition pending; (See A-343, How to Determine Eligibility for Battered Aliens).

Cuban or Haitian Entrant — admitted under Section 501(e) of the Refugee Education Assistance Act of 1980.

Trafficking Victims – victims admitted under the Trafficking Victims Protection Act of 2000.

Iraqi and Afghan Special Immigrants (SIV) – special immigrant status under 101(a)(27) of the INA may be granted to Iraqi and Afghan nations who have worked on behalf of the U.S. government in Iraq or Afghanistan. The Department of Defense Appropriations Act of 2010, PL 111-118, 120 enacted on December 19, 2009, provides that SIV are eligible for all benefits to the same extent and the same period of time as refugees.

Note: All of the above are listed in A-340, Qualified Alien Status Eligibility Charts.

 

A—312 Contact with the U.S. Citizenship and Immigration Services (USCIS)

Revision 15-4; Effective October 1, 2015

TANF and SNAP

An illegal alien is one who has received a final deportation order. Advisors must report applicants who are illegal aliens to USCIS in writing. The supervisor must sign a written notification and send it to the nearest USCIS office, which can be found at https://egov.uscis.gov/crisgwi/go?action=offices.type&OfficeLocator.office_type=LO.

Except for using the SAVE Verification Information System (VIS), advisors may contact USCIS on behalf of an alien only at the individual’s written request. If the alien does not wish to contact USCIS or give the advisor permission, the advisor must advise the household that the household may be certified without the alien (that is, disqualify the alien).


 

A—313 Absence of Proof of Alien Status

Revision 15-4; Effective October 1, 2015

 

SNAP and TANF

Advisors must disqualify a household member from the certified group if the member does not have or refuses to provide proof of alien status. The remaining members of the group are certified if they meet all eligibility requirements.

Related Policy

TANF — Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits, A-1362.1

SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

TANF

If the applicant cannot provide proof of eligible alien status for a child, the child is considered ineligible rather than disqualified.

Medical Programs

If the applicant cannot provide proof of eligible alien status after the period of reasonable opportunity explained in A-351.1, Reasonable Opportunity, the applicant is ineligible for benefits.

Household members are included in the budget group even if the member does not have proof of alien status. See A-241.1, Who Is Included.

 

A—314 Re-verification of Alien Status Due to a USCIS Document's Expiration Date

Revision 18-1; Effective January 1, 2018

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must re-verify the alien's USCIS card if the:

  • USCIS document has expired; and
  • alien wants to continue receiving or reapplies for benefits.

Advisors must allow an alien 10 days to update the card with the USCIS. If the individual cannot provide an updated document or proof within 10 days, the alien is disqualified until the individual provides a valid USCIS card or proof of application for a new card.

Exception: If the individual’s USCIS document is expired and the SAVE response shows the individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted To response is Indefinite, the individual meets alien status criteria. These individuals must not be disqualified.

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

When a certified alien's USCIS document expires before the periodic review date, the advisor must schedule a special review the month the document expires.

SNAP

Advisors must set the certification period to end the same month the USCIS document expires or schedule a special review for the month the document expires.

For streamlined reporting (SR) households, the advisor must not set a special review for the month the document expires. A document that expires during the SR certification period does not cause an individual to lose eligibility. The advisor may assume that the household will renew the document upon expiration and re-evaluate at the next certification.

Related Policy
Alien Status Policy, A-311

 

A—315 Definition of Public Charge

Revision 15-4; Effective October 1, 2015

All Programs

A public charge is defined by law as an alien who has applied for and received public cash assistance for income maintenance, such as Temporary Assistance for Needy Families (TANF) cash assistance, Supplemental Security Income (SSI) or institutionalization for long-term care at government expense, such as nursing home care.



 

A—315.1 Providing Information to Immigrants Regarding Public Charge

Revision 15-4; Effective October 1, 2015

TANF

If an immigrant inquires, staff must inform the individual that receipt of TANF cash benefits places the immigrant at risk of being considered a public charge and the individual may lose his or her immigrant status.

Exception: According to USCIS, the following individuals are exempt from public charge:

  • refugees,
  • asylees,
  • asylum applicants,
  • refugees and asylees applying for adjustment of permanent resident status,
  • Cuban/Haitian entrants and parolees,
  • Special Immigrant Visa holders from Iraq and Afghanistan,
  • Amerasian immigrants (for their initial admission),
  • individuals granted relief under the Cuban Adjustment Act (CAA),
  • individuals granted relief under the Nicaraguan and Central American Relief Act (NACARA),
  • individuals granted relief under the Haitian Refugee Immigration Fairness Act (HRIFA),
  • individuals applying for a T Visa,
  • individuals applying for a U Visa,
  • individuals who possess a T Visa and are trying to become a permanent resident,
  • individuals who possess a U Visa and are trying to become a permanent resident,
  • individuals who have been certified by the Office of Refugee
    Resettlement as a victim of trafficking (prior to being issued a T Visa
    by USCIS),
  • applications for Temporary Protected Status (TPS), and
  • certain applicants under the LIFE Act Provisions.

SNAP and Medical Programs

If an immigrant inquires, the advisor must assure the individual that receipt of Supplemental Nutrition Assistance Program (SNAP) and/or medical program benefits does not place the immigrant at risk of becoming a public charge.



 

A—315.2 Receiving Other Benefits

Revision 15-4; Effective October 1, 2015

All Programs

There are other public assistance programs that immigrants may apply for that do not result in public charge considerations. These programs
include: Special Supplemental Nutrition Program for Women, Infants and Children (WIC), immunizations, prenatal care, testing and treatment of communicable diseases, emergency medical assistance, emergency disaster relief, housing assistance, and child care.



 

A—316 Sponsored Alien

Revision 15-4; Effective October 1, 2015

 

All Programs

A sponsored alien is an individual who has been sponsored by a person who signed an affidavit of support (USCIS Form I-864 or I-864-A)on or after December 19, 1997, agreeing to support the alien as a condition of the alien's entry into the U.S.

A sponsor is someone who brings family-based or certain employment-based immigrants to the U.S. and demonstrates that he or she can provide enough financial support to the immigrant so that the individual does not rely on public benefits.

If necessary, advisors use the SAVE system to verify whether an alien has a sponsor. The SAVE system, through additional verification, can provide the sponsor's name and address.



 

A—316.1 Providing Verification of the Alien's Sponsor Income and Resources

Revision 16-2; Effective April 1, 2016

 

TANF, SNAP, TP 08, TP 43, TP 44, TP 48, TP 40, TP 07, TP 20, TP 56, TP 70, TA 84 and TA 85

For cases involving aliens and their sponsors, the alien is responsible for getting all verification from the sponsor and sponsor's spouse.

Request the following information from the alien if not otherwise available through Systematic Alien Verification for Entitlement (SAVE) or Texas Integrated Eligibility Redesign System (TIERS) inquiry or case documentation:

  • Alien sponsor name,
  • Alien sponsor date of birth,
  • Alien sponsor Social Security number,
  • Alien sponsor earned income,
  • Alien sponsor unearned income,
  • Alien sponsor self-employment income,
  • Alien sponsor resources (if applicable, as explained in A-1245, Resources of an Alien’s Sponsor), and
  • Alien sponsor citizenship status or alien number if the sponsor is a lawful permanent resident.

The income and resources (if applicable) of an alien's sponsor (and the sponsor's spouse if the spouse also signed an affidavit of support, USCIS Form I-864) must be counted (deemed) as belonging to the sponsored alien, regardless of actual availability when determining the sponsored alien's eligibility and benefit amounts.

Deeming of the sponsor’s income and resources (if applicable) to the sponsored alien lasts until the:

  • sponsored alien becomes a naturalized citizen,
  • sponsored alien can be credited with 40 qualifying quarters of work, or
  • sponsor dies.

Sponsored aliens not subject to sponsor deeming are:

  • children under age 18;
  • sponsored aliens who are ineligible for benefits (examples include
    those who are disqualified from getting benefits or those considered
    non-members, such as students who do not meet SNAP student eligibility
    criteria);
  • battered spouses or children;
  • refugees, parolees, asylees, people granted withholding of
    deportation, Amerasians, trafficking victims, and Iraqi and Afghan
    special immigrants;
  • aliens whose sponsor has not signed an affidavit of support;
  • aliens whose sponsor is in the same household/Modified Adjusted Gross Income (MAGI) household composition; and
  • indigent aliens.

TANF, TP 08, TP 43, TP 44, TP 48, TP 40, TP 07, TP 20, TP 56, TP 70, TA 84 and TA 85

If the sponsored alien fails to provide sponsor verification by the required date in B-115, Pending Verification on Applications, the alien's application is denied.

Note: Resources of an alien sponsor must only be verified if resources are counted for that program, as explained in A-1245.

SNAP

If the sponsored alien fails to provide sponsor verification by the required date in B-115,  the sponsored alien is disqualified until the alien provides the proof. If eligible, remaining household members may participate while the alien is disqualified. If the disqualified alien later provides the proof, the advisor processes it as a reported change. The Eligibility Determination Group (EDG) is denied if the household fails to provide proof of the disqualified alien's own income.

Related Policy

Resources of an Alien's Sponsor, A-1245
Alien Sponsor's Income, A-1361

 

A—320 Definitions of Military Connection

Revision 12-4; Effective October 1, 2012

 


A—321 Veteran

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

A veteran is eligible for benefits because of a military connection if the veteran is:

  • "honorably discharged" from the armed service, and
  • meets the minimum active duty requirement of:
    • 24 months of continuous active duty, or
    • the full period the person was called or ordered to active duty.

Individuals who served in the Philippine Commonwealth Army during World War II, or as Philippine scouts following the war, are veterans for purposes of eligibility.

Related Policy

Verification of Veteran Status, A-353.1


 

A—322 Active Duty Military Member

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

An active duty military member is eligible for benefits because of a military connection if currently on full-time duty in the U.S. Army, Navy, Air Force, Marine Corps or Coast Guard. It does not include full-time National Guard duty.

Active duty training as a member of the Reserves, Army National Guard, or Air National Guard does not establish eligibility for the individual. The advisor must determine that training is not the reason the reserve member is on active duty.

Related Policy

Verification of Active Duty Military, A-353.2


 

A—323 Spouse or Minor Unmarried Dependent Child of Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

A spouse is eligible for benefits because of a military connection if the individual is currently married to a veteran or active duty military member. A minor unmarried dependent child under age 18 is eligible.

Related Policy

Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member, A-353.3



 

A—324 Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

To meet the alien eligibility status as a surviving spouse of a deceased veteran or an active-duty military member, the spouse must not have remarried, and the marriage to the veteran or active duty military member must fulfill one of the following requirements:

  • lasted at least one year;
  • occurred within 15 years after the period of service in which the
    injury or disease that resulted in the death of the veteran or active
    duty member ended; or
  • a child was born between the surviving spouse and the veteran or active duty member, either during or before the marriage.

Related Policy

Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member, A-353.3

SNAP

If a currently certified surviving spouse remarries, the spouse retains eligible alien status through the end of the current certification period.


 

A—330 Lawful Permanent Resident (LPR) and 40 Qualifying Quarters of Social Security Coverage

Revision 18-1; Effective January 1, 2018

 

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

LPRs admitted prior to Aug. 22, 1996, meet the alien eligibility requirement by having 40 qualifying quarters of social security coverage.  LPRs admitted on or after Aug. 22, 1996, meet the alien eligibility requirement by having 40 countable qualifying quarters of social security coverage, if five years have passed since the legal date of entry. An LPR does not have to meet the 40-quarter requirement, including the five-year wait, if any of the following apply.

The alien:

  • has a military connection;
  • entered the U.S. with a status described in Chart C of A-342, TANF and Medical Programs Alien Status Eligibility Charts, and meets the eligibility criteria for refugees, asylees, etc., or meets the criteria in A-343, How to Determine Eligibility for Battered Aliens; and
  • is a qualified immigrant or non-immigrant child age 18 and under who lawfully resides in the U.S. with a status described in Chart D of A-342, TANF and Medical Programs Alien Status Eligibility Charts.

SNAP

LPRs with 40 qualifying quarters meet the alien eligibility requirement. An LPR does not have to meet the 40-quarter requirement if the alien:

  • lawfully resided in the U.S. as a qualified immigrant for five years from the date of entry;
  • was admitted to the U.S. on or before Aug. 22, 1996, and was age 65 or older on Aug. 22, 1996;
  • meets the definition of disability in B-432, Definition of Disability (regardless of when the alien acquired a disability or entered the U.S.);
  • is currently under age 18 (regardless of when the alien entered the U.S.);
  • has a military connection; or
  • qualifies as a refugee, asylee, etc., as shown in Chart A of A-341, SNAP Alien Status Eligibility Charts.

Related Policy
Verifying 40 "Qualifying Quarters," A-354



 

A—331 Whose Quarters Can Be Considered

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

For purposes of establishing eligibility through the use of the 40 "qualifying quarters" requirement,  LPRs are credited with quarters of earnings for the:

  • LPR,
  • LPR's current spouse or deceased spouse regardless if the spouse is an LPR or a U.S. citizen, and
  • LPR's parent before the LPR turned age 18. This includes adoptive parents or stepparents.

Note: All of the quarters earned by the LPR's parents through the quarter the LPR turns age 18 are counted.

When determining whether to credit the quarters to an individual's spouse, the advisor must count quarters earned:

  • beginning with the quarter from the date of marriage, and
  • by a deceased spouse only if the marriage was not terminated before the spouse died.

Quarters earned by divorced spouses for either ex-spouses do not count. LPRs who divorce after certification retain their eligible alien status through the end of the current certification period. This also applies to stepchildren.

Until the quarter a child turns age 18, to meet the 40-quarter requirement, a child may use quarters earned by:

  • natural or adoptive parents;
  • stepparents from the date of marriage to the legal parent; and
  • deceased parents.

Related Policy

Verifying 40 "Qualifying Quarters," A-354


 

A—340 Qualified Alien Status Eligibility Charts

Revision 18-1; Effective January 1, 2018

 

An alien's eligibility is based on the USCIS status and other criteria as shown in A-341, SNAP Alien Status Eligibility Charts, and A-342, TANF and Medical Programs Alien Status Eligibility Charts.

 

 

A—341 SNAP Alien Status Eligibility Charts

Revision 18-1; Effective January 1, 2018

 

Chart A

Advisors use the following chart to determine if a qualified alien meets the eligibility requirements to receive SNAP benefits. These aliens are eligible for benefits indefinitely, except a victim of severe trafficking.

If the qualified alien was admitted as a/an … and the USCIS document provided is a/an … then the alien is …
Refugee
  • *I-551, Permanent Resident Card, annotated with R8-6, RE-1 thru RE-9
  • I-94, Arrival/Departure Record, annotated with INA Section 207 or Refugee
  • Original certification letter from the Office of Refugee Resettlement (ORR)
  • I-766, Employment Authorization Document, annotated with Code A3
eligible from date of entry.
Asylee
  • *I-551, Permanent Resident Card, annotated with AS-6 thru AS-8
  • I-94, Arrival/Departure Record, annotated with INA Section 208 or Asylee
  • I-766, Employment Authorization Document, annotated with Code A5
  • USCIS letter from Asylum Office
  • Order from an immigration judge granting asylum
eligible from date of entry.
Deportation Withheld
  • I-94, Arrival/Departure Record, annotated with INA Section 243(h) or 241(b)(3)
  • I-766, Employment Authorization Document, annotated with Code A10
  • Order from an immigration judge showing deportation withheld under
    INA Section 243(h) or 241(b)(3). Consider the date of entry as the date
    the status was assigned.
eligible from date of entry.
Cuban/Haitian Entrant
  • *I-551, Permanent Resident Card, annotated with R8-6, CH-6, CU-6, CU-7
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) or Cuba/Haitian Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 240, Pending Hearing – Cuban granted parole for one year
  • I-94, Arrival/Departure Record, annotated as Public Interest Parole
  • I-766, Employment Authorization Document, annotated with Code C8
  • Receipt from INS Asylum Office indicating filing of Form I-589, Application for Asylum
eligible from date of entry.
Haitian Orphan
  • I-94, Arrival/Departure Record, indicating the person has humanitarian "parole" status admitted after January 12, 2010
  • Immigrant visa indicating the person was lawfully admitted for permanent residence
  • *I-551, Permanent Resident Card, annotated with Status Code CH-6
eligible from date of entry.
Amerasian *I-551, Permanent Resident Card, annotated with one of the following Status Codes: AM-1, AM-2, AM-3, AM-6, AM-7 or AM-8 eligible from date of entry.
Victim of Severe Trafficking
  • Derivative T Visa annotated with T-1
  • Derivative T Visa annotated with T-2, T-3, T-4, T-5 (family members of a victim of severe trafficking)
eligible up to four years from date of entry or until the law enforcement extension expires.
Afghani or Iraqi Special Immigrant Passport with a stamp noting that the individual has been admitted under a special immigrant visa category IV with one of the following codes:
  • SI-1 or SQ-1 for the principal applicant;
  • SI-2 or SQ-2 for the spouse of the principal applicant;
  • SI-3 or SQ-3 for the unmarried child under age 21 of the principal applicant; and a
  • Department of Homeland Security (DHS) stamp or notation on passport or I-94, showing date of entry.

For those special immigrants who are adjusting their status to LPR status in the U.S.:

*I-551, Permanent Resident Card, annotated with one of the following status codes:

  • SI-6 or SQ-6 for the principal applicant,
  • SI-7 or SQ-7 for the spouse of the principal applicant, or
  • SI-9 or SQ-9 for the unmarried child under age 21 of the principal applicant.

These special immigrants also may demonstrate nationality with an Afghani or Iraqi passport.

Note: The entry date for an Afghani special immigrant must be Dec. 26, 2007, or later. An Iraqi special immigrant's entry date must be Jan. 26, 2008, or later.

eligible from date of entry.

*An I-551, Permanent Resident Card, does not always include the holder's signature. See A-355, Verifying Alien's USCIS Documents.

Note: The category of aliens listed in Chart A are eligible for SNAP benefits from the date they adjust to any of the specific statuses listed in the chart. For example, once an alien is granted asylee status, the immigrant is potentially eligible for SNAP benefits.

 

Chart B

Advisors use the following chart to determine the eligibility of these particular qualified aliens. Their eligibility is indefinite regardless of their date of entry into the U.S.

If the alien was admitted as a … and the USCIS document provided is an … then the alien is eligible if the alien …
Parolee
  • I-94, Arrival/Departure Record, showing admission for at least one year under INA Section 212(d)(5) or Parolee
  • I-766, Employment Authorization Document, annotated with A-4 or C-11
  • has lawfully resided as a qualified immigrant in the U.S. for five years;
  • meets the SNAP definition of disability in B-432, Definition of Disability (regardless of when the alien acquired a disability or when the alien entered the U.S.);
  • is currently under age 18 (regardless of when the alien entered the U.S.); or
  • is the spouse, unmarried surviving spouse or minor unmarried
    dependent child of an honorably discharged veteran or is an active duty
    military member.
Conditional Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 203(a)(7)
  • I-766, Employment Authorization Document, annotated with A3
  • has lawfully resided as a qualified immigrant in the U.S. for five years;
  • meets the SNAP definition of disability in B-432 (regardless of when the alien acquired a disability or when the alien entered the U.S.);
  • is currently under age 18 (regardless of when the alien entered the U.S.); or
  • is the spouse, unmarried surviving spouse or minor unmarried
    dependent child of an honorably discharged veteran or is an active duty
    military member.

Chart C

Use the chart below to determine eligibility for Legal Permanent Residents.

If the qualified alien was admitted as a … and the USCIS document provide is an … then the alien is eligible if the alien …
Legal Permanent Resident
  • I-151, Alien Registration Receipt Card (also known as a Green Card)
  • I-551, Resident Alien Card
  • *I-551, Permanent Resident Card (introduced December 1997)
  • has lawfully resided as a qualified immigrant in the U.S. for five years;
  • meets the SNAP definition of disability in B-432 (regardless of when the alien acquired a disability or when the alien entered the U.S);
  • is currently under age 18 (regardless of when the alien entered the U.S.);
  • meets the 40 qualifying quarters requirement in A-354, Verifying 40 "Qualifying Quarters";
  • is an honorably discharged veteran who met the minimum active duty requirements for:
    • 24 months; or
    • the period for which the person was called to active duty; or
  • is an active duty military member; or
  • is the spouse, unmarried surviving spouse or minor dependent child
    of an honorably discharged veteran or active duty military member.

Note: To qualify for SNAP as a surviving spouse of a
deceased veteran or an active duty military member, the surviving
spouse must not have remarried.

*An I-551, Permanent Resident Card, does not always include the holder's signature. See A-355, Verifying Alien's USCIS Documents.

 

Chart D

If the alien was admitted as a … and the USCIS document provided is an … then the alien is …
  • Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551, Permanent Resident Card, annotated with KIP – Kickapoo Indian Pass
  • *I-551 annotated with S13 – American Indian born in Canada
  • A letter or other tribal document certifying at least 50 percent American Indian blood, as required by INA Section 289, combined with a birth certificate or other satisfactory evidence of birth in Canada
eligible.
  • Hmong or Highland Lao tribe member when the tribe assisted the U.S.
    Armed Forces during the Vietnam War, or their spouses, unmarried
    dependent children and the unremarried widow(er)s of those who are
    deceased
I-94 or *I-551 eligible if the immigrant:
  • is from Laos, Vietnam or Cambodia; and
  • claims to be a member of a Hmong or Highland Laotian tribe.

*An I-551, Permanent Resident Card, does not always include the holder's signature. See A-355, Verifying Alien's USCIS Documents.


 

A—342 TANF and Medical Programs Alien Status Eligibility Charts

Revision 18-4; Effective October 1, 2018

 

Chart A

Staff should use the following chart to determine eligibility for qualified  aliens who  were admitted into the U.S. before Aug. 22, 1996.

If the qualified  alien was admitted as a/an …
 
and the USCIS document is a/an … then the  alien is …
 
Refugee
  • *I-551, Permanent Resident Card, annotated with R8-6, RE1 thru RE9
  • I-94, Arrival/Departure Record, annotated with INA Section 207 or Refugee
  • I-766, Employment Authorization Document, annotated with Code A-3
  • eligible for TANF; and
  • eligible for Medicaid if the  alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI, Medicaid, or both on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note:Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Asylee
  • *I-551, Permanent Resident Card, annotated with AS-6 thru AS-9
  • I-94, Arrival/Departure Record, annotated with INA Section 208 or Asylee
  • I-766, Employment Authorization Document, annotated with Code A5
  • USCIS Asylum Office letter
  • Order from an immigration judge granting asylum
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI and/or Medicaid on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Deportation Withheld
  • I-94, Arrival/Departure Record, annotated with INA Section 243(h) or 241(b)(3)
  • I-766, Employment Authorization Document, annotated with code A10
  • Order from an immigration judge showing deportation withheld under
    INA Section 243(h) or Section 241(b)(3). Consider the date of entry as
    the date the status was assigned.
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI and/or Medicaid on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Cuban/Haitian Entrant
  • *I-551, Permanent Resident Card, annotated with R8-6, CH-6, CU-6 or
    CU-7
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) or Cuban/Haitian
    Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 240 Pending Hearing – Cuban granted parole for one year
  • I-94, Arrival/Departure Record, annotated with Public Interest Parolee
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI and/or Medicaid on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Haitian Orphan
  • I-94, Arrival/Departure Record, indicating person has humanitarian "parole" status admitted on or after Jan. 12, 2010
  • Immigrant visa indicating the person was lawfully admitted for permanent residence
  • *I-551, Permanent Resident Card, annotated with status code CH-5
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI and/or Medicaid on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Amerasian
  • *I-551, Permanent Resident Card, annotated with one of the following status codes: AM-1, AM-2, AM-3, AM-6, AM-7 or AM-8
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI and/or Medicaid on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Parolee
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) showing admission for at least one year

Note: This does not include Cuban/Haitian entrants.

  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI and/or Medicaid on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Conditional Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 203(a)(7)
  • I-766, Employment Authorization Document, annotated with status code A-3
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI Medicaid or both on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Legal Permanent Resident
  • I-151, Alien Registration Receipt Card – commonly referred to as Green Card
  • I-551, Resident Alien Card
  • *I-551, Permanent Resident Card
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI Medicaid or both on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.
Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551 annotated with KIC – Kickapoo Indian Citizen
  • *I-551 annotated with KIP – Kickapoo Indian Pass
  • *I-551 annotated with S13 – American Indian born in Canada
  • Letter — A letter or other tribal document
    certifying at least 50 percent American Indian blood, as required by INA
    Section 289, combined with a birth certificate or other satisfactory
    evidence of birth in Canada
  • eligible for TANF; and
  • eligible for Medicaid if the alien meets one of the following requirements:
    • honorably discharged veteran or active duty member of the U.S. armed forces;
    • spouse (including unmarried surviving spouse) of honorably discharged veterans or active duty members;
    • dependent child of honorably discharged veteran or active duty member;
    • American Indian born in Canada;
    • member of a federally recognized Indian tribe;
    • received SSI and/or Medicaid on 8/22/96 and lawfully resided in the U.S. on or before 8/22/96; or
    • LPR credited with 40 qualifying quarters of Social Security coverage.
  • Note: Permanently Residing Under Color of Law (PRUCOL) aliens are not eligible.

*An I-551, Permanent Resident Card, does not always include the holder's signature. See A-355, Verifying Alien's USCIS Documents.

 

Chart B

Staff should use the following chart to determine eligibility for TANF and Medicaid for qualified aliens admitted into the U.S. on or after August 22, 1996.

If the qualified alien was admitted as a/an … and the USCIS document provided is a/an … then the alien is …
Refugee
  • *I-551, Permanent Resident Card, annotated with R8-6, RE1 thru RE9
  • I-94, Arrival/Departure Record, annotated with INA Section 207 or Refugee
  • An original certification letter from the Office of Refugee Resettlement (ORR)
  • I-766, Employment Authorization Document, annotated with Code A-3
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Asylee
  • *I-551, Permanent Resident Card, annotated with R8-6, AS6 thru AS-9
  • I-94, Arrival/Departure Record, annotated with INA Section 208 or Asylee
  • I-766, Employment Authorization Document, annotated with Code A-5
  • USCIS letter from Asylum office
  • Order from an immigration judge granting asylum
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Deportation Withheld
  • I-94, Arrival/Departure Record, annotated with INA Section 243(h) or Section 241(h)(3)
  • I-766, Employment Authorization Document, annotated with Code A-10
  • Order from an immigration judge showing deportation withheld under
    INA Section 243(h) or Section 241(b)(3). Consider the date of entry as
    the date the status was assigned.
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Cuban/Haitian Entrant
  • *I-551, Permanent Resident Card, annotated with R8-6, CH-6, CU-6 or CU-7
  • I-94, Arrival/Departure Record, annotated with INA Section 212(d)(5) or Cuban/Haitian Entrant
  • I-94, Arrival/Departure Record, annotated with INA Section 240, Pending Hearing – Cuban, granted parole for one year
  • I-94, Arrival/Departure Record, annotated as Public Interest Parole
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Haitian Orphan
  • I-94, Arrival/Departure Record, indicating person has humanitarian "parole" status admitted on after January 12, 2010
  • Immigrant visa indicating the person was lawfully admitted for permanent residence
  • *I-551, Permanent Resident Card, annotated with Status Code CH-6
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Amerasian *I-551, Permanent Resident Card, annotated with one of the following status codes: AM-1, AM-2, AM-3, AM-6, AM-7 or AM-8
  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Afghani or Iraqi Special Immigrant A passport with a stamp noting that the individual has been admitted under a special immigrant visa category IV with one of the following codes:
  • SI-1, SQ-1, SI-6 or SQ-6 for the principal applicant;
  • SI-2, SQ-2, SI-7 or SQ-7 for the spouse of the principal applicant;
  • SI-3, SQ-3, SI-9 or SQ-9 for the unmarried child under age 21 of the principal applicant; and a
  • DHS stamp or notation, on passport or I-94, showing date of entry.

For those special immigrants who are adjusting their status to LPR status in the U.S.:

*I-551 annotated with one of the following status codes:

  • SI-1, SQ-1, SI-6 or SQ-6 for the principal applicant,
  • SI-1, SQ-2, SI-7 or SQ-7 for the spouse of the principal applicant, or
  • SI-3, SQ-3, SI-9 or SQ-9 for the unmarried child under age 21 of the principal applicant.

These special immigrants also may demonstrate nationality with an Afghani or Iraqi passport.

Note: The entry date for an Afghani special immigrant must be Dec. 26, 2007, or later. An Iraqi special immigrant's entry date must be Jan. 26, 2008, or later.

  • eligible for TANF for the first five years after the legal date of entry; and
  • eligible for Medicaid (including Parents and Caretaker Relatives Medicaid) for the first seven years after the legal date of entry.

Notes:

  • Qualified aliens retain this eligibility even if they have adjusted to LPR status.
  • LPRs must have 40 qualifying quarters of Social Security coverage.
Victim of Severe Trafficking
  • Derivative T Visa annotated with T-1
  • Derivative T Visa annotated with T-2, T-3, T-4, or T-5 (family members of a victim of severe trafficking)

eligible up to four years from date of entry or until the law enforcement extension expires.

Note: Qualified aliens retain this eligibility even if they have adjusted to LPR status.
Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551 annotated with KIC – Kickapoo Indian Citizen
  • *I-551 annotated with KIP – Kickapoo Indian Pass
  • *I-551 annotated with S13 – American Indian born in Canada
  • Letter A letter or other
    tribal document certifying at least 50 percent American Indian blood, as
    required by INA Section 289, combined with a birth certificate or other
    satisfactory evidence of birth in Canada
eligible.
Member of a federally recognized Indian tribe Letter A letter or other
tribal document that verifies membership of a federally recognized
Indian tribe as defined in United States Code (U.S.C.), Title 25,
Chapter 14, Subchapter II, §450b(e)
eligible.

*An I-551, Permanent Resident Card, does not always include the holder's signature. See A-355, Verifying Alien's USCIS Documents.

Note: Click on the federal regulatory language hyperlink for a list of the Indian tribes recognized by the United States Bureau of Indian Affairs.

 

Chart C

Staff should use the following chart to determine eligibility for all LPRs applying for TANF and adult LPRs applying for Medicaid who were admitted into the U.S. on or after August 22, 1996.

If the alien was admitted as a … and the USCIS document is a/an … then the alien is …
Legal Permanent Resident
  • I-151, Alien Registration Receipt Card – commonly referred to as Green Card
  • I-551, Resident Alien Card
  • *I-551, Permanent Resident Card

Notes:

  • Any status code that appears on the *I-551, Permanent Resident Card, is acceptable.
  • USCIS did not issue I-151s after 1978; therefore, any alien admitted after 1978 will have an *I-551.
  • If the LPR loses the *I-551, the LPR may present either an I-94 or a passport with the following annotation:

"Processed for *I-551, Temporary Evidence of Lawful Admission for
Permanent Residence, valid until ______, Employment Authorized."

not eligible.

Note: A qualified alien retains the refugee eligibility period even if they have adjusted to LPR status.

Exceptions: An LPR meets the eligibility requirements if the LPR:

  • has become a naturalized citizen;
  • is an honorably discharged veteran or active duty military member;
  • is a spouse, unmarried surviving spouse or minor unmarried child of
    an honorably discharged veteran or active duty military member (Note:
    To qualify for TANF/MP as a surviving spouse of a deceased veteran or
    an active duty military member, the surviving spouse must not have
    remarried.);
  • entered the U.S. before Aug. 22, 1996, and remained continuously
    present in the U.S. since at least Aug. 21, 1996, until obtaining
    qualifying immigrant status and meets the 40 qualifiying quarters of Social
    Security coverage requirement. (Note: Aliens who entered the country
    without proper documents, as well as those who overstayed
    their visa, are treated the same as those who entered and remained in
    the country with valid immigration documents. Any single absence from
    the U.S. of more than 30 days or a combined absence of more than 90 days
    is considered to interrupt "continuous presence.");
  • Received SSI Medicaid or both on Aug. 22, 1996, and lawfully resided
    in the U.S. on or before Aug. 22, 1996;
  • entered the U.S. with a status described in Chart B and meets those eligibility
    criteria, or meets the criteria in A-343, How to Determine Eligibility for Battered
    Aliens; or
  • meets the 40 qualifying quarters requirements in A-354, Verifying 40 "Qualifying Quarters," and five years have passed since the alien's legal date of entry.
Native American born in Canada who is entitled by treaty to reside in the U.S.
  • *I-551 annotated with KIC – Kickapoo Indian Citizen
  • *I-551 annotated with KIP – Kickapoo Indian Pass
  • *I-551 annotated with S13 – American Indian born in Canada
  • Letter — A letter or other tribal document
    certifying at least 50 percent American Indian blood, as required by INA
    Section 289, combined with a birth certificate or other satisfactory
    evidence of birth in Canada
eligible.
Member of a federally recognized Indian tribe Letter — A letter or other tribal document that
verifies membership of a federally recognized Indian tribe as defined in
25 U.S.C. §450b(e)
eligible.

*An I-551, Permanent Resident Card, does not always include the holder's signature. See A-355, Verifying Alien's USCIS Documents.

Notes:

  • If the alien is ineligible for TANF or Medicaid because of citizenship or alien status, the advisor must determine the alien's eligibility for Emergency Medicaid.
  • Follow the hyperlink to federal regulatory language provides a list of the Indian tribes recognized by the United States Bureau of Indian Affairs.

 

Chart D

Medical Programs

Certain additional qualified immigrant and non-immigrant children ages 18 and under who are lawfully residing in the U.S. may qualify for Medicaid regardless of their date of entry.

Staff should use the following chart to determine eligibility for qualified immigrant and non-immigrant children.

Note: The documents,  immigration statuses, or both listed in the chart are not all inclusive. All lawfully residing children with a valid immigration status are eligible.  Follow your policy clearance request procedures for questions about documents or immigration statuses not listed in this chart.

Exceptions:

  • Healthy Texas Women (HTW) recipients who turn age 19 during their certification period will continue to receive HTW until their next redetermination. Staff must review the HTW recipient's alien status at redetermination.
  • Medicaid for Transitioning Foster Care Youth (MTFCY) recipients qualify through the month of their 21st birthday.
  • Medicaid for Former Foster Care Children (FFCC) recipients qualify through the month of their 21st birthday.
  • Medicaid for Breast and Cervical Cancer (MBCC) recipients who applied before their 19th birthday remain eligible for Medicaid through the duration of their cancer treatment or until they no longer meet all the other eligibility criteria, whichever is earlier.
If the qualified immigrant and non-immigrant's USCIS document is a/an … then the qualified immigrant and non-immigrant is eligible if the annotation is …
I-94
  • INA Section 212(d)(5) showing admission for less than one year – Parolee
  • INA Section 203(a)(7) – Conditional Entrant
  • CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association
  • CFA/FSM – Citizen of the Federated States of Micronesia (FSM)
  • CFA/PAL – Citizen of the Republic of Palau

Note: The Bureau of Customs and Border Protection (CBP) also notates the I-94 with the letters "D/S," which stands for "duration of status," meaning that the authorized length of stay is not limited.

I-797C, or USCIS referral notice, or hearing notice or order from an immigration judge 241(b)(3):
  • Convention Against Torture (CAT) – An alien who has been granted withholding of removal under CAT
  • Applicants for asylum or withholding of removal, including under CAT
  • Applicants for asylum or withholding of removal, including under
    CAT if under age 14 who has had an application pending for at least 180
    days
*I-551



Note: If the LPR loses the *I-551, the LPR may present either an I-94 or a passport with the following annotation:

"Processed for I-551, Temporary Evidence of Lawful Admission for
Permanent Residence, valid until ______, Employment Authorized."
Any status code that appears on the *I-551 is acceptable.
I-766
  • CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association
  • CFA/FSM – Citizen of the Federated States of Micronesia (FSM)
  • CFA/PAL – Citizen of the Republic of Palau
Aliens who have been granted employment authorization under 8 CFR 274a.12:
  • (c)(9) or C9 – Applicant for adjustment to lawful permanent resident status
  • (c)(10) or C10 – Applicant for suspension of deportation or cancellation of removal
  • (c)(14) or C14 – Alien currently in deferred action status
  • (c)(16) or C16 – Applicant for registry (resided in U.S. since before Jan. 1, 1972)
  • (c)(18) or C18 – Under order of supervision
  • (c)(20) – Applicant for special agricultural worker legalization (INA 210)
  • (c)(22) – Applicant for legalization under INA 245A
  • (c)(24) – Applicant for adjustment under the LIFE Act Legalization Program
I-797
  • Alien currently in deferred action status
  • Action notice that identifies the alien as a self-petitioning battered alien
  • Special immigrant status under INA Section 101(a)(27)(J), the individual will also have Form I-360
Visa
  • A or G – FSM, RMI or Palauan diplomats
  • TPS – Individual under temporary protected status under INA Section 244
Academic student under INA 101(a)(15)(F):
  • F-1 - Academic student
  • F-2 - Spouse or children of F-1
Exchange visitor under INA 101(a)(15)(J)
  • J-1 - Exchange visitor
  • J-2 - Spouse or children of J-1
Fiancé or fiancée of U.S. citizen as permitted under INA Section 101(a)(15)(K):
  • K-1 – Fiancé or fiancée
  • K-2 – Child of K-1
  • K-3 – Spouse of U.S. citizen
  • K-4 – Child accompanying or following to join a K-3 alien

Vocational student under INA 101(a)(15)(M)

  • M-1 - Vocational student
  • M-2 - Spouse or children of M-1
Special immigrant under INA Section 101(a)(15)(N):
  • N-8 – Parent of alien classified SK-3 "Special Immigrant"
  • N-9 – Child of N-8, SK-1, SK-2 or SK-4, "Special Immigrant"
Religious worker under INA Section 101(a)(15)(R):
  • R-1 – Religious worker
  • R-2 – Spouse or children of R-1
Witness or informant as permitted under INA Section 101(a)(15)(S):
  • S-5 – Informant of criminal organization information
  • S-6 – Informant of terrorism information
Victim of severe trafficking as permitted under INA Section (a)(15)(T):
  • Derivative T Visa annotated with T-1
  • Derivative T Visa annotated with T-2, T-3, T-4 or T-5 (family members of a victim of severe trafficking)
Victims of certain crimes – Battered aliens under 101(a)(15)(U):
  • U-1 – Individuals who have suffered substantial physical or mental abuse as victims of criminal activity
  • U-2 – Spouse of U-1
  • U-3 – Child of U-1
  • U-4 – Parent of U-1, if U-1 is under age 21
  • U-5 – Unmarried, under age 18, sibling of U-1
Individuals with a petition pending for three years or more, as permitted under INA Section 101(a)(15)(V):
  • V-1 – Spouse of an LPR who is the principal beneficiary of a
    family-based petition (Form I-130) that was filed prior to December 21,
    2000, and has been pending for at least three years
  • V-2 – Child of an LPR who is the principal beneficiary of a
    family-based visa petition (Form I-130) that was filed prior to December
    21, 2000, and has been pending for at least three years
  • V-3 – Derivative child of V-1 or V-2
USCIS letter

An individual who is a spouse or child of a U.S. citizen, whosevisa petition has been approved, and who has a pending application for adjustment of status as described in 8 CFR INA Section 103.12(a)(4)

USCIS letter Individual under Deferred Enforced Departure pursuant to a decision made by the president
Letter A letter or other tribal document certifying at least 50 percent
American Indian blood, as required by INA Section 289, combined with a
birth certificate or other satisfactory evidence of birth in Canada
USCIS document Family Unity beneficiaries pursuant to Section 301 of Pub. L. 101-649, as amended
USCIS document An alien who is lawfully present in the Commonwealth of the Northern Mariana Islands under 48 U.S.C. §1806(e)
USCIS document Individual who is lawfully present in American Samoa under the immigration laws of American Samoa

*An I-551, Permanent Resident Card, does not always include the holder's signature. See A-355, Verifying Alien's USCIS Documents.

 

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

People eligible for emergency Medicaid are aliens residing in the U.S. who do not meet the citizenship requirements for TANF or Medical Programs. These people are non-immigrants, undocumented aliens and certain legal permanent resident aliens.

Advisors must not follow the SAVE verification procedures explained in A-355, Verifying Alien's USCIS Documents, for aliens certified on Emergency Medicaid.

Notes:

  • Individuals eligible for Emergency Medicaid must meet all other eligibility requirements.
  • A person must be caring for a deprived child who meets citizenship or alien status requirements in order to be eligible for TA 31 as a caretaker or second parent.

 

A—343 How to Determine Eligibility for Battered Aliens

Revision 18-1; Effective January 1, 2018

 

All Programs

Qualified aliens with a battered alien status do not need to be credited with 40 qualifying quarters of social security coverage, nor do they have a seven-year limited eligibility period.

 

SNAP

Advisors follow the steps in the chart below to determine whether an alien claiming battered status is potentially eligible for SNAP.

Step Yes No
  1. Can the alien provide USCIS documentation* that identifies the alien as the self-petitioning spouse, ex-spouse or child of an abusive U.S. citizen or LPR?
Note: Once the alien has provided proof that
identifies him/her as a self-petitioning battered alien, the alien meets
the definition of a "qualified alien," as defined in A-311.1, Definition of Qualified Immigrant.
Go to Step 2. Stop — The alien is not eligible.
  1. Can the battered alien meet one of the following conditions? The alien:
    • is under age 18;
    • is the spouse or minor unmarried dependent child of a person who is
      an active duty military member or an honorably discharged veteran;
    • has resided in the U.S. for 5 years from the date that the petition for battered status was approved and issued (Note: This is not the same as residing in the U.S. for 5 years as a qualified alien as defined in A-311.1); or
    • meets the SNAP definition of disability in B-432, Definition of Disability (regardless of when the alien acquired a disability or entered the U.S.).
Go to Step 3. Stop — The alien is not eligible.
  1. Is the battered alien living with the spouse/parent or other family member who abused or battered the alien?
Stop — The alien is not eligible. Go to Step 4.
  1.  Did the alien:
  • enter the U.S. and acquire “qualified alien” status before Aug. 22, 1996;
  • reside in the U.S. before Aug. 22, 1996, adjust to “qualified alien” status on or after Aug. 22, 1996, and provide proof of continuous residence;
  • reside in the U.S. before Aug. 22, 1996, adjust to “qualified alien” status on or after Aug. 22, 1996, did not provide proof of continuous residence, but meets the five-year waiting period; or
  • enter the U.S. on or after Aug. 22, 1996, and meets the five-year waiting period?
The alien is eligible if the alien
meets all other eligibility factors.
Stop — The alien is not eligible.

* Examples of acceptable USCIS documents include:

  • I-551, Permanent Resident Card, annotated with one of the following status codes: IB-1 through IB-3 or IB-6 through IB-8;
  • I-797, Action Notice, that identifies the alien as a self-petitioning battered alien; or
  • a final order from an immigration judge or the Board of Immigration Appeals granting suspension of deportation under Section 244(a)(3) of the Immigration and Nationality Act.

 

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Follow the steps in the chart below to determine if an alien claiming battered status is potentially eligible for TANF and/or Medical Programs.

Step Yes No
1. Can the alien provide USCIS documentation* that identifies the
alien, the battered alien’s child or the parent of a battered alien
child as the self-petitioning spouse and/or child of an abusive U.S.
citizen or LPR?
Go to Step 2. Stop — The alien is not eligible.
2. Is the battered alien living with the spouse, ex-spouse, parent or other family member who abused or battered the alien? Stop — The alien is not eligible. Go to Step 3.

3. Did the alien:

  • enter the U.S. and acquire “qualified alien” status before Aug, 22, 1996?
  • reside in the U.S. before Aug. 22, adjust to “qualified alien”status on or after Aug. 22, 1996, and provide proof of continuous residence;
  • reside in the U.S. before Aug.22, 1996, adjust to “qualified alien” status on or after Aug. 22, 1996, did not provide proof of continuous residence, but meets the five-year waiting period; or
  • enter the U.S. on or after Aug. 22, 1996 and meets the five-year waiting period?
The alien is eligible if the alien meets all other eligibility factors. Stop — The alien is not eligible.


 

A—350 Verification Requirements

Revision 13-2; Effective April 1, 2013

 

A—351 Verification of Citizenship

Revision 15-4; Effective October 1, 2015

 

All Programs

Items used to verify citizenship for TANF can be used for SNAP and vice versa. Items used to verify citizenship for Medical Programs can also be used for TANF and SNAP. For Medicaid Programs, only verification sources listed in A-358.1, Citizenship, can be used to verify citizenship.

TANF

Advisors verify citizenship for all household members applying for benefits. Individuals are allowed 10 days to provide proof. Advisors must document the type of proof provided. Advisors do not reverify citizenship at complete or incomplete reviews unless questionable.

If the applicant or recipient refuses or fails without good cause to provide proof,  the individual is disqualified until proof is provided.

Related Policy

TANF — Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits, A-1362.1

SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

SNAP

Advisors must verify U.S. citizenship for certified members if questionable or if a regional requirement.

If an individual fails to provide verification of citizenship for Medical Programs, the claim of U.S. citizenship is not considered questionable for SNAP based solely on this reason.

A person with a questionable claim is disqualified until proof of citizenship is received.

Related Policy

SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

Medical Programs Except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Before certifying an individual who has declared that they are a U.S. Citizen, the advisor must verify that the applicant or recipient is a U.S. citizen. Once verified, citizenship does not need to be verified again unless questionable. 

Applicants requesting three months prior Medicaid coverage must provide citizenship verification before prior coverage can be provided.

Exception: Current Medicare and SSI recipients are exempt from the verification requirement. Individuals who are receiving Retirement, Survivors and Disability Insurance (RSDI) based on disability, and who are in a 24-month waiting period to receive Medicare, are considered Medicare recipients for the citizenship and identity verification requirement.

Related Policy
At Application, A-611
Reasonable Opportunity, A-351.1
Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2

 

A—351.1 Reasonable Opportunity

Revision 18-4; Effective October 1, 2018

 

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 45 and TA 85

Medicaid applicants who declare themselves to be U.S. citizens or declare to have an eligible alien status, but for whom verification of citizenship or alien status is unavailable, must be allowed a period of reasonable opportunity to provide verification of citizenship or alien status. The definition of reasonable opportunity is the 95-day period a person is allowed to provide this verification.

At application and when adding a person during a redetermination or change, if the individual does not provide proof of citizenship or alien status and:

  • no other information is required to determine eligibility, the individual is certified for Medicaid if all other eligibility requirements are met, sent Form TF0001, Notice of Case Action, and is provided a period of reasonable opportunity.
  • other information is required to determine eligibility, the advisor must request verification of the other information in addition to citizenship or alien status prior to providing a period of reasonable opportunity. If the client returns the other information but not proof of citizenship or alien status, they are certified for Medicaid, sent Form TF0001, and provided a period of reasonable opportunity.

Form TF0001 informs the applicant that citizenship or alien status verification is required within 95 days and lists the names of each person who must provide citizenship verification. The period of reasonable opportunity begins the day Form TF0001 is generated.

All new applicants must be given a period of reasonable opportunity regardless of whether they received a reasonable opportunity period previously.

The reasonable opportunity period may be triggered under the following conditions:

  • the individual is unable to provide a Social Security number (SSN) needed to electronically verify citizenship with the Social Security Administration (SSA);
  • there is an inconsistency between the data available from an electronic source and the individual’s declaration of citizenship or alien status; or
  • Electronic verification is unsuccessful, including agency efforts to resolve any inconsistencies, and additional documentation is still needed.

The day the reasonable opportunity period expires (the 95th day), the Texas Integrated Eligibility Redesign System (TIERS) will generate an alert that will create a task. The individual is denied if they have not provided citizenship or alien status verification. TIERS provides 30 days advance notice of adverse action to the household after informing them of the denial of ongoing benefits using Form TF0001, Notice of Case Action.

Related Policy

Reasonable Opportunity to Provide Citizenship and Alien Status Verification, D-441.1

 

A—351.2 Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship

Revision 15-4; Effective October 1, 2015

 

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

If an applicant has an SSN, use SOLQ or WTPY to verify citizenship.

The system attempts to verify citizenship using SOLQ through Electronic Data Sources (ELDS). If the SOLQ system is unresponsive or unavailable due to system failure, advisors must attempt to verify using WTPY.

If the SSN is verified, WTPY provides a response code for verification of citizenship. Advisors follow the steps in the chart below to determine the required advisor action for each response code. These response codes are only provided for Medicaid or CHIP requests.

If the WTPY response code is… then staff must …
A

SSN is verified, there is no indication of death, and the allegation of citizenship is consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the citizenship verification drop-down menu.
B

SSN is verified, there is no indication of death, and the allegation of citizenship is NOT consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. See the process for If unable to verify citizenship (Code B) below.
C

SSN is verified, there is indication of death, and the allegation of citizenship is consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. Treat the death information as a change using policy in B-600, Changes.
D

SSN is verified, there is indication of death, and the allegation of citizenship is NOT consistent with SSA data,
  1. Select “Verified by SSA (SOLQ, WTPY, and HUB)” in the SSN verification drop-down menu.
  2. Treat the death information as a change using policy in B-600.

 

If unable to
Advisors should attempt to verify citizenship using the Birth Verification System (BVS).
  1. If staff is unable to verify citizenship using BVS and additional information is required to determine eligibility, request the additional information and verification of citizenship and allowthe individual at least 10 days to provide proof.
    • If the client does not return the additional information by the final due date, the advisor must deny the case for failure to provide required information.
    • If the client provides the additional information, but does not provide verification of citizenship, the advisor must allow the individual a period of reasonable opportunity (explained in A-351.1, Reasonable Opportunity) to provide the verification of citizenship.
  2. If staff is unable to verify citizenship using BVS and no other information is required to determine eligibility, the advisor must allow the individual a period of reasonable opportunity to provide the verification without pending the EDG.

After allowing reasonable opportunity, if the recipient refuses or fails to provide proof, the advisor must deny the individual until proof of citizenship is provided.

SOLQ or WTPY responses may also include information on the receipt of SSI or RSDI. Advisors can find more information on the treatment of RSDI and SSI income explained in A-1324, Government Payments.

If the WTPY system is unresponsive or unavailable due to system failure, advisors must not deny or delay certification of Medicaid or CHIP coverage for failure to verify SSN or citizenship. Advisors must:

  • enter the SSN as provided by the applicant into TIERS and allow the automated SSA interface to verify the SSN; and
  • allow the individual a period of reasonable opportunity (explained in A-351.1) to provide the verification of citizenship.

 

A—351.3 Good Cause Determination

Revision 15-4; Effective October 1, 2015

 

TANF

Good cause exists when the Texas Health and Human Services Commission (HHSC) determines that circumstances beyond the individual's control prevent proving U.S. citizenship. The individual's statement that proof is delayed is acceptable.

At initial application and when adding a person, good cause is allowed until the next complete review. The individual must be advised that the verification must be provided by the next complete review or the individual will be disqualified.

 

A—351.3.1 Referrals to OIG

Revision 15-4; Effective October 1, 2015

TANF

Advisors must disqualify and refer an individual to the Office of Inspector General (OIG) if:

  • the individual previously claimed to be a U.S. citizen but could not provide proof after allowing good cause; and
  • other information indicates the individual's claim of citizenship is questionable.

 

A—351.4 How to Verify Citizenship

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors may refer to A-358.1, Citizenship, for common sources used to verify U.S. citizenship. For Medical Programs, advisors use the most reliable level of verification available from the sources listed as acceptable for Medical Programs. An affidavit is used only as a last resort when other verification is not available.

Advisors should explore derivative citizenship for any applicant born abroad to at least one U.S. citizen parent. If the applicant claims derivative citizenship, the applicant must provide a Certificate of Citizenship issued by the U.S. Citizenship and Immigration Services.

Related Policy
Reasonable Opportunity, A-351.1
Questionable Information, C-920
Providing Verification, C-930

 

TANF and SNAP

If the applicant cannot obtain the requested proof but can reasonably explain why it is not available, the advisor must obtain an affidavit signed by someone who knows the applicant's history. The advisor should advise signers that the affidavit is a sworn statement; signers can certify only those facts of which they have personal knowledge. The affidavit must state that the signer:

  • is a U.S. citizen;
  • knows that the applicant is a U.S. citizen; and
  • may be fined, imprisoned or both if false information is given.

Through supervisory channels, the advisor must ask the regional attorney to make a determination if the applicant:

  • does not have proof of citizenship and cannot obtain an affidavit as described above; or
  • claims derivative citizenship and does not have a Certificate of Citizenship.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Verification requirements do not apply for undocumented aliens in the Emergency Medicaid certified group.



 

A—352 Verification of Alien Status

Revision 18-1; Effective January 1, 2018

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must verify alien status by:

  • obtaining documentation of alien status, as explained in A-340, Qualified Alien Status Eligibility Charts; and
  • accessing the USCIS SAVE VIS, as explained in A-355, Verifying Alien's USCIS Documents.

Advisors pend the EDG to allow an alien to update the alien's status with USCIS. An alien who does not have acceptable status is disqualified. If a certified alien’s document expires before the next redetermination, the alien’s immigration status must be re-verified following policies and procedures in A-313, Absence of Proof of Alien Status.

Advisors use the SAVE VIS:

  • at application;
  • when adding a new household member identified as an alien; or
  • when the client’s USCIS document has expired.

Notes: If the alien’s USCIS document is expired and the SAVE response shows;

  • The individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted is “Response is Indefinite,” the individual meets an alien status criteria. These individuals must not be disqualified.
  • The individual's I-766, Employment Authorization Document, is not expired. These individuals must not be disqualified due to having an expired document.

SAVE does not contain information about victims of severe trafficking or nonimmigrant alien family members. At application, advisors must call the trafficking verification toll-free number at 866-401-5510 to confirm the validity of the certification letter or Derivative T Visa and to notify the Office of Refugee Resettlement of the benefits for which the individual is applying.

Medicaid and CHIP applicants or recipients who declare an alien status, but for whom verification of alien status is unavailable, must be allowed a period of reasonable opportunity to provide verification of alien status as explained in A-351.1, Reasonable Opportunity.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Do not follow the SAVE VIS verification procedures.

 

A—353 Verification of Military Connections

Revision 13-2; Effective April 1, 2013

 

 

A—353.1 Verification of Veteran Status

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must verify an individual's eligible veteran status by:

  • a discharge certificate; or
  • Form DD-214 or equivalent that shows the individual previously met active duty status in the armed forces.

Note: Discharge certificates that show character of discharge as anything but "honorable" are not acceptable. A character of discharge "Under Honorable Conditions" is not an "honorable" discharge for purposes of eligibility.

If the veteran does not have proof of discharge status, the veteran is referred to the Veteran's Administration to obtain verification.


 

A—353.2 Verification of Active Duty Military

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Individuals who claim they are currently on active duty in the military must provide a:

  • current Military Identification Card, Form DD-2 (Active); or
  • copy of their current military orders.

If the active duty military member does not provide proof of active duty status, the advisor must request other forms of proof.


 

A—353.3 Verification of a Spouse or Minor Unmarried
Dependent Child of a Veteran or Active Duty Military Member or
Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military
Member

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Staff must verify whether an alien meets the eligibility requirements as:

  • a spouse or minor unmarried dependent child of a veteran or active duty military member; or
  • an unmarried surviving spouse of a deceased veteran or active duty military member.

To verify, advisors may use one of the following methods:

  • view Form DD-214 for the discharged veteran;
  • view the Military Identification Card (DD-2) that shows that the
    alien is married to or is a minor unmarried dependent child of a veteran
    or active duty military member; or
  • refer the individual to the Veteran's Administration for verification.


 

A—354 Verifying 40 "Qualifying Quarters"

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must verify 40 qualifying quarters for LPR applicants or household additions that must meet this requirement. Advisors use the WTPY 40 Quarters Verification System to verify covered wages. Once verified, this information does not have to be reverified.


 

A—354.1 Response from Social Security Administration's (SSA) WTPY System

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

SSA does not complete the posting of covered earnings quarters for any one year until the following year (around August). Example: Quarters earned in 2012 may not be posted on the WTPY system until August 2013. These quarters are referred to as “Lag” quarters.

A response from SSA on the 40 quarters verification request takes approximately 48 hours to receive.

Advisors base the quarters of covered earnings on the calendar year’s total earnings. Each year, the amount of income needed to earn a quarter changes. State office advises staff of the change each year.

For 2012, an individual must earn $1,130 to earn one quarter. If the individual earned at least $4,520 for 2012 ($1,130 x 4), the client has four qualifying quarters for the year.

Note: Advisors must not allow credit for an incomplete or future quarter. Example: The quarter of July to September 2012 cannot be counted until October
2012, even though the individual earned enough income by March 2012 to receive credit for three quarters in 2012.


 

A—354.2 Non-Covered Wages

Revision 18-1; Effective January 1, 2018

 

All Programs Except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

Non-covered wages are those earned by an individual whose employer was not required to pay into the Social Security system (such as certain city, federal, school or religious organization employees).

If the LPR cannot meet the 40 qualifying quarter requirement using covered earnings verified by the SSA, advisors must then obtain sufficient income verification from the individual's employer to determine the earned quarters for the period in question.

Use the chart below to determine if the individual has earned sufficient money to earn a quarter.

1984 $390 1995 $630 2006 $970 2017 $1,300
1985 $410 1996 $640 2007 $1,000    
1986 $440 1997 $670 2008 $1,050    
1987 $460 1998 $700 2009 $1,090    
1988 $470 1999 $740 2010 $1,120    
1989 $500 2000 $780 2011 $1,120    
1990 $520 2001 $830 2012 $1,130    
1991 $540 2002 $870 2013 $1,160    
1992 $570 2003 $890 2014 $1,200    
1993 $590 2004 $900 2015 $1,220    
1994 $620 2005 $920 2016 $1,260    

Example: A former custodian worked for a school district from 2008 through 2011. The school district did not pay into the Social Security system. The advisor requested that the former custodian provide verification of their earnings for this particular period.* They brought a statement from the school district verifying their wages showing they earned $9,000 for 2008. Using the chart above, the income required to earn a quarter for 2008 is $1,050. This person can be credited with four quarters for 2008 ($1,050 x 4 = $4,200).

* If HHSC already has proof of income earned, advisors
do not request that the individual provide additional
verification.

 

Note: Credit for an incomplete or future quarter is not allowed.


 

A—354.3 Quarters Earned On or After January 1, 1997

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Federal law requires that quarters earned on or after January 1, 1997, cannot be credited if the person who earned the quarters received means-tested public benefits.

When determining the total amount of quarters earned by an LPR,
advisors do not allow any quarters earned after January 1, 1997, if the
person received TANF, SNAP, Medicaid or SSI benefits for the quarter.
The WTPY system response does not reflect receipt of these benefits.

The SSA defines a quarter as a period of three calendar months:

  • Quarter 1: January, February, March
  • Quarter 2: April, May, June
  • Quarter 3: July, August, September
  • Quarter 4: October, November, December


 

A—354.4 Procedures for Verifying 40 Quarters

Revision 15-4; Effective October 1, 2015

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must:

Step Action
1 Ensure that the alien's LPR status has been verified.
2 Determine whose quarters of earnings have to be verified.
3 Obtain a consent of release before verifying quarters of coverage through the WTPY system or SSA. Use one of the following forms:

Note: A consent form or signature is not required for spouses or parents who are deceased.

    • Form SSA-3288, Social Security Administration Consent for Release of Information, must be signed by the:
      • LPR, if the LPR did not sign the application;
      • LPR's spouse, if the spouse did not sign the application; or
      • LPR's parent.
    • Form SSA-513, Request for Quarters of Coverage History Based On Relationship, is completed when the LPR, spouse and/or parent:
      • refuses to sign Form SSA-3288; or
      • cannot be located.

Example: A husband, wife and their four children have applied for SNAP benefits. Both spouses and two of the children are LPRs (advisor has verified LPR status). The husband has worked in the U.S. for about six years, and the wife has worked about five years. The advisor must verify the quarters of earnings for both spouses.



Since the husband was the one who signed the application, he does not have to sign Form SSA-3288; however, a signed Form SSA-3288 is required for the wife. The advisor must also complete Form H1079, Qualifying Quarters of Social Security Earnings, for both spouses.

4 If the household signed Form SSA-3288, submit Form H1079 to the appropriate WTPY data entry staff with the following information:
  • LPR's full name, as it appears on the Social Security card;
  • LPR's date of birth; and
  • LPR's correct Social Security number.

If the household signed Form SSA-513, send the completed form to the following address:

Social Security Administration

P.O. Box 17750

Baltimore, MD 21235-0001

5 If you are awaiting the verification from SSA's WTPY system (normally WTPY provides a response within 48 hours), issue Form H1020, Request for Information or Action, and pend the EDG.

If you sent Form SSA-513, disqualify the individual until you receive the response from SSA.

6 Use the WTPY or Form SSA-513 response to determine how many countable quarters are in the SSA records for the LPR, spouse and parent. Verify any recent earnings through the employer or case record if not yet posted on the WTPY system or not listed on Form SSA-513. Compute the quarters of covered earnings.
7 Disallow any quarters in which the wage earner received TANF, SNAP, Medicaid or SSI after January 1, 1997.
8 If the LPR:
  • has 40 quarters, the LPR is eligible.
  • does not have 40 quarters, the advisor sends Form TF0001, Notice of
    Case Action, to notify the household that the LPR is disqualified as an
    ineligible alien due to the lack of 40 allowable quarters of earnings.
9 If the individual disagrees with SSA's records for quarters of covered earnings, provide the individual with Form H1020. On Form H1020, explain that HHSC will certify the LPR if proof is provided that SSA was contacted to resolve the record of earnings. Provide the LPR copies of the WTPY response(s).

If the LPR needs to resolve a disagreement about a parent's or spouse's SSA record, advise the LPR that the spouse or parent must go to SSA to reconcile the individual's record. The LPR can resolve the SSA records for a deceased spouse or parent.

10 If the LPR contacts SSA to resolve the disagreement, SSA provides the individual with a document or Form SSA-7008, Request for the Correction of Earnings. The document or Form SSA-7008 verifies the action being taken to resolve the disagreement about the individual's SSA record. When the LPR provides the verification, submit the verification for imaging. Consider the LPR an eligible alien for TANF, SNAP and Medical Programs for one of the following time periods:
  • for six consecutive months beginning the month the LPR contacted SSA, or
  • less than six months if the LPR resolves the disagreement with SSA
    before the sixth month and the LPR does not have 40 allowable quarters
    of covered earnings.

Document this temporary eligibility period.

Note: On a denied application, if the LPR provides the needed proof by the 60th day after the file date, reopen the application using the date the LPR provided the information as the file date.


 

A—355 Verifying Alien's USCIS Documents

Revision 16-4; Effective October 1, 2016

 

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, and TP 36

Two methods exist for verifying the alien's USCIS documents:

  • Initial verification — an online inquiry process, SAVE; and
  • Institute additional verification — an online or manual process using USCIS Form G-845, Verification Request, and Form G-845 Supplement, Verification Request.

    Advisors must attempt to first verify the alien's USCIS documents during the interview, if applicable, using the initial verification process. If the initial process cannot verify the number, the SAVE response instructs staff to institute additional verification.

    Notes:

    • Do not re-verify the alien's documents if they were previously verified and documented and have not expired.
    • An I-551, Permanent Resident Card, does not always include the holder's signature and may say "Signature Waived" on the front and back of the card where a signature would normally be located. When this occurs, the individual meets an alien status criteria and must not be disqualified.
    If, at the interview, the individual does not provide his USCIS document and the document … then …
    is available, give the individual at least 10 days (or the 30th day after the
    file date, if later) to provide the information. Initiate initial
    verification when the household provides proof.

    If the household does not provide proof by the 30th day after the
    file date, disqualify the member with no proof and certify any remaining
    eligible members.

    SNAP

    Exception: If the 10-day period ends after the 30th
    day from the file date, certify the application by the 30th day.
    Include the alien with the pending information even if the verification
    has not been provided. If the household does not provide the information
    by the 10th day, take adverse action to disqualify the member with no
    proof.

    Related Policy

    Disqualified Members, A-1362

    is not available because the document is lost, instruct the alien to:
    • file for a duplicate card and I-94 at USCIS; and
    • bring the I-94 to the eligibility determination office.

    Give the individual at least 10 days (or the 30th day after the file date, if later) to provide the information.

    If the I-94 is provided, initiate initial verification.

    If the household does not provide proof by the 30th day after the file date, disqualify the member with no proof. Certify any remaining eligible members. See the exception above if the 10-day period ends
    after the 30th day.

    Related Policy

    Disqualified Members, A-1362



     

    A—355.1 SAVE Program's Verification Information System (VIS)

    Revision 15-4; Effective October 1, 2015

     

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    The SAVE program's VIS is a web-based application that provides
    alien status information using the applicant’s immigrant registration
    number.

    The SAVE system provides the following types of responses:

    • Initial Verification Results — First Name, Last Name, Country, Date
      of Entry, Date of Birth, Class of Admission (COA), and System Response.
    • Additional Verification Results — DHS Response, Expires On, Response Date, and DHS Comments.


     

    A—355.2 How to Request an Initial Verification

    Revision 15-4; Effective October 1, 2015

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Supervisors complete and route Form 4743, Request for Applications
    and System Access, to the regional security officer for employees who
    need access to the SAVE system.

    Advisors must follow these steps to access the SAVE system:

    1. Open the VIS web site at https://save.uscis.gov/Web/vislogin.aspx?JS=YES.
    2. Enter your User ID and password.
    3. Select Initial Verification from the Case Administration menu.
    4. Enter the document type that the applicant provided.
    5. Enter the applicant's information as it appears on the document:
      • Alien Number — Do not include the letter A when entering the information in SAVE. If the A number has fewer than nine digits, add leading zeroes to make it a nine-digit number. USCIS# is used on the new I-551 cards instead of Alien Number.
      • I-94 Identification Number — known as the admission number, consists of an 11-digit field. Enter leading zeroes if the I-94 number provided has less than 11 digits.
      • Card Number — Card numbers for I-551 cards issued before November 2004 are at the bottom of the card toward the right-hand side. Card numbers for newer versions of I-551 are on the back of the
        card.
      • Last name.
      • First name.
      • Date of birth.
      • Document expiration date, if applicable.
      • Required benefits — Select the benefit type from the Benefits List (SNAP, Medicaid, TANF).
    1. Select Submit Initial Verification. The response appears in the Initial Verification Results section of the same page.
    2. The screen displays one of the following messages:
    • Lawful Permanent Resident – Employment Authorized;
    • Institute Additional Verification; or
    • Temporary Resident/Temporary Employment Authorized.

    Note: If the response is Temporary Resident/Temporary Employment Authorized, the alien does not meet eligibility requirements.

    1. Review the results and select Print Case Details.
    2. Select Complete and Close Case to close the case (only if
      additional verification is not necessary). Once a case is closed, the
      user can view it for an additional 90 days.

     

    A—355.3 How to Request Additional Verification – Online Process

    Revision 15-4; Effective October 1, 2015

     

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    To request additional verification:

    1. In the Initial Verification Results section, select Request Additional Verification. The Enter Additional Verification Data section appears.
    2. Edit the default information if necessary, enter required information, and include as much information as possible. Use the Special Comments box to enter additional information to the Immigration Status Verifier (ISV) staff.
    3. Submit the request by selecting Submit Additional Verification. The response section appears indicating that the request is in process and will return the response within three working days.
    4. To view the status of the case, select View Cases from the Case Administration menu. The Case Search page appears.
    5. Enter the Case Search Criteria to search for cases based on the following case status:
        • all open cases;
        • cases requiring action;
        • cases with additional verification responses;
        • cases in process; and
        • closed cases.

    Select Display Case Summary List to open the Case Summary List page. The list displays the Case Status for cases that require action, cases in process, and closed cases. Click the Verification Number to view the Case Details. The user is able to print the case details, request additional verification, and close the case.

    When the system is unable to verify the immigration status with the information provided by the user in the automated additional verification request, or the document appears counterfeit, altered, or expired, staff may use the manual process in A-355.4, How to Request Additional Verification – Manual Process.

     

    A—355.4 How to Request Additional Verification – Manual Process

    Revision 16-3; Effective July 1, 2016

     

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, and TP 36

    To request additional verification:

    • complete Form G-845, Verification Request and Form G-845 Supplement, Verification Request;
    • attach fully readable photocopies (front and back) of original immigration documents containing the immigrant’s registration number; and
    • mail one set of copies to the USCIS office (see the instructions to Form G-845 and Form G-845 Supplement). Submit a second set of copies for imaging.

    If the applicant's name changed since the immigrant registration card was issued, advisors attach a document that verifies the name change.

    If the alien is otherwise eligible, the advisor must not delay, deny, or reduce the household's benefits while waiting for a response from the USCIS.

    When the USCIS returns Form G-845 and Form G-845 Supplement, follow these procedures:

    If the response indicates that the alien's document is … then …
    valid, send Form G-845 and Form G-845 Supplement to be imaged.
    not valid and the EDG is certified,
    • take adverse action to disqualify the individual or deny the EDG, as appropriate
    • process a fraud referral; and
    • send Form G-845 and Form G-845 Supplement to be imaged.


     

    A—356 Verifying Alien's Date of Entry

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    The date on the alien's immigration document often represents the alien's first date of entry into the United States. In some instances, an alien may be present in the United States without a qualified status. The individual may then depart and then return to the U.S. as an LPR. For these aliens, the date on their immigration document reflects the date of entry with LPR status, rather than the alien's original date of entry.

    Advisors use immigration documents to verify date of entry. Advisors must allow aliens with a USCIS document showing an entry date on or after August 22, 1996, who claim to have entered before that date, an opportunity to submit evidence of their claimed date of entry. This evidence may include pay stubs, a letter from an employer, or a lease or utility bill in the alien's name.


     

    A—357 Verifying Alien's Continuous Presence

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    USCIS maintains a record of arrivals to and departures from the country for most legal entrants. File Form G-845S,
    Document Verification Request, and Form G-845S Supplement with the
    USCIS to verify continuous presence in the U.S. Other entrants,
    including aliens who entered the U.S. without USCIS documents, must
    provide documentary evidence showing proof of continuous presence, such
    as a letter from an employer or a series of pay stubs, or utility bills
    in the alien's name and spanning the period of time in question. Note: The alien does not have to remain continuously present in the U.S after obtaining qualified immigrant status.



     

    A—358 Verification Sources

    Revision 13-2; Effective April 1, 2013

     

     

    A—358.1 Citizenship

    Revision 15-4; Effective October 1, 2015

     

    TANF and SNAP Verification Sources:

    • Birth Verification System automated process (for individuals born in Texas)
    • Birth certificate (see Note)
    • Naturalization papers (N-560 or N-561)
    • Hospital record of birth
    • Baptismal record with date and place of birth
    • U.S. passport or U.S. passport card
    • Military service papers
    • Census records showing name, U.S. citizenship or U.S. place of birth, and date of birth or age
    • Voter registration card (SNAP only)
    • Local, state or federal records showing birthplace in the U.S.
    • Regional attorney
    • Civil service employment by the U.S. government
    • American Indian Card
    • Report of birth abroad (FS-240)
    • Certificate of birth (FS-545 or DS-1350)

    Alternate Sources

    • Family Bible records
    • Affidavit from U.S. citizen

    Note: Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless previously certified using a birth certificate issued before July 1, 2010. See C-932, Advisor Responsibility for Verifying Information, for information regarding assisting an individual in obtaining birth verification from Puerto Rico.

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Citizenship and Identity Verification

    Verification sources are divided into two levels: Level 1 and Level
    2. Level 1 sources establish both citizenship and identity. Level 2
    sources establish citizenship only.

    Level 1: Verifies Citizenship and Identity
    SOLQ/WTPY
    U.S. passport
    Certificate of Naturalization (DHS Forms N-550 or N-570)
    Certificate of U.S. Citizenship (DHS Forms N-560 or N-561)
    State Data Exchange (SDX) for denied SSI recipients when the denial reason is for any reason other than citizenship
    Evidence of membership or enrollment in a federally recognized tribe
    SOLQ/WTPY and documentation on reason for Medicare denial
    Inquiry reflecting a current or denied TP 45 Medicaid EDG
    CHIP-P inquiry reflecting a current or denied CHIP-P case for the child

     

    Level 2: Verifies Citizenship Only
    If using a source from Level 2, the individual must also provide an additional source from the Medicaid and CHIP identity
    verification sources. The same source that was used to verify citizenship cannot be used to verify identity. Identify verification from A-621, Verification Sources, is required.
    A U.S. public birth certificate showing birth in one of the 50 states, the District of Columbia, Puerto Rico (if born on or after January 13, 1941)*, Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain's Island or the Northern Mariana Islands (after November 4, 1986)*
    BVS inquiry
    Report of Birth Abroad of a U.S. Citizen (FS-240)
    Certification of Birth Abroad (FS 545 or DS-1350)
    U.S. Citizen Identification Card (Form I-179 or I-197)
    Northern Mariana Identification Card (I-873)
    Final adoption decree showing the child's name and U.S. place of birth
    Evidence of U.S. civil service employment before June 1, 1976
    U.S. military record showing a U.S. place of birth (Example: DD-214)
    SAVE for naturalized citizens
    If a child has not yet received a Certificate of Citizenship, N-560 or N-561, evidence of meeting the automatic criteria for U.S. citizenship outlined in the Child Citizenship Act of 2000, which includes:
    • proof that at least one parent of the child is a U.S. citizen, by birth or naturalization;
    • proof that the child is under age 18;
    • proof that the child is residing in the U.S. in the legal and physical custody of the U.S. citizen parent;
    • I-551, Permanent Resident Card; and
    • I-551 with annotation of IR-3 or IR-4, if an adopted child.
    Hospital record of birth showing a U.S. place of birth
    Life, health, or other insurance record showing a U.S. place of birth
    Religious record of birth recorded in the U.S. or its territories within three months of birth, which indicates a U.S. place of birth, showing either the date of birth or the individual's age at the time the record was made
    Early school record (preschool or day care) showing a U.S. place of birth
    Federal or state census record showing U.S. citizenship or a U.S. place of birth
    Institutional admission papers from a nursing facility, skilled care facility or other institution showing a U.S. place of birth
    Medical (clinic, doctor, or hospital) record, excluding an immunization record, showing a U.S. place of birth
    An affidavit signed by another individual who can reasonably declare to the applicant's citizenship, regardless of blood relationship to the individual and under penalty of perjury, and that contains the applicant's name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized. Use only as a last resort when other evidence is not available.

    * Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless certified previously using a birth certificate issued before July 1, 2010. C-932, Advisor Responsibility for Verifying Information, includes information regarding assisting an individual in obtaining birth verification from Puerto Rico.

    American Indian/Alaska Natives (AI/AN)

    Individuals can self-declare AI/AN status. Form H1205, Texas Streamlined Application, and Form H1010, Texas Works Application for Assistance — Your Texas Benefits, include a general question asking whether anyone in the household is an American Indian, Alaska Native, or member of a federally recognized tribe. In some instances, Yes may be selected on the application for this question, but information is not provided by the applicant in Appendix B, American Indian or Alaska Native Family Member (AI/AN), identifying the member of the household composition for Medical Programs to whom the status applies. If the name of the individual claiming AI/AN status is not provided, AI/AN status is considered not verified.

    Related Policy
    Providing Verification, C-930
    Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2
     

    A—358.2 Alien Status

    Revision 15-4; Effective October 1, 2015

     

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

    • Form I-94, I-151, I-551, I-688B (with special annotations), I-766 (with
      special annotations), or other valid USCIS records
    • Contact with USCIS

    TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Alien Entry Date

    • Immigration document
    • Contact with the USCIS
    • Pay stubs
    • Letter from employer
    • Lease or utility bill in the alien's name
    • School records
    • Other document indicating entry date

    Alien's Continuous Presence

    • Contact with the USCIS
    • Letter from employer
    • Pay stubs or utility bills in the alien's name spanning the time period in question
    • School records
    • Other documents spanning the time period in question



     

    A—360 Documentation Requirements

    Revision 15-4; Effective October1, 2015

    All Programs

    Advisors must document the:

    • alien's status and how you verified it;
    • USCIS document's expiration date if any;
    • basis of alien's eligibility or ineligibility; and
    • temporary eligibility period for the alien, described in A-354.4, Procedures for Verifying 40 Quarters, if applicable.

    Advisors must document the verification number from the SAVE inquiry in case comments.

    Related Policy
    Documentation, C-940

    SNAP

    Advisors must document the proof of citizenship, if questionable.

    TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Advisors must document proof of citizenship.

    Advisors must document the alien's:

    • date of entry; and
    • continuous presence, if necessary to establish eligibility.

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    When using a verification source from Level 2, the advisor must document the reason Level 1 was not used.

    Copies of the document used to verify citizenship must be legible and non-questionable.

    Related Policy

    The Texas Works Documentation Guide

    A-400, Social Security Number

    Revision 18-1; Effective January 1, 2018

     

     

    A—410 General Policy

    Revision 15-4; Effective October 1, 2015

     

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    All applicants must provide a Social Security number (SSN) or apply for one through the Social Security Administration (SSA) before certification, unless they meet one of the criteria in this section.

    Exception: Undocumented aliens are not required to apply for an SSN.

    Non-applicants are not required to provide an SSN or proof of an application for an SSN. When non-applicants provide an SSN, advisors may attempt to verify the SSN using the procedures explained in A-440, Verification Requirements. If verification is not available through electronic data sources, verification of the non-applicant’s SSN must not be requested from the applicant.

    SNAP

    Children age six months or younger are not required to provide proof of an application for an SSN. Newborns may receive benefits with the household without providing proof of an application for an SSN for the later of:

    • six months following the child's birth, or
    • the next recertification/complete review.

    Applicants eligible for expedited service may receive initial benefits without providing or applying for an SSN. Initial benefits can include the first two months if receiving a combined allotment.

    Applicants who cannot provide required proof to apply for an SSN may receive the Supplemental Nutrition Assistance Program (SNAP) for each month they have good cause. Good cause exists when circumstances beyond the individual's control prevent the individual from securing proof required to obtain an SSN.

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45 

    Applicants do not need to provide an SSN if they meet any of the following good cause reasons:

    • They are not eligible to receive an SSN;
    • They do not have an SSN and may only be issued an SSN for a valid non-work reason; or
    • They refuse to obtain an SSN because of a well-established religious objection. A well-established religious objection exists when the applicant:
      • is a member of a recognized religious sect or division of the sect; and
      • adheres to the tenets or teachings of the sect or division of the sect and for that reason is conscientiously opposed to applying for or using a national identification number.

    TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

    Undocumented aliens applying for Emergency Medicaid are not required to provide an SSN.

    TP 45

    SSN requirements do not apply to TP 45.

    If a TP 45 child has an SSN, advisors enter the SSN at Application Registration or during Data Collection in the Individual Information page. If the child does not have an SSN, advisors may refer the parent or caretaker to the SSA to complete Form SS-5, Application for Social Security Number.

     

    A—411 Determining Advisor Action at Application

    Revision 18-1; Effective January 1, 2018

     

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    If the applicant ... then ...
    • cannot provide an SSN;*
    • provides an SSN that the Texas Integrated Eligibility Redesign System (TIERS) will not accept as valid; or
    • provides Form SSA-5028, Receipt for Application for an SSN, that is more than 30 days old,
    • refer the applicant to the local SSA office using a separate Form H1106, Enumeration Referral, for each member needing an SSN; and
    • pend the application until SSA returns Form H1106 verifying the applicant has completed the application process.

      Exception: Follow policy in A-410, General Policy, for the applicable exceptions, by program.

    • provides Form SSA-5028 (not more than 30 days old); or
    • provides Form SSA-2853, Message From Social Security, that is not more than 180 days old,
    • accept the form as proof that the applicant applied for an SSN;
    • tell the applicant to report the SSN when the applicant receives it; and
    • enter the SSN in the Eligibility Determination Group (EDG), when reported.

    Note: See A-412, Action at TANF and Medical Program Redetermination — Forms SSA-5028 or SSA-2853, for action to take at the next periodic review for Temporary Assistance for Needy Families (TANF) or Medicaid recipients.

    provides an SSN, enter the SSN at Application Registration or during Data Collection in the Individual Information page.
    provides an SSN but indicates the name and/or date of birth on record with SSA is not correct,
    • enter the SSN at Application Registration or during Data Collection in the Individual Information page; and
    • refer the applicant to the local SSA office to update the individual’s SSA file using Form H1106. Do not pend the application for SSA's response.
    provides an SSN but wants a replacement for a lost card,
    • enter the SSN at Application Registration or during Data Collection in the Individual Information page; and
    • refer the applicant to the local SSA office without Form H1106; and
    • inform applicants age 18 and older that replacement SSN cards can be requested online through the SSA by visiting socialsecurity.gov/ssnumber.

     

    * If the applicant cannot provide an SSN because the applicant is a documented alien without work authorization, refer the applicant to the local SSA office using Form H1106.

    Advisors must explain the following to applicants applying for an SSN:

    • the type of proof they must take to SSA to obtain an SSN (see page 2 of Form H1106, Proofs You Need to Apply for a Social Security Number Card, for common types of proof);
    • the referral procedure and the results of any delay;
    • that SSA must conduct a face-to-face interview with a person age 18 or over applying for an original SSN; and
    • that a person applying for someone else (including an adult applying for a child) must provide proof of that person's own identity in addition to proof needed for the SSN application.

    When an applicant takes Form H1106 to the SSA office, SSA:

    • determines whether the applicant is eligible for an SSN;
    • submits Form SS-5 for those eligible; and
    • adds information to Form H1106 or provides another SSA receipt or letter verifying the applicant completed the SSN application process. At the applicant's request, the SSA staff member may fax the form to the advisor listed on Form H1106.

    Advisors follow procedures in A-420, Failure to Comply, if the applicant does not return Form H1106 with entries made by SSA, or another receipt or letter, verifying application for an SSN for each applicant by the 30th day after the file date, or later, to allow at least 10 days.

    SNAP

    If the applicant cannot complete the SSN application process in a timely manner, the advisor must explain the procedure for claiming good cause. If the applicant indicates the applicant may have good cause for not complying in a timely manner, the advisor must make a good cause determination. The application is not pended for SSA's response if good cause is applicable.

     

     

    A—412 Action at TANF and Medical Program Redetermination — Forms SSA-5028 or SSA-2853

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs, except TP 43, TP 44, TP 45 and TP 48

    Advisors must provide the individual with Form H1106, Enumeration Referral, at the next complete review when:

    • Form SSA-5028 or SSA-2853 is accepted at application,
    • the form is no longer current, and
    • no SSN has been received.

    Advisors must indicate on Page 2 of Form H1106, Proofs You Need to Apply for a Social Security Number Card, that the form must be returned by the SSA within 60 days. At the applicant's request, the SSA staff member may fax the form to the advisor listed on Form H1106. The advisor must explain to the individual the result of noncompliance.

    The complete review must not be pended for the return of Form H1106. The advisor must set a special review for the end of the 60-day period. Follow procedures in A-420, Failure to Comply, for noncompliance if:

    • Form H1106 was not returned by the deadline, and
    • an SSN was not received.

    TP 43, TP 44 and TP 48

    Advisors follow the procedures above, but do not set a special review. Advisors must check for compliance at the next review.

     

    A—420 Failure to Comply

    Revision 15-4; Effective October 1, 2015

    TANF and SNAP

    If an application is certified but a member is disqualified, notification of the individual’s disqualification is included on the comment section of Form TF0001, Notice of Case Action.

    Exception: Advisors follow policy in A-410, General Policy, for applicable exceptions for SNAP.

    Related Policy
    TANF — Budgeting for a Household Member Disqualified for Noncompliance with SSN, TPR, Failure to Timely Report a Certified Child's Temporary Absence, Intentional Program Violation, Being a Fugitive or a Felony Drug Conviction, A-1362.2
    SNAP — Budgeting for Members Disqualified for Citizenship, 18-50 Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

    TANF

    Advisors must disqualify a required member of the certified group who fails to comply without good cause.

    Exception: Advisors must deny the application/EDG if the:

    • only eligible child or otherwise eligible person does not comply; or
    • caretaker/payee refuses to cooperate and the advisor cannot otherwise determine eligibility of the other members.

    SNAP

    Advisors must disqualify an applicant who fails to comply.

    Exception: Follow policy in A-410 for the following situations:

    • children under age six months,
    • expedited service, and
    • good cause claims.

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    Advisors must deny an individual's eligibility if the individual fails to comply with the SSN requirements explained in this section. Denying eligibility for an individual who does not comply with SSN requirements does not impact the eligibility for any other individuals applying for or receiving Medical Program benefits.

     

    A—421 Reestablishing Eligibility

    Revision 15-4; Effective October 1, 2015

    TANF and SNAP

    If a member is disqualified at application and later complies, the individual is included effective the month after being notified of the compliance.

     

    A—430 Proof Required by SSA

    Revision 15-4; Effective October 1, 2015

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    The proof required to get an SSN is shown in the table below, except for special situations that are listed in A-431, Special Situations. The proof needed depends on:

    • place of birth;
    • citizenship status; and
    • whether the request is for an original, duplicate, or corrected SSN.
    If the applicant is a/an ... applying for ... then the applicant must furnish proof of ...
    U.S. citizen born in the U.S., an original SSN, age, identity, and citizenship.
    U.S. citizen born in the U.S., a duplicate SSN, identity.
    U.S. citizen born outside the U.S., an original SSN, age, identity, and citizenship.
    U.S. citizen born outside the U.S., a duplicate SSN, identity and citizenship.
    alien, an original SSN, age, identity, and lawful alien status.
    alien, a duplicate SSN, identity and lawful alien status.

     

    Note: To correct/update SSN information, the applicant must provide proof required for a duplicate SSN as well as proof showing the new information.

    Acceptable Proof

    The documents must be originals, or copies made by the custodian of the record, such as a county clerk or registrar. SSA will return all documents submitted to SSA.

    Proof of Age and Citizenship

    A birth certificate is the preferred proof.

    If no birth certificate is available, a U.S.-born citizen may furnish:

    • a religious record showing age or date of birth (to establish citizenship, it must have been recorded within three months of birth);
    • a hospital birth record;
    • a notice of birth registration; or
    • other documents, at least one year old, that show:
      • name,
      • age or date of birth, and
      • place of birth.

    If no birth certificate is available, a foreign-born U.S. citizen may furnish a:

    • U.S. Consular Report of Birth,
    • U.S. Citizen Identification Card (Form I-197),
    • Certificate of U.S. Citizenship (Form N-560),
    • U.S. Passport, or
    • Certificate of Naturalization (Form N-550 or N-570).

    Proof of lawful alien status:

    • I-551, Permanent Resident Card (Resident Alien Card);
    • I-151, Alien Registration Receipt Card;
    • I-94, Arrival-Departure Record; or
    • I-688A, Employment Authorization Card.

    Proof of Identity

    Proof of identity must contain enough information to identify the applicant, such as name, age or date of birth, address, signature, and physical description. Examples of acceptable documents are:

     

    Identity card Adoption record
    Work identification card Medical record/vaccination record
    Driver's license Insurance policy
    U.S. passport School record/report card
    Marriage or divorce record Voter registration

     

    A—431 Special Situations

    Revision 15-4; Effective October 1, 2015

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    The following situations require special handling.

    • If the SSN applicant is a non-U.S. citizen who traditionally uses a name order different from the customary U.S. name order (first name, middle name, last or family name), determine name order according to U.S. custom and enter appropriately onForm H1106, Enumeration Referral.

     

    Example: Vietnamese name on I-94: Nguyen Thi Mai
    - last first middle
    Enter on Form H1106: Thi Mai Nguyen

     

    • The SSA can make citizenship determinations for SSN purposes in two situations where a child is born outside the U.S. to U.S. citizen parents. They are:
      • the child was born to parents wedded to one another, both parents were U.S. citizens when the child was born, and at least one parent resided in the U.S. any time before the child's birth; or
      • the child was born out of wedlock to a U.S. citizen mother, who resided in the U.S. at least one year before the child's birth.

     

    In these two situations, SSA requires:

    • proof of the parents' U.S. citizenship,
    • proof of the parent/child relationship, and
    • proof the parent lived in the U.S. before the child's birth.

    In all other situations, SSA will refer the SSN applicant to the U.S. Citizenship and Immigration Services for a citizenship determination.

     

    A—432 SSN Discrepancy Clearance Procedures

    Revision 15-4; Effective October 1, 2015

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    If an individual's SSN cannot be verified, TIERS will generate an Alert 268, Social Security Administration Unable to Verify SSN (RG-083). A task is created for the Alert 268, and it is routed to the Customer Care Center (CCC) for action.

    If the individual fails to cooperate in clearing the discrepancy with the SSA, advisors follow procedures in A-420, Failure to Comply.

    Note: If TIERS shows the SSN as verified, but it needs to be corrected, advisors must send a memorandum with the correct SSN to State Office Data Integrity (SODI) to make a change:

    SODI Section, Data Base Support

    P.O. Box 14930, MC Y92-2

    Or fax to Data Base Support at 512-706-7140.

    Or send the request to the Data Integrity email box at HHSC DI Biographical Corrections@hhsc.state.tx.us.

    SODI staff notifies the staff member by memo when the change is made.

     

    A—440 Verification Requirements

    Revision 15-4; Effective October 1, 2015

     

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    Advisors must verify that a household member applied for a SSN when the applicant cannot provide an SSN. Refer to A-410, General Policy, for applicable exceptions, by program.

    TANF and SNAP

    SSNs are validated through the SSA interface in TIERS. Validation of an SSN is identified in the Data Collection/Individual Summary Page when the SSA box is checked for the individual.

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    Advisors must follow the policy for verifying SSN using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) as explained in A-351.2, Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship.

    If the advisor is unable to verify the SSN using SOLQ or WTPY, the advisor must:

    • Review the information entered into the SOLQ or WTPY request with the information provided by the applicant. If a typographical error is found, submit a new SOLQ or WTPY request with the correct information.
    • If no typographical errors are found, contact the applicant by phone to ensure the information provided is accurate. If the applicant provides new information, submit another SOLQ or WTPY request with the correct information. Update the EDG record with the correct information.
    • If unable to contact the applicant by phone, send the applicant Form H1020, Request for Information or Action, to request verification of the applicant’s SSN along with any additional information needed. Allow the individual 10 days to provide proof.
    • If the individual fails to cooperate in clearing the discrepancy with the SSA, advisors must follow procedures explained in A-420, Failure to Comply.

    Advisors must verify all good cause reasons to providing an SSN, explained in A-410.

    Related Policy
    Questionable Information, C-920
    Providing Verification, C-930

     

    A—441 Verification Sources

    Revision 15-4; Effective October 1, 2015

    All Programs

    For SSN discrepancies or SSNs that cannot be verified through the SSA interface, SOLQ, or WTPY, the applicant must provide one of the following:

    • Copy of the SSN card; or
    • Social Security Administration letter confirming the SSN.

    Acceptable proof of application of an SSN includes:

    • Form SSA-5028, Receipt for Application for an SSN, less than 30 days old;
    • Form SSA-2853, Message From Social Security, less than 180 days old; and
    • Form H1106, Enumeration Referral.

    Medical Programs

    Form H1106, completed by the Social Security Administration, is the acceptable verification source for not providing an SSN due to ineligibility to receive an SSN or eligibility to receive an SSN only for a valid non-work reason. Advisors must review the response provided by the SSA on the Form H1106 to determine which good cause reason the applicant meets.

    Acceptable sources of verification for a well-established religious objection include:

    • an approved IRS Form 4029, Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits; or
    • a letter from a leader of the religious organization, a document setting out the tenets of the religious organization which justify the good cause reason, or a similar document.

    Note: If the source of verification for a religious exemption is questionable, advisors must contact their supervisor who will coordinate with the Texas Health and Human Services Commission (HHSC) regional attorneys to ensure the documentation is sufficient.

     

    A—450 Documentation Requirements

    Revision 15-4; Effective October 1, 2015

    All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

    In the Data Collection/Individual Demographics-SSN/Armed Services page, the advisor must enter the date the individual was given Form SSA-5028, Receipt for Application for an SSN, or Form SSA-2853, Message From Social Security, or the date the applicant returned Form H1106, Enumeration Referral. For EDGs with an individual currently being enumerated, the advisor sends the following documents for imaging:

    • Form H1106,
    • a copy of Form SSA-5028, or
    • a copy of Form SSA-2853.

    Advisors must document that the SSA enumerated the individual or was unable to do so.

    Related Policy

    Documentation, C-940

    SNAP

    Advisors must document good cause claims according to A-410, General Policy.

    Related Policy
    The Texas Works Documentation Guide

     

    A-500, Age/Relationship

    Revision 15-4; Effective October 1, 2015

     

     

    A—510 Age Limits

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    For age requirements, see household composition:

     

    A—520 Relationship

    Revision 13-2; Effective April 1, 2013

     

     

    A—521 Eligibility Requirements

    Revision 16-4; Effective October 1, 2016

     

    TANF

    A child must live or be expected to live in the home of one of the relatives (either biological or adoptive) listed in A-221, Who Is Included, No. 4, Caretaker.

    TANF-SP

    A child must live with or be expected to live with both legal parents, or one legal parent and a stepparent.

    Note: This also includes legal parents/stepparents who are disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements.

    TP 08 and TA 31

    In order to qualify for TP 08 or TA 31, an individual must be a:

    The caretaker must be a:

    • parent;
    • stepparent*;
    • sibling;
    • step-sibling;
    • grandparent;
    • uncle or aunt;
    • nephew or niece;
    • first cousin; or
    • first cousin once removed.

    *A stepparent of a dependent child is considered within the degree of relationship for TP 08, Parents and Caretaker Relatives Medicaid, and TA 31, Parent and Caretaker Relative Medicaid - Emergency. The relationship to the dependent child remains even if the legal parent and stepparent are divorced or the legal parent is deceased.
    The spouse of a caretaker relative may also be eligible for medical coverage if they live with the caretaker relative who cares for the dependent child receiving Medicaid.  

    Example: A grandfather is the caretaker relative of his granddaughter. The grandfather applies for Medicaid for himself, his granddaughter, and his spouse who lives with him. If the granddaughter is eligible for Medicaid, both the grandfather and his spouse may be eligible for TP 08.

    A dependent child is an individual who:

    • is under age 18; or
    • if age 18, attends school full-time.

    TP 32, TP 33, TP 34, TP 35, TP 43, TP 44, TP 48 and TP 56

    To be eligible for these programs, a child can:

    • live with the child's parents;
    • live with a caretaker within the degree of relationship required for TP 08 and TA 31;
    • live with a person not within the degree of relationship required for TP 08 and TA 31;
    • be abandoned; or
    • live independently.

    TP 45

    A child whose mother is eligible for and is receiving Medicaid coverage at the time of the child’s birth, or whose mother is eligible for and receives Medicaid coverage retroactively for the time of the child’s birth, is eligible for TP 45 coverage. The Medicaid coverage for the newborn can continue through the month of the child’s first birthday if the child remains in Texas, even if the child does not reside with the birth mother.

    Related Policy
    Guide for Determining Relationship, C-1441
    Guide for Determining Extended Relationships, C-1442

     

    A—522 Legal Parent-Child Relationship

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    A legal parent-child relationship exists between a child and:

    • an adoptive parent by proof of adoption;
    • the mother by proof of having given birth to the child; or
    • a man if one of the following conditions exist:
      • The man and the mother married (including a common-law marriage) in apparent compliance with the law before the child's birth (even if the marriage is or could be voided), and the child was born:
        • while they were married; or
        • within 300 days after the marriage terminated.
      • The man and the mother married (including a common-law marriage) in apparent compliance with the law after the child's birth (even if the marriage is or could be voided), and the man:
        • filed a paternity suit, including a statement of paternity in court;
        • is named the father on the child's birth certificate; or
        • has a written obligation to support the child voluntarily or by court order.
      • The courts determine that the man is the biological father.

    If there is no other legal father, a legal parent-child relationship exists between a man and a child if one of the following conditions exists:

    • The man and the mother do not marry, but the man consents in writing to be named as the child's father on the child's birth certificate.
    • Before the child turns age 18, the child lived with the man and holds out to the public that the man is the child's father.
    • The man signs an acknowledgement of paternity (AOP) with the Office of Attorney General or Vital Statistics Unit. The child's mother must also be available to sign the AOP.

     

    A—523 When Proof of Relationship Is Unavailable

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    If Birth Verification System (BVS) records do not establish relationship or the applicant cannot provide proof of relationship shown in A-531, Verification Sources, the advisor must use alternative ways to determine relationship. See A-523.1, How to Make an Evaluative Conclusion.

     

    A—523.1 How to Make an Evaluative Conclusion

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    The advisor must examine all available proof such as (but not limited to) school records, court records, birth records, health records, insurance policies, refugee's voluntary resettlement agency (VOLAG) or the U.S. Citizenship and Immigration Services (USCIS) records, or other sources of proof that provide the same information. The advisor should offer reasonable assistance if the individual has difficulty obtaining the information.

    Advisors must obtain supervisory approval of the evaluative conclusion.

     

    A—523.2 Children Living with Biological Father

    Revision 15-4; Effective October 1, 2015

     

    TANF, TP 08 and TA 31

    A biological father may receive TANF, TP 08, or TA 31 if the biological father proves relationship. If the father cannot provide acceptable proof, the advisor must make an evaluative conclusion to establish relationship for the father and child. The OAG uses the automated child support referral to locate the mother and establish paternity of the biological father. The OAG notifies the advisor via Form H1701, Child Support, TANF Foster Care and TANF/Medicaid Case Information Exchange, that paternity is established or excluded. If paternity is excluded, advisors must process an overpayment claim for the period of time the household erroneously received benefits as specified in B-700, Claims.

    Proof of a court determination of paternity is required if, at the time of the child's birth, the child's mother was married to another man who is presumed to be the child's legal father.

     

    A—523.2.1 Children Living with Relatives of Biological Father

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    To qualify for TANF or Medical Programs, a caretaker relative must establish required relationship to the child as specified in A-221, Who Is Included, following the steps below:

    The caretaker relative must provide acceptable proof of relationship between:

    • the caretaker and the biological father; and
    • the biological father and the child, using the conditions listed in A-522, Legal Parent-Child Relationship.

     

    A—530 Verification Requirements

    Revision 15-4; Effective October 1, 2015

     

    TANF, TP 08 and TA 31

    Advisors must verify the age and relationship of each child to the adult claiming the relationship before certifying or adding the child to the cash grant and/or before certifying the adult for Medicaid. Advisors use BVS inquiry for someone born in Texas and who is at least 46 days old but less than 19 years old.

    See A-531, Verification Sources. If these verifications are not available, make an evaluative conclusion. See A-523.1, How to Make an Evaluative Conclusion.

    Related Policy
    Birth Verification System, C-860

     

    A—531 Verification Sources

    Revision 15-4; Effective October 1, 2015

     

    Medical Programs

    Age and Relationship

    • BVS inquiry
    • Temporary Assistance for Needy Families (TANF) sources

    Medical Programs except TP 08 and TA 31

    Age and Relationship

    • Individual's self-declaration establishing age and relationship if other sources are unavailable

    TANF

    Age

    • Birth certificate
    • Hospital or public health birth records
    • Church or baptismal birth record
    • BVS inquiry
    • Local, state, federal or military record
    • Adoption papers or records
    • Indian census records
    • U.S. passport
    • School or day care records
    • U.S. Citizenship and Immigration Services records
    • Attorney General child support paternity records
    • Social Security Administration records

    Alternate Age Sources

    • Court or child welfare records
    • Insurance policies
    • Family Bible records
    • Records of voluntary social service agencies
    • Court child support order
    • Written statement from a doctor or clergy who knows date of birth
    • Juvenile court records
    • Census records
    • Written statement from a non-relative who knows date of birth

    Relationship

    • Birth certificate
    • Adoption papers or records
    • Hospital or public health records of birth and parentage
    • BVS inquiry (see A-540, Documentation Requirements)
    • Church or baptismal birth record
    • Local, state, federal government or military record
    • School or day care records
    • U.S. Citizenship and Immigration Services records
    • Attorney General child support paternity records
    • Juvenile court records
    • Indian census records
    • U.S. passport
    • Marriage license/certificate
    • Divorce papers
    • Court records of parentage

    AlternateRelationship Sources

    • Church records of parentage and relationship (including statement from clergy)
    • Family Bible records
    • Court or child welfare records
    • Insurance policies
    • Records of voluntary social service agencies
    • Statement from clergy, doctor or school official who can verify relationship
    • Statement from non-relative who has known the child since birth

    Related Policy
    Questionable Information, C-920
    Providing Verification, C-930

     

    A—540 Documentation Requirements

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    Advisors must document proof of age or relationship and the basis for the evaluative conclusion or enter on the Texas Integrated Eligibility Redesign System (TIERS) Individual Household page and the Relationship page.

    Advisors must document the following:

    • The verification source.
    • The verification date.
    • Children's names.
    • Information from the verification source to prove the children live in the home (for collateral contacts include name and address and/or phone number).
    • Reason for any temporary absence.
    • Information from the verification source to prove the household member or payee returned to and lived in the home for at least 30 days when allowing another temporary absence period.

    Related Policy
    Documentation, C-940
    The Texas Works Documentation Guide

    A-600, Identity

    Revision 15-4; Effective October 1, 2015

     

     

    A—610 General Policy

    Revision 07-4; Effective October 1, 2007

     

     

    A—611 At Application

    Revision 15-4; Effective October 1, 2015

     

    TANF, TP 08 and TA 31

    Advisors must verify the identity of the person interviewed. Once identity has been verified for an individual, advisors do not need to re-verify.

    Related Policy Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Advisors must verify the identity of all individuals requesting benefits. Once identity has been verified for an individual, advisors do not need to re-verify.

    If questionable, advisors verify the identity of the person interviewed.

    Related Policy Verification of Citizenship, A-351

    SNAP

    Advisors must verify the identity of the person interviewed.

    If the authorized representative (AR) applies for the household, the advisor must verify the identity of both the AR and the person the AR represents.

    Exception: If necessary to meet expedited service time limits, advisors only need to verify the identity of the AR being interviewed.

    Related Policy Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

     

    A—612 Redetermination

    Revision 15-4; Effective October 1, 2015

     

    SNAP, TANF and TP 08

    Advisors must verify the identity of the person interviewed if not previously verified.

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Advisors must verify the identity of each individual requesting benefits during the redetermination if identity has not been previously verified using a source from the Medical Programs list in A-621, Verification Sources, or a source from the Medical Programs list in A-358.1, Citizenship, that verifies both identity and citizenship. Once identity has been verified for an individual, advisors do not need to re-verify.

    Related Policy Verification of Citizenship, A-351 Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

     

    A—613 Receipt of Lone Star Card and/or PIN

    Revision 15-4; Effective October 1, 2015

     

    SNAP and TANF

    Advisors must verify the identity of a person receiving a Lone Star Card and/or personal identification number (PIN) (initial issuance or replacement).

     

    A—620 Verification Requirements

    Revision 03-5; Effective July 1, 2003

     

    All Programs

    Birth records and other official records are preferred sources of verification.

     

    A—621 Verification Sources

    Revision 15-4; Effective October 1, 2015

     

    SNAP and TANF

    • Driver license or Department of Public Safety (DPS) identification (ID) card (current or expired)
    • Birth certificate (see Note)
    • Hospital or birth records
    • Adoption papers or records
    • Work or school ID card
    • Voter registration card
    • Wage or check stubs or check
    • U.S. passport or U.S. passport card
    • Certificate of Naturalization
    • Certificate of U.S. citizenship
    • Finding of citizenship by another federal/state agency
    • Collateral statement
    • Immigration documents
    • Self-declaration of driver license or DPS ID number already on file, along with other identifying information (Social Security number and date of birth)
    • Self-declaration of driver license or DPS ID number listed on Data Broker, along with other identifying information (Social Security number and date of birth)

    Note: Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless certified previously using a birth certificate issued before July 1, 2010. See C-932, Advisor Responsibility for Verifying Information, for information regarding assisting an individual in obtaining birth verification from Puerto Rico.

    TP 08, TP 43, TP 44, TP 48, TP 40 and TA 31

    Copies of the document used to verify identity for individuals requesting benefits must be legible and non-questionable. Submit the document for imaging.

    Identity and Citizenship

    A-358.1, Citizenship, includes the sources that verify both identify and citizenship for Medical Programs.

    Identity Only

    • One of the following sources is acceptable for verification, if the document has a photograph and other identifying information such as (but not limited to) name, age, date of birth, sex, race, height, weight, eye color, or address:
      • Driver’s license issued by a state or territory;
      • School identification card;
      • U.S. military card or draft record;
      • Identification card issued by the federal, state, or local government with the same information included on driver’s licenses;
      • Military dependent's identification card; or
      • U.S. Coast Guard Merchant Mariner card;
    • Native American Tribal document;
    • Signed application for Medicaid (including the signature of an authorized representative acting on the individual's behalf) — this is applicable for all individuals on the application except the signee (no person may declare to their own identity);
    • Two or more corroborating documents (examples include, but are not limited to, marriage licenses, divorce decrees, or high school diplomas);
    • For children under age 19, a clinic, doctor, hospital, or school record, including preschool or day care records; and
    • Form H1097, Affidavit for Citizenship/Identity, signed by another individual who can reasonably declare to the applicant’s citizenship, regardless of blood relationship to the individual and under penalty of perjury, and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized and should be used only as a last resort when other evidence is not available.

    Related Policy
    Questionable Information, C-920
    Providing Verification, C-930
    Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2

     

    A—630 Documentation Requirements

    Revision 15-4; Effective October 1, 2015

     

    All Programs

    Advisors must document how the identity of the person interviewed was verified.

    Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Advisors must document how the identity of each individual requesting benefits was verified. Copies of the document used to verify identity must be legible and non-questionable. Submit the document for imaging.

    Related Policy
    Documentation, C-940
    The Texas Works Documentation Guide

    A-700, Residence

    Revision 18-1; Effective January 1, 2018

     

     

    A—710 General Policy

    Revision 18-1; Effective January 1, 2018

     

    All Programs

    Applicants must live in Texas to be eligible for benefits. The household is not required to have a permanent dwelling or fixed residence.

    TANF and Medical Programs

    Individuals who live in Texas (other than for migrant or itinerant work) meet the residency requirement if they are living in Texas intending to remain in Texas. People who live in Texas for a temporary purpose do not meet the residency requirement.

    The person's residence becomes questionable when the post office returns Texas Health and Human Services Commission (HHSC) correspondence or benefits as undeliverable.

    Migrant and itinerant workers meet the residency requirement when applying if they:

    • live in the state;
    • entered the state with a job commitment or an intention to seek employment (regardless of current employment status); and
    • do not receive assistance from another state.

    SNAP

    People who live in Texas for any purpose other than a vacation meet the residency requirement, regardless of the length of time they have been here or plan to stay.

    Related Policy
    Form TF0001 Required (Adequate Notice), A-2344.1

     

    A—720 New Texas Residents

    Revision 15-4; Effective October 1, 2015

     

    All Programs

    A person cannot participate in more than one state in any month.

    When an applicant recently received benefits in another state, the advisor must verify the last month the benefits were issued.

    The following links may be used as resources to contact agencies in other states to verify that a new Texas resident's benefits have ended in another state.

    Supplemental Nutrition Assistance Program (SNAP) Agencies:

    National Directory of SNAP Agencies

    Medicaid and Children’s Health Insurance Program (CHIP) Agencies:

    https://www.medicaid.gov/medicaid/by-state/by-state.html

    Temporary Assistance for Needy Families (TANF) Agencies:

    www.acf.hhs.gov/programs/ofa/help

    Medical Programs

    New Texas residents may receive overlapping Medicaid coverage. See A-822, Medicaid Coverage for New State Residents, to determine the correct medical effective dates (MEDs) for these persons.

    SNAP

    Residents in an approved shelter for battered persons may participate twice during the month of application if they participated first with the person who abused or threatened them with abuse.

     

    A—730 Moves Within Texas

    Revision 15-4; Effective October 1, 2015

     

    All Programs

    Individuals keep their residence status when they move within Texas.

    TANF and SNAP

    A person cannot participate as a member of more than one household in any month.

    SNAP

    Residents in an approved shelter for battered persons may participate twice during the month of application if they participated first with the person who abused them or threatened them with abuse.

    Related Policy
    Household Composition, A-200

     

    A—740 Moves Out of Texas

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    A certified individual becomes ineligible if the individual moves to another state:

    • with the intent to remain there, or
    • without declaring intent to return.

    If the individual returns to Texas within 90 days and states that the move was not intended to be permanent, the advisor must:

    • reopen the Eligibility Determination Group (EDG) using the reason denied-in-error; and
    • issue restored benefits, if appropriate.

    SNAP

    A household is not eligible for benefits issued for a month after the household leaves Texas.

    When a household member notifies HHSC that the household moved out of Texas, Form TF0001, Notice of Case Action, is not required. If the household has not yet moved, the advisor must issue Form TF0001 to provide adequate notice. The EDG is denied effective the end of the month they move, if possible.

    Related Policy
    Canceling Benefits, B-330

     

    A—750 Temporary Visits Out of Texas

    Revision 15-4; Effective October 1, 2015

     

    TANF and Medical Programs

    Individuals do not lose their residence status when they temporarily leave Texas.

    An individual can be absent from Texas for any length of time. Advisors must review the situation every three months to determine the individual's intent to maintain Texas residence. The individual must reasonably explain:

    • the purpose for leaving Texas,
    • the intent to return to Texas, and
    • which state the individual claims residency in.

    An individual is a resident of Texas unless there is substantial, factual evidence that proves otherwise. When the advisor determines that the individual is no longer a resident, the individual is denied.

    SNAP

    A person is not eligible for SNAP in Texas for any month the individual is out of Texas the entire month.

     

    A—760 Verification Requirements

    Revision 15-4; Effective October 1, 2015

     

    All Programs except TP 33, TP 34, TP 35, TP 43, TP 44, TP 45 and TP 48

    Advisors must verify the actual physical address of a household at each application and redetermination.

    Exceptions:

    • Residence verification is not a requirement for SNAP categorically eligible TANF/Supplemental Security Income (SSI) households.
    • Self-declaration is acceptable as verification of residence when certifying a child for TP 56, MA-Medically Needy with Spend Down.

    Note: Residence verification is a requirement for TANF and categorically eligible TANF-Non-Cash (NC) households. Refer to B-472, Special Treatment for Households Meeting Categorical Eligibility Criteria.

    When an applicant recently received benefits in another state, the advisor must verify the last month the benefits were issued.

    When the advisor cannot verify residence with readily available evidence, the advisor must:

    • contact the landlord, neighbors or other sources of reliable information; or
    • observe personal effects and living arrangements.

    When residence is difficult to verify because of unusual circumstances, the advisor must document all efforts to verify and certify the EDG.

    Note: If residence for any household is questionable, the advisor may require the household to provide a source of verification that is more reliable, such as one of the primary sources of verification listed in A-761, Verification Sources. The advisor cannot restrict verification to a specific source from that list.

    TANF and Medical Programs

    Advisors must determine that the household intends to remain in Texas at each application and redetermination.

    SNAP and TP 40

    Advisors must postpone residence verification if trying to meet expedited service time frames.

    TP 33, TP 34, TP 35, TP 43, TP 44, TP 45 and TP 48

    Self-declaration is acceptable as verification of residence.

     

    A—761 Verification Sources

    Revision 15-4; Effective October 1, 2015

     

    All Programs except Children’s Medicaid

    The following are acceptable verification sources to verify the household's current address:

    • utility bills or utility company records;
    • rent receipt or statement from non-relative landlord;
    • mortgage receipt or statement from mortgage company;
    • valid Texas driver license or Department of Public Safety (DPS) identification card;
    • Data Broker residence reported on the DPS data field;
    • Department of Motor Vehicles record;
    • school records;
    • voter registration card;
    • statement from child care provider;
    • employment records or statement from employer;
    • official records confirming ownership of property;
    • home visit;
    • WTPY or SOLQ for Social Security benefit recipients, including those receiving Medicare;
    • item of mail with household name and address;
    • if HHSC mailed the household an appointment notice (Form H1830-I, Interview Notice) to the Texas address the individual currently reports (this includes post office boxes), attendance at the appointment (either by phone or face-to-face) can be used as residence verification;
    • other HHSC correspondence the individual can provide showing the household received it at the individual’s current Texas address;
    • inquiry into Office of the Attorney General (OAG), Texas Workforce Commission (TWC) or another entity’s automated system, outside of HHSC, showing the same Texas address currently reported by the household;
    • a local landline telephone number the individual provides (not a cell phone number) that is either listed in the telephone book or an online directory with the same Texas address the household currently reports, or the household can be contacted at that local telephone number when conducting a telephone interview;
    • searches resulting in a match between the address and the telephone number provided by the individual using the Data Broker Search Options Menu, Telephone Number Search;
    • post office records;
    • city or crisscross directory;
    • church records; or
    • statement from non-relative.

    Exception: Self-declaration of residence is acceptable when certifying a child for TP 56, MA - Medically Needy with Spend Down.

    TANF and Medical Programs

    The individual's statement of intent to remain in Texas is acceptable.

    Children's Medicaid

    Self-declaration.

    Related Policy
    Questionable Information, C-920
    Providing Verification, C-930

     

    A—770 Documentation Requirements

    Revision 15-4; Effective October 1, 2015

     

    All Programs

    Advisors must document the individual's:

    • proof of address, and
    • all efforts to verify residence when residence is difficult to verify because of unusual circumstances.

    TANF and Medical Programs

    For temporary visits outside of Texas, advisors must document:

    • the individual's purpose for leaving;
    • the individual's intent to return to Texas; and
    • which state the individual considers their residence.

    Related Policy
    Documentation, C-940
    The Texas Works Documentation Guide

    A-800, Medicaid Eligibility

    Revision 18-1; Effective January 1, 2018

     

     

    A—810 General Policy

    Revision 16-4; Effective October 1, 2016

     

    Medical Programs

    Applicants may receive Medicaid during the three-month period before the month they apply for Medicaid. See A-831, Three Months Prior Coverage, for eligibility criteria and application procedures.

    Some former individuals on TP 08, TP 43, TP 44, and TP 48 remain eligible for Transitional Medicaid after their eligibility is denied. See the chart that follows for more information.

    Reason for Denial Type Program Who Is Covered?
    Alimony/Spousal support TP 20 (A-850, Alimony/Spousal Support Transitional Medicaid Coverage) The household
    New or increased earnings TP 07 (A-842, TP 07 Transitional Medicaid) The household

    Most adopted children receive Medicaid through the Texas Department of Family and Protective Services (DFPS). DFPS works with the Interstate Compact on Adoption and Medical Assistance (ICAMA) to facilitate the timely delivery of Medicaid coverage when a family moves or the adoption involves an interstate placement. If an adopted child is receiving Medicaid in another state, the parent must contact the originating state to coordinate and transfer Medicaid coverage information to Texas. If an adoptive parent has any questions about the adoptive child's Medicaid, advisors should inform them to contact their local DFPS office for assistance.

    Medical Programs, Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB)

    Individuals receiving some Texas Works Medicaid types of assistance may also qualify for the Medicaid for the Elderly and People with Disabilities (MEPD) Medicare Savings Program types of assistance, MC – QMB (TP 24) or MC – SLMB (TP 23), if they meet the eligibility criteria. See policy in the Medicaid for the Elderly and People with Disabilities Handbook, Q-2000, Qualified Medicare Beneficiaries (QMB) — MC-QMB.

    Individuals may receive QMB and the following types of assistance:

    • MA – Earnings Transitional (TP 07)
    • MA – Parents and Caretaker Relatives (TP 08)
    • MA – Pregnant Women (TP 40)
    • MA – Children Under 1 (TP 43)
    • MA – Newborn Children (TP 45)
    • MA – Children 1-5 (TP 48)
    • MA – Children 6-18 (TP 44)
    • MA – Former Foster Care Children (FFCC) (TA 82)

    The above programs cannot be dually eligible for SLMB. Even though these programs may meet SLMB eligibility requirements, the Medicare Part B premium is already paid. An individual can be dually eligible for MA – MN with Spend Down (TP 56) and SLMB.

     

    A—820 Regular Medicaid Coverage

    Revision 17-3; Effective July 1, 2017

     

    Medical Programs

    Regular Medicaid eligibility begins the day an individual meets all eligibility criteria. It is usually the first day of the application month if all eligibility criteria are met.

    The following are situations when the medical effective date (MED) may not be the first day of the application month.

    • The MED cannot precede a newborn's date of birth.
    • The MED cannot precede the date a child enters the home.

      Exception: A child's MED can be earlier than when the child enters the home when the child is born to a woman incarcerated in the Texas Department of Corrections at Gatesville. Advisors assign the date of birth as the MED for the child requiring this coverage when contacted by a special Texas Works advisor housed at the University of Texas Medical Branch (UTMB) Hospital. Advisors must document this contact in Case Comments.

    • The MED for the parent or caretaker relative cannot precede the date of birth of the newborn or a child's entry into the home when the newborn or entering child is the only child.

      TP 08 Exception: The Texas Integrated Eligibility Redesign System (TIERS) will assign an earlier MED if the parent or caretaker relative has unpaid medical bills and would have been eligible for Medicaid as a pregnant woman from the first day of her infant's birth month.

    • The MED cannot precede the start date of the emergency condition for aliens eligible for Emergency Medicaid.
    • The MED cannot precede the date a disqualified parent or caretaker relative complies.
    • The MED cannot precede the month at least one eligible dependent child is certified for Medicaid.

    If the only child that makes a parent or caretaker relative eligible for TP 08 dies before certification, advisors must process an application for Medicaid for a deceased individual. Advisors must provide coverage for the child through the date of death and for the parent or caretaker relative through the remainder of that month.

     

    TP 40

    Medicaid for a pregnant woman does not begin before the first day of the month her pregnancy began. The applicant’s (pregnant woman's, case name's or authorized representative's [AR's]) verbal or written statement of the start month, the number of expected children and anticipated date of delivery is an acceptable source of verification, as are the other sources listed in A-870, Verification Requirements, if unable to obtain the applicant's statement.

    If the applicant’s (pregnant woman's, case name's or AR's) statement is not available, advisors may use one of the verification sources in A-870 to obtain the pregnancy start date and anticipated date of delivery.

    Advisors must allow until the 15th workday for the requested information to be submitted to the Texas Health and Human Services Commission (HHSC). If it is not returned by the 15th workday, the application is denied. Advisors reopen the application if the individual provides verification by the 60th day from the file date. See B-111, Reuse of an Application Form After Denial.

    Exception: Pregnancy verification is not required if the:

    • application is processed after the pregnancy terminates; and
    • applicant provides proof of her newborn child's birth.

    A pregnant woman remains eligible through the second month following the month her pregnancy terminates if all other eligibility requirements are met and countable income is below the income limits in:

    • the application month; or
    • one of the three months prior to the application month if in the prior month she:
      • had unpaid Medicaid-reimbursable bills; or
      • received services from the Texas Department of State Health Services (DSHS).

    Example: A pregnant woman applies for Medicaid in May 2011. Her expected delivery date is December 2011. She has unpaid medical bills in February 2011 and meets all other eligibility requirements. She does not have any unpaid medical bills in March or April 2011. The advisor must certify her for Medicaid from February 2011 through February 2012.

    After determining a pregnant woman is eligible for TP 40, the woman remains eligible even if the budget group's income increases above the income limit.

    If a woman is certified for expedited benefits, but postponed verifications prove she is not eligible, the advisor must provide advance notice of adverse action and deny her coverage.

     

    TP 45

    Before providing initial TP 45 coverage for a newborn child, the advisor must verify that the:

    • mother was:
      • eligible for and received Medicaid in Texas on the day the child was born; or
      • retroactively eligible for Medicaid for the day the child was born;
    • child resides in Texas; and
    • mother was continuously eligible for Medicaid (or would have been eligible if pregnant) during the child's birth month.

    Note: A newborn born to a mother who received Emergency Medicaid coverage at the time of the child's birth is eligible to receive TP 45 coverage from the child's date of birth through the end of the month of the child's first birthday.

    The MED for the initial certification is always the child's date of birth.

    Before resuming coverage for a newborn that has been denied TP 45 the advisor must verify that the child resides in Texas.

     

    Related Policy
    Provider Referral Process, A-125

     

    TP 56

    Medicaid coverage for children or pregnant women with spend down begins the first day the household meets spend down.
    The applicant meets spend down by submitting or having a provider submit medical bills to the Clearinghouse. See A-1532.1, Spend Down EDGs.
    The Clearinghouse:

    • determines when the individual meets spend down; and
    • notifies TIERS via an interface. TIERS then sets the MED for the certified members.

    Note: The Clearinghouse may discover a discrepancy while processing a spend down Eligibility Determination Group (EDG). Processing is put on hold and the EDG is referred to State Office Data Integrity (SODI) to research. SODI sends a memo to the field asking for information to clear the discrepancy. Staff must respond quickly to these requests so that the Clearinghouse can complete the spend down process.

     

    Emergency Medicaid

    Medicaid eligibility begins on the start date of the emergency medical condition verified by the attending practitioner on Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification.

    Related Policy
    Pregnancy, A-144.5
    Medicaid Termination, A-825
    How to Determine Spend Down, A-1359
    Medicaid Reinstatement, B-826

     

     

    A—821 Types of Coverage

    Revision 15-4; Effective October 1, 2015

     

    Medical Programs

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

     

    A—821.1 Fee-for-Service

    Revision 15-4; Effective October 1, 2015

     

    Medical Programs

    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.

     

    A—821.2 Managed Care

    Revision 18-1; Effective January 1, 2018

     

    Medical Programs except TP 56, TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

    Medicaid managed care is health care provided through a network of doctors, hospitals, or other health care providers. The state pays a managed care organization (MCO) a capitated rate for each member enrolled, rather than paying for each unit of service. The providers submit claims directly to the MCO for reimbursement of Medicaid-covered services.

    Medicaid managed care programs include:

    • STAR (State of Texas Access Reform). STAR provides acute care services (like doctor visits, hospital visits, and prescriptions), and each member is enrolled in an MCO and assigned a main doctor to coordinate care. People who are dually eligible are excluded from this program. It is a statewide program.
    • STAR Health. STAR Health provides comprehensive, coordinated health care services for children in foster care and kinship care. Each member is enrolled in a single MCO, Superior HealthPlan, and is assigned a main doctor to coordinate care. People who are dually eligible are excluded from this program. It is a statewide program.
    • STAR+PLUS. STAR+PLUS provides acute care and long-term services and supports (LTSS). A key feature of this program is service coordination, or specialized care management. Each member is enrolled in an MCO, and Medicaid-only members are assigned a main doctor. STAR+PLUS serves Medicaid-only and dually eligible individuals, including most nursing facility residents. It is a statewide program.
    • STAR Kids. STAR Kids provides acute care services and long-term services (LTSS). Additionally, people eligible for Medically Dependent Children’s Program (MDCP) waiver services receive these services through STAR Kids. A key feature of this program is service coordination. Each member is enrolled in a MCO and assigned a main doctor to coordinate care. STAR Kids serves children and young adults age 20 or younger with disabilities.
    • Children's Medicaid Dental Services. Children's Medicaid Dental Services provide primary and preventive dental services in managed care. Each member is enrolled in a dental maintenance organization (DMO) and has a main dental home. Most children, birth through age 20, who receive Medicaid, are eligible for dental services.

    Medicaid managed care is available statewide in the following service areas: Bexar, Dallas, El Paso, Harris, Hidalgo, Jefferson, Lubbock, Medicaid Rural Service Area (RSA) West, Medicaid RSA Central, Medicaid RSA Northeast, Nueces, Tarrant and Travis.

    See C-1116, Managed Care Plans, for a list of the counties with Medicaid managed care, the choices available and contact numbers.

    Texas Works Medicaid recipients who reside in managed care counties must enroll in managed care. Exceptions (not comprehensive):

    • STAR exceptions: Dual eligibles (receive Medicaid and Medi