Part B, Case Management

B-100, Processing Time Frames

Revision 19-2; Effective April 1, 2019

 

B—110 Applications

Revision 13-3; Effective July 1, 2013

 

 

B—111 Reuse of an Application Form After Denial

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors use the original application form until it is 60 days old if an applicant reapplies after being denied for:

  • missing an appointment;
  • failing to furnish information/verification;
  • failure to provide postponed verification; or
  • failure to provide proof of U.S. citizenship.

Notes:

  • If the information on the application form has changed or is more than 45 days old, the individual and advisor must update the form.
  • If the application has been denied for missing an appointment, the denied application is reopened using the contact date as the new file date.
  • Advisors do not request additional income verification when reopening a redetermination denied for failure to provide information. The original income verification the individual provided at the interview date is acceptable, unless the household indicates a change in income.

TANF and Medical Programs except TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

If an applicant reapplies after being denied for missing an appointment, the advisor uses the original application form until it is 60 days old.

TP 32 and TP 56

An application may be used more than one time for TP 56 and TP 32 applicants when both of the following conditions exist:

  • the application interview or process date is after the application month, and
  • the household states that it wishes to reapply and reuse an application form.

 

B—112 Deadlines

Revision 15-4; Effective October 1, 2015

 

TANF and Medical Programs

Advisors must provide Form TF0001, Notice of Case Action, to a denied applicant by the 45th day after the file date.

Advisors must ensure that certified applicants have access to benefits by the 45th day after the file date.

A-140, Expedited Service, may be used for TP 40 expedited Eligibility Determination Groups (EDGs).

A-147, Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents, may be used for expedited time frames for medical program applicants with an active duty military connection.

Exceptions:

  • For applications requiring medical verification, the total processing time the delay caused by obtaining Form H3038, Emergency Medical Services Certification, is not counted.

    Advisors must document the date that:
    • Form H3038 was sent to the practitioner or given to the applicant; and
    • medical information was received.
  • For TANF reapplications with open Choices or school attendance penalties, a period of up to 40 days is excluded from timeliness calculations. The individual must demonstrate cooperation for 30 days before the advisor closes the penalty and processes the application.

SNAP

By the 30th day after the file date, the advisor must:

  • deny or certify an application, and
  • ensure that a certified applicant has an opportunity to participate.

Exception: For expedited service, see A-140.

Related Policy
Eligibility Dates and Benefit Amounts, A-2320
Children’s Medicaid Redetermination Expectations, B-123.6

Medical Programs

Advisors must provide Form TF0001, Notice of Case Action, the same day eligibility is determined for certified applications, including those with spend down, no later than the 45th day from the file date.

 

B—113 Delay in Processing Applications

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must follow policy below when an application is delayed until the 60th day after the file date:

If ... then ...
the agency is at fault for not completing the application process by the 60th day after the file date and was also at fault for delaying it during the first 30 days after the file date, the advisor must continue to process the original application and provide benefits retroactive to the file date (or the month the individual met all requirements, if later).

If the applicant:
  • misses a Supplemental Nutrition Assistance Program (SNAP) appointment and fails to contact the office by the 10th day as noted on Form H1020, Request for Information or Action, to request a second appointment, the application is denied the following workday. The household loses eligibility for all past months and must reapply if they still want to receive benefits.
  • fails to provide all the required verification by the 10th day noted on Form H1020, then deny the application the following workday. If the household subsequently provides the missing verification within 10 days after the Form H1020 due date, reopen the application using the original file date. Otherwise, the household must reapply if they want to receive benefits.
HHSC was at fault in the first 30 days and the individual was at fault in the second 30 days, deny the application on the 60th day after the file date and provide no benefits.
the individual was at fault the first 30 days and HHSC was at fault in the second 30 days, the advisor must continue to process the original application and provide benefits retroactive to the month following the month of application (or the month the individual met all requirements, if later).

 

B—113.1 Not Held – Agency Fault

Revision 15-4; Effective October 1, 2015

 

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

If the advisor has not contacted the household for the interview either by telephone or for a face-to-face interview by the close of business on the scheduled appointment date, the advisor must mark the Task List Manager (TLM) "Check-In" task associated with the appointment as "Not Held-Agency Fault." This creates a subsequent reschedule task. The advisor must not mark the appointment as "Show" or "No Show" when the advisor has not been able to contact the household for the interview.

Note: This policy applies to applications and redeterminations for all programs that require an interview.

 

B—114 Missed Appointment

Revision 15-4; Effective October 1, 2015

 

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

For telephone interviews, the advisor must make at least two attempts to contact the applicant via telephone. Both attempts must be conducted within the time period listed on Form H1830, Application/Review/Expiration/Appointment Notice. Each attempt must be conducted at least 10 minutes apart. If no contact is made with the applicant after two attempts, the telephone interview is considered a missed appointment. The advisor must document the time of each attempt on the Appointment – Details page.

TANF and Medical Programs except TP 33, TP 34, TP 35, TP 36, TP 40, TP 43, TP 44 and TP 48

If the applicant misses the first appointment and does not contact the office on the appointment day, the application is denied no later than the next workday.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule and keep the original file date.

If the applicant contacts the office by the 30th day after the file date to reschedule, the application is reopened using the date of contact as the new file date.

When a requested or required interview is scheduled within the 15-workday active duty military member policy but the applicant requests to reschedule the interview, staff must try 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, the advisor must document the reason for not scheduling the appointment within the required time frame.

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

SNAP

If the applicant misses the first appointment, the advisor must send the applicant Form H1020, Request for Information or Action, on the same day and pend the application. The advisor must inform the applicant that it is the applicant's responsibility to request a second appointment.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule.

If the household misses an appointment and contacts the office on or before the 30th day after the file date, the advisor must reschedule the household for another appointment before the 30th day, if possible. If there are no appointment slots available, the advisor must schedule another appointment after the 30th day, but by the 45th day, and the application is kept pending. If the household keeps that appointment and is determined eligible, the original file date is used to provide benefits.

Note: When a household misses a scheduled appointment and subsequently submits another application, the advisor must consider the second application as a household's request to reschedule the missed appointment.

If the 30th day after the file date is a non-workday, the advisor takes the appropriate action on the following workday. This also must be the final due date on Form H1020.

Additionally, if necessary, hold the application past the 30th day to allow the household at least 10 days to contact the office for a second appointment. If the household does not contact the office by this deadline, the EDG is denied no earlier than the following workday.

Notes:

  • The individual has until close of business (COB) on the final due date listed on Form H1020, Request for Information or Action, to contact the office (COB for the vendor if calling 2-1-1) to request another appointment.
  • If a second or subsequent appointment is scheduled because the individual missed the appointment, the advisor must ensure that second and subsequent appointments have been correctly recorded on the Appointment – Details page.

See B-160, SNAP Timeliness Charts for Applications and All Redeterminations.

Related Policy
Interviews, A-131
Processing Redeterminations, B-122
Children’s Medicaid Redetermination Expectations, B-123.6

TP 36 and TP 40

No appointment is required to process an application.

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

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

No appointment is required to process an application or renewal unless the individual non-complies with the Health Care Orientation requirement or Texas Health Steps (THSteps) or information needed to determine eligibility can only be obtained through a telephone interview.

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

Related Policy
Scheduling Appointments, A-122.2
Interviews, A-131
Compliance Requirements, A-1531.5
Processing Children's Medicaid Redeterminations, B-123

 

B—115 Pending Verification on Applications

Revision 15-4; Effective October 1, 2015

 

All Programs

If more information/verification is required to complete an application, the household is allowed at least 10 days to provide the information/verification. The due date must be a workday.

Advisors request documents that are readily available to the household if the documents are anticipated to be sufficient verification. Each handbook section lists potential verification sources. C-900, Verification and Documentation, provides information on verification procedures.

The advisor must give the applicant Form H1020, Request for Information or Action, explaining:

  • what is required,
  • the date the verification is due, and
  • the date the application will be denied if the verification is not received.

The day Form H1020 is sent is considered day zero of the pending period.

If the applicant does not provide the verification by the 30th day after the file date, or the next workday if the 30th day is not a workday, the application is denied no earlier than the:

  • 30th day if the 30th day is a workday, or
  • following workday if the 30th day is not a workday.

The final due date on Form H1020 must correspond with the 30th day if a workday, or the following workday if the 30th day is not a workday. The advisor must take the appropriate action on the final due date.

Exceptions:

  • If necessary, the advisor may hold the application past the 30th day to allow the household at least 10 days to provide verification. If the household does not provide required verification by this deadline, the EDG is denied no earlier than the following workday. This includes situations in which the 10th day falls on the 30th day.
  • If the eligibility factor in question does not affect eligibility of the entire household, the ineligible member(s) is disqualified and the remaining members are certified.

On an application denied for failure to furnish information or failure to provide postponed verification, if the household provides the required verification by the 60th day after the file date, the application is reopened using the date the individual provided verification as the file date.

TANF

For applications in pay for performance with a noncooperation for Choices or school attendance, the final due date is the 40th day from the date of interview. See A-2151, Open Penalty at Reapplication in Pay for Performance.

Note: When an application is pended for other eligibility verification in addition to the verification of Choices or school attendance cooperation, staff should continue to pend the TANF application until the final due date (40th day from the interview) before taking appropriate action on the TANF EDG.

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

Advisors must check for any associated EDGs and use appropriate verifications from those EDGs when the applicant does not provide verification with the application form. Advisors use proof of alien status, income or deductions (if provided in the 90 days before the file date) from an associated SNAP, Medicaid or TANF EDG as verification for a child's Medicaid application or redetermination.

SNAP

If the applicant is eligible, the advisor must provide an opportunity to participate by the 30th day after the file date. If not possible, benefits are authorized with a priority issuance the day the applicant provides the required verification.

Related Policy
Expedited Service, A-140

 

B—115.1 Pending Verification for MA – Pregnant Women – Emergency

Revision 15-4; Effective October 1, 2015

 

TP 36

An application for a TP 36 is denied by the 45th day after the file date if the applicant:

  • or her representative does not provide Form H3038, Emergency Medical Services Certification; Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification; or other required verification; and
  • had at least 10 days to provide the verification.

Advisors use the following chart to process the application for the individual's emergency condition if the required verification is received:

If the emergency condition occurs... and Form H3038/H3038-P is received ... then ...
during the month of application, by the 45th day after the file date, dispose the EDG using the original file date.
during the month of application, after the EDG is denied but by the 60th day after the file date, reopen the EDG, using the same application, as specified in B-111, Reuse of Application Form After Denial. Use the date Form H3038/Form H3038-P is received as the new file date.*
after the application month but by the 60th day after the file date, by the 45th day after the file date, use the date Form H3038/H3038-P is received as the file date.*
after the application month but by the 60th day after the file date, after the EDG is denied but by the 60th day after the file date, reopen the EDG, using the same application, as specified in B-111. Use the date Form H3038/H3038-P is received as the new file date.*

* Form H1113, Application for Prior Medicaid Coverage, is not required if processing the emergency coverage for a prior month.

 

B—116 Information Reported During Application Processing

Revision 15-4; Effective October 1, 2015

 

All Programs

In determining eligibility, the advisor must consider any information the individual reports between the application date and the decision date. The advisor must include any information the individual reports in the application decision process and send Form H1020, Request for Information or Action, if verification of the reported information is required to complete the application process, following procedures in B-115, Pending Verification on Applications.

Advisors must add a new household member the month the household member joins the household. For newborns, this is the:

  • birth month for TANF and Medical Programs, and
  • month the newborn comes home from the hospital for SNAP.

If the household has an existing case and submits a new application that includes new information, such as a new job, advisors must address changes that may impact eligibility for other programs.

Related Policy
Receipt of Duplicate Application, A-121.2
Receipt of Identical Application, A-121.3

 

B—116.1 Information Received During Expedited Application Processing

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors use the following chart to determine what action to take when the advisor receives information after certifying an expedited application with postponed verifications:

If, between the certification date and the date you release the hold ... then ...
  • an individual provides postponed verification that results in lowered or denied benefits; or
  • the advisor discovers information that existed on the interview date but the household failed to report, and the information results in lowered or denied benefits,
  • determine eligibility and benefits using the new information; and
  • release the hold and deny or issue lowered benefits effective the hold month providing adequate notice of adverse action.
an individual reports a change that occurred after the certification date, release the hold and issue benefits based on the originally requested information. Work the change using change policy in B-600, Changes, allowing advance notice of adverse action, if required.

Note: Advisors must send a fraud/overpayment referral, if applicable. See B-742, Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV).

Related Policy
Expedited Service, A-140
Action on Changes, B-631

 

B—120 Redeterminations

Revision 17-1; Effective January 1, 2017

 

Redetermination is the generic term in TIERS and the State Portal used to identify:

  • periodic reviews of TANF;
  • recertification of SNAP; and
  • renewal TP 08, TP 43, TP 44, and TP 48.

Note: Certification periods and redeterminations for individuals on Medical Programs who are receiving TANF and SNAP may not align. If the household reports new information during a redetermination, such as a new job, advisors must address changes that may impact eligibility for other programs.

Redeterminations can be submitted through any of the channels explained in A-113, Application Requests and Submissions, and signed as explained in A-122.1 , Application Signature.

Related Policy
Application Requests and Submissions, A-113
Application Signature, A-122.1

 

TANF and SNAP

Form H1830-R, Texas Works Renewal Notice, is sent to households, along with Form H1010-R, Your Texas Benefits: Renewal Form, for redeterminations.

 

TP 08, TP 43, TP 44 and TP 48

The following forms are generated for clients during the automated renewal process explained in B-122.4.1, Automated Renewal Process:

  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter;
    • Form H1020, Request for Information or Action, may be included with Form H1211;
  • Form H1206, Health Care Benefits Renewal - MA*; and
  • Form M5017, Documents to Send with Your Renewal Application.*

* The system generates these forms but does not automatically mail them to the client, as explained in B-121, Notice of Redetermination/Certification Expiration.

Form H1206, Health Care Benefits Renewal - ME, is mailed to the household when the individual receiving Medicaid for the Elderly and People with Disabilities (MEPD) is eligible to renew their benefits.

 

B—121 Notice of Redetermination/Certification Expiration

Revision 16-4; Effective October 1, 2016

 

TANF

TIERS Scheduling triggers the Texas Works renewal packet mail-out date in Correspondence 60 days before the review due date for approved Eligibility Determination Groups (EDGs).

Advisors must schedule an appointment after the household returns Form H1010-R, Your Texas Works Benefits: Renewal Form.

SNAP

TIERS Scheduling triggers the Texas Works renewal packet mail-out date in Correspondence during the first week of the month before last benefit month (LBM) of the approved EDG.

Advisors must schedule an appointment after the household returns Form H1010-R, Your Texas Works Benefits: Renewal Form. Advisors schedule the appointment no sooner than five days after the Form H1830-I, Interview Notice (Applications or Reviews), mail date, if possible.

For timely redeterminations, advisors schedule the first appointment early enough in the last benefit month to allow at least 13 days after the interview to ensure the EDG can be disposed by the last day of the certification period. This allows two days for Form H1020, Request for Information or Action, to be mailed from the central mail facility; 10 days after the H1020 issue date for the household to provide the information; and one additional day to process a denial for missed appointment, if applicable, in order to be timely.

Note: If the 10th day falls on a non-workday, the due date is the following workday.

Related Policy
Redetermination, B-476.1.6

TP 08, TP 43, TP 44 and TP 48

The system generates renewal correspondence automatically in the ninth month of the 12-month certification period.

The system generates and sends Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, to the client with no advisor action. Form H1211 is dynamic based on the eligibility outcome and program.

The system generates Form H1020, Request for Information or Action, and sends it with Form H1211 when additional information or verifications are needed from the client to complete the renewal processing.

The system generates Form H1206, Health Care Benefits Renewal - MA, but does not automatically mail it to the client. Form H1206 is pre-populated with information from the client’s case and may also include information from electronic data sources. There are different versions of this form depending on the type program in which the recipient is currently enrolled. Clients can access Form H1206 using the following methods:

  • logging into YourTexasBenefits.com using a case access account and selecting the “Letters and forms” tab to view or print the form;
  • dialing 2-1-1, selecting option 2, and requesting that Form H1206 be mailed to the client; or
  • visiting a local office and receiving lobby assistance to access the form through YourTexasBenefits.com or having local office staff print a copy of the form.

The system generates Form M5017, Documents to Send with Your Renewal Application, to include with Form H1206.

Note: Form H1010-R, Your Texas Benefits: Renewal Form, must be accepted if it contains Modified Adjusted Gross Income (MAGI) client information and a signature. The signature provided on Form H1010-R is considered valid as long as it is provided by the certified client or an individual who is allowed to sign for the client, as explained in A-121, Receipt of Application. The advisor should enter the information provided on Form H1010-R and pend for any information that cannot be verified through electronic data sources.

When a new individual is added to a case, as described at B-641, Additions to the Household, or an individual is transferred to a different medical program, their review due date may be aligned with the review due date of another individual in the same medical program on the case and will be able to renew at the same time. If the review due dates are aligned after the system has initiated the automated renewal process by requesting electronic data sources, the new individual or the individual who was transferred to a different type program will be mailed the following forms to complete the processing:

  • H1830-R, Texas Works Renewal Notice; and
  • H1010-R, Your Texas Works Benefits - Renewal Form.

 

B—122 Processing Redeterminations

Revision 15-4; Effective October 1, 2015

 

TANF

Advisors must process redeterminations before cutoff in the month:

  • the redetermination date falls, if the redetermination is due on or before cutoff; or
  • after the redetermination date, if the redetermination is due after cutoff.

When the Texas Works Renewal Packet Is Returned and a Packet Received Date Is Entered

If the household must provide verification to complete the redetermination, the household must be allowed at least 10 days to provide verification.

For telephone interviews, advisors must make at least two attempts to contact the applicant via telephone. Both attempts must be conducted within the time period listed on Form H1830-I, Interview Notice (Applications or Reviews). Each attempt must be conducted at least 10 minutes apart. If no contact is made with the applicant after two attempts, the telephone interview is considered a missed appointment. The advisor must document the time of each attempt on the Appointment – Details page.

If a household fails to keep a face-to-face or telephone interview appointment, the advisor must send Form TF0001, Notice of Case Action, to deny the EDG the workday following the scheduled appointment date.

If the individual contacts the office during the adverse action period, the advisor must reschedule the appointment to process the redetermination as soon as possible to avoid interruption of the benefit issuance cycle for the following month. The EDG is not reactivated and the EDG remains denied until the individual keeps the second appointment. A second Form TF0001 is not required if the individual misses the second appointment. If the individual keeps the appointment, the EDG must be processed as a Reactivation/Redetermination for correct eligibility determination and timeliness calculation.

When the Texas Works Renewal Packet Is Not Returned and/or a Packet Received Date Is Not Entered

TIERS runs a Mass Update (MU) on the fifth, sixth or seventh day of each month to terminate EDGs with due dates on or before cutoff of the current month.

For example: On July 5, the MU will terminate EDGs with a review due date on or before July cutoff.

Normal MU rules for exceptions may prevent an EDG from being terminated. Staff must process these EDGs online and verify that a Texas Works renewal packet has been sent and not returned.

When the Texas Works renewal packet is:

  • not returned, go to Initiate Interview in Change Action mode; the advisor must run Eligibility and dispose the TANF EDG.
  • returned, go to Initiate Interview in Ongoing mode; the advisor must enter the packet received date in the Miscellaneous Packet Received logical unit of work (LUW).

If the household returns Form H1010–R, Your Texas Works Benefits: Renewal Form, within the adverse action period, the advisor must schedule an appointment to process the complete redetermination. These EDGs must be processed as a Reactivation/Redetermination for correct eligibility determination and timeliness calculation.

Where to Find the Packet Received Date

In State Portal, the packet received date can be found in PT Inquiry in the EDG Details section in the column labeled Recertification Packet Date.

In TIERS, the packet received date can be found in two places in Data Collection:

  • Miscellaneous Packet Received LUW, which can be viewed in any mode; and
  • Initiate Interview – Initiate Review page, which can be viewed only in Complete Action mode.

Related Policy
Not Held – Agency Fault, B-113.1
The Texas Works Message, A-1527
Data Broker, C-820

SNAP

To reapply in a timely manner, the individual must submit the completed application form by the 15th day of the last month of the certification period. Exception: See B-122.1, SNAP Redeterminations Following a Short Certification.

When an individual misses a timely redetermination appointment, the advisor must send Form H1020, Request for Information or Action, on the day of the missed appointment but no later than the next workday. Form H1020 advises the household to contact the Texas Health and Human Services Commission (HHSC) before the end of the certification period to request a second appointment, or the application will be denied.

If the household contacts the office on or before the last workday of the last month of its certification period, the advisor must reschedule the household for a second appointment before the end of the certification period, if possible. If there are no appointment slots available, a second appointment should be scheduled no later than the 15th day of the following month and the application kept pending. If the household keeps the second appointment and is determined eligible, the original file date is used and a full month's benefits are provided for the first month of the new certification period.

If the household does not contact HHSC by the last workday of the certification period to request a second appointment, the redetermination application is denied on the last workday of the certification period using adequate notice.

For telephone interviews, the advisor must make at least two attempts to contact the individual via telephone. Both attempts must be conducted within the specified time period listed on Form H1830-I. Each attempt must be conducted at least 10 minutes apart. If no contact is made with the individual after two attempts, the telephone interview is considered a missed appointment. The advisor must document the time of each attempt on the Appointment – Details page.

Note: When a household misses a scheduled appointment and subsequently submits another application, the second application is considered as a household's request to reschedule the missed appointment.

Advisors must process timely redeterminations by the last workday of the certification period. If the advisor pends the redetermination for verification, the household is allowed until the last workday of the month to provide the required verification before denial action is taken. The advisor must ensure that the individual's normal issuance cycle is not interrupted.

Exception: The redetermination is pended past the last workday of the month if necessary to allow the individual at least 10 days to provide requested verification. If the individual:

  • provides verification before the end of the current certification month, then the action is processed by the last day of the month.
  • provides verification after the end of the certification period but by the end of the 10-day period, the advisor must ensure that the household receives an opportunity to participate within five workdays of receipt of the verification, if eligible. If the household is not eligible, the denial is processed by the fifth workday after receipt of verification.
  • does not provide verification by the end of the 10-day period, the redetermination is denied the next workday.

For households that miss the first appointment but keep the second appointment scheduled before the 15th day of the following month, if additional information is requested, the household is allowed at least 10 days to provide the requested verification. If the household:

  • provides the verification on or before the due date on Form H1020, the advisor must ensure that the household receives an opportunity to participate within five workdays of receipt of the verification.
  • does not provide the verification by the due date on Form H1020, the redetermination is denied the next workday.

See B-160, SNAP Timeliness Charts for Applications and All Redeterminations.

Situations in Which HHSC Fails to Timely Schedule the Redetermination Appointment

If the individual misses an appointment for a timely redetermination scheduled without enough time to allow the household 10 days to respond to the missed appointment notice before the end of the certification period, the advisor must, on the day of the missed appointment, send Form H1020 informing the individual to contact the office by the 10th day (or the following workday) to schedule a second appointment.

If the individual:

  • fails to contact the office by the due date, the application is denied on the workday after the Form H1020 due date; or
  • contacts the office by the due date to request another appointment, the advisor must schedule a second appointment within 10 days and keep the application pending for the second appointment.

Notes for SNAP policies in B-122:

  • For missed appointments, TIERS notices are mailed from the central mail facility two days after being requested in TIERS, so the Form H1020 due date is 12 days after the request date.
  • The individual has until close of business on the final due date listed on Form H1020 to contact the office (close of business day for the vendor if calling 2-1-1) to request another appointment.

Related Policy
Interviews, A-131
Missed Appointment, B-114
Redetermination, B-476.1.6
Children’s Medicaid Redetermination Expectations, B-123.6
Not Held – Agency Fault, B-113.1

TP 08, TP 43, TP 44 and TP 48

These programs complete an administrative renewal process, explained in B-122.4, Medical Program Administrative Renewals.

TP 07 and TP 20

Recipients of TP 07 and TP 20 must be retested for eligibility in other Medical Programs following the policy explained in A-2342.1, Retesting Eligibility, at the end of their certification period. These individuals are referred to the Marketplace if they are determined ineligible for all other Medical Programs.

Related Policy
Retesting Eligibility, A-2342.1
Denied for Failure to Provide Information/Verification, B-122.3.2
Processing Untimely Redeterminations, B-124
Required Verification, C-910

 

B—122.1 SNAP Redeterminations Following a Short Certification

Revision 13-3; Effective July 1, 2013

 

SNAP

Advisors must provide eligible households with benefits by the 30th day after the last monthly full benefit was provided if the individual reapplied timely and was previously certified with a short certification. A short certification is defined as a SNAP certification in which the household is certified:

  • for a one-month period; or
  • in the second month of a two-month certification.

The household must reapply within 15 days of receiving Form H1830, Application/Review/Expiration/Appointment Notice, and the application for assistance to be considered timely.

Notes:

  • This policy does not apply to households that are certified in the first month of a two-month certification. These households must continue to file their Form H1010 by the 15th of the last benefit month for a timely redetermination. Advisors must continue to process timely redeterminations on these cases by the last day of the current certification period.
  • Advisors must continue to provide Form H1830 and an application for assistance to households that are certified in the first month of a two-month certification or after cutoff in the first month of a three-month certification, because these households will not receive a redetermination packet even though they are not considered to have received a short certification.

 

B—122.1.1 Calculating the 30-Day Period After the Last Monthly Full Benefit

Revision 15-4; Effective October 1, 2015

 

SNAP

To calculate the 30-day period, the advisor considers the date the individual received the last full benefit as day zero. If the 30th day falls on a non-workday, the advisor must complete the case by the last workday preceding the 30th day.

 

B—122.1.2 Determining the Date the Client Must File the Application for a Timely Redetermination Following a Short Certification

Revision 15-4; Effective October 1, 2015

 

SNAP

To calculate the date the individual must file the application to be considered timely, the advisor must count 15 days after the individual received Form H1830, Application/Review/Expiration/Appointment Notice, and the application for assistance. This date is known as the Short Certification Timely Due Date. If the 15th day falls on a weekend or a holiday, the individual must submit the application before the 15th day in order for it to be considered a timely redetermination.

Advisors must follow the chart below in determining a timely redetermination:

If Form H1830 and Form H1010 are... then count 15 days ...
given to the individual in the office, after the date the individual is given the forms.
mailed to the individual, plus two days (17 days) after the date the forms are mailed.

To schedule timely redeterminations properly, scheduling staff need to know the due date on which the application must be submitted to be considered a timely redetermination. Therefore, when providing Form H1830 and Form H1010, Application for Assistance — Your Texas Benefits, at the time a short certification is completed, advisors must manually document the due date in the Short Cert. Timely Due Date box in the Agency Use Only section of Form H1010. Scheduling staff must then follow B-160, SNAP Timeliness Charts for Applications and All Redeterminations, to properly schedule the appointment.

 

B—122.1.3 Missed Appointments Following a Short Certification

Revision 15-4; Effective October 1, 2015

 

SNAP

For timely filed reapplications after a short certification, if an individual misses the appointment, the advisor must send the household Form H1020, Request for Information or Action, advising the household that the household must contact HHSC by the 30th day from the last month's full benefit issuance to request a second appointment.

If the household contacts HHSC on or before the 30th day after the last month's full benefit issuance, the advisor must reschedule the household for a second appointment before the end of the 30th day, if possible. If there are no appointment slots available, the second appointment is scheduled no later than the 45th day after the last month's full benefit issuance and the application is kept pending. If the household keeps the second appointment and is determined eligible, the original file date is used and full month's benefits are provided for the first month of the new certification period.

The advisor must hold the application past the 30th day after the last month's full benefit issuance to allow the household at least 10 days (or longer if the 10th day falls on a non-workday) to contact the office for a second appointment or to provide missing information/verification. The advisor must notify the household of the due date on Form H1020. When this 10-day due date is on or after the 30th day after the last month's full benefit issuance and the household fails to contact the office or provide missing information/verification by the due date, the application is denied the next workday. If the household does not contact HHSC by the 30th day to request a second appointment, the redetermination application is denied on the 30th day (or the last workday before the 30th day if the 30th day is not a workday).

If the household does not contact HHSC by the 30th day to request a second appointment, the redetermination application is denied on the 30th day (or the last workday before the 30th if the 30th day is not a workday).

 

B—122.2 HHSC Delays in Processing All Timely Redeterminations

Revision 13-3; Effective July 1, 2013

 

SNAP

If HHSC is at fault for not completing the redetermination process in a timely manner, staff must dispose the EDG the same day the advisor completes the eligibility redetermination. This ensures that benefits are available within 24 hours.

Example 1: A household's last benefit month is October. The household files the redetermination timely, but HHSC does not give the household an appointment until November. The advisor must dispose the EDG on the same day the eligibility redetermination is completed to ensure that benefits are available within 24 hours.

Example 2: A household's last benefit month is October. The household files the redetermination timely and provides all requested verification timely. Due to HHSC delay, the advisor does not complete the recertification process timely. The advisor must dispose the EDG on the same day that the eligibility redetermination is completed to ensure that benefits are available within 24 hours.

 

B—122.3 Delays Caused by Households

Revision 15-4; Effective October 1, 2015

 

TANF

When a redetermination is denied for a missed appointment or failure to provide information, the household is allowed until 60 days after the file date to schedule a second appointment or provide the missing information.

SNAP

When a timely redetermination is denied for a missed appointment or for failure to provide information, the household is allowed an additional 30 days after the end of the last benefit month to reschedule a missed appointment or to provide information or verification.

Related Policy
Verification Requirements, A-1370

 

B—122.3.1 Denied for Missed Appointments

Revision 15-4; Effective October 1, 2015

 

TANF and TP 08

The date the household requests another appointment is considered the new file date if the household requests a second appointment within 60 days after the original file date.

SNAP

The date the household requests another appointment is considered the new file date if the household requests to reschedule a missed appointment within 30 days after the end of the last benefit month. Benefits are prorated using the new file date.

 

B—122.3.2 Denied for Failure to Provide Information/Verification

Revision 15-4; Effective October 1, 2015

 

TANF

The date the household provides the missing information is the new file date if the household provides the missing information within 60 days of the original file date. If the EDG is reopened within 30 days of the denial, a new interview is not required. For TANF, a new Form H1073, Personal Responsibility Agreement, is not required if the EDG is reopened within 30 days of the denial.

SNAP

The date the household provides the information/verification is the new file date and a new interview is not required. Benefits are prorated using the new file date.

Advisors do not request additional income verification when following reuse of application policy for a redetermination denied for failure to provide information. The original income verification the individual provided at the interview date is acceptable, unless the household indicates a change in income.

TP 08, TP 43, TP 44 and TP 48

When a renewal is denied due to failure to provide information or verification and the information or verification is provided after the date of denial but by the 90th day after the last day of the last eligibility month, staff must reopen the existing case and not require a new application from the client. The date the information or verification is provided is the new file date.

Note: This may result in a gap in coverage.

 

B—122.4 Medical Program Administrative Renewals

Revision 17-2; Effective April 1, 2017

 

TP 08, TP 43, TP 44 and TP 48

An administrative renewal is initiated by the system and requires no advisor action. The administrative renewal process uses the automated renewal process, explained in B-122.4.1, Automated Renewal Process, to gather information from a client’s existing case and from electronic data sources to determine whether the client remains potentially eligible for Medical Programs.

Exception: Children whose TP 44 eligibility is reinstated upon release from a juvenile facility and who are released to a household different than the one in which they were certified at the time of placement in a juvenile facility do not administratively renew. They must submit Form H1010-R, Your Texas Benefits: Renewal Form, in order for their Medicaid eligibility to be reviewed. For additional information regarding reinstatement see policy in A-826, Medicaid Reinstatement.

TP 08

At redetermination, clients must complete an interview. During the interview, the advisor should remind the client to use YourTexasBenefits.com to:

  • create a case access account;
  • complete the renewal;
  • sign-up for email reminders and electronic correspondence; and
  • find out when the next renewal is due.

Clients cannot be required to complete a face-to-face interview, but have the right to request one.

For TP 08 interviews, advisors must use the interview policy explained in A-131, Interviews (for TP 08).

 

B—122.4.1 Automated Renewal Process

Revision 15-4; Effective October 1, 2015

 

TP 08, TP 43, TP 44 and TP 48

The automated renewal process is the first step in an administrative renewal. The automated renewal process runs the weekend before cutoff in the ninth month of the certification period and does not require advisor action.

The process uses electronic data to automatically:

  • assess the verifications required by type program for renewals;
  • determine the eligibility outcome; and
  • send the renewal correspondence to the client.

 

B—122.4.1.1 Verifications Required by Type Program for Renewals

Revision 15-4; Effective October 1, 2015

 

During the automated renewal process, the system checks for the required verification by program.

Automated Renewal Process: Verifications Required by Type Program for Renewals
TP 08, Parents and Caretaker Relatives Medicaid
  • Residence
  • Income and Expenses
  • Immigration Status
  • Domicile
  • Full-time School Attendance, when the only dependent child(ren) is age 18
TP 43, Children Under Age One
TP 44, Children Ages 6–18
TP 48, Children Ages 1–5
  • Income and Expenses
  • Immigration Status
  • Texas Health Steps (only for TP 44 and TP 48)
  • Health Care Orientation

The automated renewal process attempts to verify income by determining whether the client’s income information is reasonably compatible with income information available through electronic data sources, as explained in A-1370, Verification Requirements, Medical Programs.

When there are no earned income electronic data sources (TWC or TALX) available for the client, the automated renewal process checks to see whether there is a New Hire Report. When a New Hire Report exists with an employer's name and hire date that is not currently included in the client's income, the client must provide verification of income from the employer shown on the New Hire Report.

Immigration status is only verified during the automated renewal process if the client’s immigration document expires during the current certification period.

 

B—122.4.1.2 Eligibility Outcomes

Revision 15-4; Effective October 1, 2015

Once available verifications are assessed, the system runs eligibility. The following chart lists the possible eligibility outcomes of the automated renewal process.

Automated Renewal Process: Eligibility Outcomes
Eligibility Potentially Approved
  • All required eligibility information can be verified during the automated renewal process for the program.
  • No additional verification is required from a client.
  • Clients must review the information used to determine their eligibility.
  • Clients are only required to return a signed renewal Form H1206, Health Care Benefits Renewal, if the information on the renewal form is incorrect or there are changes to the client’s case.
Additional Information Needed
  • This outcome may be the result of two scenarios that require additional verification to determine whether the client remains eligible:
    • Electronic data sources indicate there is a change in income that may result in ineligibility for Medical Programs.
      • The reasonable compatibility calculation result is “Need Info because ELDS above limit” or verification required for information found on the New Hire Report.
      • The client must return a signed renewal Form H1206, Health Care Benefits Renewal, and all required verification(s) within 30 days.
    • No electronic data is available for the client.
      • The client must return a signed renewal Form H1206 and all requested verification(s).
  • SNAP or TANF benefits may be impacted if a member of the MAGI household is included in a SNAP or TANF budget group.
Eligibility Terminated*
  • This outcome may be the result of two scenarios:
    • The previous eligibility outcome was “Additional Information Needed” and eligibility was terminated because the client:
      • did not submit required verifications within 30 days to show that income is under the limit, or
      • submitted verifications that showed that income was over the limit.
    • The client reported a change in income that was over the income limit, and eligibility was terminated before the automated renewal process was triggered.

* See A-2342, Denial at Redetermination, for more information on individuals found ineligible for Medical Programs at renewal.

 

B—122.4.1.2.1 Determining if Verification Is Required for SNAP or TANF During an Administrative Renewal

Revision 15-4; Effective October 1, 2015

 

TP 08, TP 43, TP 44 and TP 48

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

  • the eligibility outcome of the automated renewal process is “Additional Information Needed” and the reasonable compatibility calculation result is “Need Info because ELDS above limit” or the client is required to provide verification of information found on a New Hire Report; and
  • an individual in the MAGI household is included in a SNAP or TANF budget group.

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

  • Deny SNAP and TANF benefits for the following data sources:
    • Quarterly wage data from Texas Workforce Commission (TWC), or
    • New Hire Report data from the Office of the Attorney General (OAG).
  • Notify the advisor to adjust SNAP and TANF benefits for the following data sources:
    • Earned income data from TALX,
    • Unearned Retirement, Survivors and Disability Insurance (RSDI) income data from the Social Security Administration (SSA), or
    • Unearned unemployment data from TWC.

Note: Earned income data from TALX, unearned RSDI data from SSA, and unearned unemployment data from TWC are valid verifications for SNAP and TANF. Since quarterly wage data from TWC and New Hire Report data from OAG are not valid verifications for SNAP and TANF, the client must provide verification for these types of income.

 

B—122.4.1.3 Renewal Correspondence

Revision 15-4; Effective October 1, 2015

 

TP 08, TP 43, TP 44 and TP 48

The system generates client correspondence according to the eligibility outcome of the automated renewal process and the action needed by the client.

The following chart lists the correspondence generated for each eligibility outcome of the automated renewal process and the required client response.

Automated Renewal Process: Renewal Correspondence
Eligibility Outcome Correspondence and Required Client Response
Eligibility Potentially Approved
  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, notifies the client that they must review the information used to determine their eligibility on Form H1206, Health Care Benefits Renewal - MA.
  • The client is only required to return a signed renewal Form H1206 if the information on the form is incorrect or there are changes to the client’s case.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206.
  • No additional forms are sent with Form H1211.
  • Form TF0001, Notice of Case Action, is mailed to the client to notify him or her of the eligibility determination*.
Additional Information Needed
  • Form H1211, It's Time to Renew Your Health-Care Benefits Cover Letter, and Form H1020, Request for Information or Action, are sent to the client.
  • Form H1211 notifies the client that they must return the following:
    • Signed renewal Form H1206, and
    • Required verification(s).
  • Form H1020 identifies all the required verification(s) needed to complete the renewal.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206.

Note: For TP 43, TP 44, and TP 48, Form H1014-A, Children's Health Care Benefits — Final Reminder, is sent if the eligibility outcome is “Additional Information Needed” and the client does not return his or her redetermination packet by the first calendar day in the 11th month of a 12-month eligibility period.

Eligibility Terminated
  • If additional information is needed and the client does not return a renewal form by the 30th day from the date Form H1211 is mailed, eligibility is auto-disposed and denied. No advisor action is needed.
  • If additional information is needed and the client does return a renewal form by the 30th day from the date Form H1211 is mailed, the form is routed to local offices for processing and the advisor manually processes the renewal.
  • Form TF0001, Notice of Case Action, is mailed to the client to notify him or her of the eligibility determination*.

* Form TF0001, Notice of Case Action, is sent when a final eligibility determination has been made. Depending on the renewal status outcome and client action, final eligibility determinations may be made by advisors manually processing renewal documents or by the system automatically. Form TF0001 identifies the dates of the new certification period for Medicaid benefits, potential CHIP eligibility, or the denial reason for not recertifying the case.

 

B—122.4.2 Processing a Manual Renewal

Revision 15-4; Effective October 1, 2015

 

TP 08, TP 43, TP 44 and TP 48

The file date is the day that any local eligibility determination office receives an acceptable Medical Program renewal form. The following are considered acceptable Medical Program renewal forms:

  • Form H1206, Health Care Benefits Renewal – MA
  • Form H1206, Health Care Benefits Renewal – ME
  • Form H1010-R, Your Texas Benefits: Renewal Form

A redetermination is considered timely if a renewal form is received by the first calendar day of the 11th month of the certification period. A redetermination is considered untimely if a renewal form is received after the first calendar day of the 11th month of the certification period and through the last day of the 12th month.

Note: If the first calendar day of the 11th benefit month falls on a weekend or a holiday and the redetermination is received on the following business day, the redetermination is considered timely.

Advisors must process redeterminations (received timely or untimely) by the 30th day from the date the renewal form is received or by cutoff of the last benefit month of the certification period, whichever is later. Advisors must follow the policy in B-123.4, Eligibility Transition from Medicaid to CHIP, when an individual returns a renewal form timely and is determined ineligible for Medicaid but eligible for CHIP.

Examples:

Medicaid coverage period is January through December. If the redetermination file date is:

  • October 10, the redetermination must be completed by the December cutoff date to be considered processed timely.
  • December 1, the redetermination must be completed by December 31 to be considered processed timely.

When HHSC receives an acceptable Medical Program renewal form, the advisor must review the information provided and determine whether the case needs to be updated to reflect the most recent information reported by the client on the form.

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

The household must be allowed at least 10 days to provide missing information, and the due date must fall on a workday.

Note: Information reported during renewal processing may impact other benefit programs.

 

B—122.4.2.1 When a Medical Program Renewal Form Is Not Returned

Revision 15-4; Effective October 1, 2015

 

TP 08, TP 43, TP 44 and TP 48

When an acceptable Medical Program renewal form, explained in B-122.4.2, Processing a Manual Renewal, is not returned, the system automatically makes an eligibility determination through a mass update based on the eligibility outcome from the automated renewal process. This does not require the advisor to run eligibility or dispose the EDG.

Below are the eligibility outcomes during the automated process:

  • Eligibility Potentially Approved — the client is auto-disposed and approved without advisor action. The file date is the date the EDG is auto-disposed approved, and the client is granted a new 12-month certification period.
  • Additional Information Needed — the client is auto-disposed and denied without advisor action.

Note: When an individual submits income or expense verification without a signed acceptable Medical Program renewal form, advisors manually process information as a change to determine ongoing eligibility for the remainder of the certification period if the client is in a non-continuous period. A signed acceptable Medical Program renewal form is required if additional information is needed to complete the renewal during the automated renewal process.

 

B—123 Processing Children's Medicaid Redeterminations

Revision 15-4; Effective October 1, 2015

 

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 use the correspondence and processing requirements explained in B-121, Notice of Redetermination/Certification Expiration (for TP 08, TP 43, TP 44 and TP 48), and B-122.4, Medical Program Administrative Renewals.

TP 44 and TP 48

TP 44 and TP 48 must follow the Texas Health Steps requirements explained in A-1531.5, Compliance Requirements.

Related Policy
Continuous Medicaid Coverage, A-832
Compliance Requirements, A-1531.5
Data Broker, C-820

 

B—123.1 Children's Medicaid Redetermination Due Dates

Revision 15-4; Effective October 1, 2015

 

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 follow the administrative renewal process and use the timeliness guidelines explained in B-122.4, Medical Program Administrative Renewals.

Related Policy
Eligibility Transition from Medicaid to CHIP, B-123.4

 

B—123.2 Children's Medicaid Redetermination Processing Time Frames

Revision 15-4; Effective October 1, 2015

 

TP 43, TP 44 and TP 48

Renewals for TP 43, TP 44 and TP 48 follow the administrative renewal process and use the timeliness guidelines explained in B-122.4, Medical Program Administrative Renewals.

 

B—123.3 Reuse of Form H1206 After Denial

Revision 19-2; Effective April 1, 2019

 

TP 43, TP 44 and TP 48

TP 43, TP 44 and TP 48 follow the policy for reusing renewal forms after the date of denial explained in B-122.3.2, Denied for Failure to Provide Information/Verification.

 

B—123.4 Eligibility Transition from Medicaid to CHIP

Revision 17-2; Effective April 1, 2017

 

TP 43, TP 44 and TP 48

When a child certified on TP 43, TP 44 or TP 48 is determined eligible for CHIP at the renewal and there is a delay in CHIP enrollment because of HHSC error and the redetermination packet was received timely, TIERS extends Medicaid eligibility for one or two additional months to allow the family time to complete the process and still retain coverage. The redetermination is considered timely when the redetermination packet is received by the first day of the 11th month and processed by HHSC by the 30th day from the file date.

If the family is solely responsible for the delay, Medicaid coverage is not extended when a child is determined eligible for CHIP.

Advisors use the following chart to determine when to extend Medicaid coverage:

If a child is ineligible for Medicaid but eligible for CHIP and the family ... but HHSC ... then, provide Medicaid coverage ...
completes the redetermination process timely,* does not process the form by the 15th day of the 11th month, for one additional month.
completes the redetermination process timely,* does not process the form by the 15th day of the 12th month, for two additional months.

 

* Timely means the redetermination form is received from the family by the first day of the 11th month and any required verification is received within specified time frames.

Related Policy
Medicaid Termination, A-825
Expedited CHIP Enrollment, D-1711

 

B—123.5 Processing a Redetermination for TP 45 - Transfer to TP 48

Revision 15-4; Effective October 1, 2015

 

Medical Programs

Advisors use this procedure to provide TP 45 coverage for a child whose TP 45 coverage ends and is eligible for TP 48 coverage.

If the family returns the redetermination packet and the child is eligible for TP 48, the advisor must initiate the review on the TP 45 EDG so that TIERS will build the TP 48 EDG after cutoff in the 11th month of the certification period. Children on TP 45 will be denied at the end of their certification period.

 

B—123.6 Children's Medicaid Redetermination Expectations

Revision 15-4; Effective October 1, 2015

 

Children's Medicaid

Staff must process Children's Medicaid redeterminations even if not requested on an associated SNAP application or redetermination, if the SNAP application or redetermination is received in the 10th, 11th or 12th month of a 12-month Children's Medicaid eligibility period.

Note: If the individual misses the appointment for a SNAP application or redetermination, staff must continue processing the Children’s Medicaid redetermination, even if the Children’s Medicaid program was not requested on the application.

The recipient must provide an application or redetermination application to process the Children’s Medicaid redetermination if the SNAP application or redetermination is not received within the specified time frames.

Related Policy
Receipt of Application, A-121
Deadlines, B-112
Missed Appointment, B-114
Redeterminations, B-120
Processing Redeterminations, B-122

 

B—124 Processing Untimely Redeterminations

Revision 15-4; Effective October 1, 2015

 

SNAP

If an application form is not received by the time frames in B-122, Processing Redeterminations, the advisor uses the initial application processing time frames in B-112, Deadlines.

If the individual submits an untimely reapplication and misses a scheduled appointment, the advisor uses the charts in B-160, SNAP Timeliness Charts for Applications and All Redeterminations, for processing time frames. The advisor must inform the individual that it is the individual's responsibility to request a second appointment. Form H1020, Request for Information or Action, must be sent no later than the next workday, notifying the individual of the missed appointment and pending the application.

Note: If the individual misses an appointment that the agency scheduled untimely, a second appointment is scheduled if the individual contacts the office by the 10th day after the missed appointment date to request another appointment. Otherwise, the individual must reapply with a new file date.

For telephone interviews, advisors must make at least two attempts to contact the individual via telephone.  Both attempts must be conducted within the specified time period listed on Form H1830-I, Interview Notice (Applications or Reviews). Each attempt must be conducted at least 10 minutes apart. If no contact is made with the individual after two attempts, the telephone interview is considered a missed appointment. Advisors must document the time and date of each attempt on the Appointment – Details page.

At the individual's request, HHSC must reschedule a second appointment even if it cannot be scheduled until after the 30th day. The individual does not have to show good cause for missing the first appointment.

If on the appointment date the applicant arrives too late for the appointment or calls to reschedule the appointment (because the individual cannot keep the appointment), the advisor must offer the applicant a choice of a standby appointment or an opportunity to reschedule.

Notes:

  • If a second or subsequent appointment is scheduled because the individual missed the appointment, the advisor must ensure that second and subsequent appointments have been correctly recorded on the Appointment – Detail page.

See B-160, SNAP Timeliness Charts for Applications and All Redeterminations.

  • Benefits are not prorated if an eligible individual submits an untimely reapplication because HHSC fails to provide Form H1830 timely. Benefits are provided from the first day of the month after the last benefits month (enter a file date of the first day of that month).

See A-2323, Proration, and an exception for seasonal and migrant farm workers.

  • Advisors do not use application verification requirements when processing untimely redeterminations. Verification requirements are the same for all redeterminations whether filed timely or untimely. See C-912, Required Verification for SNAP.

TP 08, TP 43, TP 44 and TP 48

If a renewal form is not received by the date of denial in the 12th month of the certification period, the EDG is denied for failure to return a renewal packet. A renewal form received after the last day of the 12-month certification period must be treated as an application using application processing time frames. The file date is the day that any local eligibility determination office receives the renewal form.

If the renewal form is received after the date of denial but before the last day of the 12th month of the certification period, the advisor reopens the Medical Program EDG and processes as a renewal.

Related Policy
Missed Appointment, B-114

 

B—125 Processing Special Reviews

Revision 15-4; Effective October 1, 2015

 

All Programs

Special reviews are contacts with the household outside of the redetermination process. Staff may conduct special reviews by home visits, telephone, or by mailing individuals Form H1020, Request for Information or Action, or a letter.

TANF and Medical Programs

Advisors contact the household to determine whether a change occurred. If the household confirms that no change occurred, the advisor documents the contact. To clear the special review alert task, the advisor must be in Data Collection Initiate Interview in Special Review mode. If the household confirms that a change occurred, the advisor follows policy in B-600, Changes.

If the household fails to furnish verification requested on Form H1020 or misses an appointment scheduled for the special review, the advisor must send Form TF0001, Notice of Case Action, to begin adverse action.

If the individual contacts the office during the adverse action period, the advisor must reschedule the appointment to process the review as soon as possible to avoid interruption of the benefit issuance cycle for the following month. A second Form TF0001 is not required if the individual misses the second appointment. If the individual does not keep the second appointment, the advisor uses the time frame of the original Form TF0001 to determine the effective date of the denial.

Related Policy
Setting Special Reviews, A-2330

 

B—125.1 Due Dates

Revision 15-4; Effective October 1, 2015

 

All Programs

An alert for a special review is triggered in TIERS, which generates a task in Task List Manager (TLM) for the special review.

TANF and Medical Programs

Advisors process special reviews before cutoff in the month:

  • the review date falls, if the review is due on or before cutoff; or
  • after the review date, if the review is due after cutoff.

SNAP

Advisors process special reviews by cutoff of the month the review date falls.

 

B—126 Processing Desk Reviews

Revision 15-4; Effective October 1, 2015

 

SNAP

A desk review is the processing of a timely or untimely filed SNAP redetermination application without scheduling or conducting an interview with the household. A SNAP redetermination may be completed by processing a desk review when all of the following criteria are met:

  • the household's current SNAP certification period is six months or less;
  • the current and new SNAP certification periods combined will not exceed a total of 12 months; and
  • eligibility for the current SNAP certification was determined without using the desk review process.

Exceptions: Staff must conduct an interview when the household:

  • has a member who is receiving or is applying for TANF or TP 08;
  • failed to complete the application form sufficiently enough (as determined by the local office) to process without an interview;
  • has a member with an intentional program violation (IPV) disqualification; or
  • lives in a drug/alcohol treatment center, homeless shelter, family violence shelter or group living arrangement.

Advisors begin processing a SNAP redetermination as a desk review within seven calendar days after the Packet Received Date (day zero) and issue either Form H1020, Request for Information or Action, or Form TF0001, Notice of Case Action, to the household within the same seven calendar days.

Note: When a SNAP redetermination Packet Received Date is the 10th through the 15th calendar day of the Last Benefit Month, the advisor must ensure that Form H1020 or Form TF0001 is sent to the household early enough to allow the household 10 days to provide missing information, while still allowing time for the final case action to be timely. Timeliness for Desk Reviews is calculated the same as if an interview was held.

Related Policy
Processing Redeterminations, B-122
Processing Untimely Redeterminations, B-124

 

B—130 Changes

Revision 02-1; Effective January 1, 2002

 

See B-600, Changes, for procedures and time frames for processing changes.

 

B—140 Summary of Due Dates for Form H1020, Request for Information or Action

Revision 15-4; Effective October 1, 2015

 

All Programs

The due date and final due date entries are shown in the following table. Note: If the 10th or 30th day falls on a non-workday, the due date is the next workday. If the due date is not an HHSC workday (on a weekend or a holiday), the due date advances to the next HHSC workday.

TANF

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Complete redetermination 10 days 10 days
Incomplete redetermination (including the addition of a household member) 10 days 10 days

SNAP

EDG Action Due Date Final Due Date
Application 10 days*
  • 30 days, or
  • 10th day if 10 days end after 30th day
Untimely redetermination (including adding a person at untimely redetermination) 10 days*
  • 30 days, or
  • 10th day if 10 days end after 30th day
Timely redetermination (including adding a person at timely redetermination) 10 days*
  • last workday of last benefit month, or
  • 10th day if 10 days end after last benefit month
Incomplete redetermination (including adding a person at incomplete redetermination) 10 days 10 days

* For SNAP EDGs pended for a missed appointment, the 10-day due date is calculated from the date the form is mailed, usually two days after the H1020-MA is triggered by TIERS or TLM entries. The two additional days for mail time when sending a Form H1020-MA in TIERS is only applicable to SNAP EDGs pended for a missed appointment.

TP 08, TP 43, TP 44 and TP 48

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Complete redetermination 10 days
  • 30 days or by cutoff in the last benefit month of certification, whichever is later; or
  • 10th day if 10 days end after 30th day
Incomplete redetermination (including the addition of a household member) 10 days 10 days

TP 40

EDG Action Due Date Final Due Date
Application 10 days
  • 15 work days, or
  • 10th day if 10 days end after 15th work day

TA 31, TP 34, TP 35, TP 36, TP 56 and TP 32

EDG Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day

 

B—150 Avoiding Invalid Denials Related to Missing Information and Missed Appointments

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff must ensure that correspondence is sent to the individual's current address. This requires updating the address in the system if the individual has reported a new address on an application form or a change of address is pending in the Task List Manager or TIERS.

Staff should make two telephone call attempts at least 10 minutes apart during the appointed time frame listed on Form H1830-I, Interview Notice (Applications or Reviews), before determining a telephone interview is a missed appointment. Advisors must document the times and dates of the attempted telephone calls on the Appointment – Details page.

An EDG is denied for failure to furnish information only if:

  • the due date on Form H1020, Request for Information or Action, has expired;
  • the information was requested on Form H1020; and
  • there is confirmation that the requested information is not in the office (front desk, mail room, fax machine, etc.) or imaged and available through the State Portal. Follow local procedures for locating submitted verifications.

An EDG is not denied for missed appointment if:

  • a second appointment has already been scheduled;
  • the denial is before the final due date on Form H1020 for applications and timely redeterminations;
  • the agency failed to make the telephone call for a telephone interview or failed to call within the specified time listed on Form H1830-I; and
  • the individual files another application after missing the initial appointment. Treat the new application as a request to reschedule a missed appointment. Reschedule a timely redetermination appointment before the end of the certification period, if possible. If there are no appointment slots available, schedule the second appointment no later than the 15th day of the following month.

SNAP Denial Reminders

 

B—160 SNAP Timeliness Charts for Applications and All Redeterminations

Revision 13-3; Effective July 1, 2013

 

SNAP

The charts in this section may be used as a guide to determine when appointments must be scheduled and benefits provided for the case action to be reported as timely. The charts detail required actions and due dates in the following type situations:

  • applications and untimely redeterminations,
  • timely redeterminations after a regular certification period, and
  • timely redeterminations after a short certification period.

SNAP Applications and Untimely Redetermination

If … then …
  • the household keeps the first appointment; or
  • the household misses the first appointment, keeps the second appointment on or before the 30th day, and the application is not pended for verification; or
  • the household misses the first appointment, keeps the second appointment, and the application is pended for verification and verification is provided timely on or before the 30th day;
  • if eligible, ensure the household has an opportunity to participate by the 30th day after the file date; or
  • if not eligible, deny the application by the 30th day after the file date. Note: If the 30th day is a non-workday, take appropriate action the following workday.
  • the household misses the first appointment and fails to request a second appointment by the 30th day after the file date; or
  • the household misses the first appointment, keeps a second appointment and the application is pended for verification with a Form H1020, Request for Information or Action, due date before the 30th day and the household fails to provide verification timely; or
  • the household misses the first appointment and misses a second appointment scheduled on or before the 30th day and by the 30th day the household does not request another appointment;
deny the application on the 30th day after the file date (or the following workday if the 30th day is a non-workday).
the household misses the first appointment and keeps a second appointment after the 30th day and the application is not pended for verification; dispose on the day of the interview. If the household is:
  • eligible, ensure the household has an opportunity to participate on the interview date; or
  • not eligible, deny the application on the interview date.
the household misses the first appointment and keeps a second appointment, and the application is pended for verification with a Form H1020 due on or after the 30th day and the household provides verification before the 30th day; dispose by the 30th day:
  • if eligible, ensure the household has an opportunity to participate by the 30th day; or
  • if not eligible, deny the application by the 30th day.
the household misses the first appointment and keeps a second appointment, and the application is pended for verification and the household provides it timely on or after the 30th day; dispose on the day the verification is provided. If the household is:
  • eligible, ensure the household has an opportunity to participate on the day verification is provided; or
  • not eligible, deny the application on the day verification is provided.
the household misses the first appointment and keeps a second appointment, and the application is pended for verification with a Form H1020 with a due date on or after the 30th day and verification is not provided timely; deny the application on the workday after the Form H1020 due date.
the household misses the first appointment and a second or subsequent appointment scheduled after the 30th day is also missed; deny the application on the day of the missed second or subsequent appointment.
misses the first appointment, misses the second appointment scheduled on or before the 30th day, and, by the 30th day, requests and is scheduled a third appointment after the 30th day; dispose/process:
  • on the day of the interview if the application is not pended for information/verification; or
  • on the day the information or verification is received if the EDG was pended and the information is provided, or
  • on the workday after the Form H1020 due date if the EDG was pended and the information was not provided.

Timely SNAP Redeterminations After a Regular Certification Period

If … then …
  • the household keeps the first timely appointment; or
  • the household misses the first timely appointment, keeps the second appointment on or before the last workday of the certification period, and the application is not pended for verification; or
  • misses the first appointment, keeps the second appointment, and verification is provided timely on or before the last day of the certification period;
  • if eligible, dispose/process the redetermination application by the last workday of the certification period; or
  • if not eligible, deny the redetermination application by the last workday of the certification period.

Note: If the last day of the certification period is not a workday, take action the last workday before the end of the certification period.

  • the household misses the first appointment and fails to request a second appointment by the last workday of the certification period; or
  • the household misses the first appointment and misses a second appointment scheduled on or before the last workday of the certification period, and by the last workday of the certification period the household does not request another appointment;
deny the application on the last workday of the certification period.
  • the household misses the first appointment and misses a second or subsequent appointment scheduled on or before the 15th of the month after the last benefit month; or
  • the household misses the first appointment and keeps a second appointment on or before the 15th of the month after the last benefit month, and the application is not pended for verification;
dispose the recertification application on the day of the second (or subsequent) appointment.
the household misses the first appointment and keeps a second appointment on or before the 15th of the month after the last benefit month, and the application is pended for verification with a Form H1020 and the household provides verification timely;
  • if verification was provided by the last workday of the certification period, process by the last workday of the certification period; or
  • If verification was provided by the Form H1020 due date but after the certification period:
    • if eligible, ensure the household has an opportunity to participate within five workdays after receipt of the verification; or
    • if not eligible, deny the application within five workdays after receipt of the verification.
the household misses the first appointment and keeps a second appointment on or before the 15th of the month after the last benefit month, and the application is pended for verification with a Form H1020 and the household fails to provide verification by the final due date;
  • if the Form H1020 due date was before the last workday of the certification period, deny the application on the last workday of the certification period; or
  • if the Form H1020 due date was on or after the last workday of the certification period, deny the application on the workday following the due date on Form H1020.
the household misses the first appointment and also misses a second or subsequent appointment scheduled after the end of the certification period; deny the application on the day of the missed second appointment.
the household misses the first appointment and also misses a second appointment scheduled on or before the end of the certification period, and by the last workday of the certification period the household requests another appointment and is scheduled a third appointment after the end of the certification period;
  • if the application is not pended or if the household misses the appointment, dispose/process the application on the day of the appointment; or
  • if the EDG is pended:
    • dispose/process within five workdays after the receipt of information/verification, if the pended information is provided; or
    • deny the application on the workday following the Form H1020 due date, if the pended information is not provided.

Timely SNAP Redeterminations After a Short Certification Period

If… then…
  • the household keeps the first appointment; or
  • the household misses the first appointment, keeps a second appointment on or before the 30th day after the last month's full benefit issuance, and the application is not pended for verification; or
  • the household misses the first appointment, keeps a second appointment, and the application is pended for verification and verification is provided timely on or before the 30th day after the last month's full benefit issuance;
  • if eligible, process the redetermination by the 30th day; or
  • if not eligible, deny the application by the 30th day.

Note: If the 30th day is not a work day, take action on the last workday before the 30th day.

  • the household misses the first appointment and fails to request a second appointment by the 30th day after the last month's full benefit issuance; or
  • the household misses the first appointment and also misses a second appointment scheduled on or before the 30th day, and by the 30th day (or last workday before the 30th day) the household does not request another appointment;
deny the application on the 30th day (or the last workday before the 30th day if the 30th day is not a workday).
  • the household misses the first appointment and also misses a second or subsequent appointment scheduled on or before the 45th day after the last month's full benefit issuance; or
  • the household misses the first appointment and keeps a second appointment on or before the 45th day and the application is not pended for verification;
dispose the recertification application on the day of the second (or subsequent) appointment.
the household misses the first appointment and keeps a second appointment on or before the 45th day after the last month's full benefit issuance, and the application is pended for verification with a Form H1020 and the household provides verification timely;
  • if verification was provided by the 30th day after the last month's full benefit issuance, process by the 30th day.
  • if verification was provided by the Form H1020 due date but after the 30th day after the last month's full benefit issuance:
    • if eligible, ensure the household has an opportunity to participate within five workdays after receipt of the verification; or
    • if not eligible, deny the application within five workdays after receipt of the verification.
the household misses the first appointment and keeps a second appointment on or before the 45th day, and the application is pended for verification with a Form H1020 and the household fails to provide verification by the final due date;
  • if the Form H1020 due date was before the 30th day after the last month's full benefit issuance, deny the application on the 30th day.
  • if the Form H1020 due date was on or after the 45th day, deny the application on the workday following the due date on Form H1020.
the household misses the first appointment and misses a second or subsequent appointment scheduled after the 30th day from the last month's full benefit issuance; deny the application on the day of the missed second or subsequent appointment.
the household misses the first appointment and misses a second appointment scheduled on or before the 30th day, and, by the 30th day of the certification period, the household requests and is scheduled for a third appointment after the 30th day;
  • if the application is not pended or if the household misses the appointment, dispose/process the application on the day of the appointment; or
  • if the case is pended:
    • dispose/process within five workdays after the receipt of information/verification, if the pended information is provided; or
    • deny the application on the workday following the Form H1020 due date, if the pended information is not provided.

 

B—161 DataMart Reports

Revision 13-3; Effective July 1, 2013

 

All Programs

DataMart provides a series of online reports accessed through the State Portal. The reports are used as monitoring tools for various EDG action activities for cases in TIERS (including timeliness of those activities). See C-840, DataMart.

 

B—170 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must document the reason(s) for delays in processing an application and advisor action as explained in B-113, Delay in Processing Applications.

For missed telephone interviews, advisors must document on the Appointment – Details page the time of each call when attempting to contact the applicant according to policy in B-114, Missed Appointment; B-122, Processing Redeterminations; and B-124, Processing Untimely Redeterminations.

Related Policy
The Texas Works Documentation Guide

B-200, Issuing Benefits

Revision 19-2; Effective April 1, 2019

 

 

B—210 General Policy

Revision 15-4; Effective October 1, 2015

 

TANF

The Texas Health and Human Services Commission (HHSC) issues Temporary Assistance for Needy Families (TANF) benefits via Electronic Benefit Transfer (EBT) or warrant. The agency issues all one-time benefits via warrant.

Related Policy
Medicaid Eligibility, A-800
Issuing OTTANF Benefits, A-2451
Issuing One-Time Grandparent Payment, A-2452

SNAP

HHSC issues all Supplemental Nutrition Assistance Program (SNAP) benefits by EBT.

 

B—220 Benefits

Revision 05-2; Effective April 1, 2005

 

 

B—221 Types of Benefits

Revision 11-3; Effective July 1, 2011

 

TANF and SNAP

There are five types of benefits:

  • initial,
  • ongoing,
  • supplemental,
  • retroactive, and
  • restored.

See Glossary for definitions of these terms.

 

B—222 Issuing Methods

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

SNAP and TANF benefits are issued using the Texas Integrated Eligibility Redesign System (TIERS).

Benefits authorized in TIERS via Eligibility or Benefit Issuance functional areas are issued by EBT.

 

B—222.1 Mailing Addresses for Issuing Benefits

Revision 19-2; Effective April 1, 2019

 

TANF and Medical Programs


Staff issue benefits to the person's physical address, unless the person:

  • is temporarily living at another address;
  • has a post office box or general delivery address;
  • has a guardian; or
  • provides a good reason for a different mailing address, showing the individual would suffer hardship if benefits were mailed to their physical address.

Staff should not use a local eligibility determination office address or an employee's physical address as a mailing address, unless the employee is the TANF applicant or recipient.

SNAP

The person's physical address is the preferred mailing address to enter in TIERS. However, the person may use another mailing address if they believe it is more secure or they have no physical address.

All Programs

Notes:

  • If a person has a post office box and physical address, both are entered in TIERS, unless they reside in a shelter for battered persons.
  • The U.S. Postal Service does not forward TANF warrants or the Your Texas Benefits Medicaid cards.

 

B—230 Electronic Benefit Transfer (EBT)

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

HHSC issues benefits by EBT and contracts with one or more vendors who perform EBT functions.

When an advisor certifies a household, HHSC establishes and deposits benefits in the household's EBT account(s). Staff issues a Lone Star Card to the individual or their representative. These cardholders access benefits using the card and a Personal Identification Number (PIN).

Staff uses TIERS to send information to the EBT system.

The EBT process includes:

  • establishing a primary cardholder and EBT account(s);
  • establishing a secondary cardholder, if requested;
  • issuing a Lone Star Card;
  • requesting that the individual select his PIN or issuing a pre-assigned PIN;
  • replacing a card and/or PIN, if required; and
  • individual training.

 

B—231 Establishing the Primary Cardholder (PCH)

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

The PCH is the household member or EBT representative designated to have primary responsibility for security and access to the household's benefits in the EBT account. Each case has only one PCH. Staff generally establishes the case name as the PCH, even if the individual is a disqualified member.

Exceptions: If an EBT representative is a PCH who is not the case name, establish the PCH in the following situations:

  • If the TANF Eligibility Determination Group (EDG) has a protective payee or representative payee, establish this person as the PCH.
  • If a SNAP individual is a resident of a drug and alcohol (D&A) treatment/group living arrangement (GLA) facility and the D&A/GLA facility is the individual's authorized representative (AR), establish the AR as the PCH.
If the TANF and SNAP EDGs have... then...
the same EDG name, establish the EDG name as the PCH for both EDGs.

Note: Ensure that the name, date of birth, sex and Social Security number (SSN) match exactly.

different EDG Names, each EDG must have a different PCH.

 

B—231.1 When to Send a PCH Record

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

HHSC must send a PCH record to the EBT system on an active EDG, even if pending the final case action, or on an application when the advisor:

  • certifies a TANF or SNAP application;
  • transfers a Medical Programs EDG to TANF;
  • changes an EDG name;
  • adds, deletes, or changes a TANF protective payee or representative payee;
  • adds, deletes, or changes the SNAP AR for a D&A/GLA facility; or
  • changes a SNAP AR type from a D&A/GLA facility to an individual (in or out of the household) when the AR name stays the same.

Note: The EDG name becomes the PCH. If the advisor changes the SNAP AR type from an individual to a D&A/GLA facility, the AR becomes the PCH. See B-440, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities.

Advisors do not send a record if:

  • pending the TANF or SNAP application due to a missed appointment; or
  • pending a change or complete action when the household does not appear to be eligible for TP 01/61.

 

B—231.2 Establishing a PCH Record and an EBT Account

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Advisors must send a PCH record to the EBT system to establish a benefit account in the cardholder's name. The advisor must establish the account before issuance staff can issue a Lone Star Card and PIN.

 

B—231.3 Sending a New PCH Record

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

A new PCH record may be sent to the EBT system to establish an account in the following two manners:

  • Through TIERS using Real Time Interface or Batch file; or
  • Via the Administrative Terminal Action (ATA) – The advisor completes Part I of Form H1175, Authorization for Administrative Terminal Application Action, to authorize this process only if they:
    • need to change the PCH on a denied EDG or an EDG being denied; or
    • cannot send the record through TIERS due to automation problems.

Exception: If the EBT system receives a benefit record before the PCH record, the EBT system uses the benefit record to create a PCH record. This usually occurs on TANF and SNAP EDGs when:

  • the advisor fails to submit Form H1175, Part I, to the EBT clerk; or
  • the EBT clerk fails to enter the data from Part I of Form H1175 on the same day the advisor disposes the EDG.

The advisor must not send another PCH record.

 

B—231.4 Updating the PCH Record

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

TIERS updates existing PCH records on active cases any time the advisor changes the cardholder's biographical data or address and completes the benefit issuance logical unit of work. The EBT system receives an update file sent from TIERS overnight that updates the record the next day.

Note: The advisor may initiate action to merge PCH records via the ATA when a household's TANF and SNAP PCH record information fails to match. See B-261.3.2, Merging Primary Cardholder Records.

 

B—232 Establishing a Secondary Cardholder

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Advisors establish a secondary cardholder only after HHSC certifies an application. Exception: If the advisor certifies an individual for one program and pends the other, the individual may authorize a secondary cardholder for both accounts.

The PCH may authorize:

  • a secondary cardholder for only one benefit account;
  • a different secondary cardholder for each benefit account; or
  • the same person as the secondary cardholder for both the cash account and the food account.

The following three methods may be used to establish a secondary cardholder:

  • the PCH requests it via the Lone Star Help Desk;
  • the PCH requests it from the local office issuance staff; or
  • the advisor authorizes the secondary cardholder via the ATA.

Only the PCH may authorize a secondary cardholder, except in the emergency situations described in B-232.3, Secondary Cardholders Established by the Advisor.

Employees involved in certification or issuance may serve as a secondary cardholder on another household's account only if the supervisor gives written approval.

 

B—232.1 Secondary Cardholder Established by the Lone Star Help Desk

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

The PCH may contact the Lone Star Help Desk any time after certification to add, delete, or change a secondary cardholder.

When the help-desk staff receives a request to add or change a secondary cardholder, the staff mails a Second Cardholder request form to the PCH. The PCH must complete, sign, obtain the secondary cardholder's signature, and return the form to the vendor to authorize a secondary cardholder.

When the vendor's staff receives the completed form, the staff mails the secondary cardholder's Lone Star Card to the PCH who must give the card to the secondary cardholder. The secondary cardholder then calls the Lone Star Help Desk to register the card.

If the PCH requests the deletion of a secondary cardholder, Lone Star Help Desk staff terminates access of the secondary card immediately.

 

B—232.2 Secondary Cardholder Established by Issuance Staff

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

When the advisor establishes a PCH on a certified application, the PCH may authorize a secondary cardholder.

The PCH must bring the secondary cardholder to the office, complete the Second Cardholder request form, give the form to issuance staff, and provide proof of identity. The advisor completes Form H1172, EBT Card, PIN and Data Entry Request. Before establishing the secondary cardholder on the ATA, issuance staff ensures the Second Cardholder request form is completed and signed by both the PCH and secondary cardholder.

The PCH may add or change a secondary cardholder using this procedure any time after certification.

 

B—232.3 Secondary Cardholders Established by the Advisor

Revision 01-3; Effective April 1, 2001

 

TANF and SNAP

The advisor may establish a secondary cardholder with supervisory approval in the emergency situations described in this section.

 

B—232.3.1 Secondary Cardholder Authorization by a Household Member Other than the PCH

Revision 01-3; Effective April 1, 2001

 

TANF and SNAP

With supervisory approval, the advisor may establish account access for a new individual if:

  • the household needs to set up a secondary cardholder; and
  • the PCH cannot complete and sign the Second Cardholder request form (due to injury, illness, etc.).

The advisor obtains a completed Second Cardholder request form signed by another responsible household member or the AR if there is no other responsible household member. The advisor and supervisor sign below the individual's signature.

The advisor completes Form H1172, EBT Card, PIN and Data Entry Request, for issuance staff to enter the data from the Second Cardholder request form into the ATA to establish a secondary cardholder record.

 

B—232.3.2 Secondary Cardholder Authorization by the Advisor

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When benefits for children remain in an EBT account and the PCH is not able or available to access the benefits, the advisor may use the following chart to determine whether the advisor may establish a secondary cardholder.

Step Action
1 Did the only household member with account access die, become incapacitated, or abandon the children? No Stop. Take no further action.
- - Yes Go to Step 2.
2 Is there another responsible household member who may be established as the PCH? No Go to Step 3.
- - Yes Establish the other responsible household member as the PCH.
3 Are the children in the care of another person? No Stop. Take no further action.
- - Yes Authorize account access to the new caregiver using the procedures that follow in this section.

The advisor:

  • uses the Second Cardholder request form to authorize the new caregiver as a secondary cardholder;
  • completes the individual (PCH) information section of the form; and
  • signs at the bottom in the section marked "Your Signature." The supervisor signs under the advisor's signature.

The new caregiver completes and signs the second cardholder information section. The advisor completes Form H1172, EBT Card, PIN and Data Entry Request, and refers the person to issuance staff.

Note: The new caregiver must make a separate application for benefits in order to continue receiving them.

 

B—233 Issuing a Lone Star Card

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

The advisor requests Lone Star Card issuance when:

  • a new PCH record is established on applications or active EDGs; or
  • the office establishes a secondary cardholder.

For pended applications, advisors may request Lone Star Card issuance immediately after the interview.

Exception: When the advisor interviews a PCH by phone, a request for the EBT vendor to mail the Lone Star Card and training materials to the PCH is required with some exceptions. Advisors follow procedures in B-233.2.2, Applicants Interviewed by Phone.

Related Policy
Applicants Interviewed by Phone, B-233.2.2
Special Certification Situations, B-240
Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities, B-440
Residents in Family Violence Shelters, B-450
Prepared Meal Services, B-460

 

B—233.1 When to Reuse a Lone Star Card

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

A Lone Star Card from a previous certification in which the individual was the PCH may be used if the same EDG number is used.

A previously issued Lone Star Card may not be used if it was:

  • deactivated because it was reported lost or stolen;
  • issued to someone who was later removed as primary or secondary cardholder on the account; or
  • issued to someone for an EDG, which was later denied and purged, and the EBT account was closed.

Note: Advisors may use ATA inquiry to determine whether the cardholder may use the Lone Star Card to access benefits for a particular EDG. Staff may use this inquiry to validate card access after verifying the individual's identity. Form H1172, EBT Card, PIN and Data Entry Request, is not required.

 

B—233.2 Issuing Lone Star Cards for PCHs

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

To issue a Lone Star Card, the advisor:

  • completes Form H1172, EBT Card, PIN and Data Entry Request; and
  • refers the PCH to issuance staff.

When issuing Lone Star Cards in the office, issuance staff must verify the identity of the person receiving the card to ensure the individual is the person listed on Form H1172. If issuing the card directly to a cardholder, issuance staff also ensures the individual signs the back of the card.

If the advisor pends the application and does not issue the Lone Star Card, the advisor must:

  • explain to the individual that after receiving the Lone Star Card, the individual must call the Lone Star Help Desk to register it; and
  • postpone sending Form H1172 to issuance staff.

If the advisor later certifies the application, the advisor must give a completed Form H1172 to issuance staff to:

  • request mail-out of a Lone Star Card and training material to the PCH; and
  • flag the cardholder record to require card registration.

Exception: When the advisor interviews a PCH by phone, the advisor is required to request that the EBT vendor mail the Lone Star Card and training materials to the PCH with some exceptions. Advisors follow procedures in B-233.2.2, Applicants Interviewed by Phone.

 

B—233.2.1 Applicants Interviewed in the Office

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

If the advisor interviews the PCH and certifies or pends the application at the initial interview, the advisor must follow the procedures in B-233.2, Issuing Lone Star Cards for PCHs.

If the advisor interviews someone other than the PCH and certifies or pends the application at the initial interview, the advisor must give a completed Form H1172, EBT Card, PIN and Data Entry Request, to issuance staff to:

  • request issuance of a Lone Star Card to the person being interviewed; and
  • flag the cardholder record to require card registration.

If a person leaves the office without picking up a Lone Star Card or the advisor later certifies an application for which card issuance was postponed, issuance staff takes the actions listed in the following chart:

If the PCH ... then ...
has a secure mailing address,
  • mail the Lone Star Card and training material to the PCH's address,*
  • flag the cardholder record to require card registration, and
  • note this procedure on Form H1172.
does not have a secure mailing address,
  • note on the bottom of Form H1172 that issuance staff did not issue a card, and
  • send Form H1172 to the Document Processing Center (DPC) in Austin for imaging.

* Exception: For expedited applications in situations that require mailing a Lone Star Card, the PCH may pick up the card in the office. If the PCH is unable to come to the office due to illness or disability, the issuance staff may issue the:

  • AR a secondary cardholder card following special procedures in B-232.3, Secondary Cardholders Established by the Advisor, if possible; or
  • PCH's card to the AR with supervisory approval on Form H1172, documenting the need for this procedure and noting that the card requires registration.

If the cardholder returns for the card, issuance staff:

  • must complete and sign a new Form H1172, and
  • issue the Lone Star Card following regular procedures.

Note: Staff must not use whiteout or other correction fluid on Form H1172. If fixing an error or a wrong date, mark through the error with a single line and make the correction.

 

B—233.2.2 Applicants Interviewed by Phone

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

If the advisor interviews a household by phone, mail issuance is required except:

  • for households who are certified for expedited SNAP benefits;
  • when the card must be issued in the local office to meet timeliness standards; or
  • when the card must be issued to an authorized representative for residents of drug and alcohol treatment centers and group living arrangement facilities.

If the household is interviewed by phone and is:

then:

eligible for expedited SNAP benefits,

or

interviewed on or after the 25th day after the file date for SNAP benefits,
staff must instruct the individual to go to the local office and pick up the Lone Star Card for timely access.

Note: The Lone Star Card can be mailed at the individual's request if unable to go to the local office.
determined to be eligible at the interview or pended for missing information and does not meet the above criteria, staff must inform the individual during the interview that their Lone Star Card will be mailed to them within the next week.
denied at the interview, staff do not request issuance of the Lone Star Card.

When pending an application, the advisor must explain the following to the person being interviewed:

  • The requested information must be provided and eligibility determined before TANF cash benefits or SNAP food benefits will be deposited into the EBT account.
  • A Lone Star card and training materials will be mailed to the PCH. Call the Lone Star Help Desk at 1-800-777-7328 to register the card.
  • A PIN selection is necessary to access their EBT account.
  • After receiving a notice of eligibility, the individual should call the Lone Star Help Desk to check the food benefit account balance.

Notes:

  • Advisors must remember to refer to policy in B-234.3, Initial PIN Issuance Procedures for Individuals with Barriers that Prevent PIN Self-Selection.
  • It is important that the applicant understands receipt of a Lone Star Card does not mean the household is eligible for SNAP or TANF, or that SNAP food benefits or TANF cash benefits are currently available in the EBT account.

Related Policy
Initial PIN Issuance Procedures for Individuals with Barriers that Prevent PIN Self-Selection, B-234.3

 

B—233.2.3 Applicants Interviewed by Phone in a Location Different Than Interviewing Worker

Revision 15-4; Effective October 1, 2015

 

If an advisor is conducting a phone interview for a household in another location, the local office may need to issue EBT cards to the household.

Staff must continue to follow the policy in B-233.2.2, Applicants Interviewed by Phone, along with the policy below.

If the household needs a new Lone Star Card, the interviewing advisor must:

  • determine whether the agency must mail a new card to the household or issue it in a local eligibility office following policy in B-233.2.2;
  • give the individual the address and contact information for the local HHSC office based on the household's residential ZIP code using the office locator in the State Portal; and
  • tell the household that the PCH (or person being interviewed) must provide proof of identity in order to get an EBT card.

Notes:

  • The EBT system may purge the EDG after 90 days if HHSC does not issue benefits. The EBT system may purge the EDG after one year if there are no EBT transactions. The advisor must request issuance of a new card in either situation.
  • If the household needs a replacement card, staff must follow policy in B-235, Lone Star Card Replacement.

When a local eligibility office must issue a new Lone Star Card, the eligibility office issuing the EBT card must:

  • verify through TIERS inquiry that an advisor in another location conducted an interview;
  • verify that the individual meets one of the criteria for local office issuance, or one of the criteria in B-235;
  • verify the identity of the PCH;
  • issue the EBT card and materials following the approved local office procedures;
  • make sure the EBT card is registered to the correct EDG number;
  • send all required EBT forms to the Austin DPC to be imaged following procedures in the Support Tools section of the Eligibility Services State Processes document; and
  • continue to follow established security and reconciliation procedures.

Note: When an individual comes into the local office asking for an EBT card, EBT issuance staff may complete Form H1172, EBT Card, PIN and Data Entry Request, but must get an advisor or supervisor sign-off.

 

B—233.2.4 Applicants Interviewed by Home Visit

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

If the advisor certifies or pends the application at the initial interview and interviews the PCH, the advisor must explain to the individual that:

  • HHSC will mail a Lone Star Card and training material; and
  • after receiving the Lone Star Card, the PCH must call the Lone Star Help Desk to register it.

Upon returning to the office, the advisor sends the PCH record and gives a completed Form H1172, EBT Card, PIN and Data Entry Request, to issuance staff to:

  • request mail-out of a Lone Star Card and training material to the PCH; and
  • flag the cardholder record to require card registration.

The advisor may also use the EBT issuance procedure described in the following chart:

Step Action
1 Request that issuance staff performs ATA inquiry to see if HHSC previously issued a Lone Star Card and, if so, write down the personal account number (PAN).
2 Use Form H1173, EBT Card Issuance and PIN Self-Selection/Issuance Log, to log out a Lone Star Card and PIN packet to deliver to the household during the home visit.
3 During the interview, ask the PCH if they still have the Lone Star Card and still remember their PIN.
4 If the PCH has a Lone Star Card and remembers his PIN, then compare the previously recorded PAN to ensure the card is valid. If so, the PCH may continue to use their Lone Star Card and PIN.
5 If the PCH needs an initial Lone Star Card/PIN issuance or a replacement:
  • give the PCH the Lone Star Card;
  • explain that the individual must select a PIN through the Lone Star Help Desk Automated Voice Response (AVR) unit*; and
  • record the PAN and, if applicable, PIN control number on Form H1172 to report back to issuance staff upon returning to the office.

* Exception:

If the individual has a barrier that prevents the individual from selecting a PIN, the advisor must issue a pre-assigned PIN. Barriers include, but are not limited to:

  • a physical or mental disability,
  • the lack of access to a touchtone phone,
  • the unavailability of the AVR, or
  • the inability to use the AVR.

The individual's statement regarding barriers that prevent the individual from self-selecting a PIN is acceptable.

Centralized Benefit Services individuals continue to receive PIN packets.

If the advisor certifies the application but interviews someone other than the PCH, the advisor may follow either of the previous procedures and provide the explanations to the person being interviewed.

 

B—233.3 Issuing Lone Star Cards to EBT Representatives

Revision 15-4; Effective October 1, 2015

 

TANF

A TANF protective payee must come to the office to be issued a Lone Star Card. Exception: If the protective payee is unable to come to the office, issuance staff may mail the Lone Star Card to the protective payee's address indicated by the advisor on Form H1172, EBT Card, PIN and Data Entry Request.

SNAP

Advisors follow the procedures for authorized representatives in B-440, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities.

 

B—233.4 Issuing Lone Star Cards to Secondary Cardholders

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When establishing a secondary cardholder at the local office as explained in B-232, Establishing a Secondary Cardholder, through B-232.3.2, Secondary Cardholder Authorization by the Advisor, issuance staff also issues a Lone Star Card to the secondary cardholder. Form H1172, EBT Card, PIN and Data Entry Request, and the Second Cardholder request form are used to serve as card issuance authorization. The secondary cardholder must come to the office and provide verification of identity to obtain the Lone Star Card.

 

B—233.5 Card Registration

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Card registration is a process by which a cardholder requests account access for a new Lone Star Card. Lone Star Help Desk staff normally completes this procedure and verifies the caller's identity before authorizing access.

A cardholder must register a new Lone Star Card (initial or replacement) by calling the Lone Star Help Desk if the card is:

  • mailed to the cardholder; or
  • given to someone other than the PCH.

Lone Star Cards issued directly to the PCH do not require registration.

 

B—233.5.1 Issuance Staff Procedures

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When policy requires registration for a card that HHSC issues at the local office, issuance staff places a registration sticker on the card and takes the actions in the following chart.

If ... then ...
mailing the card, provide a Lone Star Card mailer with it.
issuing the card to someone other than the PCH, explain that the PCH must call the Lone Star Help Desk to register the card after receiving it.

 

B—233.5.2 Special Card Registration Procedures

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Staff must register a PCH's card if the cardholder has a barrier, such as a hearing impairment or language barrier which prevents the PCH from registering the card through the regular Lone Star Help Desk process.

To complete registration of a Lone Star Card in the local office, the PCH must come to the office, verify the PCH’s identity, and show their card to the local office EBT site coordinator or designated staff (other than the EBT clerk). The coordinator/staff then:

  • completes Form H1175, Authorization for Administrative Terminal Application Action, to authorize registration; and
  • gives it to the EBT clerk to register the card via the ATA. The EBT clerk verifies that the cardholder has the same card as shown on the ATA and changes the card status to "registered."

 

B—234 Personal Identification Number (PIN) Selection and Issuance

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

In addition to the Lone Star Card, a cardholder must have a PIN to access benefits in the household's EBT account(s). The cardholder selects their PIN through the Lone Star Help Desk AVR unit.

Exceptions:

  • If the cardholder has a barrier that prevents them from selecting a PIN, the advisor may issue a pre-assigned PIN. Barriers include, but are not limited to:
    • a physical or mental disability;
    • the lack of access to a touchtone phone;
    • the unavailability of the AVR; or
    • the inability to use the AVR.

The cardholder's statement regarding barriers that prevent them from self-selecting a PIN is acceptable.

  • Centralized Benefit Services individuals will continue to receive PIN packets.

Local offices are encouraged to promote individual PIN self-selection to provide increased security and convenience for the cardholder and reduce the number of PIN packets issued and replaced. If possible, the local office allows the cardholder to use the PIN pad device to complete PIN self-selection and provides training/assistance regarding the process upon the individual's request.

Advisors must ensure that the cardholder selects or receives a PIN when:

  • issuing the initial Lone Star Card;
  • the PIN is compromised; or
  • the cardholder forgets the PIN.

When the advisor postpones issuing a Lone Star Card on a pended application, the advisor must also postpone the PIN self-selection/issuance process.

After initial PIN selection/issuance, a cardholder may select a new PIN at any time by calling the Lone Star Help Desk AVR unit.

Related Policy
Special Certification Situations, B-240
Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities, B-440
Residents in Family Violence Shelters, B-450
Prepared Meal Services, B-460

 

B—234.1 Personal Identification Number (PIN) Selection and Issuance Procedures

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

The advisor:

  • explains the PIN-selection process during the initial interview;
  • determines if the individual has a barrier that prevents the individual from using this process;
  • completes Form H1172, EBT Card, PIN and Data Entry Request, marking the method of PIN selection/issuance; and
  • refers the PCH to issuance staff.

If the advisor postpones issuing a Lone Star Card on a pended application, the advisor must postpone sending Form H1172 to issuance staff. If the advisor later certifies the application, the advisor sends the completed Form H1172 to issuance staff showing the method of PIN selection/issuance.

The advisor follows the same procedures when setting up a secondary cardholder in the local office. In addition, the advisor uses Form SCRF, Second Cardholder Request Form, to serve as authorization for PIN selection/issuance. The advisor sends this form to the Austin DPC for imaging and storage in the repository. The PCH must go with the secondary cardholder to the local office to authorize PIN selection/issuance, except in the emergency situations described in B-232.2, Secondary Cardholder Established by Issuance Staff.

If a cardholder has a problem remembering a pre-assigned PIN, the advisor should encourage the individual to choose a new PIN. If the PCH still has a problem remembering the PIN, issuance staff refers the cardholder to the advisor to discuss assigning a secondary cardholder.

A new PIN is not required for a Lone Star Card replacement unless the PIN has been forgotten or compromised.

 

B—234.2 Initial PIN Self-Selection Procedures

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Before a cardholder self-selects a PIN, issuance staff explains that the individual must call the Lone Star Help Desk from a touch-tone phone and follow the prompts. The cardholder should be advised to be prepared with a four-digit PIN that can be easily remembered, the cardholder's biographical data, and the Lone Star Card.

 

B—234.2.1 Initial PIN Self-Selection Procedures for TANF Protective and Representative Payees

Revision 15-4; Effective October 1, 2015

 

TANF

If a TANF protective or representative payee will self-select a PIN, the advisor:

  • makes the appropriate entries on the Issuance – Details page by indicating there is an alternate payee and subsequently adding the TANF protective or representative payee to the Alternate Payee – Summary page; and
  • completes Part I of Form H1175, Authorization for Administrative Terminal Application Action, and sends Form H1175 to the EBT clerk to enter additional data to the PCH record through the ATA.

At the time of disposition, advisors must ensure that TIERS has successfully included the PCH record for the TANF protective or representative payee by reviewing the Issuance – Details page and the Alternate Payee – Summary page.

Note: Because the PCH must use biographical data to access PIN selection through the Lone Star Help Desk AVR system, the EBT clerk must enter the additional data to the PCH record using the Form H1175/ATA process. TIERS does not collect this data on TANF protective or representative payees; therefore, TIERS cannot send this information to the EBT system.

EBT staff securely files the signed, original Form H1175.

Advisors follow all other regular procedures for PIN self-selection.

 

B—234.3 Initial PIN Issuance Procedures for Clients with Barriers that Prevent PIN Self-Selection

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

When a cardholder receives a pre-assigned PIN because of a barrier that prevents the person from choosing a PIN, the advisor completes Form H1172, EBT Card, PIN and Data Entry Request, to request that issuance staff have the vendor mail a PIN packet.

If interviewing someone other than the primary cardholder (PCH), the advisor gives a completed Form H1172 to issuance staff to request mail-out of a PIN packet to the PCH's address.

If a cardholder leaves the office without picking up a PIN packet, or if the advisor later certifies an application for which the advisor postponed card and PIN issuance, issuance staff take the actions listed in the following chart.

If the PCH ... then ...
has a secure mailing address,
  • Request that the vendor mail a PIN packet.*
does not have a secure mailing address,
  • note on the bottom of Form H1172 that issuance staff did not issue a PIN packet; and
  • send Form H1172 to the DPC in Austin for imaging.

* Exception: For expedited applications in situations that require mailing a PIN packet, the PCH may self-select a PIN by using the PIN pad device at the local office.

If the cardholder returns for the PIN packet, issuance staff:

  • must complete and sign a new Form H1172; and
  • issue the PIN packet following regular procedures.

Note: Advisors must not use whiteout or other correction fluid on Form H1172. A single line should be drawn through any error to make the correction.

 

B—234.4 PIN Security

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Advisors must instruct individuals not to:

  • write their PIN on their Lone Star Card sleeve;
  • keep their PIN near their Lone Star Card; or
  • share their PIN with anyone else.

 

B—235 Lone Star Card Replacement

Revision 14-4; Effective October 1, 2014

 

TANF and SNAP

An EBT vendor or HHSC replaces a Lone Star Card when a cardholder has an open EBT account and cannot access the account because the person’s Lone Star Card was lost or stolen or does not work properly.

If a primary or secondary cardholder reports a Lone Star Card is lost, stolen, damaged or not working, an EBT vendor mails the replacement card to the PCH's TIERS address within two calendar days of the request. If the TIERS address is not current, the help desk refers the individual to 2-1-1 to update the address.

In certain situations, the local office replaces Lone Star Cards. The same policies and procedures for replacing cards for PCHs apply to the secondary cardholders, except that the PCH must accompany the secondary cardholder to the local office to authorize the replacement, as required in B-232.2, Secondary Cardholder Established by Issuance Staff.

SNAP

In an effort to reduce trafficking, the EBT vendor tracks the number of replacement cards issued in a 12-month period. After the initial card issuance to a PCH or secondary cardholder, when a household requests four replacement cards within 12 months, the EBT vendor produces a report for the print vendor. The print vendor sends the household an excessive replacement card notice. The notice advises the household that:

  • four replacement cards were issued in a 12-month period; and
  • if the household requests a fifth replacement card, the Office of Inspector General (OIG) will receive notification and may investigate the case.

The notice also provides a reminder of what constitutes trafficking.

The excessive replacement card notice directs households to contact 2-1-1 for any questions regarding the notice. Households inquiring about the notice at local offices should be reminded of appropriate EBT card use and the penalties for trafficking.

The EBT vendor produces a monthly report for OIG identifying households that request a fifth replacement card.

 

B—235.1 Lone Star Card Replacement Procedures

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

When a cardholder contacts the local office to request a Lone Star Card replacement, advisors determine the correct action using the following chart:

If the card ... then ...
does not work, issuance staff inquire on the ATA to ensure the card is correctly connected to the account.
was destroyed in a household disaster as described in B-344, Destroyed Food, issuance staff replace the card only if the household needs access to its account immediately and cannot wait for a replacement by mail. Verify the disaster as explained in B-344.
is lost or stolen, refer the cardholder to the Lone Star Help Desk. Help-desk staff freeze the person's Lone Star Card and send a replacement by mail.*

* Exceptions: Issuance staff replace Lone Star Cards via the ATA for cardholders, including Centralized Benefit Services (CBS) recipients, if:

  • the household is certified for a SNAP application that requires a priority issuance. The advisor refers the individual to issuance staff for an immediate replacement. To provide a written referral, the advisor may annotate in the comment section of Form TF0001, Notice of Case Action, "Priority Issuance — card replacement needed." The local office cannot require an appointment to replace the card in this situation.
  • the individual cannot obtain a replacement from Lone Star Help Desk staff because the EBT system does not reflect the cardholder's correct biographical information or current mailing address.
  • the household does not have a secure mailing address. A local eligibility determination office is not a secure mailing address for this purpose.
  • the individual has not received a previously requested replacement from the Lone Star Help Desk within seven calendar days after the order date reflected on the ATA. Staff must highlight these replacements on Form H1173, EBT Card Issuance and PIN Self-Selection/Issuance Log, and report them to the regional director or designee at the end of each month.

When replacing Lone Star Cards, Form H1172 is not required. Issuance staff verifies the identity of the person requesting the replacement and logs the replacement on Form H1173. See Form H1173 instructions.

 

B—236 PIN Replacement

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

If the cardholder reports they forgot their PIN or that the PIN has been compromised, the cardholder should be referred to the Lone Star Help Desk AVR to select a PIN. If the cardholder is unable to self-select a PIN after two attempts, a help-desk operator offers to:

  • provide training/assistance in the PIN self-selection process; or
  • mail a PIN packet to the PCH's address if the individual has a barrier that prevents the individual from self-selecting a PIN.

If the cardholder is unable to self-select a PIN because incorrect biographical data was entered, the AVR refers them to 2-1-1 for PIN replacement.

 

B—236.1 PIN Replacement Procedures

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

When a cardholder requests a PIN replacement, advisors may use the procedures in the following chart:

If the cardholder ... then ...
reports that their PIN is compromised or forgets their PIN,* refer the cardholder to the Lone Star Help Desk to select their PIN through the AVR.
reveals their PIN to staff, issuance staff must immediately have the cardholder self-select a new PIN.

* Exception: Issuance staff use the ATA to replace the PIN with a vendor-mailed PIN packet if a cardholder has a barrier that prevents the individual from self-selecting a PIN, for these situations and in each situation described under the exceptions for card replacement.

 

B—237 Returned Lone Star Cards and PIN Packets

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

When Lone Star Cards or PIN packets are returned to the office, issuance staff logs the card/PIN packet as returned on the Void/Return Log. A person designated in the regional security procedures immediately destroys and disposes of the card/PIN packet before a witness. See the Security and Accountability Handbook, Appendix VIII.

If the Lone Star Card is returned ... then the local office ...
in person,
  • determines the reason for the return; and
  • takes the appropriate case action.
by mail, takes the appropriate case action to ensure the address is current.

 

B—238 Erroneous PIN Entry

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

If someone makes five attempts in a 24-hour period to use a Lone Star Card with the wrong PIN, the system temporarily deactivates the card. This security measure helps to prevent fraudulent use of a stolen card. To reactivate the card:

  • the cardholder must call the Lone Star Help Desk; or
  • issuance staff reset the PIN count using the ATA.

 

B—239 Client EBT Training Policy

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

HHSC must instruct the cardholder about their rights and responsibilities related to EBT.

 

B—239.1 Advisor Interview Requirements for Client Training

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

The advisor gives the individual:

  • Form H1184, Here Is Your Lone Star Card;
  • Form H1185, Important Information About Your Lone Star Card; and
  • the Second Cardholder request form.

The advisor also discusses the following issuance-related items with applicants during the interview, even if the application is pended:

  • the need for a Lone Star Card and PIN as explained in B-233, Issuing a Lone Star Card, and B-234, Personal Identification Number (PIN) Selection and Issuance;
  • how and where to use the Lone Star Card, including the use of TANF and/or SNAP benefits and keeping receipts;
  • availability and procedures for designating secondary cardholders;
  • availability of initial and ongoing benefits (circle/highlight the cardholder's specific TANF and/or SNAP availability date on Form H1184, Here Is Your Lone Star Card;
  • Lone Star Card and PIN security and responsibility for benefits in the EBT account;
  • when to contact the advisor/clerk vs. card issuance staff or the EBT vendor (point out written explanations on Form H1019, Report of Change, and on Form H1185, Important Infomation About Your Lone Star Card;
  • dormant account procedures;
  • cashing out TANF benefits before moving out of Texas and procedures for using the Lone Star Card to access TANF and/or SNAP benefits in other states as explained in B-351, Moves Out of State; and
  • advising the individual to read the training pamphlet while waiting for card and/or PIN issuance and to ask issuance staff if the individual still has questions about EBT.

 

B—239.1.1 Client Fee Policy

Revision 18-1; Effective January 1, 2018

 

SNAP

For SNAP, there are no fees.

TANF

For TANF, there is never a fee for:

  • a purchase;
  • a cash withdrawal with a purchase;
  • a cash only withdrawal under $50; or
  • the first two cash-only withdrawals of $50 or more per cash account per calendar month.

The advisor uses Form H1184, Here Is Your Lone Star Card, to explain the TANF cash-back fee policy to the individual.

  • After the second cash-only withdrawal of $50 or more in a calendar month, stores may choose to charge a fee of up to 50 cents for each additional cash-only withdrawal of $50 or more.
  • The store subtracts the fee from the cash the cardholder requests.
  • The cardholder may determine whether the store can charge a fee for a cash withdrawal based on the authorization number on the receipt. The following chart from Form H1184 may be used to explain this policy to the individual.
Lone Star Card Fees
Using TANF to buy items. No fee.
Getting cash back when using TANF to buy items. No fee.
Taking $49 or less out of your TANF account. No fee.
Taking $50 or more out of your TANF account. Two free per month, then 50 cents each.

 

 

B—239.2 Issuance Staff Requirements for Client Training

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

Issuance staff gives the PCH or person interviewed a card sleeve.

When the local office establishes someone as a secondary cardholder, issuance staff provides the person with all the training materials, except the Second Cardholder request form.

Issuance staff also provides more detailed training if the cardholder requests it or does not understand how to use the Lone Star Card.

 

B—240 Special Certification Situations

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Advisors follow the procedures in this section for households with special needs.

Related Policy
Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities, B-440
Residents in Family Violence Shelters, B-450
Prepared Meal Services, B-460

 

B—241 Applications Processed by Hospital-Based Advisors

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

As specified in the regional security procedures, advisors use the following local office procedures for the EBT activities listed:

  • Lone Star Card issuance and PIN self-selection/issuance – use procedures in B-233, Issuing a Lone Star Card, and B-234, Personal Identification Number (PIN) Selection and Issuance; and
  • transmittal of PAN via Form H1172, EBT Card, PIN and Data Entry Request, to issuance staff for data entry.

 

B—242 Itinerant Advisor Site

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

As specified in the regional security procedures, use the following local office procedures for the EBT activities listed:

  • Lone Star Card issuance and PIN self-selection/issuance – use procedures in B-233.2.4, Applicants Interviewed by Home Visit; and
  • transmittal of PAN and, if applicable, PIN control number via Form H1172, EBT Card, PIN and Data Entry Request, to issuance staff for data entry.

 

B—242.1 Expedited Applications

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

If the person is entitled to expedited SNAP benefits, staff:

  • issues the Lone Star Card and training material;
  • asks the person to select a PIN through the Lone Star Help Desk AVR or issues a vendor-mailed PIN packet if they have a barrier that prevents them from self-selecting a PIN;
  • obtains the individual's signature on Form H1172, EBT Card, PIN and Data Entry Request, to verify the PAN number of the Lone Star Card; and
  • ensures:
    • the PCH record is created;
    • PAN is entered; and
    • benefits are issued the same day.

 

B—242.2 Card/PIN Replacements

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

If a person served by an itinerant advisor contacts the local office and qualifies for a replacement card and/or PIN from the local office, the person has two options for local office replacement:

  • travel to the nearest eligibility determination office to get the replacement and self-select a PIN using the PIN pad device; or
  • have the advisor bring a replacement during the next visit to the itinerant site. EBT staff records the replacement on Form H1173, EBT Card Issuance and PIN Self-Selection/Issuance Log, with an "R" code in the first column. The EBT clerk must data enter the replacement PAN and/or PCN into the ATA upon the advisor's return to the office.

Note: The person may also choose to obtain the replacement card via the Lone Star Help Desk and/or self-select a PIN through the help-desk AVR.

 

B—243 Centralized Benefit Services (CBS) Cases

Revision 15-4; Effective October 1, 2015

 

SNAP

Follow procedures in this section for CBS cases.

Related Policy
Centralized Benefit Services (CBS) Section, B-474

 

B—243.1 Centralized Benefit Services (CBS) Case Changes

Revision 15-4; Effective October 1, 2015

 

SNAP

Local office staff must not attempt to:

  • issue benefits on a CBS case;
  • make other changes to a CBS case; or
  • make changes to the biographical data of a CBS individual.

When regional staff dispose a case when a SNAP-Supplemental Security Income (SNAP-SSI) or SNAP-Combined Application Project (SNAP-CAP) EDG is present, TIERS will not allow the advisor to dispose the CBS EDG. A task is generated for CBS staff to dispose the CBS EDG on the same day. If the client has lost SSI benefits, the EDG would no longer be considered SNAP-SSI or SNAP-CAP and can be disposed by non-CBS staff.

 

B—243.2 Initial Lone Star Card and PIN Issuance for New PCHs

Revision 13-3; Effective July 1, 2013

 

SNAP

CBS makes a change on a SNAP EDG requiring a new PCH record when a household:

  • is assigned a new EDG name; or
  • moves in or out of a D&A treatment center or GLA that serves as an AR.

When CBS sends a new Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP) PCH record to the EBT system, the EBT vendor responsible for card issuance automatically mails the new cardholder a Lone Star Card, PIN, and training material.

CBS staff also have the capability to send a request through the ATA, which authorizes the EBT vendor to mail a Lone Star Card and EBT training materials (and PIN packet, if desired) to a new PCH.

 

B—243.3 Lone Star Card Replacement

Revision 15-4; Effective October 1, 2015

 

SNAP

When a CBS case cardholder requests a Lone Star Card replacement, the individual must call the Lone Star Help Desk to request a replacement by mail.

Exception: CBS individuals may obtain replacement Lone Star Cards in the local office if they meet those replacement criteria. See B-235.1, Lone Star Card Replacement Procedures.

 

B—243.4 PIN Replacement

Revision 18-1; Effective January 1, 2018

 

SNAP

When a CBS case cardholder requests a PIN replacement, they must call the Lone Star Help Desk AVR to select a new PIN.

If the cardholder is unable to self-select a PIN after two attempts, a help-desk operator offers to:

  • provide training/assistance in the PIN self-selection process; or
  • mail a PIN packet to the PCH's address if the cardholder has a barrier that prevents them from self-selecting a PIN.

 

B—244 Homeless

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

If the office permits homeless individuals to use the local eligibility determination office as their mailing address, the office must follow their regional security procedures to process EBT-related mail. Staff must also advise these individuals to come to the local office if they require a Lone Star Card or PIN replacement.

SNAP

Homeless individuals may use SNAP benefits to purchase prepared meals.  Procedures are included in B-462, Prepared Meals for Homeless.

 

B—245 SNAP Applications Filed with the Social Security Administration (SSA)

Revision 13-3; Effective July 1, 2013

 

SNAP

The advisor must follow procedures for phone interviews. See B-233.2.2, Applicants Interviewed by Phone.

 

B—250 EBT Benefit Issuance

Revision 05-4; Effective August 1, 2005

 

TANF and SNAP

HHSC credits benefits to the cash or food account by sending a benefit record to the EBT system. This section describes the availability of those benefits for use by the cardholder.

 

B—251 Monthly Benefit Issuance Schedule

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

HHSC sends the files of benefit records for monthly issuances to the EBT system after cutoff each month.

TANF

TANF monthly benefits issued via EBT are available on a staggered basis over the first three days of the month, based on the last number in the EDG number, as follows:

Last digit of TANF EDG number Day
0, 1, 2, 3 1
4, 5, 6 2
7, 8, 9 3

SNAP

SNAP monthly benefits are available on a staggered basis over the first 15 days of the month, based on the last number in the EDG number, as follows:

Last digit of the SNAP EDG number Day
0 1
1 3
2 5
3 6
4 7
5 9
6 11
7 12
8 13
9 15

 

B—252 Benefit Issuance on Applications

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Advisors provide benefits according to the timeliness standards in B-112, Deadlines. Benefit issuances for certified applications are available immediately upon being credited to the account. Benefits requested after cutoff for the next month are available on the first day of the next month, except for SNAP-combined allotments.

SNAP

The advisor may issue EBT SNAP benefits very quickly in situations that meet the HHSC criteria for a priority issuance. Advisors may request priority issuances only for SNAP benefits in three situations:

  • expedited applications,
  • regular applications certified on or after the 25th day, and
  • benefits ordered by a hearing officer decision that requires a priority issuance to meet timeliness requirements.

The system credits benefits to the individual's account within one hour.

 

B—253 Methods for Sending Benefit Records

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

A benefit record may be sent two ways to the EBT system. TANF benefit records are sent only from TIERS. SNAP benefit records are normally sent only from TIERS, but priority issuances may also be sent by manual ATA entry.

  1. TIERS — This is the primary method of sending TANF and SNAP benefit records to the EBT system to credit a benefit to the individual's account.
  • Real time interface – credits the account right away, or
  • Overnight batch file – credits the account by the next day.
  1. Manual ATA entry — Use this process only to issue priority SNAP benefits when TIERS is unavailable.

Note: Manual ATA entry must have supervisor approval.

TANF and SNAP

When the advisor certifies an application, the EBT system credits:

  • SNAP priority issuances to the individual's account within one hour after EDG disposition; and
  • TANF benefits and SNAP benefits that are not priority issuances to the individual's account by 8 a.m. CST the day after the EDG is disposed.

 

B—254 Benefit Issuance When TIERS Is Unavailable

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Two types of “TIERS unavailable” cases are:

  • TIERS Down – TIERS is completely unavailable and the application/case cannot be accessed.
  • TIERS Read-Only – TIERS is in read-only mode and workers can access TIERS.

When TIERS is Down or is Read-Only, staff must:

  • perform the interview;
  • manually complete essential information on appropriate handbook forms;
  • provide the client with manual notice; and
  • enter information into TIERS Data Collection pages once TIERS becomes available.

 

B—254.1 Priority Issuances

Revision 15-4; Effective October 1, 2015

 

SNAP

When TIERS is Down or is Read-Only, staff must:

  • obtain the individual's signature on Form H1855, Affidavit for Nonreceipt or Destroyed Food Stamp Benefits;
  • complete Form H1175, Authorization for Administrative Terminal Application Action, for ATA entry;
  • receive approval by supervisor and EBT regional coordinator; and
  • send all case-related information and forms to the Data Processing Center for imaging.

When TIERS becomes available (fully operational), staff must complete data entry of case materials in TIERS and follow the normal flow for missing information received after an interview.

Staff designated in the regional security procedures must reconcile ATA benefit record entries.

 

B—255 Priority Issuances Using the Administrative Terminal Application (ATA)

Revision 15-4; Effective October 1, 2015

 

SNAP

To send the benefit record via ATA data entry, the advisor:

  • obtains the individual's signature on Form H1855, Affidavit for Nonreceipt or Destroyed Food Stamp Benefits;
  • completes Form H1175, Authorization for Administrative Terminal Application Action, for ATA entry; and
  • receives approval by supervisor and EBT regional coordinator.

Staff designated in the regional security procedures must reconcile ATA benefit record entries.

 

B—256 Discrepancies on Benefit Records Sent via the ATA

Revision 15-4; Effective October 1, 2015

 

SNAP

When there is a discrepancy between the benefit records in TIERS and the EBT system, advisors may use the following chart to determine how actions are processed in TIERS and the EBT system:

If the benefit amount reported to TIERS is ... then ...
more than the amount authorized on the ATA, the EBT system updates the household's benefit account to reflect the amount reported in TIERS.
less than the amount authorized on the ATA, TF-07E-01, EBT Reconciliation Exception Report, is produced and sent to the EBT regional coordinators for distribution.

Related Policy
TF-07E-01, EBT Reconciliation Exception, B-262.5
Advisor Action on TF-07E-01, B-262.5.1

 

B—260 Administrative Terminal Application (ATA)

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

The ATA allows direct access to the EBT system through a web-based program. Designated staff, other than the EBT clerk, must completeForm H1172, EBT Card, PIN and Data Entry Request, or Form H1175, Authorization for Administrative Terminal Application Action, to authorize action on the ATA.

 

B—261 ATA Functions

Revision 02-1; Effective January 1, 2002

 

TANF and SNAP

Designated staff uses the ATA to perform authorized functions. There are multiple functions that can be performed using the ATA; therefore, there are multiple levels of access secured by individual sign-on IDs.

 

B—261.1 Issuing a Lone Star Card and PIN or Enabling PIN Self-Selection

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Designated local office staff uses the ATA to issue Lone Star Cards and/or PINs or enable PIN self-selection when:

  • establishing a new PCH,
  • replacing a Lone Star Card and/or PIN, or
  • establishing a secondary cardholder in the local office.

The advisor completes Form H1172, EBT Card, PIN and Data Entry Request, Part I, to:

  • request issuance of a Lone Star Card, and/or
  • indicate that the cardholder will select their PIN, or
  • request issuance of a PIN.

 

B—261.2 Creating a Cardholder Record

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Designated staff uses the ATA to create a secondary cardholder record in the local office.

The advisor completes Form H1175, Authorization for Administrative Terminal Application Action, Part I, to establish a new cardholder record via the ATA.

 

B—261.3 Splitting and Merging Primary Cardholder Records

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Designated local office staff uses the ATA to split and/or merge PCH records.

 

B—261.3.1 Splitting Primary Cardholder Records

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Designated staff uses the ATA to split primary cardholder records when EBT accounts are incorrectly linked.

EBT accounts may be incorrectly linked when the advisor fails to correctly reassign a denied TANF EDG number. As a result, the EBT system links the food account to a cash account with a denied EDG number.

The advisor completes Form H1175, Authorization for Administrative Terminal Application Action, Part IV, to request that designated staff separate the incorrectly linked accounts.

 

B—261.3.2 Merging Primary Cardholder Records

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

Designated local office staff uses the ATA to merge PCH records when the EBT system cannot link them because of discrepancies in the cardholder's biographical data.

Discrepancies may occur in the cardholder's biographical data when the advisor does not correctly match the EDG name, date of birth (DOB), sex, or SSN on an individual's TANF and SNAP EDG. As a result, the EBT system cannot merge the two PCH records into one record with a link to both accounts and the cardholder needs a Lone Star Card for each account.

If the individual wants to use one card to access both accounts, the advisor completes Form H1175, Authorization for Administrative Terminal Application Action, Part V, to authorize the merge. When the cardholder has one card for the cash account and another for the food account before the merge, the ATA user indicates which card the individual wants to use. After completing the merge, the EBT system automatically disables the card not chosen and it must be destroyed.

Note: Advisors must not attempt a merge if the individual has any outstanding manual voucher purchases that must be reconciled by the EBT vendor. If the ATA displays the message, "NEED TO SETTLE OUTSTANDING VOICE AUTHORIZATION," the advisor should notify the EBT site coordinator.

 

B—261.4 Updating a Primary Cardholder Record

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

When data on the PCH record needs to be updated on the EBT system, issuance staff use the ATA to update it if the cardholder's EDG is no longer active in TIERS.

The advisor completes Form H1175, Authorization for Administrative Terminal Application Action, Part III, to authorize the PCH record update via the ATA.

 

B—261.5 Creating a SNAP Benefit Record

Revision 01-7; Effective October 1, 2001

 

SNAP

HHSC strictly limits the use of the ATA for SNAP benefit authorization to system downtime that prevents the timely issuance of priority SNAP benefits, or as specified in the regional security procedures.

Advisors must complete Form H1175, Authorization for Administrative Terminal Application Action, Part II, to authorize benefit data entry into the ATA following established sign-off procedures.

Designated staff completes ATA data entry only after receipt of Form H1175.

 

B—261.6 Performing ATA Inquiry

Revision 01-7; Effective October 1, 2001

 

TANF and SNAP

Designated local office staff uses the ATA to perform benefit record inquiry or validate that a particular Lone Star Card is active. The advisor completes Form H1172, EBT Card, PIN and Data Entry Request, Part I, to request validation of a previously issued Lone Star Card.

Designated regional staff uses the ATA to perform transaction history inquiry.

 

B—261.7 Changing an EDG Number

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

EDG numbers cannot be changed, but multiple EDGs can be entered and connected to the same card.

 

B—261.8 Requiring Card Registration or Registering a Lone Star Card

Revision 01-3; Effective April 1, 2001

 

TANF and SNAP

This section explains when designated local office staff uses the ATA to require card registration or register a Lone Star Card.

 

B—261.8.1 Requiring Card Registration

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Designated local office staff uses the ATA to require card registration when:

  • issuing a card to someone other than the PCH, or
  • mailing a card.

 

B—261.8.2 Registering a Lone Star Card

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Designated local office staff uses the ATA to register a Lone Star card if using the special procedures for a PCH with a barrier that prevents the PCH from registering his card through the regular Lone Star Help Desk process.

If ... then ...
  • issuing a card to someone other than the PCH, or
  • mailing a card,
the advisor completes Form H1172, EBT Card, PIN and Data Entry Request, Part I, indicating that card registration is required.
using the special procedures for a PCH with a barrier that prevents him from registering his card through the regular help desk process, the local office EBT site coordinator or designated staff, other than the EBT clerk, completes Form H1175, Authorization for Administrative Terminal Application Action, Part VI, to authorize registration.

 

B—261.9 Reactivating a Lone Star Card

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Lone Star Help Desk staff or designated local office staff uses the ATA to reset the PIN count and reactivate a card that was deactivated because the cardholder entered the wrong PIN five times in a 24-hour period.

 

B—262 Reconciliation

Revision 01-7; Effective October 1, 2001

 

This section provides general information about reconciliation. For details, see the Security and Accountability Handbook.

 

B—262.1 Reconciling Administrative Terminal Application (ATA) Benefit Records to Forms H1175

Revision 15-4; Effective October 1, 2015

 

SNAP

Each day EBT staff designated in the regional security procedures prints the local Administrative Terminal Report. This report contains a list of benefit records manually entered on the ATA, sorted by ATA user. A designated individual(s) must check these entries against Form H1175, Authorization for Administrative Terminal Application Action, on a daily basis to ensure accuracy.

 

B—262.2 Reconciling Benefit Records

Revision 14-2; Effective April 1, 2014

 

SNAP

Each day EBT staff use the list of benefit issuances on the Administrative Terminal Report to reconcile the ATA benefit record entries with Form H1175, Authorization for Administrative Terminal Application Action, within five days to correspond to the benefit records sent via the ATA, state office sends exception reports (TF-07E-01/TG-37E-1) to field offices to clear within established time frames. Regional monitoring and tracking procedures apply.

To avoid exception reports, EBT staff must ensure that advisors report issuances via TIERS within three working days.

 

B—262.3 Reconciling ATA Card Issuances to Form H1172

Revision 01-7; Effective October 1, 2001

 

TANF and SNAP

Each day, designated staff uses the list of card issuances on the Administrative Terminal Report to reconcile cards issued with Form H1172, EBT Card, PIN and Data Entry Request.

If the office has problems reconciling these, staff report the problem to the supervisor and to the regional EBT security staff, if necessary, to complete reconciliation.

 

B—262.4 TF-36, More Than One SNAP Benefit Authorized

Revision 13-3; Effective July 1, 2013

 

SNAP

After all issuances for a benefit month have been reconciled, state office produces TF-36 and sends copies to the Fiscal Division and the regional director.

 

B—262.4.1 Advisor Action on TF-36

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors review each SNAP EDG listed on the report to determine how the duplicate issuance occurred (individual error, suspected fraud, coding error), and if applicable, whether the household correctly completed Form H1855, Affidavit for Nonreceipt or Destroyed Food Stamp Benefits, before the duplicate issuance.

If there is an overpayment and ... then ...
a signed Form H1855, submit Form H4834, Individual or Recipient Provider Fraud Referral/Status Report, with the original Form H1855 to the regional Office of Program Integrity, Claims Investigation.
no signed Form H1855, initiate a nonfraud recovery. Refer to B-730, How to File an Overpayment Referral.

After each multiple issuance is reviewed, report individual case findings and recovery actions to the regional TF-36 coordinator.

 

B—262.5 TF-07E-01, EBT Reconciliation Exception

Revision 14-2; Effective April 1, 2014

 

SNAP

When an ATA issuance cannot be reconciled with the TIERS database, state office generates and sends a TF-07E-01 to the supervisor of the employee who processed the last case action. This report serves as the clearance document to report case findings and actions taken.

 

B—262.5.1 Advisor Action on TF-07E-01

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors check the case record to determine:

  • the reason for the reconciliation exception, and
  • whether the amount of benefits provided to the household is correct.
If the amount of benefits is incorrect because of an ... then ...
overpayment, initiate recovery. See B-730, How to File an Overpayment Referral.
underpayment, restore benefits. See B-800, Restored Benefits.

 

B—263 Security

Revision 01-3; Effective April 1, 2001

 

TANF and SNAP

HHSC allows only authorized staff with special permissions to enter data onto the ATA. Staff are designated by office and they must ensure that information entered remains confidential.

HHSC controls the level of access by the sign-on ID of the individual user. Designated employees have authorizations that allow updates to all or part of the system. Other users have inquiry access only.

Refer to the Security and Accountability Handbook for additional information on security.

 

B—270 Management of Automation Processes

Revision 13-3; Effective July 1, 2013

 

The EBT regional coordinator for each region reviews information for each user on a monthly basis and provides verification to Lone Star Business Services by the 15th of each month.

 

B—280 EBT Material Inventory/Distribution

Revision 04-7; Effective October 1, 2004

 

B—281 Vendor-Produced Material

Revision 18-1; Effective January 1, 2018

 

An EBT vendor provides supplies of most EBT-related materials, including:

  • Lone Star Cards;
  • PIN packets;
  • Lone Star Card registration stickers;
  • Lone Star Card mailers;
  • Lone Star Card sleeves;
  • Form H1184, Here Is Your Lone Star Card;
  • Form H1185, Important Information About Your Lone Star Card; and
  • Secondary cardholder request forms.

To order vendor-produced items, designated local office staff completes a request for Lone Star materials and sends it to the EBT regional coordinator for secure and non-secure items.

The EBT regional coordinator or authorized regional staff emails the order to the vendor and Lone Star Business Services. Refer to the Security and Accountability Handbook for specific requirements for security and accountability of Lone Star Cards.

B-300, Account Maintenance

Revision 19-4; Effective October 1, 2019

 

 

B—310 General Policy

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

After HHSC certifies an Eligibility Determination Group (EDG), the advisor uses specific procedures to maintain the Electronic Benefit Transfer (EBT) account and resolve problems.

For information about establishing accounts, see B-200, Issuing Benefits.

 

B—330 Cancelling Benefits

Revision 04-3; Effective April 1, 2004

 

 

B—331 Cancelling Benefits in EBT Accounts

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

When a Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) household moves out of state before the end of the month, advisors must cancel the next month's benefits.

TANF

When a TANF household moves out of state on or after the first of the month but before accessing that month's TANF benefits, the cardholder should use the Lone Star Card to access the TANF benefits at retailers in other states. See B-350, Using Benefits Out of State.

If the cardholder cannot find a retailer that accepts the Lone Star Card, HHSC may mail a benefit conversion warrant (full month's benefit amount only) to the household's new address. The advisor determines if the household accessed that month's benefits via Administrative Terminal Application (ATA) inquiry. Determine if the household accessed that month’s benefits by performing Administrative Terminal (AT) inquiry.

When the agency receives the report of the move:

  • deny the EDG, and
  • advise the individual to withdraw the balance from the EBT account.

Use the following chart to determine the correct action on the next month's benefits.

If the household is ... then ...
ineligible for the next month's benefits because the household left the state before the end of the previous month, cancel the next month's benefits.
eligible for the next month's benefit but unable to use the Lone Star Card out of state,
  • cancel the next month's benefits, and
  • reissue with a warrant to the new address.

Do not consider a benefit cancelled until you confirm it as cancelled via TIERS inquiry.

See A-2533.1, Deleting Months When TANF Benefits are Cancelled or Recouped, when cancelling benefits for an individual whose months count toward a time limit.

SNAP

HHSC cannot cancel benefits in a food account once the availability date is reached.

When the agency receives a report that the individual moved out of state, follow policy in A-740, Moves Out of Texas, and A-750, Temporary Visits Out of Texas, to determine whether to consider the move temporary or permanent. If the move is permanent, deny the EDG.

The cardholder can use the Lone Star Card to access benefits at retailers in other states. See B-350.

Use the TIERS Benefit Issuance – Maintain EBT Benefits – EBT Cancellation pages to cancel the next month’s benefits.

Do not consider a benefit cancelled until it is confirmed as cancelled via TIERS inquiry.

 

B—332 Cancelling Benefits Not Issued by EBT

Revision 13-3; Effective July 1, 2013

 

TANF

If an individual returns a warrant,

  • give the individual the original Form H4100, Money Receipt; and
  • send the first copy of Form H4100, the warrant, and Form H1008-A, Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-receipt of Warrant, explaining the reason for the returned warrant to Fiscal Management, Mail Code 3500.

 

B—340 Replacing Benefits

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

HHSC issues benefits via warrant or EBT. Staff replaces TANF warrants in certain situations and TANF or SNAP benefits issued via EBT in rare situations.

Related Policy
Destroyed Food, B-344

 

B—341 Replacement of Benefits Issued via EBT

Revision 04-3; Effective April 1, 2004

 

TANF and SNAP

EBT systems and procedures are designed to minimize loss and theft of individual benefits. As a result, HHSC is rarely liable for a replacement due to loss of benefits from an EBT account.

HHSC replaces benefits issued via EBT when lost through unauthorized use of the account only if the loss occurred:

  • after the individual reports the Lone Star Card lost or stolen;
  • because of local eligibility determination office card/PIN issuance error; or
  • because of an unlawful or other erroneous action on the part of HHSC or an HHSC contractor.

Do not replace benefits withdrawn from an account before the individual reports the Lone Star Card lost or stolen.

 

B—341.1 Procedures for Replacing EBT Benefits

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

If a person receiving EBT reports benefits are stolen or lost from the individual's EBT account, refer the person to the Lone Star help desk. The help desk staff researches the account credits and debits and works with state office staff to determine if any unauthorized use occurred. If state office staff determines a replacement is due because of unauthorized access or card issuance error, the replacement is authorized. See B-382.2, Balance Disputes, for resolution procedures.

If a loss occurs because of a card/PIN issuance error, go through regional channels to contact state office Lone Star Business Services (LSBS) by email at EBT_Operations@hhsc.state.tx.us.

 

B—342 Non-Receipt of TANF Warrants

Revision 13-3; Effective July 1, 2013

 

TANF

If an individual reports that a warrant was lost, stolen, or not received, check TIERS inquiry to see if the warrant was returned to Fiscal Management Services (FMS). If necessary, update the individual’s address in TIERS.

When the warrant is returned to state office, FMS staff checks inquiry for a new address and immediately re-mails the check.

 

B—342.1 Procedures for Replacing TANF Warrants

Revision 13-3; Effective July 1, 2013

 

TANF

Send Form H1008-A, Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-Receipt of Warrant, to FMS if:

  • the individual does not receive the warrant by the 10th day after HHSC mailed it; and
  • inquiry shows the warrant was not returned to FMS.

Exception: Send Form H1008-A immediately if it is obvious that a warrant was stolen or destroyed. Indicate under "Comments" the reason for this special processing request.

The advisor may:

  • fax Form H1008-A to FMS at 512-487-3400; or
  • send Form H1008-A via email. See the Electronic Transmittal section of Form H1008-A instructions for email addresses.

To check on the status of Form H1008-A, the advisor may call Fiscal Management at 512-487-3435.

After receiving Form H1008-A, FMS:

  • completes TIERS inquiry to verify warrant information/status; and
  • obtains the warrant payment status from the State Comptroller.

 

B—342.1.1 Warrant Not Cashed

Revision 13-3; Effective July 1, 2013

 

TANF

If the warrant was not returned to FMS or cashed, FMS:

  • notifies the State Comptroller to cancel the warrant;
  • receives notification from the State Comptroller when the warrant is cancelled; and
  • issues a replacement warrant. The word "Replacement" is printed in the upper right corner above the warrant number on the face of the warrant. TIERS inquiry identifies replacement warrants in Benefits Issuance under Issuance Status as “Issued” and Benefit Type as “Replacement."

If the individual reports receipt of the original warrant after the advisor sends Form H1008-A, Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-receipt of Warrant, call FMS at 512-487-3435 to discontinue the inquiry/replacement process. Instruct the individual not to cash the warrant until Fiscal Division notifies the advisor that it discontinued the replacement process.

 

B—342.1.2 Warrant Cashed

Revision 13-3; Effective July 1, 2013

 

TANF

If the warrant was cashed, Fiscal Division:

  • updates warrant status in TIERS; and
  • sends the advisor:
    • a cover memo with instructions;
    • a copy of the warrant;
    • Form 6059-A, Determination of the Validity of a Forgery Claim; and
    • Form 6059-B, Affidavit of Forgery.

The advisor:

  • investigates to determine if the warrant was forged and if the individual received the benefit from the warrant; and
  • completes Form 6059-A to document the determination.
If the advisor determines the warrant was ... then the advisor ...
forged,
  • completes Form 6059-B
  • requests that the individual sign the form, and
  • returns Forms 6059-A and B to FMS.
not forged, sends only Form 6059-A to FMS.

FMS:

  • requests that the State Comptroller charge the warrant back to the original cashing establishment;
  • updates the TIERS warrant history when the Comptroller notifies HHSC that the warrant was charged back;
  • prepares and submits a cancellation voucher to the State Comptroller;
  • updates the TIERS warrant history when the Comptroller notifies HHSC that warrant was cancelled; and
  • issues a replacement warrant.

 

B—343 Non-Receipt of One-Time Payments

Revision 01-3; Effective April 1, 2001

 

TANF

If a household reports nonreceipt of a one-time payment, use the procedures in this section to reissue the benefits.

 

B—343.1 Reissuing Grandparent Payments

Revision 01-3; Effective April 1, 2001

 

TANF

If a household reports it did not receive the one-time grandparent payment, the advisor:

  • completes Form H1084, Certification for Warrants Lost, Destroyed, Stolen, or Not Received;
  • requires the grandparent caretaker/payee to sign the certification on the form; and
  • sends it to FMS.

 

B—343.2 Reissuing OTTANF Benefits

Revision 12-1; Effective January 1, 2012

 

TANF

Use Form H1008-A, Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-Receipt of Warrant, to request reissuance of lost or stolen OTTANF warrants.

The advisor may fax Form H1008-A to FMS at 512-487-3400. Write "OTTANF" across the top of the form.

 

B—344 Destroyed Food

Revision 01-5; Effective July 1, 2001

 

SNAP

A household disaster may result from a fire, flood, tornado, accident, or other similar events that affect only that household or any number of households. Do not consider damage or destruction resulting from household neglect, such as damaged caused by pets or children, as a disaster.

When the individual reports that food purchased with SNAP benefits was destroyed in a household disaster, issue a replacement unless

  • the individual failed to report the loss within 10 days of the food being destroyed; or
  • the individual was issued an allotment under special Food and Nutrition Service (FNS)-approved disaster-issuance procedures in the same month as the replacement request.

There is no limit on the number of replacements for destroyed food.

 

B—344.1 Procedures for Replacing Destroyed Food

Revision 13-3; Effective July 1, 2013

 

SNAP

To issue a replacement for destroyed food, take the following steps:

Step Action
1 Require the head of household, spouse, or responsible household member to sign Form H1855, Affidavit for Nonreceipt of/Destroyed Food Stamp Benefits. The advisor may mail Form H1855 to the individual for signature if no responsible household member can come to the office because of
  • age or disability, or
  • distance (that is, the individual lives more than 30 miles from the office) and the individual is unable to appoint an authorized representative to bring the form to the office.
Issue a replacement only when the local office receives the completed and signed Form H1855 within 10 days of the request for replacement.
2 Verify the disaster and date by contacting a collateral source, such as the fire department or Red Cross, or by visiting the individual's home.
3 Issue a replacement benefit via TIERS – Benefit Issuance – Request Manual Issuance.

Note: Authorized staff receive an alert to approve the issuance.

 

B—350 Using Benefits Out of State

Revision 18-1; Effective January 1, 2018

 

TANF

Texans who leave the state should be able to use the Lone Star Card to access TANF benefits at retailers in other states.

People from other states may use EBT cards to access TANF benefits at retailers in Texas. When local office staff receive inquiries, advise the cardholder to try the card at stores that accept EBT cards in Texas. If it does not work, advise the person to contact the help desk of the state that issued the card.

SNAP

Texans who leave the state can use the Lone Star Card to access SNAP benefits at retailers in other states.

People from other states may use their EBT cards to access SNAP benefits at retailers in Texas. When local office staff receive inquiries, advise the cardholder to try the card at stores in Texas that accept SNAP benefits. If it does not work, advise the person to contact the help desk of the state that issued the card.

 

B—351 Moves Out of State

Revision 13-3; Effective July 1, 2013

 

TANF

If the household reports a move or temporary absence from Texas, follow the policy in A-740, Moves Out of Texas, and A-750, Temporary Visits Out of Texas, to determine whether to consider the move temporary or permanent.

The cardholder should be able to use the Lone Star Card to access benefits at retailers in other states. Advise the individual of the following:

  • Withdraw any amount of benefits remaining in the cash account before leaving.
  • Take your Lone Star Card.

Note: If the individual reports that the individual does not have a Lone Star Card, advise the individual to contact the Lone Star Help Desk.

  • In order to use cash benefits that were not accessible before the move, try the card at stores that accept EBT in other states. Ask if the store charges a fee and the amount of the fee. Verify and accept any fees before completing the cash withdrawal.
  • Call the Lone Star Help Desk at 1-800-777-7EBT (1-800-777-7328) if your Lone Star Card does not work. The Lone Star Help Desk assists the cardholder in finding an out-of-state retailer that accepts the Lone Star Card. Note: If the cardholder cannot find a retailer that accepts the Lone Star Card and moved out of state on or after the first of the month but before accessing that month's TANF benefits, HHSC may mail a benefit conversion warrant (full month's benefit amount only) to the household's new address. The Lone Star Help Desk will advise these cardholders to contact the local eligibility determination office. See B-331, Cancelling Benefits in EBT Accounts.

SNAP

If the household reports a move or temporary absence from Texas, follow the policy in A-740 and A-750 to determine whether to consider the move temporary or permanent.

The cardholder can use the Lone Star Card to access benefits at retailers in other states. Advise the individual of the following:

  • Take your Lone Star Card.

Note: If the individual reports that the individual does not have a Lone Star Card, advise the individual to contact the Lone Star Help Desk.

  • In order to use SNAP benefits, try the card at stores that accept SNAP in other states.
  • Call the Lone Star Help Desk at 1-800-777-7EBT (1-800-777-7328) if your Lone Star Card does not work. The Lone Star Help Desk assists the cardholder in finding an out-of-state retailer that accepts the Lone Star Card.

 

B—352 Households Shopping Out of State

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Cardholders can use the Lone Star Card out of state. As a result, some households may continue to use benefits without reporting an out-of-state move. Households receiving benefits in Texas who shop out of state consistently, without shopping in Texas, may no longer meet residency requirements. See A-740, Moves Out of Texas, and A-750, Temporary Visits Out of Texas.

 

B—353 Out-of-State Shopping (OSS) Reports

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

State office produces a Non-Border OSS Report and a Border OSS Report monthly. Both reports list Lone Star Card usage for households that:

  • shopped out of state in the last 60 days;
  • did not shop in Texas during that period; and
  • have active EDGs.

The Border OSS Report lists households with Lone Star Card usage in states that border Texas (Arkansas, Louisiana, Oklahoma and New Mexico). The Non-Border OSS Report lists households with Lone Star Card use in states that do not border Texas.

State office sends the Non-Border OSS report to Eligibility Operations each month for appropriate action as a potential change in Texas residence. This data also is included in a combined Data Broker report if the OSS occurred in the prior 12 months.

The Border OSS Report is not sent to Eligibility Operations each month for clearance. The data is included in a combined Data Broker report if the OSS occurred in the prior 12 months. EDGs that appear on the Border OSS Report must be cleared at a complete action after a household submits an application or redetermination.

 

B—353.1 Advisor Action on OSS Report Activity

Revision 19-4; Effective October 1, 2019

 

TANF and SNAP

Clearing Non-Border OSS Report Activity at a Change Action

Send the household Form H1020, Request for Information or Action, requesting verification of the household's address.

Exception: Clearing Non-Border OSS activity as a change action is not required when the household's most recent OSS activity occurred in the:

  • month prior to the periodic review month or in the periodic review month of the household's TANF Eligibility Determination Group (EDG); or
  • next to last benefit month or last benefit month of the household's SNAP EDG.

Clearing Non-Border OSS Report Activity at a Complete Action

The household must provide verification of the household's address when:

  • the most recent OSS activity occurred within six months of the current interview/desk review month; and
  • the OSS activity listed in the report was not previously cleared.

The interview/desk review month is month zero.

Note: Act on any associated Medical Program(s) as appropriate.

After a household has been asked to provide verification of the household's address, take the following action.

If the ... then ...
household provides verification of the household’s address, determine continued eligibility for all programs based on residency requirements.
household does not provide verification of the household’s address, deny the SNAP EDG and any associated TANF/Medical Program EDGs for failure to provide information.
agency receives returned mail with no forwarding address and the household cannot be located, deny the SNAP EDG for failure to provide information and any associated TANF/Medical Program EDGs for unable to locate.

 

Clearing Border OSS Report Activity

The requirement to clear the Border OSS Report only applies at a complete action. This report must be cleared at a complete action when a household submits an application or redetermination and the OSS activity in the report makes the household’s address questionable.

Example: A household living in Texas near the Arkansas border and shopping in Arkansas may not be questionable. A household living in Austin and shopping in Arkansas would be questionable.

When a household’s address is questionable, follow the policy outlined above for clearing a Non-Border OSS Report Activity at a Complete Action. If necessary, send the household Form H1020, Request for Information or Action, requesting verification of the household's address.

 

B—354 Card Replacements for Cardholders Who Are Out of State

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

If a Texas individual who is out of state reports that the individual’s Lone Star Card was lost or stolen, advise the individual to contact the Lone Star Help Desk at 1-800-777-7EBT (1-800-777-7328).

 

B—360 Dormant Accounts

Revision 13-3; Effective July 1, 2013

 

 

 

B—361 Dormant Account Policy

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

The EBT system changes an account status to dormant when a cardholder does not access the account for a specified period depending on:

  • the type of benefits; and
  • if applicable, the monthly benefit amount.

The EBT system notifies TIERS when changing the account status to dormant. TIERS does not place the EDG in suspense status if the EBT account becomes dormant.

The cardholder has access to the EBT account after it is dormant.

TANF

The EBT system changes an account status to dormant when a cardholder does not access the account for three months.

SNAP

The EBT system changes an account status to dormant if a cardholder does not access the account for:

  • three months; or
  • six months, when the household received an issuance of less than $20 for the previous calendar month.

 

B—362 Advisor Action on Dormant Accounts

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Advisors take no action on EBT accounts that become dormant.

Exception: For Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP) EDGs, if the advisor verifies the EBT account is dormant, the advisor must attempt to contact the individual to determine if the individual is having trouble accessing the benefits. Advisors mail Form H1030, Supplemental Nutrition Assistance Program (SNAP) Lone Star Card Assistance.

If the individual fails to contact the advisor by the due date on Form H1030, the advisor must attempt to contact the individual by telephone. If the individual does not respond to either Form H1030 or to telephone calls, advisors take no further action. Advisors must document all attempts to contact the individual.

Related Policy
Shortening Certification Periods as a Result of a Change, B-638

 

B—370 Expunged Benefits

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Expungement is a process in which HHSC removes unused TANF or SNAP benefits from an EBT account and returns them to the state or federal government.

 

B—371 Expungement Policy

Revision 13-3; Effective July 1, 2013

 

TANF

HHSC expunges TANF benefits if:

  • the household does not access its cash account for one year (The entire balance is removed.); or
  • benefits remain in an active or dormant account past their availability period.

The availability period is two fiscal years after the benefit was issued. HHSC expunges these benefits at the end of each fiscal year (August 31).

SNAP

HHSC expunges:

  • SNAP benefits remaining from a particular month's issuance when the:
    • household does not access the account for one year; and
    • benefit was issued more than one year before the expungement file is processed; or
  • the entire food account when the advisor denies a one-person household because of death.

 

B—372 Advisor Procedures for Expunged Benefits

Revision 18-4; Effective October 1, 2018

 

TANF and SNAP

The advisor explains expungement policy to people who inquire about these benefits.

Except for death denials, the advisor informs people who dispute the expungement or believe it was in error that their dispute will be routed to the Regional EBT Coordinator for review. Within two business days of receiving the dispute, the Regional EBT Coordinator will inform the person of the outcome.

SNAP

The advisor is responsible for expungements resulting from death denials.  

If the expungement resulted from an erroneously processed denial, the advisor restores benefits (rounding down to the nearest dollar if the balance includes 49 cents or less, and rounding up if it includes 50 cents or more) using a manual issuance in TIERS within one business day of discovering the error.

Related Policy
Expungement Policy, B-371

 

B—380 EBT Problem Resolution

Revision 04-7; Effective October 1, 2004

 

TANF and SNAP

The local office uses the following procedures to handle EBT-related inquiries from retailers and individuals.

 

B—381 Retailer Inquiries

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

Refer retailers who:

  • have EBT questions to the vendors' retailer Help Desks;
  • need a manual voucher authorization to the Lone Star Retailer’s Help Desk at 877-209-5339; or
  • have questions about U.S. Department of Agriculture (USDA) FNS authorization to the USDA Dallas office at 877-823-4369 or to the USDA website at https://www.fns.usda.gov/snap/RSC.

 

B—382 Client Inquiries

Revision 18-4; Effective October 1, 2018

 

TANF and SNAP

If a person contacts the local office to question an account balance, the advisor resolves the question if it relates to eligibility. If the question does not relate to eligibility, refer the person to the Lone Star Help Desk (800-777-7EBT). People can also call the help desk for questions, such as transaction history and discrepancies with retailers.

A household has 90 calendar days from the date the error occurred in an EBT transaction to request an adjustment. The EBT vendor reviews the request and notifies the household of the vendor’s determination. Within 10 business days the EBT vendor must:

  • investigate the dispute;
  • determine eligibility for an adjustment;
  • send the household a written notice informing them of the decision; and
  • if applicable, deposit the adjustment into the household’s account.

After receiving written notice of the EBT vendor’s decision, if the individual disagrees with the decision, they may contact Lone Star Business Services  for a second review.

The household retains the right to a fair hearing.

Related Policy
Balance Disputes, B-382.2
Advisor Procedures for Expunged Benefits, B-372
Fair Hearings, B-1000.

 

B—382.1 Client Problems Accessing Benefits

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

Contact the local office site coordinator for situations such as:

  • The benefits show in TIERS, but not on the ATA, and both the card and PIN appear to work.
  • The benefits show in the ATA with no benefit number, but do not show in TIERS.

 

B—382.2 Balance Disputes

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

If the individual reports an account balance dispute to the local eligibility determination office, determine if the individual contacted the Lone Star Help Desk.

If ... then ...
yes, forward the complaint to Lone Star Business Services by email at EBT_Operations@hhsc.state.tx.us.
no, refer the individual to the Lone Star Help Desk at 800-777-7EBT.

 

B—382.3 Client Problems with Retailers

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

When a person reports any problem with a retailer, other than an account balance dispute, forward it to the Lone Star Business Services by email at EBT_Operations@hhsc.state.tx.us.

 

B—382.4 Client Problems with an EBT Vendor

Revision 18-1; Effective January 1, 2018

 

TANF and SNAP

When a person reports a problem with an EBT vendor, forward it to the Lone Star Business Services by email at EBT_Operations@hhsc.state.tx.us.

 

B—390 Documentation Requirements

Revision 11-2; Effective April 1, 2011

 

TANF and SNAP

Document the reason for:

  • cancelling benefits (see B-331, Cancelling Benefits in EBT Accounts); and
  • replacing benefits (see B-341.1, Procedures for Replacing EBT Benefits).

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

B-400, Special Households

Revision 19-4; Effective October 1, 2019

 

 

B—410 Students in Higher Education

Revision 13-4; Effective October 1, 2013

 

 

 

B—411 General Policy

Revision 15-4; Effective October 1, 2015

 

SNAP

A student in higher education is one who is enrolled at least half-time (as defined by the institution) in a college or university curriculum that offers degree programs, regardless of whether a high school diploma is required for admittance, or at a business, technical, trade or vocational school that normally requires a high school diploma or equivalent for admittance.

Student higher education policy does not apply to individuals:

  • under age 18 (students are 18 the month after the student's 18th birthday);
  • age 50 or older (students are 50 the month of the student's 50th birthday);
  • enrolled in curricula (such as beauty school or auto mechanics) that do not require a diploma or the equivalent for entrance; or
  • enrolled only in English as a second language curriculum.

Enrollment begins the first day of the first school term. For example, a high school senior might be accepted by a college and register for classes before graduation; however, the Texas Health and Human Services Commission (HHSC) does not consider the student enrolled until the first day of the college term.

Once enrolled, HHSC considers the student enrolled through vacation and recess, until the student graduates, is expelled, drops out, or does not intend to register for the next usual term, excluding summer school. A student remains enrolled between terms, breaks, and during summer vacations unless the student does not intend to return to school the next term.

 

B—412 Student Eligibility Requirements

Revision 15-4; Effective October 1, 2015

 

SNAP

A student qualifies for the Supplemental Nutrition Assistance Program (SNAP) if the student is:

  1. Unfit for employment. If not evident, proof is required from a certified doctor or psychologist, or receipt of permanent or temporary disability benefits issued by government or private sources must be verified.
  2. Employed for pay an average of 20 hours a week. If self-employed, the student must work an average of 20 hours a week and earn at least the federal minimum hourly wage.
  3. Participating during the regular school year in a state or federally-funded work study program. The student must be actually working at a job for pay or for dollar credits against tuition charges. This does not include students who must work for academic requirements, such as interns and student teachers.The student exemption begins the month the school term begins or the work study is approved to begin, whichever is later. The student exemption stops:
  • if the student quits working (unless it results solely from lack of work study funds), or
  • when there is a break between terms of a full calendar month or longer unless the student continues work study during the break.
  1. Enrolled in school through one of the following programs:
    • Workforce Innovation and Opportunity Act (WIOA),
    • Choices,
    • SNAP Employment and Training (E&T),
    • Trade Adjustment Assistance (a program administered by the Texas Workforce Commission), or
    • other state and local government training programs approved by state office as equivalent to E&T.
  2. Participating in an on-the-job training program (classroom study is not considered on-the-job-training for this purpose).
  3. Approved for Temporary Assistance for Needy Families (TANF).
  4. Responsible for the care of a dependent child who is a household member and the child is:
    • under age 6;
    • at least age 6 but under age 12, and the student states there is no available child care to enable the student to attend class and comply with work requirements in Item B or C above.

      Note: If both parents/caretakers are students, both cannot obtain student eligibility by caring for the same child.

  5. A single parent (natural, adoptive or stepparent in the home or other single adult with parental control) who is:
    • enrolled full-time (as determined by the school), and
    • responsible for the care of a child under age 12.

 

B—413 Ineligible Students

Revision 15-4; Effective October 1, 2015

 

SNAP

A student who does not meet the student eligibility requirements is not a member of the household. Do not count the student's income and resources for the remaining household members. If an ineligible student is also disqualified for another reason, the student is treated as a disqualified member.

If an ineligible student is also disqualified for another reason, the student is treated as a disqualified member. Advisors follow resource policy in A-1210, General Policy, and income policy in A-1362, Disqualified Members.

 

B—414 Work Registration

Revision 13-4; Effective October 1, 2013

 

SNAP

Eligible students are exempt from work registration during the regular school term. This exemption continues between terms, breaks and through scheduled school vacations for students who remain enrolled.

 

B—415 Verification Requirements

Revision 16-4; Effective October 1, 2016

 

SNAP

Staff must verify self-employment hours of students who work at least a weekly average of 20 hours and earn at least the federal minimum hourly wage. If the student does not provide verification by the due date, the student will be denied for failure to provide and is considered an ineligible student, unless they meet another student eligibility requirement as described in B-412, Student Eligibility Requirements.

 

B—416 Documentation Requirements

Revision 16-4; Effective October 1, 2016

 

SNAP

Advisors must document the student's eligibility, if questionable.

 

B—420 Other Special Situations

Revision 13-4; Effective October 1, 2013
 

 

B—421 Food Distribution Program on Indian Reservations (FDPIR)

Revision 13-4; Effective October 1, 2013

 

SNAP

FDPIR is a food distribution program that provides commodity foods to low-income households living on an Indian reservation, and to Native American families residing near reservations. The Indian tribe administers this program under approval from the Food and Nutrition Service (FNS). Households eligible for the FDPIR receive a monthly food package based on the number of household members. The only tribe approved in Texas is the Alabama-Coushatta Tribe of Texas in Polk County.

Individuals cannot participate simultaneously in SNAP and FDPIR. An Indian Tribal Household eligible for both programs may participate in only one of the programs of its choice for a given month. The household may switch from one program to the other, but benefits must be ended in one program before certifying the household for the other program. Benefits in the new program can be issued for the month after benefits end in the previous program.

 

B—421.1 Duplicate Participation

Revision 13-4; Effective October 1, 2013

 

HHSC staff must identify household members receiving duplicate benefits with SNAP and FDPIR. The household can be denied from either program. If duplicate participation occurs, a household overpayment occurs for the program that was certified for benefits last. HHSC staff must send an overpayment referral to the Office of Inspector General (OIG) if the overpayment occurred in SNAP.

The Livingston HHSC office receives a list of certified FDPIR households each month.

HHSC staff must:

  • perform inquiry to identify any household members receiving benefits in both FDPIR and SNAP;
  • notify FDPIR staff about any household member with duplicate participation;
  • notify the corresponding HHSC office in another county, if the duplicate participant household moved to that county; and
  • deny SNAP, if appropriate, and refer the household to OIG for a SNAP overpayment.

Related Policy
How to File an Overpayment Referral, B-730

 

B—421.2 Intentional Program Violation (IPV)

Revision 13-4; Effective October 1, 2013

 

Any member disqualified from SNAP for an IPV is also disqualified from participating in the FDPIR program. Likewise, any member disqualified from FDPIR for an IPV is also disqualified from participation in SNAP for the full length of the IPV disqualification period. Advisors follow policy in B-940, Texas Works (TW) Responsibilities.

 

B—421.3 Switching from FDPIR to SNAP

Revision 15-4; Effective October 1, 2015

 

SNAP

If an Indian Tribal Household chooses to receive SNAP, staff must contact the Alabama-Coushatta FDPIR staff to verify that the household does not receive FDPIR before determining SNAP eligibility.

Note: Alabama is the only other state that can be entered in the Out of State Benefit Logical Unit of Work in this situation, and advisors must document the facts in the Texas Integrated Eligibility Redesign System (TIERS) Case Comments.

 

B—421.4 Switching from SNAP to FDPIR

Revision 15-4; Effective October 1, 2015

 

SNAP

For Indian Tribal Households switching from SNAP to FDPIR, staff must:

  • process the switch as a verbal request for voluntary withdrawal from SNAP;
  • send Form TF0001, Notice of Case Action, allowing adequate notice;
  • terminate SNAP benefits for the household as soon as possible so the household may be certified for FDPIR; and
  • notify FDPIR staff of the SNAP denial effective date for the household.

Related Policy
Form TF0001 Required (Adequate Notice), A-2344.1

 

B—421.5 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

SNAP

HHSC staff must contact Alabama-Coushatta FDPIR staff to verify that the household does not receive FDPIR and whether there is a current FDPIR IPV before determining SNAP eligibility for any Indian Tribal Household living in Polk County.

FDPIR staff must contact the Livingston HHSC office to verify the household does not receive SNAP and to verify any current SNAP IPV disqualification before certifying the household for FDPIR.

 

B—421.6 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must document the:

  • name and telephone number of the FDPIR staff who provides verification; and
  • name of the household member currently disqualified for an IPV in FDPIR.

Related Policy
Documentation, C-940

 

B—430 Households with Elderly Members or Members with a Disability

Revision 13-4; Effective October 1, 2013

 

B—431 Definition of Elderly

Revision 01-1; Effective January 1, 2001

 

SNAP

An elderly person is someone who is age 60 or older as of the last day of the month.

 

B—432 Definition of Disability

Revision 15-4; Effective October 1, 2015

 

SNAP

The following people are considered to have a disability:

  • People approved for Supplemental Security Income (SSI), Social Security disability or blindness payments, or SSI Medicaid only.
  • Veterans who receive Veterans Affairs (VA) benefits because they are rated a 100 percent service-connected disability or who, according to the VA, need regular aid and attendance or are permanently housebound.
  • Surviving spouses of deceased veterans who meet one of the following criteria according to the VA:
    • need regular aid and attendance,
    • are permanently housebound, or
    • are approved for benefits from the VA because of the veteran's death and could be considered to have a permanent disability for Social Security purposes. (See B-432.1, Social Security's Criteria for Disability.)
  • Surviving children (any age) of a deceased veteran who the VA:
    • determines are permanently incapable of self-support, or
    • approves for benefits because of the veteran's death and could be considered to have a permanent disability for Social Security purposes. (See B-432.1.)
  • People receiving disability retirement benefits from any government agency for a disability that could be considered permanent for Social Security purposes.
  • People receiving Railroad Retirement Disability who are also covered by Medicare.

 

B—432.1 Social Security's Criteria for Disability

Revision 15-4; Effective October 1, 2015

 

SNAP

The Social Security Administration (SSA) considers that any of the following 12 conditions result in permanent disability:

  • Permanent loss of use of both hands, both feet, or one hand and one foot.
  • Amputation of leg at hip.
  • Amputation of leg or foot because of diabetes mellitus or peripheral vascular diseases.
  • Total deafness, not correctable by surgery or hearing aid.
  • Statutory blindness, unless caused by cataracts or detached retina.
  • IQ of 59 or less, established after the person becomes age 16.
  • Spinal cord or nerve root lesions resulting in paraplegia or quadriplegia.
  • Multiple sclerosis in which there is damage to the nervous system caused by scattered areas of inflammation. The inflammation recurs and has progressed to varied interference with the function of the nervous system, including severe muscle weakness, paralysis, and vision and speech defects.
  • Muscular dystrophy with irreversible wasting of the muscles, impairing the ability to use the arms or legs.
  • Impaired renal function caused by chronic renal disease, resulting in severely reduced function which may require dialysis or kidney transplant.
  • Amputation of a limb of a person at least age 55.
  • AIDS progressed so that it results in extensive and/or recurring physical or mental impairment.

If the individual already receives SSI or Social Security blindness or disability payments, or the disability is obvious to the advisor (such as amputation of leg at hip), the advisor does not require additional verification. Other conditions may require the opinion of a physician. Advisors use Form H1836-A, Medical Release/Physician's Statement, in these instances.

 

B—433 Special Provisions for Households with Elderly Members or Members with a Disability

Revision 15-4; Effective October 1, 2015

 

SNAP

Households containing members who are elderly or who have a disability receive special treatment. The special provisions are:

  • Exemption from the gross income test;
  • Allowance of a deduction for medical expenses when the medical expenses exceed a total of $35 per month for all eligible members who are elderly or who have a disability; and
  • Allowance of an uncapped excess shelter deduction for the full monthly amount that exceeds 50 percent of the household's monthly income after the allowable deductions.

 

B—434 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must verify that a household member:

  • is age 60 or older; and
  • meets the disability criteria in B-432, Definition of Disability.

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

 

B—435 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must document:

  • the reason the individual is considered to have a disability (see B-432, Definition of Disability);
  • how age was verified (see B-431, Definition of Elderly); and
  • how disability was verified (see B-432).

Related Policy
Documentation, C-940

 

B—440 Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities

Revision 05-1; Effective January 1, 2005

 

 

B—441 Residents of Drug and Alcohol Treatment (D&A) Facilities

Revision 16-3; Effective July 1, 2016

 

SNAP

Individuals receiving chemical dependency treatment and residing in a facility that conducts a chemical dependency program may be potentially eligible for SNAP, regardless of the number of meals the facility provides, if the treatment facility is an approved institution. A drug and alcohol treatment (D&A) facility is an approved institution if it is either:

  • certified as a retailer by Food and Nutrition Service (FNS) to accept SNAP benefits; or
  • a private, nonprofit organization or institution, or a publicly operated community mental health center. To qualify under this provision, the facility or organization must also meet one of the following two requirements:
  1. be licensed by the Texas Department of State Health Services (DSHS) to operate a chemical dependency treatment facility; or
  2. have written verification from DSHS that it is a registered faith-based exempt chemical dependency treatment program under Texas Health and Safety Code, Chapter 464, Subchapter C, and also is recognized by DSHS as operating a program that furthers the purposes of Part B of Title XIX of the Public Health Service Act, the rehabilitation of drug addicts and/or alcoholics. The facility does not have to actually receive funds from DSHS.

Individuals residing in D&A facilities that are not approved institutions are potentially eligible for SNAP only if the facility provides half of their meals or less as described in B-490, Determining Whether an Individual Who Resides in a Facility Is Institutionalized.

Note: See A-232.2, Disqualified Persons, for disqualification of individuals due to felony drug conviction.

Advisors must evaluate all other eligibility criteria to determine whether a resident of the treatment center is eligible for SNAP.

Advisors determine eligibility following the same income and resource policy as other households. Most time frames and procedures for certifying households apply to residents of treatment facilities. The exceptions are:

  • Household size — advisors must certify:
    • single residents of the treatment facility as separate one-person households; and
    • adult residents and their children as one household.
  • Authorized representative (AR) — The treatment facility must act as the AR for all residents of the facility.

Any facility that is disqualified by the U.S. Department of Agriculture (USDA) as a retailer or that loses its license from a state agency cannot serve as an AR. If this happens, the advisor must deny all existing SNAP Eligibility Determination Groups (EDGs) of residents in the facility. The facility may not debit residents' food accounts after the disqualification occurs.

  • Expedited service — The advisor must provide benefits so the resident has an opportunity to participate by the seventh calendar day after the application date. The application date is day zero.
  • Adverse action — When the facility loses its status as AR or loses its certification, the resident must be given adequate notice of adverse action.
  • Work registration — The resident is exempt from work registration.

Note: If a treatment center inquires about obtaining a SNAP retailer license from FNS, advisors should refer the center to the USDA FNS at 1-877-823-4369 or https://www.fns.usda.gov/snap/apply-to-accept.

Related Policy
Nonmembers, A-232.1
Determining Whether an Individual Who Resides in a Facility Is Institutionalized, B-490

 

B—442 Residents of Group Living Arrangement (GLA) Facilities

Revision 16-3; Effective July 1, 2016

 

SNAP

A group living arrangement (GLA) is a public or private nonprofit residential facility that serves no more than 16 residents. Individuals residing in a GLA facility may be potentially eligible for SNAP, regardless of the number of meals the facility provides, if the GLA facility is an approved institution. A GLA is an approved institution if it is either:

  • a certified SNAP retailer; or
  • a nonprofit, certified by a state agency as required by Section 1616(e) of the Social Security Act.

Individuals residing in GLA facilities that are not approved institutions are potentially eligible for SNAP only if the facility provides half of their meals or less as described in B-490, Determining Whether an Individual Who Resides in a Facility Is Institutionalized.

Residents who meet the criteria in B-432, Definition of Disability, may be certified under group living arrangements. Eligibility is determined by the same income and resource standards as other households.

The residents of group living arrangements may apply:

  • for themselves,
  • through an AR of their choosing, or
  • through an AR employed by the facility.

If a member of the group wants to apply separately from other GLA residents, the facility makes the decision to let the resident apply separately based on the resident's physical and mental ability. Applications from any individual the facility allows to apply as a one-person household or for any group of residents applying as a household are accepted.

Most time frames and procedures for certifying households apply to group living arrangements. The exceptions are:

  • Household size — If the resident applies using the facility as AR, the resident is treated as a one-person household. If the residents apply without using the facility as AR, 16 is the largest allowable household size.
  • Expedited service — Benefits are provided so the resident has an opportunity to participate by the seventh calendar day after the application date. The application date is day zero.
  • Adverse action — When the facility loses its status as AR or loses its certification, the resident is given adequate notice of adverse action.
  • Work registration — Members must be registered unless exempt.

Related Policy
Nonmembers, A-232.1
Determining Whether an Individual Who Resides in a Facility Is Institutionalized, B-490

 

B—443 HHSC Responsibilities

Revision 13-4; Effective October 1, 2013

 

 

B—443.1 Advisor Responsibilities

Revision 18-2; Effective April 1, 2018

 

SNAP

For residents participating in D&A/GLA facilities, advisors must verify that the:

  • D&A facility meets the eligibility criteria in B-441, Residents of Drug and Alcohol Treatment (D&A) Facilities; and
  • GLA meets the eligibility criteria in B-442, Residents of Group Living Arrangement (GLA) Facilities.

Certification may be verified by contract documents or certificates of eligibility from the USDA, HHSC or DSHS. Verify nonprofit status by a current, valid Internal Revenue Service (IRS) exemption or a document from the Texas State Comptroller of Public Accounts. If the facility is a USDA-certified retailer, the facility's eligibility is verified.

  • Ensure the AR has a copy of Form H1851, Reference Guide for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities. Have the AR acknowledge receipt of Form H1851 by signing Form H1846, Facility Authorized Representative Interview. Ensure the AR understands each of the facility's responsibilities.
  • Ensure the AR has a supply of Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP). The AR must return this form by the fifth of every month, or the following workday if the fifth is not a workday. Repeated failure to return this form is a program violation. Use Form H1852 to help monitor the facility's compliance with its responsibilities as AR. Complete and send Form H1847, Reminder to Submit Form H1852, when the facility report is three days past due.
  • Ensure the AR has a supply of Form H1019/H1019-S, Report of Change, and postage-paid envelopes.
  • Make on-site visits to the facility at least once every six months.

    During these visits, use Form H1845, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility Review, to document:
    • the date of the visit;
    • the number of residents; and
    • proof the facility continues to meet eligibility requirements.
  • Report suspected misuse of SNAP by the facility to the supervisor or program manager. Use Form H1845 or Form H1853, Documentation of Findings for Form H1852, if staff discover the suspected misuse during the monthly evaluation of Form H1852 that the facility returned.
  • Ensure the facility returns the correct amount of benefits to the individual's Electronic Benefit Transfer (EBT) card. If the facility is unable or unwilling to return the individual's benefits, send Form H1096, Notification Letter, to the facility advising them of the overpayment; email Form H1095, Treatment Facility Fraud Referral, to the OIG General Investigations Policy and Quality Control unit at oig_gi@hhsc.state.tx.us; and immediately restore improperly accessed benefits to the individual.

Note: If a Centralized Benefit Services (CBS) household moves into a D&A/GLA facility, the advisor must update the Living Arrangement record to convert the EDG back to SNAP and out of the CBS caseload.

Maintain a D&A/GLA facility case file in the local office for each facility. Keep copies of any forms, reports or supporting documentation in this file.

 

B—443.1.1 Monitoring Facilities

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must monitor information provided each month by facilities on Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP), to ensure that certified residents receive the correct amount of SNAP benefits.

Facilities must return Form H1852 to the office by the fifth of every month, or the next workday if the fifth is not a workday. If the facility fails to provide the report, prompt the facility using Form H1847, Reminder to Submit Form H1852, when the report is three days past due.

Advisors must compare the information on the current month's Form H1852 to the information on the previous month's Form H1852 and clear any discrepancies. Consider the following questions in detail:

  • Are the same residents certified?
  • Did any of the residents move out during the month? If so:
    • Did the facility report the change and return the Lone Star Card and personal identification number (PIN) in the correct sleeve within three days?
    • Did the Lone Star account contain the correct amount of benefits?

If the facility fails to report residents who move out and/or fails to return the Lone Star Card and PIN, the advisor must take action to deny the EDGs following procedures in B-447, Resident Moves Out of a Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility. Remind facilities of the responsibility as an AR to report moves and return the Lone Star Card and PIN within three days of the change. Complete Form H1853, Documentation of Findings for Form H1852, monthly to document findings. If no findings, document no findings. Provide a copy of negative findings to the program manager responsible for the facility case file, and file a copy in the facility case file.

 

B—443.2 Program Manager Responsibilities

Revision 17-3; Effective July 1, 2017

 

HHSC Benefit Office program managers report misuse of SNAP benefits in facilities certified as retailers by the USDA by sending Form H1853, Documentation of Findings for Form H1852, to:

Texas Health and Human Services Commission
Eligibility Operations - Field
Mail Code 992-6
909 W. 45th Street
Austin, TX 78751

State office makes referrals to the OIG and EBT. The USDA, if necessary, sends a copy to the program manager and subsequently, notification of any action taken.

Do not take any further adverse action on a facility certified by USDA before USDA's action. Compute overissuances for the individual residents as appropriate.

If the investigative unit confirms the report is valid, the investigative unit program manager refers the misuse to the USDA for its information and consideration for prosecution. The investigative unit sends a copy of the referral to the HHSC Benefit Office program manager responsible for the facility case file and notifies the program manager of any action taken by USDA.

 

B—444 Overview of Electronic Benefit Transfer (EBT) Processes for Residents of Drug and Alcohol Treatment/Group Living Arrangement (D&A/GLA) Facilities

Revision 15-4; Effective October 1, 2015

 

SNAP

Establish the AR as the primary cardholder (PCH) and issue a Lone Star Card to access a resident's benefits in the food account. Allow the AR to select a PIN through the Lone Star Help Desk Automated Voice Response (AVR) unit or receive a pre-assigned PIN.

Some D&A/GLA facilities are certified by the USDA as SNAP retailers and some are not. Either way, the facility serves as AR and is responsible for the use of SNAP benefits of all residents who participate in SNAP (except for some GLAs). Benefits issued via EBT for residents of these D&A/GLA facilities are handled according to one of the following three methods (1A, 1B, or 2):

  1. An EBT vendor contracts with D&A/GLA facilities certified by USDA as SNAP retailers to process EBT transactions in two ways:
    1. If the D&A/GLA facility processes a minimum monthly value of SNAP transactions, an EBT vendor installs Point of Sale (POS) equipment there. The facility, as AR/PCH, debits the residents' SNAP benefits by swiping each resident's Lone Star Card through their POS equipment and entering the associated PIN. An EBT vendor completes financial settlement to pay the retailer the day after SNAP transactions are completed.
    2. If the retailer processes less than the minimum monthly value of SNAP transactions to receive POS equipment, an EBT vendor contracts with the retailer to use a manual voucher system to process EBT SNAP transactions from each resident'saccount. An EBT vendor completes financial settlement to pay the retailer the day after SNAP transactions are completed.
  2. D&A/GLA facilities that are not USDA-certified retailers do not contract with an EBT vendor to accept SNAP benefits. However, as long as the facility meets the eligibility criteria specified in B-441, Residents of Drug and Alcohol Treatment (D&A) Facilities, or B-442, Residents of Group Living Arrangement (GLA) Facilities, for non-USDA certified retailers, residents of those facilities can still participate in the SNAP program with the facility AR responsible for the residents' SNAP benefits. In this situation, the facility AR is established as the PCH; a Lone Star Card is issued; and the AR is allowed to select a PIN through the Lone Star Help Desk AVR unit or receive a pre-assigned PIN. The facility AR may use the food account Lone Star Card and PIN to purchase food for the resident at a retail food store/market.

Note: GLAs do not always serve as AR for each resident. If the GLA employee is not listed as a GLA-AR on a resident's SNAP EDG:

    • advisors must follow normal EBT issuance procedures rather than procedures in this section for issuing cards and self-selecting/issuing PINs; and
    • the resident uses the card/PIN to purchase food from a regular retailer, or purchase prepared meals from the GLA if the GLA is certified as a retailer by USDA.

 

B—445 D&A/GLA Facility Responsibilities as Authorized Representatives

Revision 15-4; Effective October 1, 2015

 

SNAP

The facility acting as AR must:

  • apply for and provide accurate information on behalf of a resident;
  • use the Lone Star Card to debit the resident's food account;
  • buy and prepare food for eligible residents;
  • buy meals delivered to the individual residents;
  • report within 10 days to the SNAP office loss of USDA/DSHS certification or loss of nonprofit status;
  • report any changes, losses, misuse and overissuances of SNAP benefits;
  • give departing residents Form H1019/H1019-S, Report of Change, as appropriate, and advise the individual to report the new address within 10 days;
  • report and return to HHSC the Lone Star Card (in the proper sleeve) issued for that resident within three days after the resident moves out, whether announced or not;
  • ensure security of all Lone Star Cards and PINs issued to the facility AR;
  • ensure that the departing resident's Lone Star Card contains all the SNAP benefits that are unspent when the resident moves out; and
  • return Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP), by the fifth of every month, or the following workday if the fifth is not a workday.

The resident and AR both must sign the application form.

The facility, acting as an AR, is liable if it knowingly commits a program violation to obtain SNAP benefits for a resident.

B-445.1, Use of SNAP Benefits by Drug and Alcohol Treatment (D&A) /Group Living Arrangement (GLA) Facilities Which Serve as SNAP Authorized Representative (AR), explains facility responsibilities specific to EBT.

The facility must maintain a sufficient supply of required forms. Form H1852, Form H1019/H1019-S and HHSC return envelopes may be obtained from the local eligibility determination office and will be offered to the AR at each certification.

 

B—445.1 Use of SNAP Benefits by Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities Which Serve as SNAP Authorized Representative (AR)

Revision 15-4; Effective October 1, 2015

 

SNAP

HHSC restricts how the D&A/GLA facility may use the resident's benefits as explained in B-445.1.1, Account Access, through B-445.1.4, Residents Moving Out Before the 16th of a Month. The advisor must inform the facility AR of these rules during the interview and provide them with Form H1851, Reference Guide for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities.

 

B—445.1.1 Account Access

Revision 15-4; Effective October 1, 2015

 

SNAP

HHSC issues a Lone Star Card to the facility AR and enables the AR to select a PIN through the Lone Star Help Desk AVR unit. HHSC allows the AR access only to benefits issued for a month the individual is a facility resident. The facility may have one person serve as AR to apply for the resident and another to serve as AR/PCH and use the Lone Star Card.

Note: When the D&A/GLA facility is the AR, it is responsible for all benefits in an account. Therefore, security of the card and PIN is as important to them as it is to an individual not in a facility.

A D&A/GLA facility AR may access benefits issued to a resident's food account only in the following situation. If HHSC is unable to issue benefits with the facility as AR for a month the resident is residing in the facility because that month's benefits were already issued to the resident's food account and the resident wants to allow the facility access to those previously issued benefits, the resident, not the facility AR, has the following options:

For facilities that are not USDA-certified retailers, the resident may:

  • use the card to purchase groceries to give to the facility; or
  • make the D&A/GLA facility AR a secondary cardholder on the existing account to access those benefits.

To establish the facility AR as secondary cardholder in this situation, the:

  • advisor must ensure that the individual made this choice and then approve it; and
  • local office EBT clerk must establish the secondary cardholder, issue the card, and enable PIN self-selection.

For facilities that are USDA-certified retailers, the resident can:

  • use one of the options listed above for facilities that are not USDA-certified; or
  • use the Lone Star Card and PIN to purchase meals via the facility POS device or via the EBT manual voucher process. The facility is not allowed possession of the card previously issued to the resident, nor knowledge of the resident's PIN. When using this option, the facility may only charge for prepared meals on a per day basis (not in advance).

 

B—445.1.2 Returning Lone Star Cards

Revision 13-4; Effective October 1, 201 3

 

SNAP

The D&A/GLA facility must return the facility AR's card for each resident who moves out within three days of the move.

 

B—445.1.3 Returning Unspent Benefits When a Resident Moves Out

Revision 15-4; Effective October 1, 2015

 

SNAP

When a resident moves out of the D&A/GLA facility, the facility must return all unspent benefits issued to the AR's account regardless of when the resident moves out, even if it means returning all of the resident's benefits. D&A/GLA facilities are not allowed to spend a resident's benefits after the resident moves out.

To return unspent benefits after a resident moves out, the facility returns the AR's card and ensures that the account contains all unspent benefits. For purposes of this policy, "spent" means the facility used the Lone Star Card to access the resident's benefits before the resident moved out.

If the facility accesses benefits that it is not allowed to use, the facility must return the benefits to the account. USDA-certified facilities can return benefits using the POS device to process a return on the account or via communication with an EBT vendor. Facilities not certified as retailers by USDA must return groceries to the store and get the store to process a return on the resident's account using the AR's card on the store's POS device.

If the retailer is unable to restore benefits to the EBT card, the advisor initiates a claim against the facility by sending Form H1096, Notification Letter, and sending Form H1095, Treatment Facility Fraud Referral, to the OIG General Investigations Policy and Quality Control Unit Outlook Mailbox. The advisor restores benefits to the individual as outlined in B-800, Restored Benefits.

 

B—445.1.4 Residents Moving Out Before the 16th of a Month

Revision 15-4; Effective October 1, 2015

 

SNAP

The D&A/GLA facility must return at least half of the monthly allotment for residents who move out before the 16th of a month. Therefore, even though the facility can access more than half of the monthly allotment before the 16th, it is not good practice to do so.

The D&A/GLA facility AR knows the full allotment amount from the individual notice. If the EDG has recoupment, the advisor must notify the facility AR so the AR can use the Lone Star Help Desk AVR system (1-800-777-7EBT) to verify monthly benefits.

When using a resident's benefits, D&A/GLA facilities without a POS device must be cautious to ensure they do not use more than half of a month's allotment before the 16th of the month, because they have no POS device to process a return if they spend more than half of a resident's allotment.

 

B—446 Application Processing for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must process SNAP EDGs for residents in D&A/GLA facilities using one of the following three procedures, depending on the resident's situation at application.

 

B—446.1 New Resident (or Denied Resident with No Benefits in an Electronic Benefit Transfer [EBT] Account) Who Moves into a D&A/GLA Facility and Applies for SNAP

Revision 15-4; Effective October 1, 2015

 

SNAP

  1. The advisor:
  • interviews the AR;
  • advises the AR about the limitations noted on Form H1851, Reference Guide for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities;
  • provides EBT training material if the AR has not already received it;
  • sends the PCH record for the facility AR to the EBT system by indicating in the TIERS issuance pages that there is an alternate payee and by filling out Part I of Form H1175, Authorization for Administrative Terminal Application Action, which is sent to EBT staff to data enter into the Administrative Terminal Application (ATA);

Note: Because the PCH must use biographical data to access PIN selection through the Lone Star Help Desk AVR system, the EBT clerk must enter additional data to the PCH record using the Form H1175/ATA process. TIERS does not collect this data on D&A/GLA facility ARs; therefore, TIERS cannot send the information to the EBT system.

At the time of disposition, advisors must ensure that TIERS has successfully included the PCH record for the facility AR by reviewing the Issuance – Details page and the Alternate Payee – Summary page.

  • disposes the SNAP EDG; and
  • completes and submits Form H1172, EBT Card, PIN and Data Entry Request, to the EBT clerk.
  1. The EBT clerk:
    • securely files the signed, original EBT forms;
    • issues a card to the AR and reports the personal account number (PAN);
    • prints the case/EDG name in the space under the signature field on the back of the Lone Star Card; and
    • enables the AR to select a PIN through the Lone Star Help Desk AVR system.
  2. The facility AR uses the card and PIN to access benefits in the food account. Note: If the resident also receives TANF, the cash account is not available to the D&A/GLA facility AR. The resident has a separate card and PIN for the cash account.

 

B—446.2 Resident Has an Active SNAP EDG (or a Denied-Ongoing SNAP EDG), No Benefits in the Food Account, and All SNAP Household Members Move into the D&A/GLA Facility

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors follow policy in B-446.1, New Resident (or Denied Resident with No Benefits in an Electronic Benefit Transfer [EBT] Account) Who Moves into a D&A/GLA Facility and Applies for SNAP, except the D&A/GLA facility representative is added as AR for the existing SNAP EDG and the SNAP EDG is certified if it is currently denied.

 

B—446.3 All Other Situations

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors assign the resident a new SNAP EDG number and certify the resident using the new EDG number to establish a separate EBT food account as a resident of a D&A/GLA facility with a facility AR.

  • If the resident is on an active SNAP EDG (and all members are not moving into the facility), the individual is removed from the existing EDG before being certified on a new case. This resident's application is processed using procedures in B-446.1, New Resident (or Denied Resident with No Benefits in an Electronic Benefit Transfer [EBT] Account) Who Moves into a D&A/GLA Facility and Applies for SNAP.
  • If the resident is currently certified as a single person household on a previous case (but has a remaining benefit balance), the resident is certified for SNAP with a certification period for the remaining months using a different case number. A new Form H1010, Texas Works Application for Assistance — Your Texas Benefits, is not required. The file date is the first day of the first month of the remaining certification period. The other case is cross referenced in the TIERS Case Comments section of each case.

Advisors enter the facility AR’s information in the Authorized Representative page and indicate in the Issuance – Details page that there is an alternate payee. Complete the subsequent Alternate Payee – Summary page.

Advisors complete and submit Form H1172, EBT Card, PIN and Data Entry Request, and Part I of Form H1175, Authorization for Administrative Terminal Application Action, to the EBT clerk. The EBT clerk enters additional data to the PCH record for the AR through the ATA for the new EDG number. Note: Because the PCH must use biographical data to access PIN selection through the Lone Star Help Desk AVR system, the EBT clerk must send the PCH record using the Form H1175/ATA process. TIERS does not collect this data on D&A/GLA facility ARs; therefore, TIERS cannot send the information to the EBT system.

At the time of disposition, advisors must ensure TIERS has successfully included the PCH record for the facility AR by reviewing the Issuance – Details page and the Alternate Payee – Summary page.

Advisors then follow policy in B-446.1, Numbers 2 and 3.

 

B—447 Resident Moves Out of a Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors follow these procedures when the resident moves out of the facility;

  1. The facility AR:
    • notifies the advisor of the move, and
    • returns the Lone Star Card (in person) for this account to the local office within three days of the move.
  2. The advisor checks the account balance to ensure the D&A/GLA facility returned the correct amount of benefits. The advisor must ensure that the facility returns to the resident's food account any amount of benefits spent after the resident moved out. Monthly benefits and account balance information are available on the ATA benefit history screen. The ATA transaction history screens provide information to verify the AR did not debit the account after the resident moved out. Transactions are listed by date and time.

Advisors must report violations as noted in B-443.1, Advisor Responsibilities.

  1. After ensuring benefits are properly returned, staff destroy the card according to procedures for returned cards in B-237, Returned Lone Star Cards and PIN Packets.
  2. The advisor follows procedure I or II below.
    1. The facility reports the move and the former resident has not contacted HHSC:
      • Send the EDG name to the EBT system as the new PCH. If necessary, complete Part I of Form H1175, Authorization for Administrative Terminal Application Action, and send to EBT staff, who will use the information to create the new PCH record through the ATA.
      • Immediately remove the AR entries in TIERS including any designations in the Issuance – Details and the Alternate Payee – Summary pages and update the address, if known.
      • Document in TIERS Case Comments the name of the facility and facility AR that are being removed and when. Do not issue a new card and PIN until the former resident requests it.
      • Follow normal adverse action procedures to deny the EDG.

Note: If the advisor fails to remove the AR before denying the EDG, establish a new PCH by updating the PCH record by completing Part III of Form H1175.

  1. Former resident reports the move:
    1. If the former resident moves to another D&A/GLA facility, the advisor must follow the procedure below:
      • Do not deny the existing active case.
      • Remove the former facility AR.
      • Document in TIERS Case Comments the name of the facility and facility AR that are being removed and the name of the new facility and facility AR that are being added and when.
      • Enter the new facility AR’s information in the Authorized Representative page and indicate in the Issuance – Details page that there is an alternate payee. Complete the subsequent Alternate Payee – Summary page.
      • Complete Form H1172, EBT Card, Pin and Data Entry Request, to issue a card and enable the new AR to select a PIN through the Lone Star Help Desk AVR system.
      • Complete Part I of Form H1175 and send to EBT staff, who will use the information to complete the new PCH record on the new AR via the ATA.

Note: Because the PCH must use biographical data to access PIN selection through the Lone Star Help Desk AVR system, the EBT clerk must enter additional data to the PCH record using the Form H1175/ATA process. TIERS does not collect this data on D&A/GLA facility ARs; therefore, TIERS cannot send the information to the EBT system.

At the time of disposition, advisors must ensure that TIERS has successfully included the PCH record for the new facility AR by reviewing the Issuance – Details page and the Alternate Payee – Summary page.

  • The EBT clerk securely files the signed, original EBT forms; issues a card to the AR; reports the PAN; prints the case/EDG name in the space under the signature field on the back of the Lone Star Card; and enables the AR to select a PIN through the Lone Star Help Desk AVR system.
  1. If the former resident moves in with another active SNAP household and the former resident will participate with that household, the advisor follows the procedure below:
    • Deny the active D&A/GLA case and send Form TF0001, Notice of Case Action, following regular adverse action procedures.
    • Send the case name to the EBT system to change the PCH on the case by removing all AR-related entries in TIERS including any designations in the Issuance – Details and the Alternate Payee – Summary pages.
    • Change the address to the resident's new address.
    • Document in TIERS Case Comments the name of the facility and facility AR that are being removed and when. Cross reference the other case in the TIERS Case Comments section of each case.
    • If there are still benefits in the account, process Form H1172 to give the former resident access to the account by issuing a card and enabling the individual to select a PIN through the Lone Star Help Desk AVR system.
    • If necessary, complete Part I of Form H1175 and send to EBT staff, who will use the information to create the new PCH record through the ATA.
    • Add the former resident to the other household's SNAP EDG effective for the month after any final benefits are received.
  2. If the former resident moves and no longer lives in a D&A/GLA facility or does not participate with another active SNAP household, use the following special procedure to move the former resident's remaining months of SNAP certification to a different case (and thus a new food account):
    • Send the case name to the EBT system to change the new PCH on the currently active case by removing all AR-related entries in TIERS including any designations in the Issuance – Details and the Alternate Payee – Summary pages.
    • Change the address to the resident's new address.
    • Document in TIERS Case Comments the name of the facility and facility AR that are being removed and when.
    • Deny the former resident's active SNAP EDG. Do not send notice of adverse action since benefits are not actually being denied.
    • Certify the former resident for SNAP with a certification period for the remaining months using a different case number. (Use a previous, denied-ongoing case number and associate the case number during Application Registration, if the former resident has one.) Do not require a new Form H1010, Texas Works Application for Assistance — Your Texas Benefits. The file date is the first day of the first month of the remaining certification period. Cross reference the other case in the TIERS Case Comments section of each case.
    • Process Form H1172 to give the former resident access to the account(s) by issuing a new card and enabling the individual to select a new PIN through the Lone Star Help Desk AVR system.
    • If necessary, complete Part I of Form H1175 and send to EBT staff, who will use the information to create the new PCH record through the ATA.

 

B—448 Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility Replaces the Authorized Representative (AR)

Revision 15-4; Effective October 1, 2015

 

SNAP

To replace an AR, the D&A/GLA facility must provide the advisor a written request.

If a D&A/GLA facility replaces the AR, the local office may avoid replacing cards for all the residents' accounts. Advisors must:

  • change the name of the AR on all applicable TIERS cases by replacing the former facility AR with the new individual in the Authorized Representative page and the Alternate Payee Summary page. Advisors must document for each case the change and when the change occurred in TIERS Case Comments.
  • complete Part III of Form H1175, Authorization for Administrative Terminal Application Action, to update the existing PCH record to reflect the new AR name and biographical information. The advisor must not create a new PCH record.

Note: Because the PCH must use biographical data to access PIN selection through the AVR, the EBT clerk must send the PCH record using the Form H1175/ATA process. TIERS does not collect this data on D&A/GLA facility ARs; therefore, TIERS cannot send this information to the EBT system.

At the time of disposition, advisors must ensure that TIERS has successfully included the PCH record for the new facility AR by reviewing the Issuance – Details page and the Alternate Payee – Summary page.

EBT staff securely file the original, signed Form H1175 with the daily paperwork and the associated Form H1172, EBT Card, PIN and Data Entry Request. The office must ensure that the new AR gets a new PIN for each account.

Note: Advisors must complete a new Form H1846, Facility Authorized Representative Interview, at the first certification interview following replacement of the AR.

 

B—449 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must verify that the GLA meets the eligibility criteria in B-442, Residents of Group Living Arrangement (GLA) Facilities.

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

 

B—450 Residents in Family Violence Shelters

Revision 13-4; Effective October 1, 2013
 

 

B—451 Eligibility Requirements

Revision 16-3; Effective July 1, 2016

 

SNAP

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

  • a certified SNAP retailer: or
  • a public or private nonprofit facility.

Individuals residing in family violence 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 B-490, Determining Whether an Individual Who Resides in a Facility Is Institutionalized.

Residents in eligible family violence shelters may receive SNAP benefits as individual household units or as part of a group of individuals like any other household.

Residents in family violence shelters may apply for SNAP and use SNAP benefits on their own behalf. They may also appoint a shelter representative or another person to act as AR and/or secondary cardholder.

Resident households must meet the same income and resource standards as other households. Resources held jointly with the person who abused the individual are considered as inaccessible. Room payments to the shelter are considered as shelter expenses. These households have the same rights to notices of adverse action, fair hearing, and lost benefits as other households. Residents should be registered for work unless otherwise exempt.

The usual processing standards for initial and later eligibility decisions, handling reported changes and other actions, and usual verification and documentation requirements apply to residents in shelters for battered persons.

Related Policy
Nonmembers, A-232.1
Determining Whether an Individual Who Resides in a Facility Is Institutionalized, B-490

 

B—452 Approved Centers That Provide Meals

Revision 15-4; Effective October 1, 2015

 

SNAP

Family violence shelters that provide meals must be public or private nonprofit residential facilities that serve victims of family violence. If a facility serves other people, part of the facility must be set aside on a long-term basis to serve only family violence victims.

Advisors must verify the shelter's status as a nonprofit organization by seeing a current certificate from the IRS or a document from the Texas State Comptroller of Public Accounts. If the shelter is a USDA-certified retailer, the shelter's eligibility is verified.

 

B—452.1 Buying Meals

Revision 13-4; Effective October 1, 2013

 

SNAP

Individual households may use their SNAP benefits to buy meals prepared for them at a shelter that is a USDA-certified retailer.

 

B—453 Authorized Representatives

Revision 01-3; Effective April 1, 2001

 

SNAP

Employees of facilities that are USDA-certified retailers may not be authorized to serve as AR/secondary cardholders unless HHSC decides that there are no other representatives available.

If the shelter is not a USDA-certified retailer, the household may authorize a shelter representative as secondary cardholder.

 

B—454 Participation Twice in Same Month

Revision 10-4; Effective October 1, 2010

 

SNAP

A shelter resident can qualify for a duplicate SNAP benefit in a single month if:

  • the resident's former household already received benefits for the month; and
  • the resident's former household was based on a household size that included the resident, any children, and the person who abused or threatened to abuse them.

 

B—454.1 Duplicate Participation Procedures

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must take action to remove the resident from the former household's case.

Special certification procedures based on entries made on the Living Arrangements screen allow duplicate participation until the resident is removed from the former household. The advisor must establish a new SNAP case and food account for the individual whether or not the individual is the case name or has a Lone Star Card on the previous case. The individual must complete a new Form H1010, Texas Works Application for Assistance — Your Texas Benefits.

If the individual has not been removed from the former case, the advisor must:

  • complete the certification process;
  • issue the individual a new Lone Star Card and PIN following procedures in B-233, Issuing a Lone Star Card;
  • enable the individual to select a PIN through the Lone Star Help Desk AVR unit following the procedures in B-234, Personal Identification Number (PIN) Selection and Issuance; and
  • issue benefits according to procedures in B-252, Benefit Issuance on Applications.

 

B—460 Prepared Meal Services

Revision 13-4; Effective October 1, 2013

 

 

B—461 Communal Dining or Meal Delivery Services

Revision 15-4; Effective October 1, 2015

 

SNAP

Eligible individuals and their spouses may use SNAP benefits to purchase prepared meals through communal dining or meal delivery services authorized by FNS.

To be eligible, a household member must:

  • be age 60 or older;
  • be housebound;
  • have a physical disability;
  • have a disability to the extent the member is unable to adequately prepare all meals; or
  • be receiving SSI.

 

B—462 Prepared Meals for Homeless

Revision 12-2; Effective April 1, 2012

 

SNAP

Homeless individuals may use SNAP benefits to purchase prepared meals from meal providers authorized by FNS.

 

B—463 Advisor Responsibilities

Revision 15-4; Effective October 1, 2015

 

SNAP

The Lone Star Card does not identify individuals qualifying for communal dining, meal delivery, or homeless individuals eligible for prepared meals. If the individual requests verification of his/her qualification for prepared meal services, the advisor must:

  • issue Form H1803, Food Stamp Identification Card; and
  • enter the appropriate code as follows:
    • C – Communal dining
    • M – Meal delivery
    • H – Homeless
    • E – Every service

When using Form H1175, Authorization for Administrative Terminal Application Action, to send the PCH record, the advisor must indicate in the endorsement box of Form H1175 either:

  • Communal dining
  • Meal delivery
  • Homeless
  • Every service

 

B—464 EBT Coordinator Responsibilities

Revision 15-4; Effective October 1, 2015

 

SNAP

If a meal-provider representative contacts HHSC about certification procedures, the advisor should refer the meal-provider representative to the EBT coordinator to approve these providers.

The EBT coordinator must ensure through discussion with the meal provider that the establishment:

  • provides meals to homeless people, and
  • is a public or private nonprofit organization as defined by IRS. HHSC may require the provider to present documentation from IRS to verify nonprofit status under §501(c)(3) of IRS regulations.

If the meal provider meets these requirements, the EBT coordinator will:

  • obtain the meal-provider representative's signature on Form H1832, Affidavit for Meal Providers to the Homeless; and
  • refer the provider to USDA, with the original, signed Form H1832, to apply for authorization as a retailer.

 

B—465 Matrix of Prepared Meals, Services, Households and Codes

Revision 15-4; Effective October 1, 2015

 

SNAP

Prepared Meals
SNAP Recipient Communal Dining (Public or Nonprofit Private) Meal Delivery Homeless Meal Provider (Public or Nonprofit Private)
Age 60 or older, not homeless XX XX  
SSI recipient who is under age 60, not homeless XX XX  
Under age 60, not an SSI recipient, housebound, a person with physical disabilities, or has disabilities to the extent they are unable to adequately prepare own meals   XX  
Homeless only     XX
Homeless age 60 or older XX XX XX
Homeless SSI recipient who is under age 60 XX XX XX
Endorsement status allowed to purchase from meal provider Codes C,E Codes C,M,E Codes H,E

Codes:

C – SSI/elderly member authorized to purchase prepared meals from communal dining facilities or meal delivery services.

E – Homeless and either elderly or SSI household authorized to purchase from every service (communal dining, meal delivery services or homeless meal providers).

H – Homeless household authorized to purchase from homeless meal provider.

M – Housebound or a member with a disability authorized to purchase from meal delivery service.

 

B—466 Loss of SNAP Identification (ID) Card (Form H1803)

Revision 15-4; Effective October 1, 2015

 

SNAP

When replacing a lost or damaged ID card, the advisor must:

  • verify the identity of the person requesting the replacement,
  • ensure the person is authorized to act for the household, and
  • issue a new SNAP ID card.

 

B—470 Categorically Eligible Households

Revision 05-5; Effective October 1, 2005

 

SNAP

Categorically eligible households are subject to fewer eligibility requirements than other SNAP households. HHSC uses special procedures to process applications from persons who potentially meet the categorical eligibility criteria. Categorical eligibility does not mean the applicants automatically receive SNAP.

 

B—471 Eligibility Criteria

Revision 15-4; Effective October 1, 2015

 

SNAP

SNAP households meet categorical eligibility criteria if:

  • all members are approved for TANF cash assistance or SSI; or
  • the household:
    • meets the resource criteria to be authorized to receive TANF Non-cash (TANF-NC) services (see A-1210, General Policy); and
    • has gross income less than or equal to 165 percent of the Federal Poverty Income Limit (FPIL) for its size.

This also includes households that have:

  • active EDGs but whose benefits are being recouped; or
  • a disqualified alien member or student who does not get TANF/SSI.

The household is not categorically eligible if:

  • one or more members are disqualified from TANF or SNAP for an IPV; or
  • the entire household is ineligible because the primary wage earner (PWE) failed to comply with E&T or voluntary quit requirements; or
  • if the household is otherwise ineligible due to one or more members' disqualification for any reason.

For TANF-NC, a household is not categorically eligible if one or more members has a current SNAP IPV disqualification. If the household meets the combined resource limit of $5,000 for liquid assets and excess vehicle value, the household is still authorized to receive TANF-NC, and their remaining resources are exempt. The household is not exempt from the gross/net income limits.

 

B—472 Special Treatment for Households Meeting Categorical Eligibility Criteria

Revision 15-4; Effective October 1, 2015

 

SNAP

Categorically Eligible TANF/SSI Households

Categorically eligible households are not subject to the resource or gross/net income limits. These households are exempt from verification requirements regarding:

  • Social Security numbers (SSNs),
  • resources,
  • residence, and
  • sponsored alien information.

Categorically Eligible TANF-NC Households

TANF-NC categorically eligible households are not subject to the gross/net income limits. Once the household passes the resource criteria for TANF-NC, the remaining non-liquid resources are exempt. TANF-NC categorically eligible households must comply with all other eligibility criteria.

Related Policy
General Policy, A-1210
Limits, A-1220
Prepaid Burial Insurance, A-1233.2
Vehicles, A-1238
How to Determine Fair Market Value of Vehicles, A-1238.5
General Policy, A-1310
Special Provisions for Households with Elderly Members or Members with a Disability, B-433

 

B—473 Application Processing

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors must follow these procedures when processing a joint application for TANF and/or SSI and SNAP:

If the TANF/SSI application is pending and the household... then ...
is eligible for SNAP without meeting categorical eligibility criteria, certify the SNAP application as soon as possible. Follow normal SNAP time frames.
will not be eligible for SNAP unless the TANF or SSI application is granted,

delay denial of the SNAP EDG. Pend the SNAP application for up to 30 days awaiting the TANF/SSI decision. If the TANF/SSI application is denied on or before the 30th day, deny the SNAP application immediately.

If the TANF/SSI application is granted by the 30th day, certify for SNAP as soon as possible. Prorate from the SNAP application date.

If the TANF/SSI application is still pending by the 30th day:

  • deny the SNAP application; and
  • notify the individual on the denial notice to contact the certification office if the TANF/SSI is later granted.

If the TANF/SSI application is granted after the 30th day:

  • copy Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and return the original to the applicant (the applicant must initial any changes, re-sign Form H1010, and return it to the local eligibility determination office);
  • reopen the SNAP application when Form H1010 is returned;
  • verify and document any changes since the initial interview; and
  • prorate benefits from the original SNAP file date or the effective date of TANF/SSI benefits, whichever is later.*

* When prorating from the effective date of TANF/SSI benefits, use this date as the new SNAP file date. The effective date of benefits for TANF is the earlier of the certification date or 30 days after the file date. The effective date of benefits for SSI applicants is the:

  • SSI file date; or
  • date the individual met all eligibility criteria, if later than the file date.

Advisors must verify the SSI benefit effective date by viewing the award letter or by running Wire Third-Party Query (WTPY) or the State Online Query (SOLQ).

 

B—474 Centralized Benefit Services (CBS) Section

Revision 13-4; Effective October 1, 2013

 

SNAP and Medical Programs

CBS is a centralized section that processes certain types of cases statewide.

Related Policy
Specialized and Centralized Casework Units, C-1471

 

B—474.1 Programs Administered by CBS

Revision 13-4; Effective October 1, 2013

 

SNAP and Medical Programs

CBS administers SNAP and Medical Programs for several individual groups. For information concerning the SNAP Combined Application Project (SNAP-CAP), which is one of the programs that CBS administers, see B-475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP).

 

B—474.1.1 SNAP Programs

Revision 18-1; Effective January 1, 2018

 

SNAP

CBS administers SNAP for:

  • pure categorically eligible SSI households:
    • either through the SNAP-SSI caseload; or
    • as part of SNAP-CAP.

 

B—474.1.1.1 SNAP-Supplemental Security Income (SSI) Caseload

Revision 15-4; Effective October 1, 2015

 

For the SNAP-SSI caseload, Texas is operating under a waiver that allows the state to process both timely and untimely redeterminations without an interview.

CBS staff may complete a redetermination for SNAP-SSI EDGs without an interview except in the following situations:

  • the household requests an interview,
  • the case contains earned income, or
  • it appears the household is going to be denied.

Advisors cannot deny redetermination households for a missed appointment, except for a case with earned income. For the other two situations, staff must schedule an appointment and attempt to conduct an interview but continue to process the redetermination application if the household misses the appointment. If the household is ineligible, the EDG must be denied for the appropriate reason rather than a missed appointment.

If the household submits a redetermination application by the last day of the last benefit month, no interview is required. If the file date falls after the last day of the last benefit month, an interview is required. These households may be denied for a missed appointment.

For untimely submitted redetermination applications, the initial application processing time frames are used, as stated in B-124, Processing Untimely Redeterminations.

 

B—474.1.1.2 Pending SNAP-SSI Redeterminations for Missing Information/Verification

Revision 15-4; Effective October 1, 2015

 

If more information is needed from the household to complete the redetermination, the advisor must attempt to contact the household immediately by telephone to obtain the information. If unable to reach the household by telephone, the advisor must mail Form H1830, Application/Review/Expiration/Appointment Notice, with the advisor’s telephone number, advising the household to call the advisor on a specific date and time, along with Form H1020, Request for Information or Action, clearly explaining the information/verification that is required.

Combining the pending information notice and the appointment notice in one envelope will help staff complete the redetermination timely, rather than waiting to schedule the appointment later if the household fails to provide requested information. The advisor should mail Form H1830-I, Interview Notice (Applications or Reviews), the same day the EDG is identified as one that must be scheduled for an interview, or no later than the next workday.

Households must be allowed the usual 10 days to provide the missing information/verification.

If the household member misses the scheduled appointment, a missed appointment notice is not required. The advisor should continue to attempt to process the EDG without an interview.

 

B—474.1.1.3 SNAP-SSI Redeterminations– Inconsistent or Discrepant Information

Revision 15-4; Effective October 1, 2015

 

While processing SNAP-SSI redeterminations, advisors may notice inconsistent or discrepant information (including management problems). If this occurs, the advisor must contact the household (and pend the EDG if necessary) to resolve the inconsistency. If unable to reach the household by telephone, the advisor must mail Form H1830, Application/Review/Expiration/Appointment Notice, with the advisor’s telephone number, advising the household to call the advisor on a specific date and time, along with Form H1020, Request for Information or Action, clearly explaining the information/verification that is required.

For the SNAP-SSI population, advisors should pay careful attention to shelter costs since this area historically is the most prone to quality control errors. Advisors should establish the actual costs the individual pays, review the current application's reported expenses compared to the previous entries, and resolve any inconsistencies or discrepant information.

 

B—474.1.1.4 SNAP-SSI Redetermination Denials

Revision 19-3; Effective July 1, 2019

 

With the exception of cases with earned income, the policy on scheduling an interview before denying a household's request to recertify SNAP benefits is a federal condition of HHSC's waiver approval. The policy helps to ensure the household has a chance to explore continued eligibility before being denied. Additionally, staff must review facts about the EDG, the household's income and all possible deductions for which the household may be eligible, especially ones that are not as commonly claimed, such as medical transportation costs or adult dependent care costs.

If staff determine that the household appears ineligible while processing the SNAP-SSI redetermination, staff must attempt to conduct an interview before the EDG can be denied. Staff must call the household to conduct the interview if a phone number is available. If unable to reach the household by phone, staff must mail Form H1830, Application/Review/Expiration/Appointment Notice, notifying the household to call to complete the interview. Form H1830 must be mailed the same day, or no later than the next workday, when the EDG is identified as one that requires an interview. Staff must continue to attempt to process the redetermination, and deny if ineligible using normal processing time frames.

 

B—474.1.2 Medical Programs

Revision 18-3; Effective July 1, 2018

 

CBS administers medical programs for:

  • children placed in or released from a Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) facility;
  • former foster care children;
  • women diagnosed with breast or cervical cancer; and
  • people incarcerated in the Texas Department of Criminal Justice (TDCJ) who receive inpatient services.

 

B—474.1.2.1 Child Placed in a Juvenile Facility

Revision 17-2; Effective April 1, 2017

 

The TJJD or JPD notifies HHSC within 30 days of a child's placement in a juvenile facility. Upon notification of the placement, TIERS automatically: 

  • suspends the child's Medicaid eligibility effective the day after HHSC receives the notification if the child is certified for TP 44;
  • terminates the child's Children's Health Insurance Program (CHIP) eligibility effective the day after HHSC receives the notification if the child is certified for CHIP;
  • terminates the child's Medicaid eligibility allowing adequate notice according to policy in A-2344.1, Form TF0001 Required, Adequate Notice, if the child is certified on a Medicaid type other than TP 44; and
  • removes the child from other Eligibility Determination Groups (EDGs) in which the child is included.

Exceptions:

  • Children certified on a Supplemental Security Income (SSI) or Department of Family and Protective Services (DFPS) type of Medicaid are not terminated by HHSC.
  • Children placed in a non-secure facility may receive TP 44 as an independent child. Therefore these EDGs are not suspended or denied when a notification of placement is received for one of these children.

When an exception to the automated process occurs, CBS must manually process the suspension, termination, or removal of the child from associated EDGs.    

Related Policy
Medicaid Suspension, A-825.2

 

B—474.1.2.1.1 Child Placed in a Non-Secure Facility

Revision 18-1; Effective January 1, 2018

 

Children placed in a non-secure juvenile facility with 16 or fewer beds are considered independent children and are potentially eligible for Medicaid. When reporting that a child has been placed in a juvenile facility, TJJD or JPD notifies HHSC if the facility is a secure or non-secure facility.

In general, children placed in a public, non-secure facility with more than 16 beds are not eligible for Medicaid, but children placed in a TJJD or JPD halfway house are not subject to this restriction. Children residing in a TJJD or JPD halfway house with more than 16 beds may be eligible for Medicaid if the halfway house meets the federally required criteria listed in A-241.3.1, Children’s Living Arrangements, and if the children meet all other eligibility criteria.

To determine the correct medical effective date (MED) for children in a non-secure facility, advisors may follow the chart below:

If the child is ...

then ...

not active on Medicaid/Children's Health Insurance Program (CHIP) and the file date is within the same month as the placement date of the child,

the MED is the placement date of the child.

not active on Medicaid/CHIP and the file date is not within the same month as the placement date of the child (that is, the application is filed the month after the placement date),

the MED is the first day of the application month. Note: For unpaid medical bills prior to the file date, follow policy in A-831.1, How to Apply for Three Months Prior Coverage.

active on CHIP,

test for Medicaid eligibility following procedures in A-126.3, Advisor Action for Determining Eligibility for Children.

Exception: If the child is receiving SSI or Foster Care Title IV-E, deny the application.

 

Related Policy
Children's Living Arrangement, A-241.3.1

 

B-474.1.2.2 Child Released from a Juvenile Facility

Revision 17-2; Effective April 1, 2017

 

Upon release from a juvenile facility, HHSC automatically reinstates the TP 44 eligibility for a child whose eligibility was suspended and there are months remaining on the child's original certification period. The effective date of the reinstatement is the date of the child's release from the juvenile facility. The child's eligibility is reinstated even if the case in which the child was originally certified is denied, or if the child is released to a different household than the one in which they were living at the time they were placed. 

If the child is not eligible for reinstatement, but is released to a home in which a sibling is receiving Medicaid or CHIP, the child is automatically added to the case. 

If the child is not eligible for reinstatement and cannot be added to an existing case, staff must send the household an application packet. 

Related Policy
Regular Medicaid Coverage, A-820
Medicaid Reinstatement, A-826
Additions to the Household, B-641

 

B-474.1.2.2.1 Notification of Anticipated Release

Revision 17-2; Effective April 1, 2017

 

Within 30 days prior to a child's release, TJJD or JPD notifies HHSC of the child's anticipated release date. Upon receipt of the information, HHSC determines if the child:

  • is eligible for reinstatement of TP 44 eligibility;
  • can be added to an existing case if not eligible for reinstatement; or
  • must reapply. 

If the child cannot be reinstated because their original certification period has ended or their TP 44 was not suspended or cannot be added to an existing case, CBS staff are notified in the HHSC Action Status field located under the TIERS TJJD/JPD Release page to send the household an application packet, which includes the following:

  • Form H1205, Texas Streamlined Application;
  • postage paid envelope addressed to CBS;
  • cover letter which provides information and instructions for submitting the application and information on how to obtain help in completing the application; and
  • list of Community Partners in the family's area that provide application assistance upon the household's request of assistance. 

Related Policy
Medicaid Reinstatement, A-826

 

B-474.1.2.2.2 Notification of Actual Release

Revision 17-2; Effective April 1, 2017

 

Upon notification from TJJD or JPD of the child's actual release, HHSC automatically reinstates the TP 44 eligibility for a child whose eligibility was suspended and there are months remaining on the child's original certification period. The child's TP 44 eligibility is effective the date of their release and they receive the remaining months of their original certification period.

Examples:

Child is certified for TP 44 from… HHSC receives notification from TJJD or JPD of the child's release from placement on… then the child's TP 44 is…

April 1, 2017 - March 31, 2018.

The TP 44 is suspended on June 3, 2017*

December 2, 2017, reinstated effective December 2, 2017 - March 31, 2018. The child's MED is 12/02/2017.

June 1, 2017 - May 31, 2018.

The TP 44 is suspended on August 19, 2017.*

March 31, 2018, reinstated effective March 31, 2018 - May 31, 2018.

The child's MED is 03/31/2018.

February 1, 2017 - January 31, 2018.

The TP 44 is suspended on July 17, 2017.*

December 19, 2017, reinstated effective December 19, 2017 - January 31, 2018. The child's MED is 12/19/2017.

December 1, 2016 - November 30, 2017.

The TP 44 is suspended on April 1, 2017.*

December 15, 2017, not reinstated, as the child does not have any months remaining on their original certification period. The child is added to an existing case or, if the child cannot be added to an existing case, the household is sent an application packet.

 

*The TP 44 suspension date is based on the date that TJJD or JPD notifies HHSC of the placement. See A-825.2, Medicaid Suspension. 

The child is automatically added to an existing case if the child is not eligible for reinstatement, but has a sibling receiving Medicaid or CHIP. The child is also added to any other EDGs on the case of which the child is required member. 

When an exception to the automated process occurs, CBS must manually process the reinstatement or add the child to an existing case. 

Within two business days of notification of the child's release, CBS staff must process and dispose any pending applications. 

CBS accepts applications up to and including the 14th calendar day after the confirmed date of release. Any applications received after the 14th day are routed to the local office for processing.

CBS reports to TJJD via the Juvenile Medicaid Tracker one of the following:

  • the child has Medicaid or CHIP;
  • the child was denied;
  • the CBS unit never received the application; or
  • the application was sent to the local office. 

If the child is eligible for Medicaid, the MED cannot be any earlier than the release date.

Related Policy
Adverse Actions Not Requiring Advance Notice, A-2344
Enrollment, D-1700
Regular Medicaid Coverage, A-820
Medicaid Reinstatement, A-826
Additions to Household, B-641

 

B-474.1.2.3   Medicaid for Transitioning Foster Care Youth

Revision 17-2; Effective April 1, 2017

 

Policy for TP 70 — Medicaid for Transitioning Foster Care Youth (MTFCY), is explained in Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

 

B-474.1.2.4 Former Foster Care in Higher Education

Revision 17-2; Effective April 1, 2017

 

Policy for type Assistance (TA) 77 — Former Foster Care in Higher Education (FFCHE), is explained in Part F, Former Foster Care in Higher Education (FFCHE).

 

B-474.1.2.5 Medicaid for Breast and Cervical Cancer

Revision 17-2; Effective April 1, 2017

 

Policy for TA 66 — Medicaid for Breast and Cervical Cancer (MBCC)-Presumptive, and TA 67 — MBCC, is explained in Part X, Medicaid for Breast and Cervical Cancer (MBCC).

 

B-474.1.2.6 Former Foster Care Children

Revision 18-1; Effective January 1, 2018

 

Policy for TA 82 — Medicaid for Former Foster Care Children (FFCC), is explained in Part E, Former Foster Care Children (FFCC).

 

B-474.1.2.7 Medicaid Coverage for Inmates of a Public Institution

Revision 18-1; Effective January 1, 2018

 

The policy and processes stated in this section only apply to inmates of the Texas Department of Criminal Justice (TDCJ) and do not apply to any other state, county, or city jails. Applications are submitted to HHSC only by The University of Texas Medicaid Branch at Galveston. 

An inmate of a public institution is eligible for Medicaid coverage if the following conditions are met:

  • The inmate meets Medicaid eligibility requirements. Inmates who are pregnant and children through age 18 could meet current Medicaid eligibility requirements. 
  • The inmate receives inpatient services.
  • The inpatient services are provided by a hospital that is not on the premises of a prison, jail, detention center, or other penal setting, including a facility run by a private health care entity.

The Medicaid coverage is limited to the specific days the inmate is admitted as a patient receiving inpatient services as verified by the medical provider using Form H1046, Inpatient Medical Services Certification. Inpatient services are those provided on the recommendation of a physician or dentist and received in a medical institution. The individual must receive or expect to receive room, board, and professional services in the institution for a 24-hour period or longer. 

If the inmate is ineligible due to U.S. citizenship or alien status, the medical provider must also complete Form H3038, Emergency Medical Services Certification. The ineligible inmate is eligible only for those dates verified as an emergency, even if the inpatient treatment continues after the verified emergency dates. 

The incarcerated individual is only eligible for prior coverage. 

The TDCJ or its designee submits the following documents to HHSC via fax:

  • Form H1205, Texas Streamlined Application, on behalf of the inmate the month following the month the eligible hospital bill was incurred;
  • Form H1046;
  • Form H3038, if applicable; and
  • all required verification, such as verification of citizenship, alien status, etc.

Note: If the required information or verification is not received, staff must call or send secure email to the designated TDCJ contact.

Upon disposition of the application, staff must send Form TF0001, Notice of Case Action, to the address of the representative provided on Form H1205. 

 

B—474.2 Conversion of EDGs

Revision 13-4; Effective October 1, 2013

 

SNAP

EDGs are converted to CBS when all members meet all SNAP eligibility requirements that pertain to categorically eligible households, receive SSI, and no individual is disqualified for:

  • able-bodied adults without dependents (ABAWD) time limits,
  • fleeing as a felon,
  • an IPV,
  • refusal to cooperate with a Quality Control review,
  • E&T noncooperation,
  • SSN noncooperation,
  • student status, or
  • felony drug conviction.

Note: Additionally, in order to be eligible for conversion to the SNAP-SSI caseload, no individual can reside in a group living arrangement, drug/alcohol treatment center or boarding house, or have earned income, including self-employment income.

After the local office completes an initial certification, an automated process converts EDGs that meet the criteria to CBS. The automated process occurs monthly at cutoff. The individual is mailed a notice to inform the individual:

  • that the EDG is handled by CBS, and
  • to report household changes by:
    • telephoning 2-1-1, or
    • entering the change in the Self-Service Portal, or
    • mail.

The notice includes contact information. Field staff continue to accept changes and complete case actions until the EDG converts to CBS.

 

B—474.3 Methods of Reporting Changes

Revision 15-4; Effective October 1, 2015

 

SNAP and Medical Programs

Local office staff may fax changes to CBS. The vendor will create a task for online or mailed changes.

Related Policy
Reporting Requirements, B-620

 

B—474.4 Reserved

Revision 15-4; Effective October 1, 2015

 

 

B—474.5 Replacement of Lone Star Cards/PINs/Medical Care IDs

Revision 15-4; Effective October 1, 2015

 

SNAP

See procedures in B-243, Centralized Benefit Services (CBS) Cases, for CBS individuals who request card or PIN replacements.

Medical Programs

Replacement or temporary medical care ID cards (Form H1027-A, Medicaid Eligibility Verification; Form H1027-B, Medicaid Eligibility Verification - MQMB; and Form H1027-C, Medicaid Eligibility Verification - QMB) must be issued by local eligibility determination offices. The individual can print an image of the medical care identification card and request a replacement online through YourTexasBenefits.com, or call 1-855-827-3748 to request a replacement.

 

B—474.6 Moving Cases Out of CBS

Revision 15-4; Effective October 1, 2015

 

SNAP

The CBS section:

  • moves cases out of the CBS caseload if:
    • the household no longer meets the criteria to be a CBS case (earnings, loss of SSI);
    • household composition changes; or
    • because regional staff request the transfer under special circumstances;
  • shortens the certification period as specified in B-474.6.1, Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs); and
  • documents in TIERS Case Comments the reason for return.

The CBS section also returns untimely redetermination EDGs received in the month after the last benefit month to the task queue and documents in TIERS Case Comments the reason for return.

Medical Programs

Children's MedicaiD – CBS moves completed Medicaid determinations, both active and denied, out of the CBS section.

 

B—474.6.1 Special Procedures for Shortening Certification Periods for Centralized Benefit Services (CBS) Eligibility Determination Groups (EDGs)

Revision 15-4; Effective October 1, 2015  

 

SNAP

If the household reports a change that results in the household no longer meeting CBS caseload criteria, such as the loss of SSI benefits, an addition to the household, or moving into a GLA, then CBS staff move the EDG out of the CBS caseload.

Before moving the EDG out of the CBS caseload, CBS must take appropriate action based on the following criteria:

If the household's certification period is in ... then ...
month 1-11, if benefits:
  • will increase or decrease, send the household Form TF0001, Notice of Case Action, informing the individual that the last benefit month is month 12; and
  • shorten the certification period to a 12-month total by processing a change action with the new benefit amount and change the last benefit month to month 12.
month 12-36, if benefits:
  • are being increased or decreased, send the household Form TF0001, Notice of Case Action, informing the household that the certification period is being shortened because it no longer meets the criteria specified in B-474, Centralized Benefit Services (CBS) Section; and
  • shorten the certification period to end on the last day of the month after the month Form TF0001 was sent.
Note: CBS staff also must include Form H1830, Application/Review/Expiration/Appointment Notice, and Form H1010, Texas Works Application for Assistance — Your Texas Benefits, advising the individual how to file future applications.

 

B—474.7 Denied EDGs

Revision 15-4; Effective October 1, 2015

 

SNAP

The local office must perform an inquiry on denied EDGs to ensure the CBS section is not in the process of certifying the EDG.

Note: Advisors must accept Form H1840, SNAP Food Benefits Renewal Form, if received at the local office and the CBS SNAP EDG certification period has expired.

Medical Programs

The local office must coordinate with CBS to determine the effective date of certification when a youth certified for TP 70, TA 82, or TP 44 (Medicaid coverage to eligible youths in the custody of or released from the Texas Juvenile Justice Department), or an adult certified for TA 67, applies for Medicaid.

 

B—474.8 Opportunity to Register to Vote

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must mail Form H0025, HHSC Application for Voter Registration, to households who do not have a face-to-face interview, unless Form H0025 is requested through the Voter Registration Information Individual Demographic screen.

If the individual contacts the local office to decline the opportunity to register to vote after receipt of Form H0025, the advisor should mail Form H1350, Opportunity to Register to Vote, to the individual for a signature. The advisor sends the completed Form H1350 for imaging and retains the form for 22 months.

Related Policy
Registering to Vote, A-1521

 

B—475 Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP)

Revision 13-4; Effective October 1, 2013

 

 

B—475.1 Overview

Revision 19-2; Effective April 1, 2019

 

SNAP-CAP

SNAP-CAP is a demonstration project to outreach older SSI recipients not currently certified for SNAP. Single SNAP-CAP households are certified for either a $75 or $130 standard SNAP-CAP allotment based on their reported monthly shelter expense.

If the household reports that the monthly shelter expense is less than $440 per month, the monthly SNAP-CAP allotment is $75. If the household reports that the monthly shelter expense is more than or equal to $ 440 per month, the monthly SNAP-CAP allotment is $130.

To be eligible for SNAP-CAP, an individual must:

  • be an SSI recipient;
  • be age 50 or older;
  • reside in Texas;
  • not reside in an institution that causes ineligibility; and
  • not receive regular SNAP benefits.

Additionally, an individual is not eligible to participate in SNAP-CAP if the person:

  • is a fleeing felon;
  • is disqualified for an IPV; or
  • is disqualified due to a felony drug conviction that occurred on or after Sep. 1, 2015 as described in A-232.2, Disqualified Persons.

No other regular SNAP eligibility criteria apply to SNAP-CAP. Note: Individuals may switch from SNAP to SNAP-CAP as described in B-475.2.2, Switching from the Regular SNAP Program to SNAP-Combined Application Project (CAP).

 

B—475.2 Application Processing

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

State office identifies potential SNAP-CAP recipients via the Texas State Data Exchange (SDX) match process. State office automatically mails a form to individuals potentially eligible for SNAP-CAP. For individuals who previously received SNAP benefits in Texas, the mail out occurs two months after the last month individuals last received benefits in Texas. CBS certifies the SNAP-CAP EDG for 36 months, provides notice of eligibility, and authorizes an EBT account without a face-to-face or telephone interview.

If an individual receives a SNAP-CAP application and also applies for SNAP at the local office, advisors coordinate the application process with CBS staff before making an eligibility decision in the local office to ensure that the individual can make an informed choice about which program the individual prefers. The individual may voluntarily withdraw the other application.

If the spouse of an active SNAP-CAP participant submits an application at the local office, advisors certify the spouse separately from the active SNAP-CAP participant. If the spouse appears potentially eligible for SNAP-CAP, the advisor explains the program and requirements outlined in B-475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP). The SNAP application may be withdrawn if the individual wants to participate in SNAP-CAP. Refer the individual to 2-1-1. Advisors must document that the individual was informed of the program, but that the individual withdrew the SNAP application.

A SNAP-CAP application returned to a local eligibility determination office must be faxed to the non-expedited fax line at 1-877-447-2839 the same day it is received.

Expedited processing and benefit proration do not apply to the SNAP-CAP program. A standard allotment is issued for the month the application is returned.

 

B—475.2.1 Identifying Intentional Program Violations (IPVs) and Felony Drug Convictions

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

The Data Broker vendor will receive the monthly SNAP-CAP application file and will notify state office Eligibility Operations of any clients with active out-of-state SNAP IPV disqualifications and felony drug convictions.

State office staff will forward any IPV matches to the Customer Care Center-Electronic Disqualified Recipient System (CCC-eDRS) staff using secure Voltage email at HHSC Office of Eligibility Services CCC Open Investigation (HHSC OES CCC IC) who will complete a secondary verification and then forward a completed Form H1856, SNAP Out-of-State Intentional Program Violations, to OIG at CDU@hhsc.state.tx.us, and document this action in TIERS Case Comments.

OIG Centralized Disqualification Unit (CDU) staff will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the advisor of the disqualification. The CBS advisor then takes appropriate action to deny the application/EDG. Note: If CBS staff has not yet processed the application, TIERS will ensure it is denied if the application is subsequently filed and/or processed.

State office also shares any felony drug conviction data matches with CBS. CBS staff must follow policy in A-232.2, Disqualified Persons, to take adverse action.

 

B—475.2.2 Switching from the Regular SNAP Program to SNAP-Combined Application Project (CAP)

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

If an SSI recipient receiving regular SNAP benefits wants to switch to SNAP-CAP, the individual must contact CBS staff and request to withdraw from the regular program and apply for SNAP-CAP.

Within 10 days of receipt of the request and determination that the individual meets SNAP-CAP eligibility requirements, CBS staff:

  • send the individual a notice of denial for the regular SNAP, using adequate notice procedures;
  • terminate the person's participation in the regular SNAP as soon as possible (that is, the end of the month the individual made the request if the 10th day falls before the monthly computer cutoff, and no later than the end of the next month); and
  • send the individual a SNAP-CAP application if the individual has not already filed one with CBS.

If HHSC fails to take action within 10 days to authorize denial of the regular SNAP EDG for the applicable month, HHSC restores any lost benefits as a result of untimely agency action.

HHSC does not provide a SNAP-CAP application to anyone who does not meet the SNAP-CAP eligibility criteria. CBS also certifies eligible individuals for SNAP-CAP if the individuals submit applications they obtained on their own. CBS will coordinate termination of the individual's participation in regular SNAP, if not already terminated. To avoid duplication of SNAP benefits when an eligible individual requests to switch from the regular SNAP to SNAP-CAP, CBS staff use a file date equal to the first day of the first month the individual qualifies for SNAP-CAP, if that date is later than the date the application form is actually received. CBS staff must document in TIERS Case Comments the reason for the modified file date as compared to the date on the application form.

Note: CBS staff may also cancel a month's regular SNAP issuance in order to expedite the recipient's switch to SNAP-CAP, if it is not too late to cancel that issuance. Refer to B-331, Cancelling Benefits in EBT Accounts.

 

B—475.3 Household Composition

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

A SNAP-CAP food unit consists of one person. Married individuals who are both receiving SSI are considered separate households and certified on individual SNAP-CAP EDGs. (See A-231, Who Is Included.)

A SNAP-CAP participant who resides in a household in which other members receive SNAP through the regular program is considered a separate household, regardless of how they purchase and prepare their meals. (See A-232.1, Nonmembers.)

Do not include a SNAP-CAP participant when determining regular SNAP eligibility for other household members. Follow policy in A-1326.1.1, Contributions from Noncertified Household Members.

A minor child residing with a SNAP-CAP participant may be certified as SNAP head of household. The SNAP-CAP participant must be listed as the AR on the minor child's EDG. (See A-231.)

 

B—475.4 Income

Revision 13-4; Effective October 1, 2013

 

SNAP-CAP

SSI eligibility is verified weekly via the SNAP-CAP participant's SDX record.

 

B—475.5 Shelter and Utility Expenses

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

Advisors follow policy in A-1429, Shelter Costs, for separate households sharing shelter expenses, including standard utility allowance (SUA)/basic utility allowance (BUA), if applicable.

 

B—475.6 Changes

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

SNAP-CAP participants are not required to report changes. CBS processes shelter and address changes reported by SNAP-CAP participants.

CBS will mail Form H0025, HHSC Application for Voter Registration, to the individual when the individual reports a change of address. If the individual contacts CBS to decline the opportunity to register to vote after receipt of Form H0025, CBS will mail Form H1350, Opportunity to Register to Vote, to the individual for a signature. After the household returns Form H1350, the advisor sends the form for imaging and retains the image for 22 months.

State office uses SDX records to automatically update individual information on a weekly basis. The weekly SDX update results in a SNAP-CAP EDG denial if the individual no longer receives SSI, dies or moves to a nursing home.

Related Policy
Registering to Vote, A-1521

 

B—475.7 Issuing Benefits

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

CBS authorizes a SNAP-CAP participant's EBT account. Replacement EBT cards may be obtained from local eligibility determination offices if the local office replacement criteria are met. Advisors follow policy in B-235.1, Lone Star Card Replacement Procedures, to determine whether the SNAP-CAP participant can get a replacement card locally or must obtain it from the Lone Star Help Desk.

Follow policy in B-362, Advisor Action on Dormant Accounts, when a SNAP-CAP EDG is dormant.

 

B—475.8 Fair Hearings

Revision 13-4; Effective October 1, 2013

 

SNAP-CAP

Follow policy in B-1000, Fair Hearings.

 

B—475.9 Claims

Revision 19-4; Effective October 1, 2019

 

SNAP-CAP

Staff file an overpayment referral when a household receives benefits it is not entitled to receive. This may occur based on agency error, applicant or recipient error or misunderstanding, through fraud or an Intentional Program Violation (IPV). OIG receives the overpayment referral and establishes a claim if the referral is valid.

SNAP-CAP households are subject to overpayment referrals and claims. Households may repay benefits through either recoupment or restitution. Recoupment is a method of recovering an overpayment claim by withholding a portion of the household's benefits. Restitution is a method of recovering an overpayment claim by the receipt of payments from the household paid to HHSC.

Related Policy
Claims, B-700
Filing an Overpayment Referral, B-770

 

B—475.10 Redeterminations

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

State office automatically mails Form H1842, SNAP-CAP Renewal Application, two months before the last benefit month. To reapply in a timely manner, the individual must submit the completed Form H1842 by the 15th day of the last benefit month.

CBS staff must process timely redeterminations by the last workday of the certification period. CBS staff certify the SNAP-CAP EDG for 36 months and provide a notice of eligibility without a face-to-face or telephone interview. Advisors must ensure that the individual's normal issuance cycle is not interrupted.

If CBS receives Form H1842 after the 15th day of the last benefit month, advisors certify or deny the application by the 30th day after the file date. Expedited processing and benefit proration do not apply to SNAP-CAP.

A Form H1842 returned to a local eligibility determination office must be faxed to CBS the same day it is received. The fax number is 1-877-447-2839.

 

B—475.10.1 Opting Out of SNAP-CAP

Revision 15-4; Effective October 1, 2015

 

SNAP-CAP

Individuals currently receiving SNAP-CAP may choose to apply for traditional SNAP because they may be eligible for a higher allotment. If an individual returns Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and chooses to opt out of SNAP-CAP, the local office must:

  • contact and confirm the applicant wants to apply for benefits under regular SNAP;
  • schedule an appointment for an interview;
  • perform Application Registration using a different SNAP EDG number than the SNAP-CAP EDG number;
  • determine if the individual would receive a higher allotment under regular SNAP;
  • notify the individual of the allotment amount under regular SNAP and confirm if the individual wishes to withdraw from SNAP-CAP;
  • contact 2-1-1 to request EDG closure because the individual wishes to withdraw from SNAP-CAP;
  • confirm the SNAP-CAP EDG has been denied; and
  • certify the individual for regular SNAP effective the first month the individual qualifies for benefits without duplicating benefits.

 

B—476 Joint Supplemental Security Income (SSI)-SNAP Applications

Revision 15-4; Effective October 1, 2015

 

 

B—476.1 Applications Filed in the Social Security Office

Revision 15-4; Effective October 1, 2015

 

SNAP

Households whose members are all applying for or receiving SSI may apply for SNAP at the SSA office unless the households already have a SNAP application pending. These individuals are not required to come to the SNAP office to complete the application or redetermination process. If more information is needed from the household, the advisor must contact the household by home visit, telephone, or mail.

SSA:

  • accepts and completes the SNAP application during the SSI interview; and
  • forwards the following items to the Document Processing Center within one workday after receiving the application:
    • the application;
    • Form SSA-4233, Social Security Administration Transmittal for Food Stamp Applications; and
    • any verification SSA has received.

The file date for the application is the date SSA receives the application. SSA notes this date on Form SSA-4233. When SSA receives additional verification after forwarding the application to the Document Processing Center, SSA sends the additional verification with Form SSA-4233.

 

B—476.1.1 Expedited Service

Revision 15-4; Effective October 1, 2015

 

SNAP

Advisors determine expedited services eligibility for SSI households the same as other households, except expedited time limits begin with the date the correct SNAP office receives the application.

SSA staff:

  • screen the application for expedited services on the day they receive it;
  • note "Expedited Processing" on the first page of Form H1010, Texas Works Application for Assistance — Your Texas Benefits, if the household appears to be eligible; and
  • fax the application within one workday to the Document Processing Center's expedited fax number.

The individual may also take the application to the SNAP office.

 

B—476.1.2 Work Registration

Revision 16-2; Effective April 1, 2016

 

SNAP

SSI household members who apply for SSI and SNAP at the Social Security office are exempt from work registration until the SSA determines their eligibility for SSI.

Related Policy
E&T Exemptions, A-1822.1

 

B—476.1.3 Special Review

Revision 15-4; Effective October 1, 2015

 

SNAP

For households applying at SSA, advisors process a special review during the third month of the certification period to determine whether the individual received a decision on the SSI claim.

 

B—476.1.4 Notice of Expiration

Revision 13-4; Effective October 1, 2013

 

SNAP

TIERS sends Form H1830-R, Texas Works Renewal Notice, to the SSI household:

  • no earlier than the month before the last month of the certification period, and
  • no later than the first day of the last month of the certification period.

The notice of expiration informs the individual:

  • what programs are due for redetermination,
  • verifications needed for the redetermination,
  • when the redetermination application and verifications are due, and
  • the individual's rights and responsibilities.

 

B—476.1.5 Reporting Changes

Revision 15-4; Effective October 1, 2015

 

SNAP

These households are subject to the same change reporting requirements as other SNAP households.

HHSC receives information on whether the SSI was granted or denied through an interface with SSA. Advisors must take action on information from this or any other source.

Related Policy
Reporting Requirements, B-620

 

B—476.1.6 Redetermination

Revision 13-4; Effective October 1, 2013

 

SNAP

Households in which all members are applying for or receiving SSI may file a redetermination for SNAP at the SSA.

The SSA office sends:

  • the application,
  • transmittal sheet (Form SSA-4233), and
  • any available verification to the Document Processing Center.

 

B—476.2 Applications Filed in Public Institutions

Revision 15-1; Effective January 1, 2015

 

SNAP

A resident of a public institution may jointly apply for SSI and SNAP while in the institution if scheduled for release within 30 days.

SSA:

  • within one business day, sends non-expedited applications to:
    • HHSC
      P.O. Box 149024
      Austin, TX 78714-9024

      or
    • faxes them to 1-877-447-2839;
  • within one business day, faxes expedited applications to 1-866-559-9628;
  • notes "PRERELEASE" in red ink across the top of Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
  • sends Form SSA-4233 to HHSC; and
  • gives HHSC the name, address and telephone number of a staff contact at the institution.

When the individual does not have a post-release address, SSA holds the application for 30 days and documents its actions. SSA sends these applications and Form SSA-4233 to HHSC within one business day when:

  • SSA receives a post-release residence address;
  • release has occurred, but SSA has not received a post-release address;
  • SSA denies SSI prior to release; or
  • release from the institution is canceled.

HHSC staff:

  • register the application, and
  • pend the application until SSA notifies HHSC that the applicant has been released.

If the applicant is:

  • not released, HHSC denies the application.
  • released, HHSC determines eligibility for benefits, including expedited services. HHSC offers benefits to allow the individual a chance to participate per the time frames in A-100, Application Processing.

Note: The file date is the date the applicant is released from the institution. The file date is day zero.

Certification Period/Special Review — The advisor must process a special review during the third month of the certification period to determine whether the individual receives SSI.

 

B—480 A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20

Revision 15-4; Effective October 1, 2015

 

TANF

When household members on a TANF EDG that includes other-related children become ineligible, and the other-related children remain eligible for TANF, advisors must ensure the other-related children continue to receive TANF.

Advisors must:

  • deny the TANF or TANF-SP EDG; and
  • continue the TANF for the other-related children.

TP 08

If a caretaker relative who receives TP 08 based on caring for (an) other-related child(ren) receiving Medicaid becomes ineligible for TP 08 due to new or increased earnings or spousal support and begins receiving TP 07 or TP 20, the other-related child(ren) will also transition from their TP 43, TP 44, or TP 48 EDG to a TP 07 or TP 20 EDG.

 

B—481 EDGs That Include an Other-Related Child

Revision 15-4; Effective October 1, 2015

 

 

B—481.1 At Initial Certification

Revision 15-4; Effective October 1, 2015

 

TANF or TANF-SP

When a TANF EDG includes an other-related child, advisors must:

  • explain to the household that the other-related child, if eligible alone, can continue receiving TANF even if the TANF for the other members of the household is denied. Denials include, but are not limited to, those because of:
    • resources,
    • earnings, or
    • child support.
  • advise households that have an other-related child included in the TANF EDG to contact HHSC immediately if they receive a notice in the mail stating that their TANF or TANF-SP will be denied because they are no longer eligible for the 90 percent earned income deduction.
  • set a special review to contact the household and continue TANF for an eligible other-related child when the EDG is expected to be denied because the 90 percent earned income deduction will be removed.

 

B—481.2 Before a TANF or TANF-SP EDG Is Denied

Revision 15-4; Effective October 1, 2015

 

TANF

Advisors determine whether an other-related child is eligible for TANF on a separate EDG before the household's TANF is denied. Advisors must contact the household to ensure that the household wants the child's TANF to continue.

Advisors provide TANF to the other-related child without a break in benefits, if the other-related child is eligible alone and the household:

  • wants the other-related child's TANF to continue, or
  • cannot be contacted.

If more than one other-related child is in the household, other-related children who are not siblings are certified on separate EDGs. Exception: The individual may choose to combine EDGs if one EDG is ineligible separately but would be eligible if the members were combined.

The other-related child is kept in the original household group if the:

  • child is not eligible alone, or
  • the household does not want the child to receive TANF.

 

B—482 Separating Household Members

Revision 15-4; Effective October 1, 2015

 

TANF

The eligibility system creates an EDG for the other-related child's TANF. Advisors must verify that each certified group contains the correct members. Advisors also must ensure that a new Lone Star Card is issued for the other-related child's new EDG. A new application is not required.

Note: These procedures ensure that TANF-SP EDG numbers follow the SP members.

 

B—490 Determining Whether an Individual Who Resides in a Facility  Is Institutionalized

Revision 18-2; Effective April 1, 2018

 

SNAP

Individuals residing in institutions that are not approved may be potentially eligible for SNAP only if the individual is not considered institutionalized. Approved institutions are defined in A-116.2, Applications from Residents of a Homeless Shelter; B-440, Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities; and B-450, Residents in Family Violence Shelters.

Additionally, individuals who reside together and receive residential services from nonprofit organizations or for-profit providers who contract with HHSC to provide residential services may participate in SNAP only if the individual is not considered institutionalized.

Provider staff may:

  • manage an individual's personal funds at the request of the individual; or
  • be the payee on the resident's SSI benefit check.

If the individual requests the provider staff to manage the individual's personal account, the staff must maintain a financial account for the individual and a separate detailed record of all deposits and expenditures for each individual.

Provider staff may not commingle the individual's personal funds with the provider's funds.

For individuals residing in a facility or receiving residential services, staff must determine whether an individual is institutionalized for SNAP eligibility following the steps below:

Step Yes No
  1. Does the individual do their own shopping and meal preparation for more than 50 percent of their meals, or do the facility staff manage the individual's personal account (which can include SNAP benefits) and use those funds to purchase a majority of the individual's meals and prepare them for the individual?
The individual is not considered institutionalized.  The individual is eligible for SNAP if all other SNAP eligibility requirements are met. Go to Step 3. Go to Step 2.
  1. Does the facility :
  • contract with HHSC to furnish a majority of the individual's meals along with other services;
  • provide a majority of the individual's meals from food purchased with money other than the individual's funds; or
  • charge the individual a standard fee for a majority of the individual's meals?
The individual is considered "institutionalized" for purposes of SNAP eligibility since the contractor is providing a majority of meals for the individual. The individual can only qualify if the individual meets the requirements for a resident of a nonprofit GLA in B-442, Residents of Group Living Arrangement (GLA) Facilities. The individual is not considered institutionalized. The individual is eligible for SNAP if all other SNAP eligibility requirements are met. Go to Step 3.
  1. Does the individual purchase and prepare their meals separately from others (including situations in which an attendant purchases food for the individual with the individual's money and prepares the individual's meals separately from other individuals), or does the individual intend to purchase and prepare separately after certification for SNAP?
The individual can apply as a one-person household following regular policy. Individuals who purchase or prepare their food together must be included together on the SNAP application. HHSC determines eligibility for all those purchasing or preparing together following policy in A-210, General Policy. Example: The facility uses each individual's personal funds to purchase groceries and then prepare meals for all individuals together. In this example, those individuals must be included together for SNAP.

 

Verify and document the answers to the questions in the chart. If the individual designates provider staff as the AR and the AR states the attendant purchases meals/food using the individual's funds, the AR must provide a copy of the detailed record of deposits and expenditures for those individuals.

 

B—491 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

SNAP

For households receiving residential assistance, responses to the questions in B-490, Determining Whether an Individual Who Receives Residential Assistance Is Institutionalized, must be documented.

B-500, Reserved for Future Use

Reserved for future use.

B-600, Changes

Revision 19-4; Effective October 1, 2019

 

 

B—610 General Policy

Revision 15-4; Effective October 1, 2015

 

All Programs

Changes are situations that occur in a household that may affect eligibility or the amount of benefits. The advisor must take action on reported changes to ensure that:

  • individual benefits are issued timely and accurately;
  • the Texas Health and Human Services Commission (HHSC) is not sanctioned for failure to provide correct benefits for the correct month; and
  • Quality Control (QC) initiatives are met.

 

B—620 Reporting Requirements

Revision 05-4; Effective August 1, 2005

 

 

B—621 What to Report

Revision 19-2; Effective April 1, 2019

 

All Programs

The advisor must inform all households of their responsibility to report changes in residence.

TANF and SNAP except SNAP Streamlined Reporting (SR) Households

The advisor must inform all households of their responsibility to report the following changes:

  • source of income;*
  • household composition;
  • ownership of a licensed vehicle; and
  • wage rate or status (full-time to part-time or vice versa as defined by the employer) for employed household members.*

* SR households must report any change that causes the ongoing income to exceed the 130 percent federal poverty income limit (FPIL) including a new household member.

TANF

The advisor must inform all households of their responsibility to report the following changes:

  • the amount of non-exempt unearned income of any household member;
  • circumstances other than employment that affect a person's amount of benefits or employment services exemption status;
  • address, job, or other information related to the absent parent; and
  • available cash, stocks, bonds, or money in a bank or savings account if the total is over $1,000.

SNAP

Streamlined Reporting 1 households meet the SR criteria described in A-2350, Streamlined Reporting Households, and have income below 130 percent FPIL. These households are required to report:

  • residence and associated changes in shelter cost such as rent or mortgage and utilities;
  • when the ongoing gross monthly income exceeds 130 percent FPIL for the household's size. Consider the income ongoing if it exceeds 130 percent FPIL for two consecutive months. Example: A new household member who is required to be included in the SNAP Eligibility Determination Group (EDG) moves into an SR household and the new member has income that causes the household's income to exceed the current 130 percent FPIL. The household must report the change. The advisor must issue a new Form TF0001, Notice of Case Action, notifying the household of the requirement to report changes in residence and associated changes in shelter costs; and
  • when the work or participation hours of an ABAWD decrease below an average of 20 hours per week. Work and participation hours include employment, self-employment and any participation hours that count toward the work requirement.

Streamlined Reporting 2 households meet the SR criteria described in A-2350 and have income above 130 percent FPIL. These households are required to report changes in residence and associated changes in shelter costs such as rent or mortgage, and utilities and when the work or participation hours of an ABAWD decrease below an average of 20 hours per week.

Streamlined Reporting 3 households do not meet the SR criteria in A-2350. These households are required to report:

  • gross monthly household unearned income if the amount changes by more than $50 during the certification period;
  • residence and associated changes in shelter costs such as rent or mortgage, and utilities;
  • legal obligation of child support paid to or for nonmembers; and
  • available cash, stocks, bonds or money in a bank or savings account if the combined resources total is $5,000 or more.

 

When an SR 1 household reports a change that occurs after certification and the change causes their ongoing income to exceed their gross monthly income limit (130 percent FPIL) for two consecutive months, the household has met the SR reporting requirement. If the household remains eligible for an allotment, the household is not required to report additional income changes during the certification period, and is only required to report changes in residence. However, if the advisor later processes a reported change and income is again below 130 percent FPIL (due to decreased income or fewer household members), Form TF0001 should be issued advising the household they are again responsible for reporting if their income exceeds 130 percent FPIL.

 

SR 1 and SR 2 households:

  • must respond as directed to all notices and letters from the employment program;
  • are not required to report any other changes. If the household reports a change, the advisor takes the appropriate action and continues to act on all agency-generated changes; and
  • are not required to report when a child turns age 18 during the certification period. If an SR household contains a child who will turn age 18 during the certification period, time limits do not apply to anyone until the next redetermination.

Advisors must inform SR 1 and SR 2 households with associated TANF or Medical Program (MP) EDGs of the TANF/MP reporting requirements. A status of SR 1 or SR 2 on a SNAP EDG does not alter the change reporting requirements for associated TANF or MP EDGs.

If the SR 1 or SR 2 household reports that a minor child is no longer in the home and the only person age 18 up to age 50 is now an Able Bodied Adult without Dependents (ABAWD) who:

  • does not meet the SNAP ABAWD work requirement, the advisor processes the household composition change and registers the individual for SNAP Employment and Training (E&T). The advisor must send the ABAWD a new notice informing the individual of the time limit and set a special review for the month before the end of the ABAWD's time limit to disqualify the ABAWD or deny the EDG.
  • meets the SNAP ABAWD work requirement, the ABAWD's months do not count and a special review is not required.

 

When an SR1 or SR2 household reports that an ABAWD is working or participating less than an average of 20 hours per week and no longer meeting the work requirement, the household will be subject to non-streamlined reporting criteria and designated as SR3.

 

Medical Programs except TP 45

Advisors must inform all households of their responsibility to report the following changes:

  • address;
  • intent to reside in Texas;
  • the people living in the home;
  • income, including sources of income, regular hours worked and pay rate;
  • Modified Adjusted Gross Income (MAGI) expenses;
  • a child being institutionalized or dying; and
  • medical insurance coverage.

TP 08 and TA 31

Advisors must inform all households of their responsibility to report changes in the address, job, or other information related to the absent parent.

TP 40

Households must report the termination of a pregnancy.

TP 45

Households must report if the child no longer resides in Texas.

Related Policy
General Reminders, A-1510
Monitoring Questionable Management, A-1731
Length of Certification, A-2324
Streamlined Reporting Households, A-2350

 

B—622 When to Report

Revision 05-4; Effective August 1, 2005

 

All Programs

During the interview or application processing, households must report changes that occurred since the application was filed. See B-116, Information Reported During Application Processing.

After the interview, the household must report changes listed in B-621, What to Report, within 10 days after the household knows about the change.

For special reviews, see the requirements in B-125, Processing Special Reviews.

 

B—623 How to Report

Revision 15-4; Effective October 1, 2015

 

All Programs

Household members or someone acting on the household's behalf may report changes:

  • online through YourTexasBenefits.com;
  • in person;
  • by telephone;
  • by fax;
  • by mail; or
  • on Form H1019, Report of Change, submitted in person, by fax or by mail.

Notes:

  • When a change is reported by telephone, the advisor must verify that the person speaking has the authority to report a change.
  • When a signed Form H1019 is not on file, the individual's signature on Form H1028, Employment Verification, is acceptable as a written, signed report of income change for adequate notice purposes.
  • When a change is reported on an application form, staff do not have to act on the change within 10 days. The file date is considered the report date for purposes of determining the effective date of the change. The date the advisor begins working the EDG and becomes aware of the change is day zero for purposes of taking action on the change for the associated EDGs. The individual must provide any requested verification by the Form H1020, Request for Information or Action, due date to be considered timely verification.
  • If the household reports a change of address in person, the advisor must provide the individual with the opportunity to complete Form H0025, HHSC Application for Voter Registration, to register to vote based on their new address. If the individual declines to register to vote, the advisor should ask the individual to sign Form H1350, Opportunity to Register to Vote. The advisor must send Form H1350 for imaging when the individual returns the form and retain the form for 22 months.
  • If the household reports a change of address online through YourTexasBenfits.com, or via mail, fax, telephone, or through an authorized representative, the advisor must mail the individual Form H0025 to register to vote based on the new address. If the individual contacts the local office to decline the opportunity to register to vote after receipt of Form H0025, the advisor must mail Form H1350 to the individual for a signature. The advisor must send Form H1350 for imaging when the individual returns the form and retain the form for 22 months.
  • When a household requests to make a new person or organization their authorized representative, the advisor must verify the change using the client’s signature or documentation explained in A-170, Authorized Representatives (AR).

Related Policy
Form TF0001 Required (Adequate Notice), A-2344.1
Receipt of Duplicate Application, A-121.2
Receipt of Identical Application, A-121.3
Registering to Vote, A-1521

 

B—623.1 Determining Whether New Income Information Is a Reported Change

Revision 15-4; Effective October 1, 2015

 

TANF, TP 08 and SNAP

When an advisor works a Children's Medicaid application/redetermination during a TANF/Medicaid/SNAP certification period, and a household member's source of income currently budgeted on the other active EDG has not changed, the advisor must determine whether the member is reporting a change in income. To do this, the advisor must determine whether the income verification the household provided with the Children's Medicaid application/redetermination is:

  • a more recent payment than previously verified; and
  • within the range of payments previously verified that are currently used in the budget for the associated active EDG(s), whether the individual provides only one or more than one. "Range of payment" is the highest to the lowest representative pay amounts used to determine the current ongoing budget.

Advisors may follow the guidelines below:

If ... then ...
any of the payment amounts provided as verification for the Children's Medicaid application/redetermination are:
  • more recent; and
  • at least $25 outside the range of payment currently used as "representative income" in the budget for the active EDG,
treat this as a reported change for the active EDG and take action following B-631, Actions on Changes (including additional verification of income, if necessary). If the individual fails to provide timely verification, follow policy in B-642, Changes Increasing Benefits (Other than Additions to the Household), and B-643, Changes Decreasing Benefits.
all of the payment amounts provided as verification for the Children's Medicaid application/redetermination are:
  • older than those currently used, or
  • less than $25 outside the range of payment currently used as "representative income" in the budget for the active EDG,
do not treat this as a reported change for the active EDG (unless the individual reports that the source of income or amount of income has changed).

 

Example: The lowest representative check used for the current certification period is $175 and the highest representative check used is $200. The individual provides a check stub for the Children's Medicaid EDG in the amount of $210. This check is less than $25 outside the range of payments and is not considered a change.

If a change is reported during the Children's Medicaid application/redetermination, the advisor processing the Medicaid EDG must either take action on the associated TANF/Medicaid/SNAP EDG or notify the local office of the reported change. The file date is considered the report date for purposes of determining the effective date of the change. The date the advisor works the Children's Medicaid EDG and becomes aware of the change is day zero for purposes of taking action on the change for the associated EDG. The individual must provide any requested verification by the due date on Form H1020, Request for Information or Action, to be considered timely verification.

 

B—624 Receipts for Reported Changes

Revision 15-4; Effective October 1, 2015

 

All Programs

Households may request a receipt to acknowledge the change report. The receipt includes the type of change(s) and the date reported. If an individual requests a receipt, the advisor must issue:

  • a copy of the individual's completed Form H1019, Report of Change; or
  • Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change.

 

B—630 Processing Requirements

Revision 05-5; Effective October 1, 2005

 

 

B—631 Actions on Changes

Revision 17-2; Effective April 1, 2017

 

All Programs

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

Upon receipt of a change report in the local office, staff must:

  • Accept the change.
  • Date stamp the written change report.
  • Enter the change into the State Portal — Report a TIERS Change portlet if the change is received without verification and verification is required.
  • Complete an MI/Change Routing Cover Sheet and fax the change to the vendor at 1-877-236-4123 if the change is received with verification. The advisor must not enter the information in the State Portal — Report a TIERS Change portlet.

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

  • To reduce the potential for quality control (QC) errors when the household reports a change in person or by phone, staff taking the change report must attempt to collect enough information to determine whether the change will decrease benefits. For new or increased income, this includes the following information:
    • date of the change;
    • date of the first payment;
    • source of the income;
    • expected pay amounts (or weekly hours and rate of pay for earnings); and
    • pay frequency.

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

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

Note: When a SNAP household reports a change during the last certification month, staff are not required to give the household Form H1020/Form H1020-A, if the effective date of the change is after the certification period expires. Staff may send the change for imaging and address it with the individual at the redetermination interview.

Advisors must:

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

Exception: Advisors must take the following steps when an individual reports a change in annual or seasonal self-employment income or expenses during their certification period:

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

 

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

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

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

The Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) notifies HHSC via the TJJD/JPD Placement Logical Unit of Work in the Texas Integrated Eligibility Redesign System (TIERS) when a child certified for Medicaid has been placed in a juvenile facility and when a child has been released. Please see policy in A-825, Medicaid Suspension, and in A-826, Medicaid Reinstatement regarding action taken on a case containing a child placed in or released from a juvenile facility.  

Related Policy
Change in Medical Expenses During Certification, A-1428.4
Adverse Actions Not Requiring Advance Notice, A-2344
Form TF0001 Required (Adequate Notice), A-2344.1
Information Received During Expedited Application Processing, B-116.1

 

SNAP

When SR and non-SR households report a change in residence address, staff must request information on the associated changes in shelter costs. The advisor contacts the household by phone or using Form H1020, Request for Information or Action, to request the amount of the new shelter cost and utilities at the new residence. If the household fails to provide this information, the advisor must rebudget eligibility without the shelter expense and notify the household.

 

Medical Programs

Advisors are required to update the case information for all reported changes regardless of whether the recipient is in a continuous or non-continuous eligibility period.

During a non-continuous eligibility period, when a client reports any financial or non-financial change, advisors must attempt to verify client-reported income and expenses by determining if the reported income is reasonably compatible with electronic data sources, as explained in A-1370, Verification Requirements, Medical Programs.

If the applicant’s or client’s statement of income is not determined to be reasonably compatible with electronic data, income must be verified using other acceptable income verification sources, explained in A-1371, Verification Sources.

When processing a change during a non-continuous eligibility period, the system automatically sends individuals determined ineligible for Medicaid and the Children’s Health Insurance Program (CHIP) to the Marketplace for an eligibility determination for federal health care coverage programs.

To qualify for the federal health care coverage programs, all individuals must first be determined ineligible for Medicaid and CHIP. Advisors must test whether an individual is eligible for all Medical Programs. The Texas Works Medical Programs Hierarchy, explained in A-132.1, Medical Programs Hierarchy, does this automatically for most programs.

Related Policy
Verification Requirements, A-1370

For non-financial changes reported during a period of continuous eligibility, advisors must set a special review in the first week of the sixth month before cutoff. Advisors must process the change following the process explained in B-125, Processing Special Reviews, before cutoff, as long as nothing else is needed to process the change. This will ensure that the change is effective in the seventh month, which is when the non-continuous eligibility period begins. A special review is not needed for financial changes, as these will be processed during a periodic income check (PIC), as explained in B-637, Periodic Income Checks.

 

TP 40, TP 43, TP 44, TP 48

When processing a change, a household may be eligible for expedited CHIP enrollment if the household:

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

As explained in D-1711, Expedited CHIP Enrollment, an appeal and reactivation due to a change or PIC is an eligible case action for expedited CHIP enrollment.

Related Policy
Medicaid Termination, A-825
Expedited CHIP Enrollment, D-1711

 

B—631.1 Multiple Changes

Revision 15-4; Effective October 1, 2015

 

All Programs

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

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

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

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

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

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

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

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

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

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

 

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

Revision 19-4; Effective October 1, 2019

 

All Programs

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

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

 

PARIS Interstate Matches 

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

 

TDCJ and PVS Matches

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

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

 

Income and Eligibility Verification Systems (IEVS)

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

 

Date of Death Matches

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

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

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

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

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

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

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

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

 

B—632 Mass Changes

Revision 15-4; Effective October 1, 2015

 

All Programs

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

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

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

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

 

B—633 Changes in Eligibility Test

Revision 15-4; Effective October 1, 2015

 

All Programs except TP 45

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

 

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

Revision 15-4; Effective October 1, 2015

 

SNAP

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

 

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

Revision 15-4; Effective October 1, 2015

 

SNAP

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

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

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

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

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

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

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

 

B—636 Change in Head of Household

Revision 15-4; Effective October 1, 2015

 

All Programs

When the current head of household dies or leaves the home, the advisor must change the head of household to another responsible household member without requiring the remaining household members to reapply for benefits.

If the head of household who left the home was the Electronic Benefit Transfer (EBT) primary cardholder, the advisor must update the primary cardholder information to allow the household access to SNAP and TANF benefits and issue the individual a new Lone Star Card if one is needed.

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

 

B—637 Periodic Income Checks

Revision 17-2; Effective April 1, 2017

 

TP 08, TP 43, TP 44 and TP 48

Initiating a PIC requires no advisor action and uses the automated income check process to determine whether there has been a change in the client’s income that makes the client potentially ineligible for Medical Programs.

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

Electronic income data is requested one month before it is used by the eligibility system. If the client’s income is not determined to be reasonably compatible with electronic data, the client must provide other acceptable verifications explained in A-1371, Verification Sources. When there are no earned income electronic data sources (TWC or TALX) available for the client, the eligibility system checks to see whether there is a New Hire Report. When a New Hire Report exists with an employer's name and hire date that is not currently included in the client’s income, the client must provide verification of the information on the New Hire Report.

Advisors must process verifications returned as the result of a PIC following the process explained in B-631, Actions on Changes. If the client does not provide the requested verification by the 10th day, the eligibility system will automatically deny the individual on the 11th day.

The eligibility system may be able to complete the entire PIC process without any advisor action or correspondence sent to the client if the PIC does not find an indication that there has been a change in the client’s income that makes them potentially ineligible for Medical Programs. If the result of the reasonable compatibility calculation is “Process Failure,” the PIC is attempted again at the next scheduled PIC.

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

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

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

  • Deny SNAP and TANF benefits for the following data sources:
    • quarterly wage data from the Texas Workforce Commission (TWC); or
    • new Hire Report data from the Office of the Attorney General (OAG).
  • Notify the advisor to adjust SNAP and TANF benefits for the following data sources:
    • earned income data from TALX;
    • unearned Retirement, Survivors, and Disability Insurance (RSDI) income data from the Social Security Administration (SSA); or
    • unearned unemployment data from TWC.

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

 

TP 08

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

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

 

TP 43, TP 44 and TP 48

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

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

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

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

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

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

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

Related Policy
Medicaid Termination, A-825
Expedited CHIP Enrollment, D-1711

 

B—638 Returned Mail

Revision 16-4; Effective October 1, 2016

 

All Programs

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

If the case includes an active SNAP EDG:

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

If the case does not include an active SNAP EDG:

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

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

 

B—640 Changes Affecting Benefits

Revision 09-3; Effective July 1, 2009

 

 

 

B—641 Additions to the Household

Revision 17-2; Effective April 1, 2017

 

TANF and SNAP

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

If the household addition is a member of another active EDG, the individual is removed from the other EDG before the individual is added to the new EDG. Benefits are restored if the addition of the individual increases benefits and HHSC failed to remove the individual from the active EDG in a timely manner. The advisor should take overpayment action on the old EDG.

 

Medical Programs except TP 45

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

 

TP 08

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

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

 

TP 43, TP 44 and TP 48

If the household requests Medicaid for a new child who is the sibling of a child receiving TP 43, TP 44 or TP 48, a separate application is not needed. If the new child is not a sibling, a new application is required. The new child is given a separate EDG and the system aligns the certification period of the newly created EDG with the existing child’s Medicaid certification period.

Exception: 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.

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

Related Policy
Regular Medicaid Coverage, A-820

 

B—641.1 Adding Newborns to the Case

Revision 15-4; Effective October 1, 2015

 

TANF and Medical Programs

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

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

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

SNAP

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

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

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

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

Related Policy
General Policy, A-410

 

B—641.2 Steps for Adding New Members

Revision 15-4; Effective October 1, 2015

 

All Programs

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

If the change is:

  • Timely reported and verified, the advisor adds the new member to the case the month after the change occurred, unless benefits decrease. If benefits decrease, the advisor sends Form TF0001, Notice of Case Action, and decreases or denies benefits effective the month after notice of adverse action expires, as explained in B-643, Changes Decreasing Benefits.
  • Untimely reported with timely verification, the advisor adds the new member effective the month after the change is reported. If the change decreases benefits, the advisor sends Form TF0001 and decreases or denies benefits effective the month after notice of adverse action expires, as explained in B-643.
  • Timely or untimely reported with a delay in verification of eligibility points that results in individual disqualification (for example, SSN or alien status) and verification is not provided by the Form H1020 due date, advisors must take the following actions:
    • For TANF, if the new member is a required member of the certified group, disqualify the new member following applicable policy. Notify the household on Form TF0001 as appropriate. Exception: See TANF policy for household members who are not required members of the certified group.
    • For SNAP, disqualify the new member following applicable policy. Notify the household of the disqualification on Form TF0001 as appropriate.
    • For Medical Programs, see reasonable opportunity policy explained in A-351.1, Reasonable Opportunity.
  • Timely or untimely reported with enough information to determine benefits will decrease, but verification is delayed, the advisor sends Form TF0001 and decreases or denies benefits based on the individual's unverified statement effective the month after notice of adverse action expires, as explained in B-643.
  • Timely or untimely reported lacking enough information regarding income, resources, or other factors necessary to determine eligibility and/or benefits, the advisor sends Form H1020 and Form H1020-A to request verification the same day the change was reported or no later than the next workday and attempts to contact the household by phone within 10 days after the change is reported to obtain enough information to determine the effect of the change.
    • If information is obtained, policies for changes apply as described in this section.
    • If information is not obtained, the impacted EDGs are kept pending until the Form H1020 due date.
    • If verification is not received by the Form H1020 due date, the advisor sends Form TF0001 the next workday to deny the EDG for failure to furnish information.

Notes:

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

TANF

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

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

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

SNAP

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

 

B—641.3 Adding Disqualified Members

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

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

SNAP

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

 

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

Revision 15-4; Effective October 1, 2015

 

All Programs

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

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

 

B—642.1 Verification Provided Timely

Revision 15-4; Effective October 1, 2015

 

All Programs

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

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

 

B—642.2 Verification Not Provided Timely

Revision 15-4; Effective October 1, 2015

 

All Programs

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

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

SNAP

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

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

 

B—643 Changes Decreasing Benefits

Revision 16-; Effective October 1, 2016

 

TANF and SNAP

Advisors must act on changes as indicated below. Benefits are decreased or denied, effective the month after the notice of adverse action expires. If applicable, an overpayment claim is processed as specified in B-700, Claims. To determine the first month of an overpayment, advisors may refer to C-1140, TANF and SNAP Overpayment Determination Chart.

If a household reports a change ... then ...
and provides all verification, send Form TF0001, Notice of Case Action, by the 10th day after the change was reported* to decrease or deny benefits.
with enough information to determine eligibility/benefits but does not provide verification, send Form H1020, Request for Information or Action, and Form H1020-A, Sources of Proof, the same day the change was reported or no later than the next workday to request verification.**

Send Form TF0001 to decrease or deny benefits based on the individual's unverified statement at the time the change was reported:

  • by the 10th day after the change was reported;* or
  • with Forms H1020 and H1020-A if the change was reported untimely.

Require verification of the change at the next TANF or SNAP redetermination.

Note: Do not verify income if the amount reported makes the household ineligible.
without enough information to determine eligibility/benefits, send Form H1020 and Form H1020-A the same day the change was reported or no later than the next workday to request verification.**

Attempt to contact the household by phone to obtain enough information to send Form TF0001 by the 10th day after the change was reported.*

Note: The regional director may opt out of the requirement to make a phone contact.

If information is not obtained to redetermine eligibility, keep the EDG pending until the Form H1020 due date. If verification is not received by the Form H1020 due date, send Form TF0001 the next workday to deny the EDG for failure to furnish information. Exception: If the household fails to provide verification of a deductible expense that requires verification, do not deny the EDG; instead, disallow the deduction. Follow policy in A-1440, Verification Requirements, to determine if any deduction is allowable for the expense.

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

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

Note: See B-631, Actions on Changes, for situations where the Texas Department of Family and Protective Services (DFPS) places a TANF or Medicaid child in foster care.

 

TP 08

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

  • the information is not questionable; and
  • they meet the eligibility requirements for the applicable Transitional Medicaid program as explained in A-842, TP 07 Transitional Medicaid and A-850, TP 20 Alimony/Spousal Support Transitional Medicaid Coverage.

In addition, the advisor must deny the Medicaid EDG and open the appropriate Transitional Medicaid EDG for each associated parent or caretaker and dependent child.

If the EDG is denied for failure to provide verification that does not cause Medicaid ineligibility, the advisor must determine the household's eligibility for other medical programs. See A-2342, Denial at Redetermination.

 

Related Policy
General Eligibility Information, A-841
General Eligibility Information, A-851

 

B—650 Correcting Incorrect Information

Revision 15-4; Effective October 1, 2015

 

All Programs

Individuals have a right to correct any information that HHSC has about the individual and any other individual on the individual's case.

Advisors follow policies in A-2300, Case Disposition; B-100, Processes and Processing Time Frames; and B-600, Changes, for the time frames and procedures to correct or update information when processing:

  • applications,
  • redeterminations, and
  • other actions on active cases.

 

B—651 Correction Request

Revision 15-4; Effective October 1, 2015

 

All Programs

A request for correction must be in writing and:

  • identify the individual asking for the correction;
  • identify the disputed information about the individual;
  • state why the information is wrong;
  • include any proof that shows the information is wrong;
  • state what correction is requested; and
  • include a return address, telephone number, or email address at which HHSC can contact the individual.

During application, redetermination, and other actions on active EDGs, individuals are not required to request correction of incorrect information in writing. (Refer to B-116, Information Reported During Application Processing; B-124, Processing Untimely Redeterminations; and B-623, How to Report.)

 

B—652 Action on Denied EDGs or During the Last Month of Certification and the Client Has Not Reapplied

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must respond according to the following chart:

When an individual requests that the agency correct their information ... then ...
at application, redetermination, or anytime when an EDG is active, follow policies in A-2300, Case Disposition; B-100, Processes and Processing Time Frames; and B-600, Changes.
on a denied EDG or during the last month of certification, and the individual has not reapplied,
  • review the request,
  • contact third parties if necessary, and
  • send the correct information for imaging.

 

The advisor notifies the individual in writing within 60 days (using current HHSC letterhead without the board members' names) that the information is corrected or will not be corrected and the reason. The advisor informs the individual if HHSC needs to extend the 60-day period by an additional 30 days to complete the correction process or obtain additional information.

If HHSC makes a correction to individually identifiable health information, the advisor must ask the individual for permission before sharing with third parties. HHSC will make a reasonable effort to share the correct information with persons who received the incorrect information from HHSC if they may have relied or could rely on it to the disadvantage of the individual. Advisors follow regional procedures to contact the HHSC privacy officer for a record of disclosures.

Note: Advisors follow procedures to establish a claim or restore benefits if an overissuance or underissuance occurred. Advisors make a referral to the Office of Inspector General for intentional program violation occurrences.

 

B—653 Different Review Process

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must not follow procedures in B-600, Changes, when the accuracy of information provided by an individual is determined by another review process such as a:

  • fair hearing,
  • civil rights hearing, or
  • other appeal process.

The decision in that review process is the decision on the request to correct information.

 

B—660 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

According to B-631, Actions on Changes, advisors must document the:

  • reported change,
  • date the change occurred,
  • date the change was reported, and
  • date the verification is provided.

For new income changes, advisors document the date of the first payment.

For address changes, advisors document the actions taken to provide the individual with Form H0025, HHSC Application for Voter Registration, and Form H1350, Opportunity to Register to Vote.

Refer to A-1380, Documentation Requirements, for further requirements related to income.

 

SNAP

Advisors must document:

  • the reason for shortening certification as a result of a change. See B-635, Shortening Certification Periods as a Result of a Change.
  • that the individual failed to provide required information to add a newborn when based on the TP 45 certification according to B-641.1, Adding Newborns to the Case.

 

Medical Programs

Clients are not required to report a change in tax status or tax relationship during the certification period because tax status and tax relationships are self-declared based on what the client expects to happen on their federal income taxes. If a change is reported, advisors should document the change in case comments and it will be addressed at the time of redetermination.

However, if multiple individuals self-declare to claiming the same person as a tax dependent, the advisor must clear the discrepancy with all individuals attempting to claim the same person as a tax dependent and update the tax statuses as a change in the eligibility system if necessary. For example, a change is reported that a child certified on Children’s Medicaid will no longer be claimed as a tax dependent. This change will be addressed at redetermination.

 

TP 08

Advisors must document the reason for denying a TP 08 EDG and opening a TP 07 EDG when new or increased income makes the household ineligible.

 

Related Policy
Documentation Requirements, A-1380
Documentation, C-940
Registering to Vote, A-1521
The Texas Works Documentation Guide

B-700, Claims

Revision 19-4; Effective October 1, 2019

 

 

B—710 General Policy

Revision 11-1; Effective January 1, 2011

 

All Programs

An overpayment is the amount of benefits issued in excess of what should have been issued.

A claim is an amount owed by an individual for an overpayment of benefits or owed by an individual for benefits that are trafficked.

The date of discovery is the date the Office of Inspector General (OIG) substantiates that an overpayment occurred.

 

B—711 Types of Overpayment Claims

Revision 15-4; Effective October 1, 2015

 

All Programs

There are three types of overpayment claims:

  • agency error,
  • inadvertent household error/misunderstanding, or
  • fraud or intentional program violation (IPV).

OIG staff process overpayment referrals, determine the overpayment amount, and submit as a claim to the Texas Health and Human Services Commission (HHSC) Fiscal Management Services (FMS) to collect.

Related Policy
Referrals for Intentional Program Violation (IPV), B-900

 

B—720 When to File an Overpayment Referral

Revision 19-4; Effective October 1, 2019

 

All Programs

Staff must file an overpayment referral when a household receives benefits the household is not entitled to receive. When an overpayment occurs, OIG establishes the claim. The household must repay any type of overpayment claim.  

If the household reports a change and staff does not take the appropriate action or fail to act on an agency-generated change, an overpayment referral must be filed.

Do not file an overpayment referral if the overpayment was due to:

  • a change the household is not required to report; or
  • an overpayment that occurred more than six years before the date of discovery.

 

SNAP

Changes for categorically eligible households, except for changes in net income, household size or both, do not cause an overpayment.

Exception: This does not apply to households who are categorically eligible based on receipt of Temporary Assistance for Needy Families - Non-Cash (TANF-NC).

OIG files a claim when an intentional program violation (IPV) is established against a person for trafficking Supplemental Nutrition Assistance Program (SNAP) benefits or accessing devices such as Electronic Benefit Transfer (EBT) cards.

 

B—730 How to File an Overpayment Referral

Revision 15-4; Effective October 1, 2015

 

All Programs

When an overpayment occurs, advisors determine the type of overpayment and enter an overpayment referral using the Automated System for Office of Inspector General (ASOIG) or the Texas Integrated Eligibility Redesign System (TIERS) referral interface. See B-770, Filing an Overpayment Referral, for overpayment referral instructions.

 

B—740 Texas Works Responsibilities

Revision 13-3; Effective July 1, 2013

 

All Programs

Texas Works staff:

  • identify overpayments;
  • enter all agency error, inadvertent household error/misunderstanding and fraud overpayment referrals using ASOIG or the TIERS referral interface, within 30 days of the date a potential overpayment is identified;
  • process fair hearing requests related to claims establishment or collection using the TIERS interface; and
  • forward any payments or warrants received at the local office, along with a copy of Form H4100, Money Receipt, within 24 hours of receipt to:

    Texas Health and Human Services Commission
    Fiscal Management Services
    ARTS Billing
    P.O. Box 149055
    Austin, TX 78714-9055

The Accounts Receivable Tracking System (ARTS) is administered by FMS staff who monitor and process payments from individuals who receive HHSC services. The ARTS Hotline number is 1-800-666-8531.

 

B—741 Texas Works Action on Agency Errors

Revision 11-1; Effective January 1, 2011

 

TANF and SNAP

When an agency error overpayment occurs, Texas Works staff:

  • correct the ongoing benefits, as needed, using adverse action procedures; and
  • enter an electronic overpayment referral using ASOIG or the TIERS referral interface within 30 days of the date a claim is identified.

Note: See B-770, Filing an Overpayment Referral, for instructions about how to complete and send an overpayment referral.

 

B—742 Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV)

Revision 15-4; Effective October 1, 2015

All Programs

When an overpayment is due to an inadvertent household error/misunderstanding or a potential IPV, Texas Works staff:

  • correct the ongoing benefits, as needed, using adverse action procedures; and
  • enter an overpayment referral using ASOIG or the TIERS interface within 30 days of the date a claim is identified.

Note: See B-770, Filing an Overpayment Referral, for instructions about how to complete and send an overpayment referral.

When an alien and the alien's sponsor are liable for an overpayment, both individuals are referred to the OIG.

The alien and the alien's sponsor are not referred for an overpayment claim if the sponsor also receives benefits in the same program in which the alien’s overpayment occurred.

 

B—750 Office of Inspector General (OIG) Responsibilities

Revision 19-4; Effective October 1, 2019

 

All Programs

The OIG Benefits Program Integrity (BPI) department investigates allegations of recipient non-fraud overpayment and fraud. The BPI department consists of the claims investigation and field investigation units located throughout the state.

 

B—751 Office of Inspector General (OIG) Investigation Staff

Revision 19-4; Effective October 1, 2019

 

All Programs

OIG staff:

  • screen all types of referrals and investigate valid agency error, inadvertent household error or misunderstanding, fraud, IPV, individual or retailer EBT trafficking, and employee fraud;
  • process referrals including initiation of demand letters and establishment of claims;
  • set restitution or recoupment amounts for active Eligibility Determination Groups (EDGs);
  • respond to follow-up questions from people who receive benefits and staff about the validity of claims;
  • coordinate with Texas Works staff to process fair hearing requests related to claims establishment or collection; and
  • initiate the process to debit an EBT food account to repay a SNAP claim when the request is made.

 

Related Policy
Texas Works Responsibilities, B-740
Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV), B-742
Texas Works Action on Agency Errors, B-741

 

B—752 Determining Claim Amounts

Revision 15-4; Effective October 1, 2015

 

All Programs

OIG staff take the following steps when determining claim accounts:

  • determine the first month of overpayment (see B-752.1, Determining the First Month of Overpayment);
  • exclude any months in which the household did not receive benefits or benefits were expunged;
  • follow applicable policy in A-1300, Income, to budget the overpayment months;
  • budget each month of an overpayment by using actual income amounts received for the month (the income is not converted);

    Exceptions: OIG staff:
    • budget the income originally projected at certification/redetermination when the income does not involve a required change; and
    • budget earned income as reported quarterly to the Texas Workforce Commission (TWC) to determine the overpayment amount when all efforts to verify earned income amounts have been exhausted; allow the household the opportunity to provide verification of actual gross pay per pay period; and recompute the overpayment if the individual provides the verification. Note: For cases sent to an administrative disqualification hearing, staff must verify the employment hire date when computing an overpayment based on TWC wage information.
  • do not allow earned income deductions for any earned income that the household failed to report timely as required and this failure caused an overpayment (deductions for overpayment months caused by an agency error are allowed);
  • for excess resource overpayment EDGs, compute earned interest income to estimate an account balance for the tax year, as reported annually by the Internal Revenue Service (IRS) through the Income and Eligibility Verification System (IEVS), to determine the overpayment amount when all efforts to verify an unreported financial institution account have been exhausted; allow the household the opportunity to provide verification of the interest income and the resource; and recompute the overpayment if the individual provides the verification;
  • subtract the amount the household was entitled to receive from the amount the household actually received before recoupment;

    Exception: There is no recoupment for Medical Programs.
  • total all the monthly amounts of overpayment; and
  • when the household is due unpaid restored benefits, offset the amount to be restored against the overpayment amount and document the offset according to B-831, Procedures for Counting Restored Benefits Toward a Claim.

Related Policy
Computing Benefits by EDG Action Type, A-1357
Reporting Requirements, B-620

TANF

When a child support payment was made during the overpayment month, the total income, less the $75 disregard, is counted to determine the overpayment amount.

 

B—752.1 Determining the First Month of Overpayment

Revision 11-1; Effective January 1, 2011

 

 

 

B—752.1.1 Errors at Certification

Revision 11-1; Effective January 1, 2011

 

All Programs

The first month of overpayment is the first month the household received more benefits than it was entitled to receive.

 

B—752.1.2 Errors After Certification

Revision 15-4; Effective October 1, 2015

 

All Programs

The first month of overpayment for non-streamlined reporting (SR) households is the month in which the change would have been effective had it been reported and acted on in a timely manner. However, the first month of overpayment can be no later than two months from the month the change occurred. Staff may use the following chart to determine the first month of overpayment.

If a change was... then the first month of overpayment is the month that begins more than...
reported timely, 23 days after the date the change was reported. (Example: Change occurred January 5 and was reported January 10. Count 23 days to February 2. March is the first month of overpayment.)
not reported timely, 33 days after the date the change occurred. (Example: Change occurred January 5. Count 33 days to February 7. March is the first month of overpayment.)

 

Exception: The first month of overpayment may be earlier for errors caused by moves out of state. The first month of overpayment may be as early as the month after all members of the household leave the state and there is duplicate participation in that month.

Charts in C-1140, TANF and SNAP Overpayment Determination Chart, provide help for determining the first month of overpayment for both timely and untimely change reports.

 

SNAP

An overpayment does not exist on a streamlined reporting EDG unless:

  • the household fails to timely report a required change, or
  • the agency fails to timely act on a reported change.

Note: The 10-day reporting requirement for SR EDGs is from the first payment that exceeds the 130 percent Federal Poverty Income Limit (FPIL) threshold. For example, an individual receives a pay raise effective May 15. The individual's gross monthly income exceeds the 130 percent FPIL with the June 27 paycheck. The household must report the change within 10 days of June 27 to be timely.

The first month of overpayment is the month after the second month the income exceeds the 130 percent FPIL for the household size. For example, income exceeds the 130 percent FPIL on June 27 and for the month of July. August is the first month of overpayment.

 

Related Policy
Reporting Requirements, B-620

 

B—753 Establishing Claims

Revision 13-3; Effective July 1, 2013

 

 

 

B—753.1 Identifying Liable Members

Revision 19-4; Effective October 1, 2019

 

TANF, One-Time TANF (OTTANF), and One-Time Grandparent Payments

The liable household members responsible for repayment of a claim are determined in the following order:

  • Caretaker or payee.
  • Second parent or step-parent who was an adult household member at the time of the overpayment.

SNAP

The liable household member responsible for repayment of a claim is determined in the following order:

  • The head of household.
  • Any household member who was an adult at the time of overpayment.

TANF and SNAP

An authorized representative (AR) is liable for paying a claim when the AR causes an overpayment or traffics in SNAP benefits.

Sponsors and eligible aliens are jointly liable for overpayments resulting from incorrect information provided by the sponsor unless the sponsor:

  • can show good cause,
  • can show the eligible alien or sponsor was not at fault for the error, or
  • receives benefits in the same program in which the overpayment occurred.

The sponsor, alien, or both may appeal the amount or fault of an overpayment.

 

B—753.2 Demand Notices

Revision 19-4; Effective October 1, 2019

 

TANF and SNAP

OIG staff send either Form OIG 5034, Notice of SNAP Overpayment Claim, or Form OIG 5039, Notice of TANF Overpayment Claim or both, along with Form OIG 5027, Repayment Agreement, to the household.

To be timely, OIG staff must send the notice no later than 180 calendar days from the date the investigation was created in the Automated System for Office of Inspector General (ASOIG).

When the case involves an alien with a sponsor, OIG staff send separate demand notices to the alien and the alien’s sponsor. The demand notice informs the sponsor that the sponsor is not responsible for the person when:

  • the sponsor has good cause for the error;
  • is not at fault; or
  • receives benefits in the same program that the alien’s overpayment occurred.

Note: Calls about overpayment demand notices are referred to the local OIG unit for clearance.  Local office contacts can be found by clicking on this link: OIG Facilities Local Office Contacts.

After navigating to the website, click on “OIG Facilities Local Office Contacts” on the right side of the page.

 

B—753.3 Claim Disposition

Revision 19-4; Effective October 1, 2019

 

TANF and SNAP

OIG staff mail a household a repayment agreement notice and an overpayment claim notice. A claim in the Accounts Receivable Tracking System (ARTS) is then established the same date of the notice.

The claim notice provides:

  • an explanation of how the overpayment claim amount was calculated;
  • repayment options (either restitution or recoupment); and
  • information about the person’s right to request a fair hearing within 90 days of the effective date of claim notice.

The person indicates whether they prefer to repay the claim by restitution or recoupment on the repayment agreement notice and must return the agreement within 30 days of receipt.  

Repayment of the claim is delayed only when the person requests a fair hearing.

 

B—760 Fiscal Management Services - Accounts Receivable Responsibilities

Revision 19-3; Effective July 1, 2019

 

All Programs

HHSC Accounts Receivable staff:

  • maintain the Accounts Receivable Tracking System (ARTS);
  • manage the billing and collection process;
  • manage delinquent claims;
  • renegotiate methods of collection;
  • modify existing claims;
  • respond to inquiries from individuals or staff from the date the claim is established, including:
    • delinquent notices;
    • collection efforts;
    • federal payment intercepts through the Treasury Offset Program; and
    • license suspensions;
  • process fair hearing requests related to claims establishment or collection (if the request is past 90 days from the claim origination date); and
  • initiate the process for one-time debits of an EBT food account to repay a SNAP claim when the request is made after the claim is established.

 

B—761 Claims Collection

Revision 11-1; Effective January 1, 2011

 

 

 

B—761.1 Recoupment

Revision 19-3; Effective July 1, 2019

 

TANF and SNAP

Recoupment, also known as allotment reduction, is a method of recovering an overpayment claim by withholding a portion of the household's benefits.

 

B—761.1.1 Action on Recoupment Cases

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Recoupment is initiated when OIG staff enters a claim against a household into ARTS. ARTS interfaces with TIERS to automatically reduce the household's ongoing benefits.

When an EDG is denied or the certification expires and the recoupment is incomplete, ARTS performs an automatic search to find another household member who is liable for the overpayment on an active EDG of the same program type. When ARTS:

  • finds no liable member, it sends a bill to the individual to request payment of the remaining balance and transfers the claim to restitution. See B-753.1, Identifying Liable Members, and B-761.2, Restitution.
  • finds a liable member, it transfers the recoupment to the active EDG.

A denied EDG is never purged from TIERS or ARTS when there is a recoupment record or a claim with a remaining balance. If the EDG is recertified, ARTS automatically resumes recoupment.

Notes:

  • FMS staff may negotiate a repayment agreement with the individual.
  • FMS staff are authorized to make corrections to the recoupment records in ARTS.

Recoupment information is available through TIERS inquiry, ARTS inquiry, or by calling the ARTS Hotline at 1-800-666-8531.

 

B—761.1.2 Recoupment Hierarchy

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Claims are recouped by error type in the following order.

  1. Type A — IPVs (fraud)
  2. Type J — inadvertent household error/misunderstanding
  3. Type L — agency error

All three claim types can be simultaneously stored on ARTS. Recoupment of a Type A claim places Type J and L claims on hold status until the Type A recoupment is completed. ARTS automatically resumes recoupment of the Type J or L claim when all of the individual's Type A claims have been paid in full.

 

B—761.1.3 Recoupment Amount

Revision 15-4; Effective October 1, 2015

 

TANF

HHSC recoups Type A, J, and L claims at 10 percent of the household's maximum grant, rounded down to the nearest dollar.

Once a TANF claim is recouped in full, TIERS will automatically rebudget any active SNAP EDG to include the appropriate ongoing TANF grant amount. See A-1324.18, Temporary Assistance for Needy Families (TANF).

 

SNAP

For Type A claims, HHSC recoups at 20 percent of the household allotment or $20, whichever is greater. When calculating a dollar amount using the percentage, TIERS rounds 49 cents down and 50 cents up to the next whole dollar.

For Types J and L claims, HHSC recoups at 10 percent of the household allotment or $10, whichever is greater. When calculating a dollar amount using the percentage, TIERS rounds 49 cents down and 50 cents up to the next whole dollar.

Notes:

  • When benefits are $10 or less, no benefits are issued.
  • When a current household member is disqualified for an IPV, recoupment is computed using the allotment the household would receive if the disqualified member was included in the household size.

 

B—761.2 Restitution

Revision 19-3; Effective July 1, 2019

 

TANF and SNAP

Restitution is a method of recovering an overpayment claim by receiving payments in the form of a cashier's check, certified or personal check, money orders made payable to the Texas Health and Human Services Commission, or credit or debit card payments through the Texas.gov HHSC Online Overpayment System (HOOPS).

 

B—761.2.1 Action on Restitution Cases

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

When the EDG is active and the individual misses a payment or makes a partial payment, ARTS sends a delinquency notice and initiates recoupment on the EDG after expiration of the advance notice period.

 

SNAP

ARTS initiates recoupment on the active EDG to repay the claim when the EDG is denied, and:

  • the individual fails to respond to the ARTS notice within 10 days; and
  • ARTS finds an adult household member who is liable for the overpayment on an active EDG of the same program.

When ARTS finds no liable adult household member on an active EDG, the claim is eligible for referral to:

  • the Federal Treasury Offset Program for an intercept of federal payments;
  • TWC for voluntary garnishment of Unemployment Insurance Benefits;
  • the Texas Lottery Commission for an intercept of lottery winnings;
  • applicable agencies to request suspension of licenses; or
  • a private collection agency.

Restitution information is available through the ARTS inquiry or by calling the ARTS Hotline at 1-800-666-8531.

 

B—761.2.2 Restitution Amount

Revision 19-3; Effective July 1, 2019

 

TANF and SNAP

The repayment agreement reflects a 36-month amortized schedule for the claim to be repaid within three years. If the amortized monthly payment is less than $25, then the agreement is generated with $25 as the minimum payment.

Only HHSC Accounts Receivable staff can renegotiate a payment plan differing from the one on the repayment agreement. Accounts receivable staff sends all subsequent monthly bills or repayment agreements to households after OIG sends the initial repayment agreement.

 

B—762 Action on Receipt of Payments

Revision 19-3; Effective July 1, 2019

 

TANF and SNAP

When staff receive restitution payments, staff:

  • complete Form H4100, Money Receipt; and
  • submit the payment or warrants with a copy of Form H4100 within 24 hours of receipt to:

    Texas Health and Human Services Commission
    Accounts Receivable
    P.O. Box 149055
    Austin, TX 78714-9055

Note: Staff must mark each TANF warrant void when received.

 

B—763 Debit of SNAP EBT Accounts

Revision 13-3; Effective July 1, 2013

 

SNAP

Debit of an EBT food account is a method of recovering an overpayment claim by electronically removing benefits from the household's EBT account. The value of the debit is applied to the SNAP claim.

 

B—763.1 One-Time Debit of an Active EBT Account

Revision 15-4; Effective October 1, 2015

 

SNAP

When an individual (primarily liable or authorized representative) requests a one-time debit of the EBT food account to pay a SNAP claim and the EBT account is active, OIG or FMS staff:

  • use the Administrative Terminal Application (ATA) to verify the:
    • status of the individual's EBT food account; and
    • balance of the account;
  • complete Form H1021, Payment Agreement — Verbal Authorization for One-Time Debit of an Active Lone Star Food Account (this form documents the individual's verbal authorization to repay the overissuance by removing benefits from the active EBT food account);
  • inform the individual that:
      • the amount of the one-time payment must be maintained in the individual's account until the debit is completed;
      • it takes approximately 14 days for the debit transaction to be completed; and
      • the individual will receive a receipt of the debit within 10 days of the debit transaction; and
  • submit the original of Form H1021 to:

    HHSC Lone Star Business Services
    State Office
    Mail Code 2033

    Maintain a copy of Form H1021 in the OIG or ARTS file.

Lone Star Business Services staff remove the SNAP benefits from the food account and submit Form H1021 to ARTS in FMS to repay the claim. ARTS staff send a receipt to the individual for the amount listed on Form H1021 within 10 days of the debit transaction.

Note: When the individual contacts HHSC and disagrees with the debit transaction, the individual may request a fair hearing to request the return of the benefits to the individual’s account.

 

B—763.2 Offset Expunged Benefits

Revision 19-3; Effective July 1, 2019

 

SNAP

When staff become aware that a household has expunged SNAP benefits, OIG or HHSC Accounts Receivable staff must offset the balance of a SNAP claim by the amount of the expungement.

 

B—764 Fair Hearings

Revision 19-4; Effective October 1, 2019

 

TANF and SNAP

When it is unclear whether the household wishes to appeal a Texas Works advisor's EDG action or an action taken by OIG staff, local eligibility office staff and OIG review the request for an appeal to determine what action the household is truly appealing. If a household disputes the establishment of a claim or collection action and requests an appeal, OIG will take the lead and begin processing the appeal.

The following procedures are used to submit an appeal request. Form H4800, Fair Hearing Request Summary, is not used, but Form H4800, sent directly to the hearings division, will be returned to staff with instructions to correctly submit the information.

 

OIG Staff

OIG staff use the Automated System for the Office of Inspector General (ASOIG) to submit appeal requests on claims or collection actions.  

OIG staff use the State Portal Appeals tab and the Hearing Evidence Packets Upload tab to transmit evidence documents related to an appeal request.

Exception: When ASOIG is not available or an investigation is not found in ASOIG, staff process the appeal through the TIERS Hearings and Appeal function located in the left navigation menu.

 

Texas Works Staff Working in TIERS

When a person verbally requests an appeal, eligibility staff process the fair hearing request by selecting the Hearing and Appeal option found on the left-navigation menu in TIERS and chooses Create Appeal.

When a fair hearing request is received in writing (by fax or mail), eligibility staff fax the appeal request, using the fair hearing cover sheet, through the expedited fax line (866-559-9628) for processing. The fair hearing request is not entered in the State Portal.

Whether the TIERS appeal request is received verbally or in writing, the Centralized Representation Unit (CRU) continues to process the appeal, including creating and submitting the evidence packet. Copies of the evidence packet are mailed to the appellant and any authorized or legal representative.

 

B—770 Filing an Overpayment Referral

Revision 12-2; Effective April 1, 2012

 

 

 

B—771 Filing an Overpayment Referral Using Automated System for the Office of Inspector General (ASOIG)

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff create referrals for overpayments caused by agency error, individual error/misunderstanding, or suspected IPV or fraud in ASOIG.

ASOIG is accessed at the following website: https://hhsportal.hhs.state.tx.us/asoig.

Users log in using a unique sign on. A disclaimer page explaining IRS Federal Tax Information requirements must be agreed to before proceeding with the referral. Agreement takes the user to the ASOIG home page.

Investigation is selected from the left navigation menu to proceed to the Referral and Investigation search page. Users must enter identifying information and select Create Referral.

Identifying information may consist of one or more of the following:

  • Suspect name,
  • Individual (client) number,
  • Social Security number, or
  • EDG or case number.

The Create Referral tab takes the user to the Create Referral screen group. This consists of the Referral, Suspects, Reasons, Contacts, Comments and Assignment tabs. The user must go through all tabs, enter information as appropriate, and save the referral.

The Referral tab is the first tab in creating a referral. The tab has two areas. The top part, Alleged Information, is for entering biographical information. The bottom portion, EDG Types, is used to enter whatever program type information is known.

The New button at the bottom of the tab is used when adding types to the EDG Types portion of the tab. If the referral is associated with more than one EDG, users must click the New button to add additional types. The user must continue to click the New button until all EDGs associated with the referral are added. Once all types have been entered, the user must click the Next button to proceed to the next tab, Suspects.

The Suspects tab is used to enter information on suspects as well as household members associated with the referral. The top portion of the screen, Suspect, allows for the entry of any known biographical information. The bottom portion, Address, is for entering any known address(es).

At least one suspect screen with a name and type of suspect is required for a referral. Although children are not "suspects," entering all household members is recommended as that information will be required if an investigation is merited.

If an automated interface finds information in TIERS, users may select from a list of names. If a name is chosen from the list in this field, the ASOIG populates applicable biographical and EDG information such as date of birth, Social Security number and address. If TIERS information is not found, users must enter all known information.

The New button on the tab is to allow the user to include all household members in the referral. Once all members are entered, the user must click the Next button to advance to the next tab, Reasons.

The Reasons tab is used to establish the basis for the referral. The screen is divided into three sections, Reason, Source Information and Source Detail. One reason type and name is required for each referral.

Multiple reasons may be entered on a single referral. If there are multiple reasons, users enter the information for the first reason and then click the New button to enter information for the next reason. Once all applicable reasons are entered, the user must click the Next button to move to the next tab, Contacts.

The Contacts tab is used to enter sources of information such as another employee, agency or other person with information about the referral. The screen is divided into two sections. The Contact portion is for information on the source of information while the Address portion is for documenting any address information for the contact.

A Contacts entry is not required for a referral, but multiple entries may be made by clicking the New button. Clicking on the Next button takes the user to the next tab, Comments.

The Comments tab is used to enter information on the referral. It is used to document information not otherwise captured by ASOIG. At least one comment is required and multiple comments may be entered. Comments are listed by subject, and users should enter a concise statement in the subject to describe the contents of the comment.

Comments may be linked to a Contact by clicking the Related Contact checkbox.

Once a comment is saved by clicking the New or Next button, it cannot be modified. Care must be exercised in completing this tab. Clicking the Next button takes the user to the final tab, Assignment.

The Assignment tab allows the assignment of the referral based on predefined rules. Once the Save Referral button is clicked, the referral is saved and all information is locked, except for the ability of the user to include additional comments.

Saving the referral takes the user back to the Referral tab; however, it is only for viewing, and the user now has the ability to attach any electronic documents saved on the user's computer to the referral. Attach documents by clicking the paper clip icon next to the tabs, browse to select the document, give a name to the document, describe the contents of the document and click Save. Multiple documents may be attached using the New button.

Note: Logging out of the referral before it is saved on the Assignment tab will result in loss of information entered, requiring the user to start over.

 

B—772 Filing an Overpayment Referral Using TIERS

Revision 15-4; Effective October 1, 2015

 

SNAP and TANF

When eligibility staff discover that an overpayment exists, either by advisor knowledge or because it is identified in the TIERS Eligibility Summary, the following steps must be taken to enter the referral in TIERS:

  • From the left navigation menu, the user must go to Data Collection > Initiate Interview and enter the case number and case mode. If a case is already in ongoing mode, the user may enter the referral.
  • From the left navigation menu, the user must select Data Collection > Miscellaneous > Referral. The TIERS referral summary page will display. If an overpayment claim exists for the EDG, there will be an entry for the advisor to review on this page. To review the claim, the user must click on the edit icon.
  • To enter a new referral, the user must click the red Add button.
  • On the Details page, the user must enter the following information:
    • Name – From the drop-down menu, select the name of the individual causing the overpayment.
    • Effective Begin Date – Enter the date the overpayment began.
    • Discovery Code – From the drop-down menu, select the most appropriate entry to describe how the overpayment was discovered. If no entry is appropriate, select "other."
    • Error Referral Type – From the drop-down menu, select an entry based on the entity causing the error. For errors caused by the agency's error or failure to take action in a timely manner, select "agency." For errors caused by individuals without the intent to commit fraud, select "client." For errors where eligibility staff believe the individual intentionally committed fraud to receive additional benefits, select "fraud."
    • Overpayment Reason – From the drop-down menu, select the most appropriate reason for the overpayment. If no entry is appropriate, select "other."
    • Overpayment Discovery Date – Enter the date HHSC discovered the overpayment.
    • Benefit Type – From the drop-down menu, make the appropriate selection based on the type of benefit overpaid.
    • Financial Penalty Code – For overpayments caused by TANF Personal Responsibility Agreement (PRA) noncompliance, select the area with which the individual noncomplied.
    • Destination Unit – Select the appropriate unit by region and by the type of referral (CI – Claims Investigation/FI – Fraud Investigation).
    • Referral Benefit Restored Amount – If the overpayment was caused by the issuance of restored benefits, enter the overpayment amount in this field. If the overpayment was not caused by the issuance of restored benefits, a zero entry remains in this field.
    • Form 1898 Completion Date – This field is used for overpayment claims caused by the issuance of restored benefits only. Enter the date Form 1898, Restored Benefits Documentation, was completed at the time the restored benefits were authorized.
    • First Month and Year of Overpayment – Enter the month and year the overpayment began. Estimate only.
    • Last Month and Year of Overpayment – Enter the month and year the overpayment ended. Estimate only.
    • Overpayment Amount – Enter the dollar amount of the overpayment for all referrals except referrals based on restored benefits. If the overpayment was caused by the issuance of restored benefits, this field should contain a zero entry. Estimate only.
    • EDG Participation – For the individual causing the overpayment, select whether or not the individual was a member of the certified group.
    • Participation Change Date – For claims based on household changes, enter the date the participation status changed for the individual causing the overpayment.
    • Participation Change Report Date – For claims based on household changes, enter the date HHSC learned of the household change.
    • Enter comments you wish OIG to receive by entering page-level comments on this page – Click on the center icon next to the Referral – Details title to enter page-level comments.
  • On the Income page (for overpayments caused by income only), if known, the user enters the following information:
    • Source Type – From the drop-down menu, select "earned income" or "unearned income" depending on the type of income causing the overpayment.
    • Source Name – Enter the name of the entity that provided the income that caused the overpayment. This may be the name of an individual, company or government agency.
    • Verification Source – From the drop-down menu, make the appropriate verification source selection. If the source used to verify the income is not available on the menu, select "none" and document the source in page-level comments on the details tab.
    • Source Hire Date – For earned income overpayments, enter the hire date for the individual.
    • First Check Date – Enter the date the individual received the first payment that caused the overpayment. Note: This could be a check or cash payment, and the payment could be for earned and unearned income.
    • Source Report Date – Enter the date the individual informed HHSC of the income change.
    • Source Amount – Type the monthly amount of the income received from the source.
    • Income Source Address – If known, enter the address of the income source.
  • On the Resources page (for overpayments caused by resources only), if known, the user enters the following information:
    • Resource Type – From the drop-down menu, select the most appropriate entry for the type of resource causing the overpayment. If no selection is appropriate, select "other."
    • Resource Change Date – Enter the date the individual obtained possession of the resource.
    • Resource Report Date – Enter the date HHSC learned of the resource change.
    • Resource Amount – Enter the countable value of the resource.
  • The user must document the overpayment referral and reason in TIERS Case Comments.

 

B—780 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Advisors must document in TIERS Case Comments:

  • that an overpayment referral was made via ASOIG or through the TIERS interface, according to B-730, How to File an Overpayment Referral; and
  • a brief description of the overpayment, and how and when the overpayment was discovered, according to B-711, Types of Overpayment Claims.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

B-800, Restored Benefits

Revision 13-3; Effective July 1, 2013

 

 

B—810 Entitlement to Restored Benefits

Revision 10-2; Effective April 1, 2010

 

TANF and SNAP

Households are entitled to restored benefits when:

  • legislation, federal regulations or court actions require restoration;
  • the Health and Human Services Commission (HHSC) makes an error in the household's amount of benefits and the household was not at fault;
  • an individual is disqualified for an intentional program violation, which is later reversed by a court; or
  • the Supplemental Nutrition Assistance Program (SNAP) or an authorized representative of a drug and alcohol facility improperly accesses and fails to return the benefits to the individual's EBT account.

Households are not entitled to restored benefits for unreported changes or household errors.

Households are entitled to restored benefits regardless of whether they are currently eligible for or receiving benefits.

 

B—820 Time Frames for Qualifying for Restored Benefits

Revision 10-2; Effective April 1, 2010

 

TANF and SNAP

Restore benefits as directed by a court or if the loss occurred within 12 months of the date:

  • the household:
    • contests an adverse decision,
    • attends a disqualification hearing, or
    • notifies HHSC that it believes it has lost benefits.
  • HHSC discovers that the household may be entitled to a restoration.

The month the agency discovers the household is entitled to a restoration is counted as month zero.

 

B—830 How to Determine the Amount of Restored Benefits

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Texas Integrated Eligibility Redesign System (TIERS) Eligibility performs the steps to calculate restored benefits in most instances. The advisor may be required to manually calculate the restored benefit, record the restored benefit and offset information, and issue benefits using the Benefit Issuance – Manual Issuance functional area in TIERS.

  1. Determine the month the loss began.
  2. Exclude months before the 12-month time limit.
  3. Determine if the household was eligible for each month the houshold lost benefits.
  4. Obtain needed information to determine eligibility for any restored benefit month in question.
  5. For each month, compute the amount of benefits the household should have received.
  6. Determine the restored benefit amount by subtracting the correct benefits from the amount of benefits actually issued. If there is a claim, subtract the restored benefit amount from the amount due on the claim. Issue any remainder to the household.

Note: When initial benefits are paid retroactively, do not reduce the retroactive payment to offset previous claims.

Issue restored benefit(s) within 30 days of the date the agency discovers the underpayment.

 

B—831 Procedures for Counting Restored Benefits Toward a Claim

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

  1. Document the amount of restored benefits owed on the Restored Benefits Details page or Request Manual Issuance page.
  2. Determine if there is a claim, as noted in A-832, How to Verify a Claim Amount. Refer to B-761.1.1, Action on Recoupment Cases.
  3. The nightly interface between TIERS and the Accounts Receivable Tracking System (ARTS) will report the offset.
  4. Notify the individual on Form H1825, Entitlement to Restored Benefits.

 

B—832 How to Verify a Claim Amount

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Advisors must go to Benefits Issuance on the left navigation bar and click on View Overpayments to verify a claim amount. TIERS users can search for overpayment information by entering a Social Security number, an Eligibility Determination Group (EDG) number or claim number. The Search Results display columns are: Social Security number, EDG number, EDG Name, Claim number and Individual number. Clicking on the Social Security number hyperlink will display overpayment information, which includes the remaining overpayment balance.

 

B—840 Notice to the Household

Revision 01-3; Effective April 1, 2001

 

TANF and SNAP

Notify the household by Form H1825, Entitlement to Restored Benefits, of

  • their entitlement to restored benefits,
  • the amount and method of restoration,
  • any claim offset, and
  • the right to appeal.

 

B—850 Disputed Benefits

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

If the household disagrees with the amount of restored benefits, or any other action the advisor takes to restore them, the household may request a hearing within 90 days of the notice date. The advisor continues the restoration while waiting for the hearing decision and adjusts the benefits according to the hearing officer's decision.

The household may request a hearing if the household believes it is entitled to restored benefits but the advisor does not agree. Document on the appropriate worksheet the request for restored benefits, the justification to deny them, and the date.

 

B—860 Method of Restoration

Revision 13-3; Effective July 1, 2013

 

TANF

Restore all benefits owed to the household at the same time. Issue a separate benefit for each month the household is owed benefits.

SNAP

Restore all benefits owed the household at the same time.

Issue a separate EBT benefit for each month the household is owed restored benefits.

 

B—870 Changes in Household Composition

Revision 01-3; Effective April 1, 2001

 

TANF and SNAP

If household membership changes, issue restored benefits to the household containing a majority of the persons who were household members when the loss occurred.

If the worker cannot locate an individual or determine which household contains a majority of members, restore benefits to the household that includes the person who was the head of the household when the loss occurred.

 

B—880 Procedure for Authorizing Restored Benefits

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Authorize the restoration within 30 days of the date the agency discovers the underpayment.

A Second Level Review (SLR) is required when, in TIERS Eligibility:

  • Restored benefits are being issued for more than three months prior to the current date.
  • The total restored benefit amount (prior to offset) for TANF is equal to or greater than $50.
  • The total restored benefit amount (prior to offset) for SNAP is equal to or greater than $125.

An SLR is required for all restored benefits requested in Manual Issuance.

 

B—890 Documentation Requirements

Revision 13-3; Effective July 1, 2013

 

TANF and SNAP

Advisors are required to document

  • why the household is entitled to restored benefits;
  • the month the loss of benefits began;
  • the time frames for benefits owed;
  • computations;
  • if there is a claim against the household; and
  • the amount of restoration approved if the household has an offset.

Note: The documentation requirements will be met if appropriate entries are made on the Restored Benefits Details page or Request Manual Issuance page.

Document in the case record the:

  • request for restored benefits;
  • justification to deny the request; and
  • date according to B-850, Disputed Benefits.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

B-900, Referrals for Intentional Program Violation (IPV)

Revision 15-4; Effective October 1, 2015

 

 

B—910 General Policy

Revision 15-4; Effective October 1, 2015

 

All Programs

An IPV occurs when a person intentionally makes a false or misleading statement, or misrepresents, conceals, or withholds facts for the purpose of receiving assistance under Texas Health and Human Services Commission (HHSC) benefit programs.

Note: A person may be charged with an IPV, even if benefits the person was not entitled to receive have not actually been received.

SNAP

An IPV occurs when a person commits an act that constitutes a violation of the Food and Nutrition Act, the Supplemental Nutrition Assistance Program (SNAP) regulations, or any state statute for the purpose of using, presenting, transferring, acquiring, receiving, possessing, or trafficking of benefits, authorization cards, or reusable documents used as part of an electronic benefit delivery system (Electronic Benefit Transfer [EBT]).

 

B—911 Elements of an IPV

Revision 11-4; Effective October 1, 2011

 

All Programs

An IPV must contain at least one or more of the following elements:

  • a falsified document,
  • a falsified statement,
  • a falsified interview,
  • a continuing scheme, or
  • trafficking of benefits.

See Glossary for definitions of the above terms.

 

B—912 IPV Disqualification Penalties

Revision 15-4; Effective October 1, 2015

General Policy

There is no IPV disqualification or disqualification penalty imposed for Medicaid or the Children's Health Insurance Program (CHIP). However, the Office of Inspector General (OIG) may establish an overpayment claim for an individual found guilty of committing fraud in these programs.

SNAP and TANF

A person found guilty by a court for an IPV will be disqualified as specified by the court. If the court fails to specify a disqualification, OIG will impose the appropriate IPV disqualification penalty as listed below.

TANF

A person found guilty of having committed an IPV through an administrative disqualification hearing (ADH) or having signed a waiver of an ADH for conduct that constitutes an IPV and that conduct occurred on or after September 1, 2003, will be disqualified:

  • 12 months for the first offense, and
  • permanently for the second offense.

A person convicted for conduct that constitutes an IPV of a state or federal offense, or granted deferred adjudication or placed on community supervision for that conduct, will be permanently disqualified from receiving financial assistance.

A person found guilty of an IPV in federal or state court, or in an ADH for making a fraudulent statement or representation with respect to the identity or residence of the individual in order to receive multiple benefits simultaneously, will be disqualified for 10 years.

SNAP

A person found to have committed an IPV either through an ADH or by a federal, state, or local court, or to have signed either a waiver of right to an ADH or a disqualification consent agreement in cases referred for prosecution, will be disqualified:

  • 12 months for the first offense,
  • 24 months for the second offense, and
  • permanently for the third offense.

SNAP Specified Offenses

  • A person found guilty of an IPV in federal or state court, or in an ADH for making a fraudulent statement or representation with respect to the identity or residence of the individual in order to receive multiple benefits simultaneously, will be disqualified for 10 years.
  • A person found guilty of an IPV in federal, state, or local court of having used or received benefits in a transaction involving the sale of a controlled substance will be disqualified:
    • 24 months for the first occasion, and
    • permanently for the second occasion.
  • A person convicted by a federal, state, or local court of an IPV due to trafficking in SNAP benefits or program access devices, such as EBT cards, and the conviction is for an aggregate amount of $500 or more, will be permanently disqualified.
  • A person found guilty of an IPV in federal, state, or local court of having used or received benefits in a transaction involving the sale of firearms, ammunition, or explosives will be permanently disqualified.

 

B—920 When to File an IPV Referral

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff are responsible for reporting to OIG any acts of fraud, waste, abuse, or misconduct in the following HHSC benefit programs:

  • Temporary Assistance for Needy Families (TANF),
  • SNAP,
  • Medicaid, and
  • CHIP.

 

B—930 How to File an IPV Referral

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff submit a fraud or IPV referral using either the:

  • Automated System for Office of Inspector General (ASOIG), or
  • Texas Integrated Eligibility Redesign System (TIERS) referral interface.

Note: If the fraud allegation contains confidential information and/or the person making the allegation requests to remain anonymous, the referral is submitted using ASOIG. Any supporting information and/or evidence should be attached to the referral using ASOIG. The TIERS referral interface does not allow attachments.

Staff must follow instructions in B-770, Filing an Overpayment Referral, for submitting a referral using either ASOIG or the TIERS referral interface.

 

B—940 Texas Works (TW) Responsibilities

Revision 15-4; Effective October 1, 2015

 

All Programs

TW staff:

  • identify potential fraud or IPV;
  • submit fraud or IPV referrals, using ASOIG or the TIERS referral interface, within 30 days of the date the IPV is identified;
  • process fair hearing requests related to claims or collections following instructions in B-1035, Appeals Related to Accounts Receivable Tracking System (ARTS), in TIERS;
  • forward any payments received in the local office to:
     

    Texas Health and Human Services Commission
    Fiscal Management Services
    ARTS Billing
    P.O. Box 149055
    Austin, TX 78714-9055

  • refer questions regarding collections on established claims to Fiscal Management Services (FMS);

    Note: The FMS hotline number is 1-800-666-8531. ARTS is administered by FMS staff who monitor and process payments from HHSC claims.
  • report fraud and/or violations of SNAP rules by drug addict/alcohol treatment centers and group living arrangement facilities by emailing Form H1095, Treatment Facility Fraud Referral, along with Form H1096, Notification Letter, and if applicable, Form H1853, Documentation of Findings for Form H1852, to OIG General Investigations at OIG_GI@hhsc.state.tx.us; and
  • report retail stores allowing unauthorized purchases and accepting benefits for previous purchase to Lone Star Business Services at LoneStar@hhsc.state.tx.us.

 

B—941 Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

SNAP

When out-of-state SNAP IPV disqualification data from the SNAP federal Electronic Disqualified Recipient System (eDRS) is identified on Data Broker, the advisor must discuss the IPV with the member to determine whether the member agrees with or disputes the information. The advisor must complete as much of the application process as possible and dispose the application for other programs if applicable; however, the advisor must follow procedures below for SNAP. Exception: This policy does not impact SNAP Combined Application Project (SNAP-CAP) or SNAP Supplemental Security Income (SNAP-SSI) Eligibility Determination Groups (EDGs) administered by Centralized Benefit Services (CBS), with one exception in SNAP-CAP as described in B-475.2.1, Identifying Intentional Program Violations (IPVs) and Felony Drug Convictions.

Procedures When Data Broker Identifies an eDRS Match

 

If the situation is ... then ...
  1. an expedited SNAP application, and the household does not dispute the IPV data,

the advisor must:

  • complete Form H1856, SNAP Out-of-State Intentional Program Violations, indicating it is for an expedited application;
  • send a copy for imaging;
  • email the form using secure Voltage to Customer Care Center (CCC)-eDRS eligibility staff at HHSC OES CCC IC, indicating Expedited in the email subject line; and
  • document this action in case comments.

CCC-eDRS staff will review the form for accuracy and forward it immediately to OIG-Central Disqualification Unit (CDU) at CDU@hhsc.state.tx.us.

If the email is received by 4:30 p.m. Central Standard Time, OIG-CDU staff will take action the same day to enter the IPV disqualification data from Form H1856 into TIERS, create a reported change task to notify the advisor to complete and dispose the SNAP EDG, and also email notice of this to the advisor. Exception: Out-of-state IPVs with non-standard penalty periods are noted on Data Broker and require secondary verification as described in Box D.

  1. an expedited SNAP application, and the household disputes the IPV disqualification,

the advisor must:

  • postpone verification of the IPV penalty and certify the application without the penalty;
  • complete Form H1856, indicating it is for an expedited application;
  • send a copy for imaging;
  • email Form H1856 using secure Voltage to CCC-eDRS eligibility staff at HHSC OES CCC IC to obtain secondary verification of the out-of-state IPV data; and
  • document this action in case comments.

If the out-of-state IPV verification is:

  • received by the final due date, the CCC-eDRS advisor forwards Form H1856 to OIG, who will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the local office advisor to complete and dispose the SNAP EDG.
  • not received by the final due date, the local office advisor must dispose the application without imposing the IPV disqualification.

When the secondary verification is subsequently received, the CCC-eDRS advisor forwards Form H1856 to OIG-CDU staff at CDU@hhsc.state.tx.us, who will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify CCC to dispose the penalty as a change and create an overpayment claim referral back to OIG.

  1. a SNAP non-expedited application, household addition or redetermination,

the advisor must discuss the out-of-state IPV disqualification with the household to confirm the IPV data if possible. If the household does not dispute the IPV data, the advisor must:

  • complete Form H1856,
  • send a copy for imaging,
  • email Form H1856 using secure Voltage to CCC-eDRS eligibility staff at HHSC OES CCC IC, and
  • document this action in case comments.

CCC-eDRS staff will review the form for accuracy and forward it immediately to OIG-CDU at CDU@hhsc.state.tx.us.

OIG-CDU staff will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the advisor to complete and dispose the EDG. Exception: Out-of-state IPVs with non-standard penalty periods are noted on Data Broker and require secondary verification as described in Box D.

If not possible to contact the household or the household disputes the IPV, then the advisor must:

  • manually pend the SNAP EDG action until the final due date for CCC-eDRS staff to complete secondary verification,
  • complete Form H1856,
  • send a copy for imaging,
  • email Form H1856 using secure Voltage to CCC-eDRS staff at HHSC OES CCC IC for a secondary verification as described above, and
  • document this action in case comments.

If the secondary verification is not received and OIG has not entered the IPV disqualification by the:

  • final due date on an application or redetermination, process it without imposing the IPV disqualification.
  • 20th day after sending Form H1856 on a requested household addition, process the change without imposing the IPV disqualification.

When the CCC-eDRS advisor subsequently receives the out-of-state IPV verification, the CCC-eDRS advisor forwards it to OIG. OIG-CDU staff will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the advisor to dispose the EDG and create an overpayment claim referral back to OIG.

  1. the IPV data on a Data Broker report is marked as “non-standard” (i.e., the penalty period listed is not a standard length),

the advisor must:

  • manually pend the SNAP EDG action until the final due date for CCC-eDRS staff to complete secondary verification,
  • complete Form H1856,
  • send a copy for imaging,
  • email Form H1856 using secure Voltage to CCC-eDRS eligibility staff at HHSC OES CCC IC to obtain secondary verification of the IPV before imposing the disqualification in Texas, and
  • document this action in case comments.

Note: Postpone verification if expedited. If not expedited, process the application as explained in Box C.

Note: If the individual is not active on a SNAP EDG or the application has already been denied, OIG will enter this out-of-state IPV data into TIERS since the individual is known to TIERS. No advisor action is required in this situation.

 

B—942 Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF

When the advisor discovers that an individual has an out-of-state TANF IPV disqualification, the advisor must discuss the IPV with the individual to determine whether the individual disputes the information.

If the household does not dispute the IPV data … the advisor must …

 

  • complete as much of the application process as possible and dispose the application for other programs if applicable,
  • pend the TANF EDG until OIG notifies the advisor to complete and dispose the EDG, and
  • send a secure email referral to OIG-CDU staff at CDU@hhsc.state.tx.us containing the following information:

    Subject: TANF Out-of-State IPV

    Out-of-state IPV information:

    • TANF EDG number
    • Originating state where IPV occurred
    • Disqualified individual's:
      • Name
      • Social Security number (SSN)
      • Date of birth (DOB)
    • Client number in originating state
    • Number of disqualified months
    • Disqualified begin date
    • Disqualified end date
    • Offense occurrence
    • Offense description
    • Federal or state court or administrative hearing decision date

Document the IPV information and the email sent to OIG in TIERS Case Comments.

OIG-CDU staff will enter the IPV disqualification data from the email into TIERS and create a reported change task to notify the advisor to complete and dispose the EDG.

If unable to contact the household or the household disputes the IPV data … the advisor must …

 

  • complete as much of the application process as possible and dispose the application for other programs if applicable,
  • pend the TANF EDG until OIG notifies the advisor to complete and dispose the EDG*, and
  • send a secure email referral to CCC-eDRS staff at HHSC OES CCC IC containing the following information:

    Subject: TANF Out-of-State IPV – Pending Secondary Verification

    Out-of-state IPV information:
    • TANF EDG number
    • Originating state where IPV occurred
    • Disqualified individual's:
      • Name
      • SSN
      • DOB
    • Client number in originating state
    • Number of disqualified months
    • Disqualified begin date
    • Disqualified end date
    • Offense occurrence
    • Offense description
    • Federal or state court or administrative hearing decision date
    • Whether the individual was/wasn’t contacted
    • If the individual disputes the IPV, details regarding why the claim is disputed

      Document the IPV information and the email sent to CCC-eDRS in TIERS Case Comments.

      CCC-eDRS staff will obtain secondary verification of the IPV and immediately forward the secondary verification to OIG. OIG will enter the IPV information into TIERS.

      * If OIG has not entered the IPV disqualification by the final due date, process the application or redetermination without imposing the IPV disqualification.

 

B—943 Expiration of an IPV Disqualification Penalty

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Once the IPV disqualification penalty begins, it continues even when benefits expire or the EDG is denied. If the person reapplies for benefits, advisors must ensure that the person has served the IPV disqualification penalty before certifying the person for benefits.

Example: A person reapplies for TANF and SNAP on April 4, 2011, for herself and her three children.

The advisor checks the person's IPV disqualification status by viewing the person's Individual-Summary using the hover menu IPV Sanctions page. The person was found guilty of committing an IPV offense on February 4, 2011, resulting in a 12-month SNAP IPV disqualification beginning March 1, 2011, through February 28, 2012. Since the disqualification period has not expired, the advisor must continue the person's disqualification.

Notes:

  • Form OIG5042, Notice of Disqualification Enforcement, may be viewed under Case Data Search.
  • To determine eligibility for the remaining household members, advisors use the budgeting procedures in:
    • A-1362.2, 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; and
    • A-1362.4, SNAP — Budgeting for Persons Disqualified for Intentional Program Violations, SNAP Employment Services Noncompliances, Felony Drug Convictions or Being a Fugitive.

 

B—944 Reinstatement of an IPV Disqualified Person

Revision 14-1; Effective January 1, 2014

 

TANF and SNAP

When the IPV disqualification penalty period expires on an active EDG, TIERS automatically adds the formerly IPV disqualified person to the household and adjusts benefits accordingly.

 

B—945 Request for New Administrative Disqualification Hearing (ADH)

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When a person disqualified for an IPV contacts the local office and claims that the individual did not receive an ADH notice and requests a new hearing, staff must notify the Office of Social Services (OSS) – Eligibility Services Support (ESS) Centralized Representation Unit (CRU). CRU coordinates with OIG in processing new ADH requests.

Staff provide CRU the following information:

  • person's name,
  • EDG number,
  • date of disqualification, and
  • status of the person's EDG (active, denied, pending).

Note: If the ADH officer grants a person's request for a new hearing, the CDU:

  • removes the IPV disqualification, and
  • contacts Texas Works to re-run the budget to allow for the person’s continued benefits pending the new ADH.

 

B—950 OIG Responsibilities

Revision 15-4; Effective October 1, 2015

 

All Programs

OIG General Investigations is organized as follows:

  • State Office Operations Unit,
  • Central Disqualification Unit,
  • Claims Investigations (CI) units, and
  • Field Investigations (FI) units.

OIG staff:

  • review allegations of HHSC benefit program recipient fraud, including employee fraud as well as recipient and/or retailer EBT trafficking fraud;
  • investigate allegations of recipient and/or employee fraud to determine whether fraud exists and, if applicable, the amount of an overpayment;
  • establish fraud claims through the Fiscal Management Services Accounts Receivable Tracking System;
  • coordinate with the HHSC Fair and Fraud Hearings Division for investigations submitted for ADH;
  • coordinate with the local district attorney office for investigations submitted for prosecution;
  • coordinate with U.S. Department of Agriculture (USDA) EBT trafficking investigations;
  • dispose investigations based on the results of either prosecution or ADH;
  • impose an IPV disqualification penalty, if applicable; and
  • coordinate with the HHSC-OSS – Eligibility Operations CCC to adjust active HHSC program benefit amounts, if appropriate.

 

B—951 Facts Do Not Support an IPV

Revision 15-4; Effective October 1, 2015

 

All Programs

The facts do not support an IPV when:

  • OIG staff review and determine that the facts do not support the allegation,
  • a court determines the person is not guilty, or
  • an ADH hearing officer determines that no IPV was committed.

OIG staff may process these claims as inadvertent household errors/misunderstandings.

 

B—952 Facts Support an IPV

Revision 15-4; Effective October 1, 2015

 

All Programs

When OIG determines that the facts support an IPV allegation, OIG submits the case to either the:

  • local district attorney for prosecution, or
  • Fair and Fraud Hearings Division for an ADH.

Note: A person may waive the right to an ADH by signing Form OIG5040, which allows OIG to establish a fraud claim and impose an IPV disqualification.

 

B—953 Enforcement of IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

OIG-CDU staff enforce the IPV Disqualification and associated disqualification penalty.

 

B—953.1 Notice of an IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

CDU staff receive the following notices that a household member has been disqualified due to an IPV:

  • Form H1856, SNAP Out-of-State Intentional Program Violations. TW staff submit this form to CDU upon discovery of a person's current IPV disqualification that was administered by another state. See B-941, Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification, for directions.
  • Form OIG5038, Notice of Disqualification Decision. OIG staff submit this form to CDU indicating when a court finds a person guilty of an IPV, or a court defers adjudication and the person voluntarily signs Form OIG5036, Disqualification Consent Agreement.
  • Form OIG5040/5040S, Waiver of Disqualification Hearing. OIG staff submit this form to CDU indicating when a person waives the right to an ADH.
  • Form H4857, Notice of Decision, Administrative Disqualification Hearing. ADH hearing officers submit this form to CDU indicating the ADH decision that a person committed an IPV.

 

B—953.2 Imposing an IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

CDU staff has primary responsibility for enforcing IPV disqualifications upon receipt of:

  • Form H1856, SNAP Out-of State Intentional Program Violations;
  • Form OIG5040, Waiver of Disqualification Hearing, signed by the person;
  • Form H4857, Notice of Decision, Administrative Disqualification Hearing; or
  • Form OIG5038, Notice of Disqualification Decision.

CDU imposes the IPV disqualification penalty:

  • by the court-specified date (as indicated on Form OIG5038);
  • within 45 days of the court disqualification decision date (as indicated on Form OIG5038) if the court did not specify a disqualification date;
  • within 45 days of the date the person signs Form OIG5036, Disqualification Consent Agreement;
  • the first month after the date the local OIG office receives a signed Form OIG5040; or
  • the month after the date the person receives Form H4857.

CDU enters the IPV disqualification details in the disqualified individual's IPV Sanction screen and:

  • sends an email request to the OSS - Eligibility Operations CCC to rebudget the household's future SNAP EDG benefit amount when the interface record exceptions out of a mass update or the IPV was manually entered by OIG staff; and
  • sends Form OIG5042, Notice of Disqualification Enforcement, notifying:
    • the household of:
      1. the begin and end dates of the IPV disqualification penalty period; and
      2. its new benefit amount (if applicable); and
    • TW staff of the enforcement of the IPV disqualification penalty.

When an IPV disqualification is not imposed in a timely manner, CDU staff initiate an overpayment referral to establish an agency error overpayment claim for any months the household received benefits to which it was not entitled.

 

B—953.3 Amendment of IPV Disqualification Penalties

Revision 15-4; Effective October 1, 2015

 

All Programs

CDU staff are authorized to modify IPV disqualification information if applicable. TW staff should contact CDU if TW staff believe IPV information is incorrect. CDU will research and respond to the problem.

 

B—960 Fiscal Management Services (FMS) Responsibilities

Revision 11-4; Effective October 1, 2011

 

 

 

B—961 IPV Claim Collection

Revision 15-4; Effective October 1, 2015

 

All Programs

FMS establishes repayment agreements and collects on IPV claims including court-deferred adjudications.

TANF

When the person fails to comply with its repayment agreement, FMS initiates recoupment at 10 percent of the household's recognizable needs.

SNAP

When the person fails to comply with its repayment agreement, FMS initiates recoupment at 20 percent of the household's allotment or $10, whichever is greater. When a current household member is disqualified for an IPV, recoupment is computed using the allotment the household would receive if the disqualified member were included in the household size.

 

B—970 HHSC Employee Fraud

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff are responsible for reporting allegations of fraud involving HHSC benefit program certification procedures by HHSC employees to the unit supervisor. The supervisor forwards the report to the program manager.

Program managers report serious violations of HHSC employee fraud to the OIG director of general investigations at 512-491-2823.

Note: Allegations of employee fraud reported by email must be reported using an electronically secure mode.

 

B—980 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff must document the reason(s) for creating a fraud or IPV referral in the case comments.

Note: If the reason contains confidential information and/or the person making the allegation requests to remain anonymous, the referral must be submitted using ASOIG. Any supporting information and/or evidence should be attached to the referral using ASOIG. The TIERS referral interface does not allow for attachments. Staff must follow instructions in B-771, Filing an Overpayment Referral Using Automated System for the Office of Inspector General (ASOIG).

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

B-1000, Fair Hearings

Revision 17-1; Effective January 1, 2017

 

 

B—1010 Right to Appeal

Revision 15-4; Effective October 1, 2015

 

All Programs

A request for a hearing is a clear expression, oral or written, by the household or its representative that indicates that the household wishes to appeal a decision. The freedom to make a request for a hearing must not be limited or interfered with in any way.

If any member of a household or the household's representative expresses dissatisfaction with a decision regarding benefits or services, the advisor takes the following actions:

  • Explain the basis for the decision and the applicable policies;
  • Provide the household an opportunity to have a conference with the supervisor;
  • Provide the household an opportunity to request a fair hearing;
  • Provide the individual with copies of all documents before the hearing that will be entered into evidence during the fair hearing; and
  • Consult with the supervisor if the individual requests information the advisor considers confidential. Note: The individual is entitled to any information that was used to determine suspension, reduction or termination of benefits. See B-1210, Disclosure of Information, for information that is considered to be confidential.

The household or the household's representative must make a request to withdraw an appeal in writing. Staff must fax the written withdrawal request to the designated hearings office. If a written withdrawal request is not obtained, staff must notify the hearings officer via email. If email is not an option, staff must notify the hearings officer via fax or phone.

SNAP

If the household requests a conference with the supervisor after a denial for expedited service, the advisor must schedule the conference within two workdays of the request, unless the household prefers a later date. The advisor must document that the household requested a later date.

 

B—1020 Time Period for Requesting Fair Hearing

Revision 15-4; Effective October 1, 2015

 

All Programs

Individuals have the right to appeal within 90 days from the effective date of any Texas Health and Human Services Commission (HHSC) action. The individual's request may be oral or in writing.

Advisors may not prevent an individual from filing an appeal, even if the appeal was not requested within 90 days from the effective date of the action. Only the hearings officer has the authority to decide the timeliness of filed appeals and can accept untimely filed appeals in order to determine whether there was good cause for the delay in filing the appeal.

SNAP

The household may appeal the denial of a request to restore benefits that were lost within one year before the request. In addition, a household may appeal its current level of benefits during a certification period.

 

B—1030 Appeals Procedures

Revision 15-4; Effective October 1, 2015

 

All Programs

All fair hearing requests are processed in the State Portal. The local office staff (including Customer Care Center [CCC] staff) and Centralized Representation Unit (CRU) staff have separate responsibilities and must follow the following procedures when processing fair hearing requests and appeals.

 

B—1031 Local Office Procedures for Hearing Requests

Revision 15-4; Effective October 1, 2015

 

When any member of a household or the household's representative expresses dissatisfaction with a decision regarding benefits or services, the local office staff takes the following actions:

  • Review the Eligibility Determination Group (EDG) to determine accuracy of the action;
  • Take action to correct any agency error that results in an increase in benefits;
  • Clearly document any discovered error and the action taken to correct the error;
  • Explain the basis for the decision and the applicable policies to the individual;
  • Provide the individual an opportunity to have a conference with the supervisor (including a conference within two workdays for an individual who wants to contest an expedited services decision); and
  • Provide the individual an opportunity to request a fair hearing.

The same day a fair hearing request is received:

  • in person, over the telephone or in writing — the advisor/supervisor enters the fair hearing request with the Add New Appeal tab in the State Portal Appeals/RFR (Request for Revision). These entries automatically create an Appeal Request for (Program/TOA) for CRU staff.
  • by fax or mail — the advisor/supervisor faxes or mails the appeal using the fair hearing cover sheet to the expedited fax line (1-866-559-9628) for processing. The advisor must not:
    • complete and submit Form H4800, Fair Hearing Request Summary;
    • enter the fair hearing request in State Portal; or
    • enter the fair hearing request through left navigation in the Texas Integrated Eligibility Redesign System (TIERS).
  • advisors must consult with the supervisor if the individual requests information staff considers confidential.

 

B—1031.1 Office of Attorney General (OAG) Child Support Division Region Contacts

Revision 15-4; Effective October 1, 2015  

 

OAG Region Primary Contact Secondary Contact Physical Mailing and Centralized Email Addresses
1
Lubbock
Angelia Gregg
806-761-4715
Fax: 806-763-7579
Renee DeLaRosa
806-761-4704
Fax:
806-763-7579
4630 50th Street, Ste 500
Lubbock, TX 79414-3521
OAGarea1.FairHearing@texasattorneygeneral.gov
2
San Antonio
Vanessa Vasquez
210-804-6488
Fax:
210-930-3625
Martin Martinez
210-804-6489
Fax: 210-930-3625
3460 Northeast Parkway
San Antonio, TX 78218-3304
OAGarea2.FairHearing@texasattorneygeneral.gov
3
McAllen
Anna Rangel
956-926-4524
Fax: 956-631-2451
Vacant 3331 N. McColl Road
McAllen, TX 78501-5536
OAGarea3.FairHearing@texasattorneygeneral.gov
4
Dallas
Nancy Hernandez
214-915-3721
Fax:
214-915-3750
Oscar Sanchez
214-915-3720
Fax:
214-915-3750
400 South Zang Blvd. Ste. 1100
Dallas, TX 75208-6646
OAGarea4.FairHearing@texasattorneygeneral.gov
5
Tyler
Christy Cates
903-533-4005
Fax:
903-592-5732
Glen Elliott
903-533-4009
Fax:
903-592-5732
200 N. Broadway Avenue, Ste 355
Tyler, TX 75702-5747
OAGarea5.FairHearing@texasattorneygeneral.gov
6
Houston
Mark Jones
713-948-7673
Fax:
713-910-4806
Melissa Jimenez
713-787-7146
Fax:
713-789-7665
8866 Gulf Freeway, Ste 200
Houston, TX 77017-6529
OAGarea6.FairHearing@texasattorneygeneral.gov
7
Austin
Patricia Roark
512-358-3242
Fax:
512-892-8967
Annette Hernandez
512-358-3249
Fax:
512-892-8967
2512 S IH 35 Ste 200
Austin, TX 78704-5751
OAGarea7.FairHearing@texasattorneygeneral.gov
8
El Paso
Lorraine Sanchez-Rayas
915-782-4211
Fax:
915-782-4276
Barbara Ramirez
915-782-4236
Fax:
915-782-4276
6090 Surety Dr., Ste 250
El Paso, TX 79905-2062
OAGarea8.FairHearing@texasattorneygeneral.gov
9
Ft. Worth
Elizabeth House
817-834-7048
Fax:
817-834-7066
Kelly Robison
817-834-7038
Fax:
817-834-7066
2001 Beach St. Ste 700
Ft. Worth, TX 76103
Regional email not yet established

OAG – Counties Served by Each Area

 

Region Counties Served
1
Lubbock
Archer, Armstrong, Bailey, Baylor, Briscoe, Brown, Callahan, Carson, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Fisher, Floyd, Foard, Gaines, Garza, Grey, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Hutchinson, Irion, Jack, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Lubbock, Lynn, Mason, McCulloch, Menard, Mitchell, Montague, Moore, Motley, Nolen, Ochiltree, Oldham, Parmer, Potter, Randall, Reagan, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Wheeler, Wichita, Wilbarger, Yoakum, Young
2
San Antonio
Atascosa, Bandera, Bexar, Comal, Dewitt, Dimmit, Edwards, Frio, Gillespie, Gonzales, Guadalupe, Karnes, Kendall, Kerr, Kinney, LaSalle, Maverick, McMullen, Medina, Real, Uvalde, Val Verde, Wilson, Zavala
3
McAllen
Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Nueces, Starr, Webb, Zapata
4
Dallas
Collin, Cooke, Dallas, Denton, Ellis, Erath, Hood, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somerville, Tarrant
5
Tyler
Anderson, Angelina, Bowie, Camp, Cass, Chambers, Cherokee, Delta, Fannin, Grayson, Gregg, Hardin, Harrison, Henderson, Hopkins, Houston, Hunt, Jasper, Jefferson, Lamar, Liberty, Marion, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Wood
6
Houston
Austin, Brazoria, Ft Bend, Galveston, Harris, Matagorda, Montgomery, Waller, Wharton
7
Austin
Aransas, Bastrop, Bee, Bell, Blanco, Bosque, Brazos, Burleson, Burnett, Caldwell, Calhoun, Colorado, Coryell, Falls, Fayette, Freestone, Goliad, Grimes, Hamilton, Hays, Hill, Jackson, Lampasas, Lavaca, Lee, Leon, Limestone, Live Oak, Llano, Madison, McLennan, Milam, Mills, Refugio, Robertson, San Patricio, San Saba, Travis, Victoria, Walker, Washington, Williamson
8
El Paso
Andrews, Borden, Brewster, Crane, Culberson, East El Paso, Ector, Glasscock, Howard, Hudspeth, Jeff Davis, Loving, Martin, Midland, Pecos, Presidio, Reeves, Terrell, Upton, Ward, Winkler

 

B—1031.2 Providing Form H4800-A, Fair Hearing Request Summary (Addendum), to Hearings Division

Revision 17-1; Effective January 1, 2017

 

Form H4800-A, Fair Hearing Request Summary (Addendum), provides a method to send documents or evidence used in a hearing that were not sent with the original submission and to report changes of address or other corrections to the appropriate hearings officer.

 

B—1032 Centralized Representation Unit (CRU)

 

Revision 15-4; Effective October 1, 2015

 

The CRU is a staff unit within Eligibility Services Support (ESS) that represents HHSC in fair hearings and implements hearing officers' decisions.

 

B—1032.1 Centralized Representation Unit (CRU) Staff Responsibilities

Revision 15-4; Effective October 1, 2015

 

CRU staff completes the following actions:

  • claim the Appeal Request for (Program/TOA) task from the Task List Manager (TLM) Global Queue;
  • review the EDG to determine if any correction is needed and take appropriate action;
  • prepare the evidence packet and mail to the Document Processing Center (DPC) for imaging;
  • ensure the hearing procedures are explained in a language the individual understands;
  • mail a copy of the evidence packet to the individual, legal representative, authorized representative and any other witnesses participating in the hearing;
  • create and send a fair hearing request in TIERS;
  • enter in TIERS any necessary accommodations; and
  • mark the task as Task Completed.

Once the fair hearings request has been scheduled by Hearings Division staff, a Fair Hearing Appointment for a (Program) Case task will be routed to the Fair Hearings Centralized Representation Unit TLM Global Queue.

CRU will:

  • assign an agency representative for each hearing;
  • attend the fair hearing as the agency representative; and
  • present the agency's case by explaining the action being appealed, the documents submitted and how the agency policy applies to the issue(s) on appeal.

 

B—1033 Appeals Related to Decisions/Actions of an Electronic Benefit Transfer (EBT) Vendor

Revision 14-2; Effective April 1, 2014

 

All Programs

When an EBT vendor cannot resolve an account balance dispute or error resolution related to benefits to an individual's satisfaction, the vendor refers the individual to Lone Star Business Services (LSBS) for a second review. The individual may contact LSBS staff to request a fair hearing if still not satisfied with the results of the second review. CRU processes the appeal following the policy and procedures outlined in this section.

 

B—1034 Appeals Related to Services for Medicaid Recipients

Revision 15-4; Effective October 1, 2015

 

All Programs

The Texas Department of State Health Services (DSHS) handles appeals concerning specific services for Medicaid recipients including:

  • lock-in;
  • medical necessity for prior authorization of services; and
  • denial, termination, suspension or reduction of covered services, or payment for services rendered.

For individuals who want to appeal service-related issues, staff must refer them to DSHS. DSHS individual notification letters include an address and telephone number for requesting appeals. Individuals who do not have a notification letter should be referred to the Medicaid Hotline at 1-800-252-8263.

Note: DSHS does not allow individuals to appeal decisions made by the Health Insurance Premium Payment (HIPP) program. To obtain assistance in resolving problems or issues with the HIPP contractor:

  • individuals must contact the Medicaid Hotline at 1-800-252-8263.
  • staff must contact the Third-Party Resource (TPR) Unit at 1-800-846-7307.

 

B—1035 Appeals Related to Accounts Receivable Tracking System (ARTS)

Revision 15-4; Effective October 1, 2015

 

All Programs

For all individual requests for appeals related to ARTS collection notices, the advisor must make the following entries on Form H4800, Fair Hearing Request Summary:

  1. In the From box, if the appeal is regarding a:
    • Claims Investigation (CI) collection notice, enter the CI unit supervisor, mail code, and phone number.
    • Treasury Offset Program (TOP) collection notice, enter ARTS Hearing Representative, 512-406-3800, at mail code E-411.

    Note: If the individual does not know if the collection notice is a result of a CI claim or TOP, enter the CI unit supervisor.

  2. In Section 1, Program, check the appropriate program box.
  3. In Section 2, Agency Action Resulting in a Hearing Request, check D, Not Benefit Amount Related. This will indicate to the hearing officer that the appeal does not affect current benefits.
  4. In Section 8, Summary of Agency Action and Applicable Handbook Reference(s) or Rules, enter the following message: "Collection Notice - Overpayment Claim" (See B-700, Claims).

The advisor must notify the appropriate Claims Investigations Unit supervisor and ARTS supervisor of the hearing request. The advisor sends a copy of Form H4800 to the local Claims Investigation Unit supervisor or the ARTS supervisor, as appropriate, and faxes a copy of Form H4800 to ARTS at 512-438-3061.

 

B—1040 Timely Action on Fair Hearings

Revision 15-4; Effective October 1, 2015

 

All Programs

Hearing decisions must comply with federal law and regulations and be based on the evidence and testimony of the hearing.

Once the fair hearing has been held and a decision rendered, the hearings officer records the decision in TIERS, and a TLM task is created and routed to the Fair Hearings Centralized Representation Unit TLM Global Queue for processing.

  1. If the decision is reversed, a Process Fair Hearings Reversal Decision for (Program/TOA) TLM task is created and routed to the CRU TLM Global Queue.
  2. If the decision is sustained, a Fair Hearings Sustain Decision for (Program/TOA) task will be created and routed to the CRU TLM Global Queue for processing.
  3. A Fair Hearings Decision Issued for (Program/TOA) task will be created for issued decisions that do not typically require an agency action.

CRU will follow these procedures to timely implement the hearing officer's instructions:

If the hearing decision results in restored benefits, an increase in benefits for the current month and/or future months, and ... then ...
no additional information or verification is needed, ensure within 10 days from the date the decision task is received that:
  • benefits for future months are increased, and
  • all benefits the household is entitled to are provided.

Authorize restored Temporary Assistance for Needy Families (TANF) benefits in Eligibility or by manual issuance within 10 days from the date Form H4807, Action Taken on Hearing Decision, is received.

additional information or verification is needed, send the individual Form H1020, Request for Information or Action, within 10 days from the date the decision task is received. List on Form H1020 the specific information/verification needed in order to provide benefits.
 

If the individual:

  • provides all of the requested information and verification, then increase benefits for future months and/or provide benefits for the current/past months within three workdays from receipt of the information/verification;
  • provides part but not all of the requested information and verification, then increase benefits for future months and/or provide benefits for each month for which information/verification is provided within three workdays of receipt of the remaining information/verification; or
  • fails to provide the requested information and/or verification, then follow the normal eligibility determination process in B-600, Changes, and complete/deny the EDG without the missing information/verification.

 

Notes:

  • Upon the individual's request, CRU will offer reasonable assistance in obtaining the necessary verification. The individual's statement is acceptable as verification if no other documentary or collateral information is available.
  • Restored benefits are not denied for any months solely because a person outside the household refuses to cooperate in providing verification.

SNAP

  • Benefits are not restored for any months more than 12 months prior to the date a fair hearing was requested.
  • If the hearing officer authorized restored benefits, TIERS sends Form H1825, Entitlement to Restored Benefits, to the household, along with a copy to the hearing officer, when benefits are approved either in Eligibility or by manual issuance.

 

B—1041 Completing and Reporting Timely Action on Fair Hearings

Revision 15-4; Effective October 1, 2015

 

SNAP

Once all restored and/or supplemental benefits have been issued, the advisor must:

  • enter all decision implementation information in TIERS in the Decision Implementation page;
  • clear any delays entered in the Implementation Delay page; and
  • enter all necessary information in the Implementation Details page and submit for supervisor review.

The supervisor must:

  • review the EDG information and all supporting documentation in accordance with agency procedures and time frames; and
  • approve the Implementation Details page.

 

B—1050 Handling of Benefits During the Appeal Process

Revision 01-3; Effective April 1, 2001

 

 

B—1051 Continued Benefits

Revision 15-4; Effective October 1, 2015

 

All Programs

Households previously certified for ongoing benefits are entitled to continued benefits if they make a timely request for a fair hearing after receiving Form TF0001, Notice of Case Action. A request is timely if it is made within 13 days of the adverse action notice (including a mailed request postmarked during the 13-day period). If a household fails to make a timely request for a hearing, but has good cause for the failure, benefits are reinstated at the previous level if the household did not waive its right to continue benefits.

TANF and Medical Programs

Households receiving an adequate notice of adverse action are not entitled to continued benefits when benefits are lowered or denied because of reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice).

Exception: If the household received a notice of adverse action based on noncompliance with child support or Choices, continued benefits are allowed if the individual timely requests a fair hearing.

SNAP

Households receiving a notice of adverse action are not entitled to continued benefits when benefits are lowered or denied because of:

  • a verbal request to voluntarily withdraw, conducted in the advisor's presence;
  • verification provided by the household that was previously postponed during expedited services;
  • the household's failure to provide verification postponed during expedited services; or
  • the expiration of the certification period.

 

B—1052 Waiver of Continued Benefits

Revision 13-3; Effective July 1, 2013

 

All Programs

The household may waive its right to continued benefits by providing a signed and dated statement to this effect. If the household waives this right, TIERS will reduce or deny benefits when the 13-day notice period (plus 2 days mail time) expires in advance notice situations.

 

B—1053 Reducing or Ending Benefits Before the Hearing Decision

Revision 15-4; Effective October 1, 2015

 

All Programs

Continued or reinstated benefits must not be reduced or denied during the appeal period before the official hearing decision unless:

  • another change adversely affects the household and the household does not appeal the adjustment for the later change. Benefits are reduced based on the change, and the advisor sends Form TF0001, Notice of Case Action.
  • a mass change affects the household's eligibility. Benefits should be adjusted accordingly.

SNAP

When a certification period expires and the household reapplies, the EDG is certified at the appropriate level of benefits.

If the hearing officer determines the only issue being appealed is federal law or regulation and there are no computation errors or misapplied law, the hearing officer instructs the advisor to reduce or deny benefits as required by the policy change.

 

B—1054 Time Frame to Stop Providing Continued Benefits

Revision 15-4; Effective October 1, 2015

 

All Programs

When a hearing officer’s decision sustains the agency action, CRU must take action to stop continued benefits and file a claim for any overpayment within 10 days of receiving the hearing decision and order. Advance notice is not provided. If the hearing decision and order are received within 10 days before cutoff, CRU must make every attempt to process the EDG action before cutoff to prevent issuing continued benefits in the next month.

 

B—1060 Fair Hearings Held by Telephone

Revision 15-4; Effective October 1, 2015

 

All Programs

Fair hearings may be conducted by telephone. However, an appellant may still request a face-to-face hearing. Upon requesting a face-to-face hearing, the appellant is notified of the date, time and location of the hearing using Form H4803, Notice of Hearing.

There are two versions of Form H4803 that indicate how a fair hearing is conducted:

If the fair hearing is scheduled using ... then ...
Form H4803-T/H4803-TS, Notice of Hearing, the hearing officer calls the appellant, the agency representative and all other fair hearing participants at the time, date and telephone number indicated on the form.
Form H4803-P, Notice of Hearing, the appellant, agency representative and all other fair hearing participants must call the Fair Hearing 1-800-Call-In number, using the toll-free number and access code at the scheduled time indicated on the form.

 

B—1070 Administrative and Judicial Reviews

Revision 15-4; Effective October 1, 2015

 

All Programs

Effective September 1, 2007, if an individual expresses dissatisfaction with a decision rendered by the fair hearings officer, the individual may have the right to have the decision reviewed. The types of review to which the individual may be entitled are an administrative review and a judicial review, depending on which program is appealed.

If the individual or individual's authorized representative is dissatisfied with a … then the individual is entitled to an administrative review. then the individual is entitled to a judicial review.
Supplemental Nutrition Assistance Program (SNAP) or Medicaid fair hearing decision, Yes Yes
TANF fair hearing decision, Yes No
SNAP administrative disqualification hearing (ADH) decision, Yes Yes
TANF ADH decision, No Yes

 

B—1071 Administrative Review

Revision 15-4; Effective October 1, 2015

 

All Programs

An administrative review is a review of the hearing record conducted by an agency attorney to determine if the hearing officer's decision was correct. The agency attorney issues a new decision, which includes the hearings officer's signature in all administrative reviews, and this decision is the agency's final action. Administrative reviews apply to SNAP, TANF and Medicaid fair hearing decisions and SNAP ADH decisions.

If the individual or individual's authorized representative is dissatisfied with a fair hearing decision issued on or after September 1, 2007, an administrative review may be requested but must be submitted in writing within 30 calendar days from the date of the hearing officer's decision. The request for an administrative review must be mailed to the following address:

Hearings Administrator
P.O. Box 149030, Mail Code W-613
Austin, TX 78714-9030

Notes:

  • For TANF fair hearings, the individual's request for an administrative review only requires that the agency attorney review the hearing record for procedural and programmatic accuracy. The case is returned to the fair hearing officer for the final decision.
  • An administrative review of the fair hearing or ADH decision by an agency attorney must be requested and completed before a judicial review is allowed. Exception: There is no prerequisite for an administrative review for a TANF ADH before a judicial review is requested.

 

B—1071.1 Centralized Representation Unit (CRU) Staff Responsibilities Following an Administrative Review

Revision 15-4; Effective October 1, 2015

 

All Programs

CRU Staff

When a fair hearing decision is reversed because of an administrative review, the agency must take action on the agency attorney's decision, as described in B-1040, Timely Action on Fair Hearings.

CRU:

  • completes actions as required by the administrative review decision; and
  • notifies the agency attorney and hearing officer that the required action has been completed.

Note: Continued benefits are not provided if the hearing officer sustains the agency action.

CRU Supervisory Staff

The CRU supervisor reviews the actions taken on the reversal and ensures all actions are complete and correct.

 

B—1072 Judicial Reviews

Revision 15-4; Effective October 1, 2015

 

All Programs

A judicial review is a review of the hearing decision by the court to determine whether the decision taken by the agency was correct. ADH decisions must be filed by the individual in a district court in Travis County. The court will determine whether the decision of the agency is correct. The individual must file a petition for a judicial review within 30 calendar days after the date the administrative review decision is rendered. The individual must complete the administrative review process before filing a petition for a judicial review.

An individual dissatisfied with a TANF ADH decision has the right to file for a judicial review in the district court in the county in which the violation occurred no later than the 30th calendar day after the date the hearing officer makes the determination.

Exception: There are no judicial review rights for a TANF fair hearing decision, but the appellant may still request a procedural review of the hearing officer's decision. A procedural review is a review of the hearing record by an agency attorney to ensure procedural and programmatic accuracy.

 

B—1072.1 Agency Staff Responsibilities Following a Judicial Review

Revision 15-4; Effective October 1, 2015

 

All Programs

Local Office and CCC Staff

If the agency's decision is reversed as a result of a judicial review, staff must implement the decision within the time frames as specified within the final orders of the court.

Note: Continued benefits are not provided due to a request for a judicial review.

 

B—1080 Verification Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must verify that the household waived its right to continued benefits according to B-1052, Waiver of Continued Benefits.

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

 

B—1090 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

Advisors must document the reason why the household is not entitled to continued benefits according to B-1051, Continued Benefits.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

B-1100, Reserved for Future Use

B-1200, Confidentiality

Revision 19-3; Effective July 1, 2019

 

 

B—1210 Disclosure of Information

Revision 15-4; Effective October 1, 2015  

 

All Programs

Advisors must disclose information to applicants or individuals who want to review their case records for information used in the eligibility determination. Advisors must withhold confidential information from the case record, such as:

  • names of persons who disclosed information about the household without the household's knowledge, and
  • the nature or status of pending criminal prosecution.

TANF and Medical Programs

Advisors must disclose information about applicants or individuals to federal, state, or local agencies, if the information is directly connected with:

  • administration of a program approved under any of the following titles of the Social Security Act:
    • Title IV-A (Temporary Assistance for Needy Families [TANF]/Choices)
    • Title IV-B (Child Protective Services [CPS])
    • Title IV-D (Child Support)
    • Title IV-E (Foster Care and Adoption Assistance)
    • Title XVI (Supplemental Security Income [SSI])
    • Title XIX (Medicaid)
    • Title XX (Social Services/Child Care)

Disclosure of information is permitted for any case audits, reviews of expenditure reports, financial reviews, investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of these programs.

  • administration of any other federal or federally assisted program that provides assistance directly to individuals on the basis of need.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

Advisors must disclose information about applicants or individuals to Medicaid providers or their contractors that is needed for the providers to submit claims for reimbursement of Medicaid services provided to individuals. See the list of releasable data items in B-1230, Releasable Information for Medicaid Providers and Their Contractors.

SNAP

Advisors must disclose information about applicants or individuals to persons or agencies directly connected to the administration or enforcement of:

  • the Supplemental Nutrition Assistance Program (SNAP);
  • food distribution programs for households on Indian reservations; or
  • other federal assistance programs or federally aided programs that base assistance on an individual's income and resources.

    Such programs include, but are not limited to: Women, Infants, and Children (WIC); TANF; Medicaid; Child Protective Services; and SSI.

Advisors must disclose information about applicants or individuals to employees of the U.S. Comptroller General's Office for audit purposes.

Individuals or the representatives of these agencies may review the individuals' case records in the advisor's office or receive a reply in writing. Information furnished to these agencies must be:

  • factual,
  • sufficiently current to serve its purpose, and
  • limited to the purpose of the disclosure.

In a written reply, the inquiring agency must:

  • agree to keep the information confidential, and
  • use the information only for the purpose stated in its request.

 

B—1211 Reporting Abuse and Neglect

Revision 15-4; Effective October 1, 2015  

 

All Programs

Policies on confidentiality do not prohibit reporting abuse or neglect that threatens the health or welfare of a child or an elderly adult or adult with disabilities. Advisors must report instances of suspected:

  • physical or mental injury,
  • sexual abuse,
  • exploitation, and
  • neglect.

Exception: Advisors are not required to report family violence.

Advisors must inform adults or their personal representative (PR) when reporting abuse or neglect of an adult, unless the advisor believes that informing the individual or PR would place the individual at risk of serious harm.

 

B—1212 Personal Representatives

Revision 15-4; Effective October 1, 2015  

 

All Programs

Only the individual's PR can exercise the individual's rights with respect to individually identifiable health information. Therefore, only an individual's PR may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of an individual. Individually identifiable health information is information that identifies or could be used to identify an individual and that relates to the:

  • past, present, or future physical or mental health or condition of the individual;
  • provision of health care to the individual; or
  • past, present, or future payment for the provision of health care to the individual.

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

 

B—1212.1 Adults and Emancipated Minors

Revision 15-4; Effective October 1, 2015  

 

All Programs

If the individual is an adult or emancipated minor, including married minors, the individual's personal representative is a person who has the authority to make health care decisions about the individual and includes a:

  • person the individual has appointed under a medical power of attorney, a durable power of attorney with the authority to make health care decisions, or a power of attorney with the authority to make health care decisions;
  • court-appointed guardian for the individual; or
  • person designated by law to make health care decisions when the individual is in a hospital or nursing home and is incapacitated or mentally or physically incapable of communication. Advisors follow regional procedures to contact the regional attorney for approval.

 

B—1212.2 Unemancipated Minors

Revision 15-4; Effective October 1, 2015  

 

All Programs

A parent is the personal representative for a minor child except when:

  • the minor child can consent to medical treatment by him or herself. Under these circumstances, do not disclose to a parent information about the medical treatment to which the minor child can consent. A minor child may consent to medical treatment by him or herself when the:
    • minor is on active duty with the US military;
    • minor is age 16 or older, lives separately from the parents and manages his own financial affairs;
    • consent involves diagnosis and treatment of disease that must be reported to the local health officer or the Texas Department of State Health Services;
    • minor is unmarried and pregnant and the treatment (other than abortion) relates to the pregnancy;
    • minor is age 16 or older and the consent involves examination and treatment for drug or chemical addiction, dependency or use at a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • consent involves examination and treatment for drug or chemical addiction, dependency or use by a physician or counselor at a location other than a treatment facility licensed by the Texas Council on Alcohol and Drug Abuse;
    • minor is unmarried, is the parent of a child, has actual custody of the child and consents to treatment for the child; or
    • consent involves suicide prevention or sexual, physical or emotional abuse.
  • a court is making health care decisions for the minor child or has given the authority to make health care decisions for the minor child to an adult other than a parent or to the minor child. Under these circumstances, the advisor must not disclose to a parent information about the health care decisions not made by the parent.

 

B—1212.3 Deceased Individuals

Revision 15-4; Effective October 1, 2015  

 

All Programs

The PR for a deceased individual is an executor, administrator, or other person with authority to act on behalf of the individual or the individual's estate. These individuals include:

  • an executor, including an independent executor;
  • an administrator, including a temporary administrator;
  • a surviving spouse;
  • a child;
  • a parent; and
  • an heir.

Advisors may consult the regional attorney with questions about whether a particular person is the PR of an applicant or individual.

 

B—1213 Establishing Identity for Contact Outside the Interview Process

Revision 15-4; Effective October 1, 2015  

 

All Programs

All information the Texas Health and Human Services Commission (HHSC) has about an individual or any person on the individual's case must be kept confidential. Confidential information includes, but is not limited to, individually identifiable health information.

Before discussing or releasing information about an individual or any person on the individual's case, steps must be taken to reasonably ensure that the person receiving the confidential information is either the individual or a person the individual authorized to receive confidential information (such as an attorney or personal representative).

Related Policy
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.1 Telephone Contact

Revision 15-4; Effective October 1, 2015  

 

All Programs

Advisors must establish a person's identity when contacting the individual, AR or PR by telephone. Refer to A-2020, Authenticating a Caller, for identity authentication policy.

Advisors must establish the identity of attorneys or legal representatives by asking the individual to provide Form H1826, Case Information Release, completed and signed by the individual. Advisors refer to B-1220, Specific Information That May Be Released, for authorization requirements.

Establish the identity of legislators or their staff by following regional procedures.

Related Policy
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

 

B—1213.2 In-Person Contact

Revision 15-4; Effective October 1, 2015  

 

All Programs

Advisors must establish the identity of a person who presents himself as an individual or individual's representative at a local eligibility determination office by:

  • driver's license,
  • date of birth,
  • Social Security number (SSN), or
  • other identifying information.

Advisors must establish the identity of other staff, federal agency staff, researchers, or contractors by:

  • employee badge, or
  • government-issued identification card with a photograph.

Advisors must identify the need for other staff, federal staff, research staff, or contractors to access confidential information through:

  • official correspondence or phone call from state or regional offices, or
  • contact with a regional attorney.

Advisors must contact appropriate regional or state office staff when federal agency staff, contractors, researchers, or other staff, etc., come to the office without prior notification or adequate identification and request permission to access HHSC records.

 

B—1220 Specific Information That May Be Released

Revision 15-4; Effective October 1, 2015  

 

All Programs

Advisors must give individual addresses or other case information only to a person who has written permission from the individual to obtain the information. The individual authorizes the release of information by completing and signing:

  • Form H1826, Case Information Release; or
  • a document containing all of the following information:
    • the applicant/individual's full name (including middle initial) and case number, or full name (including middle initial) and either the date of birth or Social Security number;
    • a description of the information to be released;

      Note: If a general release is authorized, the advisor must provide the information that can be disclosed to the individual described in B-1210, Disclosure of Information, under All Programs.

    • statement specifically authorizing HHSC to release the information;
    • the name of the person or agency to whom the information will be released;
    • purpose of the release;
    • an expiration event that is related to the individual, the purpose of the release, or an expiration date of the release;
    • statement about whether refusal to sign the release affects eligibility for or delivery of services;
    • a statement describing the applicant's or individual's right to revoke the authorization to release information;
    • the date the document is signed; and
    • the signature of the applicant or individual.

      If the case information being released includes individually identifiable health information, the document must also inform the applicant or individual that the information released under the document may no longer be private and may be further released by the person receiving the information.

Note: Advisors must not include Form H1826 or other information release authorization documents in application packets.

Advisors must give information to government agencies conducting case audits, reviewing expenditure reports, or conducting financial reviews.

Advisors must give an applicant or individual's most recent address and place of employment to Parent Locator services in state or local offices.

Advisors must refer all requests from federal, state, or local law enforcement officials for case information to the local investigation division office.

Reasonable efforts must be made to limit the use, request, or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program.

The disclosure of individual medical information from agency records must be limited to the minimum necessary to accomplish the requested disclosure. For example, if an individual authorizes release of income verification, including disability income, related case medical information must not be released unless specifically authorized by the individual.

TANF and Medical Programs

Advisors must release identifying information (such as the name and address of the individual's friends and relatives) to funeral homes, police, or agencies attempting to locate friends or relatives of deceased individuals.

Advisors reply to inquiries and complaints concerning the status of an individual's case from public officials or interested citizens who are acting as an agent for and have the consent of the individual. The case status includes whether an application was filed, action taken by HHSC and the reason for the agency's action.

Advisors provide only the specific information stated in a summons on an Internal Revenue Service (IRS) Form 2039 to the IRS representative.

Advisors provide only the following information to the Armed Forces:

  • whether an individual is receiving TANF, and
  • the amount of the TANF grant.

Advisors provide only the information in B-1230, Releasable Information for Medicaid Providers and Their Contractors, to Medicaid providers and their contractors. Note: Advisors must verify the contract with the Medicaid provider by obtaining:

  • the contract with the provider, or
  • a written document from the provider confirming the contract.

SNAP

Advisors release the names and addresses of participating individuals to persons or agencies directly connected with nutrition education.

 

B—1230 Releasable Information for Medicaid Providers and Their Contractors

Revision 19-3; Effective July 1, 2019

 

All Programs

Applicant Data
  • Name
  • SSN*
  • Social Security Claim Number (SSCN or PCN)*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Category Code
  • Application Number
  • Application Disposition Date
  • Application Status
  • Client Number
Client Data
  • Name
  • Client Number
  • SSN*
  • SSCN*
  • Date of Birth
  • Sex
  • HHSC County Code
  • Certification Date
  • Claims Administrator Update Date (Ins Sub Date)
  • Last Medical Update Date
  • Code for Type Change in Medical Coverage
  • Medicaid:
    • Open Date
    • Close Date
    • Type Coverage
    • Category
    • Type Program
    • Qualified Medicare Beneficiary (QMB) Indicator, if applicable
    • Medically Needy Indicator, if applicable
    • Client Medical Record
    • Case Numbers (active)
  • Third-Party Resource (TPR) Policy Occurs (most recent three):
    • Ins. Policy Number
    • Ins. Policy Sequence
    • Ins. Information Status
    • Type Coverage
    • Company Number
    • Group Number
    • Ins. Begin Date
    • Ins. End Date
    • Ins. Policy Holder
    • Ins. Employer
  • Medicare (Yes or No)
  • Texas Health Steps Data:
    • Texas Health Steps Decision Date
    • Dental Treatment Date
    • Medical Screen Date
  • Lock-in Data (most recent six):
    • Provider Type
    • Provider Name
    • Start Date
    • Through Date
Public Assistance (PA) Case Data
  • Case Number
  • Eligibility Determination Group (EDG) Number
  • Case Name
  • Case Status
  • Three Month Prior Date
  • End Date (For Medically Needy)
  • Denial Reasons **
  • Type Program
  • Active Clients List:
    • Client Number
    • Name
    • Date of Birth
    • Sex
  • Three Months Prior with Spend Down (not the spend down amount)

 

* Staff must confirm that the number given by the requestor is correct. Staff do not release Social Security numbers.

** Only the following denial reasons can be released:

Reason
Refusal to furnish information
Failure to furnish information
Appointment not kept (application/review)
Unable to locate
Voluntary withdrawal

 

B—1240 Preventing Disclosure of Information

Revision 15-4; Effective October 1, 2015  

 

All Programs

If the advisor receives a request for information which cannot be released, the advisor must inform the person requesting the information about the confidentiality of case records based on federal and state laws.

If the advisor receives a subpoena to appear in court with an individual's record, the advisor must notify the supervisor about the hearing. The advisor must take the case record and appear in court. When asked to disclose information from the case record, the advisor must ask the judge to be excused from disclosing information because of the laws concerning confidentiality. The advisor must abide by the judge's ruling.

See Part I, Section 3000, Health Insurance Portability and Accountability (HIPPA), in the Texas Department of Aging and Disability Services Operational Handbook for more information on disclosure of information laws.

 

B—1241 Destruction of Confidential Material

Revision 07-3; Effective July 1, 2007  

 

Confidential material that includes identifying information such as name, address or Social Security number must be disposed of according to local office procedures.

 

B—1250 Reporting Unauthorized Inspection or Disclosure of Social Security Administration (SSA)-Provided Information

Revision 14-4; Effective October 1, 2014  

 

All Programs

Staff who become aware of an incident of unauthorized access to or disclosure of restricted information (i.e., IRS Federal Tax Information and verified SSA information) or confidential information must immediately contact the HHSC IRS coordinator by sending a secure email to HHSC IRS_FTI_Safeguards@hhsc.state.tx.us.

The HHSC IRS coordinator will report the incident by contacting the information security officer (ISO).

If a person is responsible for a security breach or a person’s employment is terminated, the user's access to all information must be removed. Supervisors must follow agency procedures for removing access for employees, contractors, vendors or trainees.

Related Policy
Reporting a Security Incident Regarding Internal Revenue Service (IRS) Federal Tax Information (FTI), C-1060

 

B—1260 Verification Requirements

Revision 15-4; Effective October 1, 2015  

 

All Programs

Advisors must verify the identity of the person who contacts the advisor with a request to disclose individually identifiable health information, using sources found in A-621, Verification Sources. In addition, Form H1826, Case Information Release, presented by a legal representative or with an employee badge, may be used to identify the person.

 

B—1270 Documentation Requirements

Revision 15-4; Effective October 1, 2015  

 

All Programs

If disclosing individually identifiable health information, the advisor must document how the identity of the person was verified when contact occurs outside of the interview.

Advisors must document:

  • the name of the personal representative (see B-1212, Personal Representatives);
  • the reason why a parent is not considered a PR for an unemancipated minor (see B-1212.2, Unemancipated Minors);
  • that the inquiring agency will agree to keep information confidential; and
  • that the information is limited to the purpose of the disclosure.

Related Policy
Documentation, C-940
The Texas Works Documentation Guide

B-1300, Nondiscrimination

Revision 15-4; Effective October 1, 2015

 

 

B—1310 Nondiscrimination Policy

Revision 15-4; Effective October 1, 2015
 

All Programs

The Texas Health and Human Services Commission (HHSC) does not discriminate against any applicant or participant in any aspect of program administration. All eligible households receive benefits without regard to age, race, color, sex, disability, religious creed, national origin, or political beliefs.

HHSC must:

  • inform the public of this nondiscrimination policy and the applicable complaint procedures, and
  • provide access to nondiscrimination information within 10 days of a request.

Individuals should be referred to the Civil Rights Office toll-free at 1-888-388-6332. Staff can email the individual’s request to HHSCivilRightsOffice@hhsc.state.tx.us.

SNAP

Each certification office must display the nondiscrimination poster provided by the United States Department of Agriculture (USDA).

 

B—1320 Racial and Ethnic Data Collection

Revision 15-4; Effective October 1, 2015
 

All Programs

HHSC obtains racial and ethnic information about all individuals. The racial or ethnic categories are: American Indian or Alaskan Native, Asian or Pacific Islander, black (not of Hispanic origin), Hispanic, and white (not of Hispanic origin). Individuals are requested to voluntarily identify their race or ethnicity on the applications for HHSC assistance. If this information is not voluntarily provided on the application form, the advisor must determine the category by asking an individual to self-identify the individual’s race. The individual’s racial identity is self-declared. If the individual does not want to provide the information, the individual’s race is listed as “unknown.” In the Individual Household logical unit of work (LUW) on the individual’s Add New Individual Information, Edit Existing Individual ID Information or Edit New Individual Information page, the advisor must select the appropriate ethnicity and race from the drop-down menus.

B-1400, Complaints

Revision 19-2; Effective April 1, 2019

 

 

B—1410 Discrimination Complaints

Revision 15-4; Effective October 1, 2015

 

All Programs

Texas Health and Human Services (HHS) Circular C-001 found at www.hhsc.state.tx.us/news/circulars/c-001.shtml describes general discrimination complaint procedures.

SNAP

Explain the following procedures to individuals who feel they have been discriminated against in the Supplemental Nutrition Assistance Program (SNAP) and want to complain about it.

  • Individuals may submit their complaint to the United States Department of Agriculture (USDA), any Texas Health and Human Services Commission (HHSC) certification office, or both. Individuals may submit complaints to, or obtain information from, USDA at either of these addresses:

    Food and Nutrition Service
    United States Department of Agriculture
    Washington, D.C. 20250

    or

    Food and Nutrition Service
    United States Department of Agriculture
    1100 Commerce Street
    Suite 5-C-30
    Dallas, TX 75242

  • Individuals must file their complaints in writing within 180 days of the incident that caused the complaint.

If submitting a complaint to HHSC, individuals use Form H4870, Client Complaint of Discrimination. For verbal or hotline complaints, staff accepting the complaint complete Form H4870 for the individual. Advisors and other staff handle hotline complaints the same as any other complaints.

 

B—1420 Office of the Ombudsman

Revision 19-2; Effective April 1, 2019

 

All Programs

Office of the Ombudsman operates a toll-free customer service hotline during normal office hours. The Office of the Ombudsman assists the public with issues or complaints about health and human services programs that have not been resolved under the agency's normal resolution process. If a person has a problem or complaint, they are encouraged to first discuss it with the person, program staff or office staff involved. They can often explain a specific policy or resolve the concern immediately.

People who need assistance or information about local resources or programs are encouraged to call 2-1-1 for access to information about health and human services in their community, including information on the location and phone number of local HHSC offices.

If a person has problems with or complaints about a health and human services program, service, or benefit that has not been resolved to their satisfaction, the person has four ways to send a question or file a complaint:

  1. Call: Toll-free phone, relating to:
    1. A consumer, call 877-787-8999 (8 a.m. to 5 p.m., Central Standard Time, Monday through Friday).
    2. A consumer needing help with accessing services under a managed care plan, call 866-566-8989.
    3. A foster youth, call 844-286-0769.
    4. A consumer seeking behavioral health services, call 800-252-8154.
    5. A resident of a nursing facility or an assisted living facility, call 800-252-2412.
    6. A person who has a hearing or speech disability, call 7-1-1 or 800-735-2989.
  2. Online: hhs.texas.gov/ombudsman
  3. Fax: 888-780-8099 (toll-free)
  4. Mail: Texas Health and Human Services Commission
    Office of the Ombudsman, MC H-700
    P.O. Box 13247
    Austin, Texas 78711-3247

Ombudsman staff:

  • provide dispute resolution services;
  • perform consumer protection and advocacy functions;
  • collect consumer contact data;
  • conduct reviews of complaints concerning HHSC policy or practices;
  • ensure case actions related to complaints are consistent with applicable HHS policies;
  • provide information to people about their rights and responsibilities;
  • coordinate the resolution of complaints or requests for information with appropriate agency staff;
  • refer people who request other state health and human services to the appropriate area;
  • screen, document and track all complaints and inquiries received using the HHS Enterprise Administrative Report and Tracking System (HEART);
  • compile and share various weekly, monthly and quarterly reports with designated executive, state and regional staff, providing complaint and inquiry volume and trend analysis.

Note: Ombudsman staff cannot determine eligibility or make changes to cases.

Medicaid Managed Care Helpline

The Medicaid Managed Care Helpline is designed to help people who receive Medicaid and need help accessing health care services. The HHSC Medicaid Managed Care Helpline helps people who receive Medicaid benefits:

  • navigate the managed care system (STAR, STAR+PLUS, STAR Kids and STAR Health);
  • understand their Medicaid coverage;
  • understand their rights;
  • advocate for themselves; and
  • resolve problems, including access to care.

The Medicaid Managed Care Helpline also provides general information about managed care programs to providers, health plans, community based organizations and other stakeholders. People may contact the Medicaid Managed Care Helpline at 866-566-8989.

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