Revision 18-3; Effective July 1, 2018

 

A—1510 General Reminders

Revision 15-4; Effective October 1, 2015

 

All Programs

Before certifying applicants and recertifying recipients, staff must:

  • Ensure that the applicant completes each item and signs and dates the application or renewal form.

    Note: If the applicant indicates changes during application or renewal processing or the interview, document the nature of the change and when the individual expects the change to occur. Individuals on TP 08, TP 43, TP 44 and TP 48 complete the administrative renewal process explained in B-122.4, Medical Program Administrative Renewals, and may not be required to provide a signed renewal form.
  • Give the applicant Form H1019, Report of Change. Explain that the applicant must report changes within 10 days after the household knows about the change. Indicate the appropriate reporting requirement on page 1.
  • Refer the applicant to other programs the applicant might be eligible for, such as family planning; Supplemental Security Income (SSI); Women, Infants and Children (WIC); and Social Security. Refer individuals who are elderly or have disabilities and who are ineligible for Medical Programs for families and children to the Texas Health and Human Services Commission (HHSC) Medicaid for the Elderly and People with Disabilities (MEPD) programs. Note: If individuals indicate they need services that Texas Works does not provide and the advisor does not have a resource number, the individual should be advised to call 2-1-1 for information and referral services.
  • Inform the applicant of the right to appeal any HHSC action that affects the applicant’s eligibility or amount of benefits.
  • Check for unpaid overpayments from prior certifications.
  • Inform applicants that the information they provide is subject to verification by third parties.

TANF

Staff must:

Explain federal and state time limits on Temporary Assistance for Needy Families (TANF) benefits. Inform the individual that a Choices noncompliance penalty makes the individual ineligible for a TANF state time limit hardship exemption during the individual's five-year freeze-out period. Explain that members need to be employed or apply for other possible sources of income. Encourage individual independence.

Explain the requirement to seek other income for which the individual is potentially eligible, as explained in A-1311.1, Requirement to Pursue SSI/RSDI, and A-1311.1.1, SSI/RSDI Application Assistance. Provide Form H1859, Social Security Administration Benefits for People with Disabilities Receiving TANF, and explain that the individual must apply for and provide verification by the next TANF redetermination.

Explain the option to receive One-Time TANF (OTTANF) instead of TANF. Offer this option to households eligible for TANF but not currently receiving TANF. See A-2400, One Time Payments.

Inform the household of the one-time grandparent payment if the household is potentially eligible. See A-2400.

Inform individuals with a Choices noncooperation who reapply for TANF while in pay for performance to contact the local workforce solutions office within 10 days to allow sufficient time to demonstrate 30 days of cooperation before the 40th day after the interview date. See A-2151, Open Penalty at Reapplication in Pay for Performance.

SNAP

Staff must:

Explain the Supplemental Nutrition Assistance Program (SNAP) time limits to individuals subject to these time limits.

Give Form H1805, SNAP Food Benefits: Your Rights and Program Rules, to all households at application and redetermination. Respond to any questions the applicant has about the form.

Give Form H1019, Report of Change, to all streamlined reporting households. Explain that these households are only required to report changes in residence and when their ongoing gross income exceeds 130 percent of the Federal Poverty Income Limit (FPIL) for the household size. Explain that changes must be reported within 10 days after the household knows of the change. Explain that these households must respond to all notices and letters from the employment program as directed, even if they are employed. Indicate the appropriate reporting requirement on page 1.

TP 43, TP 44 and TP 48

Staff must:

  • Mail Form H0025, HHSC Application for Voter Registration, with the initial eligibility notice to a newly certified family. Note: Also mail Form H0025 at subsequent redeterminations.
  • Inform the family that when HHSC processes an application and determines the child is ineligible for Medicaid but eligible for the Children’s Health Insurance Program (CHIP), the family is notified on Form TF0001, Notice of Case Action. Form TF0001 also informs the household that the CHIP enrollment packet will be sent to the household.
  • Inform new caretakers about the requirement to participate in a health care orientation. Include Form TF0001. This one-time requirement applies only to caretakers who have not been included as a certified or budget group member of a Medical Programs Eligibility Determination Group (EDG) within the past two years.
  • Inform caretakers of Medicaid children under age 19 of the requirement to comply with the regimen of care prescribed by the Texas Health Steps program. The requirement applies to children starting at age 2. Begin checking for compliance with the first redetermination after the caretaker is informed of the requirement.

Related Policy
Registering to Vote, A-1521

 

A—1520 Special Reminders

Revision 11-1; Effective January 1, 2011

 

 

A—1521 Registering to Vote

Revision 15-4; Effective October 1, 2015

 

All Programs

HHSC must offer individuals an opportunity to register to vote at application, redetermination and any time the individual has a change of address. The individual is provided with Form H0025, HHSC Application for Voter Registration, with each application/redetermination packet, if not already provided. Additionally, the individual will be provided with Form H0025 whenever the individual reports a change of address. System-generated application and redetermination packets contain Form H0025.

If the individual declines the opportunity to register to vote, the individual is given Form H1350, Opportunity to Register to Vote, to sign and decline to register to vote. Advisors should indicate in the Texas Integrated Eligibility Redesign System (TIERS), Voter Registration Information section of the Individual Demographics page, that the individual declined and document that Form H1350 was mailed to the individual. When the individual returns Form H1350, advisors are to send the form for imaging. The imaged, signed form must be retained for at least 22 months. The individual is not required to sign Form H1350 if the individual has signed the form within the last 22 months.

 

A—1521.1 Who Cannot Register to Vote

Revision 15-4; Effective October 1, 2015

 

All Programs

To register to vote, a person must be:

  • a U.S. citizen; and
  • at least age 17 years and 10 months.

Staff should not offer a voter registration application to an applicant or recipient if the individual states or the advisor has proof that the individual does not meet these two requirements.

 

A—1521.2 Staff Requirements for Voter Registration

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff must tell the individual the following:

  • HHSC will offer the same help and services when aiding the individual with voter registration activities as when aiding the individual with agency forms, whether HHSC provides the service in the office, outside of the office or at the individual's home.
  • The decision to register or to decline to register to vote does not affect eligibility or benefit amount, and HHSC will keep all voter registration information confidential and only use it for voter registration purposes.
  • The individual may decide whether or not to seek help from staff to fill out the voter registration application form, or the individual may fill out the application form in private.
  • The individual may return the completed application form to:
    • the Secretary of State (SOS), by mail using the postage-paid, self-addressed application form;
    • the local voter registrar, by mail or in person; or
    • the advisor.
  • The individual may ask additional voter registration questions or file a voter registration complaint by contacting the Elections Division of the Secretary of State, P.O. Box 12060, Austin, TX 78711, 1-800-252-8683.

Staff must not:

  • influence an individual's political preference or party registration;
  • display any political preference or party affiliation;
  • make any statement to discourage the individual from registering to vote;
  • make any statement to an individual or take any action for the purpose or effect to make the individual believe that a decision to register or not to register has any bearing on the availability of services or benefits; or
  • pend the EDG or delay or deny benefits if the individual fails or refuses to complete the voter registration information on any form, or fails to return Form H0025, HHSC Application for Voter Registration, or Form H1350, Opportunity to Register to Vote.

Austin Imaging Center Staff

If the individual inadvertently sends Form H0025 to the Austin processing center with other documents, Austin staff will forward Form H0025 to the correct local voter registrar within five days of receipt.

 

A—1521.3 Voter Registration During Interviews

Revision 15-4; Effective October 1, 2015

 

All Programs

The following chart should be used by staff in addressing voter registration during the interview:

If … then …
the individual responds, "I do not wish to register," determine the reason why the individual doesn't wish to register. Ask the individual to sign Form H1350, Opportunity to Register to Vote, attesting that the individual does not wish to register to vote. Sign and mark the appropriate box in the Agency Use Only: Voter Registration Status section of Form H1350 documenting the reason the individual declined to register. Send the form for imaging.

When completing a telephone interview, mail Form H1350 to the individual. Indicate in TIERS, Voter Registration Information section of the Individual Demographics page, that the individual declined and document that Form H1350 was mailed to the individual.

When the individual refuses to sign Form H1350, mark the Client Declined box in the Agency Use Only: Voter Registration Status section of Form H1350. Send the form for imaging.

the individual is not a U.S. citizen and at least age 17 years and 10 months, TIERS will automatically mark that the individual does not meet citizenship and/or age requirements in the Valid Reason, Voter Registration Information section of the Individual Demographics screen.
the individual answered Yes to the question on the application, redetermination or change report form, "Do you wish to register to vote?" and meets citizenship and age requirements, provide the individual with Form H0025, HHSC Application for Voter Registration, to complete to register to vote. Advise the individual that the completed form can be returned directly to SOS, the local voter registrar or the local office. The local office liaison forwards to the local voter registrar. TIERS automatically sends the individual Form H0025 if the worker answers Yes to the question, “Send Voter Registration Application?” in the Voter Registration Information section of the Individual Demographics screen.

Enter the actions taken to provide the individual with the opportunity to register to vote by answering the questions in the Valid Reason, Voter Registration Information section of the Individual Demographics screen.

When interviewing an authorized representative (AR) or representative payee, ask the AR or representative payee to give the form to the individual. Enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, Client to Mail.

the individual completes and returns Form H0025 before leaving the office, review the form for completeness. Return the form to the individual for any corrections, if necessary. When the individual has fully completed Form H0025, forward the form to the local office liaison. The local office liaison will review the form for completeness and send to the local voter registrar within five days.

Enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, the actions taken to provide the individual with the opportunity to register to vote.

 

A—1521.4 Voter Registration During Non-Interviews

Revision 15-4; Effective October 1, 2015

 

All Programs

The following chart should be used by staff in addressing voter registration during non-interviews:

If … then …
the individual "does not wish to register" on the application/redetermination or change report form, mail the individual a return envelope and Form H1350, Opportunity to Register to Vote, to sign attesting that the individual declined to register to vote. Enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen. If the individual returns Form H1350, sign and mark the Client Declined box in the Agency Use Only: Voter Registration Status section of Form H1350. Send the form for imaging.
the individual is not a U.S. citizen and at least age 17 years and 10 months, TIERS automatically marks that the individual does not meet citizenship and/or age requirements in the Valid Reason, Voter Registration Information section of the Individual Demographics screen.
the individual answered Yes to the question on the application/redetermination form, "Do you wish to register to vote?",
  • if the individual did not return Form H0025, HHSC Application for Voter Registration, enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, the actions taken to provide the individual with the opportunity to register to vote.
  • when the individual returns Form H0025 to the local office, review the form for completeness. Return the form to the individual for any corrections, if necessary. Enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, the actions taken to provide the individual with the opportunity to register to vote. Forward the fully completed Form H0025 to the local office liaison. The local office liaison reviews the form for completeness and sends to the local voter registrar within five days.
the individual answered Yes to the question, "Do you wish to register to vote?" on the change report form, Enter Yes to the question, "Send Voter Registration Application?" in the Voter Registration Information section of the Individual Demographics screen. TIERS automatically sends the individual Form H0025. This documents the actions taken to provide the individual with the opportunity to register to vote.

 

A—1521.5 Local Office Liaison Duties

Revision 15-4; Effective October 1, 2015

 

All Programs

The local office liaison must:

  • Maintain in stock, the office supply of Form H0025, HHSC Application for Voter Registration, and Form H1350, Opportunity to Register to Vote.
  • Maintain the local voter registrar list to provide the name and address of the local voter registrar to staff and individuals. See www.sos.state.tx.us/elections/voter/county.shtml for information regarding the local voter registrar.
  • Review Form H0025 for completeness.
  • Send completed Form H0025 to the designated local voter registrar within five days of receipt.

 

A—1521.6 Documentation

Revision 15-4; Effective October 1, 2015

 

All Programs

All actions taken to provide the individual with an opportunity to register to vote must be documented at application, redetermination, and change of physical address in TIERS in the Voter Registration Information section of the Individual Demographics — Citizen page.

 

A—1522 Personal Responsibility Agreement

Revision 15-4; Effective October 1, 2015

 

TANF

Staff must inform TANF caretakers and second parents that they must:

  • participate in the Choices programs unless exempt;
  • cooperate with child support requirements;
  • not voluntarily quit a job;
  • have their child(ren) screened through the Texas Health Steps (THSteps) program;
  • have their child(ren) immunized;
  • have their child(ren) attend school;
  • attend parent skills training, if referred; and
  • not abuse drugs or alcohol.

Staff must inform TANF payees/disqualified adults that they must:

  • cooperate with child support requirements;
  • have their child(ren) screened through the THSteps program;
  • have their child(ren) immunized;
  • have their child(ren) attend school; and
  • not abuse drugs or alcohol.

 

A—1523 Child Support Responsibilities

Revision 15-4; Effective October 1, 2015

 

TANF and TP 08

Staff must ensure that applicants read and understand the information on Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause, and that the applicant understands that signing an application for TANF or TP 08 constitutes the assignment of rights to child and medical support.

 

A—1524 Earned Income Deduction

Revision 15-4; Effective October 1, 2015

 

TANF

Staff must inform the applicant that if the individual goes to work and reports the job in a timely manner, the individual may be eligible for extra deductions.

 

A—1525 Voluntary Quit

Revision 15-4; Effective October 1, 2015

 

SNAP

Staff must explain the voluntary quit policies in A-1850, Voluntary Quit, to applicants and individuals, including:

  • primary wage earner determination;
  • how to establish good cause; and
  • reapplication after voluntary quit.

 

A—1526 Family Violence

Revision 15-4; Effective October 1, 2015

 

TANF and TP 08

Staff must explain to applicants and recipients that if family violence or the potential for family violence exists, HHSC may grant an exemption from the requirement to cooperate with child support, and Choices staff may grant good cause for noncompliance with Choices participation for TANF.

Related Policy
Explanation of Good Cause, A-1130
Determining Good Cause, A-1860

 

A—1527 The Texas Works Message

Revision 15-4; Effective October 1, 2015

 

TANF

During the redetermination process, staff deliver the Texas Works message to TANF recipients explaining that:

  • TANF is temporary and has time limits;
  • there are alternatives and options for the recipient instead of TANF benefits;
  • a TANF recipient should consider jobs and other resources such as child support rather than continuing TANF;
  • if a TANF recipient chooses to continue receiving assistance, the recipient is requesting help finding a job; and
  • if a TANF recipient chooses not to continue receiving assistance, the recipient may still qualify for medical assistance and SNAP to support employment while working toward self-sufficiency.

Judgment must be used when deciding which messages are appropriate for a particular recipient.

 

A—1528 Handbooks

Revision 13-2; Effective April 1. 2013

 

 

 

A—1528.1 Availability of Handbooks for Client Review

Revision 13-2; Effective April 1, 2013

All Programs

A Texas Works Handbook is available for review upon request. Individuals may view an electronic version of the handbook. All sections of the handbook must be easily accessible to the individual.

 

A—1529 Interactive Voice Response (IVR) System

Revision 13-2; Effective April 1, 2013

All Programs

Eligibility staff must review and understand information currently available to individuals through 2-1-1 and encourage individuals to use the self-service options. Encouraging individuals to use the self-service options will help reduce workload in local offices. Individuals can get answers to basic questions 24 hours a day, seven days a week through the automated phone system, the IVR.

Additional information can be accessed by visiting the Texas Health and Human Services Commission, "How to Get Help" website at hhs.texas.gov/services/safety/2-1-1-disaster-assistance.

The 2-1-1 Texas Finding Help In Texas job aid describes how an individual accesses various types of information via the 2-1-1 IVR System.

 

A—1530 Medical and Dental Benefits

Revision 07-1; Effective January 1, 2007

 

 

 

A—1531 Texas Health Steps (THSteps)

Revision 15-4; Effective October 1, 2015

 

TP 43, TP 44, TP 45 and TP 48

The Early and Periodic Screening Diagnosis and Treatment (EPSDT) program is a federally mandated health care program of prevention, diagnosis, and treatment for Medicaid individuals under age 21. In Texas, EPSDT is known as THSteps. Through THSteps, individuals receive regularly scheduled medical and dental checkups. The THSteps program:

  • facilitates early detection and treatment of medical and dental problems;
  • provides health supervision for infants; and
  • enables individuals to establish links with primary health care providers who can meet future needs for care.

THSteps' mission is to:

  • expand individual awareness of existing health services offered by the program;
  • stimulate individual use of preventive services; and
  • make comprehensive services available through private and public providers so that infants, children and adolescents in the THSteps individual population can receive medical and dental care before health problems become chronic and irreversible damage occurs.

THSteps services include the following:

Medical Screens — The THSteps medical checkup is a thorough health screening that includes:

  • a comprehensive medical history (including physical and mental health and development);
  • a complete physical examination;
  • screening of nutritional, developmental and mental-health status;
  • laboratory tests (including lead screening);
  • routine immunizations;
  • health education;
  • Tuberculosis screening;
  • dental screening and referral to a dentist;
  • vision screening;
  • hearing screening; and
  • referrals to other health care providers as needed.

THSteps offers checkups according to a recommended schedule. The frequency varies according to the stages of growth. In addition to an inpatient newborn screening, THSteps individuals can get 25 outpatient checkups. The recommended schedule for periodic medical checkups is:

  • birth to 35 months — 11 health checkups to ensure:
    • proper growth and development; and
    • immunizations are administered according to the Advisory Committee on Childhood Immunization Practices (ACIP) recommended schedule;
  • 3 through 5 years — three health checkups (once a year);
  • 6 through 10 years — five health checkups (once a year); and
  • 11 through 20 years — 10 health checkups (once a year).

Dental Services — THSteps provides comprehensive dental care, including emergency, preventive, therapeutic, and orthodontic services. THSteps individuals are eligible to receive routine dental checkups every six months starting at six months of age. Emergency or medically necessary dental services are available to THSteps individuals at any time from birth through age 20.

Vision Services — Each THSteps health checkup includes:

  • a vision screen;
  • diagnosis and treatment, including eyeglasses every two years for defects in vision; and
  • one eye examination per state fiscal year (September through August).

Lost or destroyed eyeglasses are replaced with no limit on the number of replacements. The individual may receive additional services that are medically necessary because of a vision change.

Hearing Services — Each THSteps medical checkup includes a hearing screen. Additional testing for hearing problems, as well as diagnosis, treatment and hearing aids, is available through the Medicaid Program.

Case Management for Children and Pregnant Women (CPW) — In order to encourage the use of cost-effective health and health-related care, CPW provides services to children with a health condition/risk from birth through age 20 and to high-risk pregnant women of all ages. Together, the case manager and family assess the medical, social and educational needs of the eligible recipient.

THSteps Comprehensive Care Program (CCP) — This program provides expanded benefits to THSteps individuals. Under CCP, individuals under age 21 are eligible for any medically necessary and appropriate health care service covered by Medicaid. Limitations of the current Texas Medicaid Program do not apply to these individuals. Expanded benefits include durable medical equipment and supplies, prosthetics, orthotics, private-duty nursing and therapeutic services.

 

A—1531.1 Accessibility of THSteps Services

Revision 13-2; Effective April 1, 2013

Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56)

Texas Department of State Health Services (DSHS), its contractors and local Texas Works staff provide initial and periodic outreach and information to help individuals access services and assist them with appointment scheduling and transportation. Volunteers in Service to America (VISTA) also provide local outreach through the Texas VISTA Health Corps. Written information includes checkup reminders according to the THSteps periodicity schedule.

The Medical Transportation Program (MTP) provides non-ambulance transportation to a Medicaid-allowable medical or dental service for Medicaid-eligible individuals and necessary attendants when they have no other means of transportation. An HHSC contractor or an individual contractor of the individual's choice, such as a parent, friend, neighbor or volunteer may provide transportation. An individual contractor:

  • must have a written agreement with the MTP before providing the service; and
  • will be reimbursed for mileage to an authorized facility at the state rate.

MTP approves cost-effective meals and lodging and up-front funds if it is medically necessary for an individual under age 21 and the individual's attendant to be away from home overnight.

Households may contact MTP by calling toll-free 1-877-633-8747.

Complete Form H1093, THSteps Extra Effort Referral, if a household requests help accessing MTP services.

More information on MTP and a list of frequently asked questions is at hhs.texas.gov/services/questions-about-your-benefits/getting-a-ride-frequently-asked-questions.

 

A—1531.2 THSteps Service Providers

Revision 15-4; Effective October 1, 2015

 

Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56)

The Medicaid/THSteps service-delivery system includes both public and private providers. Physicians, dentists, advance practice nurses, physician assistants, home-health agencies, clinics, hospitals, Federally Qualified Health Centers (FQHCs) and others offer THSteps services to eligible individuals. Providers must enroll as THSteps providers and be enrolled with the claims administrator, HHSC's health-insuring agent.

 

A—1531.3 Program Administration

Revision 16-1; Effective January 1, 2016

 

Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56)

To comply with the Frew v. Traylor lawsuit requirements, Texas Works advisors play a role in educating individuals about the THSteps program. Within the THSteps program, "outreach/informing" is a term applied to efforts, strategies, plans, events, organized activities, and courses of action taken to advertise, educate or increase the number of THSteps checkups.

 

A—1531.4 Explanation of Benefits

Revision 18-1; Effective January 1, 2018

 

Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56)

THSteps Outreach and Informing staff provide the following materials to HHSC to help Texas Works staff effectively inform individuals:

  • A desk reference containing key THSteps information to inform individuals about the program. The desk reference has toll-free numbers, call center hours and website addresses for THSteps and the Medicaid Transportation Program. The desk reference contains information that is consistent with the current THSteps periodicity schedule.
  • The THSteps brochure, "Don't Miss a Beat," presents key information about the THSteps program and is easy to understand.
  • The Appointment Education Brochure, known as "Good Health Takes More Than an Apple a Day," provides helpful tips to make the visit to the doctor or dentist a positive experience.
  • A current THSteps wallet card to give to every Medicaid-eligible household with a child under age 21. Families use the cards as a quick reference to the THSteps screening appropriate for their child, based on the child's age. The back of the card provides important information on immunizations.

Each household is given the brochures and a wallet card at every certification or redetermination, or via mail if the individual is interviewed by telephone or when no interview is conducted.

THSteps materials may be ordered online at: dshs.state.tx.us/thsteps/THStepsCatalog.shtm.

Supervisors must ensure that each advisor has the following THSteps materials and uses them as required:

  • A desk reference.
  • "Don't Miss a Beat" and "Good Health Takes More Than an Apple a Day" brochures.
  • "Checkups Help Children Stay Healthy!" THSteps wallet cards.
  • Form H1093, THSteps Extra Effort Referral. This form is used to help individuals who need:
    • to schedule a THSteps checkup or appointment;
    • more information on THSteps medical, dental and case management services; and
    • services other than those listed above.

Fax Form H1093 to THSteps Outreach and Informing staff at 512-533-3867.

 

A—1531.5 Compliance Requirements

Revision 18-3; Effective July 1, 2018

 

TP 44 and TP 48

Starting at age 2, children under age 18 must comply with the regimen of care prescribed by the THSteps Program. At the first redetermination, advisors should check for overdue dates. If one exists, the advisor should contact the caretaker and allow the caretaker to self-declare that the child:

  • had the screening;
  • is scheduled for the screening; or
  • has not been screened, but has good cause.

If the advisor is unable to contact the caretaker by telephone, the advisor must send Form H1024, Subject: Self-Declaration Notice, to obtain the information.

If the household does not return Form H1024, deny the EDG for failure to provide. If the household returns Form H1024 indicating noncompliance, the advisor should schedule the caretaker for a telephone interview and emphasize the importance of the checkups. Staff must use the appropriate script located in C-1117, Texas Health Steps (THSteps) Quick Reference Guide and Recipient Enrollment Script, or C-1118, Health Care Orientation Quick Reference Guide and Enrollment Script, when a recipient has a telephone interview due to a THSteps/Health Care Orientation noncompliance. If the person does not keep the appointment, the EDG is denied for failure to provide. Note: The denial applies to all children's Medicaid EDGs for the household, except TP 45 for newborns.

At the next redetermination, if TIERS still shows the same overdue date for the child, the caretaker must provide verification that the child had the check up or have a telephone interview appointment before redetermination.

When adding a sibling to a case and the redetermination is due on the existing EDG, the change is processed in Change Action mode through Disposition, the review is initiated and the redetermination is processed on both EDGs. TIERS will match the EDG end dates.

If a child has a THSteps overdue date, the caretaker must comply, show good cause, or have a telephone appointment, or the advisor must deny the Medicaid EDGs for all the children in the family, except TP 45 coverage for newborns.  A parent or caretaker may self-declare on the Form H1024 or via phone if there is a good cause reason that the child has not had the check-up.

Related Policy
Continuous Medicaid Coverage, A-832
General Reminders, A-1510
Processing Children's Medicaid Redeterminations, B-123

 

A—1532 Medicaid

Revision 16-4; Effective October 1, 2016

 

Medical Programs

Applicants must be informed that:

  • they will receive a Your Texas Benefits Medicaid ID card if certified;
  • they must show the Medicaid ID card to medical providers;
  • each individual can receive three paid prescriptions a month;

    Exception: The following Medicaid recipients are eligible for unlimited paid prescriptions:
    • managed care individuals;
    • nursing facility residents; and
    • individuals under age 21, through the month of their 21st birthday.
       
    Note: Lost or destroyed prescriptions may be replaced by contacting the pharmacy that originally filled the prescriptions. The pharmacy can call the vendor drug toll-free pharmacy provider line to obtain procedures for overriding the system.
  • if they lose their Medicaid ID card, they can request a new one by calling 1-855-827-3748 (providers can still verify Medicaid eligibility without the card); and
  • Medicaid will not reimburse them for any bills they pay.

Note: If the household has members who are elderly or have disabilities who wish to apply for Medicaid, but who do not qualify for any Medical Programs for families and children, refer them to HHSC's MEPD programs. Staff must provide the household with the address and telephone number of the nearest office, or the self-service website www.hhsc.state.tx.us/help/index.shtml.

Medical Programs (except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 56)

Applicants living in a managed care area must be informed that they are required to select a managed care plan and primary care physician.

Emergency Medicaid

Staff must explain that Medicaid coverage is limited to the dates of the emergency medical condition.

TP 40

Encourage the pregnant woman to start receiving prenatal care.

 

A—1532.1 Spend Down EDGs

Revision 15-4; Effective October 1, 2015

 

TP 56 and TP 32

For applications with spend down, staff are required to verbally explain the following:

  • Children or pregnant women in the certified group are not eligible for Medicaid until spend down is met (i.e., the household's excess income is depleted with medical expenses incurred by members of the budget group).
  • TIERS mails Form H1120, Medical Bills Transmittal/Insurance Information, and Form H3087S, Spend Down Medicaid Identification, to the individual. Form H1120 provides the Medically Needy Clearinghouse with information needed to determine spend down for clients and provides the individual with information needed to submit medical bills to the Clearinghouse. Form H3087S summarizes the spend-down amount and potential eligible months and explains to providers how they can assist the individual by submitting bills.
  • The household or a provider must submit bills to the Medically Needy Clearinghouse. The Clearinghouse must receive the bills within 30 days of the later of the following dates:
    • the day Form TF0001, Notice of Case Action, processes; or
    • the last day of the application month.

    The individual should be advised to contact the Clearinghouse if the 30-day time limit is near and there is a delay getting bills from a provider, third-party resources (TPR) information, etc. The Clearinghouse allows bills paid during the month(s) of potential eligibility by:

    • members of the household composition, and
    • state or local government agencies (County Indigent Health Care, Children with Special Health Care Needs, MIHIA, etc.).

    • The Clearinghouse also allows unpaid bills that are itemized regardless of when they were incurred. Itemized bills must include:
    • name of the provider,
    • date the service was provided,
    • date(s) and amount(s) paid toward the bill, and
    • balance due.

    If a bill was incurred 60 days or more before the applicant submits it, the applicant must provide a current itemized statement.

    Staff should assist the individual in determining whether bills are current, itemized, and complete, if requested.
  • The individual must submit claims to TPRs, if any, before submitting the bills to the Clearinghouse. When submitting the bills, the individual must provide the Clearinghouse with verification that a TPR will not pay certain bills or portions of bills. An Explanation of Benefits (EOB) provides this information.
  • The individual must answer the Clearinghouse's request for additional information no later than 30 days after the:
    • last day of the application month, or
    • date of the Clearinghouse's request.

Staff should advise the applicant of the types of assistance available to help the individual with the spend-down process.

On the same day the advisor approves the EDG, the advisor gives or TIERS mails to the individual:

  • Form TF0001, Notice of Case Action;
  • Form H3087S, Spend Down Medicaid Identification;
  • Form H1120, Medical Bills Transmittal/Insurance Information; and
  • a preaddressed Clearinghouse envelope for the applicant to use to submit bills to the Clearinghouse.

Do not give Form H1120 to anyone other than the applicant or the applicant's AR. Explain that it is best to submit all bills at the same time because the Clearinghouse must establish a hierarchy when processing bills to meet spend down. This hierarchy ensures that spend down is met by nonreimbursable bills before reimbursable bills because nonreimbursable bills:

  • were incurred before a month of potential eligibility, or
  • are not for Medicaid-covered services.

 

A—1533 Transitional and Post Medicaid

Revision 15-4; Effective October 1, 2015

 

TP 08

The individual should be informed that the household may be eligible for additional months of transitional Medicaid and child care if TP 08 is denied because of earned income (TP 07).

The household should be informed that they may be eligible for four additional months of post Medicaid if TP 08 is denied because of spousal support income.

The individual should also be informed that if the household is not eligible for transitional or post Medicaid, the household may be eligible for other medical program coverage.

 

A—1534 Requirement to Report Accidents

Revision 15-4; Effective October 1, 2015

 

Medical Programs

Staff should instruct the individual to report accidents. This is to determine whether the individual has any TPRs other than Medicaid that could cover medical expenses.

 

A—1540 Redeterminations

Revision 13-2; Effective April 1, 2013

 

 

A—1541 Periodic Redeterminations and Special Reviews

Revision 15-4; Effective October 1, 2015

 

TANF and TP 08

Staff should explain to the individual that:

  • an advisor will periodically redetermine the individual's EDG, and
  • HHSC will send an appointment for the redetermination.

TANF

Staff delivers the Texas Works Message to TANF recipients.

 

A—1542 Special Reviews

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff explains to the individual:

  • that a special review is set for the individual's EDG,
  • the purpose of the special review, and
  • how and when HHSC will notify the individual of the special review.

 

A—1543 Notice of Expiration

Revision 15-4; Effective October 1, 2015

 

SNAP

TIERS automatically sends an expiration notice to households before their certification ends.

Exceptions: The individual may be given Form H1830, Application/Review/Expiration/Appointment Notice, and Form H1010, Texas Works Application for Assistance — Your Texas Benefits, at certification if the advisor approves an EDG for:

  • one or two months, or
  • three months and the advisor completes the certification after cutoff in the first benefit month.

 

A—1550 Issuance and Use of Benefits

Revision 04-1; Effective January 1, 2004

 

 

A—1551 Advisor Responsibilities

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Staff should inform the individual about:

  • how HHSC issues TANF and SNAP benefits,
  • how the individual uses those benefits, and
  • the individual's responsibilities.

Cover each item listed in C-1131, Advisor Guide for Explaining EBT.

 

A—1552 EBT Issuance Staff Responsibilities

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Staff are responsible for informing the individual about each item listed in C-1132, Issuance Staff Guide for EBT Issuance and Training. This includes the TANF cash withdrawal policy and procedures if the individual applies for TANF and has any questions about the advisor's explanation.

 

A—1553 Use of TANF Benefits

Revision 15-4; Effective October 1, 2015

 

TANF

Staff should explain that TANF benefits can only be used to purchase goods and services essential or necessary for the welfare of the family. This includes food, clothing, housing, utilities, furniture, transportation, telephone, laundry, medical supplies not paid by Medicaid, and incidentals such as household equipment, supplies, and recreation for children. Staff must advise recipients that failure to use the benefits as required may result in HHSC establishing a protective payee (as explained in A-222, Who Is Not Included).

 

A—1554 Use of SNAP Benefits

Revision 15-4; Effective October 1, 2015

 

SNAP

Staff must explain the following rules regarding use of SNAP benefits:

  • SNAP benefits may be used to purchase food items and garden seeds at retailers approved by the U.S. Department of Agriculture (USDA). They may not be used for hot, ready-to-eat foods or food marketed to be heated in the store (except as listed in B-400, Special Households).
  • SNAP benefits may not be used to pay off charge accounts.
  • Change is not given on EBT food account purchases.
  • Sales tax may not be charged on any item purchased with SNAP benefits.

 

A—1555 Use of One-Time Temporary Assistance for Needy Families (OTTANF) Benefits

Revision 15-4; Effective October 1, 2015

 

OTTANF

Staff should ensure that OTTANF applicants understand that OTTANF benefits are intended as emergency cash assistance for families who do not currently receive TANF but who are otherwise eligible. In addition to meeting TANF requirements, the household must meet one of the four crisis criteria explained in A-2440, Determining Crisis Criteria (OTTANF).

HHSC issues a $1,000 payment with the intent that it will:

  • resolve a short-term crisis,
  • keep the household connected to the workforce, and
  • serve as a diversion from ongoing TANF.

Staff shall explain the 12-month ineligibility period and obtain original signatures on Form H1072, One Time Temporary Assistance for Needy Families (OTTANF) Acknowledgement.

 

A—1560 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

The following must be documented:

  • the nature of expected changes and when the individual expects the change to occur;
  • the status of overpayments, and explain recoupment action;
  • the refusal or failure to sign Form H1350, Opportunity to Register to Vote, in TIERS Case Comments; and
  • in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, that the advisor gave or mailed Form H0025, HHSC Application for Voter Registration, to the individual, authorized representative or representative payee, providing the individual with an opportunity to register to vote.

Related Policy
Registering to Vote, A-1521

TANF

The following situations must be documented if the individual:

  • has good cause for not cooperating with THSteps services;
  • does or does not want THSteps services; and
  • chooses to withdraw from the TANF program as a result of Texas Works activities.

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