Revision 18-2; Effective April 1, 2018

 

 

D—210 Application Procedures

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

Applications may be received in person, by telephone, fax, email, Internet or mail. Texas Health and Human Services Commission (HHSC) Benefits Offices are equipped with telephones, lobby computers and fax machines for applicants to submit applications.

Households can apply using any of the Medical Program application channels explained in A-113, Application Requests and Submissions.

If the applicant fails to provide a name, address or signature on a faxed or mailed application, consider it an invalid application.

No interview is required for the Children's Health Insurance Program (CHIP) or CHIP perinatal. Schedule an appointment only upon the household's request.

On the same day of the application receipt, advisors mail the applicant Form H0025, HHSC Application for Voter Registration. If the individual contacts HHSC to decline the opportunity to register to vote after receipt of Form H0025, the advisors mail Form H1350, Opportunity to Register to Vote, to the individual for a signature. Advisors send Form H1350 for imaging when the individual returns the form and retain the form for at least 22 months.

Related Policy

Application Processing, A-100
Registering to Vote, A-1521

 

D—211 Application Assistance

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

If an applicant needs help completing the application packet, a volunteer or staff member must help. The person helping the applicant complete an application must initial the part he/she completed, or sign the application showing that he/she helped complete it.

 

D—212 Applications Received by Fax, Email, Mail or Internet

Revision 18-2; Effective April 1, 2018

 

CHIP, CHIP Perinatal

The applicant's file date is the date the Texas Health and Human Services Commission (HHSC) or an HHSC agent receives an application that contains, at a minimum, the applicant's name, address and signature. A faxed or electronic signature (if using the online application available through YourTexasBenefits.com) is acceptable. A typed signature is not valid if the application is received via fax, mail or in person. If the application does not contain a signature, return the application with Form H1020, Request for Information or Action, requesting a signature.

The file date is the date an application is received at an HHSC Benefits Office or online through YourTexasBenefits.com during state business hours. For applications received outside of state business hours, the file date is established as the next business day.

Once the initial application disposition occurs, requests for coverage for additional types of assistance are handled separately and a new application is required.

 

D—213 Applications Received by Telephone

Revision 17-1; Effective January 1, 2017

 

CHIP, CHIP Perinatal

The file date is the date the applicant submits the application by telephone through 2-1-1, and the telephonic application contains the applicant's:

  • name;
  • address; and
  • signature by telephone.

An applicant may complete and sign an application by telephone following the policy for Medical Programs explained at A-122.1, Application Signature.

Related Policy
Application Signature, A-122.1

 

D—214 Withdrawal of an Application

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

A person with case authority may submit a request to voluntarily disenroll a member. The case authority person must sign and submit the request in writing.

 

D—215 Authorized Representatives (AR)

Revision 15-4; Effective October 1, 2015

 

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

 

D—220 Reopening an Application

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

When a household is denied for failure to provide information, the household has until the 60th day after the file date to provide the information without submitting a new application. The date the household submits all of the missing information becomes the new file date. Review the information provided by the household with the information listed on the application to ensure all information remains accurate.

If the household submits the missing information after the time frame, the household must reapply by submitting a new application.

 

D—230 Application Processing Time Frames

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

Provide Form TF0001, Notice of Case Action, by the:

  • 45th day after the file date for an application requesting health care for children.
  • 15th working day after the file date for an application requesting health care coverage for a pregnant woman.

 

D—231 CHIP Perinatal Application

Revision 18-1; Effective January 1, 2018

 

CHIP Perinatal

Pregnant women who apply for medical assistance are screened for Pregnant Women Medicaid (TP 40). If ineligible for Medicaid, pregnant women under age 19 are tested for CHIP. If ineligible for CHIP because of age, income, or immigration status, pregnant women are tested for CHIP perinatal.

Women certified on CHIP perinatal due to not meeting immigration status requirements and whose household income is at or below Medicaid for Pregnant Women income limits at the time of application must submit Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification, to cover the costs of labor and delivery.

Accept the applicant’s (pregnant woman’s, case name’s or authorized representative’s) verbal or written statement of pregnancy, including the start month, number of children expected and the anticipated date of delivery, unless questionable. The woman’s statement would be considered questionable if the information provided regarding the due date is discrepant, such as the pregnancy start month and pregnancy end month are less than or more than nine months apart or if the woman reports a pregnancy with overlapping start and end months.

If questionable, verify the applicant's pregnancy by using:

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

The verification must be from an acceptable source such as a physician, hospital, family planning agency, or social service agency.

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

The application contains a field for the number of children expected and the anticipated date of delivery, but does not contain a field for the applicant to enter the pregnancy start month. Staff must use the following procedures when certain information regarding pregnancy is left blank on any application for benefits:

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

If the pregnancy verification is not received by the 15th workday from the request, deny the application. See D-220, Reopening an Application, if the verification is provided after the application is denied.

Related Policy
Pregnancy, A-144.5

 

D—231.1 Minor Pregnant Women with Potential Medicaid Eligibility

Revision 13-4; Effective October 1, 2013

 

CHIP, CHIP Perinatal

If an application is received for a minor pregnant woman, request all missing information and test for potential Medicaid eligibility.

 

D—240 Missing Information Processing for Applications

Revision 15-4; Effective October 1, 2015

 

CHIP, CHIP Perinatal

If additional information is required, send the household Form H1020, Request for Information or Action. Upon receipt of the missing information, determine if the household is eligible.

Allow the household until the final due date to provide all the missing information. If the missing information is not provided by the final due date, deny the application.

If the missing information is received after the application is denied, but by the 60th day, reopen the application following the policy explained in D-220, Reopening an Application.