Revision 15-4; Effective October 1, 2015

 

E—2110 Applications

Revision 15-4; Effective October 1, 2015

 

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

Reopen an application denied for failing to furnish information/verification if the missing information is provided by the 60th day from the file date. Use the date the missing information/verification was provided as the new file date.

Use the original application, until it is 60 days old.

If the information on the form has changed or is more than 45 days old, the individual and advisor must update the form.

 

E—2120 Deadlines

Revision 15-4; Effective October 1, 2015

 

Provide Form TF0001, Notice of Case Action, the same day eligibility is determined for an application but no later than 45 days from the file date.

 

E—2130 Missed Interviews

Revision 15-4; Effective October 1, 2015

 

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

 

E—2140 Pending Information on Applications

Revision 15-4; Effective October 1, 2015

 

Advisors may not request additional information or documentation from clients unless such information is not available electronically or the information obtained electronically is not consistent with the information provided by the client.

If additional information is needed, advisors must request documents that are readily available to the household and are considered to be sufficient verification. Each handbook section lists potential verification sources. C-900, Verification and Documentation, gives information on verification procedures.

In determining eligibility, advisors must consider any information the individual reports between the application date and the decision date. Include any information the individual reports during the application decision process.

 

E—2150 Notice of Renewal/Expiration

Revision 15-4; Effective October 1, 2015

 

The system generates and sends renewal correspondence to individuals enrolled in Medicaid for Former Foster Care Children (FFCC) following the process explained in B-121, Notice of Redetermination/Certification Expiration, for TP 08 and Children's Medicaid (TP 43, TP 44 and TP 48).

Note: The system will generate Form H1206, Health Care Benefits Renewal - FFCC, rather than Form H1206, Health Care Benefits Renewal - MA, for individuals renewing FFCC.

 

E—2160 Processing Renewals

Revision 15-4; Effective October 1, 2015

 

E—2161 How to Process a Renewal

Revision 15-4; Effective October 1, 2015

 

FFCC completes an administrative renewal process. An administrative renewal is initiated by the system and requires no advisor action. The administrative renewal process uses the automated renewal process, explained in E-2161.1, 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.

 

E—2161.1 Automated Renewal Process

Revision 15-4; Effective October 1, 2015

 

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.

 

E—2161.1.1 Verifications Required for Renewals

Revision 15-4; Effective October 1, 2015

 

During the automated renewal process, the system verifies:

  • Residency
  • Immigration status

 

E—2161.1.2 Eligibility Outcomes

Revision 15-4; Effective October 1, 2015

 

Once available verifications are assessed during the automated renewal process, 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 and no additional verification is needed from the 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 - FFCC, if the information on the renewal form is incorrect or there are changes to the client’s case.
Additional Information Needed
  • All required eligibility information cannot be verified during the automated renewal process and additional verification is needed from the client.
  • The client must return a signed renewal form, Form H1206-FFCC, and all requested verification(s).

 

E—2161.1.3 Renewal Correspondence

Revision 15-4; Effective October 1, 2015

 

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 Outcomes 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 - FFCC.
  • The client is only required to return a signed renewal form, Form H1206 - FFCC, 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.
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, Form H1206 - FFCC; and
    • Required verification(s).
  • Form H1020 identifies all the required verification(s) needed to complete the renewal and a statement that the signed renewal form is required.
  • Form M5017, Documents to Send with Your Renewal Application, is included with Form H1206 - FFCC.

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 or the denial reason for not recertifying the case.

 

E—2161.2 Processing a Manual Renewal

Revision 15-4; Effective October 1, 2015

 

If an individual is required to return a renewal form and returns a paper Form H1206, Health Care Benefits Renewal - FFCC, the form is routed to Centralized Benefit Services (CBS) for processing. If an FFCC renewal is submitted to a local office, it may be processed by the local office advisor but only CBS advisors may dispose the FFCC Eligibility Determination Group (EDG). If an FFCC renewal needs to be disposed, a Task List Manager (TLM) task will be generated for CBS instructing them to dispose the renewal.

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

  • Form H1206, Health Care Benefits Renewal - FFCC
  • Form H1010-R, Your Texas Works 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 12th month of the certification period, whichever is later.

When the Texas Health and Human Services Commission (HHSC) receives an acceptable FFCC 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.

 

E—2161.2.1 When a Renewal Form Is Not Returned

Revision 15-4; Effective October 1, 2015

 

When an acceptable FFCC renewal form 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 CBS 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.

 

E—2161.2.2 Information or Renewal Form Returned After Termination

Revision 15-4; Effective October 1, 2015

 

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 benefit month, CBS staff must reopen the EDG. The date the information or verification is provided is the new file date.

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 FFCC renewal form.

Note: If the renewal form is received after the date of denial but before the last day of the 12th month of the certification period, reopen the EDG and process as a renewal.

 

E—2170 Renewal Time Frames

Revision 15-4; Effective October 1, 2015

 

For individuals required to return a renewal packet, CBS advisors must process the manual renewal following the time frames explained in E-2161.2, Processing a Manual Renewal.

 

E—2180 Pending Information

Revision 15-4; Effective October 1, 2015

 

Advisors must allow the household at least 10 days to provide missing information/verification. The due date must be a workday. Advisors must request documents that are readily available to the household if the documents are anticipated to be sufficient verification. If the applicant has any active or inactive EDGs, check to see if any verification previously provided for the other EDGs can be used to determine eligibility for FFCC.

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

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

Note: Advisors must not use verification that is over 90 days old from the FFCC file date.

 

E—2181 Summary of Due Dates for Form H1020, Request for Information or Action

Revision 15-4; Effective October 1, 2015

 

Case Action Due Date Final Due Date
Application 10 days
  • 30th day, or
  • 10th day if the household's Form H1020 due date extends beyond the 30th day
Renewal 10 days
  • 30th day or by cutoff in the last benefit month of certification, whichever is later; or
  • 10th day if the household's Form H1020 due date extends beyond the last day of the last benefit month
Incomplete review 10 days 10th day

Note: Staff have until the 45th day from the file date to determine eligibility for applications.