Revision 15-4; Effective October 1, 2015

 

 

M—2010 Notice to Applicants

Revision 15-4; Effective October 1, 2015

 

When processing an application, redetermination or change, advisors are required to inform the individual if their request is pended, certified, sustained, or denied. Eligibility Determination Group (EDG) disposition is the end result of processing the request for assistance and will generate Form TF0001, Notice of Case Action. However, if the EDG cannot be disposed because it is pending for additional information/verification, the advisor must provide the individual with Form H1020, Request for Information or Action.

Form H1020, Request for Information or Action

Form H1020 informs the individual the:

  • reason the case is pending,
  • action the individual or advisor must take,
  • date by which the individual or advisor must take action, and
  • date the advisor must deny the application/case if the individual does not take action, if applicable.

Note: For Spanish-speaking only individuals, ensure that all comments provided are in Spanish.

Form TF0001, Notice of Case Action

TF0001 informs the individual:

  • the date benefits begin,
  • the date of denial,
  • about his/her right to appeal, and
  • address and telephone number of free legal services available in the area.

Note: For Spanish-speaking only individuals, ensure that all comments provided are in Spanish.

 

M—2020 Length of Certification

Revision 15-4; Effective October 1, 2015

 

The Texas Integrated Eligibility Redesign System (TIERS) calculates the eligibility end date from the date the advisor disposes the EDG as follows:

  • Applications – initial certification month plus 11 months.
  • Renewals – 12 months from the last certification month.

Individuals are continuously eligible for Medicaid for Transitioning Foster Care Youth benefits for 12 months or through the month of their 21st birthday, whichever is earlier.

Exception: An individual is not eligible to receive 12 months of continuous eligibility if the individual:

  • starts receiving adequate health coverage,
  • reaches age 21,
  • dies,
  • voluntarily withdraws, or
  • moves out-of-state.

 

M—2030 Setting Special Reviews

Revision 10-2; Effective April 1, 2010

 

Use Medical Programs policy in A-2330, Setting Special Reviews, to set special reviews.

 

M—2040 Adverse Action

Revision 10-2; Effective April 1, 2010

 

Any household receiving a notice of adverse action has the right to request a fair hearing. In some situations, households may continue receiving benefits pending an appeal. After certification, give households advance notice of adverse actions to deny benefits except for reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice), and A-2344.2, No Form TF0001 Required.

For adverse action, use current policy in A-2340, Adverse Action.