Revision 17-2; Effective April 1, 2017

 

 

W—2010 Applications

Revision 17-2; Effective April 1, 2017

 

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 was provided as the new file date.

Use the original Form H1867/H1867-S, Healthy Texas Women Application, or an untimely Form H1867-R/H1867-RS, Healthy Texas Women Renewal, 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.

 

W—2020 Deadlines

Revision 13-1; Effective January 1, 2013

 

Provide Form TF001W, Notice of Case Action, the same day eligibility is determined for an application but no later than 45 days from the file date.

 

W—2030 Missed Appointments

Revision 07-0; Effective July 1, 2007

 

No appointment is required to process an application or renewal unless requested by the applicant/individual. If requested, provide the applicant/individual a telephone interview. If she fails to keep the appointment, do not deny the application/renewal but continue to process.

 

W—2040 Pending Information on Applications

Revision 15-4; Effective October 1, 2015

 

Advisors must request documents that are readily available to the household 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.

 

W—2050 Notice of Renewal/Expiration

Revision 17-2; Effective April 1, 2017

 

The Texas Integrated Eligibility Redesign System (TIERS) sends a renewal packet during the 10th month of the 12-month continuous eligibility period if it is determined that the recipient is not adjunctively eligible. If she is determined adjunctively eligible, TIERS sends Form H1831, Adjunctive Eligibility Letter, in lieu of the renewal application.

Staff must determine if a woman is eligible to continue to receive Healthy Texas Women (HTW) benefits using the same eligibility requirements for an application. If Form H1831 states Yes to the pregnancy question, deny the renewal using the denial reason language in W-913, Pregnant Women.

If the woman states on Form H1831 that she has creditable health insurance that covers family planning services and that filing a claim will not cause her physical, emotional or other harm, deny the renewal using the denial reason language in W-914, Third-Party Resource (TPR).

 

W—2060 Processing Renewals

Revision 07-0; Effective July 1, 2007

 

 

W—2061 How to Process a Renewal

Revision 17-2; Effective April 1, 2017

 

Renewals are processed by mail or telephone. There is no interview requirement for a HTW renewal. The file date is the date any local Texas Health and Human Services Commission (HHSC) Eligibility Office receives the HTW renewal. If the renewal is received via fax outside of HHSC business hours, the file date is the next HHSC business day.

Verification from an associated Eligibility Determination Group (EDG) can be used if provided within 90 days of the HTW file date.

Follow the policy below when Form H1867-R/H1867-RS, Healthy Texas Women Renewal, or Form H1831, Adjunctive Eligibility Letter, is returned for a renewal:

  • If the woman previously reported a change that did not have to be acted on before the renewal, but does not send verification with Form H1867-R/H1867-RS or Form H1831, request verification via Form H1020, Request for Information or Action.
  • If she provides Form H1867-R/H1867-RS or Form H1831 indicating no change and has an associated EDG, review the associated EDG to determine if there is documentation to clear any conflicting information. If not, request new verification via Form H1020.
  • If she returns Form H1867-R/H1867-RS or Form H1831 reporting changes, provides verification, and there is no associated EDG, process the renewal using the new verification.
  • If she returns Form H1867-R/H1867-RS or Form H1831 reporting changes, provides verification, and there is an associated EDG, review the associated EDG and use the information provided for the HTW EDG as it is the most recent. The information may vary from the other EDG information since less documentation is required.
  • If the associated EDG has other information that the family did not report for the HTW EDG, that would impact HTW eligibility, contact the woman (by telephone or Form H1020 with the due date) to determine if the information in the associated EDG is correct before denying or taking adverse action on the EDG.
  • If the family reports new information that must be considered for the associated EDG such as a new job, follow current procedures to report the change on the other associated EDG.
  • If she returns Form H1867-R/H1867-RS or Form H1831, reporting changes without verification, and has an associated EDG, request new verification via Form H1020. Do not renew eligibility if the information reported on Form H1867-R/H1867-RS or Form H1831 must be verified and verification/proof is not provided. Do not allow a deduction expense if the individual does not provide verification.
  • If she returns Form H1867-R/H1867-RS or Form H1831 indicating changes, does not provide verification, and does not have an associated EDG, request information needed to determine eligibility. If she does not provide the information, do not renew eligibility.

Exception: Do not verify an income or expense change at renewal that was reported during the 12-month eligibility period if the individual is only required to provide Form H1831 at renewal since she was determined adjunctively eligible.

Process a denial action to close the EDG and record workload activity if the woman is not eligible for another 12-month continuous eligibility period.

Process the action before cutoff in the 12th month to ensure the denial code reflects the specific reason for denial.

Note: If the woman does not return the renewal form or adjunctive eligibility letter, take no action. The EDG automatically closes at the end of the 12-month eligibility period.

 

W—2062 Summary of Due Dates for Form H1020, Request for Information or Action

Revision 07-0; Effective July 1, 2007

 

Case Action Due Date Final Due Date
Application 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Untimely renewal 10 days
  • 30 days, or
  • 10th day if 10 days end after 30th day
Timely renewal 10 days
  • last workday of last benefit month, or
  • 10th day if 10 days end after last benefit month
Incomplete review 10 days
  • 10 days

Note: Staff have until the 45th day of the file date to determine eligibility.

 

W—2070 Renewal Time Frames

Revision 17-2; Effective April 1, 2017

 

HHSC must receive an individual's renewal application on or before the first day of the last month of certification. Consider a renewal untimely if received after the first day of the last month of certification. Process an untimely renewal using application processing time frames.

Staff must determine renewal eligibility on a timely submitted renewal no later than the last workday of the last month of certification to be considered processed timely.

If an individual is determined adjunctively eligible, TIERS mails the individual Form H1831, Adjunctive Eligibility Letter, in the 10th month of the 12-month certification period. Form H1831 informs the individual that the certification is ending and that she is financially eligible for a new 12-month certification. The individual must also meet non-financial requirements for HTW. Form H1831 asks the individual if she is pregnant or has creditable health insurance. Staff must determine, based on the answers provided by the individual, if she is eligible to continue receiving HTW benefits.

Individuals must sign and return the form, complete the renewal process via YourTexasBenefits.com, or call 2-1-1 to complete a telephone renewal and meet all non-financial requirements in order to receive continued benefits.

HHSC must receive Form H1831 no later than the last workday of the last certification month for the individual to receive a new 12-month continuous eligibility period. If HHSC does not receive the form by the last workday of the last certification month, the individual must reapply using Form H1867/H1867-S, Healthy Texas Women Application Form.

For adjunctively eligible individuals, staff must complete renewals by the last workday of the last certification month, or within five workdays from receiving Form H1831 if received on the last workday of the last certification month.

 

W—2080 Pending Information

Revision 17-2; Effective April 1, 2017

 

If the applicant cannot furnish all required proof/verification during the interview or with the application, allow the household at least 10 days to provide it. The due date must be a workday. Determine what sources of proof/verification are readily available to the household and request those first if you expect them to be sufficient proof/verification. If the applicant has an active or inactive EDG, check to see if any proof/verification previously provided on another EDG can be used to determine eligibility for HTW.

Note: Do not use proof/verification more than 90 days old from the HTW file date.

Use verification accepted for Temporary Assistance for Needy Families (TANF), Medical Programs or the Supplemental Nutrition Assistance Program (SNAP) for all programs.

For example, if you accept wage verification for a SNAP case, that same verification is acceptable for TANF or Medical Programs.

Exception: Verification of U.S. citizenship for applicants must be from a Medicaid acceptable source.

Form H1867/H1867-S, Healthy Texas Women Application Form, and Form H1867-R/H1867-RS, Healthy Texas Women Renewal, provide the applicant/individual the opportunity to provide a different mailing address and contact telephone number due to confidentiality issues. Since HTW provides family planning services, it is imperative for advisors to respect the privacy of an applicant/individual.