Revision 15-4; Effective October 1, 2015

 

 

X—1910 Notice to Applicants

Revision 15-4; Effective October 1, 2015

 

Case disposition is the result of processing a request for assistance. Advisors must produce a notice of eligibility status. At the end of the interview, if one was requested by the client, or once Form H1034, Medicaid for Breast and Cervical Cancer; Form H2340, Medicaid for Breast and Cervical Cancer Renewal; or Form H2340-OS, Medicaid for Breast and Cervical Cancer, has been processed, mail the client one of the following notices to inform the individual that the case is pended, certified, sustained or denied.

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.

If all required proof/verification is not available when processing the application, the advisor allows the household at least 10 days to provide it. The due date must be a workday. Advisors determine what sources of proof/verification are readily available to the household and request those sources first if the advisor expects them to be sufficient proof/verification. If the applicant has an active or inactive Eligibility Determination Group (EDG) in the Texas Integrated Eligibility Redesign System (TIERS), the advisor checks to see whether any proof/verification previously provided on any other EDG can be used to determine eligibility for Medicaid for Breast and Cervical Cancer (MBCC).

Note: Verification previously provided on another case/EDG is only acceptable if it was provided within the 90 days preceding the file date.

Form TF0001, Notice of Case Action

If eligible for MBCC-Presumptive or MBCC, Form TF0001 informs the client of:

  • the date benefits begin,
  • her right to appeal, and
  • the address and phone number of free legal services available in the area.

If the woman is certified for MBCC-Presumptive, a separate Form H1020 is sent informing her of the additional information needed to determine her eligibility for MBCC.

If ineligible for MBCC-Presumptive or MBCC, Form TF0001 informs the client of:

  • the date of denial,
  • her right to appeal, and
  • the address and phone number of free legal services available in the area.

 

X—1911 Summary of Due Dates for Form H1020, Request for Information or Action

Revision 10-2; Effective April 1, 2010

 

Case Action Due Date Final Due Date
Application 10 days from the date issued
  • 30 days, or
  • 10th day if 10 days end after 30th day
Renewal 10 days from the date issued By cutoff of review month
Incomplete review 10 days from the date issued 10 days

 

X—1920 Length of Certification

Revision 13-2; Effective April 1, 2013

 

MBCC EDGS do not have a certification period.

TIERS calculates a review date from the date the advisor disposes the case action as follows:

  • Applications – five months from the date of disposition.
  • Renewals – six months from the date of disposition.

 

X—1930 Setting Special Reviews

Revision 13-1; Effective January 1, 2013

 

When processing an application or renewal, set a special review if it is known that before the next periodic review the exclusion period of the creditable coverage will expire (pre-existing condition period has expired) or the woman’s yearly benefits for breast or cervical cancer treatment will be reinstated.

 

X—1940 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 action 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 found in A-2340, Adverse Action.