Revision 16-3; Effective July 1, 2016

 

 

X—2010 Applications

Revision 15-4; Effective October 1, 2015

 

Process the application within two business days of receipt, but no later than 15 business days from the application file date.

Re-open an application denied for failing to furnish information/verification if the missing information is provided. Use the date the missing information was provided as the new file date. Use the original Form H1034, Medicaid for Breast and Cervical Cancer, until it is 60 days old. If the information on Form H1034 has changed or is more than 45 days old, the client and advisor must update the form.

 

X—2020 Deadlines

Revision 12-3; Effective July 1, 2012

 

Provide Form TF0001, Notice of Case Action, the same day eligibility is determined. Determine eligibility no later than 15 days from the file date.

 

X—2030 Missed Appointments

Revision 12-3; Effective July 1, 2012

 

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

 

X—2040 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.

Advisors must request documents that are readily available to the household if the advisor anticipates them to be sufficient verification. Each Texas Works Handbook section lists potential verification sources. C-900, Verification and Documentation, provides information on verification procedures.

In determining eligibility, the advisor 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.

Note: Verification previously provided on another Eligibility Determination Group (EDG) is only acceptable if it was provided within the 90 days preceding the file date.

 

X—2050 Notice of Renewal

Revision 15-4; Effective October 1, 2015

 

The Texas Integrated Eligibility Redesign System (TIERS) generates a renewal packet to a recipient two months before the periodic review due date.

The renewal packet includes:

  • Form H1830, Application/Review/Expiration/Appointment Notice;
  • Form H2340, Medicaid for Breast and Cervical Cancer Renewal;
  • Form H1551, Treatment Verification, to verify if the recipient is currently receiving treatment for breast or cervical cancer; and
  • a self-addressed stamped envelope.

 

X—2060 Processing Renewals

Revision 15-4; Effective October 1, 2015

 

The file date is the date the Texas Health and Human Services Commission (HHSC) receives the renewal application. Process the renewal by mail or telephone.

Note: Send the individual Form H1020, Request for Information or Action, if the individual did not provide Form H1551, Treatment Verification, with Form H2340, Medicaid for Breast and Cervical Cancer Renewal.

A woman remains eligible for Medicaid for Breast and Cervical Cancer (MBCC) when it is verified that she:

  • has not turned age 65;
  • is actively receiving treatment, as defined in X-912, Active Treatment; and
  • does not have creditable coverage as defined in X-930, Creditable Coverage.

Deny a recipient if it is verified that she has creditable coverage, is not actively receiving treatment or is age 65 or older.

 

X—2070 Processing Time Frames

Revision 16-3; Effective July 1, 2016

 

Advisors must process periodic reviews before cutoff in the month:

  • the review date falls, if the review is due on or before cutoff; or
  • after the review date, if the review is due after cutoff.

If the household must provide verification to complete the review, allow the household at least 10 days to provide it.

Advisors must reopen a renewal form denied for failing to furnish information or verification if the missing information is provided by the 60th day from the file date. The date the missing information/verification was provided is the new file date.

The original Form H2340, Medicaid for Breast and Cervical Cancer Renewal, can be used until it is 60 days old, following the policy explained in B-111, Reuse of an Application Form After Denial.

Advisors must consider a Form H2340 received after the last day of the certification period as an application using application processing time frames in X-2010, Applications, if it is received 12 months or less after the woman's breast or cervical cancer diagnosis date or the date active treatment was last verified, whichever is later.