Revision 18-4; Effective October 1, 2018

 

 

C—1410 Legal Aid

Revision 13-3; Effective July 1, 2013

 

All Programs

Staff are required to include the address and phone number of legal services available in the area on individual notices.

 

C—1420 SSA Claim Number Suffixes

Revision 13-3; Effective July 1, 2013

A  
B  
B1 Primary beneficiary
B2 Aged wife (1st claimant)
B3 Husband (1st claimant)
B4 Young wife (1st claimant)
B5 Aged wife (2nd claimant)
B6 Husband (2nd claimant)
B7 Young wife (2nd claimant)
B8 Divorced wife (1st claimant)
B9 Young wife (3rd claimant)
BA Aged wife (3rd claimant)
BD Divorced wife (2nd claimant)
BG Aged wife (4th claimant)
BH Aged wife (5th claimant)
BJ Husband (3rd claimant)
BK Husband (4th claimant)
BL Husband (5th claimant)
BN Young wife (4th claimant)
BP Young wife (5th claimant)
BQ Divorced wife (3rd claimant)
BR Divorced wife (4th claimant)
BT Divorced wife (5th claimant)
BY Divorced husband (1st claimant)
BW Divorced husband (2nd claimant)
C1, 2 etc.1  Young husband (1st claimant)
D Young husband (2nd claimant)
D1 Child (including disabled or student child)
D2 Aged widow (1st claimant)
D3 Widower (1st claimant)
D4 Aged widow (2nd claimant)
D5 Widower (2nd claimant)
D6 Widow (remarried after attaining age 60)
D7 Widower (remarried after attaining age 62)
DB Surviving divorced wife (1st claimant)
D9 Surviving divorced wife (2nd claimant)
DA Aged widow (3rd claimant)
DC Remarried aged widow (2nd claimant)
DD Remarried aged widow (3rd claimant)
DG Surviving divorced husband (1st claimant)
DH Aged widow (4th claimant)
DJ Aged widow (5th claimant)
DK Aged widower (3rd claimant)
DL Aged widower (4th claimant)
DM Aged widower (5th claimant)
DN Remarried aged widow (4th claimant)
DP Surviving divorced husband (2nd claimant)
DQ Remarried aged widow (5th claimant)
DR Remarried aged widower (2nd claimant)
DS Remarried aged widower (3rd claimant)
DT Remarried aged widower (4th claimant)
DV Surviving divorced husband (3rd claimant)
DW Remarried aged widower (5th claimant)
DX Surviving divorced wife (3rd claimant)
DY Surviving divorced wife (4th claimant)
DZ Surviving divorced husband (4th claimant)
Surviving divorced wife (5th claimant)
E1 Surviving divorced husband (5th claimant)
E2 Mother (widow) (1st claimant)
E3 Surviving divorced mother (1st claimant)
E4 Mother (widow) (2nd claimant)
E5 Surviving divorced mother (2nd claimant)
E6 Father (widower) (1st claimant)
E7 Surviving divorced father (1st claimant)
E8 Father (widower) (2nd claimant)
E9 Young mother (widow) (3rd claimant)
EA Mother (widow) (4th claimant)
EB Surviving divorced father (2nd claimant)
EC Mother (widow) (5th claimant)
ED Surviving divorced mother (3rd claimant)
EF Surviving divorced mother (4th claimant)
EG Surviving divorced mother (5th claimant)
EH Father (widower) (3rd claimant)
EJ Father (widower) (4th claimant)
EK Father (widower) (5th claimant)
EM Surviving divorced father (3rd claimant)
F1 Surviving divorced father (4th claimant)
F2 Surviving divorced father (5th claimant)
F3 Father
F4 Mother
F5 Stepfather
F6 Stepmother
F7 Adopting father
F8 Adopting mother
G1 – G9 Second alleged father
J1 Second alleged mother
J2 Claimants of lump-sum death payments
J3 Primary PROUTY entitled to HIB (less than 3 Q.C.)2
J4 Primary PROUTY entitled to HIB (3 or more Q.C.)
K1 Primary PROUTY not entitled to HIB (less than 3 Q.C.)
K2 Primary PROUTY not entitled to HIB (3 or more Q.C.)
K3 PROUTY wife entitled to HIB (less than 3 Q.C.)
K4 PROUTY wife entitled to HIB (3 or more Q.C.)
K5 PROUTY wife not entitled to HIB (less than 3 Q.C.)
K6 PROUTY wife not entitled to HIB (3 or more Q.C.)
K7 PROUTY wife entitled to HIB (less than 3 Q.C.) (2nd claimant)
K8 PROUTY wife entitled to HIB (3 or more Q.C.) (2nd claimant)
K9 PROUTY wife not entitled to HIB (less than 3 Q.C.) (2nd claimant)
KA PROUTY wife not entitled to HIB (3 or more Q.C.) (2nd claimant)
KB PROUTY wife entitled to HIB (less than 3 Q.C.) (3rd claimant)
KC PROUTY wife entitled to HIB (3 or more Q.C.) (3rd claimant)
KD PROUTY wife not entitled to HIB (less than 3 Q.C.) (3rd claimant)
KE PROUTY wife not entitled to HIB (3 or more Q.C.) (3rd claimant)
KF PROUTY wife entitled to HIB (less than 3 Q.C.) (4th claimant)
KG PROUTY wife entitled to HIB (3 or more Q.C.) (4th claimant)
KH PROUTY wife not entitled to HIB (less than 3 Q.C.) (4th claimant)
KJ PROUTY wife not entitled to HIB (3 or more Q.C.) (4th claimant)
KL PROUTY wife entitled to HIB (less than 3 Q.C.) (5th claimant)
KM PROUTY wife entitled to HIB (3 or more Q.C.) (5th claimant)
LM PROUTY wife not entitled to HIB (less than 3 Q.C.) (5th claimant)
LW PROUTY wife not entitled to HIB (3 or more Q.C.) (5th claimant)
M Black lung miner (1st claimant)
  Black lung miner's widow (1st claimant)
M1 Uninsured beneficiary — not entitled to free HIB, entitled to SMIB only or premium HIB/SMIB
  Insured or Uninsured beneficiary — qualifies for HIB, but requests only SMIB
T Uninsured beneficiary — entitled to HIB under deemed insured provision or end stage renal disease (ESRD)
  Primary federal beneficiary not entitled to Title 11 or railroad monthly benefits (at time of filing)
TA Same as B (1st claimant)
  Same as B3 (2nd claimant)
TB Same as B7 (3rd claimant)
TG Same as BK (4th claimant)
TH Same as BL (5th claimant)
TJ Disabled child (1st claimant)
TK Same as TC (2nd - 9th claimant)
TC  Aged widow(er) (1st claimant)
T2 – T9 Same as TD (2nd claimant)
TD Same as TD (3rd claimant)
TL Same as TD (4th claimant)
TM Same as TD (5th claimant)
TN Disabled widow(er) (1st claimant)
TP Same as TW (2nd claimant)
TW Same as TW (3rd claimant)
TX Same as TW (4th claimant)
TY Same as TW (5th claimant)
TZ Parent (1st claimant)
TV Parent (2nd claimant)
TF Young widow(er) (1st claimant)
TQ Same as TE (2nd claimant)
TE Same as TE (3rd claimant)
TR Same as TE (4th claimant)
TS Same as TE (5th claimant)
TT Disabled widow (1st claimant)
TU Disabled widower (1st claimant)
W Disabled widow (2nd claimant)
W1 Disabled widower (2nd claimant)
W2 Disabled widow (3rd claimant)
W3 Disabled widower (3rd claimant)
W4 Disabled surviving divorced wife (1st claimant)
W5 Disabled surviving divorced wife (2nd claimant)
W6 Disabled surviving divorced wife (3rd claimant)
W7 Disabled widow (4th claimant)
W8 Disabled widower (4th claimant)
W9 Disabled surviving divorced wife (4th claimant)
WB Disabled widow (5th claimant)
WC Disabled widower (5th claimant)
WF Disabled surviving divorced wife (5th claimant)
WG Disabled surviving divorced husband (1st claimant)
WJ Disabled surviving divorced husband (2nd claimant)
WR  
WT  

 

1 Youngest child is assigned suffix "1." When there are more than nine children in an Eligibility Determination Group (EDG), the 10th child is coded with an A rather than 10, the 11th child is coded with a B, etc.

2 Quarters of covered employment.

 

C—1430 SNAP Allotment Charts

Revision 18-4; Effective October 1, 2018

 

See C-1431 and C-1432 for updated SNAP Allotment Chart.

 

C—1431 Whole Monthly Allotments by Household Size

Revision 18-4; Effective October 1, 2018

 

SNAP Allotment Charts

The shaded portions on the table in this section indicate monthly (not prorated) allotments available to categorically eligible households, which can be $1 or more.

The minimum monthly (not prorated) Supplemental Nutrition Assistance Program (SNAP) allotment for a one- or two-person household is $15.

Related Policy
How to Determine Monthly SNAP Allotments, C-122

 

 

 

C—1432 Prorated SNAP Allotments by Application Date

Revision 11-3; Effective July 1, 2011

 

SNAP Allotment Charts

Do not issue prorated benefit allotments of less than $10.

Related Policy
How to Determine Monthly SNAP Allotments, C-122
How to Prorate Benefits, C-123
Whole Monthly Allotments by Household Size, A-2321

 

C—1440 Relationship Charts

Revision 08-1; Effective January 1, 2008

 

 

 

C—1441 Guide for Determining Relationship

Revision 13-3; Effective July 1, 2013

 

TANF and Medical Programs

This guide provides more detailed information about the eligibility requirements for relationship discussed in A-200, Household Composition, and A-520, Relationship. This guide is not all-inclusive.

A B C
When the child no longer lives with the relative listed below ... and the child now lives with ... can the person listed in Column B be a caretaker/payee for the child?
1. Mother 1. Stepfather 1. Yes
2. Father 2. Stepmother 2. Yes
3. Stepfather 3. Stepfather's Spouse 3. Yes
4. Stepmother 4. Stepmother's Spouse 4. Yes
5. Stepfather's Spouse 5. New Spouse 5. No
6. Stepmother's Spouse 6. New Spouse 6. No
*7. Grandmother 7. Step Grandfather 7. Yes
*8. Grandfather 8. Step Grandmother 8. Yes
*9. Step Grandfather 9. New Spouse 9. No
*10. Step Grandmother 10. New Spouse 10. No
11. Brother 11. Sister-in-law 11. Yes
12. Sister 12. Brother-in-law 12. Yes
13. Brother-in-law 13. New Spouse 13. No
14. Sister-in-law 14. New Spouse 14. No
15. Stepbrother 15. Stepbrother's Spouse 15. Yes
16. Stepbrother's Spouse 16. New Spouse 16. No
17. Stepsister 17. Stepsister's Spouse 17. Yes
18. Stepsister's Spouse 18. New Spouse 18. No
*19. Aunt 19. Aunt's Spouse 19. Yes
*20. Uncle 20. Uncle's Spouse 20. Yes
21. Aunt's Spouse 21. New Spouse 21. No
22. Uncle's Spouse 22. New Spouse 22. No
**23. First Cousin 23. First Cousin's Spouse 23. Yes
**24. First Cousin's Spouse 24. New Spouse 24. No
*25. Niece 25. Niece's Spouse 25. Yes
26. Niece's Spouse 26. New Spouse 26. No
*27. Nephew 27. Nephew's Spouse 27. Yes
28. Nephew's Spouse 28. New Spouse 28. No

 

*Extends to the degree of "Great-great" for items 19, 20, 25, and 27 and to the degree of "Great-great-great" for items 7, 8, 9 and 10.

**Extends to the first cousin once removed.

 

C—1442 Guide for Determining Extended Relationships

Revision 06-1; Effective January 1, 2006

 

Extended Relationships Chart

 

C—1450 Guidelines for Clearing Quality Control (QC) Findings

Revision 12-2; Effective April 1, 2012

 

 

 

C—1451 Dropped – Subject to Review but Not Completed

Revision 15-4; Effective October 1, 2015

 

All Programs

Form H1025, Report of Quality Control Assessment Findings Penalty What to do ...
Not reviewed (reason):

 

Refusal to Cooperate1
Yes2 Issue Form TF0001, Notice of Case Action, entering the comments for the appropriate program: "Your SNAP or TANF benefits are denied due to your refusal to cooperate with the Quality Control (QC) review. You will incur this penalty through February 2, yyyy,3 or until you decide to cooperate with the QC review process, whichever occurs first." Include the Texas Health and Human Services Commission's (HHSC's) Spanish translation: "Sus beneficios de SNAP o TANF se negaron porque usted se negó a cooperar con la revisión de Control de Calidad (QC). Esta sanción se le aplicaráá hasta el 2 de febrero de [YEAR] o hasta que decida cooperar con el proceso de revisión de la QC, lo que ocurra primero."

Allow advance notice of adverse action and deny only the EDG for which Form H1025 was received. Do not deny associated EDGs. (See A-2343, Advance Notice.) Call the Texas Integrated Eligibility Redesign System (TIERS) helpdesk before disposing the denied EDG to ensure only the EDG the household refused to cooperate with is denied.

Notes:

  • Refusal to cooperate with QC does not affect Medicaid.
  • The Temporary Assistance for Needy Families (TANF) denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF EDG for refusal to cooperate with QC. Refer to policy in A-1324.18, Temporary Assistance for Needy Families (TANF).

When the EDG is denied for any other reason by the time the advisor receives Form H1025 (for example, the individual failed to return pending information and the EDG is denied effective September 30, the QC review month was September, and the advisor receives Form H1025 in October), the advisor must still send Form TF0001 to the individual.

Not reviewed (reason):


Failure to Cooperate4
No The advisor needs to analyze any information provided by QC and adjust the EDG, if necessary.

 

Notes:

1 Refusal to cooperate indicates that the individual has refused to cooperate with the QC review process, that is, refused to provide information or refused to be interviewed.

2 Form H1025 contains a checkbox followed by the statement, "Impose a non-compliance penalty due to client refusal to cooperate if this box is checked. The penalty should be imposed through February 2, yyyy, [appropriate year inserted] or until the client agrees to cooperate with QCA, whichever occurs first."

3 The penalty period always expires 125 days after the reporting period. The reporting period ends September 30 each year. The penalty period for federal fiscal year (FFY) is October through September of the following year. QC refusal to cooperate penalties expire February 2, yyyy. Example: The individual's sample month is October 2011. The individual refuses to cooperate and is penalized. The penalty period expires February 2, 2013 (125 days after September 30, 2012).

4 Failure to cooperate indicates the individual has provided all of the information and cooperated with the QC review process; however, the QC analyst is unable to complete the review due to an aspect beyond the individual's control (for example, the employer or landlord refused to provide information).

 

C—1452 Dropped – Not Subject to Review

Revision 15-4; Effective October 1, 2015

 

All Programs

Form H1025, Report of Quality Control Assessment Findings Penalty What to do ...
Not reviewed (reason):


Moved Out of State
No If the individual reports in advance of moving, issue Form TF0001, Notice of Case Action, and deny the EDG simultaneously allowing adequate notice. See A-2344.1, Form TF0001 Required (Adequate Notice). Deny the EDG for which Form H1025 was received.

When the individual reports after they move out of state or it is determined by QC, deny the EDG following A-2344.2, No Form TF0001 Required.

Adjust/deny any other EDGs in which the individual/household members are included.

Not reviewed (reason):


Referred to Fraud, Under Active Fraud Investigation or Intentional
Program Violation (IPV) EDG
No No action is required.

 

If, as of the date the EDG is selected for QC sampling, the EDG meets one of the following:

  • has been referred for investigation to the state's fraud investigation unit, and the investigation is scheduled to begin within five months of sampling;
  • is under active fraud investigation; or
  • has a pending administrative or judicial IPV hearing,

the IPV EDG is not subject to review.

Not reviewed (reason):


Retroactive Benefits
No No action is required. The sample month benefits were issued retroactively; therefore, the EDG is not subject to review. Example: The file date is November 15 and the certification date is December 15. Benefits for November are issued (retroactively) in December; if November is the sample month, the EDG is not subject to review.
Not reviewed (reason):


Unable to Locate
No When Form H1025 indicates that returned mail has been received by QC, the advisor must send Form TF0001 and deny the EDG simultaneously to allow adequate notice. (See A-2344.1.)

When Form H1025 does not indicate that returned mail has been received but that the individual has not been located, advisors must send Form TF0001 to deny for unable to locate allowing advance notice of adverse action. (See A-2343, Advance Notice.)

Adjust/deny any other EDGs in which the individual/household members are included.

Not reviewed (reason):


All Individuals Who Could Be Interviewed Are Hospitalized, Incarcerated or Placed in a Mental Institution
No Information discovered by QC is forwarded to the advisor via this format. The advisor needs to analyze the information and adjust the EDG appropriately, including denial.

Adjust/deny any other EDGs in which the individual/household members are included.

Not reviewed (reason):


EDG Pending a Hearing
No No action is required.
Not reviewed (reason):


Household Did Not Receive Benefits for Sample Month
No No action is required.

TANF

 

Form H1025 QC Findings Penalty What to do ...
Not reviewed (reason):

 

Death of All Available Adult Household Members
No Deny the EDG, allow adequate notice and send Form TF0001 simultaneously. Adjust/deny any other EDGs in which the individual/household members are included. (See A-2344.1.)

The child(ren) may be certified as independent children on appropriate Medicaid EDGs (see A-241.1, Who Is Included) or they may be determined eligible in a new TANF household when all other eligibility requirements are met.

Not reviewed (reason):

 

Dormant Electronic Benefit Transfer (EBT) Account
No No action is required.

SNAP

Form H1025 QC Findings Penalty What to do ...
Not reviewed (reason):


Death of All Household Members
No Deny the EDG. Adjust/deny any other EDGs in which the individual/household members are included. (See A-2344.2.)
Not reviewed (reason):

 

Dormant Account, No Activity in EBT Account, Sample Month and Two Following Months Up To and Including Transmission to Food and Nutrition Services
No No action is required.

 

C—1453 Completed QC Reviews

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Form H1025, Report of Quality Control Assessment Findings Penalty What to do ...
Completed – Individual Refused to Cooperate Yes Issue Form TF0001, Notice of Case Action, with the following message: "Your SNAP/TANF benefits are denied due to your refusal to cooperate with the Quality Control (QC) review. You will incur this penalty through February 2, yyyy, or until you decide to cooperate with the QC review process, whichever occurs first." Include HHSC's Spanish translation: "Sus beneficios de SNAP o TANF se negaron porque usted se negó a cooperar con la revisión de Control de Calidad (QC). Esta sanción se le aplicará hasta el 2 de febrero de [YEAR] o hasta que decida cooperar con el proceso de revisión de la QC, lo que ocurra primero."

 

Allow advance notice of adverse action and deny only the EDG for which Form H1025 was received. Do not deny associated EDGs. (See A-2343, Advance Notice.)

Notes:

  • Refusal to cooperate with QC does not affect Medicaid.
  • The TANF denial cannot cause SNAP benefits to increase. Do not remove the TANF grant from an associated SNAP budget when denying a TANF EDG for refusal to cooperate with QC. Refer to policy in A-1324.18, Temporary Assistance for Needy Families (TANF).
Findings and Dollar Amounts of Error:


Information(al) Only
No Information discovered by the QC analyst is forwarded to the advisor via this format. The advisor needs to analyze the information and adjust the EDG appropriately, including denial, if necessary.

 

The advisor must refer all SNAP overissuances identified during the QC review process to the Office of Inspector General (OIG), regardless of the dollar amount. See policy in B-720, When to File an Overpayment Referral, prior to sending the referral to OIG.

Amount Correct No No action is required.

 

Notes:

 

  • “Refusal to cooperate” indicates the individual has refused to cooperate with the QC review process, that is, refused to provide information or refused to be interviewed.
  • Form H1025 contains a checkbox followed by the statement, "Impose a non-compliance penalty due to client refusal to cooperate if this box is checked. The penalty should be imposed through February 2, yyyy, [appropriate year inserted] or until the client agrees to cooperate with QCA, whichever occurs first."
  • The penalty period always expires 125 days after the reporting period. The reporting period ends September 30 each year. The penalty period for the FFY is October through September of the following year. QC reviews expire February 2, yyyy. Example: The individual's sample month is March 2012. The individual refuses to cooperate and is penalized. The penalty period expires February 2, 2013 (125 days after September 30, 2012).

TANF

Form H1025 QC Findings Penalty What to do ...
Findings and Dollar Amounts of Error: Underpayment — $xx.00 No Note: The dollar amount listed is not necessarily the amount of the underpayment.

 

The advisor must adjust the EDG accordingly. (See B-800, Restored Benefits.) The advisor should issue supplemental benefits for the current month if the individual is currently eligible.

Note: Consider all reported changes when determining the amount of supplemental or restored benefits.

Adjust/deny any other EDGs in which the individual/household members are included.

Findings and Dollar Amounts of Error:


Overpayment — $xx.00
No Note: The dollar amount listed is not necessarily the amount of the overpayment.

 

The advisor needs to adjust the EDG accordingly and enter the overpayment referral in TIERS.

Note: Consider all reported changes when determining the amount of the overpayment claim, including changes reported to QC during the exclusionary period and any other information listed by QC as “information only.”

Adjust/deny any other EDGs in which the individual/household members are included.

SNAP

Form H1025 QC Findings Penalty What to do ...
Findings and Dollar Amounts of Error:
Underissuance — $xx.00
No Note: The dollar amount listed is not necessarily the amount of the underissuance.

The advisor must adjust the EDG accordingly. (See B-800, Restored Benefits.)

The advisor should issue supplemental benefits for the current month if the individual is currently eligible.

For agency errors only, issue restored benefits for past months regardless of whether the individual is currently eligible. Do not restore benefits for unreported changes or household errors.

Note: Consider all reported changes when determining the amount of supplemental or restored benefits.

Adjust/deny any other EDGs in which the individual/household members are included.

Findings and Dollar Amounts of Error:

 

Overissuance — $xx.00
No Note: The dollar amount listed is not necessarily the amount of the overissuance.

The advisor needs to adjust the EDG accordingly and enter the overissuance referral in TIERS. The advisor must refer all SNAP overissuances identified during the QC review process to OIG, regardless of the dollar amount. See policy in B-720, When to File an Overpayment Referral, prior to sending the referral to OIG.

Note: Consider all reported changes when determining the amount of the overissuance claim, including changes reported to QC during the exclusionary period and any other information listed by QC as “information only.”

Adjust/deny any other EDGs in which the individual/household members are included.

 

C—1454 Reapplying for Benefits after a Quality Control Penalty

Revision 15-4; Effective October 1, 2015

 

All Programs

When the penalized individual comes in to reapply for benefits after the EDG is closed and the penalty period has ... and the penalized individual is applying with ... then the advisor ...
not expired, the same household composition as was on the EDG reviewed by QC, checks with the QC State Office staff who issued Form H1025, Report of Quality Control Assessment Findings. If the individual has cooperated with the QC review, the advisor proceeds with the application process. When the individual has not cooperated with the QC review, the advisor denies the application and informs the individual to reapply after they comply with the QC review process. Form TF0001, Notice of Case Action, must include the following: "You will need to contact (insert the QC contact designated by QC State Office) at (insert the QC contact designated by QC State Office) to complete the QC review process." Include HHSC's Spanish translation: "Para completar el trámite de revisión de la Valoración de Control de Calidad (QC), tiene que comunicarse con (insert QC contact designated by State Office) al (insert QC contact designated by State Office)."
not expired, another household or moved into another household and is a required member of that household, checks with the QC State Office staff who issued Form H1025. The penalty follows the penalized individual, and the new household is not eligible until the individual complies with QC. When the individual has cooperated with the QC review, the advisor proceeds with the application process. When the individual has not cooperated with the QC review, the advisor denies the application and imposes the disqualification until the individual cooperates or the penalty period expires, whichever comes first, informing the individual to reapply after they comply with the QC review process. Form TF0001 must include the following: "You will need to contact (insert the QC contact designated by QC State Office) at (insert the QC contact designated by QC State Office) to complete the QC review process." Include HHSC's Spanish translation: "Para completar el trámite de revisión de la Valoración de Control de Calidad (QC), tiene que comunicarse con (insert QC contact designated by State Office) al (insert QC contact designated by State Office)".

Do not disqualify other adults or children who were members of the original penalized household when they apply with or enter another household and the penalized individual(s) is not applying with or entering the new household with them.

 

C—1455 Frequently Asked Questions

Revision 15-4; Effective October 1, 2015

 

All Programs

1. Q: What is the difference between refusal to cooperate and failure to cooperate?
- A: "Refusal to cooperate" is a QC response used when the individual has refused to cooperate with the QC review process, that is, refused to provide information or refused to be interviewed. "Failure to cooperate" is used when the individual has provided all of the information and cooperated with the QC review process; however, QC is unable to complete the review because of something beyond the individual's control, for example, employer or landlord refused to provide information. A penalty is incurred when the individual refuses to cooperate; a penalty is not incurred for failure to cooperate.
2. Q: How do I know if a penalty has been imposed on a case?
- A: QC maintains a list of sampled cases with imposed penalties. The list can be viewed from the Eligibility Services portal at https://ofsportal.hhsc.state.tx.us/. To view the list:

 

  • Enter your user name and password.
  • Select Report Manager.
  • Select QC/Case Review List in the Select Report Group.
  • A Drop Case Report will be displayed.
  • Select the appropriate Drop Case List Report.
  • Enter the criteria for the report.
3. Q: What is the "appropriate wording" to include when sending the individual Form TF0001, Notice of Case Action, for refusal to cooperate with QC?
- A: Form TF0001 should contain the following information: "Your SNAP/TANF benefits are denied because of your refusal to cooperate with the Quality Control (QC) review. You will incur this penalty through February 2, yyyy, or until you decide to cooperate with the QC review process, whichever occurs first." Include HHSC's Spanish translation: "Sus beneficios de SNAP o TANF se negaron porque usted se negó a cooperar con la revisión de Control de Calidad (QC). Esta sanción se le aplicará hasta el 2 de febrero de [YEAR] o hasta que decida cooperar con el proceso de revisión de la QC, lo que ocurra primero."
4. Q: Is the advisor required to send Form TF0001 with the appropriate penalty wording for individuals who are no longer receiving benefits by the time Form H1025, Report of Quality Control Assessment Findings, is received? Example: QC reviews and the EDG is denied in October. The advisor receives Form H1025 information December 2011. The individual is not receiving benefits when Form H1025 is received. The penalty period expires February 2, 2013.
- A: Yes. The individual must be notified of the penalty period. Form TF0001 must advise the individual that the individual cannot receive benefits through February 2, 2013, or until the individual cooperates with the QC analyst, whichever is earlier as noted in #3 above.
5. Q: Does the penalty period ever change? If so, how does it change?
- A: The penalty period is always 125 days after the reporting period ends. The reporting period ends each federal fiscal year on September 30. One hundred twenty-five days from September 30 is February 2. These are for the prior federal fiscal year.
6. Q: Do we deny the entire EDG or just the individual listed on Form H1025?
- A: Deny the entire EDG reviewed by QC. Note: When denying a TANF EDG for refusal to cooperate, the associated SNAP benefits should not be increased (the TANF grant should not be removed from the budget) as the individual failed to cooperate with a QC review (see A-1324.18, Temporary Assistance for Needy Families [TANF]).
7. Q: Can the individual appeal the denial of the EDG when it has been denied for refusal to cooperate?
- A: Yes, the decision may be appealed. Refer to B-1000, Fair Hearings.

TANF

1. Q: Is the individual entitled to restored benefits when QC discovers an underpayment?
- A: When the household is currently eligible for and receiving TANF, then the answer is yes. See B-810, Entitlement to Restored Benefits.
2. Q: What happens when we restore benefits and the individual has an overpayment claim filed?
- A: The restored benefits must be used to offset the claim first. See B-810.

SNAP

1. Q: Is the individual entitled to restored benefits when QC discovers an underissuance?
- A: When the QC error was caused by the agency, then the answer is yes. When the QC error was caused by the individual due to unreported changes or other individual error, then the answer is no. See B-840, Notice to the Household.
2. Q: What happens when we restore benefits and the individual has an overissuance claim filed?
- A: The restored benefits must be used to offset the claim first. See B-810.

 

C—1460 Helpful Toll-Free Numbers

Revision 15-4; Effective October 1, 2015

 

All Programs

Use the following list of toll-free telephone numbers for reference purposes, or print the list and provide it to applicants.

Question or Concern Organization Telephone Number

Questions about social services or community resources in Texas, including the location and telephone number of local agency offices.

2-1-1 Texas Information and Referral Network

2-1-1 or
1-877-541-7905 (after selecting a language, press 1)

Provides households with information about EDG status such as active, on hold or denied; benefit amounts; and availability dates of current benefits.

Automated Voice Response (AVR) system hotline

2-1-1 or
1-877-541-7905 (after selecting a language, press 2)

Assists the public with issues or complaints about health and human services programs that have not been resolved under the agency's normal complaint process.

HHSC Office of the Ombudsman

1-877-787-8999

To report suspicions of the abuse or neglect of children, or the abuse, neglect or exploitation of persons age 65 or older or adults with disabilities.

Texas Department of Family and Protective Services

1-800-252-5400

Questions about Social Security Administration benefits or the maintenance of an individual's record.

Social Security Administration

1-800-772-1213
TTY number
1-800-325-0778

For claims of discrimination experienced by either individuals or applicants.

HHSC Civil Rights Office

1-888-388-6332
TTY number
1-877-432-7232

Concerns about fraud, waste or abuse of SNAP, Medicaid, TANF or Children's Health Insurance Program (CHIP) services or benefits.

Office of Inspector General

1-800-436-6184

The Children with Special Health Care Needs Services Program, within the Division for Family and Community Health Services, which provides services to children with extraordinary medical needs, disabilities and chronic health conditions.

Texas Department of State Health Services

1-800-252-8023

For child support services including the collection of court-ordered child support, information about the Crime Victims Compensation Fund and enforcement of the state's consumer protection laws.

Office of Attorney General

1-800-252-8011

For information on early intervention services for children with disabilities and developmental delays, vocational rehabilitation for persons with disabilities, services for people who are deaf or hard of hearing or people who are blind or visually impaired, and for information on disability determination services.

Texas Department of Assistive and Rehabilitative Services

1-800-628-5115
TTY number 1-866-581-9328

Information and assistance concerning family violence.

National Domestic Violence 24-hour hot line

1-800-799-SAFE (7233) TTY number
1-800-787-3224

Medicaid

Question or Concern Organization Telephone Number

Help finding or questions about a doctor, dentist or case manager for a person age 20 or younger.

Texas Health Steps

1-877-847-8377

For transportation assistance to a doctor's appointment.

Medical Transportation (HHSC)

1-877-633-8747

Helps individuals enrolled in STAR, STAR+PLUS or Primary Care Case Management (PCCM) with Medicaid managed care issues.

HHSC Medicaid Managed Care Helpline

1-866-566-8989

Questions about which services are covered by Medicaid, or help when a bill is received from a Medicaid provider, or questions about Medically Needy with Spend Down cases.

Statewide Medicaid help line

1-800-335-8957

Questions about enrolling in the STAR Managed Care Program or help changing a health plan.

State of Texas Access Reform (STAR)

1-800-964-2777

 

C—1470 Eligibility Environments

Revision 15-4; Effective October 1, 2015

 

All Programs

Texas Works serves applicants and recipients in Texas through a variety of eligibility environments. The following is a brief summary of each type.

Local eligibility offices: HHSC staff conduct business in a face-to-face environment with people seeking information or applying for health and human services programs. Interviewing tasks are performed at the local eligibility office either in person or by telephone.

The eligibility staff in local offices provide information and application assistance, receive applications, perform Data Broker and other third-party inquiries, collect data, assess missing information, determine eligibility, issue benefits, and perform other tasks associated with eligibility services operations. Work is processed by eligibility staff in local offices in TIERS. Individuals are assigned to specific offices and a single eligibility worker processes an EDG until it is disposed as approved or denied.

Eligibility staff in a local office process multiple types of assistance: SNAP, Medicaid, CHIP, and TANF. Eligibility staff in the offices work all types of EDGs/cases; however, some offices may have specialized staff based on workload. Clerical staff handle front desk and lobby-area tasks, telephones, mail, faxes, scheduling and other support duties.

Vendor staff creates and routes tasks for applications received via mail or fax to staff in the local eligibility offices or changes received via telephone, mail or fax to staff in the Customer Care Centers (CCCs). The vendor may register a new application or reschedule an appointment, then route the interviewing tasks to local eligibility offices. Applications, redeterminations and changes submitted online through YourTexasBenefits.com are routed to the appropriate areas by the State Portal.

Centralized units: These units are able to specialize in certain programs or tasks and conduct eligibility work through the mail and by telephone without face-to-face contact. The centralized units help balance the workload of local eligibility offices. In a centralized unit, tasks are assigned based on due dates. Centralized functions have centralized mail, centralized telephone systems and do not require lobby space as eligibility offices do. Centers also have staff to answer telephones and provide status information, in addition to the staff working the cases.

 

C—1471 Specialized and Centralized Casework Units

Revision 18-1; Effective January 1, 2018

 

The following chart details various specialized and centralized casework units.

Centralized Units That Serve Both Texas Works (TW) Programs and Medicaid for the Elderly and People with Disabilities (MEPD) Programs

Unit Name Description
Centralized Representation Unit (CRU) The CRU files appeal requests and assembles EDG information in preparation for hearings for TIERS cases. The CRU represents the agency at fair hearings and implements all decisions for EDGs statewide. Members of this unit are housed across the state in local eligibility offices. HHSC created the unit in September 2007, and the unit initially processed EDG actions resulting from TIERS fair hearings for both Texas Works and MEPD. More details are available in the Eligibility Services State Processes document. Staff must file all appeal requests using the Hearings and Appeal — Create Appeal functionality in TIERS, accessed through the left navigation menu. Form H4800, Fair Hearing Request Summary, which is sent directly to the hearings division, will be returned to staff with instructions to enter the information in TIERS.
Customer Care Centers (CCCs) The CCCs are located in Athens, Austin, El Paso, Houston and San Antonio. State staff, along with vendor staff, conduct business using the 2-1-1 Texas telephone system. CCC staff handle inquiries and concerns that vendor staff cannot resolve. The vendor creates tasks and routes non-interview changes received via telephone, mail, fax or the Self-Service Portal to state staff in the CCCs. The CCCs are supported by TIERS and by Eligibility Supporting Technologies, such as the Task List Manager and the State Portal. CCC state staff perform Data Broker and other third-party inquiries, collect data, assess missing information, determine eligibility, issue benefits, process individual- and agency-generated changes, perform other non-interview tasks, and process six-month income check task. CCC performs these functions, as applicable, for TW and MEPD.

The CCC operates Monday to Friday from 8 a.m. to 6 p.m. Central time (excluding state holidays).

Below are some helpful toll-free numbers:
  • 800-645-7164 — CHIP provider toll-free telephone line
  • 877-543-7669 (877-KIDS-NOW) — CHIP and Children’s Medicaid toll-free telephone line
  • 800-735-2988 or 7-1-1 — TDD/TTY users (Relay Texas)

Effective Jan. 15, 2013, HHSC centralized the clearance of Income Eligibility and Verification System (IEVS) Internal Revenue Service (IRS) data matches for TW and MEPD. Data matches that OIG identifies for each program are processed by CCC staff.

HHSC set up CCCs with the Integrated Eligibility and Enrollment pilot rollout in January 2006.

Assistance Response Team (ART) ART staff housed throughout the state serve as on-site support to regional staff. These state staff offer TIERS technical support for Texas Works and MEPD on-the-job trainings (OJT), conduct clerical OJTs, offer TIERS technical support to eligibility staff (offer pre-ticket support to all regions to mitigate unneeded tickets), process Texas Works cases based on MEPD email box referrals and Health Insurance Portability and Accountability Act of 1996 (HIPAA) referrals for all regions, and assist State Office Data Integrity with merging assignments. HHSC set up ART with the Integrated Eligibility and Enrollment pilot rollout in January 2006.

 

Centralized Units That Serve Only MEPD Programs

Unit Name Description

MEPD

HHSC created a special statewide eligibility unit in January 2007 to process eligibility for MEPD programs. Statewide staff specialize in MEPD eligibility programs to help make sure MEPD casework is evenly distributed. Members of this unit are housed across the state in local eligibility offices.

 

Centralized Units That Serve Only Texas Works Programs

Unit Name Description
Centralized Benefit Services (CBS) Staff in this centralized Austin location process SNAP EDGs for households in which all members get Supplemental Security Income (SSI), using specialized automation that supports the modified eligibility requirements for these households. In addition, the unit also processes applications and redeterminations for:
  • SNAP Combined Application Project (SNAP-CAP) EDGs;
  • Medicaid for Breast and Cervical Cancer (MBCC);
  • Medicaid for children under the jurisdiction of the juvenile court and for youth under age 19 in non-secure facilities;
  • Medicaid for Transitioning Foster Care Youth (MTFCY);
  • Former Foster Care Children (FFCC); and
  • Medicaid for inmates of a public institution;
and applications for:
  • Former Foster Care in Higher Education (FFCHE) health care benefits program.
Appointed staff process Medicaid requests for babies who are born to mothers incarcerated in Texas. Most babies receive ongoing Medicaid, but factors such as with whom the baby will reside or if the baby will remain in Texas may affect eligibility.

When the baby cannot be certified for ongoing newborn Medicaid, the EDG is referred to Data Integrity to add coverage for the birth of the baby under a state-paid medical program.
Children's Medicaid Center (CMC) Centralized CMCs process applications and/or renewals for Children's Medicaid and CHIP, but do not process other associated-program case actions, to ensure a streamlined, timely approach. The CMCs are located in regions across the state:
  • Region 3 (Dallas Metroplex)
  • Region 6 (Houston)
  • Region 8 (San Antonio)
  • Region 11 (Rio Grande Valley)
Currently, Regions 3, 6 and 8 have CMCs to process applications and renewals for Children's Medicaid and CHIP for their respective regions.
Region 8 Central Processing Unit Staff in this centralized Region 8 location process applications and redeterminations for all SNAP-interviewed applications from the Community Partners Interviewer (CPI) Project. This single regional structure simplifies reporting and data gathering; centralizes EBT activities under one EBT coordinator, which streamlines record keeping and adds integrity to the EBT accounting and audit functions; adds efficiency to training activities since there is one location for staff; and enhances accountability as all regional activities will be under one management structure.

The five CPI project food banks as of June 2011 were:
  • Houston Food Bank
  • North Texas Food Bank
  • San Antonio Food Bank
  • Tarrant Area Food Bank
  • South Plains Food Bank (limited to six counties in Region 1 — Bailey, Crosby, Floyd, Hockley, Lamb and Lubbock)
Healthy Texas Women (HTW) This center, located in San Antonio, processes statewide HTW applications, changes and renewals. The HTW center also process Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification, for CHIP perinatal mothers.