A-2340, Adverse Action | Texas Health and Human Services

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Revision 13-2; Effective April 1, 2013

All Programs

Any household receiving a notice of adverse action has the right to request a fair hearing. In some situations households may continue benefits pending an appeal.

Related Policy

Fair Hearings, B-1000

A—2341 Denial of an Application

Revision 17-2, Effective April 1, 2017

All Programs

Denials are effective immediately. Advisors must provide the applicant with Form TF0001, Notice of Case Action, stating the reason for the denial. Advisors must follow the procedures and time frames in B-100, Processes and Processing Time Frames.

Note: Advisors determine eligibility for multiple programs independently of each other and do not deny an application for one program based solely on the denial of another program unless the household fails to meet the eligibility requirements.

Medical Programs

The system automatically sends individuals determined ineligible for Medicaid and the Children's Health Insurance Program (CHIP) at application to the Marketplace for an eligibility determination for federal health care coverage programs.

To qualify for the federal health care coverage programs, all individuals must first be determined ineligible for Medicaid and CHIP. Advisors must test whether an individual is eligible for all Medical Programs. The Texas Works Medical Programs Hierarchy, explained in A-132.1, Medical Programs Hierarchy, does this automatically for all clients at application.

Notes:

Advisors must follow a manual process when retesting eligibility for a minor parent aging out of TP 44, a pregnant woman from TP 40 at the end of the certification period, or an individual at the end of the transitional Medicaid certification period, as explained in A-2342.1, Retesting Eligibility.
Pregnant woman whose TP 40 coverage terminates prior to the end of their original certification period may be eligible for automatic retesting of eligibility for all Medical Programs as explained in A-825, Medicaid Termination.

A—2342 Denial at Redetermination

Revision 17-2; Effective April 1, 2017

TANF

Process TANF EDGs found ineligible at review following adverse action procedures.

SNAP

Denials are effective immediately. Advisors provide the household with Form TF0001, Notice of Case Action, stating the reason for denial.

Timely Redeterminations — If a household applies by the 15th of the last month of their certification period and is ineligible, advisors use the policy and procedures in B-120, Redeterminations, to deny the EDG.

Untimely Redeterminations — If a household applies after the 15th of the last month of their certification period and is ineligible, advisors use the policy and procedures in B-110, Applications, to deny the EDG.

Medical Programs

The system automatically sends individuals determined ineligible for Medicaid and CHIP at redetermination to the Marketplace for an eligibility determination for federal health care coverage programs.

Notes:

Advisors must follow a manual process when retesting eligibility for a minor parent aging out of TP 44, a pregnant woman from TP 40 at the end of the certification period, or an individual at the end of the transitional Medicaid certification period, as explained in A-2342.1, Retesting Eligibility.
Pregnant woman whose TP 40 coverage terminates prior to the end of their original certification period may be eligible for automatic retesting of eligibility for all Medical Programs as explained in A-825, Medicaid Termination.

TP 08

Before denying for missing a redetermination appointment, advisors must determine whether the individual is eligible for TP 07 in the denial effective month. If so, advisors provide TP 07 rather than denying the EDG.

TP 43, TP 44 and TP 48

Advisors process a denial if the household fails to provide pending verification by the 30th day from the file date or by cutoff in the last benefit month of certification, whichever is later. Advisors do not provide 13 days advance notice prior to denying the EDG.

When an advisor processes a renewal, which results in a shortened Medicaid certification period, the household may be eligible for expedited CHIP enrollment as explained in D-1711, Expedited CHIP Enrollment.

A—2342.1 Retesting Eligibility

Revision 15-4; Effective October 1, 2015

TP 44, TP 40, TP 07 and TP 20

The advisor must retest the following clients' potential eligibility for other Medical Programs by manually running the Texas Works Medical Program Hierarchy explained in A-132.1, Medical Programs Hierarchy, from the beginning:

Minor parents aging out of TP 44, Children Ages 6-18;
Individuals under TP 40, Pregnant Women, once their certification period ends; and
Individuals terminated from TP 07 or TP 20, transitional Medicaid.

All other clients will flow through the hierarchy to either the next available program (for example, a child aging out of TP 48 will automatically be tested for TP 44) or will be referred to the Marketplace if determined ineligible for all other Medical Programs (for example, a non-parent child aging out of TP 44).

The system will not terminate eligibility of the individuals listed above at the end of the certification period. An advisor must take action to review the individual's eligibility and re-run the hierarchy to determine potential eligibility for other programs. Advisors must use the first day of the last month of the current certification period as the file date. Advisors should treat these cases like a redetermination without an actual renewal form. Except in the case of TP 40 where there may be an application, in which case advisors would process the case as they do redeterminations with renewal forms. Advisors must verify information as is currently done in the redetermination process.

The remaining individuals in the client's household composition are not re-evaluated for eligibility during a continuous eligibility period. Changes to household composition for the aging out of minor parents, end of pregnancy, or termination of transitional Medicaid coverage will be acted upon once the individuals transition from a continuous eligibility period to a non-continuous eligibility period.

Note: An interview is required when testing for TP 08.

A—2343 Advance Notice

Revision 15-4; Effective October 1, 2015

All Programs

After approval, advisors give households advance notice of adverse actions to deny, terminate, lower, or restrict existing benefits except for reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice), and A-2344.2, No Form TF0001 Required.

A—2343.1 How to Take Adverse Action if Advance Notice Is Required

Revision 20-4; Effective October 1, 2020

All Programs

TIERS provides 13 days advance notice to the household after informing them of a denial or termination of ongoing benefits using Form TF0001, Notice of Case Action. The day Form TF0001 is sent is day zero of the adverse action period.

If the 13-day advance notice period:

does not expire until after the last day of the month (regardless of whether the 13th day is a business day), the household is eligible for the same level of benefits the month after the notice was sent.
expires between cutoff and the end of the month, the reduction or denial is effective the following month. Note: Do not deny TP 40 EDGs when taking adverse action for failure to provide postponed verification.

TANF

Provide 13 days advance notice to the household using Form TF0001 before taking action to:

establish a protective payee; or
continue a protective payee because of mismanagement.

To establish a protective payee because the person mismanaged TANF benefits, follow advance notice policy above.

At complete redetermination, re-evaluate the situation to determine whether the protective payee should continue. If the decision is to continue, notify the person by sending Form TF0001.

If the person appeals this decision, issue TANF benefits to a protective payee until the hearing is completed.

Medical Programs

A person applying for Medicaid who declares U.S. citizenship or an eligible alien status, but for whom verification is unavailable, receives a 95-day period of reasonable opportunity to provide verification of citizenship or alien status. The reasonable opportunity period expires on the 95th day from when the TF0001 was generated. Deny the person and provide 30 days advance notice of adverse action to the household if they do not provide verification of citizenship or alien status.

Related Policy

Reasonable Opportunity, A-351.1

A—2344 Adverse Actions Not Requiring Advance Notice

Revision 13-2; Effective April 1, 2013

A—2344.1 Form TF0001 Required (Adequate Notice)

Revision 15-4; Effective October 1, 2015

All Programs

The following situations require that the household be provided adequate notice:

The individual's location is unknown, and the post office returns Texas Health and Human Services Commission (HHSC) mail with no forwarding address.
The head of the household, authorized representative or other responsible household member:
- in the HHSC advisor's presence (in the office or by telephone) verbally volunteers to withdraw; or
- gives HHSC a written, signed report of change, and the advisor determines the:
  - exact amount of the reduced benefits, or
  - that the household is ineligible.
  Note: This includes situations in which the advisor receives Form H1028, Employment Verification, signed by the individual and completed by the employer.
The household reports in advance they will move out of state.
Employment and Training (E&T) noncooperation is received in the last benefit month.

Related Policy

How to Report, B-623
Sending Notice of Failure to Cooperate, A-1845.1

TANF and Medical Programs

In the following situations, advisors send Form TF0001, Notice of Case Action, without advance notice:

The advisor denies or reduces benefits when an individual reaches the maximum age as described in A-220, TANF, and A-240, Medical Programs.
The advisor confirms the individual's or payee's death when no relative is available to serve as new payee.
The advisor reduces the grant or denies a Medical Program individual because the individual received a new TANF or SSI grant.
The advisor imposes a full-family sanction because of noncooperation with one or more Personal Responsibility Agreement (PRA) requirements.
The advisor denies a TP 08 individual because of noncooperation with medical support.
The individual was admitted/committed to an institution and no longer qualifies for TANF or Medical Programs benefits.
The individual was placed in skilled nursing care or intermediate care.
The advisor denies a TANF or TANF-State Program (SP) EDG because the caretaker or second parent received their lifetime limit of 60 months.
HHSC verifies an individual is certified for SSI or TANF in another state.
A TANF or Medical Program child is removed from the home by court order or voluntarily placed in foster care by the legal guardian.

Related Policy

The Texas Works Message, A-1527

SNAP

In the following situations, advisors send Form TF0001 without advance notice:

The household fails to provide verification postponed during expedited services, or provides postponed verification that results in lowered or denied benefits.
The advisor discovers information an expedited household failed to report. The information:
- - exists on the interview date,
  - results in lowered or denied benefits, and
  - is discovered between the time the application is approved with postponed verification and on or before the 30th day.
A drug and alcohol treatment/group living arrangement facility loses its status as authorized representative or loses its certification.
Centralized Benefit Services (CBS) contacts field staff to deny the SNAP EDG in order to certify the SNAP Combined Application Project (SNAP-CAP) EDG. Note: If the SNAP-CAP applicant is certified for SNAP with other household members, allow advance notice of adverse action before removing the individual from the existing SNAP EDG.

Related Policy

General Policy, A-710
Information Received During Expedited Application Processing, B-116.1

A—2344.2 No Form TF0001 Required

Revision 15-4; Effective October 1, 2015

All Programs

Form TF0001, Notice of Case Action, is not required in the following situations:

the state or federal government initiates mass changes that affect the entire caseload or significant portions of the caseload, such as the annual Social Security cost-of-living adjustment.
the household moves out of state and reports it afterward.
the household gives HHSC a written, signed request to voluntarily withdraw.

TANF

Form TF0001 is not required when child support collected by the Office of the Attorney General exceeded the amount of the grant plus the $75 disregard. In these cases, state office sends Form H1718, Notice of Benefit Denial, to the individual.

SNAP

Form TF0001 is not required in the following situations:

All members of a household have died.
The individual's allotment changes from month to month during the certification period because of changes expected at the time of certification. In this situation, inform the individual on Form TF0001 at the time of certification that the household's allotment will vary.
The individual applied for TANF and SNAP at the same time and received SNAP while waiting for approval of the TANF grant.