Revision 24-4; Effective Dec. 1, 2024

Revision 25-3; Effective Sept. 1, 2025

The medical effective date (MED) is the first day of the month an applicant meets all eligibility criteria. The MED may be up to three months before the date of application if:

• the person had unpaid or reimbursable medical expenses, whether the person is alive or not when the application is made; or
• the person entered a nursing facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID), or state supported living center.

The MED is used to initiate all medical benefits to the person and payments to providers.

The MED for Community Attendant Services is the first of the month that:

• the application was received; or
• an eligibility decision was made.

MED for Home and Community-Based Waiver Services after a Denial for No Renewal Packet

Financial eligibility for prior and ongoing months requires verification that the person received waiver services when re-establishing an MED for Home and Community-Based Services (HCBS) waiver services after a denial for failure to return a redetermination packet.

Coordinate financial case actions with a waiver case manager.

The following examples are for the financial Medicaid eligibility component for waivers and are not intended to address any situation with continuous QMB benefits.

• Example 1: TIERS denies a case for failure to return the redetermination packet effective June 30. In October, the person returns the redetermination packet. Staff process the redetermination as an application. The person meets all financial eligibility criteria for October and all months since the denial. Staff receive verification that the person received waiver services continuously since June. The MED is July 1, and there is no break in coverage.
• Example 2: TIERS denies a case for failure to return the redetermination packet effective March 31. In October, the person returns the redetermination packet. Staff process the redetermination as an application. The person meets all financial eligibility criteria for October and all months since denial. Staff receive verification that the person received waiver services continuously since March. The MED is July 1. There is a break in coverage because the MED is the first day of the month up to three months before the receipt of the application or redetermination.
• Example 3: TIERS denies a case for failure to return the redetermination packet effective Jan. 31. In June, the person returns the redetermination packet. Staff process the redetermination as an application. The person meets all financial eligibility criteria for February and all months since denial. Staff receive verification that waiver services stopped effective Feb. 28. The MED is June 1 or the first day of the month waiver services begin. There is a break in coverage.

Related Policy

General Information for Denials and Terminations, B-9100
Qualified Medicare Beneficiaries, Q-2000
QMB Medical Effective Date, Q-2700
Qualified Disabled and Working Individuals (QDWI), R-1230

R-1210 Medicare Skilled Nursing Facilities

Revision 12-2; Effective June 1, 2012

The medical effective date for a person in a Medicare skilled nursing facility (SNF) potentially can be as early as the first day of the month of entry to the nursing facility or the first day of a prior month. If eligible, this will ensure payment of any other medical expenses (including returns to the hospital during the initial 20 days of full Medicare coverage). At certification, the eligibility worker must verify and document in TIERS case comments section that the individual:

• remains in the SNF section; or
• has been discharged to a Medicaid-certified facility.

Medicare approval of the applicant for the SNF bed meets the medical necessity (MN) requirement. If the MED is prior to the applicant's move to the Medicaid-only bed, the MN requirement has been met.

Note: If the person remains in the SNF when the case is certified, it is recommended that a special review be scheduled to monitor for the completed MN determination when SNF does end.

See Chapter H, Co-Payment, for issues related to the 30 consecutive day stay requirement and the appropriate income limit.

Examples:

• Marsha Ford is admitted to an SNF as full Medicare on 11-15-XX. The 21st SNF day is 12-05-XX. The application is received 12-14-XX. Application is ready to certify 01-03-XX. The eligibility worker verifies that Ms. Ford has unpaid/reimbursable hospital bills for 11-XX. Ms. Ford is still in the SNF bed and has met all eligibility criteria as of 12:01 a.m. 11-01-XX. MED = 11-01-XX. Co-payment begins 12-05-XX.
• Fred McDaniel is admitted to an SNF as full Medicare on 03-24-XX. The 21st SNF day is 04-13-XX. The application is received 04-05-XX. He is discharged from the SNF to a Medicaid bed on 05-20-XX. Application is ready to certify 06-15-XX. Mr. McDaniel meets all eligibility criteria as of 12:01 a.m. 03-01-XX. MED = 03-01-XX. Co-payment begins 04-13-XX. MN is not necessary, as MED is prior to discharge to Medicaid-only bed.

R-1220 Out-of-State Transfers

Revision 12-2; Effective June 1, 2012

If a person from another state declares an intention to live in Texas and meets Texas eligibility requirements, contact the Medicaid agency of the former state of residence. Request that the agency notify HHSC about Medicaid eligibility and the denial, including its effective date. The denial effective date is the last day for which the person's former state of residence will pay Medicaid claims. This is not necessarily the denial effective date on the former state's computer system.

Texas residency is met the first day of the month of move to Texas with the intent to remain in Texas.

If the person did not receive any form of Medicaid in the former state of residence, the earliest MED is the first day of the month of move to Texas, regardless of the actual date of the move. Follow MED policy for month of application and three months prior.

Exception: For QMB, coverage begins the first of the month after eligibility is determined.

If the person did receive Medicaid in the former state of residence, the MED for the person in Texas is no earlier than the day following the date his/her former state of residence will pay Medicaid claims.

If an out-of-state person receives SSI and indicates that he/she intends to live in Texas, refer him/her to a Social Security office. That office makes the SSI (and Medicaid) residence determination.

Examples:

1. A person was not receiving any form of Medicaid in another state, moved to Texas on July 7 and applied to have the Medicare premium paid. The application for Medicare Savings Programs was filed on July 28. The person met all eligibility criteria in July for Specified Low Income Medicare Beneficiaries (SLMB).
   
   The MED for SLMB is July 1. Prior months would not be applicable in this situation because the person did not reside in Texas before July.
2. A person was not receiving any form of Medicaid in another state, moved to Texas on July 30 and entered a nursing facility (NF) that day. An application for MEPD was filed on Aug. 14. The individual met all eligibility criteria in July for Medicaid and QMB.
   
   In this situation, July is a prior month. Because coverage for a prior month must begin the first day of that month, the MED is July 1. The MED for QMB in Texas is the first day of the month following the month in which QMB eligibility is determined.
    
3. A person was receiving Medicaid in another state, moved to Texas on Jan. 15 and entered an NF that day. The application for ME – Nursing Facility was filed on Feb. 10. Medicaid coverage in the other state ended on Jan. 15. The individual met all eligibility criteria in January.
   
   In this situation, January is a prior month. Because coverage for a prior month must begin the first day of that month, the MED would normally be Jan. 1. If the MED were reported as Jan. 1, there would be federal financial participation (FFP) for two states for the same time period (Jan. 1-15), which is prohibited by federal regulations. Because the correct MED in this case is Jan. 16, the file date must be adjusted to reflect the date following Medicaid closure in the other state, or Jan. 16. Case comments should explain the file date discrepancy.
4. A person was an SSI recipient in another state and moved to Texas on July 7.
   
   Because the Social Security Administration (SSA) determines SSI entitlement, HHSC uses the effective date in Texas as communicated by the State Data Exchange (SDX) tape. This date should be the first day of the month following the month in which the SSI recipient moves to Texas.
    
5. A person who was a QMB recipient in another state, moved to Texas on July 7 and applied to have the Medicare premium paid. The application for Medicare Savings Programs was filed on July 28.
   
   If QMB coverage in the other state ended during July, the effective date of QMB coverage in Texas should be no earlier than Aug. 1. The other state is payer of record for Medicare buy-in for July 1993 and receives FFP for that purpose. Any buy-in attempt by Texas for that month will be rejected by the federal system. Because of the prohibition against dual FFP, QMB eligibility cannot be divided between two states for a given month.
    
6. The person received ME – Nursing Facility with Q benefits in a Texas NF, but moved out-of-state in April and began receiving Medicaid in the other state. The person returned to a Texas NF on Nov. 15 and applied for MEPD on Nov. 15. The person never received QMB benefits in the other state, although he/she appears to have been eligible since leaving Texas.
   
   The other state will pay no claims after Nov. 15; therefore, the MED for ME – Nursing Facility with may be no earlier than Nov. 16, because November is the month of application. In this situation, there is no continuous Q to ensure. The person did not have QMB coverage in the other state, and HHSC cannot grant QMB coverage for the period of time he/she lived out of state, as he/she was not a Texas resident. The effective date of QMB coverage in Texas is the first day of the month following the month in which QMB eligibility is determined.

R-1230 Qualified Disabled and Working Individuals (QDWI)

Revision 09-4; Effective December 1, 2009

The MED is influenced by whether a person enrolls for Medicare coverage during the initial enrollment period (IEP) but before his/her present Medicare entitlement ends, after the IEP begins but after his entitlement ends, or following the IEP. HHSC considers the date the person enrolled for continuation of his Medicare entitlement when determining the MED. The MED does not precede the earliest date the person is entitled to reinstatement of his/her Part A coverage. Otherwise, use the same procedures for determining the MED for all other MEPD non-institutional groups (including retroactive coverage).

The following chart may be used as a reference for the MED determination policies and examples.

The following apply when determining the MED:

• The IEP for a person who has been notified that his free entitlement to Medicare Part A coverage will end is a seven-month period. The enrollment period begins the month the person is notified.
  
  Example: A person is notified in April that his free entitlement to Part A coverage ends at the end of June. His initial enrollment period begins in the month of notification (April) and ends at the end of October. To reinstate his Part A coverage, he must enroll with SSA before the end of October. He then must apply with the department for QDWI benefits.
   
• In the case of a person who enrolls in an IEP before meeting QDWI criteria and applies for QDWI benefits, the MED is the first day of the month he meets the QDWI criteria.
  
  Example: A client is notified in April that her free entitlement to Medicare Part A coverage ends at the end of June. She enrolls for reinstatement of her Part A coverage with SSA in April and applies for and is determined eligible for QDWI benefits with HHSC in May. The earliest MED she can have for QDWI benefits is July 1 because it is the first month she meets QDWI criteria and is allowed to purchase Part A coverage.
   
• If a person enrolls in the first month that he meets all QDWI criteria except for reinstatement (fourth month of the initial enrollment period), and applies for QDWI benefits, the medical effective date is effective the first of the following month.
  
  Example: A person is notified in April that his free entitlement to Medicare Part A coverage ends at the end of June. He enrolls for reinstatement of his Part A coverage with SSA in July and applies for and is determined eligible for QDWI benefits in July. The earliest MED date he can have for QDWI benefits is August 1 because that is the first month he is entitled to reinstatement of his Part A coverage.
• If a person enrolls in the second month that she meets all QDWI criteria except for reinstatement (fifth month of the IEP) and applies for QDWI benefits, the medical effective date is effective the second month after enrollment.
  
  Example: A person is notified in April that her free entitlement to Medicare Part A coverage ends at the end of June. She enrolls for reinstatement of her Part A coverage with SSA in August and applies for and is determined eligible for QDWI benefits in September. The earliest MED she can have for QDWI benefits is October 1 because that is the first month she is entitled to reinstatement of her Part A coverage.
   
• If a person enrolls in the third or fourth month that he meets all QDWI criteria except for reinstatement (sixth or seventh month of the IEP) and applies for QDWI benefits, the MED is effective the first day of the third month following the month he enrolled.
  
  Example: A person is notified in April that his free entitlement to Medicare Part A coverage ends at the end of June. He enrolls for reinstatement of his Part A coverage with SSA in September and applies for and is determined eligible for QDWI benefits in October. The earliest MED he can have for QDWI benefits is December 1 because that is the first month he is entitled to reinstatement of his Part A coverage.
• If a person enrolls during the general enrollment period (GEP), the MED is always effective July 1.
  
  Example: A person is notified in April that her free entitlement to Medicare Part A coverage ends at the end of June. She does not enroll during the IEP and decides to enroll during the GEP, from January through March 31, of the next year. The earliest MED she is allowed is the July 1 following her enrollment.

Revision 25-4; Effective Dec. 1, 2025

When processing an application, redetermination or change, notify the person and their authorized represented (AR) of the eligibility determination and any applicable co-payment.

Mail the written notice to the person and AR within two business days of the date of the eligibility decision. All information on the notice must be accurate. All notices must be in plain language and follow agency accessibility policy.

For Eligibility:

Include the medical effective date (MED) and any co-payment amount on the eligibility notice.

Note: For Mason Manor cases, refer to Appendix XXIII, Procedure for Designated Vendor Number to Withhold Vendor Payment, for the appropriate forms and explanation to send.

For Ineligibility:

On the ineligibility notice, include the reason for the decision and the appropriate chapter of this handbook that supports the decision.

More information on each notice and its purpose is provided below.

Approved Applications and Redeterminations

Denied Applications and Terminated Redeterminations

Changes

Note: Image all notices generated outside of TIERS for the case record.  Notices generated in TIERS can be viewed on the View History Correspondence page with the date they are generated.

Revision 09-4; Effective December 1, 2009

When a recipient in a long-term care facility is discharged to a Medicaid-certified hospital, the recipient continues to be eligible during his/her absence. Redetermine eligibility if the recipient does not re-enter the nursing facility after discharge from the hospital.

To monitor a recipient in a nursing facility who is discharged to a hospital, use a tracking system. This ensures prompt awareness of a change in the recipient's status, such as death or a return to the community after he/she is discharged to a hospital.

The following procedures are recommended for establishing a tracking system:

• Immediately upon receipt of Form 3618, Resident Transaction Notice, showing discharge to a hospital, establish a control record for the recipient. Use Form 3618 as the control record or prepare a card file record. The control file may be maintained separately by each eligibility specialist or centrally for all eligibility specialists in an office.
• At least every 15 calendar days, confirm the recipient's status and location. Contact the nursing facility first because the recipient may have been readmitted. If he/she has not returned to the facility, the facility may supply the name of the hospital or the authorized representative to determine if the recipient is still a patient. Follow up with the hospital or authorized representative every 15 days until the recipient returns to the nursing facility, is discharged to another living arrangement or dies.
• If the recipient is no longer in the hospital, remove the control record from the file and take action to update the case, if required.

Revision 12-2; Effective June 1, 2012

Revision 19-4; Effective December 1, 2019

When a person is certified for ongoing Medicaid benefits, a Your Texas Benefits Medicaid card is mailed, which should:

• be carried and protected like a driver license or credit card; and
• used when visiting a Medicaid provider (i.e., doctor, dentist, or pharmacy).

The Your Texas Benefits Medicaid card is plastic, like a driver’s license or credit card, and includes the following information printed on the front:

• person’s name and Medicaid ID number;
• managed care program name (if STAR Health);
• date the card was issued; and
• billing information for pharmacies.

The back of the card includes the statewide toll-free phone number where people can get more information on the Your Texas Benefits Medicaid card.

Each person certified for Medicaid in a household receives a Your Texas Benefits Medicaid card. It is intended to be the person’s permanent card.

If a person loses:

• Medicaid coverage but later regains coverage, the person can use the same Your Texas Benefits Medicaid card.
• Their Your Texas Benefits Medicaid card, they can request a replacement:
  • By logging onto their YourTexasBenefits.com account;
  • Calling 2-1-1 (after selecting language, select Option 2, and then Option 1); or
  • Calling 855-827-3748.

If the person forgets their Your Texas Benefits Medicaid card, a provider (i.e., doctor, dentist or pharmacy can) verify Medicaid coverage by:

• calling the Texas Medicaid and Healthcare Partnership’s (TMHP) Contact Center at 800-925-9126; or
• visiting Texas Medicaid and Healthcare Partnership’s (TMHP's) TexMedConnect website using the person’s Medicaid ID number or one of the following combinations for the person:
  • Social Security Number (SSN) and last name;
  • SSN and date of birth (DOB); or
  • last name, first name, and DOB.

If a person needs quick proof of eligibility they can: 

• log in to their www.YourTexasBenefits.com account to print a temporary card; or   
• go to a local benefits office to request a card. Staff in the office will:
  • assist the person in accessing and printing a Medicaid card from the person’s www.YourTexasBenefits.com account from the office’s lobby computer; or
  • generate a temporary Form H1027, Medicaid Eligibility Verification via TIERS if the person prefers not to or has trouble accessing their Medicaid card online.

A Your Texas Benefits Medicaid card is not issued for residents of a state supported living center because Medicaid state institutions are responsible for all medical care for Medicaid-eligible residents. Each state institution is sent a monthly listing of all Medicaid individuals currently shown on computer files as living in that facility.

Note: A Your Texas Benefits Medicaid card is not issued to Community Attendant Services (CAS) recipients. A person with CAS receives a Your Texas Benefits Medicaid card only if they are also eligible for the Qualified Medicare Beneficiary Program (QMB). No other Medicare Savings Program (MSP) generates a Medicaid card.

Related Policy

Issuance of Form H1027, Medicaid Eligibility Verification, R-2400

Revision 16-3; Effective September 1, 2016

Occasionally, a recipient who needs medical services may lack current medical care identification.

HHSC may issue a Medicaid verification letter to an eligible Medicaid recipient who lacks a Your Texas Benefits Medicaid ID card if the:

• recipient is newly certified and has not received the initial card; or
• current card has been lost or destroyed.

Note: Do not issue Form H1027 to Community Attendant Services, SLMB or QDWI individuals (ME-Community Attendant with no QMB, MC-SLMB and MC-QDWI).

Form H1027 is issued in three versions. Issuance of the appropriate version of Form H1027 is dependent on the benefits the recipient is currently eligible for and receiving. Following is a brief description of each version of Form H1027.

Form H1027-A, Medicaid Eligibility Verification, is issued to recipients who are eligible for and receiving Medicaid benefits only.

Form H1027-B, Medicaid Eligibility Verification – MQMB, is issued to recipients who are eligible for and receiving both Medicaid and Qualified Medicare Beneficiary (QMB) benefits.

Form H1027-C, Medicaid Eligibility Verification – QMB, is issued to recipients who are eligible for and receiving QMB benefits only. Do not issue Form H1027-C to recipients who are receiving Medicaid benefits.

Reference: For additional information regarding client eligibility for QMB, see Chapter Q, Medicare Savings Programs.

Reminder: To ensure that the appropriate form is issued to an eligible person, only intake screeners and TANF, Medicaid, LTC (ME/CCAD), foster care or adoption assistance eligibility specialists and supervisors are authorized to complete the form.

Form H1027-A, Form H1027-B or Form H1027-C must be issued only to eligible persons who need verification of their current eligibility for benefits and who have no access to a current Your Texas Benefits Medicaid ID card. The forms are issued only for the current month and never for retroactive periods of eligibility.

Verify a recipient's current eligibility by:

• contacting Data Integrity; or
• checking inquiry in TIERS.

Note: If unable to verify the recipient's eligibility because of computer problems, follow regional procedures to verify eligibility.

After verifying eligibility, complete the appropriate Form H1027.

After completing the appropriate Form H1027, have the form approved, signed and dated by the unit supervisor. The supervisor may also approve the form by telephone. If obtaining the supervisor's approval by telephone, note "by telephone" on the approval line. If the unit supervisor is not available, the lead eligibility specialist in the locality may approve the form.

Reference: For additional information about issuing Form H1027, refer to the instructions. See Chapter B, Applications and Redeterminations, for emergency manual certification procedures.

Revision 12-2; Effective June 1, 2012

Form H3086, Explanation of Benefits (EOB), is mailed each month to a random sample of Medicaid recipients. The EOB is a statement of all Medicaid services that were billed and paid on the recipient's behalf in the preceding month.

The EOB is mailed with a return envelope. If a recipient has a question about reported Medicaid services, the recipient circles the service in question, enters a contact telephone number and returns the EOB to state office. The recipient can call 1-800-252-8263 if questions arise about the EOB information.

If a recipient contacts HHSC about a questionable EOB, explain the purpose of the EOB. If a question still exists, instruct the recipient to mail the EOB to:

Office of Inspector General/Medicaid Provider Integrity
Mail Code 1361
P.O. Box 82500
Austin, TX 78708-9920

If the EOB is readily available, record on the EOB the recipient statement about the discrepancy. (Example: "Client states she has never seen a Dr. Jones.")

After an EOB is returned to state office, the EOB analyst checks the service in question for possible billing errors. If a billing error is found, appropriate action is taken to correct the files. The EOB analyst notifies the recipient that correction has been made. If no billing error can be found, the EOB is referred to the appropriate local office for a contact with the recipient.

When an EOB from state office is received, attempt to contact the recipient and discuss the reason for returning the EOB. The contact may be by telephone, office visit or home visit. Do not contact the provider of service under any circumstance.

If the recipient did not understand the purpose of the EOB, or if the problem can be resolved by talking to him/her, check the appropriate box on the EOB-Form Letter (FL) 1 and return the EOB-FL 1 and EOB to state office.

If the recipient alleges that the service in question was not received, reports an additional charge or reports other problems in relation to the service questions, check the appropriate box, record the recipient's statement in the space provided on the EOB-FL 1 and return the EOB-FL 1 and EOB to state office. (A cover memorandum is not necessary.) After the EOB is returned to state office, the EOB is referred to the Texas Medicaid and Healthcare Partnership (TMHP) for further investigation, and no further action on the part of the eligibility specialist is required.

If a provider of services has questions about an EOB, explain the purpose of the EOB. If additional information is requested, or a service listed is in question, ask the provider to telephone TMHP using the provider contact information below:

• Automated Inquiry System (AIS) – 1-800-925-9126
• TMHP Contact Center – 1-800-925-9126

Reminder: Only services billed and paid appear on the monthly EOB.

Revision 14-1; Effective March 1, 2014

Revision 12-2; Effective June 1, 2012

Occasionally, for purposes of receiving assistance from drug companies or other private entities, a person will request a pre-screening for Medicaid in conjunction with a request for a letter to substantiate the results of the pre-screening.

Form H1035, Pre-Screening Result for Medicaid, is used to notify an interested person of the pre-screening results for Medicaid if:

• the notice is requested by the person;
• the pre-screening is based on a verbal conversation;
• an official determination of eligibility is not conducted; and
• the person does not appear eligible for Medicaid.

Revision 12-2; Effective June 1, 2012

When taking an application, designated staff complete Application Registration. Applications are tracked using TIERS and Data Mart reports.

When the application is for a person who is younger than 65 and has never had a disability determination, the eligibility specialist must pend for Disability on the Disability – Details page and run Eligibility Determination and Benefit Calculation (EDBC) to override the application due date default of 45 days. The application due date will be 90 days from the file date. If the application is not pended appropriately, the application will be delinquent in 45 days.

Sometimes an application cannot be certified before the 45th/90th day. In these cases complete Form H1215, Report of Delay in Certification, and submit the form for approval. Once approval for the delay is received, send Form H1247, Notice of Delay in Certification, to the applicant and the facility administrator. Enter appropriate information in TIERS to initiate the delay in certification.

Note: Do not send Form H1247 if certification is delayed because Home and Community-Based Services waiver services are pending. No notification is required for those cases because services have not yet begun.

Applications for which delay-in-certification procedures have been followed are excluded from the delinquent count in timeliness reports. However, the exclusion is only for a specific period of time, as follows:

• Applications for persons age 65 or older are excluded for 135 days (45 + 90-day extension); however, if the application is still pending on the 136th day, it will be counted as delinquent.
• Applications for persons under age 65 who have never had a disability determination are excluded for 180 days (90 days + 90-day extension); however, if the application is still pending on the 181st day, it will be counted as delinquent.

Applications that cannot be certified within the normal 45/90-day limit, plus the 90-day extension, must be denied. A new application will be necessary to reconsider eligibility.

TIERS Delay Reasons Drop-down

• 30-day consecutive requirement not met
• Medical necessity decision is pending
• Level of care decision is pending
• Disability determination pending
• Home and Community-Based Services waiver services pending
• Nursing facility pending certification
• New resource/information received after 30th day
• Resource spend-down
• Miscellaneous
• CC Pending
• Documentation of citizenship and identity
• Legal review of documents

Revision 12-2; Effective June 1, 2012

When an application for assistance is entered into the system for the first time a unique 10-digit application number is assigned. The application number begins with the letter T. The letter T changes to the number one when the application moves to Data Collection and becomes a case. The case number is unique to that household. The household members may consist of more than one individual on more than one HHSC programs including Texas Works as well as MEPD programs.

If a certified member of the household leaves the household and establishes a new household, a new case is created and a new case number is assigned for the member who left the original household.

R-3210 Association of Case Number

Revision 12-2; Effective June 1, 2012

When a former recipient reapplies for assistance during File Clearance, determine if the individual should be associated to a former case number. This includes associating a former case number to a person who applies for ME – A and D-Emergency.

Revision 12-2; Effective June 1, 2012

The first time a person is certified by HHSC, a unique client/individual number is automatically assigned by state office. Once assigned, the number must be used by all program areas. The client/individual number is used in the system to locate identification information, certain types of income, Medicaid coverage and the numbers for all Edges in which the person appears.

Individuals certified under the legacy system (SAVERR) had their client numbers changed to nine-digit individual numbers at TIERS conversion.

R-3310 Association of Client/Individual Number

Revision 12-2; Effective June 1, 2012

During application registration, a procedure called File Clearance is performed on each individual that is recorded on the Individual Logical Unit of Work (LUW).

File Clearance is a process that compares the demographic information for an applicant (SSN, name, date of birth, gender and so on) against information in the Master Client Index (MCI). The MCI is a database containing information on all individuals known to the agency. Known to the agency means the individual has been on an application or case in either TIERS or the SAVERR legacy system.

File Clearance identifies and displays individuals whose information may match the application individual. If a match occurs, staff must investigate the matches to determine whether the applicant is in fact one of these people, or is a person completely new to the agency. The purpose of this process is to avoid duplicate individual information and duplicate cases or applications by reassigning the existing client/individual number.

Note: TIERS scores a match at 100% only when the first name, last name, SSN, DOB and gender are provided and that information matches an existing individual. Many instances exist where no Social Security number is available, and it sometimes is not required; therefore, staff should not assume the person is new to the system when the score is not a 100% match. Staff must be sure the person is new to the system before creating a new client/individual number and avoid creating multiple client/individual numbers for the same person.

When an individual is a match for an applicant, staff have various options that depend on whether the need is to match the application to an entire case or only to selected individuals. Associate the application to an existing TIERS case or application, or add TIERS individuals from an existing case to the new application.

Revision 25-4; Effective Dec. 1, 2025

There may be situations when a person is incorrectly assigned more than one client or individual number or when two or more people are assigned the same client or individual number. Resolve the situation by requesting to merge or separate the client or individual numbers, depending on the situation.

Use the Merge/Separate functional area on the TIERS left navigation bar and the following procedures to request a merge or separate.

Merge

Use Request Merge when a single person has more than one Individual number.

• Enter two to 10 Individual numbers to be merged. Enter the mandatory comments explaining the reason for the merge request.
• After entering the Individual number in the Individual number field and clicking on the Add button, TIERS displays the demographic information associated with that Individual number in the Selected Individuals section. If it is not the correct person, delete the entry using the delete icon, or use the binoculars icon to search for the individual using demographic data. This is like the individual search in Inquiry.
• Once all the Individual numbers and mandatory comments are entered, click the Submit button to send the request to Data Integrity.

Separate

Use Request Separate when more than one person is assigned to a single Individual number.

• Enter one Shared Individual number and up to three Individual numbers to be separated. Enter mandatory comments explaining the reason for the separate request.
• After entering the Individual number in the Shared Individual number field or demographic information and clicking on the Add button, TIERS displays the demographic information related to that Individual number in the Selected Shared Individuals and Shared ID above is to be separated to these individuals sections if it is not the correct person. Delete that entry using the delete icon or use the binoculars icon to search for the individual using demographic data, like the individual search in Inquiry.
• Once all the Individual numbers and mandatory comments are entered, click the Submit button to send the request to Data Integrity.

When a merge or separate request already exists, it cannot be requested again, and TIERS displays a validation message. When TIERS displays a validation message, staff must either correct the information , or use Search Merge/Separate to determine if the Individual numbers on the request are related to an existing request.

Tracking Progress

Use Search Merge/Separate to track the progress of the request. Some requests take longer than others. This may occur when the person receives both MEPD and Texas Works benefits.

Data Integrity staff can mark an Individual number as a potential duplicate (PD) when a merge or separate request is made. Staff cannot select an Individual number for addition to new cases if it is marked as PD, which limits the potential for the wrong Individual number to be awarded benefits or coverage in error.

Send questions about a merge or separate request to the Data Integrity mailbox.

Revision 12-2; Effective June 1, 2012

When a person is certified for assistance, the following information is kept electronically:

• Identification data
• Client/Individual number
• Name
• Birth date
• Sex
• Race
• Social Security account number
• Social Security claim number
• Client Residence County Code

The county related to the person's home address is used. For residents of a long-term care facility, record the county for the facility address. The person's residence county should be updated whenever there is a change of address involving a new county. This entry is used to identify a person who is eligible or required to enroll in managed care. It is also used by the Service Authorization System Online (SASO).

Revision 12-2; Effective June 1, 2012

Revision 12-2; Effective June 1, 2012

Through interagency agreements, several automated verification systems have become available to staff. This has allowed staff to obtain necessary verifications in a more efficient and timely manner. All systems require specific password permission for access.

R-3710 Automated Status Verification Index

Revision 12-2; Effective June 1, 2012

The Automated Status Verification Index (ASVI) is a Department of Homeland Security (DHS) online system used to verify immigration status of non-citizens applying for benefits. The system is accessed through UNISCOPE EMULATION. Information is obtained using the individual's Alien Registration Number. Result response time is generally immediate.

If the Alien Registration Number is found by the system, the following information will be displayed:

• Alien number
• Last name
• First name
• Middle name
• Date of birth
• Country of birth
• Alternate ID
• Social Security number
• Date of entry
• USCIS (formerly INS) status
• Verification number

Residency status is reported with one of the following messages:

• Lawful Permanent Resident/Employment Authorized
• Institute Secondary Verification
• Temporary Resident/Temporary Employment Authorized

Refer to D-8000, Alien Status, for additional policy and verification information.

A user guide, ASVI/SAVE System, contains detailed information regarding access and data interpretation. The guides are available through unit supervisors. 

R-3720 Reserved for Future Use

Revision 20-2; Effective June 1, 2020

R-3730 State Online Query/Wire Third Party Query

Revision 12-2; Effective June 1, 2012

State Online Query (SOLQ) is a Social Security Administration (SSA) automated system used to verify Social Security and Supplemental Security Income (SSI) benefits. The system is Windows-based. It uses the individual's name, Social Security number (SSN) or Social Security claim number (SSCN) and date of birth to identify and provide the appropriate records. When an inquiry match occurs, the response provides all available benefit information attributable to a particular claim number. SOLQ responses are not to be printed. SOLQ responses provide current information and are available immediately after request in the system.

If the individual has entitlement under more than one SSCN, those numbers will be identified. You must submit separate inquiries to obtain data related to those claims.

Information includes:

• Standard Response — individual name, date of birth, verified SSN and error messages regarding any discrepancies between inquiry and response match.
• Title II (RSDI) — individual demographics, enrollment in Medicare Part A and/or Part B, supplementary medical income benefits (SMIB) premium deduction, benefit amounts and dates, unearned income, disability onset dates, etc.
• Title XVI (SSI) — individual demographics, Medicaid, SSI payment history, benefit amount, payment status code, resource and earned income leads, etc.

Note: The SOLQ system is available only in TIERS. The response only includes information for individuals in TIERS.

If more detailed information is needed, it is recommended to request a WTPY.

Wire Third Party Query (WTPY) is an SSA automated overnight batch process system used to verify Social Security and SSI benefits. Information is obtained using the person's name, SSN or SSCN, and date of birth. Response is usually received on the next business day following transmittal of the inquiry, provided the request is transmitted by 2:30 p.m. If the request is transmitted after that time, the response will be delayed one day.

If an inquiry match occurs, the response will provide all available benefit information attributable to a particular claim number. If a person has entitlement under more than one SSCN, those numbers will be identified. Separate inquiries are not necessary. The programming logic within the WTPY system will do an automated request within three business days on the newly discovered SSCNs. Staff do not have to create additional requests to obtain data related to those claims.

Information will include:

• Standard Response — Name, date of birth, verified SSN and error messages regarding any discrepancies between inquiry and response match.
• Title II (RSDI) — Demographics, enrollment in Medicare Part A and/or Part B, SMIB premium deduction, benefit amounts and dates, unearned income, disability onset dates, etc.
• Title XVI (SSI) — Demographics, Medicaid, SSI payment history, benefit amount, payment status code, resource and earned income leads, etc.
• 40 Quarters — Used for legal permanent residents, their spouses or parents. Response will provide employment history, identify the qualifying quarters and give the type income received during that period. Note: Response time for this data is within two days of transmittal (rather than one day as with other WTPY information).
• Citizenship Verification — Effective Feb. 1, 2011. WTPY makes citizenship verification available, and is available for use by HHSC to verify citizenship for Texas Works and MEPD applicants.

The Wire Third Party Query User Guide contains detailed information regarding data interpretation. The 40 Quarters Operations Guide and 40 Quarters Response contain information outlining inquiry and response interpretation of 40 Quarters data.

Reminder: Federal tax information is provided through SOLQ and WTPY. Federal tax information is confidential. It is not to be shared with unauthorized individuals. SOLQ and WTPY responses should not be printed.

R-3740 Asset Verification System (AVS)

Revision 25-4; Effective Dec. 1, 2025

The Asset Verification System (AVS) is an automated system to request information from financial institutions for people applying or currently eligible for programs with a resource test. AVS is available through the Data Broker system, and is accessed through TIERS and is also available through Stand Alone Data Broker. AVS uses a person’s name, TIERS Individual ID, current address, previous address if available, and Social Security number to request financial record information. Information received through the AVS is an acceptable verification source for all programs.

Request AVS information regardless of the person’s age.

If the applicant does not have a Social Security number, an AVS report is not required.

AVS information must be reviewed for the following types of assistance (TOAs) that have a resource test at application, renewal, add a person and program transfer when consent is provided:

• Waiver Program (TA 10);
• Program of All-Inclusive Care for the Elderly (PACE) (TA 10);
• State Group Home (TA 12);
• Pickle (TP 03);
• State Supported Living Center (TP 10);
• Supplemental Security Income (SSI) Prior Medical (TP 11) - at application only;
• Community Attendant Services (CAS) (TP 14);
• Non-State Group Home (TP 15);
• State Hospital (TP 16);
• Nursing Facility (TP 17);
• Disabled Adult Child (TP 18);
• Disabled Widow(er) (TP 21);
• Early Aged Widow(er) (TP 22);
• Specified Low-Income Medicare Beneficiaries (SLMB) (TP 23);
• Qualified Medicare Beneficiaries (QMB) (TP 24);
• Qualified Disabled and Working Individuals (QDWI) (TP 25);
• Qualifying Individuals (QI-1) (TP 26);
• Emergency Medicaid (TP 30) - at application only; and
• Medicaid Buy-In (MBI) Program (TP 87 ME).

Note: The Medicaid Buy-In for Children (TP 88) program does not require a resource test and is not subject to AVS at application or renewal. When processing a program transfer to another MEPD TOA, request AVS to verify financial account information.

R-3741 AVS Consent

Revision  24-4; Effective  Dec. 1, 2024

Consent to access AVS is required for a person whose assets are considered in the eligibility determination for AVS applicable programs. People who must provide consent are:

• the applicant or recipient, or the person’s legal guardian, power of attorney or authorized representative;
• parents whose resources are deemed to a minor child;
• a spouse whose resources are deemed to the applicant or recipient; or
• the community spouse for spousal impoverishment cases.

A person provides consent by submitting a signed application or renewal form that contains the asset verification consent language. If the application or renewal form does not contain the AVS language or does not contain the signature of the person whose resources are considered in the eligibility determination, staff must pend for a signed Form H0003, Agreement to Release Your Facts if one was not returned with the application or renewal form. Only request AVS information for someone who has provided consent.

Deny the person if consent is not provided for all people whose resources are considered in the eligibility determination or if a written request to revoke consent to access AVS is received. Do not run AVS if consent is not provided or a written request to revoke consent is received.

Note: An electronic signature is valid for AVS consent when submitting an application or renewal through YourTexasBenefits.com (YTB) as long as the form includes the AVS consent language.

A previously signed Form H0003, Agreement to release your facts, remains valid until:

• an application for benefits is denied;
• benefits are terminated; or
• the person submits a written request to withdraw consent.

Related Policy

Resource Limits, F-1300
Deeming of Resources, F-1400
Joint Bank Accounts, F-4121

R-3742 AVS Requests

Revision 25-4; Effective Dec. 1, 2025

Request Asset Verification System (AVS) at application, renewal, add a person and program transfer. Do this for all MEPD type of assistance (TOA) that require a resource test before requesting information from the applicant or recipient. If an applicant does not have a Social Security number, an AVS report is not required.

AVS is one of the Electronic Data Sources (ELDS) that is requested automatically in the eighth month of the person’s certification period. It is part of the administrative renewal process.

Review other available electronic data sources, including Systematic Alien Verification for Entitlements (SAVE) and State Online Query (SOLQ), to explore potential obvious denial before requesting AVS. Do not request AVS if available information shows the person is not eligible, such as when the person:

• does not meet immigrant status per SAVE; or
• exceeds the income limit per SOLQ.

When requesting AVS, on the Request Details screen complete the following two mandatory fields so the correct number of months are requested:

1. Number of Months: Select Number of Months

   Month of Application and 3 months prior

   This response time frame is for the following TOAs:

• Pickle (TP 03)
• Supplemental Security Income (SSI) Prior Medical (TP 11) - at application only
• Community Attendant Services (CAS) (TP 14)
• Disabled Adult Child (TP 18)
• Disabled Widow(er) (TP 21)
• Early Aged Widow(er) (TP 22)
• Specified Low-Income Medicare Beneficiaries (SLMB) (TP 23)
• Qualified Medicare Beneficiaries (QMB) (TP 24)
• Qualified Disabled and Working Individuals (QDWI) (TP 25)
• Qualifying Individuals (QI-1) (TP 26)
• Emergency Medicaid (TP 30) - at application only
• Medicaid Buy-In (MBI) Program (TP 87 ME)

    60 months

This response time frame is for the following TOAs:

• Waiver Program (TA 10)
• Program of All-Inclusive Care for the Elderly (PACE) (TA 10)
• State Group Home (TA 12)
• State Supported Living Center (TP 10)
• Non-State Group Home (TP 15)
• State Hospital (TP 16)
• Nursing Facility (TP 17)

2. File Month - enter file date application was received

For applications, follow the time frames above.

For renewals, request AVS for the month the renewal was received and three months prior, regardless of the TOA.

Note: Use the AVS report from the automated administrative renewal process when processing a renewal if:

• the AVS Screen includes an Asset Verification – Automated Admin Renewal report processed on the 8th month of the current renewal cycle; and
• there is no indication that there was a changes from month eight to the current month staff is processing the case.

Do not re-request AVS if an AVS response was submitted in the previous 60 days for the same response time frame.

A second response may be requested within the 60 days when processing a program transfer from a community-based TOA to a full verification TOA. Example: CAS only to nursing facility Medicaid. 

R-3743 AVS Responses

Revision 25-4; Effective Dec. 1, 2025

Asset Verification System (AVS) responses give information on both disclosed and undisclosed financial accounts for the following:

• Annuity
• Burial Funeral
• Certificate of Deposit (CD)
• Checking Account
• Christmas (Xmas) Club
• Convertible Bond
• Custodial Other, UGMA, UTMA
• Custodial Retirement
• Individual Retirement Account (IRA)
• Keogh
• Money Market
• Other
• Rent Security
• Savings Account
• Trust

When the following financial account types are reported for the first time, an AVS response cannot be used as a verification source. They must be reviewed by legal:

• Annuity
• Convertible Bond
• Custodial Other, UGMA, UTMA
• Custodial Retirement
• Individual Retirement Account (IRA)
• Other, depending on what other type of account is
• Trust

At renewal, AVS may be used as a verification source if there are no changes or potential transfer of assets.

Custodial other, custodial retirement, and rent security are types of liquid resource accounts.

Burial funeral is a type of savings accounts. Use Bank Account Savings for this Liquid Resource Type when adding this type of account to the case record.

Note: For a rent security account, the account is considered countable when the person no longer owns rental property.

Determine the type of account listed if an above account type is not on the dropdown menu for Liquid Resource Type. Document the resource using an applicable existing Liquid Resource Type option.

Initial AVS responses are received immediately. They include information from the major banking institutions.

In addition to the immediate initial responses, Data Broker also provides enhanced AVS responses when financial information is identified for more banking institutions not included in the immediate AVS response. The enhanced AVS response is available on the Data Broker report no earlier than five days after the initial AVS request. Do not delay case disposition for a pending enhanced AVS response if all other necessary information is provided. The enhanced response is treated as an agency reported change no matter when the agency receives the response.

AVS enhanced response reports are available through the Data Broker Portal and updated periodically. When the AVS enhanced response report is updated, a change task is generated the following day.

• First report includes enhanced responses received by the 5th day.
• Second report includes enhanced responses received by the 15th day.
• Third report includes enhanced responses received by the 30th day.
• Final report includes enhanced responses received by the 60th day.

R-3744 Consideration of AVS Information

Revision 25-4; Effective Dec. 1, 2025

Determine eligibility based on the Asset Verification System (AVS) response received by Data Broker. The AVS response is an acceptable verification of financial accounts.

Complete the eligibility determination if the AVS information is consistent with the client-provided information. Do this for both immediate and enhanced AVS responses.

If the AVS information is new or inconsistent but does not affect eligibility, do not request more verification. Enter the new information in the case record and complete the eligibility determination.

Request further verification from the person before completing the eligibility determination:

• if the AVS information is new or inconsistent; and
• the person is potentially ineligible.

Deny for failure to provide required information if the person fails to provide verification of new or inconsistent AVS information.

Pay close attention to the account history for large balance increases or decreases. A large decrease may suggest a transfer.

Request current verification from the person instead of re-requesting AVS if:

• AVS was requested in the last 60 days; and
• the person was denied due to excess funds in a financial account(s).

The Fair Credit Reporting Act (FCRA) requires the language below be in the TF0001, Notice of Case Action, when HHSC takes adverse action on an EDG based on information gained directly or indirectly by using a credit report. Consumer Financial Protection Bureau determined AVS is subject to FCRA requirements.

FCRA language listed on the TF0001, Notice of Case Action:

We use several online sources to help determine if you’re eligible for benefits. One source we use is a report from a company called Early Warning.

You have the right to contact Early Warning to:

• Get a free copy of your report by contacting them within 60 days of receiving this notice.
• Ask them to correct anything that is wrong on your report.

Contact Early Warning at 800-745-1560, earlywarning.com or 5801 N. Pima Road, Scottsdale, AZ 85250.

If you have questions about any actions taken on your application or case, call us at 2-1-1 or 877-541-7905. After you pick a language, press 2.

Note: FCRA language is subject to change based on federal requirements. 

Revision 24-4; Effective Dec. 1, 2024

The Data Broker system is an online portal. It provides financial and other information about people applying for or receiving Texas Works and MEPD types of assistance.

The system collects and combines information from multiple data sources into one report, called the Data Broker Combined Report. The report includes information such as residential address, people living at the address, vehicle ownership, employment status, income verification, financial account balances and other information.

The Data Broker Combined Report includes information from multiple data sources including:

• Department of Public Safety (DPS)
• United States Citizenship and Immigration Services (USCIS) Systematic Alien Verification for Entitlements (SAVE)
• Texas Department of Motor Vehicles (DMV)
• Office of the Attorney General (OAG)
• Texas Workforce Commission (TWC)
• Texas Lottery Commission
• Department of State Health Services (DSHS)
• SNAP Electronic Disqualified Recipient System (EDRS)
• Electronic Benefit Transfer (EBT)
• Texas Department of Criminal Justice (TDCJ)
• Federal Data Services Hub (FDSH)

These agencies provide information on:

• people search, including name, address, driver license or ID and neighbor information;
• alien verification through USCIS SAVE;
• vehicle search, including owner name, address, license plate, vehicle identification number and vehicle valuation;
• income search, including new hire reports, TWC quarterly wages and unemployment insurance benefits, child support, current earned income and Texas lottery winnings;
• marriage and divorce records; and
• The Work Number (TWN) data, including earned income and employment information.

In the TIERS Regular or Customized Redetermination Driver Flow (CRDF), submit a Data Broker request for each individual household member 16 and older, including members without a Social Security Number (SSN). Request the Data Broker Combined Report in the Individual Household logical unit of work (LUW) in any mode other than Ongoing.

Although the Data Broker Combined Report includes the option to request a credit report on the person, federal law limits the use of credit reports.

Note: Do not request credit reports for MEPD programs.

Data Broker information can also be requested in the stand-alone Data Broker Portal system. The Combined Report and individual data searches, such as TWC and OAG are accessible through the Data Broker Portal. Use the Data Broker Portal to pull specific data element searches and when TIERS is experiencing technical issues.

The combined report and individual data searches are accessible through the Data Broker Portal. They ensure accurate eligibility determinations and resolve any discrepancies between the information in Data Broker and information provided by the person before disposition. Failure to review report may result eligibility errors.

If the information available through Data Broker is inconsistent with information provided by the person, but the information does not affect eligibility, do not request additional documentation from the person.

Resolve all discrepancies between the information in Data Broker and information provided by the person, if the new or inconsistent information potentially makes the person ineligible. To clear discrepant information:

• Attempt to contact the person by phone to allow them the opportunity to explain the discrepancy, and document their statement in the case record; or
• If phone contact is unsuccessful, send Form H1020, Request for Information or Action, requesting necessary information to resolve the discrepancy.

Before beginning denial procedures based on information obtained in a Data Broker report, always give the person the opportunity to rebut and provide clarification or more verification.

Refer to the Data Broker Frequently Asked Questions (FAQs) and the Data Broker User Guide located under the Training section on the left navigation menu within the Data Broker Portal for more information. These documents provide answers to frequently asked questions about Data Broker and include instructions and sample screens on the different types of reports available in the Data Broker system.

Related Policy

Documentation and Verification Guide, MEPD Appendix XVI
Data Broker, TWH C-820

R-3810 Data Broker Combined Report Sources

Revision 24-4; Effective Dec. 1, 2024

This section describes the various data sources available in Data Broker.

R-3811 Systematic Alien Verification for Entitlements

Revision 24-4; Effective Dec. 1, 2024

Although the Systematic Alien Verification for Entitlements (SAVE) system can be accessed through Data Broker, it can also be accessed through its own web application. Refer to D-8800, Systematic Alien Verification for Entitlements, for more information about SAVE and how to use it to verify alien status.

R-3812 Driver License Information

Revision 24-4; Effective Dec. 1, 2024

Data Broker matches information from the Combined Report Search screen against the Texas Department of Public Safety (DPS) data. When a match is found, DPS data is pulled into the report. Information in this report may identify discrepancies in the person’s identity and residence address. This report includes a person’s sex, race, height, hair color, eye color, name, date of birth (DOB), address, and any previous names or addresses. Because DPS re-issues driver’s licenses and ID numbers approximately two years after the driver license and ID number expires, previous names and addresses associated with that number may be listed in this section.

The Validated field displays the date DPS last updated the driver’s license or ID information.

Note: DPS updates information on this report only when the person with a Texas driver license (TDL) or DPS ID provides updated information to DPS.

R-3813 People at Entered Address

Revision 24-4; Effective Dec. 1, 2024

Data Broker searches the DPS database and pulls records for all people listed at the address entered on the Combined Report Search screen. The information pulled includes each person's name, address and DOB. Previous residents may appear if they have not changed their address with DPS.

Information on this report is useful to provide case clues about household composition and exploring potential support and maintenance (S&M).

Related Policy

Support and Maintenance, E-8000

R-3814 Texas Vehicle

Revision 24-4; Effective Dec. 1, 2024

The Texas Department of Motor Vehicles (DMV) database gives information for all vehicles registered at the person’s address as entered on the Combined Report Search screen. The information obtained on each vehicle includes the:

• owner(s) name(s)of each vehicle;
• Texas vehicle license tag number(s);
• year, make and model of each vehicle;
• average wholesale value of the vehicle(s); and
• lien holder of the vehicle(s), when available on DMV records.

This information can be used to verify vehicle ownership and value, as well as provide case clues on household composition. Staff must explore and clear discrepancies.

The value provided is the average wholesale value of the vehicle and can be used as verification to determine the countable equity value of the vehicle.

Vehicles not owned by the household may appear on the Data Broker Combined Report when a person does not complete a title transfer or does not update an address with the DMV.

Vehicles registered at an address other than where the person lives do not appear on this report. When a person has a vehicle not shown on the report, use the owner's name, vehicle license plate number or vehicle identification number (VIN) to get information through the Vehicle Search option in the left navigation menu of the Data Broker Portal.

Related Policy

Automobile, F-4221
Business Property, F-4330

R-3815 Texas Marriage and Divorce

Revision 24-4; Effective Dec. 1, 2024

The Texas Department of State Health Services (DSHS) Texas Vital Statistics Unit provides the dates and names of people married and divorced in Texas. This information is only available by an interactive inquiry in the Data Broker Portal. Information from this report is not included on the Combined Report.

The marriage and divorce reports reflect the names provided to DSHS on marriage and divorce documents recorded in Texas. If a person has changed their name, staff may need to search using the prior name to find records.

Although the report is updated annually, data may be delayed and may not contain recent marriage and divorce information.

Related Policy

Companion and Couple Budgets, E-8300

R-3816 Employer New Hire Report and National Directory of New Hire Report

Revision 24-4; Effective Dec. 1, 2024

The Employer New Hire Report (ENHR) and National Directory of New Hire Report (NDNH) reports provide employment information such as hire date, employer name and address, and employee name, DOB and address.

• The ENHR has employer information for people whose employers are based in Texas.
• The NDNH has employer information from all 50 states, four territories and all federal agencies.

Data Broker displays new hire data from 180 days before the date the report was requested up to the current date. This information may be an indicator of unreported earned income.

The ENHR and NDNH reports may list the corporate name and address of the employer instead of the local business name and address. The commonly known name of a business provided by the person may be different than the corporate name.

Related Policy

General Income, Chapter E

R-3817 Texas Workforce Commission Wages and Benefits

Revision 24-4; Effective Dec. 1, 2024

The Texas Workforce Commission (TWC) Wages and Benefits report provides information on wages, claimants and unemployment benefit records in Texas. Claimant and unemployment benefit payments will display only if the person has applied for, is receiving, or has received unemployment benefits from TWC.

The TWC information can be obtained through the Standard Combined Data Broker report option or the interactive search by using the TWC Quarterly Wages and Unemployment Insurance Benefits (UIB) link in the Data Broker Portal left navigation menu.

The Standard Combined Report includes the TWC information and all other available reports.

TWC information returned on the Standard Combined Report defaults to the last two years of data available for wage detail, claimant and benefit payments. If the user needs more than two years of data, the interactive search in the Data Broker Portal can be used.

If no information is available for a person, a message with "No records found" displays.

R-3818 Office of the Attorney General Child Support

Revision 24-4; Effective Dec.1, 2024

The Office of the Attorney General’s (OAG) Child Support database provides child support data. Data Broker searches the OAG database and pulls records for the person entered on the Combined Report Search screen and displays all people receiving and paying support payments associated with that person.

The OAG information available through Data Broker allows staff to get child support income. Additionally, Data Broker offers case clues on household composition by listing an address for each member, if available, on the Combined Report associated to a particular OAG case.

This report is also available by an interactive inquiry in the Data Broker Search Options menu:

• A member search is used when the case name or adult household member's SSN is not available.
• A financial search can be done when specific financial information for a period is not available on the Combined Report Search.

Note: When the OAG information is requested and unavailable, a feature in the table of contents of the Standard Combined Report will display the following message:

Request timed out. Please click here to retry again.

By clicking on this link, staff can re-request the report without reentering all the person's information. Staff should continue to retry until the information becomes available.

Related Policy

Child Support Payments, E-2350
Child Support Payments, E-3321
Accessing Texas Child Support Enforcement System (TXCSES), TWH C-832.1

R-3819 Inmate or Parolee Match

Revision 24-4; Effective Dec. 1, 2024

The Inmate or Parolee Match displays prisoner information for people who are incarcerated.

The following identifying information is displayed, if applicable, for the incarcerated person:

• name;
• SSN;
• DOB;
• last known address;
• incarceration sentence date, first day of incarceration;
• earliest release date;
• prison unit;
• offense; and
• date of offense.

Prisoner match information displayed on the Data Broker Combined Report is considered a case clue, and must be addressed before denying, reducing or terminating benefits. For applications, redeterminations and changes, attempt a phone contact to address the information found in the Data Broker Combined Report.

If the person is incarcerated or no longer living with the household, remove the person from the case and retest eligibility.

Send Form H1020, Request for Information or Action, to request verification if:

• the household states that the person is not incarcerated and lives in the home; or
• phone contact cannot be made.

If a response is not received, terminate benefits for failure to provide.

R-3820 Texas Lottery Commission

Revision 24-4; Effective Dec. 1, 2024

The Texas Lottery Commission report provides verification of lottery winnings and is included in the Data Broker Combined Report.

The report contains the following information:

• winner’s full name, DOB and SSN;
• date paid;
• gross winnings, net payment and taxes withheld;
• check ID number, claim number and date claim created;
• debt offset, also known as recoupment:
  • reason for the offset;
  • the agency name the offset is for;
  • amount withheld;
  • withholding number;
  • withholding sequence number; and
  • check ID and agency ID; and
• void date:
  • only provided when the Texas Lottery Commission voids a check.
  • if voided, do not count the winnings as income.

Revision 12-2; Effective June 1, 2012

The Beneficiary and Earnings Data Exchange (BENDEX) is an automated data information exchange received from SSA. HHSC initiates the process by sending SSA a tape containing a person's identifying information. The BENDEX data is SSA's response. The data exchange is performed twice per month.

BENDEX data matches SSA recipient information against the TIERS information. Data matches include recipient's name, sex, date of birth, Social Security number, Social Security claim number and RSDI amount. Should there be a discrepancy in data, an ALERT will be generated for the individual case in the Task List Manager (TLM) and sent to the eligibility specialist for clearance.

At the time of SSA's annual Cost of Living Adjustment (COLA), HHSC receives a BENDEX that is used to update RSDI amounts on all current cases.

R-4110 Social Security Administration Deceased Individual Report

Revision 12-3; Effective September 1, 2012

The Deceased Individual Report from SSA identifies individuals receiving benefits from both SSA and HHSC who have been reported as deceased to SSA. SSA provides the date of death reported to their agency.

Revision 12-2; Effective June 1, 2012

The State Data Exchange (SDX) is an automated data information exchange received from SSA. The SDX tape contains all newly certified Texas SSI recipients and current SSI recipients with updated/changed information. HHSC normally receives SDX data five to six times per month, but not necessarily weekly.

SDX data matches SSI recipient information against all case and client information.

R-4210 Contacting Data Integrity

Revision 12-2; Effective June 1, 2012

Incorrect SSI information can be temporarily changed or corrected by the Office of Eligibility Services (OES), Business Services, Data Integrity area. Processing of the next SDX tape with updated information on that person will override temporary information entered by Data Integrity. Permanent corrections or changes must be completed by SSA and will be reflected on subsequent SDX tapes.

Staff can request the Data Integrity area make a temporary correction. Staff must also inform the person of the need to make a permanent correction at the local SSA office. A person should never be told to contact the Data Integrity area directly. Follow local procedures for contacting Data Integrity.

Revision 21-3; Effective September 1, 2021

The Income and Eligibility Verification System (IEVS) was established to conduct data matches as part of the verification process for Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP) and Medicaid programs. IEVS data includes taxable income reported to the Internal Revenue Service (IRS). Income may have been earned through existing resources or generated by the liquidation of a resource. IEVS data also includes unemployment insurance benefits (UIB), wage information from the Texas Workforce Commission (TWC) and self-employment and earned data from the Social Security Administration (SSA).

An annual IRS data match is processed on all active recipients in August or September to obtain data from the last tax year. The system receives quarterly wage data from TWC and the annual self-employment and earned data from SSA. The files are run against the system of record using the Social Security number and first four letters of the recipient's last name. If a match occurs, the Automated System for Office of Inspector General (ASOIG) application will create, assign and distribute an IEVS worksheet to the designated MEPD specialists for review

The Deficit Reduction Act of 1984 and IEVS regulations require state agencies to safeguard the IEVS match data.

Related Policy

Safeguarding Federal Income Data, C-2400
System Generated IEVS Worksheets Legends for IRS Tax Data, Appendix XVII

Revision 20-1; Effective March 1, 2020

HHSC matches the names of active recipients with the benefits records of the Texas Teachers Retirement System (TRS) and the Employees Retirement System (ERS). The TRS/ERS tape match is conducted quarterly and generates a report with the gross and net income amount and any deductions. TIERS automatically updates the appropriate income record. If unable to update the income record automatically, TIERS creates tasks for staff to verify the income.

Matches are conducted during the first week of the following months:

• March;
• June;
• September; and
• December.

The system will also provide information when ERS/TRS issues a one-time supplemental payment (13th check) for cost-of-living increases or other adjustments of benefits. This one-time payment (13th check) from ERS/TRS is countable income and considered an irregular payment.

The ERS/TRS match is considered acceptable verification. If the information received differs from the information in the case record, TIERS will generate alerts indicating additional action is needed from staff to clear the discrepancy.

To verify income for new applicants, send Form H1297, Request for Information from Teacher Retirement System of Texas, to request verification of the TRS income or Form H1214, Request for Pension Information, to request verification of ERS income. The form must be annotated to indicate the person is a new applicant.

 Related Policy

Documentation and Verification Guide, Appendix XVI
Other Annuities, Pensions and Retirement Plans, E-4400
Infrequent or Irregular Income, E-9000
When to Apply the Infrequent or Irregular Exclusion, E-9300

Revision 20-1; Effective March 1, 2020

Revision 21-3; Effective September 1, 2021

HHS uses the Public Assistance Reporting Information System (PARIS) data match. This use ensures people enrolled in Medicaid or other public assistance benefits in one state are not receiving duplicate benefits based on simultaneous enrollment in the Medicaid program or other public benefit programs in another state.

The Office of the Inspector General’s (OIG’s) clearance action on interstate worksheets must have the recipient's residency verified by the verification letter OIG 5079, Request for Verification of Residence.

HHS IEVS staff performing clearance action on PARIS matches related to MEPD Programs use the manual Form H1020, Request for Information or Action, for verification of residence requests.

Selection of “Interstate” allows authorized staff access to PARIS worksheets.

ASOIG allows authorized users to access reports, view and clear worksheets, create referrals, create interstate referrals, view and add comments, search and transfer worksheets, view related worksheets and generate correspondence.

HHS IEVS staff do not print the OIG 5079.