A—111 Pre-Application Process

Revision 15-4; Effective October 1, 2015

TANF

Before the Application process begins, staff deliver an up-front Texas Works message to the Temporary Assistance for Needy Families (TANF) applicants explaining that:

• TANF is temporary and has time limits;
• there are other alternatives and options for the applicant instead of TANF benefits;
• an applicant should consider jobs and other resources (such as child support) before pursuing TANF;
• if an applicant chooses to apply for assistance, the individual is requesting help finding a job; and
• even if an applicant chooses not to apply for TANF, the individual still may apply for Medicaid and the Supplemental Nutrition Assistance Program (SNAP) to support employment while working toward self-sufficiency.

Staff must consider and determine which messages are appropriate for a particular applicant.

A—112 Application Assistance

Revision 15-4; Effective October 1, 2015

All Programs

If an applicant needs help completing the application packet, a volunteer or staff member must help. Anyone helping the applicant complete a paper application must initial the completed sections or sign the form showing that  a volunteer or staff person helped complete the application.

A—113 Application Requests and Submissions

Revision 15-4; Effective October 1, 2015

All Programs

Applications must be given to anyone who requests the form. Each household has the right to file an application on the same day the household contacts the office during office hours. The local office must ensure that a person can obtain an application packet within 15 minutes of coming into the office.

Staff must advise the household  that an applicant does not have to be interviewed before filing the application. The household may file an incomplete application as long as the form contains the applicant's name, address, and signature as explained in A-121, Receipt of Application.

* Staff must give the applicant an application on the same day it is requested. If a household contacts the local office by telephone and does not wish to come to the designated office to file an application on the same day of the request and prefers receiving the application by mail, staff send an application packet on the same day of the telephone request. For written requests, including those received electronically or by fax, staff mail an application packet on the same day the request is received.

The Texas Health and Human Services Commission (HHSC) must accommodate reasonable requests to receive communications by alternative means or at alternative locations. The individual must specify in writing the alternate mailing address or means of contact, and include a statement that using the home mailing address or normal means of contact could endanger the individual.

Note: Individuals applying for Medical Programs may also use the Marketplace-only applications explained in A-113.1, Application Forms. These applications can be submitted to HHSC in person, by fax, by mail, or via an account transfer explained in A-118, Coordination with the Federal Marketplace.

Related Policy

Registering to Vote, A-1521

A—113.1 Application Forms

Revision 19-4; Effective October 1, 2019

YourTexasBenefits.com

The online application on YourTexasBenefits.com integrates HHSC programs into one single application flow. Applicants only see the questions relevant to the programs they request. A PDF copy of the application information is created for applicants and staff to view. 

YourTexasBenefits.com can be used to apply for the following benefits:

• SNAP food benefits;
• TANF cash help for families;
• health care for:
  • children;
  • adults caring for a child;
  • adults not caring for a child (if this is selected, YourTexasBenefits.com will allow applicants to identify themselves as a refugee; if they are not a refugee, they will be redirected to HealthCare.gov);
  • pregnant women;
  • people age 65 or older or with a disability; and
  • people under age 26 who were in foster care in Texas and receiving federally funded Medicaid at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an Interstate Compact on the Placement of Children (ICPC) agreement at age 18 or older;
• Medicare Savings Programs; and
• long-term services and supports for:
  • people with intellectual or developmental disabilities; and
  • people with no intellectual or developmental disabilities.

Form H1010, Texas Works Application for Assistance — Your Texas Benefits

Form H1010 integrates Texas Works programs into one single application.

The addendum to Form H1010 — Form H1010-M, Applying for or Renewing Medicaid or CHIP? — captures the information needed to make an eligibility determination for Medicaid or the Children's Health Insurance Program (CHIP).

Form H1010 can be used to apply for the following benefits:

• SNAP food benefits;
• TANF cash help for families; and
• health care for:
  • children;
  • adults caring for a child;
  • adults not caring for a child;
  • pregnant women;
  • people under age 26 who were in foster care in Texas and receiving federally funded Medicaid at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an ICPC agreement at age 18 or older.

Form H1205, Texas Streamlined Application

Form H1205 can only be used to apply for health care benefits.

Form H1205 can be used to apply for the following benefits:

• health care for:
  • children;
  • adults caring for a child;
  • adults not caring for a child;
  • pregnant women; and
  • people under age 26 who were in foster care at age 18 or older; and
  • people under age 21 who were in foster care in Texas or had an ICPC agreement at age 18 or older. 

Applications Solely Used by the Marketplace

The online Marketplace application is a single interactive application based on an applicant's selections. In addition, there are three paper applications for the Marketplace:

• Application for Health Coverage — for anyone who needs health coverage, but does not need help paying for health insurance costs.
  • Used by applicants who want to purchase a Qualified Health Plan (QHP) through the Marketplace.
• Application for Health Coverage & Help Paying Costs (Short Form) — for single adults who need help paying for health care coverage (mostly for states offering Medicaid expansion coverage to single adults ages 19 through 64) and who:
  • are not married, do not claim any tax dependents, and cannot be claimed as a tax dependent on someone else's federal income tax return;
  • were not formerly in the foster care system; and
  • are not American Indian (AI)/Alaska Native (AN).
• Application for Health Coverage & Help Paying Costs — for anyone who needs help paying for health care coverage, including:
  • people who are married, have tax dependents, or can be claimed as a tax dependent on someone else's federal income tax return;
  • people with or without current health care coverage;
  • families that include immigrants; and
  • people who were formerly in the foster care system.

Since these applications do not contain additional questions that were included on Form H1205, Texas Streamlined Application, send out Form H1020, Request for Information or Action, to request any additional information necessary to make an eligibility determination. 

A—114 Applications Causing Conflicts of Interest

Revision 15-4; Effective October 1, 2015

All Programs

The advisor must avoid the appearance of impropriety or conflict of interest when determining eligibility. The advisor is not allowed to work on a case if the individual is a relative (by blood or marriage), roommate, dating companion, supervisor, or someone under the advisor's supervision. The advisor may never work on a case in which the advisor is a case participant or an authorized representative (AR).

The advisor:

• may provide anyone with an application and information about how and where to apply for benefits;
• may help a person gather any documents needed to verify eligibility; but
• must not take any other role in determining eligibility.

The advisor must consult with the supervisor if the individual is a friend, acquaintance or coworker. Generally, the advisor should not work on cases involving these individuals, but the degree and nature of the relationship should be taken into account. In remote areas where it is impractical for another person to process the application, the unit supervisor should be contacted to determine the best method to process the application.

A—114.1 Applications Submitted by Texas Works or Medicaid for the Elderly and People with Disabilities Employees

Revision 18-1; Effective January 1, 2018

All Programs

Give special handling to applications and redeterminations submitted by Texas Works and Medicaid for the Elderly and People with Disabilities employees.

• A Texas Works or MEPD employee at the next higher administrative position must complete the eligibility determination for another Texas Works employee.
• A designated supervisor must complete the eligibility determination for a Texas Works or MEPD supervisor or higher position.
• The employee's immediate supervisor or someone in the direct line of supervision may not process the Texas Works or MEPD employee's application.

A—115 Applications Filed in Hospitals and Clinics

Revision 19-1; Effective January 1, 2019

All Programs

Facility work is the primary assignment for Outstationed Worker Program (OWP) staff. Staff will process workload following the OWP Hierarchy order below:

• OWP Lobby Facility Workload
• OWP Statewide Facility Workload
• Regional EWMS Teams (Supplemental) Workload

Staff follow the most current business processes found in the Eligibility Operations Procedures Manual to complete this workload.

The file date is the date HHSC receives the application from the contracted facility.

A—116 Special Application Processes

Revision 12-2; Effective April 1, 2012

A—116.1 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

A—116.2 Applications from Residents of a Homeless Shelter

Revision 22-1; Effective January 1, 2022

SNAP

People staying in homeless shelters are potentially eligible for SNAP, regardless of the number of meals the facility provides, if the homeless shelter is an approved institution. A homeless shelter is an approved institution if it is a:

• public or private, nonprofit shelter for the homeless; or
• certified SNAP retailer.

Verify the homeless shelter is an approved institution, if questionable.

People staying in homeless shelters that are not approved institutions are potentially eligible for SNAP if the facility provides half of their meals or less. Consider this when determining if a person staying in a facility is institutionalized.

Homeless households must meet the same household composition, income, and resource standards as other households. If the household pays for room in a shelter, consider the payments as shelter expenses.

Related Policy

Nonmembers, A-232.1
Prepared Meals for Homeless, B-462
Homeless Shelter Standard, A-1427
Determining Whether a Person Who Resides in a Facility Is Institutionalized, B-490

A—116.3 Applications for Babies Born to Women in Prison

Revision 15-4; Effective October 1, 2015

Medical Programs

A pregnant woman who enters the state prison system is sent to the Texas Department of Criminal Justice women's facility. Before the baby is born, the prison social worker assists the pregnant woman to arrange for a responsible individual to pick up the baby from the hospital. The pregnant woman is sent to a prison section of the University of Texas Medical Branch (UTMB) in Galveston a few weeks before she is due to deliver, unless an emergency occurs earlier. If an emergency does occur, she will deliver at a closer facility when necessary. Before releasing the baby from the hospital, UTMB requires the individual who picks up the baby to complete an application for Medicaid. Designated Texas Works advisors ensure that the baby is certified for Medicaid using special application processing procedures and follow-up activities.

The designated advisors coordinate Medicaid certification by other advisors in special situations when the newborn needs to be added to an active case. Upon request by the designated advisors, which must be documented in the case record, an advisor must certify the newborn:

• for Medicaid (TP 43) from the date of birth (DOB), not the day the caretaker brought the baby home from the hospital; or
• after normal application time frames have passed. If needed, staff may follow procedures to request a timeliness exception.

State law requires Medicaid coverage for Texas newborns for at least 28 days after birth and possibly longer if the child is hospitalized at that time. If the hospital followed required procedures before releasing the baby, but the baby does not meet eligibility requirements for Medicaid, the designated advisor and State Office Data Integrity (SODI) staff certify the baby for TA 62, MA - State-Paid Coverage. Examples of not meeting eligibility requirements are:

• the individual caring for the child does not reside in Texas, and the baby will be taken out of state;
• the individual caring for the child refuses to apply for Medicaid; or
• the household is over the income limit.

Related Policy

Documentation Requirements, A-190
Medical Programs, A-240

A—116.4 Reserved for Future Use

Revision 20-4; Effective October 1, 2020

A—116.5 Food Distribution Program on Indian Reservation (FDPIR)

Revision 11-3; Effective July 1, 2011

For application processing related to FDPIR, refer to the policy in B-421, Food Distribution on Indian Reservation (FDPIR).

A—116.6 Joint SSI-SNAP Applications

Revision 22-3; Effective July 1, 2022

For application processing related to joint Supplemental Security Income (SSI)-SNAP applications, refer to the policy in B-476, Joint Supplemental Security Income (SSI)-SNAP Applications.

A—116.7 Types of Assistance Administered by Centralized Benefit Services (CBS)

Revision 11-3; Effective July 1, 2011

A—116.7.1 Reserved for Future Use

Revision 22-3; Effective July 1, 2022

A—116.7.2 Applications for SNAP-CAP

Revision 15-4; Effective October 1, 2015

For application processing related to SNAP-CAP, refer to the policy in B-475, Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP).

A—116.7.3 Medicaid for Transitioning Foster Care Youth (MTFCY) (TP 70)

Revision 15-4; Effective October 1, 2015

For application processing related to MTFCY, staff should refer to policy in B-474.1.2, Medical Programs, 2; and Other Medical Programs, Part M, Medicaid for Transitioning Foster Care Youth (MTFCY).

A—116.7.4 Medicaid Coverage for Children Placed in or Released from a Juvenile Facility

Revision 20-4; Effective October 1, 2020

For application processing related to Medicaid for children placed in the custody of or released from the Texas Juvenile Justice Department or Juvenile Probation Department, refer to policy in B-543, Child Placed in a Juvenile Facility, and B-546, Notification of Actual Release from a Juvenile Facility.

A—116.7.5 Medicaid for Breast and Cervical Cancer (MBCC)

Revision 15-4; Effective October 1, 2015

For application processing related to MBCC, staff should refer to policy in B-474.1.2, Medical Programs, 4; and Other Medical Programs, Part X, Medicaid for Breast and Cervical Cancer (MBCC).

A—116.7.6 Reserved for Future Use 

A—116.7.7 Former Foster Care in Higher Education (FFCHE) (TA77)

Revision 11-3; Effective July 1, 2011

For application processing related to FFCHE, refer to policy in Other Medical Programs, Part F, Former Foster Care in Higher Education (FFCHE).

A—116.7.8 Former Foster Care Children (FFCC)

Revision 15-4; Effective October 1, 2015

For application processing related to FFCC, refer to policy in Other Medical Programs, Part E, Former Foster Care Children (FFCC).

A—117 Applications Filed Online through YourTexasBenefits.com

Revision 15-4; Effective October 1, 2015

When the household submits an application online, a process formats the information entered on the online application and imports certain data into TIERS. The process creates the PDF file of the application that is stored in the image repository and is viewable in the State Portal.

TIERS edits the data passed by YourTexasBenefits.com. The fields must contain valid characters and be valid values to be imported into TIERS. Dates must be in the correct format, fields that are numeric must contain only numbers and data must be in accepted ranges for fields with values such as Yes or No, or ZIP codes.

Applications that do not contain required data or have data that may be invalid may be rejected. When an application is rejected for electronic processing into TIERS, the system creates a non-SSP Application Registration Task List Manager (TLM) task.

Applications that are valid and accepted as electronic input into TIERS have an Application Registration TLM task created for them. The task is routed to the appropriate office based on Type of Assistance (TOA) and individual ZIP code for the clerk to perform the Application Registration process task.

A—117.1 Application Registration

Revision 15-4; Effective October 1, 2015

Clerks select the Application Registration task and review the application. Staff will perform Application Registration using certain pre-filled data from the online application that was entered by the individual. All online applications must have Application Registration processed even if the case is approved. It is important to associate the online application to the existing case.

A logical unit of work (LUW) is in Application Registration; Self-Service Application Search. Clerks search for the self-service application using any of the fields in the search area. The search results will be displayed by the head of household name even when the search was not on the head of household.

After successful Application Registration, an appointment or process task will be created for Data Collection, depending upon the programs requested on the online application.

The Application T number is changed to a case number upon clicking Submit in Application Registration.

A—117.2 Data Collection

Revision 15-4; Effective October 1, 2015

When performing Data Collection, the data entered in the online application is displayed for the advisor either as:

• pre-filled TIERS fields and a message at the top of the page stating that the fields are pre-filled from self-service data (for new applications); or
• YourTexasBenefits.com information that must be addressed, which displays in a comparison pop-up window (existing cases).

Click on the C icon in the Details page to access the comparison pop-up.

The comparison pop-up window displays the current data in TIERS and the data from the online application to allow the advisor to select the correct data to use in Data Collection.

The advisor may choose to:

• accept all TIERS data,
• accept all YourTexasBenefits.com data, or
• select each data element to be used individually from the comparison pop-up.

These comparison windows are displayed on most Data Collection pages through Resources. There is no YourTexasBenefits.com information or comparison windows in the Program, Income or Expenses pages. The advisor must complete the Data Collection driver flow.

A screen is added in the driver flow just before Run Eligibility. This screen is a summary screen that displays each LUW with YourTexasBenefits.com comparison data and the status of that data. Once the case is disposed, all YourTexasBenefits.com comparison data that was not resolved or processed will be marked completed by the system.

A—118 Coordination with the Federal Marketplace

Revision 24-4; Effective Oct. 1, 2024

Medical Programs

Eligibility determinations for Medicaid must be coordinated with the federal Marketplace. A person who applies for health care coverage through the Marketplace at HealthCare.gov is also assessed for Medicaid eligibility. If the Marketplace assessment does not show the person may be eligible for Medicaid, the person can still request their information be transferred to HHSC for a full eligibility determination.

The Marketplace assesses a person as:

• potentially eligible for Medicaid based on Modified Adjusted Gross Income rules; or
• potentially eligible for Medicaid on a non-MAGI basis if the person is 65 or older or reports having a disability or blindness.

If the assessment shows the person may be eligible for Medicaid, the person’s application information is transferred to HHSC.

HHSC must evaluate the person’s eligibility for Medicaid without requiring a new application.

A—118.1 Applications Received from the Marketplace

Revision 24-4; Effective Oct. 1, 2024

Medical Programs

The federal Marketplace sends the information from a person’s application to HHSC through an electronic interface when:

• the Marketplace assessment shows the person may be eligible for Medicaid; or
• the person requests a full eligibility determination for Medicaid.

The electronic transfer of information from the application is referred to as an account transfer. The account transfer includes information provided by the person on the Marketplace application and information verified by the Marketplace.

The account transfer process generates a PDF application with the information the Marketplace provides. Verifications completed by the Marketplace are included in the Verifications section of the PDF. Like an application from YourTexasBenefits.com, enter applicant information into the appropriate logical unit of work (LUW) following the policies for documentation and verification requirements. This includes any required documentation about blanks or discrepancies on the PDF application, and steps taken to resolve questionable information.

A—118.1.1 Non-MAGI Account Transfers

Revision 24-4; Effective Oct. 1, 2024

Medical Programs

A non-Modified Adjusted Gross Income (non-MAGI) account transfer is an account transfer sent from the Marketplace to HHSC. This is done when the Marketplace has identified that an applicant may be eligible for Medicaid for the Elderly and People with Disabilities (MEPD) because the applicant reported being 65 or older, having a disability or being blind.

HHSC must accept the Marketplace account transfer and evaluate the person’s eligibility for Medicaid without requiring a new application.

A—118.1.2 Verifications Provided by the Marketplace

Revision 24-4; Effective Oct. 1, 2024

Medical Programs

Marketplace account transfer PDFs also include a Verifications section. Enter information from the verification section as follows:

• If the Marketplace verified the person's Social Security number (SSN) or citizenship status using data from the Social Security Administration (SSA), accept the information as Verified by SSA.
• If the Marketplace verified the person's alien status using data from the Department of Homeland Security (DHS), accept the information as Verified by DHS.
• If the Marketplace verified other eligibility criteria, such as income or resources, per HHSC verification policy, accept the information as verified.

Verify all other applicant information as required by the applicable HHSC verification policy. Do not request additional verification for information verified by the Marketplace per HHSC verification policy.

Related Policy

Verification and Documentation, C-900

A—118.2 Applications Sent to the Marketplace

Revision 24-4; Effective Oct. 1, 2024

Medical Programs

HHSC transfers the person's account information back to the Marketplace to be assessed for other health care coverage programs, if the person is:

• ineligible for Texas Works Medicaid or CHIP;
• eligible for TP 56, Medically Needy with Spend Down;
• eligible for TP 32, Medically Needy with Spend Down-Emergency;
• eligible for TA 41, Healthy Texas Women; or
• only eligible for three months prior Medicaid.

Send Form TF0001, Notice of Case Action, to inform the person their information was transferred to the Marketplace.

A—119 Correspondence Options

Revision 15-4; Effective October 1, 2015

A—119.1 Electronic Correspondence

Revision 15-4; Effective October 1, 2015

All Programs

The head of household or authorized representative (AR) for a case may each choose at any time to receive most eligibility correspondence electronically rather than through the mail. By selecting this option, applicable forms and notices are posted to the client's or AR's YourTexasBenefits.com case account, and the client or AR receives a cell phone text message or email reminder each time a new form or notice has been posted to their account. Clients may print a copy of the correspondence from their account or request that a paper copy be mailed to them. Any forms or notices that are not available electronically will continue to be mailed to the client. 

Once a head of household or AR has opted to receive electronic correspondence through their case account on YourTexasBenefits.com or by indicating that preference to staff through 2-1-1 (Option 2), a confirmation cell phone text message or email reminder will be sent to the client. The head of household or AR must enter the code provided in that confirmation message in their YourTexasBenefits.com case account in order to confirm their choice to receive electronic correspondence. Once confirmed, Form H1013, Electronic Correspondence Confirmation Letter, will automatically be mailed to the head of household or AR to further confirm the selection and to provide instructions about how to opt out of receiving electronic correspondence.

After a failed delivery of a text or email alert, the client is automatically unsubscribed from electronic correspondence. The eligibility system then automatically prints and mails to the client a paper copy of the correspondence that failed to reach the client with the original generation date, attached to Form H1015, Electronic Correspondence Failed Delivery. The client will receive future correspondence through the mail. However, the client may opt to subscribe again to receive electronic correspondence and start over the confirmation process.

A—119.2 Preferred Language for Correspondence

Revision 15-4; Effective October 1, 2015

All Programs

The head of household or AR for a case has the ability to choose the language in which certain forms and notices are generated from the eligibility system. The head of household or AR can select their primary household language from the following options:

• English
• Spanish
• Both English and Spanish
• Vietnamese*

* Clients who select Vietnamese as their primary household language will receive correspondence in English, and the eligibility system will automatically attach to the form or notice the Vietnamese Translation Interpreter Form, which directs clients to translation services.

Once a primary household language is selected, both the head of household and AR will receive correspondence in that language.

A-121 Receipt of Application

Revision 23-3; Effective July 1, 2023

All Programs

Applications must be signed under or on the same page as the penalty of perjury statement before certification.

TANF

An application is valid if it has the applicant's name, the applicant’s address, and the signature of the:

• applicant; or
• applicant's designated authorized representative (AR).

SNAP

An application is valid if it has the applicant's name, the applicant’s address, and the signature of:

• the applicant;
• another responsible household member; or
• the applicant's designated AR.

Medical Programs

An application is valid if it has the applicant's name, the applicant’s address, and the signature of any of the following people:

• the adult or minor applicant;
• the applicant's designated AR;
• an adult applying on behalf of a minor child; or
• a person 19 or older who:
  • is included in the applicant’s MAGI household composition; or
  • has a tax relationship with the applicant.

Note: Applicants are not required to live at the same physical address to apply for each other. For example, a non-custodial parent may apply for Medicaid and CHIP on behalf of their child if the parent expects to claim the child as a tax dependent on their federal income tax return.

TP 43, TP 44 and TP 48

Do not require a new application when a household has an active Medicaid type program and requests to add Medicaid for another child who needs a new EDG. Add the child to the case per additions to the household policy. Exception: Do not add more children to a case where a Medicaid EDG was reinstated due to the child’s release from a juvenile facility. The household must submit an application for the other children. To identify these EDGs, view the Individual – Medicaid History page for the active child. If the Juvenile Placement History field indicates "Yes", the EDG has been reinstated.

This policy does not apply when there is no existing Children's Medicaid EDG. For example, do not add a child when the only other child is certified for Medicaid because the certified child receives SSI. A separate application is required to initiate coverage for the child being added.

Related Policy

Application Requests and Submissions, A-113
Filing the Application, A-122
Application Signature, A-122.1
Authorized Representatives (AR), A-170
Medical Programs, A-240
Children's Medicaid Redetermination Expectations, B-123.6
Denied EDGs, B-474.7
Additions to the Household, B-641

A-121.1 Receipt of Application from Residential Child Care Facility

Revision 24-1; Effective Jan. 1, 2024

Medical Programs

When a representative from a licensed residential child care facility applies for an independent child, accept and process the application.

A-121.2 Receipt of Duplicate Application

Revision 15-4; Effective October 1, 2015

All Programs

A duplicate application:

• is an application filed after another application has already been filed;
• does not include a request for programs different from programs requested on the initial application submitted;
• does not include a request for programs different from programs currently received by the applicant; and
• is not needed for a redetermination of any active program.

Example: If a household submits an application for SNAP on January 2 and later submits one or more additional applications for SNAP that are different from the one the household filed on January 2, and are not needed for a redetermination of any active program, the additional application submitted is considered a duplicate application.

Duplicate Application Received While Original Application Is Being Processed

If an office receives a duplicate application while staff are in the process of making an eligibility determination (an application or redetermination) based on the original application submitted, staff must:

• treat the duplicate application as a report of change; and
• assign the duplicate application as a change to the advisor currently processing the case.

The advisor processing the original application must:

• review the duplicate application for reported changes;
• document the duplicate application was reviewed for changes;
• document the type of changes, if changes were reported on the duplicate application; and
• use information provided by the household on both the original application and the duplicate application when determining eligibility for the household.

Duplicate Application Received After Original Application Is Processed

If an office receives a duplicate application and the applicant has already been certified for assistance based on another application previously submitted, staff must review the duplicate application to determine if the household is applying for programs other than what the household is currently receiving and if any redeterminations are due.

If the household is applying for different types of programs, the application is not a duplicate application and must be processed as a new application for assistance.

If the household is not applying for a different type of program and there are no redeterminations, office staff must:

• treat the duplicate application as a report of change; and
• assign the duplicate application as a change indicating "duplicate application."

Staff are not required to create a T number for TIERS cases and/or dispose of a duplicate application as "filed in error." If staff erroneously create a T number, staff must deny/dispose the T number as filed in error, in addition to other required actions listed above.

Note: If the office that receives the duplicate application does not normally process reported changes, staff may mark the application form as a duplicate application and route it to appropriate staff following local office procedures.

Advisors who process the duplicate application as a reported change must review the application to determine if any changes are indicated and take the following action. If no change is indicated on the duplicate application, the advisor must:

• document receipt of the duplicate application in TIERS Case Comments;
• route the duplicate application to be imaged as part of the electronic case record;
• sustain the benefits for each Texas Works program the household receives; and
• send an individual notice to the household that eligibility for benefits has not changed.

If a change is indicated on the duplicate application, staff must follow the procedures outlined in B-600, Changes, when processing changes reported on the duplicate application.

A-121.3 Receipt of Identical Application

Revision 15-4; Effective October 1, 2015

All Programs

An identical application is one or more exact copy of an application previously filed by an applicant.

Example: If a household faxes in an application on January 2 and later submits an exact copy of the same application, which includes the same signature and date of the application the household previously submitted, the newly submitted application is considered an identical application.

Required Action on Identical Application Received

If an identical application is received, staff must write "Identical Application" on the front page of the application and route the application for imaging. The vendor will image the identical application and add it to the electronic case record. No other action is needed.

A-122 Filing the Application

Revision 26-3; Effective July 1, 2026

All Programs

Staff should encourage households to file an application the same day the household or its representative contacts the office and shows interest in assistance. This includes contacts by phone, mail, fax or in person. Staff should explain how to file an application. Application forms are also available at YourTexasBenefits.com. They can be downloaded, printed and electronically submitted.

The file date is the day HHSC receives an application form which has the applicant's name, address and appropriate signature. This is day zero in the application process. Staff use this as the file date to determine eligibility for the programs the household requests upon filing the application through the time of the interview.

For applications submitted by phone through 2-1-1, the file date is the date the applicant submits the application with the applicant's name, address and telephonic signature.

The file date is the date the applicant clicks the Submit Application button in YourTexasBenefits.com, for electronically filed applications.

Exception: The file date is the next business day for all applications received outside of business hours when HHSC is closed, including weekends and holidays.

The household must file another application form to apply for more programs after the interview is held. This is even if the case was pended and is not completed at the time of the request for a new program. 

Exception: If the household requests three months prior Medicaid coverage, staff should use an existing application. The file date of the application used should correspond with the three-month prior period to determine eligibility.

Once an application is filed, staff must take the following actions:

• enter the file date in the appropriate section on the application form, if received as a paper document;
• screen the application for expedited service eligibility for SNAP and TP 40;
• give the household Form H1800, Receipt for Application, Medicaid Report, Verification, Report of Change, on request;
• register the application when required; and
• schedule an interview appointment for the applicant when required as soon as possible.

Refer to special procedures in this section to determine the file date for TP 40, TP 40 Continuous Coverage and TP 45 Retroactive Coverage.

Related Policy

Application Requests and Submissions, A-113
Receipt of Application, A-121
Documentation Requirements, A-190

TP 40 Continuous Coverage

The file date is the date the advisor determines eligibility, if an application form is not used.

Related Policy

Continuous Medicaid Coverage, A-832

TP 45 Retroactive Coverage

The file date is the date the advisor is notified about the child's unpaid medical bills.

Related Policy

TP 45 Retroactive Coverage, A-833

TP 33, TP 34, TP 35, TP 43, TP 44 and TP 48

The file date is the date a contracted facility accepts the application. If the application is not forwarded to HHSC within three business days, the file date is the date the HHSC office receives the application.

The file date is the date a person submits an application to any HHSC office. The application must be faxed or mailed to the correct office the same day it is returned.

The date the applicant clicks the Submit Application button in YourTexasBenefits.com is the file date for electronically filed applications. The file date is the next business day for applications received outside of business hours when HHSC is closed. This includes weekends and holidays.

A-122.1 Application Signature

Revision 25-3; Effective July 1, 2025

All Programs

The applicant must provide a signed application form before being certified. The signature can be captured anywhere on the same page the penalty of perjury statement is captured.

If the agency receives an application with no required signature and the application is not date-stamped, the application is considered invalid. Return the application with a letter and a pre-paid envelope explaining that the application must be signed before the agency can establish a file date.

If the agency accepts an application without a required signature and the application is date-stamped, the date the application is received is considered a valid file date. Send Form H1020, Request for Information or Action, along with the signature page requesting a signature. If the applicant fails to provide a signed application by the final due date, deny the application for failure to provide information.

Eligibility Support Vendor Action on Unsigned Applications

If the eligibility support vendor receives an unsigned application, the application is considered invalid. Within one business day, return the application to the household with a letter and a pre-paid envelope explaining that the application must be signed before a file date can be established.

The file date is the receipt date of the application if:

• the eligibility support vendor accepts an application without a signature; and
• it is not identified as missing a signature before data entry or the data entry date is more than one business day after the receipt date of the application.

The missing signature is treated as missing information.

Electronically Filed Applications

All Programs

Applications submitted online through YourTexasBenefits.com by the applicant or authorized representative (AR), are considered electronically signed.

Exception: Do not consider the application electronically signed when a non-applicant or non-AR completes and submits the online application for the household. In this situation, a pre-populated application is mailed to the household requesting a written signature from the applicant.

Signatures Elsewhere

Accept the applicant’s signature on the first or last page of Form H1010 to establish a file date if the application meets all other application receipt requirements.

Note: If the applicant only provides a signed first or last page of Form H1010, do not require another signature.

TANF and Medical Programs

Applications Filed by Phone

An applicant, recipient, or AR may complete and sign an application by phone.

The applicant or AR may complete and sign an application over the phone by:

• providing their information over the phone to the customer care representative; and
• signing the application over the phone by stating their name and agreeing to a penalty of perjury statement read by the customer care representative.  This information is being recorded for verification.

The customer care representative enters and submits the information provided by the applicant or AR through YourTexasBenefits.com.

Note: HHSC staff cannot accept telephonic signatures.

Applications signed and submitted over the phone by the applicant or AR are considered signed by phone except when:

• the applicant or AR declines to sign the application by phone; or
• a non-applicant or non-AR completes the application by phone for the household.

Correspondence is sent based on the following actions taken by the applicant or AR:

Related Policy

Application Requests and Submissions, A-113
Authorized Representatives (AR), A-170

Signatures Elsewhere

All Programs

Accept the applicant’s signature on the first or last page of Form H1010, Texas Works Application for Assistance - Your Texas Benefits, to establish a file date if the application meets all other application receipt requirements.

Note: If the applicant only provides a signed first or last page of Form H1010, do not require another signature.

SNAP

If SNAP is included in the combined application, Form H1031A, SNAP Telephonic Signatures Cover Letter, notifies the household a telephonically signed SNAP application or renewal was submitted and gives the household an opportunity to make and return corrections to HHSC.

Medical Programs

If an applicant signs and returns only Form H1010-MR, MAGI Renewal Addendum, with no corresponding application, the application is considered invalid. Attempt to contact the applicant by phone and advise them to file an application. No action is taken on Form H1010-MR without a corresponding application.

If the applicant returns a signed application without Form H1010-MR, consider the application incomplete. Send Form H1020, Request for Information or Action, with Form H1010-MR requesting the necessary information to make a determination based on Modified Adjusted Gross Income (MAGI) rules. If the applicant fails to provide a completed Form H1010-MR by the final due date, deny the request for failure to provide information.

Related Policy

Application Requests and Submissions, A-113
Receipt of Application, A-121

A-122.2 Scheduling Appointments

Revision 26-2; Effective April 1, 2026

SNAP and TANF

An interview is required at application and redetermination. Complete an interview even if the application only has the applicant’s name, address, and signature. Attempt to interview the applicant as a lobby walk-in or by making a cold call. Mail the applicant Form H1830, Application, Review, Expiration, Appointment Notice if the cold call is unsuccessful. It provides the applicant information on how to call the agency for a flexible appointment interview.

Medical Programs

An interview is not required. Process the application unless the applicant requests an interview.

Process the application without an interview if an interview is requested by the applicant and they fail to keep it. Do not deny the EDG for a missed appointment or send Form H1020-MA-FA, Request for Information or Action-Missed Appointment-Flexible Appointment.

Exceptions:

• If the applicant was previously denied for failure to provide Form H1024, Subject: Self-Declaration Notice for missing an appointment about HCO or Texas Health Steps noncompliance, schedule a phone interview and deliver the HCO. Remind the applicant about the importance of the Texas Health Steps checkup at that time.
• Staff conduct an interview for an initial application or redetermination when HHSC receives conflicting information about household composition or income that affects eligibility and the information cannot be verified through other means, such as an associated EDG.

Related Policy

Interviews, A-131
Explanation of Benefits,  A-1531.4
Compliance Requirements, A-1531.5

A-122.3 Registering an Application

Revision 22-3; Effective July 1, 2022

All Programs

Perform Application Registration (App Reg) within one workday after the file date when application registration is required.

To prevent overpayments or incorrectly providing benefits, take the following action before registering an application:

• screen each application filed; and
• associate the old case number in File Clearance when appropriate.

Perform inquiry on all household members applying for benefits listed on the application for assistance. Use Social Security numbers (SSNs), case name search and available case or EDG numbers to determine case status.

A-123 Withdrawal of an Application

Revision 15-4; Effective October 1, 2015

All Programs

The individual may voluntarily withdraw an application any time before certification.

SNAP

If someone other than the head of household, spouse, a responsible household member, or an AR requests a withdrawal, staff should contact the household to confirm the withdrawal.

Related Policy

The Texas Works Message, A-1527

A-124 Processing Presumptive Eligibility Applications

Revision 15-3; Effective July 1, 2015

TA 66, TA 74, TA 75, TA 76, TA 83, TA 86 and TP 42

Presumptive eligibility (PE) provides short-term medical coverage to pregnant women, MBCC applicants, children under age 19, parents and caretaker relatives of dependent children under age 19, and former foster care children. PE provides full fee-for-service Medicaid with the exception of pregnant women. Pregnant women receive ambulatory prenatal care only.

Qualified hospitals (QHs) determine PE for all groups except MBCC.

Qualified entities (QEs) determine PE for pregnant women and MBCC applicants. For MBCC applicants, only QEs that are also Texas Department of State Health Services (DSHS) Breast and Cervical Cancer Services contractors may make MBCC PE determinations, following the process outlined in X100, Application Processing.

A-124.1 Eligible Groups

Revision 15-3; Effective July 1, 2015

The following groups can receive presumptive eligibility coverage:

• Children:
  • MA-Children Under 1 Presumptive — TA 74
  • MA-Children 1–5 Presumptive — TA 75
  • MA-Children 6–18 Presumptive — TA 76
• Former Foster Care Children (MA-FFCC Presumptive — TA 83)
• Pregnant Women (MA-Pregnant Women Presumptive — TP 42)
• Parents and Other Caretaker Relatives (MA-Parents and Caretaker Relatives Presumptive — TA 86)

A-124.2 File Clearance

Revision 15-3; Effective July 1, 2015

TIERS performs automated file clearance for each individual determined presumptively eligible if the individual has a 100 percent match in TIERS or if there is no match for the individual in TIERS. For individuals for whom TIERS cannot perform automated file clearance, TIERS triggers an alert to create a TLM task for staff to manually do file clearance for the individual. TIERS routes manual file clearance tasks to the Out-stationed Worker Program (OWP) queue for assignment and processing.

A-124.3 Task List Manager

Revision 15-3; Effective July 1, 2015

When TIERS cannot automatically perform file clearance for an individual whom a QH/QE has determined to be presumptively eligible, an OWP advisor needs to take action. TIERS creates the task "Process a File Clearance Failure for Presumptive Eligibility" and sends it to an OWP advisor based on the applicant's ZIP code.

To complete the task, the advisor:

1. Selects the Work icon.
2. Selects the individual who needs file clearance from the Presumptive Eligibility Individual — Summary page.
3. Matches the PE individual to the TIERS individual on the PE File Clearance — Results page.
4. Selects Auto Process PE on the File Clearance — Results page to complete the task once the advisor has performed file clearance for all individuals on the case.  

The advisor can also manually clear the task. When an advisor searches for an application on the Self Service Application Search page, the SS Application Search Results section displays a Determine PE link if a PE individual on the case requires manual file clearance. TIERS displays the Presumptive Eligibility Individual — Summary page when the advisor clicks the link.

Once the advisor completes file clearance, TIERS notifies TLM to close the QH/QE PE task.

A-124.4 Application Processing

Revision 15-3; Effective July 1, 2015

The TLM routes applications for regular Medicaid from individuals whom a QH/QE has determined to be presumptively eligible for Medicaid to an OWP advisor for processing. If the QH has an OWP advisor, the TLM assigns the application to that advisor for processing. If the QH does not have an OWP advisor or a QE submits the application, the TLM routes the application to the regional OWP queue.

Process the applications using current policy and application processing time frames. See B112, Deadlines. If both a PE task for file clearance and a regular Medicaid application exist for the same person, clear the PE task first.

A-124.5 Verifications

Revision 15-3; Effective July 1, 2015

Use standard verification requirements when processing an application for regular Medicaid from an individual determined presumptively eligible. See C900, Verification and Documentation.

Related Policy

Verifications, C1113.4

A-124.6 Medical Effective Date

Revision 15-4; Effective October 1, 2015

The medical effective date for PE is the date that the QH or QE determines the individual is presumptively eligible for Medicaid. 

Note: An individual is not eligible for PE coverage if the individual is currently certified for Medicaid, CHIP or CHIP perinatal.  

If the individual does not apply for regular Medicaid, PE coverage ends the last day of the month after the month of the PE determination (see scenario 1 below).

If the individual submits Form H1205, Texas Streamlined Application, or Form H1010, Texas Works Application for Assistance — Your Texas Benefits, HHSC determines whether the individual is eligible for regular Medicaid. If the person is not eligible for regular Medicaid, the individual's PE coverage ends the date that HHSC determines the individual is ineligible (see scenario 2 below). If the person is eligible for regular Medicaid, the person’s PE coverage ends when HHSC makes the Medicaid eligibility determination, following cutoff rules. 

If an individual is Medicaid-eligible during the application month, the individual receives Medicaid from the first of that month through the PE MED. Regular Medicaid coverage for the ongoing period starts once the PE period ends (see scenarios 3 and 4 below). Exception: Since PE for pregnant women provides only limited prenatal services, ongoing Medicaid coverage overlays the PE coverage (see scenario 5 below).

Examples:

A-124.7 Periods of Presumptive Eligibility

Revision 15-3; Effective July 1, 2015

Pregnant women are allowed one PE period per pregnancy.

For all other PE groups, an individual is allowed no more than one period of PE per two calendar years. Example: An individual receives PE for children ages 6–18 in June 2015. He cannot receive another period of PE until January 2017.

A-124.8 Fair Hearings

Revision 15-3; Effective July 1, 2015

Appeals and fair hearings do not apply to PE.

A-124.9 Questions About the Presumptive Eligibility Process

Revision 20-4; Effective October 1, 2020

Refer hospitals and entities that are interested in becoming qualified to make PE decisions to the PE website.

Refer a person with questions about their PE coverage dates to the QH/QE that made the PE determination. For questions about services covered by Medicaid, tell the person to call the Medicaid help line at 800-335-8957.

A-124.10 Presumptive Eligibility Forms

Revision 15-3; Effective July 1, 2015

Qualified hospital/qualified entity staff use the following forms in the presumptive eligibility process: 

• Form H1265, Presumptive Eligibility (PE) Worksheet — Completed by the QH/QE and used to determine if an applicant is presumptively eligible.    
• Form H1266, Short-term Medicaid Notice: Approved — Completed by the QH/QE and given to an individual determined presumptively eligible. This form notifies the individual about PE coverage and lists the eligibility start and end dates. If an individual takes this form to a local eligibility determination office and requests a temporary Medicaid identification card, give the person Form H1027-A, Medicaid Eligibility Verification.
• Form H1267, Short-term Medicaid Notice: Not Approved — Completed by the QH/QE and given to an individual determined ineligible for PE coverage. This form explains the reason for ineligibility and how to apply for regular Medicaid.

Related Policy

Qualified Hospital/Qualified Entity Policy and Procedures for Presumptive Eligibility Determinations, C1113

A-125 TP 45 Provider Referral Process

Revision 25-1; Effective Jan. 1, 2025

TP 45

Customer Care Center (CCC) Data Integrity (DI) uses the Provider Referral Process when a hospital, birthing center or Federally Qualified Health Center (FQHC) submits a referral directly to DI for a newborn whose mother is Medicaid eligible. The provider does not submit a claim for payment to the claims administrator for the child at this time.

DI verifies the mother's Medicaid coverage, which can be retroactive, and creates a TP 45 EDG for the newborn.

Coverage for the child begins on the child's date of birth (DOB). The last month of coverage is the last day of the month that the child turns one, except in the following situations:

• The hospital notifies DI through the Texas Electronic Registration (TER) system or Form 7484, Hospital Report for Newborn Child or Children, that the child's mother relinquished her parental rights.
  • If TER or Form 7484 indicates a relinquishment, but the new caretaker’s information is incomplete or not provided, DI provides newborn Medicaid coverage from the child's DOB through the end of the month the child is relinquished.
  • If TER or Form 7484 indicates a relinquishment, and the new caretaker’s name and address are provided, DI completes two case actions. The first action is to process an open and close newborn Medicaid EDG with the birth mother as the case name. The coverage begins with the child’s DOB and continues through the end of the month the child was relinquished. The second action is to open a newborn Medicaid case or EDG with the new caretaker as the case name. The coverage begins the first of the month after the original newborn Medicaid coverage ended and continues through the month of the child’s first birthday.
• The child's mother received TP 42 Pregnant Women Presumptive coverage at the time of the child's birth, and the mother's application for regular Medicaid coverage is denied. DI certifies the child through the birth month.

The computer generates and sends the following documents for each EDG:

• Notice of the newborn's individual number to the referring provider and other providers, if identified on the provider's referral;
• Your Texas Benefits Medicaid card to the newborn's mother; and
• Notice informing the newborn's mother or caretaker:
  • that the child is eligible to receive medical coverage through the month of their first birthday while they remain a Texas resident and to report any changes concerning these eligibility requirements;
  • to report any incorrect information on Form H1027-A, Medicaid Eligibility Verification;
  • to report if the newborn's siblings receive TANF; and
  • if the mother's Medicaid end date changes because the child was not born in the anticipated month.

A-125.1 Advisor Action in Provider Referral Process

Revision 15-4; Effective October 1, 2015

TP 45

A task is created when a TP 45 EDG is established and the TIERS case contains an active SNAP or TANF EDG. The advisor must take the following actions once the advisor claims the newborn alert task.

A-125.2 Suspended Claim Process

Revision 15-4; Effective October 1, 2015

TP 45

The Medicaid provider sends a claim for a newborn child with the child's mother's claim to the claims administrator. If the claims administrator cannot find the child on HHSC's eligibility files, the claims administrator suspends the child's claim and sends an exception notice to State Office Data Integrity (SODI). SODI checks the child's mother's Medicaid eligibility. If the mother received Medicaid at the time of the child's birth, including a retroactive determination, SODI follows procedures in the Provider Referral Process to provide Medicaid coverage for the child.

A-125.3 Mandated TIERS Inquiry

Revision 15-4; Effective October 1, 2015

TP 45

Field staff must perform TIERS inquiry before providing coverage for a newborn when there is no evidence of SODI TP 45. Staff should inquire by the newborn's mother's individual number and look for a process date that is after the child's DOB.

A-126 Processing Children’s Insurance Applications

Revision 15-4; Effective October 1, 2015

See A-113, Application Requests and Submissions, for how to apply for Medical programs for children.  

A-126.1 Front Desk Process

Revision 15-4; Effective October 1, 2015

CHIP and TP 43, TP 44 and TP 48

When individuals come to a local eligibility office to inquire about health insurance for their child(ren), the front desk clerk must:

• explain the ways to submit an application as outlined in A-113, Application Requests and Submissions; and
• explain that the Medicaid application process provides that if a child is found ineligible for Medicaid based on income, HHSC will test the child for CHIP and, if eligible, the Enrollment Broker will send an enrollment packet to the household.

A-126.2 Inquiry

Revision 15-4; Effective October 1, 2015

CHIP and TP 43, TP 44 and TP 48

Before certifying a child for any type of Medicaid program, advisors must perform an inquiry to determine whether the child applying for Medicaid is already enrolled or pending enrollment in Medicaid, CHIP, or CHIP perinatal.

A-126.3 Advisor Action for Determining Eligibility for Children

Revision 16-2; Effective April 1, 2016

CHIP and TP 43, TP 44 and TP 48

When taking action on an application, the following procedures must be applied:

After determining a child is ineligible for Medicaid, TIERS will test eligibility for CHIP.

When the head of household does not provide their date of birth (DOB) and/or Social Security number (SSN), the following steps are taken to obtain the information:

• Call the household to try to obtain the correct DOB and/or SSN. Let the household know this information is voluntary and is not required to make an eligibility determination for the child; however, it will help expedite the process.
• If unable to obtain the DOB and/or SSN by telephone, continue to process the child's application for Medicaid.
• Select a random DOB for the caretaker/second parent, with a year between 1965 and 1975. Using randomly selected DOBs reduces or eliminates the problem of duplicate individual numbers.
• The SSN field is left blank if the correct number is not available.
• Staff ensure that all other demographic information is correct and include the individual's middle name, when available.

A-126.3.1 Neonatal Intensive Care Unit (NICU) Newborn Process

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 36, TP 43 and TP 45

Income Above the Limit for Medicaid for Pregnant Women (TP 40)

When a CHIP perinatal mother whose household income is above the income limit for TP 40 applies for Medicaid for her newborn and HHSC hospital-based staff have information from the applicant or the hospital that the newborn is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the newborn using the following process:

• Upon receipt of an application for a Medicaid NICU newborn, HHSC hospital-based staff must perform inquiry to determine if the mother is on CHIP perinatal or whether the newborn has been assigned a TIERS individual identification (ID) number and is active on Medicaid.
• If the newborn is not active on Medicaid, staff must deny the CHIP perinatal and certify the eligible newborn for TP 43, if eligible, following existing policy.
• If not eligible, test the newborn for TP 56 and do not deny the newborn’s CHIP perinatal coverage.
• If eligible, the newborn may receive TP 56 and CHIP perinatal coverage.

Income at or Below the Limit for Medicaid for Pregnant Women (TP 40)

When HHSC hospital-based staff have information from the applicant or the hospital that a newborn born to a CHIP perinatal mother whose household income is at or below the income limit for TP 40 is medically fragile and that the newborn is admitted into the NICU, HHSC hospital-based staff must certify the eligible mother for Emergency Medicaid and the newborn for TP 45, effective on the newborn's date of birth. The CHIP perinatal mother must submit Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification, to the hospital. HHSC hospital-based staff must process Form H3038-P.

Upon receipt of Form H3038-P, HHSC hospital-based staff must:

• perform inquiry on the Newborn Perinatal Match Interface (Interfaces – TIERS Left Navigation) to verify the CHIP perinatal household's FPIL;
• use the date Form H3038-P is provided as the file date for both the Emergency Medicaid and Medicaid for the newborn child;
• certify the CHIP perinatal mother for Emergency Medicaid and deny the CHIP perinatal Eligibility Determination Group (EDG); and
• certify the eligible newborn for TP 45, effective on the newborn's date of birth.

Related Policy

Adding a New Child, D1433.1

A-126.4 CHIP Good Cause

Revision 15-4; Effective October 1, 2015

CHIP good cause is explained in D-1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

A-126.4.1 Claiming Good Cause

Revision 15-4; Effective October 1, 2015

CHIP good cause is explained in D-1723.6, Good Cause Exemptions for Children Subject to the 90-day Waiting Period.

A-127 Prior Medicaid Coverage

Revision 15-4; Effective October 1, 2015

Children's Medicaid and TP 33, TP 34 and TP 35

Staff use any valid application or renewal form to determine three months prior coverage for Children's Medicaid. Do not require Form H1113, Application for Prior Medicaid Coverage, if the family provides enough information to determine eligibility for prior months. If the family does not provide enough information and cannot be reached by telephone, staff sends Form H1113 with Form H1020, Request for Information or Action, to request verification. Note: Three months prior coverage does not apply to CHIP. See D-1723.5, Coverage Start Dates, to determine when CHIP coverage begins.

Staff must not delay certification of ongoing eligibility to determine if any child is eligible for prior coverage.

Related Policy

Medicaid Coverage for the Months Prior to the Month of Application, A-830

A-128 Processing Applications for Pregnant Women

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 40 and TP 36

A pregnant woman may apply for health care coverage using applications and ways to submit an application explained in A-113, Application Requests and Submissions.

When a pregnant woman applies for health care coverage, she will first be tested for TP 40 coverage. If ineligible for TP 40, TIERS will determine whether the woman is eligible for CHIP or CHIP perinatal.

CHIP perinatal coverage provides services to unborn children of pregnant women, regardless of age, who are at or below the program income limit and are ineligible for:

• Medicaid because of immigration status or income; or
• CHIP because of age or immigration status.

CHIP perinatal households are exempt from the:

• 90-day waiting period;
• cost-sharing (enrollment fees and co-payments); and
• six-month income check.

A-128.1 Inquiry for Pregnant Women

Revision 15-4; Effective October 1, 2015

CHIP Perinatal, TP 40 and TP 36

Before certifying a pregnant woman for any type of health care coverage, advisors must perform inquiry to determine whether the pregnant woman is already certified for Medicaid or enrolled or pending enrollment in CHIP or CHIP perinatal.

Searching by the woman's last name and date of birth may increase the possibility for a match.

A-128.2 Staff Action for Determining Eligibility for Pregnant Women

Revision 21-2; Effective April 1, 2021

TA 85 (CHIP-P), TP 40 and TP 36

When taking action on an application, apply the following procedures.

* When a woman enrolled in CHIP perinatal submits a new application, they must be tested for Medicaid coverage. When processing a change for a woman certified for CHIP perinatal, TIERS will automatically test for Medicaid eligibility. A new application is not required.

A-128.3 CHIP Perinatal Application Process

Revision 21-2; Effective April 1, 2021

TA 85 (CHIP-P), TP 36 and TP 45

CHIP perinatal (TA 85) covers labor with delivery charges for households with income above the income limit for Medicaid for Pregnant Women (TP40), but not for households that qualify for Emergency Medicaid coverage (women who do not meet citizenship requirements, and whose household income is at or below the income limit for TP40). These Medicaid-eligible households must submit Form H3038-P, CHIP Perinatal — Emergency Medical Services Certification, to apply for Emergency Medicaid to pay for these charges.  A woman certified for TA 85 with household income above the TP40 income limit cannot be certified for Emergency Medicaid to cover the labor with delivery charges.

A child born to a CHIP perinatal mother whose household income is at or below the income limit for TP40 and who receives Emergency Medicaid to cover labor with delivery charges is enrolled in Medicaid instead of CHIP perinatal.  

Thirty days before the expected due date, TIERS generates and sends Form H3038-P with Form H1061, Birth Outcome Letter, to the household. If the household has not reported the child’s birth by 30 days after the expected due date, TIERS sends a Form H1062, Birth Outcome Reminder Letter, and a second Form H3038-P with instructions for getting Form H3038-P completed and signed by the medical practitioner, along with a self-addressed postage-paid envelope. The household must return Form H3038-P to HHSC.

Upon receipt of Form H3038-P:

• the form is linked to the mother's case; and
• a task is created for Customer Care Center (CCC) staff to certify the mother for Emergency Medicaid and the newborn for TP 45.

Staff must not certify the mother for Emergency Medicaid or the newborn for TP 45 if the household has not returned Form H3038-P within 60 days from the date of the expected pregnancy due date. Reopen three-month prior applications for people who return Form H3038-P after 60 days from the expected pregnancy due date.

Note: For newborns admitted to the Neonatal Intensive Care Unit (NICU), process both the Emergency Medicaid coverage for the mother and the TP 45 for the newborn.

CCC Staff Process

CCC is assigned a task to process Form H3038-P. Staff must:

• determine whether mother and newborn are already active on Medicaid;
• if mother and newborn are not active on Medicaid, use all TP 40 eligibility policies and procedures to determine Emergency Medicaid eligibility, except when verifying income and citizenship/alien status;
• use the verified income provided to determine CHIP perinatal eligibility to determine Emergency Medicaid eligibility. Note: TIERS will not run financial rules when certifying a recipient for Emergency Medicaid and will instead use the verified income used to determine the woman’s CHIP Perinatal eligibility;
• verify all non-financial eligibility points prior to certification using:
  • identity verification sources; and
  • residence verification sources;
• use the date Form H3038-P is received as the file date for the Emergency Medicaid and TP 45; and
• process Form H3038-P by the 45th date after the file date.

The file date for the TP 45 is usually the date Form H3038-P is received if it includes the newborn's information. Birth outcome information can also be received via the newborn interface or from the person by phone or in writing. When birth outcome information is received after Form H3038-P has already been submitted to the HHSC, a second task is assigned to CCC to process TP 45 coverage for the newborn.

When CCC staff receive a task that includes Form H3038-P dated more than 60 days after the pregnancy due date, CCC must stamp "Received (Date) CCC" on Form H3038-P, to indicate the form was provided after the 60 days from the pregnancy due date. CCC staff must return Form H3038-P along with an application and a letter informing the person that they must apply for Medicaid. The person is instructed to complete the application and return it to the nearest HHSC office or appropriate out-stationed worker, if an out-stationed worker is housed at the hospital where the delivery took place.

Out-Stationed and HHSC Eligibility Office Staff Process

The chart below explains procedures staff must follow to determine appropriate action.

Notes:

• Fax the bar-coded Form H3038-P to 877-447-2839. If Form H3038-P is not bar-coded, write the mother's case and CHIP perinatal EDG number on the top of the form.
• If the applicant requests the fax number for Form H3038-P, instruct the applicant to fax the form to 877-447-2839.

Related Policy

Receipt of Duplicate Application, A-121.2
Receipt of Identical Application, A-121.3
Neonatal Intensive Care Unit (NICU) Process, A-126.3.1
Verification Sources, A-621
Verification Sources, A-761
Reopening Three Months Prior Applications, A-831.2.1
Deadlines, B-112

A-129 Data Broker Requirements

Revision 15-4; Effective October 1, 2015

All Programs

Staff must request Data Broker reports as required in C-820, Data Broker.

Related Policy

Permissible Purpose, C-824

A-131 Interviews

Revision 26-2; Effective April 1, 2026

TANF and SNAP

Conduct an interview at application and redetermination with the applicant or the applicant's spouse if the spouse is a member of the household to determine eligibility.

Exceptions:

• A household may designate an authorized representative (AR), who must also sign the application.
• For SNAP, another responsible household member may also be interviewed.
• For TSAP redeterminations, no interview is required unless the household requests an interview, the case contains earned income, or it appears the household is going to be denied.

Note: The spouse, or other responsible household member for a SNAP interview, does not have to sign the application to be interviewed. Staff must not exempt the household from any program or verification requirements due to interviewing an AR or conducting a phone interview.

Medical Programs

Interviews are not required for medical programs but can be requested by the applicant or recipient. Document how the person’s identity was verified if an interview is conducted for a non-interview required program.

Related Policy

Authorized Representatives, A-170
SNAP Programs, B-474.1.1 
Texas Simplified Application Project (TSAP) for SNAP Food Benefits, B-477

A-131.1 Home Visits

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must provide notice to the household before making any home visit. Application and redetermination interviews must be scheduled in writing. Notification of other home visits may be:

• verbal,
• given or mailed to the individual, or
• by telephone contact with a responsible household member.

The notification should include the time (at least whether morning or afternoon) and date of the visit. Advisors should route the notification for imaging to add to the electronic case record or document the specific information in TIERS Case Comments. If regions have specialized staff that conduct home visits, the documentation may be maintained in a separate location as long as it is accessible if needed.

Home visits to collateral sources do not have to be scheduled in advance.

No one should be denied for refusing to agree to a home visit unless there is no other sufficient and reliable verification available.

Related Policy

Advisor Responsibility for Verifying Information, C932

A-131.2 Requirement to Provide Interpreter or Translation Service

Revision 15-4; Effective October 1, 2015

All Programs

HHSC is required to provide interpreter and translation (written or verbal) services to applicants and recipients with Limited English Proficiency (LEP). Consider an individual with LEP even if they do not request an interpreter on the application if the individual indicates they would like to speak a language other than English during the interview. HHSC is also required to provide an effective method to communicate with applicants and recipients who indicate they are deaf or hearing impaired. Applicants and recipients may indicate on an application or during an interview that they need interpreter services.

A-131.2.1 Availability of Interpreters and Translation Services

Revision 23-3; Effective July 1, 2023

All Programs

Local offices must set up procedures to ensure interpreters and translators are available for applicants or recipients who indicate needing such services on an application.

To meet the requirement for applicants and recipients who indicate they are Limited English Proficiency (LEP), offices can use:

• Bilingual advisors – when it is reasonably possible to do so, schedule LEP applicant or recipient interviews with bilingual advisors.
• Bilingual clerical staff – use bilingual clerical staff as interpreters whenever possible.
• Local community interpreter providers.

Use the following methods for interpretation only after exhausting all local and regional resources:

• Language Line Services – This service is available to all regions. Staff can use the service by calling the primary vendor at 844-403-1611 or the secondary vendor at 866-975-3097 and using their 11-digit employee identification number.
• •    Applicants or recipients may provide their own interpreter if they wish to do so. Note: A minor, 15 or older, can act as an interpreter at the person's request and when the minor accompanies the person to the interview. Do not use a minor under 15 as an interpreter.

To meet this requirement for applicants and recipients who indicate they are deaf or hearing impaired, offices can:

• Schedule a phone interview if the applicant indicates the contact phone on the application is a TDD/TTY line unless the applicant requests a face-to-face interview.  
  Note: Relay Texas can be reached at these numbers:
  • 7-1-1, 800-RELAYTX (800-735-2989), Spanish to English (Spanish speaking callers to English speaking HHSC staff) at 888-777-5861; and
  • and Spanish to Spanish at 800-662-4954.
• If unable to reach the applicant by phone, schedule a face-to-face interview and arrange for interpreter services at the interview location.

Note: In situations where an interpreter services vendor is not available, the use of handwritten notes with the hearing-impaired person is allowed. The notes must be  an effective and acceptable means of communication for the person.

A-131.2.2 Availability of Translated Written Material

Revision 15-4; Effective October 1, 2015

All Programs

Staff must inform applicants/recipients about the availability of translation (written or verbal) services regarding written materials HHSC sends to them by following the two processes below, when applicable.

When staff verbally communicate with LEP applicants/recipients at application, redetermination (including desk reviews) and change actions, staff  must ensure that applicants/recipients understand the eligibility action (Form H1020, Request for Information or Action, and Form TF0001, Notice of Case Action) being taken and the requirements for the  application process (including any missing information being requested). Providing a verbal explanation to all LEP applicants/recipients in their preferred language regarding the eligibility action being taken and/or missing information being requested meets this requirement.

Note: This requirement is not applicable for desk reviews and change actions when staff process the case action without talking with the applicants/recipients.

The Vietnamese Translation Interpreter Form is automatically attached to applicable eligibility notices when clients select Vietnamese as their primary household language.

A-131.3 Interview Requirements

Revision 26-2; Effective April 1, 2026

All Programs

During the interview, staff must:

• protect the household’s confidentiality and conduct the interview as a confidential discussion of household circumstances;
• review the application and resolve unclear and incomplete information with the household;
• advise the household of their rights and responsibilities, including the right to appeal, voter registration, work requirements and other general reminders;
• advise the household of the application processing time frames;
• advise the household of their responsibility to report changes; and
• ensure that the address in the eligibility determination system reflects the household's current address. 

Staff must take the following actions and provide the following referrals and information during the interview:

• Verify that the household agrees the information is complete and correct on the application form and in the case documentation for household composition, income, and expenses.
• Verify that the income and expense information from past periods including self-employment, accurately reflect the amounts that can be anticipated for future income and expenses. If the information is inaccurate, determine why it is inaccurate.
• Determine if households with questionable or negative management can explain how the household's bills are paid.
• Determine if households with other discrepancies in information that could affect eligibility can provide information to resolve those discrepancies.
• Determine if households who have not provided all verification requested on Form H1020, Request for Information or Action, have a reason beyond their control that prevents the household from providing verifications. If a collateral source is designated, accept the household’s statement or use other forms of verification for the missing verifications.
• Determine if income verification may be calculated based on year-to-date information from other paychecks provided by the household when income verification is missing for a particular pay period(s), rather than requesting it on Form H1020.
• Refer the household to other state or local resources for types of assistance the household requested on the application form, such as childcare, child support, utilities, or rent, that are provided by other agencies.

TANF

Determine if:

• any adult household member received TANF cash assistance from another state since October 1999;
• any member of the household was disqualified in another state for a felony or drug conviction;
• any member of the household was disqualified from participating in TANF for an intentional program violation (IPV) in another state; and
• applicants must provide information on parent(s) living outside of the home to meet child and medical support requirements, or if applicants meet a good cause exemption.

SNAP

• Determine if households qualifying for the standard medical expense want to claim actual expenses.
• Determine if the household wants to prorate an expense or income.
• Determine if any household member claims an exemption to Employment and Training (E&T) work requirements.
• Provide reminders. Include the household's change reporting requirement, for E&T requirements, able-bodied adult without dependents (ABAWD) time limit policy if there is an ABAWD in the household, and how the household can get and use SNAP benefits issued via EBT.
• Determine if an ABAWD received any countable months of benefits in another state.
• Determine if any member of the household was disqualified from participating in SNAP for an IPV or a felony drug conviction in another state. Note: Data Broker displays current out-of-state IPV disqualification data.

Related Policy

Explanation of Good Cause, A-1130
How to Project Income, A-1355
Budgeting Options for SNAP Households, A-1355.1
How to Budget Expenses, A-1358
Verification Requirements, A-1370
Medical Deduction, A-1428
Reminders, A-1500
Management, A-1700
Determining the Number of FTL Months Used, A-1920
Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification, B-942

A-132 Eligibility Factors

Revision 26-3; Effective July 1, 2026

All Programs

* TP 08, TA 31, TPs 32, 33, 34, 35, 36, 40, 43, 44, 45, 48 and 56.

Note: For medical programs, the eligibility factors noted above do not necessarily apply in all cases.

A-132.1 Medical Programs Hierarchy

Revision 19-4; Effective October 1, 2019

Medical Programs

Texas Works Medical Programs Hierarchy

Notes:

• If the pregnant woman or child under age 19 indicates unpaid medical expenses for any of the three months prior to application month or for the application month, determine eligibility under the following programs:
  • TP 56, Medically Needy with Spend Down, for pregnant women and children under age 19 who are ineligible for Medicaid because of income.
  • TP 32 Medically Needy with Spend Down - Emergency, for pregnant women and children under age 19 who are ineligible for Medicaid because of income and alien status.
• Children ages 0 thru 18 who are ineligible for medical programs because of income are tested for CHIP.

Related Policy

Income Limits, C-131 
Qualified Hospital/Qualified Entity Procedures for Presumptive Eligibility Determinations, C-1113 
Guidelines for Providing Retroactive Coverage for Children and Medical Programs, C-1114 
Type Programs (TP) and Type Assistance (TA), C-1150 
Former Foster Care in Higher Education (FFCHE), Part F 
Medicaid for Transitioning Foster Care Youth (MTFCY), Part M 
Medicaid for Breast and Cervical Cancer (MBCC), Part X
Healthy Texas Women, Part W

A-132.2 Guidelines for Pregnant Women

Revision 15-4; Effective October 1, 2015

See A-240, Medical Programs.

A-133 Rights and Responsibilities

Revision 26-2; Effective April 1, 2026

SNAP and TANF

Before completing the interview, staff must ensure that the applicant:

• provides all the information requested on the application;
• reports any changes that occurred since filing the application; and
• reads and understands persons's rights and responsibilities as explained on the application.

TANF

Staff must also ensure that:

• TANF applicants read and understand the rights and responsibilities of the child support program explained on Explanation of Child Support Eligibility Requirements Family Violence and God Cause FAQS (PDF);
• TANF applicants read and understand Form H2580, TANF Employment Services Notice, and receive a copy of the form; and
• TANF applicants read, understand and sign Form H1073, Personal Responsibility Agreement.

SNAP

Staff must provide the applicant with Form H1805, SNAP Food Benefits: Your Rights and Program Rules.

Medical Programs

Before completing the interview, if requested, make sure the applicant:

• completes all sections of the application; and
• reads and understands the person's benefits and responsibilities as explained on Form H1010, Texas Works Application for Assistance — Your Texas Benefits, and Form H1205, Texas Streamlined Application.

A-134 Documentation Guidelines

Revision 13-2; Effective April 1, 2013

A complete list of documentation requirements for determining eligibility can be found at the conclusion of each eligibility section within the Texas Works Handbook. TIERS Data Collection pages handle a vast majority of the required documentation for case records. For the remaining small percentage of documentation still required by policy, staff must include the information in TIERS Case Comments. For documentation that is not captured within the Data Collection pages, a comprehensive guide, The Texas Works Documentation Guide, has been developed. This documentation guide outlines the requirements for documentation that must be entered in TIERS Case Comments.

A-135 Pending Information

Revision 24-1; Effective Jan. 1, 2024

All Programs except TP 40

If the applicant cannot furnish all required proof during the interview or with the application, allow the household at least 10 days to provide the information. The due date must be a business day.

Staff must provide an applicant Form H1020, Request for Information or Action, explaining:

• what is needed;
• the due date for receipt of the information; and
• the date the application must be denied if information is not received.

Form H1020 should include Form H1020-A, Sources of Proof, that corresponds to the verification requested.

Medical Programs

Do not request additional verification if available through electronic data sources unless questionable.

TP 40

Do not allow 10 days for the applicant to provide verification if doing so exceeds the 15 business day processing time frame and verification can be postponed.

Related Policy

Expedited Certification Procedures, A-145
Pending Verification on Applications, B-115
Questionable Information, C-920

A-136 Eligibility Decision and Privacy Notice

Revision 22-1; Effective January 1, 2022

All Programs

After obtaining all required proof, dispose of the application and provide the applicant Form TF0001, Notice of Case Action, detailing the decision.

Medical Programs

HIPAA requires HHSC to provide a notice of privacy practices that explains:

• the person's privacy rights;
• the duties of HHSC to protect the person's health information; and
• how HHSC may use or disclose the person's health information without an authorization. For example, HHSC may share health information with the person's providers to arrange for services or with other government entities to report suspected abuse or neglect.

Provide Form 0401, Notice of Privacy Practices (English PDF), or Form 0401-S, Aviso de Normas Sobre la Privacidad (Spanish PDF), as appropriate, to each household enrolled in a medical program.

Provide Form 0401 or Form 0401S with Form TF0001, Notice of Case Action, to each head of household:

• at initial certification; and
• at recertification after a break in services of more than 180 days.

Form 0403, Explanation to Health Information Privacy Rights, provides a reminder of privacy practices and where to find Form 0401.

Provide Form 0403 (PDF) with Form TF0001 to each head of household:

• at each recertification;
• after a break in services of at least 30 days but not more than 180 days; and
• when a new person is added to a case.

A-137 Prudent Person Principle

Revision 15-4; Effective October 1, 2015

All Programs

The policies and procedures included in the handbook are rules for determining eligibility. It is impossible to provide examples for all policy situations. When staff encounter rare and unusual situations, HHSC encourages them to use reason and apply good judgment in making eligibility decisions. The "prudent person" principle allows staff to make reasonable decisions based on the best available information using:

• common sense,
• program knowledge,
• experience, and
• expertise.

Staff should document the rationale used to make a decision and any applicable handbook references.

Revision 26-2; Effective April 1, 2026

SNAP

Use the expedited screening questions on the following forms to screen all applications and redeterminations for expedited service:

• Form H0011, Texas Simplified Application Project (TSAP) for SNAP Food Benefits;
• Form H0011-R, Texas Simplified Application Project (TSAP) for SNAP Food Benefits Renewal;
• Form H1010, Texas Works Application for Assistance; or
• Form H1010-R, Your Texas Works Benefits – Renewal Form.

Redeterminations submitted within 30 days after the certification period ended must be screened for expedited benefits. HHSC staff screen applications and redeterminations received in the local office. Vendor staff screen applications and redeterminations sent to the Document Processing Center by fax or mail. An automated system screens applications and redeterminations submitted online through the Your Texas Benefits website.

Households who meet the test for expedited services are entitled to:

• postpone all verification until after receiving the first month's benefit, except:
  • identity; and
  • proof they meet or are currently exempt from the SNAP ABAWD work requirement if they have already received the maximum number of benefit months without meeting the work requirement; and
• get benefits the same day they apply, if possible, but no later than the next business day.

Expedited Redeterminations 

Redetermination applications or renewal packets submitted within 30 days after the certification period has ended must be screened for expedited benefits per the following chart. 

Exceptions: In the following situations, households may not get benefits within this time frame:

• Applicants or recipients in a drug and alcohol treatment or a group living arrangement facility. Approve benefits so the resident can participate by the seventh day after the application date.
• Joint SNAP/SSI applicants released from public institutions. The Centralized Benefit Services (CBS) section approves benefits so the person can participate by the fifth day after release from the institution.

Late Determinations

Additionally, households may not get benefits within this time frame in late determinations for expedited service. These are households that:

• the agency did not identify as entitled to expedited service when the household filed the application or untimely redetermination after the certification period;
  • expedited processing begins on the day the office becomes aware the household is entitled to this service; and 
  • do not enter a late determination date if the agency failed to properly screen the household using the expedited screening questions on the application or redetermination form;
• meet expedited criteria and have a household member who served the minimum employment and training penalty, but the household chose to delay their certification until all disqualified members signed Form H1808, Agreement to Follow SNAP Work Rules;
• require an interview;
  • but HHSC must mail the application or redetermination back to the household for signature; and
  • the late determination date is the date the applicant returns the signed application or redetermination;
• mail or drop off the application or redetermination form. 
  • contact the applicant to conduct an interview;
  • if the applicant cannot be contacted by phone, mail Form H1830, Application, Review, Expiration, Appointment Notice, the same day the application or redetermination is screened; 
  • the interview must be completed and benefits provided to an eligible household by the seventh calendar day from the file date; and
  • if the household also applies for TANF, schedule a regular TANF appointment on the same notice;
• miss their expedited appointment and contacts office to complete an interview, expedited processing begins the day the household contacts the office for an interview;
• do not provide acceptable proof of identity, or proof of meeting or being exempt from the SNAP ABAWD work requirement, as explained in the beginning of this section, expedited processing begins when the household provides the required proof;
• are not eligible for expedited processing when screened for expedited services at the time of application or untimely redetermination;
  •  but meet expedited criteria later in the initial month because of a change in household circumstances after the application; or
  • redetermination form was submitted;
  • the late determination date is the date the eligibility for expedited processing is met; or
• submitted an application or redetermination through the Your Texas Benefits website when the office was closed due to weather-related conditions, flooding or other similar situations so the late determination date is the first business day the office reopens following the office closure.

Notes:

• Enter the late determination date in the eligibility determination system for late determinations caused by the applicant, resulting from a change in the household's circumstances or due to office closures, as explained above.
• Except for delays in screening due to office closure, enter the late determination date only if HHSC, the vendor or the Your Texas Benefits website screened the application on the file date or no later than the next business day.
• The late determination date becomes day zero in determining timeliness on expedited applications.

TP 40

Expedite applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy. These applicants are entitled to:

• have their eligibility determined no later than 15 business days from the date HHSC receives the application; and
• postpone all verification, except identity, until the 30th calendar day from the application file date. 

Postponing verification only applies to current and ongoing coverage. For prior coverage, act by the 15th business day. Deny the application if the applicant does not provide verification and reopen denied applications within two years at the applicant's request.

Note: An interview is not required when processing a TP 40 application.

Related Policy

Application Signature, A-122.1  
Postponed Verification Procedures, A-145.1
Medicaid Coverage for the Months Prior to the Month of Application, A-830
ABAWD Referral Process, A-1831.1.2
Counting Months Toward Time-Limited Eligibility, A-1950
Regaining Eligibility, A-1960
Residents of D&A Facilities, B-441
Residents of GLA Facilities, B-442

A-141 Expedited Eligibility Criteria

Revision 15-4; Effective October 1, 2015

SNAP

Applicants are entitled to expedited service if they meet one of the following criteria:

• The household's:
  • liquid resources total $100 or less, and
  • countable gross monthly non-converted income totals less than $150. Note: When determining eligibility for expedited services, staff must count the actual amount of TANF the individual actually receives.
• The household's liquid resources plus actual, non-converted countable gross monthly income total less than the most recent monthly expenses for rent/mortgage and utilities. Staff should include the standard telephone allowance for households with a telephone expense.
• The household includes a migrant or seasonal farmworker and meets the destitute criteria listed in A-146, Expedited Policy for Migrant or Seasonal Farmworkers.

An individual who reapplies within the last month of a current certification period is not eligible for expedited service.

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to a pregnancy are eligible for expedited processing.

A-142 Limit on Expedited Certification

Revision 22-2; Effective April 1, 2022

SNAP

A household may receive expedited services any number of times if, before the expedited certification, the household:

• completes the verification requirements postponed at the last expedited certification; or
• was certified under the usual 30-day processing standards since the last expedited certification.

The household may provide the postponed verification after denial and qualify for expedited services at a later application.

Notes:

• The household may re-apply without submitting a new application until the 60th day after the file date, when an expedited application with postponed verification is denied for failure to provide requested information or verification.
• The household may re-apply without submitting a new application until the 60th day after the file date. Reopen the application using the date the person provided verification as the new file date. If the household submits another application, consider the second application a duplicate. Follow related policy.
• If the information satisfies the verification requirements postponed at the last expedited certification, the household is eligible for expedited services.
• The household may re-apply without submitting a new application until the 30th day following the last benefit month if a redetermination is denied for:
  • failure to provide requested information; or
  • for a missed appointment.
• If the household submits another application, staff must consider the second application a duplicate and follow related policy.

Related Policy

Receipt of Duplicate Application, A-121.2  
Reuse of an Application Form After Denial, B-111
Pending Verification on Applications, B-115  
Delays Caused by Households, B-122.3

A-143 How to Determine Eligibility for Expedited Service

Revision 24-2; Effective April 1, 2024

SNAP

TP 40

All applications for Medicaid from women applying for current or ongoing coverage due to pregnancy are eligible for expedited processing.

Related Policy

Receipt of Duplicate Application, A-121.2
SNAP Work Requirement Exemptions, A-1822.1
ABAWD Work Requirement, A-1940
Regaining Eligibility, A-1960
Reuse of an Application Form After Denial, B-111
Delays Caused by Households, B-122.3

A-144 Expedited Verifications

Revision 15-4; Effective October 1, 2015

SNAP and TP 40

See A-140, Expedited Service.

A-144.1 Social Security Numbers (SSNs)

Revision 20-2; Effective April 1, 2020

SNAP

Include household members for the initial month, or initial two months if household members are receiving a combined allotment. This is true even if the household members fail to provide or apply for an SSN at the interview or if State Online Query (SOLQ) does not validate a member’s SSN at the interview. Follow policy outlined in A-413, Social Security Number (SSN) Validation Through State Online Query (SOLQ), if the SSN does not validate at the interview.

Disqualify people who fail to provide or apply for an SSN without good cause or do not provide information to clear the discrepancy related to a SSN validated with verification code F or X before the next monthly issuance. See A-410, General Policy, for rules for children age six months or younger and good cause.

TP 40

Certify a pregnant woman by the 15th working day from the application file date to meet expedited processing timeframes even if:

• she fails to provide or apply for an SSN; or
• her SSN is verified with verification code F or X and unable to clear the discrepancy by viewing case documentation or contacting the household by phone. Postpone verification needed to clear the discrepancy.

Deny the woman’s eligibility if by the postponed verification due date she fails to:

• provide or apply for an SSN; or
• provide information to clear the discrepancy related to a SSN validated with verification code F or X.

Related Policy

Postponed Verification Procedures, A-145.1
General Policy, A-410
Social Security Number (SSN) Validation Through State Online Query (SOLQ), A-413

A-144.2 Work Registration

Revision 15-4; Effective October 1, 2015

SNAP

Advisors should register the applicant being interviewed for work unless:

• the applicant is exempt from work registration, or
• an AR is applying for the household.

Advisors should register other household members if possible. Advisors should postpone registration for the initial month if it cannot be completed within the expedited time frames.

A-144.3 Citizenship

Revision 16-2; Effective April 1, 2016

SNAP

Household members whose citizenship/eligible alien status is questionable can receive expedited benefits with the household. These household members must provide verification of citizenship/eligible alien status before the next month's benefits are issued or be disqualified.

TP 40

Citizenship/eligible alien status must be verified using policy in A-350, Verification Requirements, for pregnant women who declare to be a U.S. citizen or declare to have an eligible alien status. If a pregnant woman does not provide proof of citizenship or alien status and:

• no other information is required to determine eligibility, she is provided a period of reasonable opportunity as explained in A-351.1, Reasonable Opportunity.
• other information is required to determine eligibility, she is allowed to postpone verification (except identity) until the 30th calendar day from the application file date, as explained in A-145.1, Postponed Verification Procedures. If during that time she returns the other information, but not proof of citizenship or alien status, she is certified, sent Form TF0001, Notice of Case Action, and provided a period of reasonable opportunity at that time.

Related Policy

Reasonable Opportunity, A-351.1

A-144.4 Reserved for Future Use

Revision 20-2; Effective April 1, 2020

A-144.5 Pregnancy

Revision 18-1; Effective January 1, 2018

TP 40

Accept the individual’s (pregnant woman’s, case name’s or AR’s) verbal or written statement of pregnancy as verification, unless questionable. The woman’s statement would be questionable if the information provided regarding the due date is discrepant, such as the pregnancy start month and pregnancy end month are less than or more than nine months apart or if the woman reports a pregnancy with overlapping start and end months.

The individual’s statement of pregnancy must provide the following information:

• Name of woman who is pregnant
• Pregnancy start month and/or anticipated date of delivery
• Number of expected children

If questionable, advisors must verify pregnancy by using:

• Form H3037, Report of Pregnancy; or
• other documentation containing the same information as Form H3037.

The verification must be from an acceptable source such as:

• a physician;
• a hospital;
• a family planning agency; or
• a social service agency.

A physician, nurse, advanced nurse practitioner or other medical professional must sign Form H3037 or another document for it to be considered verification from a medical source. If another medical professional completes the form, the advisor must ensure that information about the supervising physician is provided.

Staff must use the following procedures when certain information regarding pregnancy is not provided on an application for benefits.

• If the only item missing on the application form is the pregnancy start month, staff must count nine months back from the pregnancy end month to determine the pregnancy start month. The pregnancy end month is month zero.
• If the only item missing on the application form is the pregnancy end month, staff must count nine months from the pregnancy start month to determine the anticipated date of delivery. The pregnancy start month is month zero.
• If both the pregnancy start and end months are missing, attempt to obtain the information by phone. If unable to obtain the information by phone, send Form H1020, Request for Information or Action, to request the information.

Related Policy

Verification Requirements, A-870

A-145 Expedited Certification Procedures

Revision 26-2; Effective April 1, 2026                        

SNAP

Assign normal certification periods even if postponing verifications.

Issue the second month's benefits as a combined allotment, if the household applies after the 15th of the month and benefits are prorated.

Related Policy

Length of Certification, A-2324
Combined Allotments, A-150

TP 40

If an applicant provides the minimum information required to process the application, staff may certify the application before the 15th  business day and allow postponed verification.

Deny the application no later than 15 business days if:

• the information given shows the applicant is not eligible; or
• not enough information was given to determine eligibility.

Reopen applications denied because there was not enough information provided if the information is received within 60 days of the file date.

Use the date the information is provided as the new file date. Follow the expedited processing guidelines.

Note: An interview is not required when processing a TP 40 application.

A-145.1 Postponed Verification Procedures

Revision 26-2; Effective April 1, 2026

SNAP

When an expedited application or redetermination is certified with postponed verification, ensure the Form TF0001, Notice of Case Action, includes the following information:

• what verification is needed on a Form H1020, Request for Information or Action;
• the date it is needed; and
• that the person must provide the information before the issuance of benefits for the:
  • second month; or
  • third month, if the person received a combined allotment.

The eligibility determination system identifies and holds benefits for the second month for households not issued a combined allotment or the third month for combined allotment households.

Postponed Verification Procedures Table

 Use the following chart to determine what action to take when information is received after certifying an expedited application or redetermination with postponed verifications:

Information Received During Expedited Processing

Staff must send a fraud or overpayment referral, if applicable.

If the household does not provide postponed verifications within 30 days of the application date, staff must:

• disqualify the person when appropriate; or
• deny the SNAP EDG for failing to provide postponed information and send the person adequate notice using Form TF0001.

A household denied for failure to provide postponed verification must submit a new application to receive benefits if the household does not provide the postponed verification by the 60th day from the file date. If the household provides the verification by the 60th day, staff must reopen the application using the date the household provided the verification as the new file date.

A person receiving adequate notice of adverse action as noted above cannot receive continued benefits pending appeal.

Related Policy

Changes, B-600
Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV), B-472

TP 40

Send Form TF0001, including the:

• eligibility start and end date;
• postponed verifications on a Form H1020; and
• date the verifications are due.

If the person does not provide postponed verification by the 30th day following the file date, staff must provide advance notice of adverse action and deny ongoing coverage. The person must reapply if the verification is not provided by the expiration of the adverse action.

Provide advance notice of adverse action and deny ongoing coverage if the person provides verification by the 30th day following the file date but does not meet eligibility requirements.

Note: Do not deny the EDG if the person is eligible in the application month or one of the three prior months.

Certify the woman on TP 40 following postponed verification procedures when a Medicaid recipient’s coverage from a DFPS, SSI, MEPD or MBCC type of assistance is terminated, and unverified pregnancy information is received through an interface.

Note: For children under 19, if verification is not provided by the 30th day, ongoing TP 40 coverage is terminated and the MEPD or MBCC type of assistance coverage is re-established.

Related Policy

Combined Allotments, A-150 

A-146 Expedited Policy for Migrant or Seasonal Farmworkers

Revision 15-4; Effective October 1, 2015

SNAP

The expedited processing procedures apply to migrant or seasonal farmworkers except for the following:

• If verifying something other than identity and the source of verification is out of state, the advisor postpones verification until after the household receives the second month's benefit. Advisors should use this procedure for only one two-month postponement during one round-trip from home.
• Households with a migrant or seasonal farmworker are destitute if they have $100 or less countable liquid resources and meet any of the following:

  • The household's only income for the application month is from a terminated source, and the household will not receive any more payments from that source after the application date.  
    
    Advisors should consider terminated income if it is usually received:

    • monthly or more often but will not be received from that source the following month, or
    • at intervals of more than one month but will not be received from that source in the next usual payment period.

    
    Advisors should not consider terminated income in the following situations:

    • Someone changes jobs while working for the same employer;
    • A self-employed person changes contracts or has different customers without having a break in normal income cycle; or
    • Someone receives regular contributions, but the contributions are from different sources.
  • Note: When determining destitute status, advisors do not consider terminated income if a payment from the same source will be received after the file date in the month of application.
  • All household income in the application month is from a new source, and the household will receive income of $25 or less from the first of the month up to and including the 10th day after the application date (or the end of the month if there are not 10 days left in the month).  
    
    Income received monthly or more frequently is from a new source if the household did not receive $25 or more from that new source in the 30 days up to and including the application date.  
    
    Income received at intervals of more than one month is new income if the household has not received more than $25 from that source between the last usual payment month and the application date.  
    
    Advisors count new income received after the application date to determine whether the individual is destitute, but disregard it in determining eligibility and benefits for the month of application.

  • The household has a combination of terminated income through the application date and new income after the application date if:

    • there is no other income from the terminated source that month, and
    • the household will receive income of $25 or less from the new source from the first of the month through the 10th day after the application date (or the end of the month if there are not 10 days left in the month).

    At recertification, advisors disregard income from a new source in the first month of the certification period if that income will not exceed $25 within 10 days after the individual's usual issuance cycle.  
    
    Notes:

    • Advisors count an advance of wages for travel expenses as income unless it is a reimbursement.
    • Advisors do not consider the advance in determining whether the household is destitute or in determining whether later payments from the employer are from a new source.
    • Self-employed farmworkers whose income is annualized are not destitute if they do not receive income each month of the year.
    • The grower, not the crew chief, is the farmworker's source of income. An individual who follows a crew chief to a new grower is leaving a terminated source for a new source.

The policies in this section apply to income determinations for destitute applicants at initial and later certifications but only in the first month of any certification period.

A-147 Expedited Eligibility and Enrollment of Active Duty Military Members and Their Dependents

Revision 15-4; Effective October 1, 2015

Medical Programs – All Except Emergency Medicaid and TP 56

All applications for Medicaid from active duty military members and their dependents applying for coverage are eligible for expedited processing.

Active duty refers to military members who currently are serving full time in their military capacity. A military member is defined as someone in the:

• U.S. Armed Forces/Reserves
  • Army
  • Marine Corps
  • Navy
  • Air Force
  • Coast Guard
• National Guard
  • Army
  • Marine Corps
  • Navy
  • Air Force
  • Coast Guard
  • Reserve/Guard
• Army National Guard
• Air National Guard
• State Military Forces/Texas State Guard
  • Texas State Guard – Unless activated by the governor and placed on paid state active duty, these personnel receive no compensation for their time.
  • Texas Army National Guard
  • Texas Air National Guard

When an application for Texas Works medical assistance is received and includes an active duty military member, staff should take the following action on or before the 15th workday of the application file date:

• Provide an interview if requested or required;
• Send/provide Form H1020, Request for Information or Action, to request missing information if no interview was requested or required and the household did not provide information with the application; and
• Send/provide Form TF0001, Notice of Case Action, if the household provided all verification with the application and no interview was requested or required.

Military status is self-declared. Additional verification is not required.

Advisors should use processing time frames stated in B-112, Deadlines, if the household did not provide all required information and verification with the application.

The expedited processing requirement does not apply to TP 56 (Medically Needy with Spend Down) or to Emergency Medicaid for ineligible aliens, and only applies to applications and untimely reviews/renewals.

A household is not eligible for expedited processing if the military member is on active duty because of training as a member of the Reserves, National Guard, or State Military Forces.

When an application consists of a pregnant member and an active duty member, advisors use TP 40 expedited application processing time frames.

Advisors provide expedited processing for a Medicaid application if the budget group includes the needs of an active duty member even if the active duty member is not included in the certified group.

Advisors must not pend an application if the household:

• fails to answer the Yes/No question and name/designation. Advisors must not process the application using expedited time frames. If the Yes/No question is left blank, advisors enter No in the system.
• fails to answer the Yes/No question but provides a name or information that can be used to determine who the active military member is. Advisors should assume that the answer is Yes and process the application using expedited time frames.
• answers Yes to the question but does not provide a name or information that can be used to determine who the active military member is. Advisors must not process the application using expedited time frames.

When an interview is scheduled timely within 15 workdays, but the applicant requests to reschedule the interview, staff should attempt to accommodate the rescheduled appointment within the 15-workday time frame. If, at the household’s request, the interview is rescheduled after the 15-workday time frame, staff should document the reason for not scheduling the appointment within the required time frame.

Note: For requested interviews, if the applicant requests to be rescheduled, staff should inform the household that an interview is not required and that the processing of the application can begin without an interview. Staff must not deny an application if the household fails to show for the appointment when an interview is not required.

Revision 26-2; Effective April 1, 2026

SNAP

A combined allotment is when benefits are issued for the initial month and the following month at the same time.

Issue a combined allotment for applications if the:

• benefits are prorated;
• household is eligible for the application month and the following month; and
• application file date is after the 15th of the month.

Issue a combined allotment for redeterminations if the:

• benefits are prorated;
• household is eligible for application month and the following month; and
• file date is after the certification period between Day 16 through Day 30.

Note: Issue a combined allotment if the household is eligible for the first month but not receiving benefits because the proration is less than $10. Issue a combined allotment within expedited service time frames for expedited applications and redeterminations, even if postponing verification.

Inform households receiving combined allotments:

• when the benefits are available;
• that no other benefits are available until the third month; and
• that the third month’s benefits are available on the regular issuance schedule.

The eligibility determination system identifies and issues benefits to households eligible for a combined allotment. It holds the third month's benefits if the combined allotment certification has postponed verification.

Revision 26-2; Effective April 1, 2026

TANF and SNAP

Conduct a single interview  when all household members are applying for or receiving SNAP and TANF and apply for both programs at the same time.

Exception: Conduct the unfinished TANF interview later, if necessary, to meet the SNAP expedited processing time limits.

A-161 When Receipt of TANF Is Uncertain

Revision 15-4; Effective October 1, 2015

TANF and SNAP

When TANF eligibility is uncertain, advisors must:

• certify the household for Non-Public Assistance (NPA) SNAP benefits if eligible. Note: If the TANF members have resources, advisors do not exclude the resources for SNAP until the household’s TANF EDG is certified (see A-1248, Resources of TANF and SSI Recipients); and
• assign an NPA certification period (see A-2324, Length of Certification).

If TANF is approved later, advisors should process it as a reported change and add the TANF benefit to the SNAP budget as soon as possible. (See A-1324.18, Temporary Assistance for Needy Families [TANF].) Advisors should adjust the certification period to expire when the next TANF periodic review is due. Advisors should send or give the applicant Form TF0001, Notice of Case Action, with the new certification period stated. Exception: One-Time Temporary Assistance for Needy Families (OTTANF), A-1324.11.

If the TANF application is denied later, the advisor should continue SNAP eligibility based on the original application.

Revision 25-3; Effective July 1, 2025

All Programs

An applicant, person receiving benefits, head of household (HOH), or someone with legal authority to act on their behalf such as a legal guardian or power of attorney, may designate a person or organization as an authorized representative (AR).

An AR must be verified using a(n):

• applicant's or recipient's signature on one of the following HHSC applications for benefits containing the AR designation:
  • Form H0011, Texas Simplified Application Project (TSAP) for SNAP Food Benefits;
  • Form H0011-R, Texas Simplified Application Project (TSAP) for SNAP Food Benefits Renewal;
  • Form H1010, Texas Works Application for Assistance — Your Texas Benefits;
  • Form H1010-R, Your Texas Works Benefits: Renewal Form;
  • Form H1034, Medicaid for Breast and Cervical Cancer;
  • Form H1200, Application for Assistance — Your Texas Benefits;
  • Form H1200-MBI, Application for Benefits — Medicaid Buy-In;
  • Form H1200-MBIC, Application for Benefits — Medicaid Buy-In for Children;
  • Form H1205, Texas Streamlined Application;
  • Form H1206, Health Care Benefits Renewal;
  • Form H1840, SNAP Food Benefits Renewal Form;
  • Form H1841, SNAP-CAP Application;
  • Form H1842, SNAP-CAP Renewal Application;
  • Form H2340, Medicaid for Breast and Cervical Cancer Renewal; or
  • Form H2340-OS, Medicaid for Breast and Cervical Cancer.
• applicant's signature on a Marketplace application for health care benefits that is transferred to HHSC and contains the AR designation;
• legal document that the AR has authority to act on behalf of the applicant or recipient under state law, such as legal guardianship or power of attorney;
• letter designating AR authority and containing the applicant's or recipient's signature, and the name, address and signature of the AR;
• Form H1003, Appointment of an Authorized Representative;
• applicant's or recipient's electronic signature designating the AR on an application, renewal or reported change submitted through YourTexasBenefits.com.

If a person or organization applies on someone’s behalf and is not their verified AR, send correspondence to both the unverified AR and the HOH. Then, request verification the household would like to appoint the person or organization as their AR.

• Send the following to the HOH for the case:
  • Form H1020, Request for Information or Action, listing the missing information needed before eligibility can be determined; and
  • Form H1003 to capture the AR designation and the signatures of the applicant and the AR.
• Send the following to the unverified AR:
  • Form H1004, Cover Letter - Authorized Representative Not Verified, explaining what is needed to verify the AR; and
  • Form H1003 to capture the AR designation and the signatures of the applicant and the AR.

For the AR to be verified, either the AR or the HOH must return the completed Form H1003 within 10 days or 30 days from the file date. All missing information listed on the Form H1020 must also be returned on time. If the AR verification is not received by the due date, do not designate an AR.

The AR designation is effective from the date the AR is verified until:

• the applicant or recipient notifies HHSC that the AR is no longer authorized to act on their behalf;
• the AR notifies HHSC that they no longer wish to act as AR for the applicant or recipient;
• there is a change in the legal authority, e.g., legal guardianship or power of attorney, on which the AR’s designation is based; or
• the applicant or recipient designates a new AR to act on their behalf. If there is an existing AR designated on a case, the person or organization that the applicant or recipient most recently designated as the AR will replace the existing AR on the case.

Requests to end the designation of an AR must include the signature of the applicant, the recipient or the AR as appropriate. During the redetermination process, the AR cannot end their AR designation if the AR is the person completing and signing the redetermination.

Note: An AR is not automatically a personal representative.

An AR is designated at the case level with access to all benefit information for that case. A verified AR may:

• sign an application on behalf of an applicant;
• complete and submit a renewal form;
• receive copies of notices or renewal forms in the preferred language selected on the application and other communications from HHSC;
• designate a health plan; and
• act on behalf of the applicant or the recipient in all other matters with HHSC.

The applicant, recipient or AR may also request that the AR receive the recipient’s Medicaid or CHIP ID card and enrollment-related agency correspondence.

Note: The AR will not receive Healthy Texas Women (HTW) correspondence.

Mailing Address for AR

During the interview, get the AR’s complete mailing address if not included on the application form. Record the AR’s address on the TIERS Data Collection page, Household – Authorized Representative. If the applicant cannot provide a complete mailing address for the AR during the interview or an interview is not required for the program type, do not pend the case. Record the household’s mailing address as the AR’s address in TIERS.

When an applicant or recipient and their designated AR have the same mailing address, correspondence will only be sent to the AR.

When an applicant or recipient has a legal guardian, correspondence is sent only to the guardian, even if the applicant or recipient and the guardian have different mailing addresses.

Applicants, recipients or ARs who have chosen to receive eligibility correspondence electronically will continue to receive them electronically.

All Programs An AR can be verified using an applicant or recipient’s telephonic signature submitted by calling 2-1-1.

SNAP

People disqualified for SNAP benefits because of an administrative disqualification hearing or a nonmember living with the household can be an AR only if:

• no other responsible household member is reasonably able to be the HOH or AR; or
• that person is the only adult living in the household.

HHSC employees involved in certification or issuance of SNAP benefits and retailers authorized to accept SNAP benefits can be an AR only if their supervisor gives written approval.

Related Policy

Electronic Correspondence, A-119.1
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000
Personal Representatives, B-1212
Establishing Identity for Contact Outside the Interview Process, B-1213
Telephone Contact, B-1213.1
Confidentiality, W-2400

A-171 Protective Payee

Revision 22-3; Effective July 1, 2022

TANF

A grandparent, aunt, uncle, brother or sister who is 25 or older may represent the household in the application and review process upon the relative’s request, if staff determine the parent is not using TANF for the child's benefit. In these situations, the parent’s signature and designation of the relative as AR in writing is not required on Form H1010, Texas Works Application for Assistance — Your Texas Benefits. When the relative is designated as the protective payee, the relative is automatically the AR.

The Texas Department of Family and Protective Services (DFPS) may also designate a protective payee.

Related Policy

Receipt of Application, A-121
Authorized Representatives, A-170
Verification Requirements, A-180
Documentation Requirements, A-190
Who Is Not Included, A-222

A-172 AR Applying for Household

Revision 15-4; Effective October 1, 2015

All Programs

The AR must be informed about the household circumstances. The individual is liable for any overissuance resulting from inaccurate information that the AR gives, except in situations when drug/alcohol treatment centers or group living facilities act as AR for a SNAP household.

The AR must be an adult.

A-173 AR for Residents of Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities

Revision 22-1; Effective January 1, 2022

SNAP

For residents of D&A facilities, a facility employee must serve as the AR to apply for the household and to use the benefits.

Residents of GLA facilities may apply:

• for themselves;
• through an AR of their choosing; or
• through an AR employed by the facility.

For D&A and GLA facilities, the AR designated to use SNAP benefits may be a different person from the AR who applies for the household.

Related Policy

Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440
D&A or GLA Facility Responsibilities as Authorized Representatives, B-445
Authorized Representatives, B-453

A-174 Abuse by AR

Revision 15-4; Effective October 1, 2015

SNAP

An advisor who suspects an AR of acting against the household's interests must report the circumstances to the advisor's program manager.

Revision 22-3; Effective July 1, 2022

All Programs

When an eligibility determination is requested for multiple programs and the programs allow the same verification sources, staff must use the same verifications for all applicable programs. For example, if a person is applying for SNAP, TANF and Medical Programs and provides acceptable wage verification for SNAP, do not request additional wage verification for TANF or Medical Programs, provided the source is acceptable verification for TANF or Medical Programs.

Make the eligibility decision for each program when all verifications are received for that program.

Related Policy

Data Broker, C-820
Questionable Information, C-920
Providing Verification, C-930

TANF

If a grandparent, aunt, uncle, brother or sister reports a parent is not using TANF benefits for the child’s needs, verify the claim. Designate one of these relatives, provided they are 25 or older and meet TANF relationship requirements, to serve as the protective payee and authorized representative (AR). A child’s cousins, nieces and nephews are not included in the list of potentially eligible relatives.

If the parent requests the relative's removal as protective payee and AR, staff must verify the parent intends to use TANF benefits for the child's needs.

Note: A protective payee is automatically the AR.

Related Policy

Relationship Charts, C-1440

SNAP

Verify the nonprofit status of homeless shelters, if questionable. See IRS documentation that proves the nonprofit status under Section 501(c)(3) of IRS regulations.

A—181 Verification Sources

Revision 22-3; Effective July 1, 2022

TANF

Use the following sources to verify if the parent is using TANF funds for the child’s needs, based on a claim from a grandparent, aunt, uncle, brother or sister. Use the same sources when the parent requests the removal of the relative as protective payee and AR:

• Non-related landlord
• Non-related neighbor
• School officials
• Child Protective Services worker
• Person without vested interest in the outcome of the decision

Revision 26-2; Effective April 1, 2026

All Programs

Document the date and method that advance notice of a home visit was given and the date and time of the visit. An imaged copy of the appointment notice given to the person is enough.

Document why a certain file date was used to determine eligibility when:

• the file date used differs from the received date on the application; or
• the application has two received dates.

Document:

• A household requesting more programs after filing an application. This includes the requested program and the date of the request.
• The reasoning to make a prudent person principle decision and any applicable handbook references.
• That form VR30, Texas Voter Registration Application was given to the applicant, AR representative payee under the Agency Use Only section of the application.
• On the application and on Form H1350, Opportunity to Register to Vote, in the Agency Use Only section, the actions taken when a person notifies HHSC that they declined the opportunity to register to vote after receiving Form H0025.
• Detailed information to support the eligibility decision so others can understand all computations and advisor decisions.

TANF and SNAP

For all interviews, staff must document:

• if the person met phone interview criteria;  
• if a phone interview was not done; and
• how interpreter services were provided when the application shows the person requested these services, including when staff conducted the interview and acted as an interpreter.

Medical Programs

Document when designated staff request that a child born to a woman in prison be certified for TP 43.

Interviews are not required for medical programs but can be requested by the applicant or recipient. Document how the person’s identity was verified if an interview is conducted for a non-interview required program.

TANF

Document the specific reason for designating a protective payee, who is also the authorized representative (AR).

When a grandparent, aunt, uncle, brother or sister requests to be the protective payee, document the:

• information the relative gives to support the claim that the parent is not using the TANF benefit for the child's needs;
• information obtained from collateral contacts, documents or both; and
• decision whether to designate the relative as the protective payee and AR.

SNAP

Document:

• the name and address of the AR;
• that no one else is available, if a person disqualified for intentional program (IPV) or a nonmember living with the household is appointed as AR;
• the tax-exempt status [Section 501(c)(3)] for public or private homeless shelters, if applicable;
• expedited service eligibility by marking the appropriate box on Form H1010, Texas Works Application for Assistance - Your Texas Benefits, and explain if eligibility is questionable;
• the decision on the length of certification and reporting requirements for expedited service EDGs;
• if a migrant is in or out of the workforce;
• the reason for entering a late determination date; and
• the reason why an appointment for an expedited applicant is not scheduled for an interview within the expedited time frame.

Related Policy

Prudent Person Principle, A-137
Registering to Vote, A-1521
Documentation, C-940
The Texas Works Documentation Guide (PDF)

Revision 24-3; Effective July 1, 2024

TANF

A Temporary Assistance for Needy Families (TANF) certified group:

• Is a person or group of relatives whose needs are included in one Eligibility Determination Group (EDG).
• Must include an eligible child, unless the eligible relative cares for a child who receives:
  • Supplemental Security Income (SSI), Foster Care with Cash or Adoption Assistance with Cash; or
  • SSI Medicaid, and the relative chooses not to request TANF for the child.

Some people are required members of the TANF certified group. The applicant may not choose to exclude a required member from the certified group. If the applicant fails to provide available verification for a required member, deny assistance for the entire certified group.

A TANF-State Program (SP) certified group must contain both an eligible:

• caretaker or parent; and
• second parent.

Households are eligible for TANF-SP if the budget group contains:

• two eligible parents who are certified for TANF;
• one TANF-certified parent and a disqualified parent unless the disqualified parent does not meet citizenship requirements; or
• two disqualified parents unless the disqualified parents do not meet citizenship requirements.

Related Policy

Who is Not Included, A-222
Alien Sponsor's Income, A-1361
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480

SNAP

A Supplemental Nutrition Assistance Program (SNAP) unit is one person or a group of people who live:

• together and usually purchase and prepare their food together; or
• with others and intend to purchase and prepare food separately after certification.

When a person is 60 or over and lives with others but cannot purchase and prepare food separately because of a permanent incapacity, the person and their spouse may claim a separate household status if they meet certain criteria. To allow the person and their spouse to claim separate household status, the gross income of the other household members, not including the elderly and disabled person and spouse, must be less than 165 percent of the Federal Poverty Level (FPL) for the number of other people in the household.

To claim a separate household status, the elderly person must:

• prove that they meet the Social Security disability criteria, if questionable; and
• provide verification of the other household member's income.

Note: When granting separate household status, always include required members in the elderly person's household. For example, the elderly person's spouse or children under 22 are always included in the same household unless elderly members have their own SNAP Combined Application Project (SNAP-CAP) EDGs.

Related Policy

Who Is Included, A-231
Noncommercial Roomer/Boarder Payments, A-1323.4.3
Disqualified Members, A-1362
Alien Sponsor's Income, A-1361
Students in Higher Education, B-410
Definition of Disability, B-432
Joint Supplemental Security Income (SSI)-SNAP Applications, B-476
Categorically Eligible Households, B-470

Medical Programs

Use the modified adjusted gross income (MAGI) household composition to determine whose needs, income and expenses are considered when determining eligibility for medical programs. Determine each person's MAGI household composition at an individual level. People living at the same physical address may have different MAGI household compositions. MAGI household composition is based on federal income tax rules.

Exception: Medically Needy with Spend Down has certain exceptions for determining MAGI household composition and income.

A person does not have to file a federal income tax return to apply for medical programs.

Related Policy

How to Determine Spend Down, A-1359

A—211 Relationships Resulting from Termination of Parental Rights

Revision 15-4; Effective October 1, 2015

All Programs

When a court terminates the relationship between a biological or adoptive parent and child, a legal parent/child relationship does not exist between the two individuals.

If a biological or adoptive parent's parental rights to a child are terminated, that parent no longer has a legal parent/child relationship to that child, nor to any of the child's children who are born after the date the parental rights were terminated.

Example: Amy's parental rights to her child Julie are terminated when Julie is 16. Julie already has one child, Jill, at the time Amy's parental rights are terminated. Subsequently, Julie has a second child, Bill. As a result, Amy no longer has a legal relationship with Julie or Bill, but she retains her grandparent relationship to Jill.

Note: A parent whose parental rights have been terminated is not considered the natural parent of their biological child.

Relationships that existed between the child and other relatives of the biological parent are not interrupted or terminated. The only relationship terminated is that of the parent that relinquished his or her parental rights. Example: The child's biological or adoptive grandparents, siblings, aunts, uncles, and cousins still have the same relationship to the child they had before the parental rights were terminated.

Related Policy

Child Support and Medical Support Referrals, A-1122.2

A—212 Relationships Resulting from Adoption Procedures

Revision 15-4; Effective October 1, 2015

All Programs

A legal parent/child relationship is created when an individual adopts a child. The adoptive parent/child relationship creates the same relationships with the adoptive parent's relatives that are created with a biological parent/child relationship. Example: When a grandparent adopts a biological grandchild, the:

• grandparent becomes the child's adoptive parent, and
• the biological parent becomes the child's adoptive sibling.

A—213 Adoption Household Composition Situations

Revision 15-4; Effective October 1, 2015

TANF

Adoption household composition is determined by the advisor using the following steps:

Example 1

If a household consists of the applicant, the applicant's two biological children, ages 15 and 17, the 15-year-old's baby (age 1) that the applicant has adopted, and the 17-year-old's 2-year-old baby, the advisor must:

Example 2

If a household consists of the applicant, adopted child (biological grandchild), and the adopted child's half-sibling, not related to the applicant, the advisor must:

Note: For TP 32, TP 33, TP 34, TP 35, TP 43, TP 44, TP 48 or TP 56, the half-sibling can be considered an independent child when determining the child's eligibility for Medicaid. See A-910, General Policy.

A—221 Who Is Included

Revision 24-3; Effective July 1, 2024

TANF

The following are always included in the TANF certified group:

1. Eligible Child

An eligible child is a person who meets TANF requirements, is not married per Texas state law, and is:

• under 18; or
• 18 and:
  • is a full-time student, as defined by the school, in high school, attends an accredited general equivalency diploma (GED) class, or regularly attends vocational or technical training as an equivalent to high school attendance; and
  • expects to graduate before or during the month of the child’s 19th birthday.

Notes:

• GED is approved only if the class is administered by an accredited institution.
• When removing a child who has turned 18 or 19 from the grant, determine if diversion is needed to account for the needs of the removed child.
• A child certified for foster care, Medicaid only, or adoption assistance Medicaid only is a potentially eligible child.

An emancipated minor is an eligible child if the:

• child meets the TANF age criteria;
• child is not married per Texas state law; and
• caretaker or payee exercises parental control of the child.

Related Policy

Diversions, Alimony, and Payments to Dependents Outside the Home, A-1424 

2. Eligible Legal Parent

An eligible legal parent is a legal parent who meets TANF requirements and lives with an eligible child. This includes:

• A parent who is absent solely because of employment or active duty in the U.S. military.
• Parents receiving foster care or adoption assistance services for themselves, but not the child.

Exception: Review No. 6, Minor Parents, below.

Related Policy

Deprivation Based on Absence from the Home, A-1040

3. Siblings

A sibling is a brother or sister of an eligible child, including legally adopted and half-brothers and sisters. Siblings must be certified together if they meet all TANF requirements. If an unborn child will be a required member of the certified group, a special review is set for the first day of the month after the expected delivery month.

Note: Half-brothers or sisters who do not meet the degree of relationship to the caretaker are not eligible to receive TANF benefits. However, they can be certified as an independent child on a separate Medicaid EDG.

Example: The household includes a grandparent, two grandchildren and a half-sibling to the grandchildren. The two grandchildren can be certified for TANF and Medicaid because they meet the required degree of relationship to the caretaker. The half-sibling does not meet the required degree of relationship to the caretaker and cannot be certified for TANF. The half-sibling can be certified as an independent child on a separate Medicaid EDG.

Exception: Review No. 6, Minor Parent, below.

Related Policy

General Policy, A-910

4. Caretaker

A caretaker is any specified relative who:

• is present in the home; and
• supervises and cares for the TANF child.

A caretaker must be the child's:

• father or mother;
• grandfather or grandmother;
• brother or sister;
• uncle or aunt;
• first cousin;
• nephew or niece;
• stepfather or stepmother;
• stepbrother or stepsister; or
• first cousin once removed.

Relationship extends to the:

• Spouse of the listed relatives, even after the marriage has ended in death or divorce, regardless of when the child's birth occurred.
• Degree of great-great for uncles or aunts and nephews or nieces.
• Degree of great-great-great for grandparents.

A caretaker meets the relationship requirement even if a court has jurisdiction over the child or an agency is the child's managing conservator. If a child lives with a managing conservator, the conservator must meet the relationship requirement.

If a child lives with a married relative, not a parent, who wants to be considered the caretaker, eligibility and benefits are determined using:

• normal budgeting procedures for the applicant's income; and
• stepparent budgeting for the income of the applicant's spouse.

If the non-parent caretaker applying for the child is not financially eligible based on their income or resources to receive TANF, then financial eligibility can be determined using only the eligible children.

No one else is included as caretaker if the legal parent is:

• in the home; and
• physically and mentally able to provide care.

Exception: The stepparent may be certified as caretaker if the stepparent wants to be included and the legal parent has a disability. The stepparent and legal parent who has a disability are certified for TANF-SP when the stepparent is included in the certified group.

Related Policy

Relationship, A-520
Stepparent EDGs, A-1366
Relationship Charts, C-1440

5. Second Parent

When a child lives with both legal parents, both parents are included in the certified group. The parent who is not the caretaker is the second parent. The second parent must meet all TANF requirements.

The household may be certified for TANF-SP when:

• both parents are eligible and certified for TANF;
• one parent is eligible and certified for TANF and the other parent is disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements; or
• both parents are disqualified for one of the reasons listed in A-222, No. 4, unless that disqualification is due to not meeting citizenship requirements.

Related Policy

General Policy, A-1310 

6. Minor Parent

A minor parent and child living with the minor parent's parent or siblings may:

• be certified separately if the:
  • minor parent's parent or sibling is not a TANF applicant or recipient; or
  • minor parent cannot be included in their parent or sibling TANF EDG because they are not an eligible child; or
• continue to receive TANF on a separate EDG if the minor parent's EDG was certified before the:
  • month the parent or sibling applied for TANF; or
  • day the minor parent moved into the home with the parent or sibling.

Otherwise, the minor parent must be included as a child with the:

• legal parent(s) who receives TANF or TANF-SP; or
• sibling certified for TANF or TANF-SP as a child.

If the caretaker or payee in the EDG requests TANF for the minor parent's child, the child is included in the EDG with the caretaker or payee and the minor parent.

Exception: A married minor parent is an eligible legal parent and must be certified separately from the minor parent’s parents. Review No. 1, Eligible Child, above. 

Related Policy

Requirement for Unmarried Minor Parents to Live with an Adult or in an Adult-Supervised Setting, A-930
Unmarried Minor Parent Income, A-1365
Stepparent Budgeting Procedures, A-1366.2 

7. Stepparents

A stepparent is not a child's legal parent but is the legal parent's spouse. Stepchildren are deprived of parental support because one legal parent is absent.

Include the stepparent in the certified group only if the stepparent wants to be included and:

• the stepparent is the only parent in the home; or
• both the legal parent and the stepparent are in the home and the legal parent has a disability.

Certify the stepparent and legal parent with disabilities for TANF-SP when the stepparent is included in the certified group. If the legal parent and stepparent live in the home and have mutual children, they must all be included in the same certified group.

Related Policy

Determining Incapacity, A-1051
Resources of Stepparents, A-1247
Stepparent EDGs, A-1366
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480

8. People in Nursing Homes

If a member of the TANF-certified group temporarily enters a nursing facility, the person’s needs are left in the TANF budget during the nursing facility stay or until the person is certified for Supplemental Security Income (SSI). The person should be referred to the Social Security Office for an SSI eligibility determination.

A—222 Who Is Not Included

Revision 22-3; Effective July 1, 2022

TANF

The following are not included in the TANF-certified group:

1. Payee

   A payee is a relative who meets relationship requirements and lives with, supervises, and cares for an eligible child. The payee is authorized to receive the TANF benefits for an eligible child but is not a member of the certified group because the person is a:

   • legal parent who would be a caretaker but is ineligible due to receipt of SSI; or
   • relative other than the legal parent who qualifies as a caretaker except the person:
     • chooses not to be included as caretaker;
     • receives SSI, Foster Care with Cash or Adoption Assistance with Cash payments;
     • is disqualified for an intentional program violation (IPV); or
     • fails to comply with a program requirement that would disqualify a legal parent (see No. 4, Disqualified Members, below).

   Note: A payee who chooses not to be included as a caretaker on one EDG may be a caretaker on another TANF EDG for other related children.

2. Protective Payee

   A protective payee must be selected to receive and manage the TANF benefit if the caretaker is not using the TANF payments for the children's benefit.

   The protective payee must be someone who can help the person spend the household's TANF benefits properly. The person receiving TANF must agree to the person designated as the protective payee unless:

   • the Texas Department of Family and Protective Services (DFPS) designates a protective payee; or
   • staff designate a grandparent, aunt, uncle, brother or sister who is 25 or older to be the protective payee because the parent is not using the TANF payments for the child's benefit. Great-grandparents, great-aunts, and great-uncles may be designated as protective payees. Follow TANF relationship requirements.

   The protective payee is automatically the authorized representative (AR).
   
   The protective payee cannot be a:

   • Texas Health and Human Services Commission (HHSC) employee;
   • person who provides HHSC services to the family; or
   • a relative who is younger than 25 when a relative protective payee is designated by HHSC. 
   • A child’s cousin, niece or nephew.

   The protective payee situation must be re-evaluated at each complete redetermination. For EDGs with a:

   • DFPS-requested protective payee. DFPS must be contacted at each complete redetermination to determine whether the protective payee should continue; and
   • grandparent, aunt, uncle, brother or sister designated by HHSC as protective payee. Investigate any alleged report of the relative not using TANF for the child's benefit.

   Note: When designating or continuing a protective payee, notify the recipient and allow an opportunity to appeal.

3. Representative Payee

   A representative payee is designated if a person is unable to receive and manage the household's TANF or Medicaid benefits because of incapacity or incompetence. The representative payee must be knowledgeable about the family members and interested in the family’s welfare. The person must designate this representative in writing if physically or mentally capable of doing so.

   A representative payee is automatically the AR. The representative payee may be the AR who assisted in the eligibility process.

4. Disqualified Members

   A legal parent is disqualified from the certified group if the person:

   • does not meet citizenship requirements;
   • refuses to comply with Medicaid third-party resource (TPR) requirements;
   • does not comply with Social Security number requirements;
   • is found guilty of an IPV;
   • fails to timely report the temporary absence of a certified child;
   • is a fugitive fleeing to avoid prosecution of or confinement for a felony criminal conviction, or found by a court to be violating federal or state probation or parole;
   • is convicted of a felony drug offense (not deferred adjudication) for the possession, use or distribution of a controlled substance as defined in 102(6) of the Controlled Substances Act [U.S. Code (USC) 802(6)] that was committed on or after April 1, 2002, in Texas or another state;
   • has received benefits for the total months allowed by the state time limit;
   • is a minor parent who fails to comply with the unmarried minor parent domicile requirement; or
   • is denied for refusal to cooperate with the program integrity assessment (quality control) process.

   Note: A legal parent is permanently disqualified for a felony drug conviction (not deferred adjudication) for an offense committed on or after April 1, 2002.

   A child is disqualified from the certified group if the child:

   • is a fugitive;
   • fails to comply with Social Security number requirements;
   • is a minor parent and fails to report the temporary absence of their child; or
   • is convicted of a felony drug offense that was committed on or after April 1, 2002.

   If the disqualified member wishes to apply for Medicaid, determine which medical program applies to the disqualified household member. If all eligibility requirements are met, certify the person for the appropriate medical program.
   
   When the criminal history report in the Data Broker system indicates the person has been convicted of an offense involving a controlled substance, discuss the situation with the person. If the person claims they are not the person on the criminal history report but the identifying information on the report (name, date of birth, physical description) leads staff to believe the report is correct, or the person disagrees with other information provided in the report, for example, the type of conviction or whether it was a felony or misdemeanor:

   • document the person's response in Case Comments;
   • proceed with the appropriate EDG action without acting on the criminal history report;
   • contact the Office of Inspector General (OIG) Benefits Program Integrity (BPI) Department by emailing the OIG BPI mailbox; and
   • document the reason for contacting OIG BPI in Case Comments. Once OIG BPI obtains information to clear the discrepancy, the assigned OIG BPI investigator provides the information via email. Staff responsible for clearing the task must document the results of the OIG BPI's findings in Case Comments. If applicable, enter information in the Data Collection-Individual Demographic-Conviction/Rehabilitation page and make an overpayment referral if appropriate. 

5. SSI Recipients

   A TANF family member is removed from the certified group when the person is certified for SSI. The Social Security Administration (SSA) notifies HHSC by an interface when a TANF recipient is determined eligible for SSI.

6. Residents in State Supported Living Centers for Individuals with Intellectual Disabilities

   If a TANF recipient enters a state supported living center for persons with intellectual disabilities, the person’s needs are removed from the TANF grant. If the recipient is the caretaker or payee, the grant continues for the remaining eligible children in another eligible person's name.

7. Strikers

   A household's application or ongoing benefits are denied for any month where a certified or disqualified legal parent is participating in a strike.

8. Foster Care with Cash Payment, Adoption Assistance with Cash Payment, and Permanency Care Assistance (PCA) with Cash Payment recipients.
   
   A person receiving these cash benefits is not included in the TANF EDG.
   
   Note: A person may potentially receive DFPS foster care through their 22nd birthday month. Adoption assistance and PCA are only received through the 18th birthday month unless the family signs an agreement after the youth turns 16. When this occurs, the youth may receive adoption assistance or PCA through their 22nd birthday month.
    
9. Ineligible Children
   
   A child who is ineligible, such as an ineligible alien child or a child who is not within the required degree of relationship to the adult caretaker or payee, is not included.

Related Policies

Authorized Representatives, A-170
TANF, A-220
Temporary Absence from the Home, A-920
General Policy, A-1210
Disqualified Members, A-1362
Use of TANF Benefits, A-1553
When the Person Signs Form H1073, A-2128.1
Filing an Overpayment Referral, B-770
Relationship Charts, C-1440

A–223 Certifying Children on Non-Parent Caretaker EDGs

Revision 22-3; Effective July 1, 2022

TANF

When an eligible child lives with a relative other than the legal parent, the child is certified on:

• a separate EDG with the relative as a payee when the relative receives TANF for children who are not the child's natural, adopted or half siblings; or
• the same EDG with the non-parent caretaker when the relative:
  • requests it and is not receiving TANF for any other children; or
  • is receiving TANF for children who are the child's natural, adopted, or half siblings.

Certify each other-related child, unless they are siblings, on a separate EDG.

Exception: Other-related children are certified on the same EDG if:

• at least one EDG is ineligible separately;
• the members would be eligible if the EDGs were combined; and
• the relative requests that they be combined.

A child's TANF must not be denied because of the income or resources of a:

• child who is not the child’s natural, adopted, or half sibling; or
• caretaker who is not the child’s parent (for example, a stepparent).

When an EDG is denied because of the income or resources of a non-parent relative caretaker:

• deny the EDG, which includes the caretaker's request for aid; and
• process a separate EDG to determine the child's eligibility without the caretaker.

Note: Households that include a non-parent caretaker are not eligible for TANF-SP. See related policy for more information on the action to take when non-parent relative caretakers must be denied while the other-related children remain eligible.

Related Policy  

Stepparent Budgeting Procedures, A-1366.2
OTTANF, A-2411
One-Time TANF for Relatives, A-2412 
Documentation Requirements, A-2470
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480

A–224 Special Household Composition Situations

Revision 02-8; Effective October 1, 2002

A–224.1 TANF-SP EDGs with Stepchildren or a Parent's Child from a Previous Relationship

Revision 15-4; Effective October 1, 2015

TANF

The following must be included in the TANF-SP EDG:

• a child who lives with a natural/adoptive parent, a stepparent, and a sibling who is the parent and stepparent’s mutual child.
• parents and all children, when:
  • the legal parents of a mutual child are not married to each other, and
  • one or both have a child living in the home who is not a mutual child.

If the household is ineligible for TANF-SP because they do not meet other TANF eligibility requirements such as income or resources, the family unit must remain as one filing unit even when stepchildren are included. In this situation, the advisor must determine whether the household meets eligibility requirements for the Medical Programs.

If an active TANF-SP EDG is denied because of earnings or the removal of the 90 percent earned income deduction and the household is receiving TP 08, the Texas Integrated Eligibility Redesign System (TIERS) will deny both the TANF-SP and TP 08 EDGs and create:

• a transitional Medicaid EDG if the certified group meets the eligibility criteria; or
• another Medical Program type of assistance EDG for eligible members if they are not eligible for transitional Medicaid and are otherwise eligible for medical coverage.

Related Policy

Transitional Medicaid Coverage, A-840
General Eligibility Information, A-841
TP 07 Transitional Medicaid, A-842

A–224.2 TANF-SP EDGs with an Other-Related Child

Revision 15-4; Effective October 1, 2015

TANF

Each other-related child living in the family (see A-223, Certifying Children on Non-Parent Caretaker EDGs) is certified on a separate EDG unless the child or other members are ineligible separately. If the child or other members are ineligible separately, the other-related child in the TANF-SP EDG is included. The advisor must ensure that the other-related child has the opportunity to continue receiving TANF when the TANF-SP EDG is denied.

A-231 Who Is Included

Revision 25-3; Effective July 1, 2025

SNAP

The following people must be certified as a Supplemental Nutrition Assistance Program (SNAP) household if they live together:

• A person under 22 living with their natural, adoptive or stepparents.
  • Parents and children are considered living together even when they are away from home for employment or educational purposes and return home at least one day a month. This includes college students who are eligible for SNAP.
  • Consider a person 22 starting the month they turn 22.  
  • When determining if a person is a required household member, consider the following:
    • The parent-child relationship terminates when parental rights are terminated.
    • The stepparent and stepchild relationship terminates when the marriage between the parent and stepparent terminates, either by death or divorce.
    • When DFPS places a child in foster care, the foster child is considered under parental control of the foster parent. If the foster child's parent moves into the home, the parent, child and foster parent must all be included in the SNAP household.
    • If the parents of a child do not live together and the child lives with each parent part of the month, the child can be certified with either parent. If both parents apply, then certify the child with the parent who provides more meals for the child.
    • A parent or child living with a SNAP-CAP recipient can apply separately. Certify the child as the SNAP head of household.
• A child under 18 and any nonparent adult household member who has parental control over the child.
  • A child not under parental control may apply separately if the child purchases and prepares food separately.
  • Consider children 18 years old, starting the month they turn 18.
  • Even if under parental control of a nonparent household member, the following exceptions apply:
    • A foster parent or caregiver can choose to include or exclude a foster care, adoption assistance or permanency care assistance (PCA) payment recipient as a household member in their SNAP certified group.
    • Households with more than one recipient can choose to include some foster care or PCA recipients while excluding others, even if the foster care or PCA recipients are related to each other or related to the foster parent or caregiver.
    • A foster care or PCA recipient who is excluded from their foster parents or caregivers SNAP certified group is not eligible to participate as a separate SNAP household or in another SNAP household.
    • The household may consider a foster child as a boarder instead of a household member.
    • A child under 18 who purchases and prepares food separately can apply separately if they are:
      • married and living with the spouse;
      • emancipated; or
      • not financially or otherwise dependent on another member of the household.
    • A child under 18 living with a SNAP-CAP recipient can apply separately. Certify the minor child as the SNAP head of household.
• Spouses. Consider spouses as living together when one spouse leaves the home for employment or educational purposes and returns home at least one day a month.
  • A spouse living with a SNAP-CAP recipient can apply separately,
  • Consider the following for a same-sex marriage. If the couple married:
    • before June 26, 2015, the marriage date is considered June 26, 2015; or
    • on or after June 26, 2015, the marriage date is the date the marriage occurred.

Related Policy

Noncommercial Roomer/Boarder Payments, A-1323.4.3
Foster care and Permanency Care Assistance (PCA) Payments, A-1326.4
Students in Higher Education, B-410
Household Composition, B-475.3

A-232 Who Is Not Included

Revision 15-4; Effective October 1, 2015

A-232.1 Nonmembers

Revision 22-1; Effective January 1, 2022 

SNAP

The following are not included in a Supplemental Nutrition Assistance Program (SNAP)-certified group:

1. Roomers — Certify a roomer who pays for lodging but not food as a separate household unless the person meets one of the three categories of who is included in a SNAP household, if they live together.
2. Live-in attendants — Certify a live-in attendant as a separate household, unless the person meets one of the three categories of who to include in a SNAP household, if they live together.
3. Boarders — Boarders in noncommercial boarding houses cannot receive SNAP separate from the household they live with. Boarders who live in a commercial boarding house cannot participate in SNAP. Note: A foster parent or caretaker has the option to include or exclude a foster child or adult as a SNAP household member.  
4. Ineligible students — Students in higher education who do not meet the student eligibility criteria.
5. New household members — Do not add new household members certified in another household to the new EDG until they are removed from the previous EDG. Exception: Residents in shelters for battered persons may receive two allotments in the same month, if the original benefits issued to the former household included the battered persons, the children and the abuser.
6. Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP) participants — Certify people living with an active SNAP-CAP participant as a separate household.
7. Institutional residents — Residents who are offered more than half their meals from a facility that is not an approved institution. 

Note: Residents of institutions such as homeless shelters, drug and alcohol treatment (D&A) or group living arrangement (GLA) facilities, or family violence shelters are potentially eligible for SNAP, if it is an approved institution. These residents may be certified separately, regardless of how they purchase and prepare meals with other residents. The resident’s SNAP household still includes mandatory required SNAP household members, if they live together.

Common examples of institutions are hospitals, nursing homes, public or private homes for persons with a disability, establishments for delinquents and young offenders, group homes for children, penal and correctional institutions, jails, homeless shelters, and students living in a school dormitory where most meals are provided.

Foster placement agencies place some foster children or adults in homes or facilities other than foster parent homes, and are cared for by people who are employees of, or contract with placement agencies. Such facilities usually house multiple foster children or adults. Foster children or adults who reside in these unapproved institutions rather than in the foster parent’s home, are considered institutionalized and cannot receive SNAP.

Related Policy

Applications from Residents of a Homeless Shelter, A-116.2
Who Is Included, A-231
Noncommercial Roomer/Boarder Payments, A-1323.4.3
Foster Care and Permanency Care Assistance (PCA) Payments, A-1326.4
Students in Higher Education, B-410
Ineligible Students, B-413
Drug and Alcohol Treatment (D&A) or Group Living Arrangement (GLA) Facilities, B-440
Residents in Family Violence Shelters, B-450
Participation Twice in Same Month, B-454
Prepared Meal Services, B-460
Household Composition, B-475.3
Determining Whether a Person Who Resides in a Facility Is Institutionalized, B-490

A-232.2 Disqualified People

Revision 26-3; Effective July 1, 2026

SNAP

The following people would otherwise be required SNAP household members but are disqualified, and cannot participate during their disqualification period. However, the disqualified person’s circumstances, income, and resources are considered in determining the household's eligibility and benefit allotment. 

Fugitives

People who:

• are fleeing to avoid prosecution of or confinement for a felony criminal conviction; or 
• a court found them in violation of federal or state probation or parole.

People with a felony drug conviction

A person with a felony drug conviction, not deferred adjudication, in Texas or another state occurring Sept. 1, 2015 or after. The conviction must be for the possession, use or distribution of a controlled substance per 102(6) of the Controlled Substance Act [21 USC 802(6)]. A person with a felony drug conviction who:

• violates a condition of parole or community supervision, incurs a two-year SNAP disqualification; or
• is convicted of a subsequent felony drug offense in Texas or another state while receiving SNAP, incurs a permanent SNAP disqualification.

Accept the person's statement as verification of a felony drug conviction.

When electronic data sources show the person was convicted Sept.1, 2015 or after, for an offense involving a controlled substance, discuss the situation with the person and:

• if they claim not to be the person on the report, but identifying information on the report such as name, date of birth and physical description lead staff to believe using the prudent person principle that the report is correct; or
• if the person disagrees with other information provided in the report such as the type of offense or if it was a felony or misdemeanor conviction. 

If unable to clear the discrepancy between the household’s statement and the electronic data sources, staff must: 

• document the person's response in TIERS Case Comments;
• proceed with the appropriate case action without the information on criminal history report;
• contact the Texas Office of Inspector General (OIG) by emailing the OIG Benefits Program Integrity (BPI) mailbox; and
• document the reason for contacting OIG BPI in case comments. 

The assigned OIG BPI investigator provides the information by email once OIG BPI receives information to clear the discrepancy. Staff responsible for processing this task must document the results of the OIG BPI's findings in TIERS Case Comments. If applicable, staff enter information in the Individual Demographic-Conviction/Rehabilitation page. File an overpayment referral, if appropriate.

Intentional Program Violation (IPV)

People disqualified for an IPV in Texas or another state.

Noncooperation with SNAP Employment and Training (E&T)

People disqualified for failing to cooperate with E&T requirements.

Noncooperation with Social Security number (SSN) requirements

People disqualified for failing to cooperate with SSN requirements.

Ineligible Alien

People who do not have eligible alien status to receive benefits.

SNAP Able Bodied Adult Without Dependents ABAWD Work Requirement

ABAWDs who have received their initial three months of SNAP benefits and who do not meet the ABAWD work requirement.

Related Policy 

Prudent Person Principle, A-137
Absence of Proof of Alien Status, A-313
Qualified Alien Status Eligibility Charts, A-340
Failure to Comply, A-420
Disqualified Members, A-1362
Noncooperation with E&T, A-1844
ABAWD Work Requirement, A-1940
After the Three Months of Time-Limited SNAP Eligibility, A-1951
Filing an Overpayment Referral, B-770
IPV Disqualification Penalties, B-912 

Revision 16-4; Effective October 1, 2016

Medical Programs

The following individuals may be certified for medical coverage if they meet all eligibility criteria:

• children under age 19;
• other-related children under age 19;
• independent children under age 19;
• pregnant women;
• legal parent(s);
• caretaker relatives; or
• spouse of caretaker relatives.

MAGI rules are used to determine financial eligibility for certain Medical Programs. MAGI rules are based on Internal Revenue Service tax rules.

The following criteria are considered when determining the MAGI household composition for Medical Programs:

• tax status;
• tax relationships;
• living arrangements; and
• family relationships.

Tax Status

An individual's tax status must be designated before their MAGI household composition can be determined.

Tax status is based on the individual's self-declaration for what he or she plans to report on his or her federal income tax return for the taxable year in which eligibility for Medical Programs is requested.

Individuals must be designated as one of the following:

• A taxpayer – an individual who plans to file a federal income tax return for the taxable year in which eligibility for Medical Programs is requested and who is not claimed by another taxpayer. Spouses who plan to file a joint or separate federal income tax return are both considered taxpayers.

Note: For MAGI household composition purposes, an unmarried individual who intends to file a joint tax return is considered a taxpayer filing separately. An individual who is unmarried is not considered a taxpayer filing jointly.

• A tax dependent – an individual who plans to be claimed as a tax dependent by a taxpayer.

Note: An individual who is both a taxpayer and tax dependent is considered a tax dependent. Example: A college student who plans to file his or her own federal income tax return and expects to be claimed by his or her parents will be considered a tax dependent.

• A non-taxpayer/non-tax dependent – an individual who does not plan to file a federal income tax return in the taxable year in which eligibility for Medical Programs is requested and does not plan to be claimed by a taxpayer. 

Tax Relationships

Individuals have a tax relationship to one another if they:

• plan to file a joint federal income tax return;
• are the taxpayer that plans to claim specific tax dependent(s); or
• are a tax dependent of a specific taxpayer.

Individuals do not have a tax relationship to anyone if they:

• do not plan to file a federal income tax return;
• are not the taxpayer planning to claim the specified tax dependent(s); or
• are not a tax dependent of a specified taxpayer.

Living Arrangements

Individuals are not required to live at the same physical address in order to apply for each other if they have a tax relationship, as explained in A-121, Receipt of Application.

Domicile requirements explained in A-900, Domicile, apply to TP 08, Parents and Caretaker Relatives Medicaid. A parent/caretaker relative must reside with a dependent child to receive TP 08 benefits.

A child entering a state hospital may qualify as an independent child. The child may qualify even if ordered by the court into a state hospital. A child is considered an independent child if court ordered into a state hospital because the parent/caretaker relative no longer has care and control. If the parent/caretaker relative admitted the child voluntarily into a state hospital, verification of whether the parent/caretaker relative still has care and control to determine independent child status is required.

An inquiry should be performed prior to certifying an independent child. The child is certified as an independent child if all eligibility criteria are met. The coverage continues for 12 months, even if the child is released from the state hospital. If a child is released from the facility prior to the end of the 12-month period, the address change is processed and coverage is continued.

Determining Custodial Parent

A custodial parent is established based on physical custody and who has legal authority to claim a child as a tax dependent specified in a court order, binding separation agreement, divorce agreement, or custody agreement.

• If there is no order or agreement, or in the event of a shared custody agreement without specifications for filing federal income tax returns, the custodial parent is the parent with whom the child spends most nights. In the event that the child spends an equal amount of nights with both parents, the advisor must make a prudent person decision regarding which parent should be considered the custodial parent.
• If both a custodial parent and a non-custodial parent declare that they plan to claim the same child as a tax dependent on their federal income tax return, the advisor should build the child's MAGI household composition as a tax dependent of the custodial parent. 

Family Relationships

Family relationships that impact household composition include:

• marriage;
• parents of children under age 19; and
• siblings under age 19 or a child under age 19.

The tax status of the individual impacts how the family relationship is used in determining MAGI household composition.

Notes:

• For MAGI only applications and renewals, a relationship and tax status of unmarried and intending to file jointly is not an indication that the individual is currently married or that there is a discrepancy in the individual's marital status.
• For integrated applications and renewals that include SNAP or TANF, a relationship and tax status of unmarried and intending to file jointly should be treated as a case clue if marital status is questionable.
• For all applications and renewals, if the client provides a tax document with an indication of marital status that is inconsistent with the marital status that was reported on an application, the discrepancy in the marital status must be resolved.

A household cannot choose to exclude a child from the budget group when determining eligibility for Medical Programs. 

The policy in A-241, Budget Group, and A-242, Certified Group, is used to determine whom to include in the budget and certified group.

Related Policy

Children Admitted into State Hospitals, A-922
Verification Requirements, A-940
Documentation Requirements, A-950
Applications for Babies Born to Women in Prison, A-116.3
Eligibility Requirements, A-521

A—241 Budget Group

Revision 12-1; Effective January 1, 2012

A—241.1 Who Is Included

Revision 15-4; Effective October 1, 2015

A—241.1.1 Taxpayer's MAGI Household Composition

Revision 15-4; Effective October 1, 2015

Medical Programs

The following individuals are included in the taxpayer's MAGI household composition:

• The taxpayer;
• The taxpayer's spouse, if the taxpayer and the spouse live together;
• The taxpayer's spouse, if the taxpayer and spouse file a joint federal income tax return; and
• Any individual the taxpayer plans to claim as a tax dependent.

A—241.1.2 Tax Dependent Exceptions

Revision 19-1; Effective January 1, 2019

Medical Programs

If a tax dependent meets any one of the following exceptions, staff must use the non-taxpayer/non-tax dependent rules explained in A-241.1.4, Non-Taxpayer/Non-Tax Dependent's or Tax Dependent with an Exception MAGI Household Composition, (not the tax dependent rules) to build the tax dependent's MAGI household composition:

• The tax dependent is not the taxpayer's spouse or the taxpayer's child (natural, adopted or step) regardless of age;
• The tax dependent is a child under age 19 who lives with both parents who do not plan to file a joint federal income tax return and the child was claimed by one parent; or
• The tax dependent is a child under age 19 who is claimed as a tax dependent only by a non-custodial parent.

For a child claimed as a tax dependent by both parents who are filing jointly, with one parent living outside the home, the child does not meet the third tax dependent exception. Staff must build the child's MAGI household composition using the tax dependent rules explained in A-241.1.3, Tax Dependent's MAGI Household Composition.

A—241.1.3 Tax Dependent's MAGI Household Composition

Revision 15-4; Effective October 1, 2015

Medical Programs

If an individual is a tax dependent and does not meet a tax dependent exception previously listed, the following individuals must be included in the tax dependent's MAGI household composition:

• The tax dependent;
• The individuals in the MAGI household composition of the taxpayer who is planning to claim the tax dependent; and
• The tax dependent's spouse, if the tax dependent and the spouse live together.

A—241.1.4 Non-Taxpayer/Non-Tax Dependent's or Tax Dependent with an Exception MAGI Household Composition

Revision 15-4; Effective October 1, 2015

Medical Programs

If an individual does not plan to file a tax return nor plans to be claimed as a tax dependent, the individual is considered a non-taxpayer/non-tax dependent. All tax dependents who meet an exception – Tax Dependent Exceptions­ – will build his or her MAGI household composition using the non-taxpayer/non-tax dependent rules.

The following individuals must be included in the non-taxpayer/non-tax dependent's or tax dependent with exception's MAGI household composition if living together: 

• The individual,
• The individual's spouse,
• The individual's children under age 19, and
• If the individual is a child under age 19:
  • The individual's parents, and
  • The individual's siblings under age 19.

A—241.1.5 Inclusion of the Unborn

Revision 16-4; Effective October 1, 2016

Medical Programs

The expected number of unborn children are included in the MAGI household composition of:

• a pregnant woman; and
• any individual whose MAGI household composition includes a pregnant woman.

Note: When including the expected number of unborn children in the MAGI household composition, the pregnant woman is not required to be certified on a medical program.

Related Policy

General Policy, A-910
Income Limits and Eligibility Tests, A-1341
Who Is Included, D-321
Who Is Not Included, D-322

A—241.2 Who Is Not Included

Revision 15-4; Effective October 1, 2015

Advisors must use the MAGI household composition policy explained in A-241.1, Who Is Included, when determining eligibility for Medical Programs. 

A—241.3 Household Composition Situations (Minor Parents, Independent Children, Etc.)

Revision 15-4; Effective October 1, 2015

Advisors must use MAGI household composition policy explained in A-241.1, Who Is Included, when determining eligibility for Medical Programs.

A—241.3.1 Children's Living Arrangements

Revision 22-1; Effective January 1, 2022

Medical Programs

A child is considered institutionalized if the child is residing in a facility:

• that is an organizational part of a governmental entity, such as a county holding facility for juveniles; or
• over which a government unit exercises final administrative control.

A child is not considered institutionalized if the child is residing in a facility that is a:

• publicly operated community residence that serves no more than 16 residents, such as a county emergency shelter;
• non-public facility, such as a group or foster home or a general residential operations facility;
• state hospital; or
• halfway house operated by the Texas Juvenile Justice Department (TJJD) or Juvenile Probation Department (JPD) that allows residents freedom of movement and association according to the following tenets:
  • residents are not precluded from working outside the facility in employment available to people not under justice system supervision;
  • residents can use community resources at will; and
  • residents can seek health care treatment in the community to the same or similar extent as other Medicaid enrollees.

Related Policy

Child Placed in a Non-Secure Facility, B-544

A—241.4 Family Violence Exemption

Revision 15-4; Effective October 1, 2015

Medical Programs

Individuals may not be able to or may not want to provide information about a member of their MAGI household composition because they fear physical or emotional harm by that person. Individuals who are pended for missing information about a MAGI household composition member who may be a family violence offender can contact HHSC to request the family violence exemption by calling 2-1-1 or visiting a local office.  

Advisors must ask the individual requesting the family violence exemption, at the time the exemption is requested, if they want to be designated as the head of household for the case. Advisors must also confirm the address that should be used for agency correspondence and offer to set up an alternate address if needed. Individuals experiencing family violence must be allowed to provide an address for agency correspondence other than the address on the case with the offender.

If the individual wants to pursue the family violence exemption, advisors must determine whether the individual has existing approved Office of the Attorney General (OAG) good cause for TANF or TP 08 as explained in A-1130, Explanation of Good Cause. 

• If the individual has existing OAG good cause, no further action is required for the individual. The advisor must select "OAG Good Cause" as the verification source in TIERS.
• If the individual does not have existing OAG good cause, the advisor must make a referral to a family violence specialist at a nearby family violence service provider, following the process explained in A-241.4.1, Referral to a Family Violence Specialist. 

A—241.4.1 Referral to a Family Violence Specialist

Revision 15-4; Effective October 1, 2015

Advisors must send the contact information for the nearest family violence shelter to the individual pursuing the family violence exemption using Form H1071, Family Violence Exemption for Medicaid and CHIP. Form H1071 informs the individual how they can claim the family violence exemption and is sent along with Form H1020, Request for Information or Action. 

The individual must contact the family violence specialist and explain the need to claim the family violence exemption. After the family violence specialist makes the recommendation, the family violence specialist completes Form H1706, Good Cause Recommendation and Family Violence Exemption, and may mail or fax the form to HHSC, or send the form back with the individual to HHSC. Only a family violence specialist can recommend the exemption using Form H1706. Form H1706 is due 10 days from the date Form H1020 was sent (or 30 days from the file date, whichever is later).

• If the family violence specialist recommends the family violence exemption, the exemption is granted and will affect all MAGI EDGs on the case by removing the offender from their MAGI household composition. 
• If the family violence specialist does not recommend the family violence exemption, the exemption is denied. The advisor must re-pend the MAGI EDGs to give the individual additional time to provide the information that was originally requested for the MAGI household member.
• If Form H1706 is not returned by the due date, the exemption is denied. All pending MAGI EDGs are denied for failure to provide information that was originally requested for the MAGI household member.
• If the client withdraws the request for the family violence exemption, the client must provide the information that was originally requested for the MAGI household member by the due date, or the pending MAGI EDGs are denied.

Once the family violence exemption has been established by a family violence specialist, advisors do not need to re-evaluate the exemption. If the individual contacts HHSC to indicate that they no longer wish to receive the family violence exemption, advisors should update the page by indicating that the exemption has been withdrawn by the client.

The individual continues to receive the family violence exemption until there is a break in eligibility for all MAGI EDGs on the case. If an individual wants to pursue the family violence exemption again after a break in eligibility, advisors must follow the referral process explained in this section.

A—242 Certified Group

Revision 17-1; Effective January 1, 2017

Medical Programs

Each EDG will have one individual in the certified group.

TP 08

Parents and caretaker relatives caring for a dependent child who receives Medicaid.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Pregnant women, children under age 19, and parents and caretaker relatives who are ineligible for ongoing Medicaid because they are non-immigrants, undocumented aliens, or certain legal permanent resident aliens who do not meet the citizenship eligibility requirement but meet all other eligibility requirements. Only a person with an emergency medical condition is certified.

TP 40

Minor or adult pregnant woman unless disqualified from Medical Programs for not complying with TPR or SSN requirements.

TP 43

Children under age 1.

If the child is hospitalized on the child's first birthday, eligibility is continued through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 44

Children age 6 to 18. Children are eligible through the month of their 19th birthday.

Note: A child should be certified for TP 48 rather than TP 44 the month of the child's sixth birthday.

If the child is hospitalized on his 19th birthday, eligibility is continued through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 45

Children under 12 months old whose mother was eligible for and receiving Medicaid at the time of the child's birth. The mother's eligibility for the child's birth month can be determined retroactively.

TP 48

Children age 1 to 5. Children are eligible through the month of their sixth birthday.

Note: A child should be certified for TP 45 (or 43) rather than TP 48 the month of the child's first birthday.

If the child is hospitalized on the child's sixth birthday, eligibility continues through the month the hospitalization ends. See A-825, Medicaid Termination, for additional information.

TP 56

The following individuals should be certified for TP 56 if they meet all other eligibility criteria:

1. A pregnant woman with household income that exceeds the income limits for TP 40 unless disqualified from Medical Programs for not complying with:
   • TPR requirements; or
   • SSN requirements.
2. Children under age 19 with household income that exceeds the income limits for TP 43, TP 44 and TP 48 unless disqualified from Medical Programs for not complying with:
   • TPR requirements; or
   • SSN requirements.

Revision 24-3; Effective July 1, 2024

SNAP and TANF

Verify fugitive status for people who are fleeing felons or violating their probation or parole.

TANF

There are no verification requirements for household composition. Age, relationship and domicile eligibility criteria are verified to determine people included in the TANF certified group.

Verify out-of-state disqualifications for felony drug convictions.

SNAP

Verify:

• household size and composition, if questionable;
• out-of-state disqualifications for intentional program violations;
• out-of-state disqualifications for felony drug convictions;
• compliance with parole or community supervision for people with a felony drug conviction on or after Sept. 1, 2015, at each application, renewal, and when adding a new household member with a felony drug conviction at a change; and
• if a felony drug conviction is:
  • after another felony drug conviction on or after Sept. 1, 2015; and
  • received while the person was receiving SNAP.

Unless questionable, the household’s statement is acceptable verification of:

• a felony drug conviction; and
• who purchases and prepares meals together.

If the required household members claim to live at separate physical addresses and the information in the case record shows otherwise, including electronic data sources, request additional verification to clear the discrepancy between the household’s statement and the information in the case record. Use Form H1020, Request for Information or Action to request additional verification.

If the required household members claim to live in separate dwelling units at the same physical address, attempt to clear the discrepancy using the county appraisal district (CAD). If the information from the CAD does not clear the discrepancy or shows there is only one dwelling unit at the physical address, request additional verification using Form H1020.

To be considered as living separately, required household members must provide verification that they live in separate dwelling units. If unable to clear the discrepancy, consider the required household members as living together.

A dwelling unit is a home, mobile home, duplex unit, apartment unit, condominium unit or any unit in a multiunit residential structure. A multiunit residential structure is two or more dwelling units in one or more buildings that are:

• under common ownership;
• managed by the same owner, agent or management company; and
• located on the same lot or tract of adjacent lots or tracts of land.

Include required household members on the SNAP EDG who live at the same physical address, regardless of the design of their unit.

Medical Programs

To determine a person’s MAGI household composition, each person on the application must provide their tax status, which will identify the person as a taxpayer, tax dependent, a non-taxpayer or non-tax dependent. Additionally, applicants must provide the following information about their tax relationships to one another:

• a taxpayer who plans to claim one or more dependents must provide the name of each dependent;
• a taxpayer who plans to file a joint federal income tax return with a spouse must provide the spouse’s name;
• a taxpayer who plans to file a separate federal income tax return from their spouse must provide the name and filing status of the spouse; and
• a tax dependent must provide the name of each taxpayer who expect to claim them.

Note: For a pregnant woman, if tax status information is not available and the client cannot be reached, staff can create a Medicaid for Pregnant Women (TP 40) EDG and certify the pregnant woman by postponing verification of tax status. Using the non-taxpayer and non-tax dependent household policy, request additional information for the tax status on the TP 40 EDG. Staff must verify tax status for a TP 40 EDG after certification if the tax status was not verified by the client during the eligibility determination.

Related Policy

Postponed Verification Procedures, A-145.1
Age/Relationship, A-500
Domicile, A-900
Deprivation, A-1000
Social Security's Criteria for Disability, B-432.1

A-251 Verification Sources

Revision 26-3; Effective July 1, 2026

SNAP and TANF

Verify household composition using the following verification sources:

• building permits;
• court documents;
• county records;
• child welfare records;
• court child support order;
• current school record showing the same address as the specified relative;
• hospital, clinic, health department or private doctor's records;
• juvenile court records;
• juvenile Medicaid tracker, only for those placed or released by the Texas Juvenile Justice Department or Juvenile Probation Department;
• lease agreements;
• marriage license or certificate;
• mortgage statements;
• property deeds;
• statement from clergy, non-relative landlord or non-relative neighbor;
• tax records;
• titles; or
• visual observation of the child.

Note: Explore any discrepancies when a household’s statement contradicts information found in the Case Action Documentation (CAD). Use prudent person principle to make sure statements from a non-relative landlord, non-relative neighbor or clergy adequately explain the discrepancy.

Verify intentional program violations and felony drug convictions with an out-of-state human services agency.

Verify fugitive status for fleeing felons and probation or parole violators with law enforcement by using a:

• written notification that law enforcement is actively seeking to apprehend the person within the next 30 days; and
• copy of the arrest warrant.

For fugitives who are fleeing felons, the arrest warrant must also contain one of the following National Crime Information Center (NCIC) codes:

• Escape (4901);
• Flight to Avoid (4902); or
• Flight-Escape (4999).

Note: Staff must not pend for, or attempt to get, verification of fugitive status for fleeing felons or probation or parole violators. Verification of fugitive status is provided to HHSC by law enforcement when law enforcement actively seeks to apprehend a person.

TANF

Verify time limits with an out-of-state human services agency.

SNAP

Verify compliance with parole or community supervision for people with a felony drug conviction on Sept. 1, 2015, and after, using:

• Form H1806, Parole or Community Supervision Report; or
• answers to the parole or community supervision compliance questions submitted online through YourTexasBenefits.com or the Your Texas Benefits mobile app when the person who has the felony drug conviction is the same person who:
  • signed the online application;
  • signed the renewal; or
  • submitted the change.

Verify subsequent felony drug convictions while receiving SNAP using:

• criminal history in Data Broker;
• an out-of-state human services agency; or
• TIERS inquiry.

Medical Programs

Verify MAGI household composition, including a person’s tax status and tax relationships, using client statement unless questionable.

Related Policy

Prudent Person Principle, A-137
Questionable Information, C-920
Providing Verification, C-930

Revision 24-3; Effective July 1, 2024

TANF and TP 08

Document the reason why people living in the home are not included on the EDG.

Refer to relationship, domicile and deprivation policy for other verification and documentation requirements.

TANF

Document:

• the specific reason for designating a representative payee or protective payee;
• the basis for giving separate household status to married minors;
• the name and phone number of an out-of-state human services employee who provides information;
• months of TANF cash assistance received in other states since October 1999 by an adult household member;
• the household was informed of the one-time payment at application and if the caretaker requested it or declined it; and
• a relative caring for a related dependent child or children receiving TANF was informed of One-Time TANF for Relatives at application or periodic review if the relative is potentially eligible and if they requested it or declined it.

SNAP

Document:

• an explanation of the household composition;
• the basis of granting separate household status;
• the applicant’s or recipient's response to electronic data sources or other information in the case record and the reason the person disagrees with the information, if applicable;
• the information from the county appraisal district (CAD) and the attempt to clear the discrepancy;
• the reason for an OIG referral resulting from the Data Broker criminal history record for a felony drug conviction;
• the result of OIG's findings;
• the disqualification status of any disqualified household member;
• the name and phone number of an out-of-state human services employee who provides verification;
• the name of the household member currently disqualified for an intentional program violation (IPV) in another state; and
• the number of any countable months of benefits received in another state as an able-bodied adult without dependents (ABAWD).

Related Policy

Documentation Requirements, A-540
Documentation Requirements, A-950
Disability Verification, A-1080
Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification, B-941
The Texas Works Documentation Guide (PDF)

Revision 13-2; Effective April 1, 2013

All Programs

U.S. citizens and certain legally-admitted alien residents are
eligible for benefits if they meet all other eligibility criteria.

A person born in the 50 states, District of Columbia, Puerto Rico,
Guam, the U.S. Virgin Islands, America Samoa, Swain's Island or Northern
Marianna Islands is considered a U.S. citizen.

A person born abroad to at least one U.S. citizen parent may claim derivative citizenship. See How to Verify Citizenship, A-351.4.

Exception: Undocumented aliens applying for Emergency Medicaid do not have to meet citizenship status eligibility requirements.

A-311 Alien Status Policies

Revision 22-2; Effective April 1, 2022

All Programs

Before certifying any alien resident, ensure that the U.S. Citizenship and Immigration Services (USCIS):

• legally admitted the person to live in the United States; and
• they meet the definition of a "qualified immigrant".

Review the person's USCIS document(s) and the Qualified Alien Status Eligibility charts to determine the programs where the person is potentially eligible. Disqualify a person who does not have acceptable alien status. Check USCIS documents for expiration dates. An expired document is not acceptable.

Exception:

Do not disqualify the person:

• if the person provides an expired USCIS document; and
• the Systematic Alien Verification for Entitlements (SAVE) response indicates the person is a Lawful Permanent Resident – Employment Authorized; and
• the ‘Date Admitted To’ response shows ‘Indefinite’, the person meets alien status criteria.

Notes:

• Use the TANF and Medical Programs Alien Status Eligibility Charts to determine Emergency Medicaid eligibility for aliens without acceptable status.
• Before disqualifying a person with an expired document, check the expiration date of the document in SAVE. USCIS automatically extends certain I-766, Employment Authorization Documents, for up to 180 days when USCIS receives a renewal application for the document. When this occurs, SAVE displays the new expiration date. Do not disqualify the person if SAVE shows the I-766 is current.

Related Policy

Definition of Qualified Immigrant, A-311.1
Qualified Alien Status Eligibility Charts, A-340
Verification of Alien Status, A-352
Verifying Alien's USCIS Documents, A-355 

A-311.1 Definition of Qualified Immigrant

Revision 22-2; Effective April 1, 2022

All Programs

The USCIS defines a qualified immigrant as an alien in one of the following categories:

• Asylee;
• Battered Alien;
• Conditional Entrant;
• Cuban or Haitian Entrant;
• Deportation (or Removal) Withheld;
• Iraqi and Afghan Special Immigrants (SIV);
• Lawful Permanent Resident (LPR);
• Parolee;
• Refugee;
• Special Immigrant Conditional Permanent Resident (SI CPR); or
• Trafficking Victims.

Note: The Qualified Alien Status Eligibility Charts list all the above categories.

Related Policy

Qualified Alien Status Eligibility Charts, A-340
How to Determine Eligibility for Battered Aliens, A-343

A-312 Contact with the U.S. Citizenship and Immigration Services (USCIS)

Revision 15-4; Effective October 1, 2015

TANF and SNAP

An illegal alien is one who has received a final deportation order. Advisors must report applicants who are illegal aliens to USCIS in writing. The supervisor must sign a written notification and send it to the nearest USCIS office, which can be found at https://egov.uscis.gov/office-locator.

Except for using the SAVE Verification Information System (VIS), advisors may contact USCIS on behalf of an alien only at the individual’s written request. If the alien does not wish to contact USCIS or give the advisor permission, the advisor must advise the household that the household may be certified without the alien (that is, disqualify the alien).

A-313 Absence of Proof of Alien Status

Revision 24-2; Effective April 1, 2024

SNAP and TANF

Disqualify a household member from the certified group if the member does not have or refuses to provide proof of alien status. The remaining members of the group are certified if they meet all eligibility requirements.

Related Policy

TANF — Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits, A-1362.1

SNAP — Budgeting for Members Disqualified for Citizenship, SNAP ABAWD Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

TANF

If the applicant cannot provide verification of eligible alien status for a child, the child is considered ineligible rather than disqualified.

Medical Programs

If the applicant cannot provide verification of eligible alien status after the period of reasonable opportunity, the applicant is ineligible for benefits.

Required household members are included in the budget group or Modified Adjusted Gross Income (MAGI) household composition, even if the household members do not have proof of their alien status.

Related Policy 

Who is Included, A-241.1
Reasonable Opportunity, A-351.1
 

A-314 Re-verification of Alien Status Due to a USCIS Document's Expiration Date

Revision 18-1; Effective January 1, 2018

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must re-verify the alien's USCIS card if the:

• USCIS document has expired; and
• alien wants to continue receiving or reapplies for benefits.

Advisors must allow an alien 10 days to update the card with the USCIS. If the individual cannot provide an updated document or proof within 10 days, the alien is disqualified until the individual provides a valid USCIS card or proof of application for a new card.

Exception: If the individual’s USCIS document is expired and the SAVE response shows the individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted To response is Indefinite, the individual meets alien status criteria. These individuals must not be disqualified.

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

When a certified alien's USCIS document expires before the periodic review date, the advisor must schedule a special review the month the document expires.

SNAP

Advisors must set the certification period to end the same month the USCIS document expires or schedule a special review for the month the document expires.

For streamlined reporting (SR) households, the advisor must not set a special review for the month the document expires. A document that expires during the SR certification period does not cause an individual to lose eligibility. The advisor may assume that the household will renew the document upon expiration and re-evaluate at the next certification.

Related Policy

Alien Status Policy, A-311

A-315 Definition of Public Charge

Revision 15-4; Effective October 1, 2015

All Programs

A public charge is defined by law as an alien who has applied for and received public cash assistance for income maintenance, such as Temporary Assistance for Needy Families (TANF) cash assistance, Supplemental Security Income (SSI) or institutionalization for long-term care at government expense, such as nursing home care.

A-315.1 Providing Information to Immigrants Regarding Public Charge

Revision 15-4; Effective October 1, 2015

TANF

If an immigrant inquires, staff must inform the individual that receipt of TANF cash benefits places the immigrant at risk of being considered a public charge and the individual may lose his or her immigrant status.

Exception: According to USCIS, the following individuals are exempt from public charge:

• refugees,
• asylees,
• asylum applicants,
• refugees and asylees applying for adjustment of permanent resident status,
• Cuban/Haitian entrants and parolees,
• Special Immigrant Visa holders from Iraq and Afghanistan,
• Amerasian immigrants (for their initial admission),
• individuals granted relief under the Cuban Adjustment Act (CAA),
• individuals granted relief under the Nicaraguan and Central American Relief Act (NACARA),
• individuals granted relief under the Haitian Refugee Immigration Fairness Act (HRIFA),
• individuals applying for a T Visa,
• individuals applying for a U Visa,
• individuals who possess a T Visa and are trying to become a permanent resident,
• individuals who possess a U Visa and are trying to become a permanent resident,
• individuals who have been certified by the Office of Refugee
  Resettlement as a victim of trafficking (prior to being issued a T Visa
  by USCIS),
• applications for Temporary Protected Status (TPS), and
• certain applicants under the LIFE Act Provisions.

SNAP and Medical Programs

If an immigrant inquires, the advisor must assure the individual that receipt of Supplemental Nutrition Assistance Program (SNAP) and/or medical program benefits does not place the immigrant at risk of becoming a public charge.

A-315.2 Receiving Other Benefits

Revision 15-4; Effective October 1, 2015

All Programs

There are other public assistance programs that immigrants may apply for that do not result in public charge considerations. These programs
include: Special Supplemental Nutrition Program for Women, Infants and Children (WIC), immunizations, prenatal care, testing and treatment of communicable diseases, emergency medical assistance, emergency disaster relief, housing assistance, and child care.

A-316 Sponsored Alien

Revision 15-4; Effective October 1, 2015

All Programs

A sponsored alien is an individual who has been sponsored by a person who signed an affidavit of support (USCIS Form I-864 or I-864-A)on or after December 19, 1997, agreeing to support the alien as a condition of the alien's entry into the U.S.

A sponsor is someone who brings family-based or certain employment-based immigrants to the U.S. and demonstrates that he or she can provide enough financial support to the immigrant so that the individual does not rely on public benefits.

If necessary, advisors use the SAVE system to verify whether an alien has a sponsor. The SAVE system, through additional verification, can provide the sponsor's name and address.

A-316.1 Providing Verification of the Alien's Sponsor Income and Resources

Revision 16-2; Effective April 1, 2016

TANF, SNAP, TP 08, TP 43, TP 44, TP 48, TP 40, TP 07, TP 20, TP 56, TP 70, TA 84 and TA 85

For cases involving aliens and their sponsors, the alien is responsible for getting all verification from the sponsor and sponsor's spouse.

Request the following information from the alien if not otherwise available through Systematic Alien Verification for Entitlement (SAVE) or Texas Integrated Eligibility Redesign System (TIERS) inquiry or case documentation:

• Alien sponsor name,
• Alien sponsor date of birth,
• Alien sponsor Social Security number,
• Alien sponsor earned income,
• Alien sponsor unearned income,
• Alien sponsor self-employment income,
• Alien sponsor resources (if applicable, as explained in A-1245, Resources of an Alien’s Sponsor), and
• Alien sponsor citizenship status or alien number if the sponsor is a lawful permanent resident.

The income and resources (if applicable) of an alien's sponsor (and the sponsor's spouse if the spouse also signed an affidavit of support, USCIS Form I-864) must be counted (deemed) as belonging to the sponsored alien, regardless of actual availability when determining the sponsored alien's eligibility and benefit amounts.

Deeming of the sponsor’s income and resources (if applicable) to the sponsored alien lasts until the:

• sponsored alien becomes a naturalized citizen,
• sponsored alien can be credited with 40 qualifying quarters of work, or
• sponsor dies.

Sponsored aliens not subject to sponsor deeming are:

• children under age 18;
• sponsored aliens who are ineligible for benefits (examples include
  those who are disqualified from getting benefits or those considered
  non-members, such as students who do not meet SNAP student eligibility
  criteria);
• battered spouses or children;
• refugees, parolees, asylees, people granted withholding of
  deportation, Amerasians, trafficking victims, and Iraqi and Afghan
  special immigrants;
• aliens whose sponsor has not signed an affidavit of support;
• aliens whose sponsor is in the same household/Modified Adjusted Gross Income (MAGI) household composition; and
• indigent aliens.

TANF, TP 08, TP 43, TP 44, TP 48, TP 40, TP 07, TP 20, TP 56, TP 70, TA 84 and TA 85

If the sponsored alien fails to provide sponsor verification by the required date in B-115, Pending Verification on Applications, the alien's application is denied.

Note: Resources of an alien sponsor must only be verified if resources are counted for that program, as explained in A-1245.

SNAP

If the sponsored alien fails to provide sponsor verification by the required date in B-115, the sponsored alien is disqualified until the alien provides the proof. If eligible, remaining household members may participate while the alien is disqualified. If the disqualified alien later provides the proof, the advisor processes it as a reported change. The Eligibility Determination Group (EDG) is denied if the household fails to provide proof of the disqualified alien's own income.

Related Policy

Resources of an Alien's Sponsor, A-1245
Alien Sponsor's Income, A-1361

Revision 12-4; Effective October 1, 2012

A-321 Veteran

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

A veteran is eligible for benefits because of a military connection if the veteran is:

• "honorably discharged" from the armed service, and
• meets the minimum active duty requirement of:
  • 24 months of continuous active duty, or
  • the full period the person was called or ordered to active duty.

Individuals who served in the Philippine Commonwealth Army during World War II, or as Philippine scouts following the war, are veterans for purposes of eligibility.

Related Policy

Verification of Veteran Status, A-353.1 

A-322 Active Duty Military Member

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

An active duty military member is eligible for benefits because of a military connection if currently on full-time duty in the U.S. Army, Navy, Air Force, Marine Corps or Coast Guard. It does not include full-time National Guard duty.

Active duty training as a member of the Reserves, Army National Guard, or Air National Guard does not establish eligibility for the individual. The advisor must determine that training is not the reason the reserve member is on active duty.

Related Policy

Verification of Active Duty Military, A-353.2 

A-323 Spouse or Minor Unmarried Dependent Child of Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

A spouse is eligible for benefits because of a military connection if the individual is currently married to a veteran or active duty military member. A minor unmarried dependent child under age 18 is eligible.

Related Policy

Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member, A-353.3 

A-324 Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

To meet the alien eligibility status as a surviving spouse of a deceased veteran or an active-duty military member, the spouse must not have remarried, and the marriage to the veteran or active duty military member must fulfill one of the following requirements:

• lasted at least one year;
• occurred within 15 years after the period of service in which the
  injury or disease that resulted in the death of the veteran or active
  duty member ended; or
• a child was born between the surviving spouse and the veteran or active duty member, either during or before the marriage.

Related Policy

Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member, A-353.3

SNAP

If a currently certified surviving spouse remarries, the spouse retains eligible alien status through the end of the current certification period.

Revision 18-1; Effective January 1, 2018

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

LPRs admitted prior to Aug. 22, 1996, meet the alien eligibility requirement by having 40 qualifying quarters of social security coverage.  LPRs admitted on or after Aug. 22, 1996, meet the alien eligibility requirement by having 40 countable qualifying quarters of social security coverage, if five years have passed since the legal date of entry. An LPR does not have to meet the 40-quarter requirement, including the five-year wait, if any of the following apply.

The alien:

• has a military connection;
• entered the U.S. with a status described in Chart C of A-342, TANF and Medical Programs Alien Status Eligibility Charts, and meets the eligibility criteria for refugees, asylees, etc., or meets the criteria in A-343, How to Determine Eligibility for Battered Aliens; and
• is a qualified immigrant or non-immigrant child age 18 and under who lawfully resides in the U.S. with a status described in Chart D of A-342, TANF and Medical Programs Alien Status Eligibility Charts.

SNAP

LPRs with 40 qualifying quarters meet the alien eligibility requirement. An LPR does not have to meet the 40-quarter requirement if the alien:

• lawfully resided in the U.S. as a qualified immigrant for five years from the date of entry;
• was admitted to the U.S. on or before Aug. 22, 1996, and was age 65 or older on Aug. 22, 1996;
• meets the definition of disability in B-432, Definition of Disability (regardless of when the alien acquired a disability or entered the U.S.);
• is currently under age 18 (regardless of when the alien entered the U.S.);
• has a military connection; or
• qualifies as a refugee, asylee, etc., as shown in Chart A of A-341, SNAP Alien Status Eligibility Charts.

Related Policy

Verifying 40 "Qualifying Quarters," A-354

A-331 Whose Quarters Can Be Considered

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

For purposes of establishing eligibility through the use of the 40 "qualifying quarters" requirement,  LPRs are credited with quarters of earnings for the:

• LPR,
• LPR's current spouse or deceased spouse regardless if the spouse is an LPR or a U.S. citizen, and
• LPR's parent before the LPR turned age 18. This includes adoptive parents or stepparents.

Note: All of the quarters earned by the LPR's parents through the quarter the LPR turns age 18 are counted.

When determining whether to credit the quarters to an individual's spouse, the advisor must count quarters earned:

• beginning with the quarter from the date of marriage, and
• by a deceased spouse only if the marriage was not terminated before the spouse died.

Quarters earned by divorced spouses for either ex-spouses do not count. LPRs who divorce after certification retain their eligible alien status through the end of the current certification period. This also applies to stepchildren.

Until the quarter a child turns age 18, to meet the 40-quarter requirement, a child may use quarters earned by:

• natural or adoptive parents;
• stepparents from the date of marriage to the legal parent; and
• deceased parents.

Related Policy

Verifying 40 "Qualifying Quarters," A-354

Revision 23-2; Effective April 1, 2023

An alien's eligibility is based on the USCIS status and other criteria as shown in A-341, SNAP Alien Status Eligibility Charts, and A-342, TANF and Medical Programs Alien Status Eligibility Charts.

A-341 SNAP Alien Status Eligibility Charts

Revision 23-2; Effective April 1, 2023

Chart A

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Note: The category of aliens listed in Chart A are eligible for SNAP benefits from the date they adjust to any of the specific statuses listed in the chart. For example, once an alien is granted asylee status, they are potentially eligible for SNAP benefits.

Use the following chart to determine the eligibility of these qualified aliens. Their eligibility is indefinite regardless of their date of entry into the U.S.

Chart B

Use the chart below to determine eligibility for Legal Permanent Residents.

Chart C

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Chart D

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Related Policy

Verifying 40 "Qualifying Quarters," A-354
Verifying Alien's USCIS Documents, A-355
Definition of Disability, B-432

A-342 TANF and Medical Programs Alien Status Eligibility Charts

Revision 25-1; Effective Jan. 1, 2025

Use the following chart to determine eligibility for qualified aliens admitted into the U.S. before Aug. 22, 1996.

Chart A

*An I-551, Permanent Resident Card, does not always include the holder’s signature.

Note: An I-766 with the statement Serves as I-512 Advance Parole is a Combination Employment Authorization and Advance Parole Card, known as a combo card. The combo card serves as both an EAD and an Advance Parole Document. The combo card is only available for certain applicants who have a pending Form I-485, Application to Register Permanent Residence or Adjust Status. This document may also include the letter P, such as C09P. Disregard the letter P.

Use the following chart to determine eligibility for TANF and Medicaid for qualified aliens admitted into the U.S. on or after Aug. 22, 1996.

Chart B

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Notes:

• Click on the federal regulatory language hyperlink for a list of the Indian tribes recognized by the United States Bureau of Indian Affairs.
• An I-766 with the statement, Serves as I-512 Advance Parole, is a Combination Employment Authorization and Advance Parole Card, known as a combo card. The combo card serves as both an EAD and an Advance Parole Document. The combo card is only available for certain applicants who have a pending Form I-485, Application to Register Permanent Residence or Adjust Status. This document may also include the letter P, such as C09P. Disregard the letter P.

Use the following chart to determine eligibility:

• for all LPRs and Parolees applying for TANF; and
• adult LPRs and Parolees applying for Medicaid who were admitted into the U.S. on or after Aug. 22, 1996.

Chart C

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Notes:

• If the alien is ineligible for Medicaid because of citizenship or alien status, determine the alien's eligibility for Emergency Medicaid.
• The federal regulatory language (external link) provides a list of the Indian tribes recognized by the United States Bureau of Indian Affairs.
• An I-766 with the statement Serves as I-512 Advance Parole, is a Combination Employment Authorization and Advance Parole Card, known as a combo card. The combo card serves as both an EAD and an Advance Parole Document. The combo card is only available for certain applicants with a pending Form I-485, Application to Register Permanent Residence or Adjust Status. This document may also include the letter P, such as C09P. Disregard the letter P.

Medical Programs

Certain other qualified immigrant and non-immigrant children 18 and under who are lawfully living in the U.S. may qualify for Medicaid regardless of their date of entry.

Use the following chart to determine eligibility for qualified immigrant and non-immigrant children.

Note: The documents, immigration statuses, or both listed in the chart are not all inclusive. All lawfully residing children with a valid immigration status are eligible. Follow policy clearance request procedures for questions about documents or immigration statuses not listed in this chart.

Exceptions:

• Healthy Texas Women (HTW) recipients who turn 19 during their certification period will continue to receive HTW until their next redetermination. Review the HTW recipient's alien status at redetermination.
• Medicaid for Transitioning Foster Care Youth (MTFCY) recipients qualify through the month of their 21st birthday.
• Medicaid for Former Foster Care Children (FFCC) recipients qualify through the month of their 21st birthday.
• Medicaid for Breast and Cervical Cancer (MBCC) recipients who applied before their 19th birthday remain eligible for Medicaid through the duration of their cancer treatment or until they no longer meet all the other eligibility criteria, whichever is earlier.

Chart D

*An I-551, Permanent Resident Card, does not always include the holder's signature.

Note: An I-766 with the statement Serves as I-512 Advance Parole, is a Combination Employment Authorization and Advance Parole Card, known as a combo card. The combo card serves as both an EAD and an Advance Parole Document. The combo card is only available for certain applicants who have a pending Form I-485, Application to Register Permanent Residence or Adjust Status. This document may also include the letter P, such as C09P. Disregard the letter P.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Aliens living in the U.S. who do not meet the citizenship or immigration status requirements for Medical Programs may be eligible for Emergency Medicaid. These people include non-immigrants, undocumented aliens and certain legal permanent resident aliens.

Do not follow SAVE verification requirements for aliens applying for Emergency Medicaid.

Notes:

• To be eligible for Emergency Medicaid, a person must meet all other eligibility requirements.
• A person must be caring for a deprived child who meets citizenship or alien status requirements to be eligible for TA 31 as a caretaker or second parent.

Related Policy

How to Determine Eligibility, A-343
Verifying 40 "Qualifying Quarters," A-354
Verifying Alien's USCIS Documents, A-355

A-343 How to Determine Eligibility for Battered Aliens

Revision 18-1; Effective January 1, 2018

All Programs

Qualified aliens with a battered alien status do not need to be credited with 40 qualifying quarters of social security coverage, nor do they have a seven-year limited eligibility period.

SNAP

Advisors follow the steps in the chart below to determine whether an alien claiming battered status is potentially eligible for SNAP.

* Examples of acceptable USCIS documents include:

• I-551, Permanent Resident Card, annotated with one of the following status codes: IB-1 through IB-3 or IB-6 through IB-8;
• I-797, Action Notice, that identifies the alien as a self-petitioning battered alien; or
• a final order from an immigration judge or the Board of Immigration Appeals granting suspension of deportation under Section 244(a)(3) of the Immigration and Nationality Act.

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Follow the steps in the chart below to determine if an alien claiming battered status is potentially eligible for TANF and/or Medical Programs.

Revision 13-2; Effective April 1, 2013

A-351 Verification of Citizenship

Revision 25-3; Effective July 1, 2025

All Programs

Items used to verify citizenship for Medical Programs, can also be used for SNAP and TANF.

If previously verified, do not reverify citizenship at application, redetermination or incomplete review unless questionable.

TANF

Verify citizenship for all household members applying for benefits and allow the household 10 days to provide verification. Document the type of verification provided.

If a household member applying for benefits refuses or fails without good cause to provide verification, the household member is disqualified until verification is provided.

SNAP

If questionable, verify U.S. citizenship for certified members. Disqualify any person with a questionable claim of U.S. citizenship until verification of citizenship is received.

Do not consider a person’s claim of U.S. citizenship questionable for SNAP solely if they fail to provide verification of citizenship for Medical Programs.

Medical Programs Except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Verify citizenship for all household members applying for benefits and allow the household a reasonable opportunity to provide verification.

Applicants requesting three months prior Medicaid coverage must provide citizenship verification before prior coverage can be provided.

Exception: Current Medicare and SSI recipients are exempt from the verification requirement. People who receive Retirement, Survivors and Disability Insurance (RSDI) based on disability, and who are in a 24-month waiting period to receive Medicare, are considered meeting the citizenship and identity verification requirement as Medicare recipients.

Related Policy

At Application, A-611
How to Verify Citizenship, A-351.4
Verification Sources, A-358
Budgeting for Members Disqualified for Citizenship, SNAP ABAWD Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3
Budgeting for a Legal Parent Disqualified for Alien Status, Failure to Prove Citizenship, Noncompliance with the Unmarried Minor Parent Domicile Requirement or State Time Limits, A-1362.1

A-351.1 Reasonable Opportunity

Revision 20-4; Effective October 1, 2020

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 45 and TA 85

Medicaid applicants who declare themselves to be U.S. citizens or declare to have an eligible alien status, but for whom verification of citizenship or alien status is unavailable, must be allowed a period of reasonable opportunity to provide verification of citizenship or alien status. Reasonable opportunity is defined as the 95-day period a person is allowed to provide this verification beginning the day the Form TF0001 is generated.

At application and when adding a person during a redetermination or change, if the person does not provide proof of citizenship or alien status and:

• no other information is required to determine eligibility, certify the person for Medicaid if all other eligibility requirements are met, send Form TF0001, Notice of Case Action, and provide a period of reasonable opportunity.
• other information is required to determine eligibility, request verification of the other information in addition to citizenship or alien status prior to providing a period of reasonable opportunity. If the other information is not returned, deny the person. If the person returns the other information but does not provide proof of citizenship or alien status, certify the person for Medicaid, send Form TF0001, and provide a period of reasonable opportunity.

Form TF0001 informs the person that verification of citizenship or alien status is required within 95 days and lists the names of each person who must provide citizenship verification. The period of reasonable opportunity begins the day Form TF0001 is generated.

All new applicants must be given a period of reasonable opportunity even if they have received a previous reasonable opportunity period.

The reasonable opportunity period may be triggered under the following conditions:

• the person cannot provide a Social Security number (SSN) needed to electronically verify citizenship with the Social Security Administration (SSA);
• the data available from an electronic data source and the person’s declaration of citizenship or alien status are inconsistent; or
• electronic verification is unsuccessful, including agency efforts to resolve any inconsistencies, and additional documentation is still needed.

The day the reasonable opportunity period expires (the 95th day), TIERS generates an alert that creates a task. If verification of citizenship or alien status has not been provided, deny the person. 30 days advance notice of adverse action is provided to the household after informing them of the denial of ongoing benefits using Form TF0001, Notice of Case Action.

Related Policy

How to Take Adverse Action if Advance Notice Is Required, A-2343.1
Medicaid Suspension, B-520
Reasonable Opportunity after a Medicaid Suspension and Reinstatement, B-533
Reasonable Opportunity to Provide Citizenship and Alien Status Verification, D-441.1

A-351.2 Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship

Revision 15-4; Effective October 1, 2015

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

If an applicant has an SSN, use SOLQ or WTPY to verify citizenship.

The system attempts to verify citizenship using SOLQ through Electronic Data Sources (ELDS). If the SOLQ system is unresponsive or unavailable due to system failure, advisors must attempt to verify using WTPY.

If the SSN is verified, WTPY provides a response code for verification of citizenship. Advisors follow the steps in the chart below to determine the required advisor action for each response code. These response codes are only provided for Medicaid or CHIP requests.

If unable to, Advisors should attempt to verify citizenship using the Birth Verification System (BVS).

1. If staff is unable to verify citizenship using BVS and additional information is required to determine eligibility, request the additional information and verification of citizenship and allow the individual at least 10 days to provide proof.
   • If the client does not return the additional information by the final due date, the advisor must deny the case for failure to provide required information.
   • If the client provides the additional information, but does not provide verification of citizenship, the advisor must allow the individual a period of reasonable opportunity (explained in A-351.1, Reasonable Opportunity) to provide the verification of citizenship.
2. If staff is unable to verify citizenship using BVS and no other information is required to determine eligibility, the advisor must allow the individual a period of reasonable opportunity to provide the verification without pending the EDG.

After allowing reasonable opportunity, if the recipient refuses or fails to provide proof, the advisor must deny the individual until proof of citizenship is provided.

SOLQ or WTPY responses may also include information on the receipt of SSI or RSDI. Advisors can find more information on the treatment of RSDI and SSI income explained in A-1324, Government Payments.

If the WTPY system is unresponsive or unavailable due to system failure, advisors must not deny or delay certification of Medicaid or CHIP coverage for failure to verify SSN or citizenship. Advisors must:

• enter the SSN as provided by the applicant into TIERS and allow the automated SSA interface to verify the SSN; and
• allow the individual a period of reasonable opportunity (explained in A-351.1) to provide the verification of citizenship.

A-351.3 Good Cause Determination

Revision 15-4; Effective October 1, 2015

TANF

Good cause exists when the Texas Health and Human Services Commission (HHSC) determines that circumstances beyond the individual's control prevent proving U.S. citizenship. The individual's statement that proof is delayed is acceptable.

At initial application and when adding a person, good cause is allowed until the next complete review. The individual must be advised that the verification must be provided by the next complete review or the individual will be disqualified.

A-351.3.1 Referrals to OIG

Revision 15-4; Effective October 1, 2015

TANF

Advisors must disqualify and refer an individual to the Office of Inspector General (OIG) if:

• the individual previously claimed to be a U.S. citizen but could not provide proof after allowing good cause; and
• other information indicates the individual's claim of citizenship is questionable.

A-351.4 How to Verify Citizenship

Revision 15-4; Effective October 1, 2015

All Programs

Advisors may refer to A-358.1, Citizenship, for common sources used to verify U.S. citizenship. For Medical Programs, advisors use the most reliable level of verification available from the sources listed as acceptable for Medical Programs. An affidavit is used only as a last resort when other verification is not available.

Advisors should explore derivative citizenship for any applicant born abroad to at least one U.S. citizen parent. If the applicant claims derivative citizenship, the applicant must provide a Certificate of Citizenship issued by the U.S. Citizenship and Immigration Services.

Related Policy

Reasonable Opportunity, A-351.1
Questionable Information, C-920
Providing Verification, C-930

TANF and SNAP

If the applicant cannot obtain the requested proof but can reasonably explain why it is not available, the advisor must obtain an affidavit signed by someone who knows the applicant's history. The advisor should advise signers that the affidavit is a sworn statement; signers can certify only those facts of which they have personal knowledge. The affidavit must state that the signer:

• is a U.S. citizen;
• knows that the applicant is a U.S. citizen; and
• may be fined, imprisoned or both if false information is given.

Through supervisory channels, the advisor must ask the regional attorney to make a determination if the applicant:

• does not have proof of citizenship and cannot obtain an affidavit as described above; or
• claims derivative citizenship and does not have a Certificate of Citizenship.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Verification requirements do not apply for undocumented aliens in the Emergency Medicaid certified group.

A-352 Verification of Alien Status

Revision 18-1; Effective January 1, 2018

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must verify alien status by:

• obtaining documentation of alien status, as explained in A-340, Qualified Alien Status Eligibility Charts; and
• accessing the USCIS SAVE VIS, as explained in A-355, Verifying Alien's USCIS Documents.

Advisors pend the EDG to allow an alien to update the alien's status with USCIS. An alien who does not have acceptable status is disqualified. If a certified alien’s document expires before the next redetermination, the alien’s immigration status must be re-verified following policies and procedures in A-313, Absence of Proof of Alien Status.

Advisors use the SAVE VIS:

• at application;
• when adding a new household member identified as an alien; or
• when the client’s USCIS document has expired.

Notes: If the alien’s USCIS document is expired and the SAVE response shows;

• The individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted is “Response is Indefinite,” the individual meets an alien status criteria. These individuals must not be disqualified.
• The individual's I-766, Employment Authorization Document, is not expired. These individuals must not be disqualified due to having an expired document.

SAVE does not contain information about victims of severe trafficking or nonimmigrant alien family members. At application, advisors must call the trafficking verification toll-free number at 866-401-5510 to confirm the validity of the certification letter or Derivative T Visa and to notify the Office of Refugee Resettlement of the benefits for which the individual is applying.

Medicaid and CHIP applicants or recipients who declare an alien status, but for whom verification of alien status is unavailable, must be allowed a period of reasonable opportunity to provide verification of alien status as explained in A-351.1, Reasonable Opportunity.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Do not follow the SAVE VIS verification procedures.

A-353 Verification of Military Connections

Revision 13-2; Effective April 1, 2013 

A-353.1 Verification of Veteran Status

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must verify an individual's eligible veteran status by:

• a discharge certificate; or
• Form DD-214 or equivalent that shows the individual previously met active duty status in the armed forces.

Note: Discharge certificates that show character of discharge as anything but "honorable" are not acceptable. A character of discharge "Under Honorable Conditions" is not an "honorable" discharge for purposes of eligibility.

If the veteran does not have proof of discharge status, the veteran is referred to the Veteran's Administration to obtain verification.

A-353.2 Verification of Active Duty Military

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Individuals who claim they are currently on active duty in the military must provide a:

• current Military Identification Card, Form DD-2 (Active); or
• copy of their current military orders.

If the active duty military member does not provide proof of active duty status, the advisor must request other forms of proof.

A–353.3 Verification of a Spouse or Minor Unmarried Dependent Child of a Veteran or Active Duty Military Member or Unmarried Surviving Spouse of a Deceased Veteran or Active Duty Military Member

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Staff must verify whether an alien meets the eligibility requirements as:

• a spouse or minor unmarried dependent child of a veteran or active duty military member; or
• an unmarried surviving spouse of a deceased veteran or active duty military member.

To verify, advisors may use one of the following methods:

• view Form DD-214 for the discharged veteran;
• view the Military Identification Card (DD-2) that shows that the
  alien is married to or is a minor unmarried dependent child of a veteran
  or active duty military member; or
• refer the individual to the Veteran's Administration for verification.

A–354 Verifying 40 "Qualifying Quarters"

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must verify 40 qualifying quarters for LPR applicants or household additions that must meet this requirement. Advisors use the WTPY 40 Quarters Verification System to verify covered wages. Once verified, this information does not have to be reverified.

A–354.1 Response from Social Security Administration's (SSA) WTPY System

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

SSA does not complete the posting of covered earnings quarters for any one year until the following year (around August). Example: Quarters earned in 2012 may not be posted on the WTPY system until August 2013. These quarters are referred to as “Lag” quarters.

A response from SSA on the 40 quarters verification request takes approximately 48 hours to receive.

Advisors base the quarters of covered earnings on the calendar year’s total earnings. Each year, the amount of income needed to earn a quarter changes. State office advises staff of the change each year.

For 2012, an individual must earn $1,130 to earn one quarter. If the individual earned at least $4,520 for 2012 ($1,130 x 4), the client has four qualifying quarters for the year.

Note: Advisors must not allow credit for an incomplete or future quarter. Example: The quarter of July to September 2012 cannot be counted until October
2012, even though the individual earned enough income by March 2012 to receive credit for three quarters in 2012.

A–354.2 Non-Covered Wages

Revision 18-1; Effective January 1, 2018

All Programs Except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

Non-covered wages are those earned by an individual whose employer was not required to pay into the Social Security system (such as certain city, federal, school or religious organization employees).

If the LPR cannot meet the 40 qualifying quarter requirement using covered earnings verified by the SSA, advisors must then obtain sufficient income verification from the individual's employer to determine the earned quarters for the period in question.

Use the chart below to determine if the individual has earned sufficient money to earn a quarter.

Example: A former custodian worked for a school district from 2008 through 2011. The school district did not pay into the Social Security system. The advisor requested that the former custodian provide verification of their earnings for this particular period.* They brought a statement from the school district verifying their wages showing they earned $9,000 for 2008. Using the chart above, the income required to earn a quarter for 2008 is $1,050. This person can be credited with four quarters for 2008 ($1,050 x 4 = $4,200).

*If HHSC already has proof of income earned, advisors do not request that the individual provide additional verification.

Note: Credit for an incomplete or future quarter is not allowed.

A-354.3 Quarters Earned On or After January 1, 1997

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Federal law requires that quarters earned on or after January 1, 1997, cannot be credited if the person who earned the quarters received means-tested public benefits.

When determining the total amount of quarters earned by an LPR,
advisors do not allow any quarters earned after January 1, 1997, if the
person received TANF, SNAP, Medicaid or SSI benefits for the quarter.
The WTPY system response does not reflect receipt of these benefits.

The SSA defines a quarter as a period of three calendar months:

• Quarter 1: January, February, March
• Quarter 2: April, May, June
• Quarter 3: July, August, September
• Quarter 4: October, November, December

A-354.4 Procedures for Verifying 40 Quarters

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must:

A-355 Verifying Alien's USCIS Documents

Revision 20-2; Effective April 1, 2020

A-355.1 SAVE Program's Verification Information System (VIS)

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

The Systematic Alien Verification for Entitlements (SAVE) program's Verification Information System (VIS) is a web-based application that provides alien status information using the applicants' alien registration number.

The SAVE System provides the following types of responses:

• Initial Verification Results: First Name, Last Name, Country, Date of Entry, Date of Birth, Class of Admission (COA) and System Response; and
• Additional Verification Results: Department of Homeland Security (DHS) Response, Expires On, Response Date and DHS Comments.

If the alien’s USCIS document is expired and the SAVE response shows the individual is a Lawful Permanent Resident - Employment Authorized and the Date Admitted is “Response is indefinite,” they meet alien status criteria.

Use the SAVE Verification Information System:

• at application;
• when adding a new household member identified as an alien; or
• if a person's alien documentation has expired.

Exceptions:

When SAVE does not contain information about victims of severe trafficking or non-alien family members, call the trafficking verification toll-free number at 866-401-5510 to:

• confirm the validity of the certification letter or Derivative T Visa; and
• notify the Office of Refugee Resettlement of the benefits for which the person is applying.

SAVE does not normally contain information about American Indians born outside of the U.S.

Related Policy

American Indians Born Outside the U.S., D-8420

A-355.2 How to Request an Initial Verification

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Supervisors complete and route Form 4743, Request for Applications
and System Access, to the regional security officer for employees who
need access to the SAVE system.

Advisors must follow these steps to access the SAVE system:

1. Open the VIS web site at https://save.uscis.gov/Web/vislogin.aspx?JS=YES.
2. Enter your User ID and password.
3. Select Initial Verification from the Case Administration menu.
4. Enter the document type that the applicant provided.
5. Enter the applicant's information as it appears on the document:
   • Alien Number — Do not include the letter A when entering the information in SAVE. If the A number has fewer than nine digits, add leading zeroes to make it a nine-digit number. USCIS# is used on the new I-551 cards instead of Alien Number.
   • I-94 Identification Number — known as the admission number, consists of an 11-digit field. Enter leading zeroes if the I-94 number provided has less than 11 digits.
   • Card Number — Card numbers for I-551 cards issued before November 2004 are at the bottom of the card toward the right-hand side. Card numbers for newer versions of I-551 are on the back of the
     card.
   • Last name.
   • First name.
   • Date of birth.
   • Document expiration date, if applicable.
   • Required benefits — Select the benefit type from the Benefits List (SNAP, Medicaid, TANF).
6. Select Submit Initial Verification. The response appears in the Initial Verification Results section of the same page.
7. The screen displays one of the following messages:

• Lawful Permanent Resident – Employment Authorized;
• Institute Additional Verification; or
• Temporary Resident/Temporary Employment Authorized.

Note: If the response is Temporary Resident/Temporary Employment Authorized, the alien does not meet eligibility requirements.

8. Review the results and select Print Case Details.
9. Select Complete and Close Case to close the case (only if
   additional verification is not necessary). Once a case is closed, the
   user can view it for an additional 90 days.

A-355.3 How to Request Additional Verification – Online Process

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

To request additional verification:

1. In the Initial Verification Results section, select Request Additional Verification. The Enter Additional Verification Data section appears.
2. Edit the default information if necessary, enter required information, and include as much information as possible. Use the Special Comments box to enter additional information to the Immigration Status Verifier (ISV) staff.
3. Submit the request by selecting Submit Additional Verification. The response section appears indicating that the request is in process and will return the response within three working days.
4. To view the status of the case, select View Cases from the Case Administration menu. The Case Search page appears.
5. Enter the Case Search Criteria to search for cases based on the following case status:
   •  
     • all open cases;
     • cases requiring action;
     • cases with additional verification responses;
     • cases in process; and
     • closed cases.

Select Display Case Summary List to open the Case Summary List page. The list displays the Case Status for cases that require action, cases in process, and closed cases. Click the Verification Number to view the Case Details. The user is able to print the case details, request additional verification, and close the case.

When the system is unable to verify the immigration status with the information provided by the user in the automated additional verification request, or the document appears counterfeit, altered, or expired, staff may use the manual process in A-355.4, How to Request Additional Verification – Manual Process.

A-355.4 Secondary Verification of Alien Immigration Status

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, and TP 36

If staff are unable to verify an alien's immigration status through primary verification procedures, use SAVE to request additional information from USCIS by requesting a Data Broker Combined Report through TIERS or the Data Broker Portal.

Once a request from USCIS is obtained for verification of immigration status, the information received must be processed. Staff receive one of the following responses from SAVE via the Combined Report in TIERS or in the Data Broker Portal:

• First level verification - initial verification request in TIERS.
• Second level verification - situations that require additional (secondary) verification in the Data Broker Portal.
• Third level verification - situations that require staff to upload documents for verification in the Data Broker Portal via SAVE.

For the first level verification, staff enter the information provided by the person into TIERS. Once the information is entered and SAVE is requested, SAVE will return an immediate response back indicating if the information entered was able to be verified with USCIS or if more information is needed.

If the information entered can be verified on the first level verification, staff will see the alien status, category code, and entry date. If the information entered is unable to be verified against USCIS records, then staff will have to proceed to second or third level verification responses to correctly verify the person’s citizenship and alien status.

For second level verification and third level verification responses, Data Broker automatically requests additional verification from SAVE. Once obtained from SAVE, staff receive an email from the Data Broker vendor notifying them that the verification requested has been returned from SAVE.

For second level verification responses:

• The Data Broker vendor sends a subsequent email notifying staff that the verification has been returned from SAVE.
• Staff must then:
  • login to the Data Broker Portal to retrieve the information; and
  • update the Alien/Refugee Details page in TIERS accordingly.

For third level verification responses:

• Staff must:
  • upload the verification documents requested into the Data Broker Portal;
  • not mail the documents to USCIS; and
  • ensure only one PDF file containing all required verification documents is uploaded.
• The Data Broker vendor sends a subsequent email notifying staff SAVE has returned the verification.
  • staff must then login to the Data Broker Portal to retrieve the information; and
  • update the Alien/Refugee Details page in TIERS accordingly.

Note: SAVE only populates alien sponsor information into TIERS for the additional verification response. This is unlike initial verification that populates the response data for the applicant in the appropriate ELDS tables on the TIERS Alien/Refugee-Details page.

Related Policy

Filing an Overpayment Referral, B-770
Referrals for Intentional Program Violation (IPV), B-900

A-356 Verifying Alien's Date of Entry

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

The date on the alien's immigration document often represents the alien's first date of entry into the United States. In some instances, an alien may be present in the United States without a qualified status. The individual may then depart and then return to the U.S. as an LPR. For these aliens, the date on their immigration document reflects the date of entry with LPR status, rather than the alien's original date of entry.

Advisors use immigration documents to verify date of entry. Advisors must allow aliens with a USCIS document showing an entry date on or after August 22, 1996, who claim to have entered before that date, an opportunity to submit evidence of their claimed date of entry. This evidence may include pay stubs, a letter from an employer, or a lease or utility bill in the alien's name.

A-357 Verifying Alien's Continuous Presence

Revision 20-1; Effective January 1, 2020

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

The USCIS maintains a record of arrivals to and departures from the country for most legal entrants.

To verify continuous presence in the U.S., submit the Form G-845, Verification Request, and Form G-845S, Supplement Verification Request, electronically through the Data Broker system to the USCIS.

Other entrants, including aliens who entered the U.S. without USCIS documents, must provide documentary evidence showing proof of continuous presence, such as a letter from an employer, a series of pay stubs, or utility bills in the alien's name spanning the period in question.

Note: The alien does not have to remain continuously present in the U.S after obtaining qualified immigrant status.

Related Policy

How to Request Additional Verification – Online Process, A-355.3
How to Request Additional Verification – Manual Process, A-355.4

A-358 Verification Sources

Revision 13-2; Effective April 1, 2013 

A-358.1 Citizenship

Revision 15-4; Effective October 1, 2015

TANF and SNAP Verification Sources:

• Birth Verification System automated process (for individuals born in Texas)
• Birth certificate (see Note)
• Naturalization papers (N-560 or N-561)
• Hospital record of birth
• Baptismal record with date and place of birth
• U.S. passport or U.S. passport card
• Military service papers
• Census records showing name, U.S. citizenship or U.S. place of birth, and date of birth or age
• Voter registration card (SNAP only)
• Local, state or federal records showing birthplace in the U.S.
• Regional attorney
• Civil service employment by the U.S. government
• American Indian Card
• Report of birth abroad (FS-240)
• Certificate of birth (FS-545 or DS-1350)

Alternate Sources

• Family Bible records
• Affidavit from U.S. citizen

Note: Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless previously certified using a birth certificate issued before July 1, 2010. See C-932, Advisor Responsibility for Verifying Information, for information regarding assisting an individual in obtaining birth verification from Puerto Rico.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Citizenship and Identity Verification

Verification sources are divided into two levels: Level 1 and Level
2. Level 1 sources establish both citizenship and identity. Level 2
sources establish citizenship only.

* Individuals born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless certified previously using a birth certificate issued before July 1, 2010. C-932, Advisor Responsibility for Verifying Information, includes information regarding assisting an individual in obtaining birth verification from Puerto Rico.

American Indian/Alaska Natives (AI/AN)

Individuals can self-declare AI/AN status. Form H1205, Texas Streamlined Application, and Form H1010, Texas Works Application for Assistance — Your Texas Benefits, include a general question asking whether anyone in the household is an American Indian, Alaska Native, or member of a federally recognized tribe. In some instances, Yes may be selected on the application for this question, but information is not provided by the applicant in Appendix B, American Indian or Alaska Native Family Member (AI/AN), identifying the member of the household composition for Medical Programs to whom the status applies. If the name of the individual claiming AI/AN status is not provided, AI/AN status is considered not verified.

Related Policy

Providing Verification, C-930
Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2

A-358.2 Alien Status

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36 

• Form I-94, I-151, I-551, I-688B (with special annotations), I-766 (with
  special annotations), or other valid USCIS records
• Contact with USCIS

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Alien Entry Date

• Immigration document
• Contact with the USCIS
• Pay stubs
• Letter from employer
• Lease or utility bill in the alien's name
• School records
• Other document indicating entry date

Alien's Continuous Presence

• Contact with the USCIS
• Letter from employer
• Pay stubs or utility bills in the alien's name spanning the time period in question
• School records
• Other documents spanning the time period in question

Revision 15-4; Effective October1, 2015

All Programs

Advisors must document the:

• alien's status and how you verified it;
• USCIS document's expiration date if any;
• basis of alien's eligibility or ineligibility; and
• temporary eligibility period for the alien, described in A-354.4, Procedures for Verifying 40 Quarters, if applicable.

Advisors must document the verification number from the SAVE inquiry in case comments.

Related Policy

Documentation, C-940

SNAP

Advisors must document the proof of citizenship, if questionable.

TANF and Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Advisors must document proof of citizenship.

Advisors must document the alien's:

• date of entry; and
• continuous presence, if necessary to establish eligibility.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

When using a verification source from Level 2, the advisor must document the reason Level 1 was not used.

Copies of the document used to verify citizenship must be legible and non-questionable.

Related Policy

The Texas Works Documentation Guide

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

All applicants must provide a Social Security number (SSN) or apply for one through the Social Security Administration (SSA) before certification, unless they meet one of the criteria in this section.

Exception: Undocumented aliens are not required to apply for an SSN.

Non-applicants are not required to provide an SSN or proof of an application for an SSN. When non-applicants provide an SSN, advisors may attempt to verify the SSN using the procedures explained in A-440, Verification Requirements. If verification is not available through electronic data sources, verification of the non-applicant’s SSN must not be requested from the applicant.

SNAP

Children age six months or younger are not required to provide proof of an application for an SSN. Newborns may receive benefits with the household without providing proof of an application for an SSN for the later of:

• six months following the child's birth, or
• the next recertification/complete review.

Applicants eligible for expedited service may receive initial benefits without providing or applying for an SSN. Initial benefits can include the first two months if receiving a combined allotment.

Applicants who cannot provide required proof to apply for an SSN may receive the Supplemental Nutrition Assistance Program (SNAP) for each month they have good cause. Good cause exists when circumstances beyond the individual's control prevent the individual from securing proof required to obtain an SSN.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Applicants do not need to provide an SSN if they meet any of the following good cause reasons:

• They are not eligible to receive an SSN;
• They do not have an SSN and may only be issued an SSN for a valid non-work reason; or
• They refuse to obtain an SSN because of a well-established religious objection. A well-established religious objection exists when the applicant:
  • is a member of a recognized religious sect or division of the sect; and
  • adheres to the tenets or teachings of the sect or division of the sect and for that reason is conscientiously opposed to applying for or using a national identification number.

TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Undocumented aliens applying for Emergency Medicaid are not required to provide an SSN.

TP 45

SSN requirements do not apply to TP 45.

If a TP 45 child has an SSN, advisors enter the SSN at Application Registration or during Data Collection in the Individual Information page. If the child does not have an SSN, advisors may refer the parent or caretaker to the SSA to complete Form SS-5, Application for Social Security Number.

A—411 Determining Staff Action at Application

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

* If the applicant cannot provide an SSN because the applicant is a documented alien without work authorization, refer the applicant to the local SSA office using Form H1106.

Explain the following to applicants applying for an SSN:

• the type of proof they must take to SSA to obtain an SSN (see page 2 of Form H1106, Proofs You Need to Apply for a Social Security Number Card, for common types of proof);
• the referral procedure and the results of any delay;
• that SSA must conduct a face-to-face interview with a person age 18 or over applying for an original SSN; and
• that a person applying for someone else (including an adult applying for a child) must provide proof of that person's own identity in addition to proof needed for the SSN application.

When an applicant takes Form H1106 to the SSA office, SSA:

• determines whether the applicant is eligible for an SSN;
• submits Form SS-5, Application for a Social Security Card, for those eligible; and
• adds information to Form H1106 or provides another SSA receipt or letter verifying the applicant completed the SSN application process.

Follow policy in A-420, Failure to Comply, if the applicant does not return Form H1106 with entries made by SSA, or another receipt or letter, verifying that an application for an SSN was submitted for each applicant by the 30th day after the file date, or later, to allow at least 10 days.

SNAP

If the applicant cannot complete the SSN application process in a timely manner, explain the procedure for claiming good cause. If the applicant claims to have good cause for not complying in a timely manner, determine whether good cause applies. The application is not pended for SSA's response if good cause applies.

Related Policy

General Policy, A-410
Action at TANF and Medical Programs Redetermination, A-412
Social Security Number (SSN) Validation Through State Online Query (SOLQ), A-413
Failure to Comply, A-420

A—412 Action at TANF and Medical Program Redetermination — Forms SSA-5028 or SSA-2853

Revision 20-2; Effective April 1, 2020

TANF and Medical Programs, except TP 43, TP 44, TP 45 and TP 48

Provide the person with Form H1106, Enumeration Referral, at the next complete review when:

• Form SSA-5028 or SSA-2853 is accepted at application,
• the form is no longer current; and
• no SSN has been received.

Inform the applicant that the form must be returned within 60 days. Explain to the person the consequence of noncompliance.

The complete review must not be pended for the return of Form H1106. Set a special review for the end of the 60-day period. Follow procedures in A-420, Failure to Comply, for noncompliance if:

• Form H1106 is not returned by the deadline; and
• an SSN is not received.

If an SSN is provided at the next complete review, enter the SSN during Data Collection and run SOLQ if it is not automatically invoked by TIERS. Follow policy in A-413, Social Security Number (SSN) Validation Through State Online Query (SOLQ), if SOLQ

• verifies the SSN with a SSN Verification Code of F or X; or
• does not verify the SSN.

TP 43, TP 44 and TP 48

Follow the procedures above, but do not set a special review. Check for compliance at the next review.

Related Policy

Social Security Number (SSN) Validation, A-413
Failure to Comply, A-420

A—413 Social Security Number (SSN) Validation Through State Online Query (SOLQ)

Revision 23-1; Effective Jan. 1, 2023

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

A person’s SSN is verified when all the demographic information provided by the person matches the information available in SOLQ. When the information matches, TIERS will display the SSN as validated. If the SSN is not verified, TIERS will display in the SOLQ screen the reason why the SSN is not verified.

SSN Verified

A person’s SSN is verified when SOLQ provides one of the following SSN Verification Codes:

• F: SSN is verified, but last name does not match SSN (an indication that the person has changed their last name due to marriage, divorce or adoption);
• M, P, R and V: SSN is verified; or
• X: Data exists that the validated SSN belongs to a person who is deceased.

When a person’s SSN is verified with SOLQ, but information given by the SSA shows that the person is deceased (code X) or that the name does not match (code F), the person’s identity is questionable. Clear the discrepancy before disposing the case action. If the person does not provide the information needed to clear the discrepancy, either disqualify or deny the person using failure to comply policy. Exception: When processing expedited SNAP benefits or Medicaid for Pregnant Women, certify the person with a validated SSN with verification code F or X if unable to clear the discrepancy by viewing case documentation, or contacting the household by phone. Postpone verification needed to clear the discrepancy to meet expedited processing time frames.

Note: If a person with a SOLQ verified SSN requests to change their name, date of birth or gender, the person must first update their information through the Social Security Administration.

SSN Not Verified

If the person’s SSN is not verified with SOLQ, review the information on the application and other supporting documents and update any information entered incorrectly. After making corrections, manually invoke SOLQ to re-run the verification process.

If the person’s identity is not questionable and the SSN remains unverified after re-running the SOLQ verification process, try to contact the person by phone to clear the SSN discrepancy. If unable to clear the discrepancy by phone and:

• No other information is required to determine eligibility, certify the person if all other eligibility requirements are met.
• Other information is required to determine eligibility, include the request for information to clear the SSN discrepancy on Form H1020, Request for Information or Action.
  • Manually generate the Form H1020 and attach the Form HRG-83, SSN Maintenance Memorandum, before mailing.

If the person:

• Returns all requested information and staff verify the SSN, certify the person if all other eligibility requirements are met.
• Returns all requested information, but staff are unable to verify the SSN with the information provided, certify the person if all other eligibility requirements are met.
• Returns information, but not the information to clear the SSN discrepancy, certify the person if all other eligibility requirements are met.
• Does not return requested information, disqualify or deny the person.

If the person’s identity is questionable, request information to clear the discrepancy. If the information is not provided or the information provided does not clear the discrepancy, disqualify, or deny the person.

If unable to verify a person’s SSN via SOLQ, the monthly SSA interface will attempt to validate the SSN. If the monthly interface does not validate the SSN, TIERS generates Alert 268, Social Security Administration Unable to Verify SSN (RG-83), or Alert 269, Social Security Administration Reports a Duplicate SSN, to address the discrepancy.

Related Policy

Social Security Numbers (SSNs), A-144.1

Postponed Verification Procedures, A-145.1

Failure to Comply, A-420

SSN Discrepancy Clearance Procedures, A-432

Verification Requirements, A-440

Questionable Information, C-920

Revision 24-2; Effective April 1, 2024

TANF and SNAP

If an application is certified but a household member is disqualified, notification of the person’s disqualification is included on the comment section of Form TF0001, Notice of Case Action.

Related Policy

TANF — Budgeting for a Household Member Disqualified for Noncompliance with SSN, TPR, Failure to Timely Report a Certified Child's Temporary Absence, Intentional Program Violation, Being a Fugitive or a Felony Drug Conviction, A-1362.2
SNAP — Budgeting for Members Disqualified for Citizenship, SNAP ABAWD Work Requirement or Noncompliance with Social Security Number Requirements, A-1362.3

TANF

Disqualify a required member of the certified group who fails to comply without good cause.

Exception: Deny TANF if the:

• only eligible child or otherwise eligible person does not comply; or
• caretaker or payee refuses to cooperate and eligibility cannot be determined for the other members.

SNAP

Disqualify an applicant who fails to comply unless a social security number (SSN) cannot be provided because:

Exception: Follow policy in A-410 for the following situations:

• the person is a child under six months;
• the household is eligible for expedited service; or
• good cause exists for the applicant.

Related Policy 

General Policy, A-410

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Deny a person's eligibility if they fail to comply with the SSN requirements unless they meet a good cause reason. Denying a person’s eligibility who does not comply with SSN requirements does not impact the eligibility for any other people applying for or receiving Medical Program benefits.

Related Policy

General Policy, A-410

A—421 Reestablishing Eligibility

Revision 15-4; Effective October 1, 2015

TANF and SNAP

If a member is disqualified at application and later complies, the individual is included effective the month after being notified of the compliance.

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

The proof required to get an SSN is shown in the table below, except for special situations that are listed in A-431, Special Situations. The proof needed depends on:

• place of birth;
• citizenship status; and
• whether the request is for an original, duplicate, or corrected SSN.

Note: To correct/update SSN information, the applicant must provide proof required for a duplicate SSN as well as proof showing the new information.

Acceptable Proof

The documents must be originals, or copies made by the custodian of the record, such as a county clerk or registrar. SSA will return all documents submitted to SSA.

Proof of Age and Citizenship

A birth certificate is the preferred proof.

If no birth certificate is available, a U.S.-born citizen may furnish:

• a religious record showing age or date of birth (to establish citizenship, it must have been recorded within three months of birth);
• a hospital birth record;
• a notice of birth registration; or
• other documents, at least one year old, that show:
  • name,
  • age or date of birth, and
  • place of birth.

If no birth certificate is available, a foreign-born U.S. citizen may furnish a:

• U.S. Consular Report of Birth,
• U.S. Citizen Identification Card (Form I-197),
• Certificate of U.S. Citizenship (Form N-560),
• U.S. Passport, or
• Certificate of Naturalization (Form N-550 or N-570).

Proof of lawful alien status:

• I-551, Permanent Resident Card (Resident Alien Card);
• I-151, Alien Registration Receipt Card;
• I-94, Arrival-Departure Record; or
• I-688A, Employment Authorization Card.

Proof of Identity

Proof of identity must contain enough information to identify the applicant, such as name, age or date of birth, address, signature, and physical description. Examples of acceptable documents are:

A-431 Special Situations

Revision 19-4; Effective October 1, 2019

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

The following situations require special handling.

• If the SSN applicant is a non-U.S. citizen who traditionally uses a name order different from the customary U.S. name order (first name, middle name, last or family name), determine name order according to U.S. custom and enter appropriately on Form H1106, Enumeration Referral.

Examples:

A-432 SSN Discrepancy Clearance Procedures

Revision 24-4; Effective Oct.1, 2024

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

The monthly Social Security Administration (SSA) interface tries to verify the SSN after certification when a person’s Social Security Number (SSN) is not verified through the State Online Query (SOLQ) automated system. If the SSN cannot be verified during the interface or a duplicate SSN is found, one of the following alerts is generated:

• Alert 268, Social Security Administration Unable to Verify SSN (RG-83) when the information does not match. This triggers the Task List Manager (TLM) Alert 268, Agency Generated Change - Social Security Administration Unable to Verify SSN (RG-83) for Client (Individual ID) XXXXXXXXX, and routes it to the Customer Care Center (CCC) for case action; or
• Alert 269, Duplicate SSN for Individual Number, when the SSN is a duplicate. This triggers the TLM Alert 269, Agency Generated Change - Social Security Administration Reports a Duplicate SSN XXXXXXXXXX, and routes it to the CCC for case action.

Upon receipt of Alert 268 or Alert 269, research the case and contact the household to clear the discrepant or duplicate SSN. If unable to clear the discrepant or duplicate SSN and the person does not have good cause for not providing a SSN, the following correspondence is generated and the person has a 60-day period to clear the discrepancy:

• Form TF0001, Notice of Case Action, with the following language in the Notes section of the form:
  
  The person is granted extra time to resolve the problem with their Social Security Number.
  
  We need proof that you have gone to the Social Security Administration to resolve the issue with XXXXXXX XXXXX’s Social Security Number by XX/XX/XXXX. If we don’t receive the proof, your XXXXXX benefits will end.
• Form HRG-83, SSN Maintenance Memorandum, instructing the household to go the SSA office to correct or update the person’s Social Security records.

SSA staff will help the person complete an application to correct or update their Social Security records and will provide them with Form SSA-5028, Receipt for Application for a Social Security Number as proof.

If the person’s SSN has not been validated by the 60th day from the date the Form TF0001 and Form HRG-83 are sent, staff are prompted to review the case via Alert #796, Reasonable Opportunity Period has Expired for EDG #.

If the person fails to cooperate in clearing the discrepancy with the SSA or if the SSN has not been validated, refer to related policy to disqualify or deny the person.

Note: This 60-day period is different from the Medicaid reasonable opportunity period for applicants to provide verification of U.S. citizenship or an eligible alien status, when verification is not available when the person applies.

If the system shows an SSN was verified, but the SSN needs to be corrected, send the correct SSN to Data Integrity (DI) to make a change by one of the following methods:

Mail to: DI Section, Data Base Support
4616 W Howard Ln,
Suite 275, MC Y92-2
Austin, TX 78728

Fax to Data Base Support at 512-483-3992.

Email the request to the Data Integrity email box at HHSC CCC Data Integrity Program.

Include in the body of the email:

Case number:

Client name:

Individual number:

Situation:

DI staff send an email to the staff member stating the request was processed or it was unable to process request with substantiation.

Related Policy

Failure to Comply, A-420

Revision 20-2; Effective April 1, 2020

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Verify that a household member applied for a SSN when the applicant cannot provide an SSN. Refer to A-410, General Policy, for applicable exceptions, by program.

SSNs are verified through:

• State Online Query (SOLQ) being invoked during Data Collection. Verification of an SSN via this process is identified in both the Individual Household Summary page with a checkmark in the box by the person’s SSN and a checkmark in the Validated by SSA checkbox on either the Data Collection/Add New Individual page, the Modify Non File Cleared Individual page, or the Edit Existing Individual page.
• The monthly SSA interface. Verification of an SSN via this process is identified in the Individual Summary Page when the SSA box is checked for the individual.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

Follow policy in A-351.2, Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, for verifying SSN using SOLQ or Wire Third-Party Query (WTPY).

If unable to verify the SSN using SOLQ or WTPY:

• Review the information entered into the SOLQ or WTPY request with the information provided by the applicant. If a typographical error is found, submit a new SOLQ or WTPY request with the correct information.
• If no typographical errors are found, contact the applicant by phone to ensure the information provided is accurate. If the applicant provides new information, submit another SOLQ or WTPY request with the correct information. Update the EDG record with the correct information.
• If unable to contact the applicant by phone, send the applicant Form H1020, Request for Information or Action, to request verification of the applicant’s SSN along with any additional information needed. Allow the person 10 days to provide proof.
• If the person fails to cooperate in clearing the discrepancy with the SSA, follow policy in A-420, Failure to Comply.

Follow policy in A-410 to verify all good cause reasons to providing an SSN.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

A—441 Verification Sources

Revision 15-4; Effective October 1, 2015

All Programs

For SSN discrepancies or SSNs that cannot be verified through the SSA interface, SOLQ, or WTPY, the applicant must provide one of the following:

• Copy of the SSN card; or
• Social Security Administration letter confirming the SSN.

Acceptable proof of application of an SSN includes:

• Form SSA-5028, Receipt for Application for an SSN, less than 30 days old;
• Form SSA-2853, Message From Social Security, less than 180 days old; and
• Form H1106, Enumeration Referral.

Medical Programs

Form H1106, completed by the Social Security Administration, is the acceptable verification source for not providing an SSN due to ineligibility to receive an SSN or eligibility to receive an SSN only for a valid non-work reason. Advisors must review the response provided by the SSA on the Form H1106 to determine which good cause reason the applicant meets.

Acceptable sources of verification for a well-established religious objection include:

• an approved IRS Form 4029, Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits; or
• a letter from a leader of the religious organization, a document setting out the tenets of the religious organization which justify the good cause reason, or a similar document.

Note: If the source of verification for a religious exemption is questionable, advisors must contact their supervisor who will coordinate with the Texas Health and Human Services Commission (HHSC) regional attorneys to ensure the documentation is sufficient.

Revision 15-4; Effective October 1, 2015

All Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 45

In the Data Collection/Individual Demographics-SSN/Armed Services page, the advisor must enter the date the individual was given Form SSA-5028, Receipt for Application for an SSN, or Form SSA-2853, Message From Social Security, or the date the applicant returned Form H1106, Enumeration Referral. For EDGs with an individual currently being enumerated, the advisor sends the following documents for imaging:

• Form H1106,
• a copy of Form SSA-5028, or
• a copy of Form SSA-2853.

Advisors must document that the SSA enumerated the individual or was unable to do so.

Related Policy

Documentation, C-940

SNAP

Advisors must document good cause claims according to A-410, General Policy.

Related Policy
The Texas Works Documentation Guide

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

For age requirements, see household composition:

• A-220 for TANF, and
• A-240 for Medical Programs.

Revision 13-2; Effective April 1, 2013

A-521 Eligibility Requirements

Revision 21-1; Effective January 1, 2021

TANF

A child must live, or be expected to live, in the home of one of the relatives (either biological or adoptive) listed in A-221, Who Is Included, No. 4, Caretaker.

TANF-SP

A child must live with, or be expected to live, with both legal parents, or one legal parent and a stepparent.

Note: This also includes legal parents or stepparents who are disqualified for one of the reasons listed in A-222, Who Is Not Included, No. 4, Disqualified Members, unless that disqualification is due to not meeting citizenship requirements.

TP 08 and TA 31

To qualify for TP 08 or TA 31, a person must be a:

• legal parent of a dependent child (both legal parents can be eligible);
• caretaker relative of a dependent child; or
• spouse of a caretaker relative.

The caretaker must be a:

• parent;
• stepparent*;
• sibling;
• step-sibling;
• grandparent;
• uncle or aunt;
• nephew or niece;
• first cousin; or
• first cousin once removed.

*A stepparent of a dependent child is considered within the degree of relationship for TP 08, Parents and Caretaker Relatives Medicaid, and TA 31, Parent and Caretaker Relative Medicaid - Emergency. The relationship to the dependent child remains even if the legal parent and stepparent are divorced or the legal parent is deceased.

The spouse of a caretaker relative may also be eligible for medical coverage if they live with the caretaker relative who cares for the dependent child receiving Medicaid.  

Example: A grandfather is the caretaker relative of his granddaughter. The grandfather applies for Medicaid for himself, his granddaughter, and his spouse who lives with him. If the granddaughter is eligible for Medicaid, both the grandfather and his spouse may be eligible for TP 08.

A dependent child is a person who:

• is under age 18; or
• if age 18, attends school full-time and expects to graduate in or before the month of their 19th birthday.  Note: A child who will not graduate until after the month of their 19th birthday is not considered a dependent child after the month of their 18th birthday.

TP 32, TP 33, TP 34, TP 35, TP 43, TP 44, TP 48 and TP 56

To be eligible for these programs, a child can:

• live with the child's parents;
• live with a caretaker within the degree of relationship required for TP 08 and TA 31;
• live with a person not within the degree of relationship required for TP 08 and TA 31;
• be abandoned; or
• live independently.

TP 45

A child whose mother is eligible for and is receiving Medicaid coverage when the child is born, or whose mother is eligible for and receives Medicaid coverage retroactively for the time of the child’s birth, is eligible for TP 45 coverage. The Medicaid coverage for the newborn can continue through the month of the child’s first birthday if the child remains in Texas, even if the child does not reside with the birth mother.

Related Policy
Guide for Determining Relationship, C-1441
Guide for Determining Extended Relationships, C-1442

A-522 Legal Parent-Child Relationship

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

A legal parent-child relationship exists between a child and:

• an adoptive parent by proof of adoption;
• the mother by proof of having given birth to the child; or
• a man if one of the following conditions exist:
  • The man and the mother married (including a common-law marriage) in apparent compliance with the law before the child's birth (even if the marriage is or could be voided), and the child was born:
    • while they were married; or
    • within 300 days after the marriage terminated.
  • The man and the mother married (including a common-law marriage) in apparent compliance with the law after the child's birth (even if the marriage is or could be voided), and the man:
    • filed a paternity suit, including a statement of paternity in court;
    • is named the father on the child's birth certificate; or
    • has a written obligation to support the child voluntarily or by court order.
  • The courts determine that the man is the biological father.

If there is no other legal father, a legal parent-child relationship exists between a man and a child if one of the following conditions exists:

• The man and the mother do not marry, but the man consents in writing to be named as the child's father on the child's birth certificate.
• Before the child turns age 18, the child lived with the man and holds out to the public that the man is the child's father.
• The man signs an acknowledgement of paternity (AOP) with the Office of Attorney General or Vital Statistics Unit. The child's mother must also be available to sign the AOP.

A-523 When Proof of Relationship Is Unavailable

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

If Birth Verification System (BVS) records do not establish relationship or the applicant cannot provide proof of relationship shown in A-531, Verification Sources, the advisor must use alternative ways to determine relationship. See A-523.1, How to Make an Evaluative Conclusion.

A-523.1 How to Make an Evaluative Conclusion

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

The advisor must examine all available proof such as (but not limited to) school records, court records, birth records, health records, insurance policies, refugee's voluntary resettlement agency (VOLAG) or the U.S. Citizenship and Immigration Services (USCIS) records, or other sources of proof that provide the same information. The advisor should offer reasonable assistance if the individual has difficulty obtaining the information.

Advisors must obtain supervisory approval of the evaluative conclusion.

A-523.2 Children Living with Biological Father

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and TA 31

A biological father may receive TANF, TP 08, or TA 31 if the biological father proves relationship. If the father cannot provide acceptable proof, the advisor must make an evaluative conclusion to establish relationship for the father and child. The OAG uses the automated child support referral to locate the mother and establish paternity of the biological father. The OAG notifies the advisor via Form H1701, Child Support, TANF Foster Care and TANF/Medicaid Case Information Exchange, that paternity is established or excluded. If paternity is excluded, advisors must process an overpayment claim for the period of time the household erroneously received benefits as specified in B-700, Claims.

Proof of a court determination of paternity is required if, at the time of the child's birth, the child's mother was married to another man who is presumed to be the child's legal father.

A-523.2.1 Children Living with Relatives of Biological Father

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

To qualify for TANF or Medical Programs, a caretaker relative must establish required relationship to the child as specified in A-221, Who Is Included, following the steps below:

The caretaker relative must provide acceptable proof of relationship between:

• the caretaker and the biological father; and
• the biological father and the child, using the conditions listed in A-522, Legal Parent-Child Relationship.

A—530 Verification Requirements

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and TA 31

Advisors must verify the age and relationship of each child to the adult claiming the relationship before certifying or adding the child to the cash grant and/or before certifying the adult for Medicaid. Advisors use BVS inquiry for someone born in Texas and who is at least 46 days old but less than 19 years old.

See A-531, Verification Sources. If these verifications are not available, make an evaluative conclusion. See A-523.1, How to Make an Evaluative Conclusion.

Related Policy

Birth Verification System, C-860

Revision 15-4; Effective October 1, 2015

TANF, TP 08 and TA 31

Advisors must verify the age and relationship of each child to the adult claiming the relationship before certifying or adding the child to the cash grant and/or before certifying the adult for Medicaid. Advisors use BVS inquiry for someone born in Texas and who is at least 46 days old but less than 19 years old.

See A-531, Verification Sources. If these verifications are not available, make an evaluative conclusion. See A-523.1, How to Make an Evaluative Conclusion.

Related Policy

Birth Verification System, C-860

A—531 Verification Sources

Revision 24-3; Effective July 1, 2024

TANF and Medical Programs

Verify the age and relationship requirements using the following verification sources.

Age

• birth certificate;
• hospital or public health birth records;
• church or baptismal birth record;
• BVS inquiry;
• local, state, federal or military record;
• adoption papers or records;
• Indian census records;
• U.S. passport;
• school or day care records;
• U.S. Citizenship and Immigration Services records;
• Attorney General child support paternity records; or
• Social Security Administration records.

Alternate Age Sources

• court or child welfare records;
• insurance policies;
• family Bible records;
• voluntary social service agency records;
• court child support order;
• written statement from a doctor or clergy member who knows the date of birth;
• juvenile court records;
• census records; or
• written statement from a non-relative who knows the date of birth.

Relationship

• birth certificate;
• adoption papers or records;
• hospital or public health records of birth and parentage;
• BVS inquiry;
• church or baptismal birth record;
• local, state, federal government or military record;
• school or day care records;
• U.S. Citizenship and Immigration Services records;
• Attorney General child support paternity records;
• juvenile court records;
• Indian census records;
• U.S. passport;
• marriage license or certificate;
• divorce papers; or
• court records of parentage.

Alternate Relationship Sources

• church records of parentage and relationship including statement from clergy;
• family Bible records;
• court or child welfare records;
• insurance policies;
• voluntary social service agency records;
• statement from clergy, doctor or school official who can verify relationship;
• statement from non-relative who has known the child since birth;
• Declaration of Informal Marriage filed with the county clerk;
• sworn statement signed by both spouses; or
• Form H1057, Declaration of Informal Marriage.

Medical Programs except TP 08 and TA 31

If other sources are unavailable, verify the age and relationship requirements using the household’s written or verbal statement.

Related Policy

Documentation Requirements, A-540
Questionable Information, C-920
Providing Verification, C-930

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Advisors must document proof of age or relationship and the basis for the evaluative conclusion or enter on the Texas Integrated Eligibility Redesign System (TIERS) Individual Household page and the Relationship page.

Advisors must document the following:

• The verification source.
• The verification date.
• Children's names.
• Information from the verification source to prove the children live in the home (for collateral contacts include name and address and/or phone number).
• Reason for any temporary absence.
• Information from the verification source to prove the household member or payee returned to and lived in the home for at least 30 days when allowing another temporary absence period.

Related Policy

Documentation, C-940
The Texas Works Documentation Guide

Revision 07-4; Effective October 1, 2007

A-611 At Application

Revision 26-2; Effective April 1, 2026

TANF

Verify the identity of the person interviewed. Once identity is verified for a person, do not re-verify.

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Verify the identity of all applicants requesting benefits. Once identity is verified for a person, do not re-verify.

Verify the identity of the person interviewed if questionable, if an interview was requested or conducted.

Related Policy

Verification of Citizenship, A-351

SNAP

Verify the identity of the person interviewed.

Verify the identity of both the AR and the person the AR represents If the authorized representative (AR) applies for the household.

Exception: If necessary to meet expedited service time limits, staff only need to verify the identity of the AR being interviewed.

Related Policy

Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

A-612 Redetermination

Revision 26-2; Effective April 1, 2026

SNAP and TANF

Verify the identity of the person interviewed if not previously verified.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Verify the identity of each person requesting benefits during the redetermination, if identity was not previously verified. Once identity is verified for a person, do not re-verify.

Related Policy

Verification of Citizenship, A-351
Citizenship, A-358.1
Verification Sources, A-621
Identifying Applicants Interviewed by Phone and Prevention of Duplicate Participation, A-2000

A-613 Receipt of Lone Star Card and/or PIN

Revision 15-4; Effective October 1, 2015

SNAP and TANF

Advisors must verify the identity of a person receiving a Lone Star Card and/or personal identification number (PIN) (initial issuance or replacement).

Revision 03-5; Effective July 1, 2003

All Programs

Birth records and other official records are preferred sources of verification.

A-621 Verification Sources

Revision 25-3; Effective July 1, 2025

SNAP and TANF

Verify identity using the following verification sources:

• Adoption papers or records
• Birth certificate - refer to Note: under this bulleted list
• Certificate of Naturalization
• Certificate of U.S. citizenship
• Collateral statement
• Driver license or Department of Public Safety (DPS) identification (ID) card, current or expired
• Finding of citizenship by another federal or state agency
• Hospital or birth records
• Immigration documents
• Self-declaration of driver license or:
  • DPS ID number already on file, along with other identifying information such as date of birth; or
  • DPS ID number listed on Data Broker, along with other identifying information such as date of birth.
• U.S. passport or U.S. passport card
• Voter registration card
• Wage or check stubs or check
• Work or school ID card

Note: People born in Puerto Rico must provide a birth certificate issued on or after July 1, 2010, unless certified previously using a birth certificate issued before July 1, 2010. Staff are responsible for helping a person get birth verification from Puerto Rico.

TP 08, TP 43, TP 44, TP 48, TP 40 and TA 31

Copies of the document used to verify identity for people requesting benefits must be legible and non-questionable. Submit the document for imaging.

Identity and Citizenship

Verify both identity and citizenship for Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36.

Identity Only

Use one of the following sources as acceptable verification if the document has a photograph and other identifying information such as name, age, date of birth, sex, race, height, weight, eye color or address:

• Driver’s license issued by a state or territory;
• School identification card;
• U.S. military card or draft record;
• Identification card issued by the federal, state, or local government with the same information included on driver’s licenses;
• Military dependent's identification card;
• U.S. Coast Guard Merchant Mariner card; or
• Native American Tribal document.

Use two or more corroborating documents, including but not limited to:

• marriage licenses, divorce decrees or high school diplomas;
• for children under 19, a clinic, doctor, hospital or school record, including preschool or day care records; and
• Form H1097, Affidavit for Citizenship/Identity, signed by another person who can reasonably declare to the applicant’s citizenship, regardless of blood relationship to the person and under penalty of perjury, and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized, and the Form H1097 should be used only as a last resort when other evidence is not available.

Note: A signed application for Medicaid, including the signature of an authorized representative acting on the person’s behalf, is applicable for all household members on the application except the signee. No person may declare their own identity.

Related Policy

Using State Online Query (SOLQ) or Wire Third-Party Query (WTPY) to Verify Citizenship, A-351.2
Citizenship, A-358.1
Questionable Information, C-920
Providing Verification, C-930
Advisor Responsibility for Verifying Information, C-932

Revision 26-1; Effective Jan. 1, 2026

All Programs

Document how the identity of the person interviewed was verified.

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35 and TP 36

Document how the identity of each person requesting benefits was verified. Copies of the document used to verify identity must be legible, non-questionable. Submit the document for imaging.

Related Policy

Documentation, C-940
The Texas Works Documentation Guide (PDF)

Revision 18-1; Effective January 1, 2018

All Programs

Applicants must live in Texas to be eligible for benefits. The household is not required to have a permanent dwelling or fixed residence.

TANF and Medical Programs

Individuals who live in Texas (other than for migrant or itinerant work) meet the residency requirement if they are living in Texas intending to remain in Texas. People who live in Texas for a temporary purpose do not meet the residency requirement.

The person's residence becomes questionable when the post office returns Texas Health and Human Services Commission (HHSC) correspondence or benefits as undeliverable.

Migrant and itinerant workers meet the residency requirement when applying if they:

• live in the state;
• entered the state with a job commitment or an intention to seek employment (regardless of current employment status); and
• do not receive assistance from another state.

SNAP

People who live in Texas for any purpose other than a vacation meet the residency requirement, regardless of the length of time they have been here or plan to stay.

Related Policy

Form TF0001 Required (Adequate Notice), A-2344.1

Revision 24-2; Effective April 1, 2024

All Programs

A person cannot participate in more than one state in any month.

Use these resources to contact agencies in other states to verify if a new Texas resident's benefits have ended in another state:

• Medicaid and CHIP program contact information;
• The National Directory of SNAP Agencies on The LOOP; or
• TANF program contact information.

Medical Programs

New Texas residents may receive overlapping Medicaid coverage.

SNAP

Residents in an approved shelter for battered persons may participate twice in the month of application if they participated first with the person who abused or threatened them with abuse.

Related Policy 

Medicaid Coverage for New State Residents, A-822
 

Revision 15-4; Effective October 1, 2015

All Programs

Individuals keep their residence status when they move within Texas.

TANF and SNAP

A person cannot participate as a member of more than one household in any month.

SNAP

Residents in an approved shelter for battered persons may participate twice during the month of application if they participated first with the person who abused them or threatened them with abuse.

Related Policy

Household Composition, A-200

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

A certified individual becomes ineligible if the individual moves to another state:

• with the intent to remain there, or
• without declaring intent to return.

If the individual returns to Texas within 90 days and states that the move was not intended to be permanent, the advisor must:

• reopen the Eligibility Determination Group (EDG) using the reason denied-in-error; and
• issue restored benefits, if appropriate.

SNAP

A household is not eligible for benefits issued for a month after the household leaves Texas.

When a household member notifies HHSC that the household moved out of Texas, Form TF0001, Notice of Case Action, is not required. If the household has not yet moved, the advisor must issue Form TF0001 to provide adequate notice. The EDG is denied effective the end of the month they move, if possible.

Related Policy

Canceling Benefits, B-330

Revision 15-4; Effective October 1, 2015

TANF and Medical Programs

Individuals do not lose their residence status when they temporarily leave Texas.

An individual can be absent from Texas for any length of time. Advisors must review the situation every three months to determine the individual's intent to maintain Texas residence. The individual must reasonably explain:

• the purpose for leaving Texas,
• the intent to return to Texas, and
• which state the individual claims residency in.

An individual is a resident of Texas unless there is substantial, factual evidence that proves otherwise. When the advisor determines that the individual is no longer a resident, the individual is denied.

SNAP

A person is not eligible for SNAP in Texas for any month the individual is out of Texas the entire month.

Revision 24-4; Effective Oct.1, 2024

All Programs except TP 33, TP 34, TP 35, TP 43, TP 44, TP 45, TP 48 and TP 56

Verify the actual physical address of a household at each application and redetermination.

Verify the last month any benefits were issued when an applicant recently moved to Texas from another state.

When staff cannot verify residence with readily available evidence, they must:

• contact the landlord, neighbors, or other sources of reliable information; or
• observe personal effects and living arrangements.

Note: If any household residence is questionable, staff may require the household provide a more reliable source of verification, such as one of the primary verification sources. Do not restrict the additional verification requested to a specific source from that list.

TANF and Medical Programs

Determine if the household plans to remain in Texas at each application and redetermination.

TP 40

Postpone verifying residence if trying to meet expedited service time frames.

TP 33, TP 34, TP 35, TP 43, TP 44, TP 45, TP 48 and TP 56

Verify residency using the household’s statement, unless questionable.

Related Policy

Prudent Person Principle, A-137
Expedited Service, A-140
Special Treatment for Households Meeting Categorical Eligibility Criteria, B-472
Questionable Information, C-920

A-761 Verification Sources

Revision 22-2; Effective April 1, 2022

All Programs except Children’s Medicaid

The following are acceptable sources to verify the household's current address:

• utility bills or utility company records;
• rent receipt or statement from non-relative landlord;
• mortgage receipt or statement from mortgage company;
• valid Texas driver license or Department of Public Safety (DPS) identification card;
• Data Broker residence reported on the DPS data field;
• Department of Motor Vehicles record;
• school records;
• voter registration card;
• statement from child care provider;
• employment records or statement from employer;
• official records confirming ownership of property;
• home visit;
• SOLQ for Social Security benefit recipients, including those receiving Medicare;
• item of mail with household name and address;
• other HHSC correspondence the applicant can provide showing the household received it at the applicant's current Texas address;
• inquiry into Office of the Attorney General (OAG), Texas Workforce Commission (TWC) or another entity’s automated system, outside of HHSC, showing the same Texas address currently reported by the household;
• a local landline number the applicant provides (not a cell phone number) that is either listed in the phone book or an online directory with the same Texas address the household currently reports, or the household can be contacted at that local phone number when conducting a phone interview;
• searches resulting in a match between the address and the phone number provided by the applicant using the Data Broker Search Options Menu, Telephone Number Search;
• post office records;
• city or crisscross directory;
• church records; or
• statement from non-relative.

Exception: Self-declaration of residence is acceptable when certifying a child for TP 56, MA - Medically Needy with Spend Down.

TANF and Medical Programs

The applicant's statement of intent to remain in Texas is acceptable.

Children's Medicaid

Self-declaration.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

Revision 24-4; Effective Oct. 1, 2024

All Programs

Document:

• the household’s proof of address; and
• all efforts to verify residence if unusual circumstances make residency verification difficult.

TANF and Medical Programs

For temporary visits outside of Texas, document the household member’s:

• purpose for leaving the state;
• intent to return to Texas; and
• state they consider their residence.

Related Policy

Prudent Person Principle, A-137
Documentation, C-940
The Texas Works Documentation Guide

Revision 16-4; Effective October 1, 2016

Medical Programs

Applicants may receive Medicaid during the three-month period before the month they apply for Medicaid. See A-831, Three Months Prior Coverage, for eligibility criteria and application procedures.

Some former individuals on TP 08, TP 43, TP 44, and TP 48 remain eligible for Transitional Medicaid after their eligibility is denied. See the chart that follows for more information.

Most adopted children receive Medicaid through the Texas Department of Family and Protective Services (DFPS). DFPS works with the Interstate Compact on Adoption and Medical Assistance (ICAMA) to facilitate the timely delivery of Medicaid coverage when a family moves or the adoption involves an interstate placement. If an adopted child is receiving Medicaid in another state, the parent must contact the originating state to coordinate and transfer Medicaid coverage information to Texas. If an adoptive parent has any questions about the adoptive child's Medicaid, advisors should inform them to contact their local DFPS office for assistance.

Medical Programs, Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB)

Individuals receiving some Texas Works Medicaid types of assistance may also qualify for the Medicaid for the Elderly and People with Disabilities (MEPD) Medicare Savings Program types of assistance, MC – QMB (TP 24) or MC – SLMB (TP 23), if they meet the eligibility criteria. See policy in the Medicaid for the Elderly and People with Disabilities Handbook, Q-2000, Qualified Medicare Beneficiaries (QMB) — MC-QMB.

Individuals may receive QMB and the following types of assistance:

• MA – Earnings Transitional (TP 07)
• MA – Parents and Caretaker Relatives (TP 08)
• MA – Pregnant Women (TP 40)
• MA – Children Under 1 (TP 43)
• MA – Newborn Children (TP 45)
• MA – Children 1-5 (TP 48)
• MA – Children 6-18 (TP 44)
• MA – Former Foster Care Children (FFCC) (TA 82)

The above programs cannot be dually eligible for SLMB. Even though these programs may meet SLMB eligibility requirements, the Medicare Part B premium is already paid. An individual can be dually eligible for MA – MN with Spend Down (TP 56) and SLMB.

Revision 26-1; Effective Jan. 1, 2026

Medical Programs

Regular Medicaid eligibility begins the day  an applicant meets all eligibility criteria. The medical effective date (MED) cannot precede:

• a newborn's date of birth (DOB);
• the date a child enters the home;
• the start date of the emergency condition for a person eligible for Emergency Medicaid;
• the date a disqualified parent or caretaker relative complies; and
• the month at least one eligible dependent child is certified for Medicaid.

Note: Assign the DOB as the MED for a child born to a woman incarcerated in the Texas Department of Corrections at Gatesville when contacted by HHSC staff housed at the University of Texas Medical Branch (UTMB) Hospital. Document this contact in Case Comments.

For parent or caretaker relative’s Medicaid, the MED cannot precede:

• the newborn’s date of birth when the newborn is the only eligible child; or
• the date a child enters the home when the newborn or entering child is the only eligible child.

The eligibility determination system assigns an earlier MED if the parent or caretaker relative has unpaid medical bills and would have been eligible for Medicaid as a pregnant woman from the first day of her newborn’s birth month.

If the only child of a parent or caretaker relative eligible for TP 08 dies before certification, process an application for Medicaid for a deceased person. Certify coverage for the child through the date of death and for the parent or caretaker relative through the remainder of that month.

TP 40

Medicaid for a pregnant woman the first day of the month her pregnancy starts, not before. The verbal or written statement from the applicant, pregnant woman, head of household or authorized representative (AR) is an acceptable source of verification for the start month, the number of expected children, and the anticipated delivery date.

If the applicant’s verbal or written statement is not available, use one of the acceptable verification sources to get the pregnancy start date and anticipated delivery date.

If information is requested but not returned by the 15th business day from the file date, deny the application. Reopen the application if the person provides verification by the 60th day from the file date.

Exception: Do not request verification of pregnancy if the:

• application is processed after the pregnancy terminates; and
• applicant provides proof of the newborn child's birth.

A pregnant woman remains continuously eligible through the 12th month following the month her pregnancy ends if all other eligibility requirements are met and countable income is below the income limits in:

• the application month; or
• one of the three months before the application month if in the prior month she:
  • had unpaid Medicaid-reimbursable bills; or
  • received services from the Texas Department of State Health Services (DSHS).

Example: A pregnant woman applies for Medicaid in June 2024. Her expected delivery date is December 2024. She has unpaid medical bills in March 2024 and meets all other eligibility requirements. She does not have any unpaid medical bills in April or May 2024. Certify her for Medicaid from March 2024 through December 2025.

After determining a pregnant woman is eligible for TP 40, the woman remains continuously eligible regardless of any changes unless she:

• voluntarily withdraws;
• moves out of state;
• is ineligible due to agency error or fraud, abuse or perjury attributed to the person; or
• dies.

Note: If a woman certified for Healthy Texas Women (HTW) reports her pregnancy, the HTW and Medicaid for Pregnant Women (TP 40) coverage may overlap because HTW does not provide prenatal or pregnancy benefits. In this situation, HTW is denied prospectively, and the woman is enrolled in TP 40 beginning the first day of the month she meets all eligibility criteria.

If a woman who was certified for expedited benefits provides postponed verification that prove she does not meet eligibility requirements, provide advance notice of adverse action and deny her coverage.

TP 45

Before providing initial TP 45 coverage for a newborn child, verify that the:

• mother was:
  • eligible for and received Medicaid in Texas on the day the child was born;
  • retroactively eligible for Medicaid for the day the child was born;
  • continuously eligible for Medicaid or would have been eligible if pregnant, during the child's birth month; and
• child lives in Texas.

Note: A newborn child born to a mother who received Emergency Medicaid coverage at the child's birth is eligible to receive TP 45 coverage from the date of birth through the end of the month of the child's first birthday.

The MED for the initial certification is always the child's date of birth.

Before resuming coverage for a newborn who was denied TP 45, verify that the child lives in Texas.

TP 56

Medicaid coverage for children or pregnant women with spend down begins the first day the household meets the spend down amount.

• Pregnant women who meet the spend down amount receive TP 56 coverage through their pregnancy; and
• 12-month postpartum period without being required to meet the spend down amount again.

Note: A woman certified for HTW may have overlapping coverage with TP 56 if she has unpaid medical bills related to her pregnancy because HTW does not provide full coverage benefits.

The applicant meets spend down by submitting or having a provider submit eligible medical bills to the Clearinghouse.

The Clearinghouse:

• determines when the person meets spend down; and
• notifies HHSC by an interface. The eligibility determination system sets the MED for the certified members.

Note: The Clearinghouse may discover a discrepancy while processing a spend down EDG. Processing is put on hold and the EDG is referred to Data Integrity (DI) to research. DI sends a memo to staff asking for information to clear the discrepancy. Respond timely to these requests so that the Clearinghouse can complete the spend down process.

Emergency Medicaid (TA 31, TP 32, TP 33, TP 34, TP 35, TP 36)

Medicaid eligibility begins on the start date of the emergency medical condition verified by the attending practitioner on Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification.

A pregnant woman certified for Emergency Medicaid will receive Emergency Medicaid coverage through the 12-month postpartum period.

A child under 19 certified for Emergency Medicaid receives Emergency Medicaid coverage for a continuous 12-month certification period.

Only services needed to stabilize the patient’s condition during an emergency or life-threatening situation are covered. Services provided after the emergency condition becomes stable are not covered.

TP 36

TP 36 recipients do not have to submit another Form H3038 or Form H3038-P during the 12-month postpartum period for any subsequent emergency events. Do not process the TP 36 certification as an open and close segment. The eligibility determination system automatically provides the 12-month certification and postpartum period.

If the TP 36 recipient submits a change or new application reporting a new pregnancy during the 12-month postpartum period, certify the recipient for CHIP-P, if eligible, and maintain the current TP 36 12-month postpartum period. The eligibility determination system also creates a new EDG for the new postpartum period.

Note: Households with income at or below 198% of the Federal Poverty Limit (FPL) can receive concurrent CHIP-P and TP 36 coverage. CHIP-P coverage ends on the last day of the pregnancy termination month, while TP 36 coverage continues through the end of the 12-month postpartum period.

Related Policy

Provider Referral Process, A-125
Pregnancy, A-144.5
Medicaid Termination, A-825
Verification Requirements, A-870
How to Determine Spend Down, A-1359
Spend Down EDGs, A-1532.1
Reuse of an Application Form After Denial, B-111
Medicaid Reinstatement, B-530
Current Medicaid, Medicare (Part A or B) and Children's Health Insurance Program (CHIP) recipients, W-911
Pregnant Women, W-912

A-821 Types of Coverage

Revision 15-4; Effective October 1, 2015

Medical Programs

The type of coverage determines how recipients access Medicaid services. There are two types of coverage: fee-for-service and managed care.

A-821.1 Fee-for-Service

Revision 15-4; Effective October 1, 2015

Medical Programs

Fee-for-service, also known as Traditional Medicaid, allows access to any Medicaid provider and self-referral to specialists. The provider submits claims directly to the claims administrator for reimbursement of Medicaid-covered services.

A-821.2 Managed Care

Revision 21-1; Effective January 1, 2021

Medical Programs except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, and TP 56

Medicaid managed care is health care provided through a network of doctors, hospitals or other health care providers who contract with a managed care organizations (MCO). The state pays the MCO a capitated rate for each member enrolled, rather than paying for each unit of service. The providers submit claims directly to the MCO for reimbursement of Medicaid-covered services.

Medicaid managed care programs include:

• STAR (State of Texas Access Reform). STAR provides acute care services (like doctor visits, hospital visits and prescriptions), and each member is enrolled in an MCO and assigned a main doctor to coordinate care. People who are dually eligible for Medicare and Medicaid are excluded from this program.
• STAR Health. STAR Health provides comprehensive, coordinated health care services for children in foster care and kinship care. Each member is enrolled with a single MCO, Superior HealthPlan, and is assigned a main doctor to coordinate care. People who are dually eligible are excluded from this program.
• STAR+PLUS. STAR+PLUS provides acute care and long-term services and supports (LTSS). A key feature of this program is service coordination, or specialized care management. Each member is enrolled with an MCO, and Medicaid-only members are assigned a main doctor. STAR+PLUS serves Medicaid-only and dually eligible people, including most nursing facility residents. It is a statewide program.
• STAR Kids. STAR Kids provides acute care services and LTSS. Additionally, people eligible for Medically Dependent Children’s Program (MDCP) waiver services receive these services through STAR Kids. A key feature of this program is service coordination. Each member is enrolled with an MCO and assigned a main doctor to coordinate care. STAR Kids serves children and young adults age 20 or younger with disabilities.
• Children's Medicaid Dental Services. Children's Medicaid Dental Services provide primary and preventive dental services through managed care. Each member is enrolled in a dental maintenance organization (DMO) and has a main dental home. Most children, birth through age 20, who receive Medicaid, are eligible for dental services.

Medicaid managed care is available statewide. Information concerning the medical and dental managed care plans with contact information for each plan is located at Managed Care Organization and Dental Maintenance Organization Provider Services Contact Information.

Texas Works Medicaid recipients must enroll in managed care. Exceptions (not comprehensive):

• STAR exceptions:
  • people who are dually eligible for Medicaid and Medicare;
  • children enrolled in the DSHS Children with Special Health Care Needs (CSHCN) Program;
  • children and adults residing in institutions (nursing facilities, Intermediate Care Facilities, and State Supported Living Centers);
  • medically-needy program participants;
  • children in foster care or kinship care;
  • adults that receive SSI; and
  • children and adults that are in a 1915(c) waiver program.
• STAR Health exceptions:
  • youth adjudicated in Texas Juvenile Justice Department (TJJD) facilities;
  • youth from other states placed in Texas, or Texas youth placed in other states; and
  • youth residing in Medicaid-paid facilities.
• STAR+PLUS exceptions:
  • a person 20 or younger who is not in the Medicaid for Breast and Cervical Cancer (MBCC) program;
  • people over the age of 21 in Former Foster Care in Higher Education (FFCHE); and
  • people over 21 who are in a 1915(c) waiver program or who reside in community home for people with Intellectual Developmental Disabilities and are dually eligible for Medicare and Medicaid.
• STAR Kids: A person over the age of 21 and a person 20 or younger without disabilities.
• Children's Medicaid Dental Services exceptions:
  • people 20 or younger who reside in an institution;
  • people in STAR Health;
  • youth placed in other states; and
  • adults 21 and older.

MAXIMUS:

• Contracts with the state to enroll recipients into Medicaid managed care.
• Mails enrollment packets that include information about the plan choices available in their county of residence to newly certified recipients.

If a recipient does not choose a plan or a main doctor by the deadline provided in the enrollment packet, MAXIMUS assigns a plan and a main doctor. They then mail the information to the recipient.

Members of federally recognized Indian tribes are exempt from mandatory enrollment in Medicaid managed care but may choose to participate voluntarily.

At all Medicaid applications and redeterminations, identify and determine if the person qualifies for this exemption. If this information is not available, do not designate the person as exempt. Do not pend the application or delay the eligibility determination for this information.

TIERS refers newly certified recipients to MAXIMUS to initiate their enrollment into managed care. MAXIMUS staff is available in some local eligibility determination offices. A recipient can call the MAXIMUS Helpline at 800-964-2777 to initiate enrollment, to request a plan change, or to disenroll from managed care if they are exempt from mandatory enrollment in Medicaid managed care.

If a recipient has difficulty accessing medical services in a managed care plan, refer the person to the Medicaid Managed Care Helpline at 866-566-8989. The Medicaid Managed Care Helpline advocates for managed care recipients who are having trouble accessing the medical and dental care they need.

Related Policy

Office of the Ombudsman, B-1420
Managed Care Plans, C-1116

A-822 Medicaid Coverage for New State Residents

Revision 15-4; Effective October 1, 2015

Medical Programs

Advisors must determine the correct MED for applicants who:

• move to Texas from another state during the application month or the three months prior to the application month, and
• are Medicaid recipients in the losing state in the month they move.

Note: If the applicant is unable to provide a contact person in the losing state, the advisor must contact the appropriate state Medicaid director's office. See C-1111, State Medicaid Agencies, for telephone numbers.

When a Texas Medicaid recipient moves to another state, staff from the gaining state may contact the local office about effective dates of denial and coverage of bills incurred in the gaining state. Texas Medicaid pays for Medicaid-reimbursable services provided out-of-state if the:

• recipient needs services because of a medical emergency documented by the attending physician or other provider;
• recipient's health could be jeopardized by not obtaining services; and
• provider enrolls in the Texas Medicaid Program. Out-of-state providers can obtain enrollment information by calling the claims administrator at 1-800-925-9126.

A-823 Lock-In Status

Revision 26-3; Effective July 1, 2026

Medical Programs

HHSC identifies fee-for-service and managed care people who:

• received duplicative, excessive, contraindicated or conflicting health services, including drugs; or
• abused, misused or committed fraudulent actions related to Medicaid benefits and services.

These people may choose one pharmacy and one main doctor to be their designated provider for Medicaid services.

The duration periods of lock-in status are:

• The initial period is 36 months.
• The second period is 60 more months.
• The third period is for the extent of eligibility and all later periods of eligibility.
• The period of lock-in status for people arrested, indicted, convicted or admitting to a crime about Medicaid fraud differs from the first, second and third lock-in periods. These people are assigned lock-in status for:
  • 60 months; or
  • the length of eligibility and later periods of eligibility up to or equal to 60 months.

HHSC issues a Your Texas Benefits Medicaid card printed with the name of the Lock-in Doctor, Lock-in Drug Store or both on the front of the card for people with enrollment lock-in status. If a person with lock-in status prints a Medicaid card from the YourTexasBenefits.com, the same information is displayed.

Staff must verify current lock-in status when issuing Form H1027-A, Medicaid Eligibility Verification. To verify a person’s lock-in status, staff may access the person’s Lock-In Enrollment page from the Individual – Summary page’s hover menu. If a person is in lock-in status, the Lock-In Enrollment page displays the provider name and begin date of the status.

People are removed from lock-in status at the end of the specified period if their use of medical services no longer meets the criteria for lock-in status.

Refer people with questions about their lock-in status to the:

• HHS Office of Inspector General (OIG) using the HHS Lock-In Program mailbox for people receiving fee-for-service.
• Managed care organization for people who receive managed care.

A-824 Issuance of Form H1027-A, Medicaid Eligibility Verification

Revision 15-4; Effective October 1, 2015

Medical Programs

Advisors must issue Form H1027-A, Medicaid Eligibility Verification, to an eligible Medicaid individual only if the individual:

• needs his eligibility verified to receive medical services;
• does not have access to a Your Texas Benefits Medicaid card; and
• is unable to reprint the Medicaid card from YourTexasBenefits.com.

The individual may not have a Your Texas Benefits Medicaid card if the individual:

• is newly certified and has not received it,
• lost or accidentally destroyed the card, or
• is temporarily separated from other eligible family members who have their card.

Before issuing Form H1027-A, staff must verify the individual's current eligibility, enrollment lock-in status and managed care enrollment by accessing the Individual – Summary and Individual – Medicaid History pages. If inquiry is unavailable, advisors must follow regional procedures.

Medicaid with No Enrollment Lock-in or Managed Care Coverage

Issue Form H1027-A for current eligibility if the most recent medical coverage period on the Individual – Summary and Individual – Medicaid History pages:

• is open (no close date shown), and
• reflects regular Medicaid coverage.

Enrollment Lock-in

If an individual is in enrollment lock-in status, "Yes" will display after Lock-In on the Individual – Summary page. Advisors select Lock-In Enrollment from the hover menu over the individual's client number. The Individual – Lock-In Enrollment page provides information regarding the provider(s) to which the individual is currently or was once locked in.

If an individual is currently in lock-in, advisors issue a separate Form H1027-A for the individual and print LIMITED and the name(s) of the provider(s) to which the individual is locked in. Form H1027-A generated in TIERS is printed with "LIMITED" in the "Type of Coverage" field.

Managed Care Coverage

If an individual is in a managed care service area, "Yes" will display after Managed Care on the Individual – Summary page. Select Managed Care from the hover menu over the individual's client number. Advisors select the Individual – Managed Care page to view the individual's plan to which the individual is enrolled.

Advisors must issue Form H1027-A for everyone on the case in the same managed care plan by printing the appropriate managed care program name (e.g., STAR, STAR Health, STAR+PLUS) and the name and telephone number of the plan. This information is in C-1116, Managed Care Plans.

After staff verify eligibility, enrollment lock-in status and managed care enrollment, advisors complete, sign and date Form H1027-A. The unit supervisor or other second party must approve the form indicating he verified eligibility and lock-in status.

Form H1027-A is not used if the most recent medical period:

• is closed, or
• shows institutional coverage.

Form H1027-A instructions include detailed information for completing the form.

TA 74, TA 75, TA 76, TA 83, TA 86 and TP 42

The advisor must issue Form H1027-A if the person has a completed Form H1266, Short-term Medicaid Notice - Approved, showing the date the person is approved for coverage.

Form H1027-A instructions include detailed information for completing the form.