C-1111 State Medicaid Agencies

Revision 13-3; Effective July 1, 2013

Medical Programs

For links to all State Medicaid Agencies, go to https://www.medicaid.gov/medicaid/by-state/by-state.html.

C-1112 Services Under the Texas Medical Assistance Program

Revision 19-3; Effective July 1, 2019

Medical Programs

Benefits provided through health insuring agent:

• In-patient hospital services*
• Out-patient hospital services*
• Laboratory and x-ray services
• Physician's services
• Podiatrist's services
• Optometric services*
• Ambulance services*
• Family planning services*
• Home health services limited to nurse and home health aide visits*
• Medicare Part A deductible and coinsurance when benefits would otherwise be payable under Medical Assistance and Medicare Part B deductible and coinsurance for assigned claims only
• Chiropractic treatment — limited to Medicare Part B deductible and coinsurance for assigned claims only
• Eyeglasses*
• Rural health clinics*

Services provided through contract or by direct vendor payments from the Health and Human Services Commission (HHSC):

• Nursing care skilled and intermediate care. Skilled care is limited to recipients age 21 and over. Medicare SNF coinsurance.*
• Active treatment for recipients or patients of any age in licensed and approved section of institutions for persons with intellectual disabilities.*
• In-patient hospital care for recipients or patients age 65 and older in contracted mental hospitals and state (tuberculosis) hospitals.*
• Texas Health Steps screening program and limited dental treatment for eligible persons under age 21.
• Prescriptions limited to no more than three covered per month if over 18. Unlimited if 18 and under.
• Prior authorized hearing aid services.*
• Primary home care for recipients age 18 and over.*
• Other medical transportation.

*With limitations — see appropriate provider manuals for details.

The benefits of this program do not extend to:

• Inmates in a public institution. (Recipients in approved medical units in certain contracted institutions are eligible for vendor payments made by HHSC.)
• Special shoes or other supportive devices for the feet or walking aids.
• Services in military medical facilities, Veteran's Administration (VA) facilities, or United States Public Health Service Hospitals.
• Care and treatment related to any condition for which benefits are provided or are available under Workman's Compensation laws.
• Dental care and services except certain oral surgery or that provided under Texas Health Steps.
• Any services or supplies provided in connection with a routine physical examination except family planning services.
• Any care or services payable under Title XVIII (Medicare).
• Any service provided by an immediate relative of the recipient or member of the recipient's household.
• Any services or supplies not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of the malformed body member.
• Custodial care.
• Any services provided to the recipient after a utilization review or medical review finding that such services are not medically necessary.
• Any services or supplies that are payable through a third party.
• Any service or supplies not specifically provided by the Texas Medical Assistance Program.

Disclaimer: This list is for convenient reference and does not have the effect of law, regulation or policy. If there is a conflict between this list and law, regulations, and policy, the latter will prevail. If there is a question, use the appropriate provider manuals or filed releases for clarification.

C-1113 Qualified Hospital/Qualified Entity Policy and Procedures for Presumptive Eligibility Determinations

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, Medicaid for Breast and Cervical Cancer (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 can make MBCC PE determinations, following the process outlined in X-100, Application Processing.

C-1113.1 Eligible Groups

Revision 15-3; Effective July 1, 2015

The following groups can receive presumptive eligibility coverage:

• Children:
  1. MA-Children Under 1 Presumptive — TA 74
  2. MA-Children 1–5 Presumptive — TA 75
  3. 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)

C-1113.2 Household Composition

Revision 15-3; Effective July 1, 2015

The QH/QE uses the non-taxpayer/non-tax dependent rules to determine the household composition.

C-1113.3 Modified Adjusted Gross Income (MAGI) Methodology

Revision 15-4; Effective October 1, 2015

The QH/QE uses a simplified MAGI methodology to determine if an individual meets the income requirements for PE. The income limits for each PE type of assistance are the same as the income limits for the associated regular Medicaid type of assistance. For example, MA-Children Under 1 Presumptive has the same income limit as MA-Children Under 1.

C-1113.4 Verifications

Revision 15-3; Effective July 1, 2015

The individual must attest to being:

• a Texas resident, and
• a United States citizen or an eligible immigrant.

For all other PE criteria, the individual's statement is acceptable verification. Additional forms of verification beyond an individual's statement are not required.

C-1113.5 Medical Effective Dates

Revision 15-4; Effective October 1, 2015

The medical effective date (MED) is the date the QH or QE determines the individual is presumptively eligible for Medicaid. If the individual is presumptively eligible, QH/QE staff give the individual Form H1266, Short-term Medicaid Notice: Approved. It informs the individual when the PE coverage begins and when the PE coverage ends, based on whether the individual applies for regular Medicaid.

Note: An individual is not eligible for PE if they are currently receiving Medicaid, Children's Health Insurance Program (CHIP) or CHIP perinatal.

If the individual does not apply for regular Medicaid, the 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 staff determine whether the individual is eligible for regular Medicaid. If the individual 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 individual is eligible for regular Medicaid, the individual'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 begins 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:

PE Scenarios

C-1113.6 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 MA-Children 6–18 Presumptive in June 2015. He cannot receive another period of PE until January 2017.

C-1113.7 Three Months Prior Coverage

Revision 15-3; Effective July 1, 2015

Three months prior coverage does not apply to presumptive eligibility. Eligibility for three months prior Medicaid coverage is determined when HHSC eligibility staff make a regular Medicaid determination, if requested.

C-1113.8 Application Processing

Revision 15-4; Effective October 1, 2015

QH/QE staff first must perform a PE portal inquiry to find out if an individual is currently receiving Medicaid, CHIP or CHIP perinatal or if the applicant has received a period of PE within the PE period limit.

QH/QE staff make the PE determination based on information the individual provides about citizenship/immigration status, Texas residency, income and household composition. To determine whether the individual is presumptively eligible, QH/QE staff fill out Form H1265, Presumptive Eligibility (PE) Worksheet, using the information the individual provides.

If the individual is presumptively eligible, QH/QE staff do the following:

• Enter the individual's demographic information and the PE type of assistance for which the individual is eligible into the PE portal. QH/QE staff use the PE portal to conduct limited inquiries and submit PE determinations.
• Give the individual Form H1266, Short-term Medicaid Notice: Approved. QH/QE staff also help the individual complete and submit the regular Medicaid application via YourTexasBenefits.com if the individual wants to apply. Note: An individual is not required to submit a regular Medicaid application to receive PE Medicaid.

If the individual is not eligible for PE, QH/QE staff issue Form H1267, Short-term Medicaid Notice: Not Approved, to the individual and tell the individual about the right to apply for regular Medicaid.

C-1113.9 Due Dates and Processing Time Frames

Revision 15-3; Effective July 1, 2015

Within one business day of the PE determination, the QH/QE must submit the PE determination to HHSC through the PE portal.

C-1113.10 How to Become a Qualified Hospital or Qualified Entity

Revision 15-3; Effective July 1, 2015

Hospitals or entities that want to become qualified to make PE determinations must (1) submit to HHSC a notice of intent, (2) sign a Memorandum of Understanding, and (3) complete online training at the PE website at www.TexasPresumptiveEligibility.com.

C-1113.11 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 date and end date, which is based on whether the individual submits an application for regular Medicaid. If an individual needs proof of Medicaid coverage before receiving their Medicaid identification card, the individual can present this form in an HHSC local eligibility determination office, and HHSC staff will provide the individual with Form H1027-A, Medicaid Eligibility Determination.
• 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

Processing Presumptive Eligibility Applications, A-124

C-1114 Guidelines for Providing Retroactive Coverage for Medical Programs

Revision 26-2; Effective April 1, 2026

Medical Programs

Use the applicable income, standard MAGI income disregard and IRS monthly income thresholds charts when determining retroactive eligibility for children and pregnant women.

Federal Poverty Level (FPL)

March 2024 through February 2025

Five Percentage Points of FPL

IRS Monthly Income Thresholds

Federal Poverty Level (FPL)

March 2025 through February 2026

Five Percentage Points of FPL

IRS Monthly Income Thresholds

C-1115 Immunization Terms

Revision 13-3; Effective July 1, 2013

TANF and Medical Programs

Immunization by inoculation or vaccination protects against childhood diseases. Except for tetanus, these diseases are contagious. Encourage individuals to follow the Texas Department of Health's recommended schedule found on Form H1012, Immunization Record. If a child is on an alternate schedule refer to A-2125, Immunizations.

The following are descriptions of the diseases and symptoms associated with immunizations.

• Diphtheria — An acute, bacterial illness that causes a sore throat and a fever and sometimes causes more serious or even fatal complications.
• Haemophilus Influenza Type b (HIB) — A bacterium that can cause meningitis and pneumonia and infect other body systems such as blood, joints, bones and soft tissue under the skin, throat, and the covering of the heart.
• Hepatitis A — An infection of the liver caused by the Hepatitis A virus.
• Hepatitis B — An infection of the liver caused by the Hepatitis B virus.
• Measles — An acute, highly contagious viral disease involving the respiratory tract that causes a characteristic rash, fever, runny nose, sore eyes, and cough.
• Mumps — An acute viral disease mainly of childhood. It is characterized by a swelling of the parotid (salivary) glands on one or both sides and may cause fever, headache, and difficulty swallowing may develop.
• Pertussis (Whooping Cough) — An acute highly contagious respiratory disease characterized by a severe attack of coughing that ends in a characteristic "whoop" as breath is drawn in.
• Poliomyelitis (Polio – once known as "infantile paralysis") — An infectious disease that may lead to extensive paralysis of the muscles.
• Rubella (German Measles) — A viral infection characterized by a mild fever, swollen glands in the neck and a rash that lasts up to three days.
• Tetanus (Lockjaw) — A very serious disease of the central nervous system caused by an infection of a wound that makes an individual unable to open his/her mouth or swallow and causes muscle spasms in the jaw, neck, leg or other muscles.
• Varicella (Chickenpox) — A highly contagious viral infection which presents as a generalized, itchy, vesicular rash. The rash begins as smooth, red spots which develop into blisters that last three to four days before forming crusty scabs.

C-1116 Managed Care Plans

Revision 19-1; Effective January 1, 2019

Information concerning the medical and dental managed care plans with contact information for each plan is located at https://www.hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip/medicaid-medical-dental-policies.

Related Policy

Managed Care, A-821.2 
Releasable Information for Medicaid Providers and Their Contractors, B-1230 
Office of the Ombudsman,B-1420

C-1118 Health Care Orientation Quick Reference Guide

Revision 24-4; Effective Oct. 1, 2024

TP 43, TP 44, and TP 48

Steps to Verification

Use the following items to verify the person's identity. Review the Expanded Health Care Orientation and Enrollment Script below for verification instructions.

• Address
• Date of birth
• Medicaid ID number or SSN
• Name
• Phone number
• Primary language spoken in the home
• Third-Party resources, such as private insurance

Essential Steps to Education - Quick Reference Guide:

• Introduce yourself by providing your name and position.
• Explain Medicaid program knowledge, including not to pay bills and what Medicaid covers.
• Explain the Your Texas Benefits Medicaid ID card.
• Explain how to maintain eligibility, including reading mail, returning information and receiving checkups.
• Explain the Texas Health Steps program knowledge, including checkup schedules, for children through 20 years. Refer to the Texas Health Steps Desk Reference below for the information that should be covered.
• Explain medical and dental providers can be located by calling your health or dental plan or for immediate help finding a doctor or dentist, call 877-847-8377.
• Explain how to schedule an appointment and how to offer to get help with scheduling, call the toll-free number at 877-847-8377 and get information on keeping and canceling appointments.
• Explain managed care, including how to enroll and select a primary care provider (PCP).
• Explain about PCPs, referrals, specialists and emergency rooms.
• Explain STAR enrollment will be effective in 15 to 45 days and traditional Medicaid is in effect until STAR enrollment.
• Explain they will receive an ID card from the health plan.
• Explain how to make managed care changes, including how to change plans or a primary care provider and how often it is allowed. Provide the contact information necessary to call to make changes.
• Explain case management for children and pregnant women for health risk or health condition and trouble finding services.
• Explain medical transportation is an available benefit and provide the contact information. If needed, the person should call for transportation help.
• Explain CHIP for any uninsured children in the household.
• Explain the Women, Infant, and Children's Program (WIC) is for pregnant women or children in the family who are under 5.
• Ask if the person has any questions or if they would like you to repeat any information, especially any of the contact information given.
• Inform the person they have completed the Health Care Orientation.

Expanded Health Care Orientation Script

Introduction

Standard greeting to include your name, program and purpose for calling. For example: Hello, may I speak with [case name]: Hello, Mr. or Mrs._______________________. My name is _________________ with Texas Health and Human Services. Since your child or children are new to Medicaid, a state law requires that you receive what is known as a Health Care Orientation. This will only take a few minutes and I will give you some valuable information about how to use your child's or children's Medicaid benefits.

Steps to Caller Verification

Use the following questions to verify the caller’s identity.

• Medicaid ID number or SSN - Do you have Your Texas Benefits Medicaid ID card handy? Will you read the number that appears on the card below your child's name?
• Name - What is the name of your child?
• Address – What is your address?
• Primary Language Spoken in Home – What is the preferred language spoken in the home and document the language.
• Phone Number – What is your correct phone number?
• Date of birth – What is the full date of birth for the child?
• Third Party Resources - Private Insurance: Does your child have any private health insurance?

Medicaid Program Knowledge

Tell the family Medicaid pays for you or your child's care when they go to the doctor, if they are in the hospital, if they go to the dentist and if they go to a specialist. It will also pay for prescriptions, vaccines, transportation to any Medicaid covered service, and for behavioral health services. It also pays for Texas Health Steps preventive medical and dental checkups for children through 20. Medicaid only pays providers like doctors, dentists, specialists and hospitals. You should not receive any bills. However, if you receive a bill don't pay it. First call the provider and find out why they did not send the bill to Medicaid. Make sure your provider has the Medicaid ID number needed for billing.

Note: If the recipient is on STAR, direct them to call their health plan. If they are on fee for service, direct them to call the number on the back of the Your Texas Benefits Medicaid ID card for billing questions 800-252-8263.

Your Texas Benefits Medicaid ID Card-Process

Ask the family if they have received their new Your Texas Benefits Medicaid ID card. If not, explain the new card they will receive is good for as long as they are on Medicaid. Describe the Your Texas Benefits Medicaid ID card.

Inform the family that their STAR health plan should be listed on the Your Texas Benefits Medicaid ID card.

Remind the family to take the Your Texas Benefits Medicaid ID card to the doctor, dentist, pharmacy and every time they obtain a Medicaid service.

Explain to the family if they do not receive their Your Texas Benefits Medicaid ID card in the next couple of weeks, they should contact their local HHSC office to confirm eligibility. Once eligibility is confirmed, they can contact the Your Texas Benefits Medicaid ID card Help Desk at 855-827-3748 to check the status of the card order. Inform them they can also print a copy of their card from the YourTexasBenefits.com website while they wait on their permanent card.

Maintaining Eligibility

Tell the family to Follow up with any paperwork you receive from the Texas Health and Human Services Commission (HHSC). HHSC reviews your case from time to time, usually every 12 months. So, it is important to complete the paperwork to keep your child or children on Medicaid.

It is a requirement to receive your Health Care Orientation, which we are providing right now, and for your children to receive their Texas Health Steps preventive checkups to avoid having to go to the office for a face-to-face interview or to be required to return follow-up information at your redetermination.

Texas Health Steps Program Knowledge

If the parent or caretaker is being interviewed for an initial certification including a reapplication after a break in benefits of 60 days or more, the advisor is responsible for initial Texas Health Steps informing, even if the household does not require a Health Care Orientation.

Refer to the Texas Health Steps Desk Reference for the information that must be covered during the Health Care Orientation or when the parent or caretaker must receive just the initial Texas Health Steps informing.

Refer to the Texas Health Steps Program Desk Reference to educate parents and caretakers about when a child's Texas Health Steps medical and dental* checkups are due and issues a health care provider may address during a Texas Health Steps medical or dental checkup. The health care provider will address specific issues for each age and each child.

• Texas Health Steps Preventive Checkups: Recipients through age 20 are eligible for preventive medical and dental checkups through Texas Health Steps. Medical checkups may include a health history, physical exam and measurements, screening for vision and hearing, development and behavioral health, nutrition and dental. The dental checkup may include cleaning of teeth, fluoride treatment, sealants and follow up visits.
• Checkup Schedule: Texas Health Steps medical checkups are due periodically starting at birth, 1-2 weeks, 2, 4, 6, 9, 12, 15 and 18 months and then once a year based on date of birth. Dental checkups start at 6 months old. Following the first visit, dental checkups are needed every six months.

* Emergency dental services are available at any age and do not require a check on ID.

Texas Health Steps Desk Reference

• If the information is being provided in person, give the family a:
  • Checkups Help Children Stay Healthy! wallet card
  • Don't Miss a Beat brochure
  • Keep Your Child's Checkups in Check brochure
• Advise the family to contact the Texas Health Steps helpline if they would like a medical or dental provider list mailed to them or if they would like immediate help: 877-847-8377, available 8 a.m. - 6 p.m. Central Time, Monday - Friday. The family may also contact their health or dental plan for help locating providers once enrolled.

Steps to Education - Essential Information About Medicaid Health Plans (Managed Care)

1. Explain Managed Care and Primary Care Provider. Let me tell you a little about the STAR program. The STAR program is Texas Medicaid Managed Care. Managed care means that you will receive your Medicaid services through a health plan. You only have 30 days from the date you are certified to select a health plan and a primary care provider. The primary care provider can be a doctor, specially trained nurse, clinic or health center. If you don't choose, the STAR program will pick a health plan and primary care provider for you. The primary care provider is available 24 hours a day, 7 days a week to coordinate care for you and your child or children. Have you received an enrollment packet? This is a large white envelope with the different health plan booklets, enrollment form and instructions. Have you already enrolled? If not, I can tell you how to enroll or change your plan if the STAR program picked a plan for you.

   Note: If the person has not yet enrolled, refer them to the enrollment hotline, 800-964-2777.

2. Explain about primary care providers and emergency rooms. Your child's primary care provider is the one you contact first when your child or children need any kind of medical health care. Unless it is an emergency, you should contact your primary care provider before you take your child to the emergency room. An emergency would be a problem or condition, including severe pain that is so serious that waiting for routine care might result in serious harm. In an emergency, you may not have time to contact the primary care provider. In that case, call 9-1-1 or take your child to the nearest emergency room.
3. Explain referrals: Referrals to specialists for STAR recipients must be obtained through the primary care provider. However, families do not need a referral for the following services: family planning, eye exams and glasses, behavioral health and Texas Health Steps medical or dental checkups. The primary care provider refers your child or children to specialists or hospitals when needed.
4. Explain the recipients will receive a Your Texas Benefits Medicaid ID card. After the recipient is enrolled in the STAR program, a Your Texas Benefits Medicaid ID card will be mailed. The recipient will also receive a member ID card from the plan.
5. Explain limits on making certain changes to STAR Recipients can change their primary care provider up to four times a year. They can have unlimited changes in their health plan, however, there are time restrictions. Each health plan change can take 15 to 45 days. Call the STAR helpline to change the health plan and call the health plan directly to request a primary care provider change.

Case Management for Children and Pregnant Women

• Explain Case Management for Children and Pregnant Women is a Medicaid benefit. Case managers help families get medical services, school services, medical equipment and supplies, and other services that are medically necessary.
• Case managers can help children and young adults 20 and younger who have a health condition or health risk who are covered by Medicaid. They also can help women of any age with a high-risk pregnancy. The person or family must need help getting services or they must be having trouble finding or connecting with the services that they need related to their health condition or health risk. The family must want the case management services.
• Case managers are either licensed social workers or registered nurses and are trained to help get families the services that they have trouble finding on their own.
• The case manager will meet with the person approved for Medicaid, the person's parent or guardian. They will do a full assessment to find out all the needs a family might have related to the health condition. Then the case manager and family will make a service plan that addresses all the needs.
• Anyone can refer someone for case management services by calling the Texas Health Steps helpline toll-free at 877-847-8377, 8 a.m. - 6 p.m. Central Time, Monday - Friday.

Medical Transportation Service (MTS)

• The MTS provides non-emergency medical transportation (NEMT) services.
• Explain the MTS is available for all Medicaid-covered health care services to those with full Medicaid, not Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB), Children with Special Health Care Needs (CSHCN), and Transportation for Indigent Cancer Patients (TICP), who do not have any other means of transportation.
• Call at least two business days before the appointment in the same county or adjacent county and five business days before an appointment outside the county adjacent to your residence and be prepared to provide your:
  • name;
  • Medicaid ID number;
  • address;
  • phone number;
  • doctor's name and address;
  • doctor's phone number;
  • date; and
  • time of appointment.

Ways to Travel:

• If you don't have a car and you don't have anyone else to drive you, the MTS will help. This may be by bus tickets or by van.
• If you have a car or know someone who can drive you to the appointment, the MTS can pay you or your driver gas reimbursement by the mile.

How do I get a ride? First, set up an appointment with your doctor or provider.

To request a ride, call at least two business days before your appointment, or five business days before the appointment if it is outside your county. Phones are answered Monday - Friday, 8 a.m. - 5 p.m. local time.

You may be able to be approved for same day rides when:

• Your doctor or dentist must see you on the same day.
• You are released from a hospital, clinic, or other health care facility.
• You need a ride to a drugstore.

If you or your child have a Medicaid health plan:

• Call your health plan’s medical transportation contact number.

If you or your child do not have a health plan:

• Call 877-633-8747 (877-MED-TRIP).

Children 14 and younger may not travel without a parent or guardian. Children 15 through 17 may travel without a parent, but the parent must provide written permission before the trip is scheduled.

CHIP

• If anyone in the household is under 19 and does not have health insurance, explain they may be eligible for some type of state-funded health insurance. They may call 2-1-1 Option 2 to apply for CHIP and Children's Medicaid or go to the Your Texas Benefits website.

WIC

• Explain WIC is a supplemental nutrition and education program to provide nutritious foods to help women, infants and children improve on their nutrition. "If you are receiving Medicaid, you are income-eligible for WIC, but you will have to complete a nutritional screening to receive benefits."
• If pregnant or a postpartum woman or a child under 5 years lives in the household, give the parent the 800-942-3678 number or the WIC website so they can locate their nearest WIC office.

Summary

• Any questions about Texas Health Steps or Medicaid?
• Inform the person that they have received a Health Care Orientation.
• Verify the person's information, phone number, migrant status, and if any other children are in the household.
• If enrolled, recap enrollment information including the names of the primary care provider and main dentist, if known, and the name of the health plan.
• Provide toll free number from the Resource Directory for future help and thank the person for their time.
• If in person, provide literature and any numbers needed from the Resource Directory.

Resource Directory

Revision 15-4; Effective October 1, 2015

Unauthorized disclosure or unauthorized inspection of an applicant or client’s federal tax information by HHSC staff is punishable by law, including but not limited to:

• felony charges,
• imprisonment,
• fines,
• employment dismissal, or
• civil charges.

See United States Code (U.S.C.), Title 26, §7213; 26 U.S.C. §7213A; and 26 U.S.C. §7431 for a complete list of penalties for the unauthorized disclosure or inspection of this information.

Revision 21-3; Effective July 1, 2021

C—1141 Timely Reported

Revision 13-3; Effective July 1, 2013

TANF and SNAP

When the individual reports a change timely (i.e., individual reported within 10 days of knowing of the change), use B-600, Changes, B-752.1.2, Errors After Certification, and the following chart to determine the first month of overpayment.

Note: The first month of overpayment can be no later than two months from the month the change occurred.

C—1142 Untimely Reported

Revision 13-3; Effective July 1, 2013

TANF and SNAP

When the individual fails to report a change timely (i.e., does not report a change later discovered by HHSC or untimely reports a change), use B-600, Changes, B-752.1.2, Errors After Certification, and the following chart to determine the first month of overpayment.

Note: The first month of overpayment can be no later than two months from the month the change occurred.

Revision 22-3; Effective July 1, 2022

SNAP, TANF and Medical Programs/Assistance

SNAP

TANF

Medical Programs/Assistance — Texas Works

Medical Programs/Assistance — Medicaid for the Elderly and People with Disabilities