A-2340, Adverse Action

Body

Revision 13-2; Effective April 1, 2013

All Programs

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

Related Policy

Fair Hearings, B-1000

A-2341 Denial of an Application

Revision 25-4; Effective Oct. 1, 2025

All Programs

Staff must provide the applicant with Form TF0001, Notice of Case Action, stating the reason for the denial. Staff must follow the policy for processing time frames. Denials are effective immediately.

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

Medical Programs

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

To qualify for the federal health care coverage programs, all applicants must first be determined ineligible for Medicaid and CHIP. Staff must test if an applicant is eligible for all Medical Programs. The Texas Works Medical Programs Hierarchy does this automatically for all applicants at application.

Notes:

  • Staff  must follow a manual process when retesting eligibility for a minor parent aging out of TP 44, a pregnant woman from TP 40 at the end of the certification period, or a recipient at the end of the Transitional Medicaid certification period, as explained in retesting eligibility policy.
  • Pregnant woman whose TP 40 coverage terminates before the end of their original certification period may be eligible for automatic retesting of eligibility for all Medical Programs as explained in Medicaid termination policy.
  • When the continuous eligibility period ends, staff must retest the recipient’s eligibility for all appropriate Medicaid and transfer coverage, if eligible, without requiring a new application.

Related Policy

General Information for Denials and Terminations, A116.1
Medical Programs Hierarchy, A-132.1
Medicaid Termination, A-825
Retesting Eligibility, A-2342.1
Processing Time Frames, B-100

A-2342 Denial at Redetermination

Revision 26-2; Effective April 1, 2026

TANF

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

SNAP

Staff provide the household with Form TF0001, Notice of Case Action, stating the reason for denial.

Timely Redeterminations — If a household renews by the 15th of the last month of their certification period and is determined ineligible, staff must use redetermination policy and procedures, to deny the EDG.

Untimely Redeterminations — If a household renews after the 15th of the last month of their certification period and is determined ineligible, staff must use the application policy and procedures to deny the EDG.

Medical Programs

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

To qualify for federal health care coverage programs, all individuals must first be determined ineligible for Medicaid and CHIP. Staff must test if an applicant is eligible for all medical programs. The Texas Works Medical Programs Hierarchy does this automatically for all applicants at redetermination.

Notes:

  • Staff must follow a manual process when retesting eligibility for a minor parent aging out of TP 44, a pregnant woman on TP 40 at the end of the certification period, or a recipient at the end of the Transitional Medicaid certification period, as explained in retesting eligibility policy.
  • Pregnant women whose TP 40 coverage terminates before the end of their original certification period may be eligible for automatic retesting of eligibility for all Medical Programs as explained in Medicaid termination policy.
  • When the continuous eligibility period ends, staff must retest the recipient’s eligibility for all appropriate Medicaid and transfer coverage, if eligible without requiring a new application.

TP 08

Staff must determine if the person is eligible for TP 07, Earnings Transitional, or TP 20, Alimony/Spousal Support Transitional, in the denial effective month. Staff provide TP 07 or TP 20 instead of denying the EDG if the person is found eligible.

TP 43, TP 44 and TP 48

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

Related Policy

General Information for Denials and Terminations, A116.1
Medical Programs Hierarchy, A-132.1
Medicaid Termination, A-825
Transitional Medicaid Coverage, A-841
TP 20 Alimony/Spousal Support Transitional Medicaid Coverage, A-850
Retesting Eligibility, A-2342.1
Applications, B-110
Redeterminations, B-120

A-2342.1 Retesting Eligibility

Revision 25-4; Effective Oct. 1, 2025

TP 44, TP 40, TP 07 and TP 20

Staff must retest the following applicants’ potential eligibility for other medical programs by manually running the Texas Works Medical Program Hierarchy explained in Medical Programs Hierarchy, starting policy, Step 1 in the following hierarchy:

  • minor parents aging out of TP 44, children 6-18;
  • recipients  on TP 40, pregnant women, once their certification period ends; and
  • recipients terminated from TP 07 or TP 20, transitional Medicaid programs.

All other recipients flow through the hierarchy to either the next available program  or referred to the Marketplace if determined ineligible for all other medical programs. For example:

  • A child aging out of TP 48 is automatically tested for TP 44.
  • A non-parent child determined ineligible because of aging out of TP 44 is referred to the Marketplace.

The system does not terminate eligibility for the people listed above at the end of the certification period. Staff act to review the person’s eligibility and re-run the hierarchy to determine potential eligibility for other programs. Staff must use the first day of the last month of the current certification period as the file date. Staff should process the EDGs like a redetermination, without requiring a renewal form. Except in the case of TP 40, where there may be an application, staff process the EDG as they do redeterminations with renewal forms. Staff must verify information the way it is done in the redetermination process.

Do not re-evaluate the remaining people in the recipient’s household composition for eligibility during a continuous eligibility period. Changes to household composition such as a minor parent aging out, the end of a pregnancy, or the termination of Transitional Medicaid coverage, must be addressed once the person is no longer eligible for a program with 12-month continuous eligibility. This includes Children’s Medicaid (TP 44), Pregnant Women (TP 40), or Transitional Medicaid programs (TP 07 and TP 20). Once the continuous eligibility period ends, staff must re-evaluate the recipient’s eligibility for all appropriate Medicaid or MSP and transfer coverage, if eligible, without requiring a new application.

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

Related Policy

General Information for Denials and Terminations, A-116.1
Medical Programs Hierarchy, A-132.1

A-2343 Advance Notice

Revision 15-4; Effective October 1, 2015

All Programs

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

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

Revision 20-4; Effective October 1, 2020

All Programs

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

If the 13-day advance notice period:

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

TANF

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

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

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

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

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

Medical Programs

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

Related Policy

Reasonable Opportunity, A-351.1

A-2344 Adverse Actions Not Requiring Advance Notice

Revision 13-2; Effective April 1, 2013

A-2344.1 Form TF0001 Required (Adequate Notice)

Revision 26-2; Effective April 1, 2026

All Programs

The following situations require that the household is given adequate notice:

  • The post office returns Texas Health and Human Services Commission (HHSC) mail with no forwarding address because the person's location is unknown.
  • The head of the household, authorized representative or other responsible household member:
    • verbally volunteers to withdraw in HHSC staff’s presence, either in the office or by phone; or
    • gives HHSC a written, signed report of change, and staff determine the:
      • exact amount of the reduced benefits; or
      • that the household is ineligible.

Note: This includes situations when HHSC receives Form H1028, Employment Verification, signed by the household and completed by the employer.

  • The household reports in advance they will move out of state.
  • Employment and Training (E&T) noncooperation is received in the last benefit month.

Related Policy

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

TANF and Medical Programs

Send Form TF0001, Notice of Case Action, without advance notice in the following situations:

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

Related Policy

The Texas Works Message, A-1527

SNAP

Send Form TF0001 without advance notice in the following situations:

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

Related Policy

General Policy, A-710

A-2344.2 No Form TF0001 Required

Revision 15-4; Effective October 1, 2015

All Programs

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

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

TANF

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

SNAP

Form TF0001 is not required in the following situations:

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