A-2310, Notice to Applicants

Body

Revision 26-1; Effective Jan. 1, 2026

All Programs

The Eligibility Determination Group (EDG) disposition produces the person's notice of eligibility status. After the interview or during processing of the application or renewal form, the EDG is pended, certified, sustained or denied. After disposition, provide one or more of the following notices, as applicable:

  • Form H1020, Request for Information or Action , tells the applicant the:
    • reason the case is pending;
    • action the applicant or staff must take;
    • date when the applicant or staff must take action; and
    • date staff must deny the application or EDG if the person does not take action, if applicable.

Note: For those who are Spanish speaking only, make sure all comments provided on the H1020 are in Spanish. Refer to Form H1020 instructions for translation of common pending phrases.

  • Form TF0001, Notice of Case Action
    • If benefits were approved, the notice informs the person of:
      • the date benefits begin or Medicaid effective date;
      • the amount of benefits;
      • the length of certification for Supplemental Nutrition Assistance Program (SNAP) EDGs; and
      • the remaining federal and state time limit months for Temporary Assistance for Needy Families (TANF), if applicable;
    • If benefits were denied, terminated or reduced, the notice informs the person:
      • the reason for the denied application, denied EDG or reduced benefits;
      • that a protective payee is required for TANF;
      • the effective date of the action;
      • the person's right to appeal;
      • the address and phone number of free legal services available in the area; and
      • that staff used a credit report resulting in less benefits than the person would have received.

The credit report information is only included on the TF0001 if applicable to the case action. If an application is denied because a person failed to keep an appointment or provide information, inform the person through the notice of what they must do to reuse the application.

Notes:

  • Eligibility for multiple programs is determined independently. Do not deny an application for one program based solely on the denial of other programs unless the household fails to meet the eligibility requirements.
  • When the continuous eligibility period ends, staff must retest the individual’s eligibility for all appropriate Medicaid or Medicare Savings Program (MSP) and transfer coverage if eligible without requiring a new application.

Related Policy 

Reuse of an Application Form After Denial, B-111
Denied for Missed Appointments, B-122.3.1
Denied for Failure to Provide Information/Verification, B-122.3.2 

A–2311 General Information for Denials and Terminations

Revision 26-1; Effective Jan 1, 2026

All Programs

Denials and terminations are different types of adverse case actions.

  • A denial refers to a determination of ineligibility for a person not currently receiving benefits. A denial action may occur when processing an application or a request for a new type of benefit program.
  • A termination refers to a determination of ineligibility for ongoing benefits. A termination action may occur when a person no longer meets the program requirements during the certification period or when processing a redetermination based on changes in circumstances.

Note: Unless otherwise specified, the following policy applies to denials and terminations.

Procedural Denials

A procedural denial occurs when a person fails to provide all the information needed to determine eligibility. Examples of procedural denial reasons on Form TF0001, Notice of Case Action, include recipients who were sent forms to renew benefits but failed to return them by the due date. The person failed to provide the missing information by the due date.

Non-Procedural Denials

A non-procedural denial occurs when a person is not eligible for benefits based on the information provided. They do not meet one or more specific financial or non-financial eligibility requirements, and there are no exceptions that would make them eligible. Examples of non-procedural denial reasons on the Form TF0001 notice include:

  • The income a person gets is more than allowed for this program. Applicant did not provide proof showing that they live in Texas.
  • Applicant has not verified they are either a citizen or non-citizen who qualifies to receive benefits.

Medicaid Eligibility on All Bases

HHSC must determine if an applicant or recipient is eligible for any other type of medical benefit before determining ineligibility. Determine the person’s eligibility for both Modified Adjusted Gross Income (MAGI) and non-MAGI types of assistance (TOAs).

If the applicant is eligible for another type of medical benefit, transfer them to the new TOA without requiring a new application. Only send Form H1020, Request for Information or Action, to request the information or verification needed if more information is needed to determine eligibility for other TOAs. Do not request a new application or verification of information available through electronic data sources.

Examples:

  • A person submits a Form H1200 to apply for Medicaid for their minor child. Staff process the Form H1200 application, and TIERS cascades to a Children’s Medicaid (CMA) EDG. Staff should review the Children’s Medicaid EDG for accuracy and request any other information necessary to complete the CMA eligibility determination, without requiring the person to complete a Form H1010 or other acceptable TW application.
  • An elderly person submits a Form H1010 to apply for Medicaid. Staff process the form H1010 application and TIERS cascades to a Medicaid Savings Program (MSP) EDG. Staff should review the MSP EDG for accuracy and request additional information necessary to complete the MSP eligibility determination, without requiring the person to complete a form H 1200 or other acceptable application.   

Note: Form H1010 does not capture resources.  When a Form H1010 is used to determine eligibility for MEPD programs, submit a request for the Asset Verification System (AVS) and obtain consent to explore resources.

Related Policy

Notice to Applicants, A-2310
Denial of an Application, A-2341
Denial at Redetermination, A-2342