5/13/2020 Mail - Dylan Winters - Outlook From: "Sprehe,Elliott (HHSC)" Date: Wednesday, May 6, 2020 at 12:07 PM To: AO Records Subject: [Ext]FW: Public Records Request (TX-HHSC-20-0960) - Reference No. OR20200420-22086 Good morning, Documents responsive to your request below are attached. We wouldn’t have information responsive to #4 of your request. Thanks. Elliott Sprehe Press Officer Texas Health & Human Services Commission 512-462-6350 n [twitter.com/TexasHHSC]a ma #TeamTexasHHS #TexasHHSProud From: AO Records Sent: Friday, April 17, 2020 12:58 PM To: HHSC Open Records Request Subject: Public Records Request (TX-HHSC-20-0960) - Reference No. OR-20200420-22086 AMEHICAN PVERSIGHT https://outlook.office365.com/mail/dylan.winters@americanoversight.org/inbox/id/AAQkAGJmZjIxNGNhLTM3ZDAtNDFkNy1hZjNjLTVhN2Y1ODc1NWFkNAA… 1/2 5/13/2020 Mail - Dylan Winters - Outlook WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Dear Public Records Officer: Please find attached a request for records under Texasʼs public records laws. Sincerely, Clay M. Goode Paralegal American Oversight records@americanoversight.org www.americanoversight.org   @weareoversight PRR: TX-HHSC-20-0960 AMEHICAN PVERSIGHT https://outlook.office365.com/mail/dylan.winters@americanoversight.org/inbox/id/AAQkAGJmZjIxNGNhLTM3ZDAtNDFkNy1hZjNjLTVhN2Y1ODc1NWFkNAA… 2/2 TEXAS Healthand Human Services National Voter Registration Act Implementation Plan (2019) Implementation Date Ongoing. Previously, Health and Human Services Commission (HHSC) and Department of State Health Services (DSHS) administered voter registration responsibilities separately. As of September 1, 2019, this plan is inclusive of both Health and Human Services system (system) agencies. Implementation Statewide All HHSC and DSHS offices serving clients. Purpose To provide applicants and recipients of public assistance and services for persons with disabilities the opportunity to register to vote and to update voter registration information. Authorities • National Voter Registration Act of 1993 (NVRA), 52 U.S.C. Ch. 205 • Texas Election Code, Ch. 20 Primary Responsibility The HHSC Voter Registration Coordinator (coordinator) has primary responsibility for the Health and Human Services system National Voter Registration Act (NVRA) Implementation Plan (plan). 1 Texas Health and Human Services ● hhs.texas.gov VERSIGHT TX-HHSC-20-0960-A-000001 Scope HHSC and DSHS have been designated by the legislature to provide voter registration services. This plan applies to any system office that provides either public assistance or state-funded programs primarily engaged in providing services to persons with disabilities. The following HHSC divisions and services provide public assistance or state-funded programs primarily engaged in providing services to persons with disabilities: HHSC Divisions • Health and Specialty Care System Division • Access and Eligibility Services Division • Health, Developmental, and Independence Services Division • IDD and Behavioral Health Services Division • Medicaid and Children’s Health Insurance Program (CHIP) Services Division HHSC Programs/Services/Local Authorities Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), Supplemental Nutrition Assistance Program (SNAP), Disaster Supplemental Nutrition Assistance Program (D-SNAP), Medicaid, Children’s Health Insurance Program (CHIP), Medicaid Eligibility for the Elderly and People with Disabilities (MEPD), Community Care for the Aged/Disabled (CCAD), STAR+PLUS Home & Community Based Services (HCBS), Healthy Texas Women (HTW), State Hospitals (SH), State Supported Living Centers (SSLC), Independent Living Services (ILS), Centers for Independent Living (CILs), Comprehensive Rehabilitation Services (CRS), Community Care Services Eligibility and contracted local intellectual and developmental disability authorities (LIDDA), and contracted local mental health authorities/local behavioral health authorities (LMHA/LBHA). In addition, this plan applies to the following DSHS programs and services: DSHS Programs/Services The Texas Center for Infectious Disease (TCID). 2 A ICA PVERSIGHT Texas Health and Human Services ● hhs.texas.gov TX-HHSC-20-0960-A-000002 Policy Background The NVRA sets forth certain voter registration requirements with respect to elections for federal office. Specifically, Section 7 requires that states offer voter registration opportunities at certain state and local offices, including public assistance offices and offices that provide assistance to persons with disabilities. This plan standardizes agency voter registration responsibilities across the system to ensure consistent implementation of the NVRA. The coordinator is responsible for overseeing and tracking implementation of the plan, maintaining a current list of voter registration liaisons, organizing voter registration training, and submitting the plan to the SOS. To ensure system compliance, the coordinator shall ensure appropriate system staff is properly trained, including how to correctly register a person to vote in person or via mail, document the declination to register to vote, and comply with restrictions on staff/applicant interactions. Policy Description System staff shall provide a voter registration application form to each person in connection with the person’s application for initial public assistance services, recertification, redetermination, renewal, or change of name or address, unless the person declines in writing to register to vote. HHS Plan Basic Overview of Procedures Opportunity to register to vote HHSC and DSHS must provide the opportunity to register to vote to a person when: • Applying for the system’s public assistance and/or services for persons with disabilities; • Seeking recertification, redetermination, or renewal of those services; or • Changing the name or address on file for assistance or services. 3 A ICA PVERSIGHT Texas Health and Human Services ● hhs.texas.gov TX-HHSC-20-0960-A-000003 Distribution of voter registration application forms, process, and assistance Each system office designated as a voter registration location that provides public assistance or services to persons with disabilities and offers voter registration application assistance must do the following: • Distribute voter registration application forms; • Provide the same level of assistance to all applicants in completing a voter registration application form as is provided with respect to every other service or application for benefits (unless the applicant specifically refuses such assistance); • Accept completed voter registration application forms; and • Transmit each completed voter registration application form to the county voter registrar within five days of receipt by system staff. Change of Name or Address • In person: w hen system staff receives a change of name or address request in person for an applicant/recipient regarding a public assistance service, staff follows the regular process regarding voter registration assistance as described in the program policies and procedures. • Remote request: w hen system staff receives a completed agency-approved change of name or address form in the mail from an applicant/recipient regarding a public assistance service, staff shall mail the voter registration application form to the individual. Mail, Telephone, and Fax • Voter registration application forms are mailed to applicants/recipients with every application, redetermination packet, and each change reporting form. • When mailing a voter registration application form, agency staff also provides notice to the applicant that the application may be submitted in person or by mail to the county voter registrar or in person to a volunteer deputy registrar in the county where the applicant resides. 4 VERSIGHT Texas Health and Human Services ● hhs.texas.gov TX-HHSC-20-0960-A-000004 Online access to most HHSC public assistance services via the HHS website • When an applicant/recipient applies for public assistance services using the HHS website, the applicant/recipient can also request a voter registration application form or decline to register to vote. Declination Process • If the applicant does not wish to complete a voter registration application form, agency staff shall request that the applicant complete and sign the official declination form. • If the applicant refuses to sign the declination form, agency staff shall enter a notation of that fact on the form. • The declination form shall be maintained for at least 22 months after the date of signing. Forms State forms Only state forms shall be used for voter registration applications and to document an applicant’s declination to register to vote. System staff is provided with printed forms and access to the PDF version. • The HHSC and DSHS applications, renewal/recertification forms, and change report forms contain the language required by the NVRA and SOS. • The HHSC and DSHS applications, renewal/recertification forms, and the declination forms contain an "agency use only" section to provide an area for agency documentation of voter registration activity. • The declination form includes the phone number (1-800-252-8683) for applicants to call the SOS with any questions regarding voter registration and to receive the name, address, and telephone number of the appropriate official to whom a complaint may be addressed. How to Obtain Voter Registration Applications Forms In compliance with state and federal law, system staff will ensure they have access to an adequate supply of voter registration application forms. Voter registration application forms can be obtained in several ways, including: 5 VERSIGHT Texas Health and Human Services ● hhs.texas.gov TX-HHSC-20-0960-A-000005 • If system staff has access to a printer, a PDF version of the voter registration application can be printed from the website. English and Spanish language versions of the form are available. • System staff can obtain preprinted cards through the HHS Forms and Print Catalogue website. • System staff can obtain the voter registration applications by contacting the HHSC Warehouse. The HHSC Warehouse can deliver smaller quantities of cards (under 1000). • For larger orders of voter registration applications (1000+), system staff should contact HHSC Printing. Please be aware the bulk order option can take more time to process. Liaisons & Deputy Voter Registration Coordinators Each HHSC and DSHS division or section with voter registration responsibilities may appoint at least one staff to serve as a deputy voter registration coordinator and an adequate team of voter registration local liaisons to work with the coordinator to implement this plan. Upon appointment as a new deputy or local liaison, staff will inform the coordinator of the appointment. Each local liaison in a regional office or facility shall maintain regular communication with the voter registrar in the county where the office or facility is located. The local liaisons have the following responsibilities: • Ensure each office or facility has an adequate supply of required forms; • Review all completed voter registration application forms for completeness; and • Transmit completed voter registration application forms to the county voter registrar within five days of receipt by system staff. Training of Staff for Voter Registration Procedures The coordinator is responsible for ensuring that all system staff with voter registration responsibilities are trained in voter registration policies and procedures. Content Training shall include the following: 6 A ICA PVERSIGHT Texas Health and Human Services ● hhs.texas.gov TX-HHSC-20-0960-A-000006 • An overview of the procedures required to ensure that system staff understands voter registration requirements; • Instructions about incorporating voter registration procedures during the initial application, renewal/recertification, redetermination, and change of name or address process; • Prompts, handbook or program manual references, and other appropriate reminders for system staff when discussing voter registration with an applicant and/or recipient; • Instructions for completing voter registration application forms and declination forms; and • Required actions after receipt of completed voter registration application forms or declination forms. Frequency • The coordinator will maintain regular contact with the SOS to ensure the coordinator is properly trained in voter registration requirements, including receiving any updates in the law that will affect this plan. The coordinator will also maintain regular contact with the SOS to receive updates and respond to requests, as needed. • The coordinator will work with the SOS to ensure that deputy voter registration coordinators and voter registration local liaisons receive voter registration training on a regular basis. • Voter registration training is incorporated into new staff training for new hire or rehire staff whose job duties include voter registration responsibilities. Voter registration local liaisons in each office will ensure that all system staff interacting with applicants and/or recipients understand and implement appropriate voter registration procedures. Office Locations and Hours HHSC and DSHS provides voter registration services at hundreds of locations throughout the state of Texas. HHSC and DSHS normal business hours are 8:00 a.m. to 5:00 p.m., Monday – Friday. The following website provides the address, telephone, TDD, and fax information for local system office or local authority: https://apps.hhs.texas.gov/contact/search.cfm. 7 A ICA PVERSIGHT Texas Health and Human Services ● hhs.texas.gov TX-HHSC-20-0960-A-000007 The following website provides the address, telephone, TDD, and fax information for local WIC offices: http://txhealth.ziplocator.com. Additional Assistance If a question arises concerning voter registration that system staff cannot answer, the applicant will be provided: • the toll-free telephone number of the SOS Elections Division; and • the telephone number of the county voter registrar to whom registration applications are submitted. HHSC Agency Coordinator Ben Taylor Telephone: (512) 424-6833 Email: voterregistration@hhsc.state.tx.us Agency Contact Information Texas Health and Human Services Commission Brown-Heatly Building 4900 N. Lamar Blvd. Austin, TX 78751 Telephone: (512) 424-6500 TTY: (512) 424-6597 Website: www.hhs.texas.gov Texas Department of State Health Services Moreton Building 110 West 49th Street Austin, TX 78756 Telephone: (512) 776-7111 Toll-free: (888) 963-7111 Website: www.dshs.texas.gov 8 A ICA PVERSIGHT Texas Health and Human Services ● hhs.texas.gov TX-HHSC-20-0960-A-000008 Attachment 10 TEXAS H1206MA Rev. 05/2018 Page 1 ENG Case Number: 1902285558 Healthand Human Services MARY ANN APT 5168 1609 CENTRE CREEK DR AUSTIN TX 78754 Health-Care Benefits Renewal How to Renew 1. Review and Update the Form • If any of the facts printed on this form are not correct, you must cross out the information and write in the correct information. • If you have any new facts you must write them in. This includes but is not limited to: income, health insurance, individuals living in your home and expenses. If you update any information you must sign and return the renewal form to HHSC. 2. Submit Form There are five ways to renew your benefits. Pick only one: • YourTexasBenefits.com: You can update the facts we have about you and upload your items online. • Mail: Mail the renewal form with all the correct facts about you and the items we need from you to: TEXAS HEALTH AND HUMAN SERVICES COMMISSION P O BOX 149024 AUSTIN, TEXAS 78714-9024 • Fax: Fax the renewal form with all the correct facts about you and the items we need from you packet to 1-877-447-2839, If your form is 2-sided, fax both sides. • Phone: Call 2-1-1 (after you pick a language, press 2). If you have a hearing or speech disability, call 7-1-1 or any relay service. • In person: At a benefits office. To find an office near you, go to YourTexasBenefits.com or call 2-1-1 (after you pick a language, press 1). Items you may need to renew • Employer and income information for everyone in your family (for example, from pay stubs, W-2 , or wage and tax statements). • Policy numbers for any current health insurance. • Information about any job-related health insurance. Questions about this form • Online: YourTexasBenefits.com • Phone: Call us at 2-1-1. After you pick a language, press 2. • In person: At a benefits office. To find an office near you, go to YourTexasBenefits.com or call 2-1-1 (after you pick a language, press 1). T-H1206MA-3446055922638 VERSIG HT [[ll[[ll [[II[[ l[ll[l[[I[[ lllll[[ll[II[Im[[[II[[ll[I II[l[l[ l[ll[l[11111[1111 [1[ 11[1[ TX-HHSC-20-0960-A-000009 Page 1 of 7 H1206MA Rev. 05/2018 Page 2 ENG Case Name: Mary Ann TEXAS HealthandHuman Services Case Number: 1902285558 Contact Information Phone Home 7862948868 Office E-mail Address: Other 2581630524 Testing@hhsc.state.us Head of Household I Name Mary Ann Home Address Apt # City State County 1609 Centre Creek DR Austin TX 78754 5168 Austin Texas Travis Individuals Ready For Renewal Name Gender Date of Birth Relationship to Head of Household This Person Lives U.S. Citizen Lives in Texas Plans to Stay in Texas Eve Hart Female 07/01/2004 Daughter At home Yes Yes Yes People in your household or on your Tax Return who DO NOT need to renew now Name Gender Date of Birth Relationship to Head of Household Mary Ann Female 07/01/1977 Self Receiving Health Care Benefits Lives in Texas No Yes Immigration Status Has immigration status changed?........................................................................................... This person lives Plans to Stay in Texas At home I□ □ Yes Yes No T-H1206MA-3446055922638 VERSIGHT IIIIIIIII IIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIII IIIIIllllllll llllllllll111111111111111 11111 111111111111111 IIIIIIIIIIIIIIIIIIIIIII TX-HHSC-20-0960-A-000010 Page 2 of 7 I H1206MA Rev. 05/2018 Page 3 ENG If yes, complete the following: Name Immigration Registration Number Document Type Facts about NEXT YEAR'S Federal Income Tax Return Name Tax Dependent Filing Separately Mary Ann Filing Jointly Filing Separately and as a Tax Dependent Filing Jointly and as a Tax Dependent Doesn't file taxes and isn't a Tax Dependent Yes Eve Hart Yes □ Yes Has tax status for any individual changed? □ No Your Family's Health Coverage Policy Holder's Name Insurance Company Effective Date Income Update Income (If the facts about your income have changed you must correct any wrong information).............................. Name Name of Employer Income Type Amount Mary Ann Walmart Wages 500.00 Add New Income ................................................................................................................................................................................. You must report all types of income including: -Income from a job -Unemployment, Pensions -Social Security -Retirement accounts -Alimony received, Net -farming / fishing -Net rental / royalty -Other income Name Person, company, or agency paying the money. If Employer Phone Hours worked per Employer Address you were working for Number week yourself, write "self." Amount If you need to list more income, add more pages with the same facts. T-H1206MA-3446055922638 VERSIG HT [[ll[[ll [[II[[ l[ll[l[[I[[ lllll[[ll [II[Im[[[I I[[ll[I II[l[l[l[ll[l[11111[1111 [1[ 11[1[ TX-HHSC-20-0960-A-000011 Page 3 of 7 H1206MA Rev. 05/2018 Page 4 ENG Expenses Add New Expense ............................................................................................................................................................................... Name Expenses Type Amount / Value How Often Paid More Facts about the People included on this Form Is anyone pregnant?.................................................................................................................................... □ Yes □ No □ Yes □ No □ Yes □ No a.) If yes who is pregnant? b.)How many babies are expected during this pregnancy? c.)Due date (mm/dd/yyyy): I I Does a child applying for health care travel with a family member who is a migrant farm worker? If yes, who? I I Does anyone have unpaid medical bills from the last 3 months?............................................................. If yes, who? I I In the last 12 months, did you transfer, deed, sell or give away any houses, lots, land or money, or did you waive your right to any income? Yes □ Is anyone who is applying for health coverage in jail (incarcerated)? If yes, who? T-H1206MA-3446055922638 VERSIG HT I □ Yes □ No □ No I [[ll[[ll [[II[[ l[ll[l[[I[[ lllll[[ll [II[Im[[[I I[[ll[I II[l[l[l[ll[l[11111[1111 [1[ 11[1[ TX-HHSC-20-0960-A-000012 Page 4 of 7 ii Do you want to give someone the right to act for you - to be your authorized representative? If you want, you can give someone the right to act for you (an authorized representative). That person can: give and get facts for this application. take any action needed for the application process. This includes appealing an HHSC decision. take any action needed to enroll in Medicaid or CHIP. This includes picking a health plan. take any action needed to get benefits. This includes reporting changes and renewing benefits. □ Yes H1206MA Rev. 05/2018 Page 5 ENG □ No • • • • By agreeing to act as your authorized representative, I agree to: fulfill all your responsibilities related to Medicaid; • • • keep information about you private; obey state and federal laws about conflict of interest and keeping information private, including: • • • laws that protect information on people who apply for or receive Medicaid (42 CFR part 431, subpart F); laws about the privacy and safety of personally identifiable information (45 CFR §155.260(f)); and laws barring the state from paying anyone other than your provider or you for Medicaid services, except in a few circumstances (42 CFR §447.10). You can have only one authorized representative for all your benefits from HHSC. If you want to change your authorized representative: (1) log in to your account on YourTexasBenefits.com and report a change, or (2) call 2-1-1 (after you pick a language, press 2). If you're a legally appointed representative for someone on this application, send proof with the application. Authorized Representative's Name: Organization Address Phone Number Family violence exemption • If you're afraid that giving us facts about someone could cause harm (physical or emotional) to you or your child, you might be able to get the "Family Violence Exemption.” This means you might not have to give us facts about that person. T-H1206MA-3446055922638 VERSIG HT [[ll[[ll [[II[[ l[ll[l[[I[[ lllll[[ll [II[Im[[[I I[[ll[I II[l[l[l[ll[l[11111[1111 [1[ 11[1[ TX-HHSC-20-0960-A-000013 Page 5 of 7 H1206MA Rev. 05/2018 Page 6 ENG Signing up to vote Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency. If you are not registered to vote where you live now, would you like to apply to register to vote here today? □ YES □ NO IF YOU DO NOT CHECK EITHER BOX, YOU WILL BE CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO VOTE AT THIS TIME. If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private. If you believe that someone has interfered with your right to register or to decline to register to vote, or your right to choose your own political party or other political preference, you may file a complaint with the Elections Division, Secretary of State, PO Box 12060, Austin, TX 78711. Phone: 1‐800‐252‐8683 Agency Use Only: Voter Registration Status Agency Use Only: Voter Registration Status □ Agency registered □ Client declined □ Agency transmitted □ Client to mail □ Mailed to client Other Agency staff signature Important Information for Former Military Service Members Women and men who served in any branch of the United States Armed Forces, including Army, Navy, Marines, Air Force, Coast Guard, Reserves or National Guard, may be eligible for additional benefits and services. For more information, please visit the Texas Veterans Portal at https://veterans.portal.texas.gov. Read & sign this application I'm signing this application under penalty of perjury which means I've provided true answers to all the questions on this form to the best of my knowledge. I know that I may be subject to penalties under federal law if I provide false or untrue information. • I know that I must tell the Texas Health and Human Services Commission (HHSC) if anything changes (and is different than) what I wrote on this application. To report changes, I can go to YourTexasBenefits.com or call 2‐1‐1 or 1‐877‐541‐ 7905. I understand that a change in my information could affect the eligibility for member(s) of my household. • I know that under federal law, discrimination isn't permitted on the basis of race, color, national origin, sex, age, sexual orientation, gender identity, or disability. I can file a complaint of discrimination by visiting www.hhs.gov/ocr/office/file T-H1206MA-3446055922638 VERSIGHT llllll llllllllll111111111111111 11111 111111111111111 IIIIIIIIIIIIIIIIIIIIIII TX-HHSC-20-0960-A-000014 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIll Page 6 of 7 H1206MA Rev. 05/2018 Page 7 ENG I confirm that no one applying for health insurance on this application is incarcerated (detained or jailed). If not , is in-carcerated. (name of person) We need this information to check your eligibility for help paying for health coverage if you choose to apply. We'll check your answers using information in our electronic databases and databases from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security, and/or a consumer reporting agency. If the information doesn't match, we may ask you to send us proof. Renewal of coverage in future years To make it easier to determine my eligibility for help paying for health coverage in future years, I agree to allow the agency to use income data, including information from tax returns. The agency will send me a notice, let me make any changes, and I can opt out at any time. Yes, renew my eligibility automatically for the next □ □ 5 years (the maximum number of years allowed), or for a shorter number of years: 4 years □ 3 years □ 2 years □ 1 year □ Don’t use information from tax returns to renew my coverage. If anyone on this application is eligible for Medicaid I am giving to HHSC the rights to pursue and get any money from other health insurance, legal settlements, or other third parties. I am also giving to HHSC rights to pursue and get medical support. Yes No Does any child on this application have a parent living outside of the home? □ □ If yes, I know I will be asked to cooperate with the agency that collects medical support from an absent parent. If I think that cooperating to collect medical support will harm me or my children, I can tell HHSC and I may not have to cooperate. My right to appeal If I think HHSC has made a mistake, I can appeal its decision. To appeal means to tell someone at HHSC that I think the action is wrong and ask for a fair review of the action. I know that I can find out how to appeal by contacting HHSC at 2‐1‐1 or 1‐877‐541‐7905 (after you pick a language, press 2). I know that I can be represented in the process by someone other than myself. My eligibility and other important information will be explained to me. If you think you have been discriminated against because of race, color, national origin, age, sex, disability, or religion, you can file a complaint by calling (888) 388‐6332. Sign this application Signature Date (mm/dd/yyyy) The person who filled out the form or their authorized representative should sign. T-H1206MA-3446055922638 VERSIG HT [[ll[[ll [[II[[ l[ll[l[[I[[ lllll[[ll [II[Im[[[I I[[ll[I II[l[l[l[ll[l[11111[1111 [1[ 11[1[ TX-HHSC-20-0960-A-000015 Page 7 of 7 •••• Attachment 11 IMPORTANT: DO NOT ENLARGE, REDUCE OR MOVE the FIM and POSTNET barcodes. They are only valid as printed! Special care must be taken to ensure FIM and POSTNET barcode are actual size AND placed properly on the mail piece to meet both USPS regulations and automation compatibility standards. County of Residence _____________________________ Fold on line and seal before mailing NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY MAIL FIRST-CLASS MAIL PERMIT NO. 4511 AUSTIN, TX POSTAGE WILL BE PAID BY ADDRESSEE SECRETARY OF STATE ELECTIONS DIVISION PO BOX 12887 AUSTIN TX 78711-9972 1111 11111•11• ,111.,11,.,1111111••l'1'''111'•1•l11l•1•11l1 111•1•11 Fold on line and seal before mailing Qualifications • You must register to vote in the county in Artwork for User Defined (4" x 6") which you reside. Layout: sample BRM Env with IMB.lyt • November 29, 2011 You must be a citizen of the United States. • You must be at least 17 years and 10 months old to register, and you must be 18 years of age by Election Day. • You must not be finally convicted of a felony, or if you are a felon, you must have completed all of your punishment, including any term of incarceration, parole, supervision, period of probation, or you must have received a pardon. • You must not have been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or partially mentally incapacitated without the right to vote. Filling out the Application • Review the application carefully, fill it out, sign and date it and mail it to the voter registrar in your county or drop it by the Voter Registrar’s office. - PVERSIGHT I SECRETARY OF STATE_2016_VR30.indd 1 • All voters who register to vote in Texas must provide a Texas driver's license number or Produced by DAZzle Designer, Version 9.0.05 personal identification number issued by the (c) 1993-2009, Endicia, www.Endicia.com Texas Department of Public Safety. If you U.S. Postal Service, Serial # don’t have such a number, simply provide the last four digits of your social security number. If you don’t have a social security number, you need to state that fact. • Your voter registration will become effective 30 days after it is received or on your 18th birthday, whichever is later. Your registration must be effective on or before an election day in order to vote in that election. • If you move to another county, you must re-register in the county of your new residence. Please visit the Texas Secretary of State website, www.sos.state.tx.us, and for additional election information visit www.votetexas.gov. Este formulario está disponible en español. Favor de llamar a su registrador de votantes local para conseguir una versión en español. TX-HHSC-20-0960-A-000016 5/9/2016 10:46:10 AM •••• -1 Texas Voter Registration Application Prescribed by the Office of the Secretary of State For Official Use Only VR30.2016E.I3 Please complete sections by printing LEGIBLY. If you have any questions about how to fill out this application, please call your local voter registrar. ■1 These Questions Must Be Completed Before Proceeding (Check one) □ New Application □ Change of Address, Name, or Other Information Are you a United States Citizen? □ □ □ Will you be 18 years of age on or before election day? Request for a Replacement Card Yes Yes □ □ No No If you checked 'No' in response to either of the above, do not complete this form. Are you interested in serving as an election worker? 2 Last Name Include Suffix if any 3 Residence Address: (Jr, Sr, III) Yes First Name No Former Name (if any) Middle Name (If any) Street Address and Apartment Number. If none, describe where you live. (Do not include P.O. Box, Rural Rt. or Business City TEXAS County Zip Code City State Address) 4 Mailing Address: Street Address and Apartment Number. (If mail cannot be delivered to your residence address.) Zip Code 5 City and County of Former Residence in Texas 6 Date of Birth: (mm/dd/yyyy) 7 : □□/DD/□□□□ Lg Gender (Optional) Male Female 9 Texas Driver's License No. or Texas Personal I.D. No. (Issued by the Department of Public Safety) □□□□□□□□ 10 ■ □ 8 Telephone Number (Optional) L□□□ □□□-□□□□ ( Include Area Code ) If no Texas Driver's License or Personal Identification, give last 4 digits of your Social Security Number xxx-xx- □□□□ I have not been issued a Texas Driver's License/Personal Identification Number or Social Security Number. I understand that giving false information to procure a voter registration is perjury, and a crime under state and federal law. Conviction of this crime may result in imprisonment up to 180 days, a fine up to $2,000, or both. Please read all three statements to affirm before signing. • I am a resident of this county and a U.S. citizen; • I have not been finally convicted of a felony, or if a felon, I have completed all of my punishment including any term of incarceration, parole, supervision, period of probation, or I have been pardoned; and • I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or partially mentally incapacitated without the right to vote. X Date / / Signature of Applicant or Agent and Relationship to Applicant or Printed Name of Applicant if Signed by Witness and Date. - PVERSIGHT I SECRETARY OF STATE_2016_VR30.indd 2 TX-HHSC-20-0960-A-000017 5/9/2016 10:46:10 AM TW BST: SNAP January 2020 Module 6: Individual Information Objective Given the application and information collected at the interview, complete Texas Integrated Eligibility Redesign System (TIERS) entries Individual Information functional area with accuracy. Lessons • • • • • • • • • • • • • • • • • • Initiate Interview Household Information Household Address Sponsor(s)-Permission(s) provided for Electronic Data Sources (ELDS) Service Individual Household Head of Household (HOH) Individual Interviewed Program Appointment Relationship Education Living Arrangement/Domicile Individual Demographics Alien/Refugee Individual-Questions Aged/Disability Benefits Disability Individual Information-Run Eligibility Module 6: Individual Information AMERICAN PVERSIGHT 1 TX-HHSC-20-0960-A-000018 TW BST: SNAP January 2020 Lesson 1: Initiate Interview Purpose This logical unit of work (LUW) starts the interview process. Objective Select the correct mode from the Interview Mode dropdown using the Interview Modes job aid. Policy TWH A–122 Filing the Application (Application Received Date) Reference the Interview Modes job aid. Initiate Interview Page • \ ,n;f Initiate Interview \ ....... \ °'""!I" Passo.nl Logout Head of Household G) @ Case Name: _ 8 @ @ Case#: -----==:J Case Mode: llltake Case Status: Pe ndmg Individual Inform ation lndividua.l # : _v .._______________________________ • Name: ~ Dates • Head of Household Begin Month: Imm / IYYYY ~ Head of Household End Month: Imm 1 IYYYY ~ Head of Household Name HoH Begin Date HoH End Date Inactive/Invalidated Description The head of household is the individual who makes decisions for the household. Step Click Next (you already established the Head of Household when you entered the Primary Applicant during Application Registration). Module 6: Individual Information VERSIGHT 42 TX-HHSC-20-0960-A-000059 TW BST: SNAP January 2020 Lesson 7: Individual Interviewed LUW Purpose Use this page to identify the individual you are interviewing. Objective Using assigned casework, correctly identify and data enter the appropriate individual in the Individual Interviewed – Details page according to policy. Policy TWH A–131 Interviews (SNAP interview requirements) TWH B–126 Processing Desk Reviews (Desk review criteria) Interview Job Aid Review the section of the Interview job aid relating to this page. Verification Job Aid Review the section of the Verification job aid relating to this page. Module 6: Individual Information A\11 ~ 11(,J\ PVERSIGHT 43 TX-HHSC-20-0960-A-000060 TW BST: SNAP January 2020 Individual Interviewed - Details Page I interv iew Conducted ~Was Intervi ew Conducted? I Indivi dual Informati on ~lntervrew Dat e: ~ , ic--, lndividua.l # : Name : Indivi dual Detaill Infor mati on Prefix: r""""EJ First Middle: I Last: Suffix : r""""EJ Relationship to Client: ID Ve rifica tion: Description Households who apply for SNAP are required to be interviewed. Applicants can be interviewed via phone, in person, or home visit. For some redeterminations, HHSC may be able to renew benefits without an interview. This is referred to as a desk review. If a household member is interviewed, select their name from the Name dropdown. If an AR is interviewed, select Authorized Representative from the Name dropdown. This populates the Individual Detail Information section of the page from information entered into the Household Information LUW. Steps 1. Was Interview Conducted? 2. Date Interviewed — TIERS defaults this field to the current date. Update if necessary. 3. Name: 4. Click Next Module 6: Individual Information VERSIGHT 44 TX-HHSC-20-0960-A-000061 TW BST: SNAP January 2020 Lesson 8: Program Summary LUW Purpose Use this page to review the programs requested and the individuals requesting each program based on the information you entered in Application Registration. Objective Compare the individuals requesting SNAP on the Program – Summary page with those on Form H1010 and make corrections as needed with 100% accuracy within the Program - Individuals page. Policy TWH A–122 Filing the Application (File Date) Interview Job Aid Review the section of the Interview job aid relating to this page. Program - Summary Page Food Stamps Program @ Food s t amps Program st atu s A pplication Date lndividuaI1s Date Requested (Indiv idual) Program Action Requ ested Program Program statu s Application Date Individuals Program Action Program Program st atus Application Date Individuals Program Action Program Program statu s Application Date lndividuaI1s Module 6: Individual Information VERSIGHT (Indiv idual) Program Action 45 TX-HHSC-20-0960-A-000062 TW BST: SNAP January 2020 Description TIERS displays each program separately on this page. When you select a program action to perform on the Program - Summary page, the Program - Details and Program - Individual pages change accordingly. Notes: This is your first opportunity to ensure all household individuals are included in the program request. When you add an individual to a case, refer to the Program Page Reference Guide in ASK iT (Browse>Reference>Active) to guide you in requesting assistance for the individual Step Programs Requested (SNAP), the Application Date and the Date Requested—Review for accuracy. If information is correct, click Next. Module 6: Individual Information AMERICAN PVERSIGHT 46 TX-HHSC-20-0960-A-000063 TW BST: SNAP January 2020 Lesson 9: Appointment LUW Purpose This LUW collects information about the appointment. It also collects actions taken to confirm the identity of the caller, which is referred to as caller authentication. Objectives • In the Appointment LUW, use the Form H1010 and supportive documents to accurately determine when to add or edit a SNAP appointment and capture appointment details according to the Eligibility Operations Procedures Manual (EOPM). Using electronic data sources and supportive documents, authenticate the caller according to policy when required and accurately record caller details within the Appointment - Caller Authentication page. • Policy TWH A–2020 Authenticating a Caller Appointment - Summary Page t Appo intmen t t Appo intme nt Type Appl i c ati on t Case /App Numbe r t Program t Appo intment Status Food Description The type of action you take on this page is dependent on the type of appointment you are handling. You will either add a new appointment or edit an existing appointment. In some cases, you may do both: • Add Appointment—when the Appointment Status displays Action Taken for No Show and the client calls in to the Interview line or arrives in the office for an interview or when the client requests an additional program (during the interview) that requires an interview. • Edit Appointment—when you are conducting an interview and the Appointment Status is not Show or the Appointment Status is Show but you must complete the Caller Authentication page for a phone appointment. If you do not add or edit an appointment, the EDG "other" pends. Step Click Edit or Add, as applicable Module 6: Individual Information VERSIGHT 47 TX-HHSC-20-0960-A-000064 TW BST: SNAP January 2020 Appointment - Details Page (edit appointment) I Appo intme nt Information • Are yo u conducting a flexible appointment interview now? • Contact Type: I c lient Initiated • Date r- ,r ,r -; • Begin Time: • Appoi ntment Type : I GI Bl • Does a TLM task need to be IN o created? • Appointme nt Status : B V Monitoring Type : I Attempted B l s how ~I • End Time: I Application B • Appointme nt Mode : ! Phone Appointment Number: 11 B B ~I B Co ntacts YYY ~ Attempted DatefTime One: ~tFt~ Attempted DatefTime Two: Imm Phone# : 111 / Ft ~yyy - Bl Bl Bl Bl Appo intment Mode : Attempted Contact Summary Attempted Time One Attem pted Time Two 04/ 17/2017 07:00 PM Phone Number Appointment Mode Phone Description If an appointment already exists, the appointment needs to be edited. Steps Steps for Face-to-Face Appointment: 1. Attempted Contact Summary section — Delete the phone record 2. Appointment Status: — Change to Show (only applies to interviews after an unsuccessful cold call and it is prior to the date on Form H1830-FA) 3. Appointment Mode: — Change to In Person 4. Attempted Date/Time One: 5. Click Add 6. Click Next to go to the Relationship LUW Module 6: Individual Information VERSIGHT 48 TX-HHSC-20-0960-A-000065 TW BST: SNAP January 2020 Steps for Phone Appointment: 1. Attempted Contact Summary: — Edit the phone record 2. Appointment Status: — Change to Show (only applies to interviews after an unsuccessful cold call and it is prior to the date on Form H1830-FA) 3. Attempted Date/Time One: 4. Phone #: 5. Click Update 6. Click Next to go to the Appointment – Caller Authentication page These steps also apply to a Desk Review; however, Caller Authentication does not apply. Module 6: Individual Information AMERICAN PVERSIGHT 49 TX-HHSC-20-0960-A-000066 TW BST: SNAP January 2020 Appointment – Details Page (add appointment) IAppo intme nt Informatio n • Are you conduct ing a flex ible appointme nt interview now? B • Contact Type: V • Does a TLM task need to be created? V • Date 1 11 11 -; • Appoi ntment Status : ! No Show • Begin Time: I GrBrB • End Time: !BIBI El • Appoi ntme nt Type: B El • Appoi ntment Mode : Appo intmen t Number: Monitoring Type : B 11 B IAttemp ted Contacts Attemp ted Date/Time One: [mrn , jdd',jmy ,.,, Attemp ted Date/Time Two : Imm/ ~ Phone#: 111 l ~ YYY '"" Bl Bl Appo intment Mode : Attempted Contact Summary Attempted Time One Attempted Time Two Phone Number Appointmen t Mode Description If an appointment does not already exist, an appointment will need to be added. Steps 1. 2. 3. 4. 5. 6. 7. 8. Are you conducting a flexible appointment interview now? Date: Appointment Status: Begin Time: End time: Appointment Type: Appointment Mode: Appointment Number: — defaults to 1, change to 2 only when you add an appointment because the current appointment status is set to Action Taken for No Show 9. Attempted Date/Time One: 10. Click Add 11. Attempted Contact Summary — Review to confirm interview information is recorded 12. Click Next and wait for the pop up window to display 13. Select the program(s) for which you are conducting an interview 14. Click Close to allow the page to advance to the next LUW in the driver flow Module 6: Individual Information VERSIGHT 50 TX-HHSC-20-0960-A-000067 TW BST: SNAP January 2020 Appointment - Caller Authentication Page I Caller Response •Did the caller accurately respond to the authentication questions? YES ,.. Authentication Response Date: j ,comm,m, I l ~ /r ~ Description At the beginning of every phone interview, you must ask certain identifying questions to confirm the identity of the individual to whom you are speaking. The questions must be information the applicant should know the answers to, but ones not easily known by others. The requirement to authenticate the identity of the individual you interview applies whether you interview the applicant, their AR, or another responsible household member. Steps 1. Did the caller accurately respond to the authentication questions? — If the applicant cannot accurately respond to two authentication questions, and the applicant does not meet hardship criteria, require the individual to come into the office to provide proof of their identity. Answering NO pends for proof of identity. 2. Enter Authentication Response Date: 3. Comments: — Briefly document the questions asked and responses given (allows a maximum of 2000 characters) 4. Click Next Module 6: Individual Information VERSIGHT 51 TX-HHSC-20-0960-A-000068 TW BST: SNAP January 2020 Lesson 10: Relationship LUW Purpose This LUW collects relationship information for everyone on the case. Objective Using the SNAP Employment and Training (E&T) exemptions in TIERS and Relationship LUW job aids, correctly select the relationship type(s) and answer applicable questions within the Relationship LUW according to policy. Policy TWH A–210 General Policy (purchase and prepare) TWH A–1822.1 E&T Exemptions (care for a child under 6) TWH B–412 Student Eligibility Requirements (responsible for care of dependent child) Interview Job Aid Review the section of the Interview job aid relating to this page. Verification Job Aid Review the section of the Verification job aid relating to this page. Module 6: Individual Information A\11 ~ 11(,J\ PVERSIGHT 52 TX-HHSC-20-0960-A-000069 TW BST: SNAP January 2020 you to hide the top page so TIERSonly HouseholdRelalio I Relationship Details Prit~ett ,Haltie 59F ; Sanchez.Antonio 45M I\ Sanchez,Sallena 43F v Sanchez,Marcia 16F is Pritchetl,Hatlie 59F Sanchez.,Anton io 45M A Sanohez,SaUena43F v Sanchez.Marcia 16F I UseRetrieve when1nformalionexIs1s in the Household Relabonsh1p Gndand you wantto "retrieve" a particular relalionshipfor editing. To usethis button, selecta source individua1I(fromleft.dropdown)anda reference(fromright dropdown) . Click Retrieve . fim,~,fmy ' Date. I I 11 I .... VerificationReceived On: ~ ationship Information Ir yes, physically able to Purehase/prepare together? 0 Yes 0 No purchase/prepare separately? O ves 0 Fins Parental Role? 0 Yes 0 No Tax Dependent? 0 Yes 0 No Providessupport for? O ves 0 Providescare for? No No Household Relationship Gnd ExpandAll Collapse Al l Source Reference Use Expend All to display relationships for all individuals and Collapse All to hide relationshipsFor all individuals. Record Completed N N Sanchez , Marci a 16F Sanchez, Johnny 4M Pritchett, Effective Begin Date 11111 11111 N j/j/[ N 11111 La· ~ 1 - ~ / t- fi'm'; -- Hattie. Use the minus sign next to each individual'sname to hide the infom1ationfor that individual.After the information is hidden, TIERSdisplays a plus sign next to the individual's name. I I Click the plus sign to disp lay information for the indrvidual. r.;i Sanchez, Sa 11 ena El HF Module 6: Individual Information VERSIGHT Pritchett S·9F , Hattie I N 53 TX-HHSC-20-0960-A-000070 TW BST: SNAP January 2020 Description The Relationship LUW is used to capture basic family relationship information for the household. This page is also where you begin entries for E&T exemptions. TIERS identifies household members eligible for the E&T exemption caring for a child under the age six based on your entry in the Provides care for? field on the Relationship - Details page. TIERS only allows one Yes answer selection per each child under age six. Reference the Relationship LUW job aid. Reference the SNAP Employment and Training (E&T) Exemptions in TIERS job aid. Steps 1. 2. 3. 4. 5. 6. 7. 8. 9. Select an individual listed under the page header, Relationship Details Select an individual in the other (right-hand side) list Select the appropriate relationships for the highlighted individuals Effective Begin Date: End Date: — Disabled (TIERS populates this information in the background) Reported On: Date Client Became Aware: Verification Received On: Purchase/prepare together? — Select whether the source individual (left column) purchases and prepares meals with the reference individual (right column) 10. If yes, physically able to purchase/prepare separately? — Select whether the source individual is physically able to prepare and purchase meals separately from the referenced individuals This can only be chosen if a household member is 60+(TWH A–210 Exception) 11. Fills Parental Role? — Select YES if the referenced individual is a child in the home and the source individual is responsible for their care 12. Tax Dependent? — Select NO for initial entries on a new SNAP application. For cases with history, do not change to a NO if already answered YES (unless you are working TANF). 13. Provides care for? — Select whether the source individual provides care for the referenced individual. 14. Provides support for? — Select NO. For cases with history, do not change to a NO if already answered YES. Module 6: Individual Information A\11 ~ 11(,J\ PVERSIGHT 54 TX-HHSC-20-0960-A-000071 TW BST: SNAP January 2020 15. Living Together? — Select YES when the source individual lives together with the referenced individual 16. Relationship Verification: 17. Click Update to post your entries so far into the Relationship Grid in the bottom of the page. (Going forward, repeat this step each time you need to post new entries into the Relationship Grid.) 18. Repeat these steps for each individual in the household. After you establish relationships in the Relationship Details and Relationship Information sections, scroll down to the Household Relationship Grid and continue with the steps below. 19. Review the Relationship Type for each set of individuals. To make corrections click on the relationship to display the dropdown menu 20. When all types are filled in, review the record for each set of individuals 21. Click Save 22. When all records show completed (Y), click Next Note: Be sure to check and revise entries in the bottom grid to reduce errors before you finish and exit this page. If you get an error message upon clicking Next, review the Record Completed column for any relationships marked N. Update the relationship information for those records and click Save. Module 6: Individual Information AMERICAN PVERSIGHT 55 TX-HHSC-20-0960-A-000072 TW BST: SNAP January 2020 Lesson 11: Education LUW Purpose Educational information is collected for all household members on this page. Objective Using information collected during the interview, accurately complete the Education Details page for all required household members according to policy. Policy TWH B–412 Students in Higher Education TWH A–1822 E&T Procedures TWH A–1323.1 Children’s Earned Income TWH A–1610 Eligibility Requirement (school attendance) Education - Summary Page i·il@H+i • Name • Individual # • Highest Level of Education Completed • Enrollment Status • Type of Educational Institution • Updated On kHl@H+i rifiil Description Collect education information for all household members who are 6 through 59 years of age, as required by SNAP. You must obtain this information from the individual since the Form H1010 does not provide highest grade completed. Step Select an individual and click Edit. This takes you to the Education - Details page where the education information for all household members aged 6 through 59 years is entered. Module 6: Individual Information PVERSIGHT 56 TX-HHSC-20-0960-A-000073 TW BST: SNAP January 2020 Education - Details Page I Individua l Information Name : Ind ividual # : ,, ,,, ,,, ;-; ;..- Dates , • Effective Begin Date: • Reported On: • Verification Received On: , , , , =; ,, , ~ ,F ilww End Date: • Date Client Became Aware: Age Information DOB : I High School Graduation 43 Age : Information • Status: B Status Ve rification: Status Verificat ion Date: Imm 6 Expected Graduation Date Ver ification: 1 / jnim,~t :~: :cted Graduation Graduation Date: /~ v1 Expected Graduation ~ jym""" l'riirii"""" t ~ , r;:;;;;;- L..:....JVe rification Date: I""" luu p n1 I Education Details • Highest Level of Education Completed: ~ • Education Level Ve rification: • Enrollment Status: B H.S. Diploma required? Enrollment Status Verification: FFCHE School Enrollment V erification: Type of Educational Institution: Type of Educational Institution Verification: B Verification Date: B Is this Individual enrolled in school? Does this include Shop Practice? B B Is this School located In Texas? School Name: FFCHE School Enrollment Ve rification Received Date: Enrolled in training program? Enrolled in program or work study? Able to work? Child care available? TANF: Should this person be enrolled? jnim/ ~ t B Imm I I F 1IYYYY G B Imm I /~ / IYYYY V jym""" B lvi L..:..J G G G Module 6: Individual Information VERSIGHT Ve rification Date: B Type : Hours Work Study/Week : I i---- If No, Verification: 57 TX-HHSC-20-0960-A-000074 TW BST: SNAP January 2020 Steps 1. 2. 3. 4. 5. 6. 7. Effective Begin Date: End Date — Disabled (TIERS populates this information in the background) Reported On: Date Client Became Aware: Verification Received On: High School Graduation Information — Status: Status Verification — Leave blank. This field is not mandatory for SNAP; however, if you select a Status Verification option then the Status Verification Date field becomes mandatory. 8. Highest level of Education Completed: 9. Verification: — Client Statement 10. Enrollment Status: — if Not Enrolled, skip down to step 13 11. Is this individual enrolled in school? 12. Type of Educational Institution: 13. Click Next Repeat these steps for each household member. When you finish entering education details, click Next to open the Education - School Attendance page. Module 6: Individual Information AMERICAN PVERSIGHT 58 TX-HHSC-20-0960-A-000075 TW BST: SNAP January 2020 Education - School Attendance Page D - IIndividual Information Nam e : er I V to nso r V Tyoe: oroanizaoon : If other . organ ization name : Ali en is a victim of s evere huma n tr afficlong with ~---approvestanttally retatQd to the need f0< benefits? __ USCI S has Iden~ battery sut>stan:oauyrelated rto the need f0< benefits? Does USC IS doc umentation nav e an e.xpiranon date? US CIS docum entatio n expiranon date: Is There ver lllcanon of the org aruzatlon no longer ex ists? Did the organization pcoVide ancome a.net resource s mfonnauon? v -_ -_ -_ -_ -_ ~ V ~ ~._ If law enforcement has extended an individual's status after the initia l 4 years , answer YES . V fnm 1 [o(i'"""1 Jr'fY [J I Module 6: Individual Information pVERSIGHT ~ e,;_J r.:;1 L.:.J 75 TX-HHSC-20-0960-A-000092 TW BST: SNAP January 2020 Alien/Refugee - Details Page, continued I Special tmmigranl Has this personbeen grantedspecial immigrant status? Registration USCISOocumenled US r- r- r- e, 1I 1I EntryOate: I Whatdate did this person begin to continuously reside in Ille United Stales? Continuous Residence Verification ResidenceBegin Dale Verification Alien Registralion Number: Special immigrant status elate: Imm ,i;- ,j:m""e:il:J IRef\lgeeInformation Nationality: Countryor Origin: Slaws Date Granted: ts !tie individual an unaccompanied refugee minor? Deportation I 11[;"""",liimji:J ~ [mm , i;- Decision Date: Expiration Oate: 11 r;--,r □ , Jr,w ~ Repealed: Dale: Fm,g-,f'iii:j □ AffidawtSigned: Oate: r,f:o'i""",twJ □ IEmergencyMedicalInformation Vetification: Is emergencycoveragefor laborlde lmlY'/: 8egin0ate: !verification Imm 1~,lm Begin Date y IEiJ EndOate: [mm , i;-,l EndOate Processed - m1 Ell I ~ i fil+li·Hi 81¥11 Description If the individual does not have legal documentation, you must select Undocumented on the Alien Status drop-down menu. This will deactivate the remaining fields on the page. If the individual has a USCIS document, you must enter it in TIERS and validate through SAVE. Non-citizens applying for SNAP benefits must show proof of acceptable alien status. Module 6: Individual Information pVERSIGHT 76 TX-HHSC-20-0960-A-000093 TW BST: SNAP January 2020 Verify alien status by: • Viewing the immigration document or card, and • Validating the card using SAVE’s VIS database You will see many different forms of documentation. Some of the most common include: • Permanent Resident Card, Form I-551 USCIS#—Legal Residence Number used to verify status in SAVE (Also known as Alien Registration Number) Category—describes why the individual is in the U.S. Use this code to identify the individual’s status in the TWH (Annotation) Resident Since—entry date, which is very important when verifying status in the TWH (also referred to as USCIS Documented US Entry Date). Document Type Card Number—enter this 13-digit number in TIERS after you select the Document Type (also referred to as Document ID). Module 6: Individual Information VERSIGHT 77 TX-HHSC-20-0960-A-000094 TW BST: SNAP • Employment Authorization Document, Form I-766 January 2020 USCIS#—Also referred to as Alien Registration Number Category—describes why the person is in the U.S. and identifies the individual’s status in the TWH. Also referred to as Annotation Card Number—also referred to as Document ID Document—Type of USCIS Issued Card Module 6: Individual Information ERSIGHT Expires—USCIS documentation expiration date 78 TX-HHSC-20-0960-A-000095 TW BST: SNAP • January 2020 Arrival-Departure Record, Form I-94 - Departur e N um be r 742831632 I I I I I . 01 I I I - - I EP 1 3 1991 (] --1../ 1-94 AOMllTteY Departu re Re cord r"7 /t~ C... J+ UNTIC 14. Fa m ily am e €. 15.F irst (Gi ven ) Nam e ~o.f r. r' , ' I I I I I 17.Co untr y o f Ci tizen shi p s: I r--> I c;,I L , A ,rJ tl , . - 7 I Im mi gra t ion and at u raliza ti on Se rvice .P,o ..-~ •• , • • _....,_'I..,.,_.._. - " See Other S ide I I I ' I ' . I ~ !CL.ASA? /1--1 I I I ' I 16 .Birt h Date 15;-z..--' ' (D ay / Mo/ Yrl ' Describes why the person is in the U.S.-use this to identify the category / annotation in the TWH ' - . I Admission Number-if the Admission Number starts with an “A” use SAVE to verify Make sure the name on the I-94 matches the name on the unexpired passport. -STAPLE HERE -· Warnin g - A nonimmi grant who acce pt s unaut hori zed emplo yment is subject to depo rta tion . Important - Retain thi s permit in your possession ;y ou must surrender it when y ou leave the U.S. Failur e to do so may delay your entr y into the U .S. in the futur e. You ar e authori z.ed to sta y in th e U.S. only unti l th e da te writt en o n t his form. To rema in pa t thi da te, without perm ission from immigratio n authorities , is a viola t ion of the law . Surrender thi permit when you leave the .S. : - By sea or air , to the trans por tation line· - Aero s the Canadia n bo rder , to a Cana d ian OfficiaJ; - Across the Mexican border , to a U .. Official. Studen ts planning to reenter the U.S. with in 30 day to ret urn to the same school , see "Arr ival- Departure " on page 2 of Form 1-20 prior to surrendering this permit. Record of Changes Port : Departure Record Date : Carrier: Flight #/ Ship Name : For sale by t h e Supe ri n t e11dent of Doc umt'n t s. .S . Government P r in ti ng Office Was hing ton . D.C. 20 4 02 Module 6: Individual Information VERSIGHT 79 TX-HHSC-20-0960-A-000096 TW BST: SNAP January 2020 Identify Information on USCIS Documents Activity There are a number of different immigration documents. The first step to determining the citizenship status for SNAP benefits is finding the information you need on the document a household provides so you can research the applicant’s citizenship status for potential eligibility. Instructions: View the USCIS documents below and answer the questions. PERMANENT RESIDE.NT CARD . . ··\ NAME CRITTENDE N, LEE W . INS A# 02 2 -3 45-679 Bi Sex M C Oi. Ca CA ·I Res i 07 /97 C1USA0223456791EAC9730053465<< 4910040M9411014CAN<<<<<<<<<<<9 CRITTENDEN<lnteg~ted Eligibthty Redesign Systm, - Web~e Diolog lnd1v.dual APTC lnformat lon 1 l/1/2014 Unearned Jnc:ome , l/1/201 4 T ax Status Informal.ton · 1/1/ 2014 This date should be the file date EOBC R.vn O•t• ·• .,. 4/ 18/1 4 4/ 23/ 14 4/ 28/ 14 , 13/ 1• • , 1e11• , , 13/ 14 , 118/1• , 123/ 14 '128/14 Confirm the LUWs have the correct EBD. If you did not update a date, navigate back to that LUW via the Left Nav. and update the Effective Begin Date before you click NEXT. Once you complete Individual Information - Run Eligibility, TIERS continues to run from the oldest date shown, even if you update the date later. Steps 1. Review pre-populated information 2. Do you want to assign a specific SNAP EDG used to issue EBT benefits on the ATA to this TIERS Case? — NO 3. Select Process: — Accept the default 4. Click Next Module 6: Individual Information VERSIGHT 94 TX-HHSC-20-0960-A-000111 TW BST: SNAP January 2020 Individual Information - Eligibility Summary • \ "l!V Individual Information - Eligibility Summary G) @ Caise Name: Vtews: , _, °'""9" l'assf.<>nl Logout summary Sanc hez , Sallena Awaiting EOG# H, 8 Ca se#: Disposition TOA \. Programs: Benetit Period Benefit Amount ($) Eligi bility CG Status (PRA Size Appeal w ith cont.benefit ) ~I_A_L_L_______ l_ •~I Pending VCL Authorization Status other (Overridden ) FS - NPA 05/01/2019- 5 0 NA FS-N PA 04109/2019-04130/2019 5 0 NA Authorization Date Description This page displays potential EDGs for the case. This is the first time you see a summary of the information entered in Individual Information. Review the information to ensure your entries up to this point are correct. It is important to review the summary information presented as it is. Correcting information as you discover it is much easier than waiting until the end of Data Collection. Note: TIERS builds one EDG for SNAP with separate Benefit Periods for each month. The last Benefit Period does not have an end date. This is the Ongoing Benefit Period and represents the benefits the household will receive for the remainder of the certification period. Module 6: Individual Information VERSIGHT 95 TX-HHSC-20-0960-A-000112 TW BST: SNAP January 2020 Steps 1. Review the eligibility results. 2. Ensure Benefit Periods are correct. Ask yourself: • Do the correct Benefit Periods display? • Do the correct months display? • Does the first Benefit Period begin with the file date? 3. Check CG Size for the household to ensure it reflects the correct number of individuals included in the Certified Group. If not, click on the month (start with application month) and look at the details. Module 6: Individual Information AMERICAN PVERSIGHT 96 TX-HHSC-20-0960-A-000113 TW BST: SNAP January 2020 •Summary ~~--.-.. ~~~:.. FS - EDG Summary Page FS- EOG Summary ~~ 0 El1gib11ity Summary C as e#: Cas e Name: Case C a se Statu..s: M o d e : In take Pe nd in g ED G Name: ED G # : TOA : FS - NPA Benefit Eli g ibi l ity status: Auth o r izat io n sta ,t us: Ce rtificat R evie w D u e Da te: P eriod : S pecial Re ·v iew S p e cial Re ·v ie •w Reason: Da te : ion Pe ri :od: - EOG l nfonna tiori: E li gi b il ity Beg in Da ,te : E ligi b ility Non Fina ncia l Resources Reaso nab le Co mpati bility Typ e Reasonab le Com patibility Resu lt Financial SNAP RA SC L :No End Date : Verification AutoDispose : No Previous BenefitAmount Curren! Benefit Amount Exp edited : No Suppleme nt ta te Delenni na!io n Date Overpayment Sho rt Ce rtifi catio n Suspens ion Non E&T County Ma nua l Issu ance Rein st at eme nt Reaso n For Late Determina ti on Foo d St am p St ream lined Repo rting Type MEPD Slream lined Redetermi natio n Su pplemen t Comments : Res tored Benefit Detai ls : Court Ord:er Original Benefit Ap prov ed Am ount Net Restorati on A mount Restored Bene fit Request Date Reason Household is Entitled to Benefits : Reason HHSC Owe s Benefit s : Name Certified G roup Relations hip Recomp ute d Benefit Resto red Offset A mo unt Indigent A lieri Work Participation Regist ratio n Status St atus EOG Group Member(s ) y Self NIA Eli gible Adu lt y Daughter NIA Eli gible Adu lt y Grandd aughter NIA Eli gible Ch ild: y Gre at Graridso n NIA Eli gible Ch ild' ExcJuded Group Membe r(s) < > Elig1bil1ty Summaiy Module 6: Individual Information VERSIGHT 1 97 TX-HHSC-20-0960-A-000114 TW BST: SNAP January 2020 Description Ensure all information is correct. When you need to correct information, use the Left Nav. to go back to the appropriate LUW and correct your entries. Check all household members to ensure they are listed. If someone is missing, check under the "Excluded" heading and click the hyperlink of the missing person's name to see details. Note: Only correct one LUW at a time, then re-run Individual Information – Run Eligibility. Correcting more than one LUW before EDGs are re-run could cause the error to escalate, making it more difficult to find and correct the error. Module 6: Individual Information AMERICAN PVERSIGHT 98 TX-HHSC-20-0960-A-000115 MEPD New Hire Part 1 January 2020 Module 9: Individual Information To process an application for assistance, you must collect information on each individual in the household. This module describes the information collected and the impact on eligibility for MSPs. Purpose This module describes non-financial eligibility factors that affect MEPD applicants, specifically clients applying for MSP. It also describes how to appropriately enter nonfinancial information in the Individual Information section of TIERS. • • Medicare status Support and maintenance Learning Objectives After completing this module, you will be able to correctly identify individual information and apply MEPD policy to the application scenarios provided. Lessons Lessons in this module include: • • • • • Individual Information Support and Maintenance Medicare Eligibility Automated Support Systems Individual Information in TIERS Individual Information VERSIGHT 1 TX-HHSC-20-0960-A-000116 MEPD New Hire Part 1 January 2020 Page Intentionally Left Blank Individual Information AMERICAN PVERSIGHT 2 TX-HHSC-20-0960-A-000117 MEPD New Hire Part 1 January 2020 Lesson 1: Individual Information ll~v erms Term Application for Assistance, Form H1200 and H1200EZ Definition The application form used by individuals applying for Medicare Savings Program (MSP) benefits. Data Broker Eligibility staff uses this intranet application to access online data about individuals. A number of sources compile the information into one Combined Report. Compare this information to the application and details from the interview to identify case discrepancies. This reduces the possibility of case error and fraud. Driver Flow A TIERS feature that automatically determines the appropriate Logical Units of Work that need to be scheduled during a Data Collection Interview mode and presents those LUW to the user. This allows the user to proceed by using the Next and Previous buttons, rather than having to use the Left Navigation Bar to access each LUW. Interview mode A particular mode that TIERS uses to determine the sequence of Logical Units of Work it presents during Data Collection. The Interview mode is typically determined by the type of action being taken on the case, for example, Intake (new application), Complete Action (redetermination), Change Action (processing a change), and so on. Electronic Data Sources (ELDS) Verification sources that are available electronically and presented to advisors in TIERS during Data Collection. Examples include Data Broker, Birth Verification Sources (BVS), and State Online Query (SOLQ). Logical Unit of Work (LUW) A grouping of information within TIERS. A logical unit of work may contain multiple pages. The LUW uses tabs to identify the various pages within it. TIERS saves the LUW to its database as a whole, meaning that information on individual pages within the LUW is not permanently saved until the entire LUW is saved. Medicare Medical coverage available to persons 65 years of age or older and to certain people with disabilities under Title XVIII of the Social Security Act. Individual Information 3 TX-HHSC-20-0960-A-000118 MEPD New Hire Part 1 January 2020 Information, primarily demographic, that is used to determine potential eligibility for a program. It does not Non-Financial Information include information about resources, income or expenses, which is considered financial information. State Online Query (SOLQ) A system that provides information from the Social Security Administration (SSA). It provides Medicare and SSI eligibility information, along with some individual demographics. SSI-Related Eligibility An individual can automatically meet MEPD nonfinancial eligibility requirements if the individual already meets Supplemental Security Income (SSI) criteria. For example, if the individual meets SSI requirements for age or disability, the individual meets MEPD requirements. Food or shelter that is provided to the client or that is purchased by someone else. Any cash payments given Support and Maintenance directly to the client for food or shelter are cash income and not in-kind support and maintenance. Third Party Resource Individual Information VERSIGHT A source of payment for medical expenses other than the client, the department, or Medicaid. 4 TX-HHSC-20-0960-A-000119 MEPD New Hire Part 1 January 2020 To determine an individual’s eligibility for a Medicare Savings Program, you need to review non-financial and financial eligibility information. This module describes nonfinancial eligibility factors. An individual may be potentially eligible for a MSP if the individual meets eligibility requirements, such as: • • • Aged (at least 65 years old) Blind Disabled The individual must also meet non-financial requirements: • • • • Medicare Part A recipient U.S. citizen Texas resident Social Security Number Generally, if an individual is receiving Medicare Part A, the individual has already met all SSI-related non-financial requirements. However, you must still identify and verify this information, according to policy, to determine the individual’s non-financial eligibility. D-1200 D-1300 D-1400 D-2100 D-3400-3520 D-3630 D-5200-5300 D-6200-6300 R-3730 Individual Information VERSIGHT 5 TX-HHSC-20-0960-A-000120 MEPD New Hire Part 1 January 2020 Activity: Age Requirements Which of these individuals meet the age requirement? Yes No 1. Clarence Oshman, born October 12, 1943 2. Doris Hunt, born May 13, 1964 3. Allan Wilson, born December 29, 1933 4. Louisa Waxman, born January 2, 1958 5. Leslie Doran, born May 20, 1944 Individual Information VERSIGHT 6 TX-HHSC-20-0960-A-000121 MEPD New Hire Part 1 January 2020 Activity: Disability Use the MEPDH section on disability to answer the following questions and recite the MEPDH section. 1. According to policy, an individual is considered blind if the visual acuity in the individual’s better eye is _________ or less with corrective lenses, or if the individual has tunnel vision that limits the field of vision to _______ degrees or less. 2. According to policy, an individual is considered disabled if the individual has a determinable physical or mental impairment that can be expected to result in death or has lasted or can be expected to last for a continuous period of at least _______ months. 3. A disability determination is not required if the individual is receiving Medicare or receiving disability benefits through ______________________________, ______________________________, or ______________________________. ME Individual Information pVERSIGHT 7 TX-HHSC-20-0960-A-000122 MEPD New Hire Part 1 January 2020 Residence The applicant must be a resident of Texas and intend to continue to live in Texas. Activity: Residence Use the MEPDH Residence section to answer the following questions and cite the handbook section. 1. Inez Rodgers, age 65, came to Texas on the 2nd of last month. Today is the 15th. She intends to make Texas her home. Is she considered a Texas resident? Why or why not? 2. Kathleen Clark, age 68, came to Texas to visit her aunt three months ago. She intends to return to New Mexico soon, but is unsure when. Is she considered a Texas resident? Why or why not? 3. Mary Bell, age 70, is an MSP recipient in Texas. She is visiting her daughter in New York for two months. Is she considered a Texas resident? Why or why not? ME Individual Information pVERSIGHT 8 TX-HHSC-20-0960-A-000123 MEPD New Hire Part 1 January 2020 Citizenship . ' . er Rememb Because Medicare is one of the eligibility criteria for MSP, documentation of citizenship is not required for MSP if the client states they are a U.S. citizen. If the individual is receiving Medicare this has already been established by SSA. Citizenship verification is an eligibility factor for other MAO programs. Activity: Citizenship Determine if these individuals meet the Citizenship requirements? 1. Siobhan Doyle, age 59, was born in Ireland. She married an American citizen twelve years ago and was legally admitted to the U.S. and naturalized. Does she meet citizenship/qualified alien requirements? 2. Thomas Cale, age 33, was born in the U.S. Virgin Islands and moved to Houston a year ago. Does he meet citizenship/qualified alien requirements? Why or why not? Individual Information 9 TX-HHSC-20-0960-A-000124 MEPD New Hire Part 1 January 2020 Non-Financial Eligibility Factors In addition to meeting categorical eligibility requirements, an individual applying for MSP must meet other non-financial requirements. Age Verify the individual’s age based on the Date of Birth (DOB) listed on the application H1200. Clarify the DOB through the State Online Query (SOLQ). Disability Check the application H1200 for information such as Medicare Claim Number or a YES answer to the question “Do you have Medicare Part A?” If the individual is receiving Medicare, the individual is assumed to be aged or disabled and does not require a disability determination. In the Income section of the form, check whether the individual is receiving benefits from Social Security or Railroad Retirement. You may have to contact the client and verify whether these are disability benefits, or you can verify the type of benefit through the SOLQ request in TIERS. Residence (Texas Residency & Intent to remain in Texas) On the application, verify that the individual’s address is a Texas address. Check that the individual has answered YES to the questions “Resident of Texas?” and “Do you plan to stay in Texas?” Once you request SOLQ, you can also match the application address against the address reported in SOLQ. Citizenship On the application, verify that the individual has answered YES to the question “U.S. Citizen?” You can also verify citizenship through SOLQ. Remember, if SSA has already established citizenship status, it is considered verified. If the individual is an alien, HHSC utilizes the Systematic Alien Verification for Entitlements (SAVE) system to verify the alien’s status. You will learn more about the SAVE system later in this module. Individual Information AMERICAN PVERSIGHT 10 TX-HHSC-20-0960-A-000125 MEPD New Hire Part 1 January 2020 Social Security Number On the application, check that the individual has provided the SSN. After requesting SOLQ, compare the SSN against the one listed in SOLQ. Remember, if the individual is receiving Medicare, the SSN has been verified by SSA. If an individual does not have an SSN, follow procedures in MEPDH D-6200 for encouraging the client to apply for a SSN. The individual must provide an SSN or be in the process of applying for one. Medicare Part A Individuals requesting MSP must have verification of current or conditional enrollment in Medicare Part A. In order to be eligible for Medicare Part A, the individual’s age, disability, citizenship and SSN status would have been determined by SSA. Therefore, in most instances, enrollment in Medicare Part A is itself verification of those other factors. However, the actual information and verification must still be recorded. Check the application to determine if the individual has declared enrollment of Medicare Part A. Verify the information through the SOLQ request. SOLQ or Medicare can be used as valid forms of verification for most non-financial eligibility criteria. Individual Information AMERICAN PVERSIGHT 11 TX-HHSC-20-0960-A-000126 MEPD New Hire Part 1 J Individual Information AMERICA pVERSIGHT January 2020 Individual-Non-Financial Quiz 12 TX-HHSC-20-0960-A-000127 MEPD New Hire Part 1 January 2020 Lesson 2: Support and Maintenance E-8000 – E-8160 Support and maintenance is food, and/or shelter provided to our client that is provided or purchased by someone else. Cash payments given directly to the client for food, or shelter are not considered in the support and maintenance calculations. These cash payments are considered gift income and will be discussed in a later module. Support and maintenance does not apply if: • The individual is applying for: o o o o • MBI MBIC Waiver programs Payment for an institutional setting facility Payments are infrequent and irregular When the individual is living in another's household for a full calendar month and is contributing nothing to the household's expense, count up to 1/3 FBR as in-kind income. Individual Information VERSIGHT 13 TX-HHSC-20-0960-A-000128 MEPD New Hire Part 1 January 2020 Support and Maintenance Quick Reference If the individual does contribute toward household expenses: 1. Determine monthly household expenses for such items as food, mortgage or rent, real property taxes, heating fuel, natural gas, electricity, water, and garbage collection. 2. Determine the applicant's pro-rata share of monthly household expenses by dividing the sum of these expenses by the total number of people living in the household, both adults and children. 3. If the applicant is: • Not paying pro-rata share, count up to 1/3 FBR as in-kind unearned income. • Paying pro-rata share, do not count any in-kind, unearned income for support and maintenance. • "Earmarking" the payments, i.e., something/nothing for food and/or something/nothing for shelter, determine the amount paid for each. o If payments made for each are each less than the pro-rata share of each, count up to 1/3 FBR. o If payment equals an earmarked pro-rata share of either food or shelter, but not both, count up to 1/3 FBR + 20. If 1/3 FBR is used, no opportunity for rebuttal is offered. If 1/3 FBR + 20 is used and it causes ineligibility, prior to denial the individual must be offered an opportunity to rebut and show that the actual value of support and maintenance is less. Appendix XIV In-Kind Support & Maintenance Charts & worksheets Individual Information VERSIGHT 14 TX-HHSC-20-0960-A-000129 MEPD New Hire Part 1 -.. . ......... January 2020 Support and Maintenance .,-■■ 1. Randy Johnson is a MSP applicant who is living with his daughter in her home. He does not contribute any money toward household expenses. Action: Count 1/3 FBR as unearned income. No rebuttal is allowed. Individual Information pVERSIGHT 15 TX-HHSC-20-0960-A-000130 MEPD New Hire Part 1 January 2020 Randy Johnson DETERMINING IN-KIND SUPPORT AND MAINTENANCE FOR CLIENT LIVING IN ANOTHER PERSON’S HOUSEHOLD If client is not contributing to the Household expenses, then: Count 1/3 FBR. No rebuttal allowed. If Community Attendant Services, count 1/3 FBR + 20 If client is making a contribution for General Household expenses, then: $ Total HH expenses for Room +$ + Total HH expenses for Board $ Balance ÷ __________# of people in HH $ Client’s Total Prorata Share Compare: $_____Client’s Payment ≥ $______Client’s Total Prorata Share: No S&M $_____Client’s Payment < $______Client’s Total Prorata Share: Count 1/3 FBR. No rebuttal If CAS Situation: Count 1/3 FBR +$20. Can rebut. $ -$ $ Client’s Total Prorata Share - Client’s Payment Actual Value Considered up to 1/3 FBR + $20 Go to Page 2 for Earmarked Situations Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, and property taxes. Food: meals/groceries. Individual Information VERSIGHT 16 TX-HHSC-20-0960-A-000131 MEPD New Hire Part 1 January 2020 2. Emily Evans is a MSP recipient who is living with her daughter in her daughter's home. She contributes $50.00 per month toward general household expenses. Total expenses for the household are room $400.00 and board $350.00 Action: Count 1/3 of current FBR as unearned income. No rebuttal is allowed. Individual Information AMERICAN PVERSIGHT 17 TX-HHSC-20-0960-A-000132 MEPD New Hire Part 1 January 2020 Emily Evans DETERMINING IN-KIND SUPPORT AND MAINTENANCE FOR CLIENT LIVING IN ANOTHER PERSON’S HOUSEHOLD If client is not contributing to the Household expenses, then: Count 1/3 FBR. No rebuttal allowed. If Community Attendant Services, count 1/3 FBR + 20 C -:> If client is making a contribution for General Household expenses, then: $ 400.00 Total HH expenses for Room +$ 350.00 + Total HH expenses for Board $ 750.00 Balance ÷ ___2______# of people in HH $ 375.00 Client’s Total Prorata Share Compare: $ _____ Client’s Payment ≥ $______Client’s Total Prorata Share: No S&M $ 50.00 Client’s Payment < $375.00 Client’s Total Prorata Share: Count 1/3 FBR. No rebuttal YES If CAS Situation: Count 1/3 FBR +$20. Can rebut. $ -$ $ Client’s Total Prorata Share - Client’s Payment Actual Value Considered up to 1/3 FBR + $20 Go to Page 2 for Earmarked Situations Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, and property taxes. Food: meals/groceries. Individual Information VERSIGHT 18 TX-HHSC-20-0960-A-000133 MEPD New Hire Part 1 January 2020 3. Ofelia Swains is a MSP applicant who is living with her daughter and her daughter’s spouse and two children in their home. Mrs. Swains contributes $75.00 towards monthly household expenses. Total expenses for the household are room $200.00 and board $175.00 Action: Do not count support and maintenance. Individual Information AMERICAN PVERSIGHT 19 TX-HHSC-20-0960-A-000134 MEPD New Hire Part 1 January 2020 Ofelia Swains DETERMINING IN-KIND SUPPORT AND MAINTENANCE FOR CLIENT LIVING IN ANOTHER PERSON’S HOUSEHOLD If client is not contributing to the Household expenses, then: Count 1/3 FBR. No rebuttal allowed. If Community Attendant Services, count 1/3 FBR + 20 If client is making a contribution for( General Household ~expenses, then: $200.00 Total HH expenses for Room +$175.00 + Total HH expenses for Board $375.00 Balance ÷ 5 # of people in HH $ 75.00 Client’s Total Prorata Share Compare: $75.00 Client’s Payment ≥ $ 75.00 Client’s Total Prorata Share: No S&M $_____Client’s Payment < $______Client’s Total Prorata Share: Count 1/3 FBR. No rebuttal If CAS Situation: Count 1/3 FBR +$20. Can rebut. $ -$ $ Client’s Total Prorata Share - Client’s Payment Actual Value Considered up to 1/3 FBR + $20 Go to Page 2 for Earmarked Situations Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, and property taxes. Food: meals/groceries. Individual Information VERSIGHT 20 TX-HHSC-20-0960-A-000135 MEPD New Hire Part 1 January 2020 4. Rosie Russell is a MSP applicant who is living with her son, his spouse and two children. Expenses are: Room $500.00 and Board $500.00. She contributes $120.00 per month for food but does not contribute toward other household expenses. Action: Deduct payment from total pro-rata share. Count 1/3 current FBR + $20.00 as in-kind income. Client can rebut. After rebuttal, countable support and maintenance is $80.00 Individual Information AMERICAN PVERSIGHT 21 TX-HHSC-20-0960-A-000136 MEPD New Hire Part 1 January 2020 Rosie Russell If client is making an earmarked payment toward HH expenses: $500.00 $500.00 Total HH Exp. For Room ÷ Total HH Exp. For Board ÷ 5 # of People in HH $ 100.00 Client’s Share of Room 5 # of People in HH $+100.00 + Client’s Share of Board $ 200.00 Client’s Total Prorata Share Client pays $120 Board, $0 Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. $0 <$100 Compare Client’s Payment for Board to Client’s Prorata Share for Board. $120>$100 If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M NO If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. NO If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 YES 0 ** If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. $ 200.00 Client’s Total Prorata Share $ -120.00 - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 80.00 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. I I I 1Compare Client’s Payment for Room to Client’s Prorata Share for Room. $ Total HH Exp. For Room  # of People in HH $ Client’s Share of Room If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries Individual Information VERSIGHT 22 TX-HHSC-20-0960-A-000137 MEPD New Hire Part 1 January 2020 5. Jacob Jones is a MSP applicant who is living with his son in his home. The total amount of household expenses are $100.00 for room and $60.00 for electricity and $120.00 for board. Mr. Jones contributes $50.00 for room and $50.00 for board. Action: Count 1/3 FBR as both are less than the fair share amount. Individual Information AMERICAN PVERSIGHT 23 TX-HHSC-20-0960-A-000138 MEPD New Hire Part 1 January 2020 Jacob Jones If client is making an earmarked payment toward HH expenses: $160.00 $120.00 Total HH Exp. For Room ÷ Total HH Exp. For Board ÷ 2 # of People in HH $ 80.00 Client’s Share of Room 2 # of People in HH $+ 60.00 + Client’s Share of Board $ 140.00 Client’s Total Prorata Share Client pays $50 Room, $50 Board Compare Client’s Payment for Room to Client’s Prorata Share for Room. $50 vs $80 R Compare Client’s Payment for Board to Client’s Prorata Share for Board. $50 vs $60 B If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M NO If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. YES If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. $ Client’s Total Prorata Share $- - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room  1- # of People in HH $ Client’s Share of Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries. Individual Information VERSIGHT 24 TX-HHSC-20-0960-A-000139 MEPD New Hire Part 1 January 2020 6. Frank Martin is a MSP applicant living with his sister in her home. He contributes $150.00 for rent and nothing for groceries. The total room is $300.00, and board is $300.00. Action: Deduct payment from total fair share. Count up to 1/3 FBR + $20.00. Individual Information AMERICAN PVERSIGHT 25 TX-HHSC-20-0960-A-000140 MEPD New Hire Part 1 January 2020 Frank Martin If client is making an earmarked payment toward HH expenses: $300.00 $300.00 Total HH Exp. For Room ÷ Total HH Exp. For Board ÷ 2 # of People in HH $ 150.00 Client’s Share of Room 2 # of People in HH $+150.00 + Client’s Share of Board $ 300.00 Client’s Total Prorata Share Client pays $150 Room, $0 Board Compare Client’s Payment for Room to Client’s Prorata Share for Room. $150 vs $150 R Compare Client’s Payment for Board to Client’s Prorata Share for Board. $ 0 vs $150 B If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M NO If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. NO If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 YES ** If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. 0 $ 300.00 Client’s Total Prorata Share lc----=,I $ -150.00 - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 150.00 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room  1- # of People in HH $ Client’s Share of Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries Individual Information VERSIGHT 26 TX-HHSC-20-0960-A-000141 MEPD New Hire Part 1 January 2020 Rental Subsidy Rental subsidy is unearned income that represents support and maintenance from outside the household. Rental subsidy policy applies when: • • • Someone in the household has a rental liability; The rental property is owned by a parent or child of someone in the household; The One-Third Reduction Rule (1/3 FBR) does not apply. In rental subsidy situations (support and maintenance from outside the household), consider the following: • If the amount of rent required by the property owner equals or exceeds either the current market rental value (CMRV) or 1/3 FBR + $20.00 Then: Count no S/M • If the amount of rent required by the property owner is less than both the CMRV and 1/3 FBR + $20.00 Then: Calculate as follows: CMRV - Amount Required = or 1/3 FBR + $20.00 - Amount Required = Count whichever amount is less, but never more than 1/3 FBR + $20.00 Individual Information VERSIGHT 27 TX-HHSC-20-0960-A-000142 MEPD New Hire Part 1 -.. . ......... January 2020 Rental Subsidy .,-■■ 1. Ernest Jeffery is a MSP applicant who lives in a house owned by his son. Mr. Jeffery pays $30.00 a month for home insurance and taxes. The rental value of the home is $350.00 monthly including utilities. Action: Count 1/3 FBR + $20.00 as unearned income. If this is rebutted, take CMRV minus payment up to a maximum value of 1/3 current FBR + $20.00 or take 1/3 FBR + $20.00 minus the payment and count whichever is less. Individual Information pVERSIGHT 28 TX-HHSC-20-0960-A-000143 MEPD New Hire Part 1 January 2020 Ernest Jeffery- Client pays $30.00 Determining In-Kind Support and Maintenance For Rental Subsidy Situations Rental Subsidy is help for household expenses from outside. Client has an obligation to pay rent, but may not be making full or any payment. When client is paying equal to or more than CMRV or the 1/3 FBR + 20, then: NO S & M counted. When client pays less than CMRV, then: Calculation #1 Calculation #2 $ 350.00 Current Market Rental Value $ 281.00 1/3 FBR + 20 $ - 30.00 - Client’s Payment $ - 30.00 - Client’s Payment $*320.00 Difference to Compare to $* 251.00 Difference to Compare to '--2nd Calculation 1st Calculation *Count lesser amount up to 1/3 FBR + 20 ,,,,.--- If client is also receiving help for household expenses paid directly to the vendor from inside, and then do the following: Step 1: Complete the above; Step 2: Complete the following; $ Client’s Prorata $- - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 Step 3: Add Step 1 and Step 2. Count up to 1/3 FBR + 20. Any cash given to the client for household expenses or anything else = cash income CMRV: Current Market Rental Value Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries Individual Information VERSIGHT 29 TX-HHSC-20-0960-A-000144 MEPD New Hire Part 1 January 2020 2. Same situation as #1, except the rental value of this home is $100.00 monthly. Action: Count 1/3 FBR + $20.00 as unearned income. If this is rebutted, take CMRV minus payment up to a maximum value of 1/3 current FBR +$20.00 or 1/3 FBR +$20.00 minus the payment and count whichever is less. Individual Information AMERICAN PVERSIGHT 30 TX-HHSC-20-0960-A-000145 MEPD New Hire Part 1 January 2020 Ernest Jeffery- Client pays $30.00 Determining In-Kind Support and Maintenance For Rental Subsidy Situations Rental Subsidy is help for household expenses from outside. Client has an obligation to pay rent but may not be making full or any payment. When client is paying equal to or more than CMRV or the 1/3 FBR + 20, then: NO S & M counted. When client pays less than CMRV, then: Calculation #1 Calculation #2 $100.00 Current Market Rental Value $ 281.00 1/3 FBR + 20 $ -30.00 - Client’s Payment $ - 30.00 - Client’s Payment $*70.00 Difference to Compare to $ *251.00 Difference to Compare to 2nd Calculation 1st Calculation *Count lesser amount up to 1/3 FBR + 20 If client is also receiving help for household expenses paid directly to the vendor from inside, and then do the following: Step 1: Complete the above; Step 2: Complete the following; $ Client’s Prorata $- - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 Step 3: Add Step 1 and Step 2. Count up to 1/3 FBR + 20. Any cash given to the client for household expenses or anything else = cash income CMRV: Current Market Rental Value Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries Individual Information VERSIGHT 31 TX-HHSC-20-0960-A-000146 MEPD New Hire Part 1 January 2020 3. Same as situation #1 except Mr. Jeffrey pays his son $290.00 a month for home insurance and taxes. The rental value is still $350.00. Action: No S/M counted as the rent required by the landlord equals or exceeds 1/3 FBR + $20.00. Individual Information 32 TX-HHSC-20-0960-A-000147 MEPD New Hire Part 1 January 2020 Ernest Jeffery- Client pays $280.00 Determining In-Kind Support and Maintenance For Rental Subsidy Situations Rental Subsidy is help for household expenses from outside. Client has an obligation to pay rent but may not be making full or any payment. When client is paying equal to or more than CMRV or the 1/3 FBR + 20, then: NO S & M counted. $290.00 > $281.00 When client pays less than CMRV, then: Calculation #1 Calculation #2 $ Current Market Rental Value $ 1/3 FBR + 20 $- - Client’s Payment $- - Client’s Payment $* Difference to Compare to $* Difference to Compare to 2nd Calculation 1st Calculation *Count lesser amount up to 1/3 FBR + 20 If client is also receiving help for household expenses paid directly to the vendor from inside, and then do the following: Step 1: Complete the above; Step 2: Complete the following; $ Client’s Prorata $- - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 Step 3: Add Step 1 and Step 2. Count up to 1/3 FBR + 20. Any cash given to the client for household expenses or anything else = cash income CMRV: Current Market Rental Value Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries Individual Information VERSIGHT 33 TX-HHSC-20-0960-A-000148 MEPD New Hire Part 1 January 2020 4. Roman Silva is applying for benefits. He lives in a house owned by his daughter rent free. CMRV is $575.00 per month. Roman pays all the utilities directly to the company and purchases his own food. Use Worksheet C. Client is receiving help from outside as this is a rent-free situation. Action: Count 1/3 FBR + $20.00 as support and maintenance Individual Information AMERICAN PVERSIGHT 34 TX-HHSC-20-0960-A-000149 MEPD New Hire Part 1 January 2020 Example Roman Silva Appendix XIV – Worksheet C Determining In-Kind Support and Maintenance For Rent Free-Situations Rent-free situations are when the client has no obligation to pay. The client may be making a voluntary payment. These situations are considered help from outside. No Payment: Count 1/3 FBR + 20. If ineligible, complete following: $ 575.00 $ -0- $ 575.00 CMRV - Client’s Payment Actual Value considered up to 1/3 FBR + 20 Voluntary Payment: Count 1/3 FBR + 20. If ineligible, complete the following: $ CMRV $- - Client’s Voluntary Payment $ Actual Value considered up to 1/3 FBR + 20 If client is receiving help for household expenses paid directly to the vendor from inside, then do the following: $ Client’s Pro-rata $ - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 If client receiving help for household expenses from outside (which is not given in cash to the household), complete the following charts: $ CMRV $ - Household Payment Toward Item $ Balance $ $ (Balance) ÷ # of Household members = Actual value to individual (Client) up to 1/3 FBR + 20 $ Client’s Pro-rata of Household Payment $ - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 Combine both values. Count up to 1/3 FBR + 20. Any cash given to the client for household expenses or anything else = cash income. CMRV: Current Market Rental Value Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, & property taxes Food: meals/groceries Individual Information VERSIGHT 35 TX-HHSC-20-0960-A-000150 MEPD New Hire Part 1 January 2020 5. Shana Stevens lives in her own home. Her adult son lives with her. Shana pays the cost of butane. Her son pays the electricity bill directly to SWEPCO. They have a water well with an electric pump and do not receive a water bill. Each buys their own groceries. The monthly average for butane is $35.00 per month. The monthly average for electricity is $80.00 per month. Use Worksheet D. The principle of 1/3 FBR + $20.00 applies. Client's rebuttal shows that actual value is less. Computation of actual value is as follows: $35.00 Butane + $80.00 Electricity = $115.00 Total Household Shelter Costs $115.00 ÷ 2 = $57.50. Client's pro-rata share = $57.50. Action: Consider $22.50 as support and maintenance rather than the 1/3 FBR + $20.00 since it is the lesser of the two. Individual Information AMERICAN PVERSIGHT 36 TX-HHSC-20-0960-A-000151 MEPD New Hire Part 1 January 2020 Example Shana Stevens Appendix XIV – Worksheet D Determining In-Kind Support and Maintenance For Own Household or Home Ownership/Interest Situations If client is receiving help for household expenses from outside, count 1/3 FBR + 20. If ineligible, complete the following: $ CMRV of Item $- - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 $35 + $80 = $115 ÷ 2 = $57.50 Total Pro-rata Share If client is receiving help for household expenses paid directly to the vendor from inside, count 1/3 FBR + 20. If ineligible, complete the following: $ 57.50 Client’s Pro-rata $- 35.00 - Client’s Payment $ 22.50 Actual Value considered up to 1/3 FBR + 20 If client is receiving help for household expenses from outside (which is not given in cash to the household), complete the following: $ Current Market Value of Item $- - Household Payment Toward Item $ Balance $ $ (Balance) ÷ # of Household members = Actual value to individual (client) up to 1/3 FBR + 20 $ Client’s Pro-rata of Household Payment $- - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 Combine both values. Count up to 1/3 FBR + 20. Any cash given to the client for household expenses or anything else = cash income CMRV: Current Market Rental Value Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, & property taxes Food: meals/groceries Individual Information VERSIGHT 37 TX-HHSC-20-0960-A-000152 MEPD New Hire Part 1 January 2020 Activity: Support and Maintenance For each of the following case examples, determine the value of support and maintenance. When applicable apply rebuttal procedures. Use the charts in the handbook & worksheets to help with your decision. 1. James Sullivan, a MSP applicant, lives with his sister in her home. His sister's spouse and their child are also living in the household. They report the following monthly household expenses: house payment and utilities = $320.00, groceries = $240.00. Mr. Sullivan does not pay for any bills. ME Individual Information pVERSIGHT 38 TX-HHSC-20-0960-A-000153 MEPD New Hire Part 1 January 2020 James Sullivan DETERMINING IN-KIND SUPPORT AND MAINTENANCE FOR CLIENT LIVING IN ANOTHER PERSON’S HOUSEHOLD If client is not contributing to the Household expenses, then: Count 1/3 FBR. No rebuttal allowed If Community Attendant Services, count 1/3 FBR + 20 If client is making a contribution for General Household expenses, then: $ Total HH expenses for Room + + Total HH expenses for Board Balance ÷ # of people in HH $ Client’s Total Prorata Share Compare: $_____Client’s Payment ≥ $ _____ Client’s Total Prorata Share: No S&M $_____Client’s Payment < $______Client’s Total Prorata Share: Count 1/3 FBR. No rebuttal If CAS Situation: Count 1/3 FBR +$20. Can rebut. $ -$ $ Client’s Total Prorata Share - Client’s Payment Actual Value Considered up to 1/3 FBR + $20 Go to Page 2 for Earmarked Situations Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, and property taxes. Food: meals/groceries. Individual Information VERSIGHT 39 TX-HHSC-20-0960-A-000154 MEPD New Hire Part 1 January 2020 2. Eleanor Connor, a MSP applicant, lives with her son in his home. They report the following monthly household expenses: rent and utilities = $175.00, groceries = $175.00. Mrs. Connor contributes $185.00 towards monthly household expenses. Individual Information AMERICAN PVERSIGHT 40 TX-HHSC-20-0960-A-000155 MEPD New Hire Part 1 January 2020 Eleanor Connor DETERMINING IN-KIND SUPPORT AND MAINTENANCE FOR CLIENT LIVING IN ANOTHER PERSON’S HOUSEHOLD If client is not contributing to the Household expenses, then: Count 1/3 FBR. No rebuttal allowed If Community Attendant Services, count 1/3 FBR + 20 If client is making a contribution for General Household expenses, then: Total HH expenses for Room + Total HH expenses for Board Balance ÷ # of people in HH Client’s Total Prorata Share Compare: $Client’s Payment ≥ $ _Client’s Total Prorata Share: No S&M $_____Client’s Payment < $______Client’s Total Prorata Share: Count 1/3 FBR. No rebuttal If CAS Situation: Count 1/3 FBR +$20. Can rebut. $ -$ $ Client’s Total Prorata Share - Client’s Payment Actual Value Considered up to 1/3 FBR + $20 Go to Page 2 for Earmarked Situations Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, and property taxes. Food: meals/groceries. Individual Information VERSIGHT 41 TX-HHSC-20-0960-A-000156 MEPD New Hire Part 1 January 2020 3. Lou Mayer, a MSP applicant, lives with her son in his home. They report the following monthly household expenses: rent and utilities = $500.00, groceries = $200.00. Mrs. Mayer does not contribute toward rent and utilities but does contribute $100.00 for groceries. Individual Information AMERICAN PVERSIGHT 42 TX-HHSC-20-0960-A-000157 MEPD New Hire Part 1 January 2020 Lou Mayer If client is making an earmarked payment toward HH expenses: $ Total HH Exp. For Room ÷ # of People in HH $ Client’s Share of Room $ Total HH Exp. For Board ÷ # of People in HH $+ + Client’s Share of Board $ Client’s Total Pro-rata Share Client pays $100.00 for Board, $0 for Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. Compare Client’s Payment for Board to Client’s Prorata Share for Board. If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 ** If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. $ Client’s Total Pro-rata Share $- - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room 11 # of People in HH $ I I Compare Client’s Payment for Room to Client’s Prorata Share for Room. Client’s Share of Room If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries Individual Information VERSIGHT 43 TX-HHSC-20-0960-A-000158 MEPD New Hire Part 1 January 2020 4. Broderick Morgan, a MSP applicant, lives in a house owned by his son. Mr. Morgan pays $65.00 a month for a home improvement loan required by his son and pays his own utilities, which average $35.00 a month. The rental value of the house is verified as $175.00 without utilities. Individual Information AMERICAN PVERSIGHT 44 TX-HHSC-20-0960-A-000159 MEPD New Hire Part 1 January 2020 Broderick Morgan- Client pays $65.00 and utilities Determining In-Kind Support and Maintenance For Rental Subsidy Situations Rental Subsidy is help for household expenses from outside. Client has an obligation to pay rent but may not be making full or any payment. When client is paying equal to or more than CMRV or the 1/3 FBR + 20, then: NO S & M counted. When client pays less than CMRV, then: Calculation #1 Calculation #2 Current Market Rental Value 1/3 FBR + 20 - Client’s Payment - Client’s Payment Difference to Compare to Difference to Compare to 2nd Calculation 1st Calculation *Count lesser amount up to 1/3 FBR + 20 If client is also receiving help for household expenses paid directly to the vendor from inside, and then do the following: Step 1: Complete the above; Step 2: Complete the following; $ Client’s Prorata $- - Client’s Payment $ Actual Value considered up to 1/3 FBR + 20 Step 3: Add Step 1 and Step 2. Count up to 1/3 FBR + 20. Any cash given to the client for household expenses or anything else = cash income CMRV: Current Market Rental Value Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries Individual Information VERSIGHT 45 TX-HHSC-20-0960-A-000160 MEPD New Hire Part 1 January 2020 5. Jan Minton, a MSP applicant, lives with her daughter in her daughter's home. Also living with them is her daughter's child. They report the following household expenses: rent and utilities = $85.00, groceries = $370.00 (including $195.00 which is paid with Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps). Ms. Minton contributes $146.00 toward monthly household expenses. Individual Information AMERICAN PVERSIGHT 46 TX-HHSC-20-0960-A-000161 MEPD New Hire Part 1 January 2020 Jan Minton DETERMINING IN-KIND SUPPORT AND MAINTENANCE FOR CLIENT LIVING IN ANOTHER PERSON’S HOUSEHOLD If client is not contributing to the Household expenses, then: Count 1/3 FBR. No rebuttal allowed. If Community Attendant Services, count 1/3 FBR + 20 If client is making a contribution for General Household expenses, then: Total HH expenses for Room + Total HH expenses for Board Balance ÷ # of people in HH Client’s Total Prorata Share Compare: $Client’s Payment ≥ $ Client’s Total Prorata Share: No S&M $_____Client’s Payment < $______Client’s Total Prorata Share: Count 1/3 FBR. No rebuttal If CAS J Situation: Count 1/3 FBR +$20. Can rebut. $ -$ $ Client’s Total Prorata Share - Client’s Payment Actual Value Considered up to 1/3 FBR + $20 Go to Page 2 for Earmarked Situations Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection, and property taxes. Food: meals/groceries. Individual Information VERSIGHT 47 TX-HHSC-20-0960-A-000162 MEPD New Hire Part 1 January 2020 6. Joe Grant is applying for MSP. Mr. Grant lives with his daughter and her two children in her home. They report the following total household expenses: rent = $900.00 and board = $500.00. Mr. Grant pays only $100.00 towards the rent and does not pay anything towards his board. Individual Information AMERICAN PVERSIGHT 48 TX-HHSC-20-0960-A-000163 MEPD New Hire Part 1 January 2020 Joe Grant If client is making an earmarked payment toward HH expenses: $ Total HH Exp. For Room ÷ # of People in HH $ Client’s Share of Room $ Total HH Exp. For Board ÷ # of People in HH $+ + Client’s Share of Board $ Client’s Total Prorata Share Client pays $100 Room, $0 Board Compare Client’s Payment for Room to Client’s Prorata Share for Room. Compare Client’s Payment for Board to Client’s Prorata Share for Board. If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room  1- # of People in HH $ Client’s Share of Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries. Individual Information VERSIGHT 49 TX-HHSC-20-0960-A-000164 MEPD New Hire Part 1 January 2020 7. John Hill, a MSP applicant, has advised that he is currently residing with his son George and George’s spouse in their home. They report the following household expenses: rent= $500.00 and board = $600.00. Mr. Hill states his son does not charge him for rent, but he does contribute $210.00 towards his board. Individual Information AMERICAN PVERSIGHT 50 TX-HHSC-20-0960-A-000165 MEPD New Hire Part 1 January 2020 John Hill If client is making an earmarked payment toward HH expenses: $ Total HH Exp. For Room $ Total HH Exp. For Board ÷ # of People in HH ÷ # of People in HH 11= Client’s Share of Room $+ + Client’s Share of Board $ Client’s Total Prorata Share I I Client pays $0 Room, $210.00 Board Compare Client’s Payment for Room to Client’s Prorata Share for Room. Compare Client’s Payment for Board to Client’s Prorata Share for Board. If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room  1- # of People in HH $ Client’s Share of Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries. Individual Information VERSIGHT 51 TX-HHSC-20-0960-A-000166 MEPD New Hire Part 1 January 2020 8. Wendy George is an MSP applicant who lives with her daughter. They report the following household expenses: room = $800.00 and board = $400.00. Ms. George pays $225.00 for board expenses but her daughter pays for the total amount of room expenses. Individual Information AMERICAN PVERSIGHT 52 TX-HHSC-20-0960-A-000167 MEPD New Hire Part 1 January 2020 Wendy George If client is making an earmarked payment toward HH expenses: $ $ Total HH Exp. For Room ÷ Total HH Exp. For Board ÷ # of People in HH $ $ Client’s Share of Room # of People in HH $+ $ + Client’s Share of Board Client’s Total Prorata Share Client pays $0 Room, $225 Board Compare Client’s Payment for Room to Client’s Prorata Share for Room. Compare Client’s Payment for Board to Client’s Prorata Share for Board. If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room  1- # of People in HH $ Client’s Share of Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries. Individual Information VERSIGHT 53 TX-HHSC-20-0960-A-000168 MEPD New Hire Part 1 January 2020 9. Trey Scott is a MSP applicant who is living with his daughter and his daughter’s spouse and one child in their home. They report the following household expenses: room = $485.00 and board = $300.00. Mr. Scott contributes $175.00 towards room expenses and $100.00 towards his board. Individual Information AMERICAN PVERSIGHT 54 TX-HHSC-20-0960-A-000169 MEPD New Hire Part 1 January 2020 Trey Scott If client is making an earmarked payment toward HH expenses: $ Total HH Exp. For Room ÷ # of People in HH $ $ Total HH Exp. For Board ÷ # of People in HH +$ Client’s Share of Room + Client’s Share of Board $ Client’s Total Prorata Share Client pays $175.00 Room, $100.00 Board Compare Client’s Payment for Room to Client’s Prorata Share for Room Compare Client’s Payment for Board to Client’s Prorata Share for Board. If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. $ Client’s Total Prorata Share $ - Client’s Total Payment $ Actual Value Considered up to 1/3 FBR + 20 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room  1- # of People in HH $ Client’s Share of Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries. Individual Information VERSIGHT 55 TX-HHSC-20-0960-A-000170 MEPD New Hire Part 1 January 2020 10. Sydney Lashay is applying for CAS benefits. She advises that she lives with her son and his wife in their home. They report the following household expenses are: room = $780.00 and board= $400.00. Ms. LaShay reports she does not contribute towards the room but does contribute $75.00 towards her board. Individual Information AMERICAN PVERSIGHT 56 TX-HHSC-20-0960-A-000171 MEPD New Hire Part 1 January 2020 Sydney Lashay If client is making an earmarked payment toward HH expenses: $ Total HH Exp. For Room ÷ # of People in HH $ Client’s Share of Room $ Total HH Exp. For Board ÷ # of People in HH +$ + Client’s Share of Board $ Client’s Total Prorata Share Client pays $0 Room, $75 Board Compare Client’s Payment for Room to Client’s Prorata Share for Room Compare Client’s Payment for Board to Client’s Prorata Share for Board. If BOTH Client Payments are > Client’s Prorata Share for BOTH: No S & M If BOTH Client Payments are < Client’s Prorata Share for BOTH: Count 1/3 FBR. No rebuttal. If CAS situation: Count 1/3 FBR + 20. Can rebut. $ Client’s Total Prorata Share $ - Client’s Total Payment Actual Value Considered up to 1/3 FBR + 20 If ONE of Client Payments is ≥ Client's Prorata Share for that item: Count 1/3 FBR + 20. If ineligible, can rebut. *. Client’s Total Prorata Share - Client’s Total Payment Actual Value Considered up to 1/3 FBR + 20 If client purchases and maintains food separately, then: Count 1/3 FBR + 20. If ineligible, can rebut. $ Total HH Exp. For Room  1- # of People in HH $ Client’s Share of Room Compare Client’s Payment for Room to Client’s Prorata Share for Room. If Client’s Payment for Room is > Client’s Prorata Share for Room: No S & M If Client’s Payment for Room is < Client’s Prorata Share for Room: $ Client’s Total Prorata Share for Room $- - Client’s Total Payment for Room $ Actual Value Considered up to 1/3 FBR + 20 Shelter: mortgage payments, rent, gas, electricity, heating fuel, water, sewer, garbage collection & property taxes Food: meals/groceries. Individual Information VERSIGHT 57 TX-HHSC-20-0960-A-000172 MEPD New Hire Part 1 January 2020 Support and Maintenance Quiz I I r. The quiz is based on 2020 limits e b m e em • R Individual Information 58 TX-HHSC-20-0960-A-000173 MEPD New Hire Part 1 January 2020 Lesson 3: Medicare Eligibility A-9000 – A-9210 In this lesson you will learn how Medicare eligibility affects eligibility for MEPD applicants and recipients. Receipt of Medicare is a key factor in determining eligibility for Medicare Savings Programs. Medicare is a federal program administered by the Social Security Administration. There are four parts of Medicare: • Part A: Hospital Insurance includes: o Inpatient care in hospitals and skilled nursing facilities o Hospice services o Home health care services • Part B: Medical Insurance includes: o Medically necessary services o Preventative services • Part C: Medicare Advantage Plans are a private health care option. Plans all work differently. • Part D: Medicare Prescription Drug Plan includes coverage for prescription drugs. Availability and cost of plans vary by area. All Medicare recipients who have Medicaid are required to enroll in a Medicare Prescription Drug Plan. Individual Information VERSIGHT 59 TX-HHSC-20-0960-A-000174 MEPD New Hire Part 1 January 2020 To be eligible for Medicare, an individual must be: • Age 65 or older • Disabled, as defined by the SSA for at least two years. Exceptions to the two-year waiting period, include diagnosis of: o o Chronic renal disease which required a kidney transplant or maintenance dialysis Lou Gehrig’s Disease (amyotrophic lateral sclerosis) If a Medicare recipient chooses to delay enrollment in Medicare Parts B or D, an enrollment penalty may apply. This means premiums cost the recipient more. Medicare information can be found on the individual’s Medicare card, Application for Assistance or SOLQ response. On the Form H1200, Application for Assistance it looks like this: Medicare Do you get Medicare ? ............... ........................................................... ................... O Yes O N o Spouse You If yes , mark the type you get . 0 Part A If yes , what is your Medicare premium (monthly cost)? 0 Part B 0 Part D $ o :Part A 0 Part B O Part D $ For MSP, an individual must be enrolled, or eligible to enroll in Medicare Part A. If Medicare coverage is not indicated on the application, but is verified with SOLQ, MSP coverage must be explored. Beginning April 2018 to April 2019, the Centers for Medicaid and Medicare Services (CMS) will issue new Medicare cards to all beneficiaries. CMS was mandated by Congress to replace the current Medicare claim with a randomly generated Medicare Beneficiary Identifiers (MBI). This is part of an effort to decrease fraud and identify theft and help protect the Medicare program. The new cards will include the MBI instead of the current SSCN. Review MEPD Broadcast “New Medicare Card” dated March 30, 2018. -- JOHN LSMITH Mtthwe-~-- teN M~ 1EG4-TE5-MK72 ["l,tlH •<• lkttdte. HOSPITAL (PART A) MEDICAL (PART B) Individual Information VERSIGHT (O'ftt. s:tartv"°"C- ( ~: Error Coocl!JonCOd8< Re:q)Ofl5e : C-; t ~ , sex: l)!i Vor111eolioJ; Tllle iA S1atus: TIiie XVI Sta>tu a: sumnmr. ~•rt•mei ".I TIiie I Claim Ae.c t Disability Onset Date: If under 65 and there is NO disability onset date, the individual is receiving RSDI due to early retirement (at 62) but not receiving Medicare. ,, ~w,:::;!~ unes 3 RSDI Claim number. S(l>o(lut(I Pdor $<'-l!o 12()11201? P•ymen, combined"""" r,ot I.AFCod . ""'°""t ~':'.:.i ''"'"° ( tie<>;; Doteo!Bjrlt< Proor or.o.o [I!! o.ce..r~u., RSDI Net Monthly Benefit after deductions Examples: child support or overpayment. ~.o (<,01<11 p;r; n11"1$~• [O.te!IP1f "'d 1Jil 1ffl8nl Bll1h'Bai:,tsmol °"'""'°"""'' 0,.,0 1'2001 E111lll o1mU<1~ Dot&o1 ·c...-eat Date RSDI Benefits started E..Ullom..,~ Ocl'll112007 at;•blld y Qnwl o.,., 09130.'200~ IIOI 10'1!1>/r •79 00 Bene 1rPa10ille: y 11lndle>IOC II _, .., l,lodk.>n> · II Ptvt'ni1.11 n:: _, oc C1 11um1>or or c- • l,1Mlf!ll)Eton. O>1B Ouol!'miUtmon1BIC: Cr00! 12 , 01 200:il IOJ.00 U > OJ 200".'" •·· .oo .1n.oo 0,. • VERSIGHT ,.st<>I.,..,., ,.,,,,,..,., tlLlffllMI DAI « 118uy-ln Supplemental Medical Insurance indicator and a medical deduction ~ 0 b 01 10:: ;;:~o;- s:os. ..oo 50s:. o-:i RSDI Gross Benefit amount (MEPDH E-4000) 69 TX-HHSC-20-0960-A-000184 MEPD New Hire Part 1 January 2020 Bureau of Vital Statistics (BVS) Requesting Birth Verification via Bureau of Vital Statistics in TIERS Birth Verification via Bureau of Vital Statistics When you are unable to verify information, or you select an invalid source when verification is required, TIERS pends for missing information. For example, TIERS pends a medical assistance EDG for verification of age when using client statement as the verification source. Per Appendix XVI, BVS is an acceptable verification source to verify Citizenship. At Individual Information, TIERS displays available information pulled from SOLQ or BVS in the Electronic Data Sources information table. This information includes Name, Place of Birth, SSN Verification, DOB Verification, Race, Data Source, and Date of ELDS Acquisition. Electronic Data Sources Information Dateof ELDSAcquisition Name S ,10 / 30 / 03 : 04 :59 Individual Information PVERSIGHT PM m+i,H!+ iliiiiiHI iitiil SSNVerification DOBVerification Race DataSource ,verifi ed by SSA SOLQ/WTPY 70 TX-HHSC-20-0960-A-000185 MEPD New Hire Part 1 January 2020 Data Broker A Data Broker agency collects credit and other individual information from a variety of sources, including government agencies and businesses such as retail stores, car dealers, lending institutions, and apartment management companies. The Data Broker combines this information into a report that is provided to HHSC. HHSC uses the Data Broker report to access financial and other background information on applicants and current recipients of MEPD programs. The data includes information on household members, residence, vehicle ownership, and employment. While the report provides some demographic information, it is primarily used to identify resource and income details for individuals. Sample Data Broker Report rtv1.0 :10PM HHS UserlD : Youcannavigate to a specificreport byclickingonthecorresponding hyper-link CASE# : S.S.N.: Address : TableOfContents Report Drivers License Information Address DLsatEntered DLsatDLAddress Neighborhood @Entered Address Vehicles @DLAddress Vehicles TheWorkNumber TWCWages andBenefits Child Support DataReport Individual Information pVERSIGHT WereRecords Found? Number ofRecords Found Yes No Yes No Yes No No No No 2 0 2 0 3 0 0 0 0 71 TX-HHSC-20-0960-A-000186 MEPD New Hire Part 1 January 2020 Data Broker Combined Report Information available on the Data Broker Combined Report comes from a variety of sources, including government agencies. HHSC staff use the Combined Report to: • • • determine the risk for potential fraud or Quality Control (QC) errors on a case; identify clues to unreported income, resources and household members; and verify income, and vehicle and property values. Specialists are required to run a Data Broker Combined Report for household members without a credit report at: • • application change when adding an adult household member What to Look For There is no single element in a Data Broker report which identifies an inaccurate case. Judgment on the part of the specialist is a critical factor in the process. There are, however, some general guidelines to use when reviewing Data Broker information. Almost any element of a Data Broker report can have a legitimate explanation. Research indicates that the majority of cases are worked correctly. Additionally, research indicates that of the small portion of cases containing errors, approximately one-quarter contain errors which could have been prevented by using Data Broker information. Although cases with errors are relatively uncommon, the individual reviewing the Data Broker information must be attentive and alert to clues which may indicate potential case errors. If you fail to complete File Clearance prior to requesting Data Broker, TIERS displays the following error message: View Report lilk • lndi'Vidual Id • R• port Lin< Individual Information pVERSIGHT ti Requested Date - 72 TX-HHSC-20-0960-A-000187 MEPD New Hire Part 1 January 2020 What does a Data Broker Combined Report Include? A Data Broker Combined Report includes public information taken from multiple sources found in Data Broker and combines them into a single report. In TIERS, a Data Broker Combined Report includes the following information, if available: • • • • • • • • • • • • Name Address Texas Driver’s license (TDL) information Credit header (not the credit report) Note: Not for MEPD use Texas vehicles Texas Workforce Commission wage reports and unemployment insurance benefit information SNAP Electronic Disqualified Recipient System (eDRS) Office of Attorney General child support data Texas criminal history Neighborhood Out-of-State Shopping data Note: This pertains to Lone Star Card usage Employee New Hire Report (ENHR) Individual Information AMERICAN PVERSIGHT 73 TX-HHSC-20-0960-A-000188 MEPD New Hire Part 1 January 2020 Accessing the Data Broker System The Data Broker system is used by staff responsible for determining eligibility for SNAP, TANF, and Medicaid. Users in State Office have limited access to the Data Broker system for inquiry and monitoring purposes. To request a Data Broker Combined Report: Within TIERS, navigate to the Individual LUW, edit the individual. On the Individual Information page, request the information by answering YES to the Data Broker question and complete the LUW. Retrieve the information by clicking the DB icon on the Individual Information page or on the Vehicle – Details page. i ;M i!i:frii Upda 1e 1PreV10us Upda te/ Ne xt lndr>,dualWofrN!,on llome: Sancht z Sarilndr.tduaf ,,_ 42F lndlvlduall : Prelix , Last !Sanchu Otfflog,apt.c Wonnat,on • Gtnde< FttN!t " r p~~ td llon-Hispan,c .., IJnalllt(Odtt.-llCf ~ CK? Clilnl Id • dicta. Id dll t ol dt atlt I Imm~ lrm-0 Vlltdfltd by SSA --- A .., tAaidtn 11- 0.Cn std VtMUtJOn lt1otMls'ilaidtn flOlt>trltdormatoon Dots the indr.~uaf h•·•othtt namn? °' IX> .., IIO v Do you ..,,sh to request• Crtdit Repon? IIO v t, IIO v Dots the indr.~ "--·• SSCI~ Ra.ftoad Rt11rtf'MnlI~ anbmatoon? ft tht indt..clual 1ft HHSCtmplo) ... ? Is lht indt,,duaf • SlMt tmpO) ... ? Rtc;uttl fCtdat l b ,C:, L - ' , A,rJ 0 , ' ' I 16.Binh Date I (D ay / Mo I ' ! -- " See Other Side Yr) ■ STAPLE Make sure the name on the I-94 matches the name on the unexpired passport. HER E Warning - A nonimmigrant who accept s unauthorized employment is subject to deportation . Imp o rta nt- Retain this permit in yo ur possession;y ou must surrender it when you leave the U.S. Failure to do so may delay your entry into the U.S . in the future . You arc authorized to stay in the U.S. onl y until the date written on this form . To remain past this da te, without permis sion from immigration authorities , is a violation of the law. Surr end er thi s permit when you leave the U.S.: - By sea o r air , to the transporta tion line; - Across the Canadian borde r, to a Ca nadian Official ; - Across the Mexican border , to a U.S. Official. Student s planning to reenter the U.S. within 30 days to return to the same schoo l, see "Arrival - Departure " on page 2 of Form 1-20 prio r to surrendering this permit . Record of Chang es Port : Departure Re co rd Date : Carrier: Flight # / Ship Name: For sale by the Supe r intendent of l)ocnml.'nts . U.S. Government W11s htngt o n. n.c. 20402 Individual Information pVERSIGHT Print i ng Office 88 TX-HHSC-20-0960-A-000203 MEPD New Hire Part 1 January 2020 Requesting SAVE Locate the Alien Status option at the top of the Data Broker TIERS Report page along the blue bar at the top of the Data Broker report. Case H1sto~ AlienStatus HHS User lD: Data Broker Combined Report (HHSC TW) PCG Report v1.0 18Apr 2017 09:48 52AM Click on Alien Status to open the Alien Status Verification page. Case History Alien Status USCIS Documents A lien Status Verificat ion Client Details Documents Document Type : Alien Number : El Alien Card Number /Receipt Number : Card Expiration Date : First Name : Middle Name : Last Name : Birth Date : Individual Id : Program Code : - " CommunityCare Medical Eligibility v IIMIM@M Individual Information PVERSIGHT 89 TX-HHSC-20-0960-A-000204 MEPD New Hire Part 1 January 2020 Entries–Alien Status Verification To submit a request for Alien Status Verfication, you must understand the acceptable manner in which to enter the data on the page. Case History Alien Status AlienStatusVerification Enter the Alien NumberWITHOUT the leading "A"in the firstfield and the First/Middle/LastName andBirth Date fields auto-populate. Documen ts Client Details Alien Number: Selectthe appropr iate Document Type from the dropdown selections. DocumentType: 999888999 Alien Card Number/Receipt Number: Enterthe card number WITHthe leadingthree letters. CardExpiration Date: First Name: Middle Name: You can change information inthese fields. Last Name: BirthDate: Individual Id : ProgramCode: - I\ community care v Medical Eligibility Select all programs for which the household is requesting. Click to submit the request. The alien registration number and the card number are located on the USCIS document. The alien number is 10 digits and usually begins with the letter A. The card number is 13 digits, beginning with three letters. Individual Information PVERSIGHT 90 TX-HHSC-20-0960-A-000205 MEPD New Hire Part 1 January 2020 Initial Response For an initial response to be complete, it must display information in at least the three required fields: • • • Alien Status Date of Entry Country If all three fields are populated, the verification is complete. If any one of the three fields shows blank, request Additional Verification. Additional Verification Request Additional Verification when one of the following occurs: • • • Any of the three required fields are missing information from the response Department of Homeland Security responds with ‘initiate additional verification, or Sponsorship information is required After you submit the Additional Verification request, you will receive an email. The response could take up to 4 days. The response will include the following information: • • • Full case number Individual’s first name Initial request date From: To: 0.mibc'ok•rOckllnfoly, .com Tlff1r,, ,Jo,Ml4ttll k t UC. but Cc Subjt ct o,te 8rol:tr: 1 Ahtn Stet us Rtspons t Data Broker has rece ived 1 Homeland Security response for Alien Statu.s verification.s that you injtiated . Please access Data Brok,er to rev iew the responses for the following cases : case Number 100000099 First Name JANE Initia l Request Date 2/28 / 2013 I This email was sent to U:l!D!!l~-i2!ltdhh2, JU!!!t~-1.!2 Individual Information 91 TX-HHSC-20-0960-A-000206 MEPD New Hire Part 1 January 2020 Resubmit/Retry Initial Verification Use the Resubmit or Retry Initial Verification request button when: • You notice you made an incorrect entry during the initial request. Make the necessary corrections and Resubmit, or • There are changes in the client’s alien status and we require a new verification. Make the necessary corrections and Retry Initial Verification. Both options return an immediate response. Reading the Response SAVE gives you one of the following responses in the Alien Status Description field: • LAWFUL PERMANENT RESIDENT – EMPLOYMENT AUTHORIZED • INSTITUTE ADDITIONAL VERIFICATION • TEMPORARY RESIDENT/TEMPORARY EMPLOYMENT AUTHORIZED You will encounter new terms in the response: •I OhsCaseNumber : 2015126161843RK AlienStatusCode :1 The DhsCaseNumber = SAVE Verification Number AllenStatusOesc rlptlon: LAWFUL PERMANENTRESIDENT-EMPLOYMENTAUTHORIZED Country: BURMA OateOfEntry: 6/2/200612:00:00AM COA stands for Condition of Admittance OateAdmittedTo: INDEFINITE ExpirationDate: CoaCode: IR5 I Coaoescription : Parentof a U.S. citizen. Let us look at an example of a complete SAVE response on the next page. Individual Information PVERSIGHT 92 TX-HHSC-20-0960-A-000207 MEPD New Hire Part 1 January 2020 SAVE Initial Response Al ien Status Response ClientReferenceCode : 0123 45 6789 User ld: 00000 654321 CreateDate : 5/6/2015 4 :18:47 PM Action : Initial response Cl ientFirstName: AM ELIA ClientlastName · SEDELIA The response disp lays the infor mat ion yo u need to determ ine if the ind ividua l is eligible fo r SNAP BirthDate : 9/20 / 1941 12 :00 :00 AM A lienNumbe r: 01 23 4 567 8 ResponseDate : 5/6/20 15 4:18 :47 PM DhsCaseNumber : 2015126 16 1843RK A lienStatusCode : 1 A lienStatusDescr iption : LAWFU L PERMANENT RESI DE NT-EMP LOYMENT AU T HOR IZED Country : SURMA DateOfEntry : 6/2/2006 12:00:00 AM DateAdmittedTo: INDEF INITE ExpirationDate : CoaCode : IRS CoaDescription : Paren t of a U.S . citizen _ lsSponsorl ikely : Tr ue DhsComm ents : SponsorName : C LARK K ENT SponsorAddress : 100 TEST DR. SponsorCity : PFLUGERVILLE SponsorState : J - Sponso r informat ion disp lays at the bottom sect ion of the response wh en app licab le. l -- ~ --- SponsorZ ip: 78660 Note: If SAVE lists a sponsor, or a sponsor was previously in the household, but you are removing them for a reason other than they are deceased, alien sponsor policy may apply. Individual Information VERSIGHT 93 TX-HHSC-20-0960-A-000208 MEPD New Hire Part 1 January 2020 Asset Verification System (AVS) TIERS uses the automated process known as Asset Verification System (AVS) to determine if there are undisclosed financial accounts or under reported disclosed financial accounts and as a case clue to indicate a potential transfer of liquid resources. AVS information will not verify an individual's resources. If undisclosed resources or under reported disclosed resources are discovered through AVS, staff must follow current processes to clear any discrepancies identified by AVS. AVS automated process provides electronic information of an individual’s financial accounts, including disclosed and undisclosed resources from financial institutions including: • Savings Accounts • Checking Accounts • Annuities • CDs • Convertible bonds Individual Information AMERICAN PVERSIGHT 94 TX-HHSC-20-0960-A-000209 MEPD New Hire Part 1 January 2020 Programs Impacted An AVS response must be requested for the following MEPD programs at application, redetermination, when adding a new individual and at program transfer. • • • • • • • • • • • Waivers State Group Home State Supported Living Center Non-State Group Home State Hospital Nursing Facility Pickle Disabled Adult Child Disabled Widower Early Aged Widower Medicaid Buy-In for Adults AVS is applicable for reapplications and reactivations unless a case is reopened within 90 days of denial and AVS was previously provided. Request AVS only for the time from the last AVS inquiry to current action. For initial applications, request 60 months of AVS information. Request only after consent is provided and EDBC has been ran and the individual meets all eligibility requirements. Programs Not Impacted AVS requirements do not apply. Do not request AVS for the following TOA's: • • • • • • • • • Specified Low-Income Medicare Benefits (SLMB) Qualified Medicare Benefits (QMB) Qualified Disabled Working Individuals (QDWI) Qualified Individuals 1 (QI1) Medicaid Buy-In for Children (MBIC) Community Attendant Services(CAS) SSI Prior Coverage A and D Emergency All Texas Works Programs Individual Information AMERICAN PVERSIGHT 95 TX-HHSC-20-0960-A-000210 MEPD New Hire Part 1 January 2020 Permission to access AVS is required in the eligibility determination for individuals applying for or receiving Medicaid. This includes: • Individuals whose assets are required to be considered in the eligibility determination for individuals applying on the basis of age (65 or older), blindness or disability. • SSI recipients who are applying for a program that AVS is applicable or are the spouse of an individual applying for a program that AVS is applicable. Note: If the individual is 16 years old or younger, an AVS response will need to be obtained from the Data Broker Portal instead of TIERS. Consent to access AVS information is on MEPD application forms, renewal forms, and YourTexasBenefits.com effective December 2017. By signing an application or renewal form, an individual or the individual’s authorized representative, power of attorney, or guardian agrees to allow HHSC to access AVS. Prior to accessing AVS, review the application or redetermination form to verify it contains the AVS consent language and the signatures of all individuals whose assets will be considered in the eligibility determination. If a previous version of an application or renewal form is received and does not include the AVS consent language or a signed Form H0003 with AVS consent, pend the case for a signed Form H0003. If a signed Form H0003 is not returned, deny the application or redetermination for failure to provide AVS consent. If the application or renewal form does not contain the signature of an individual whose assets are considered for determining eligibility, send Form H1020, Form H0003, and pend the case for AVS consent. If a signed Form H0003 is not returned, deny the application or redetermination for failure to provide AVS consent. Note: Allow the individual until the 39th day from the file date to provide the signed Form H0003. Revoking Consent Individuals can revoke consent to access AVS in writing. If an applicant or recipient submits a written request to revoke AVS consent, document in case comments, deny the case, and send a TF0001. Do not access AVS. AVS Consent Provided After Denial If an individual is denied for failure to provide AVS consent and later reapplies and provides AVS consent, determine eligibility beginning the month after the month AVS consent was provided. The individual cannot receive benefits for any of the months AVS consent was not provided. Individual Information AMERICAN PVERSIGHT 96 TX-HHSC-20-0960-A-000211 MEPD New Hire Part 1 January 2020 Two questions on the Add New Individual or Edit Existing ID Information must be answered to request an AVS response. Was assetverilication consent provided for IYESL::'..J ConsentReceivedDate: ~I~ I 12016 ~ I individual? •Did individual havegood cause for not providing consent? Consent RevOkedDate: ~/ ~ / ~ lu r-q tiiifii·Fi if ii I Was asset verification consent provided for individual? YES Was asset verification consent revoked for individual? NO Currently there is no good cause, answer NO. The good cause field is only enabled when one of the two previous question indicate that consent was not provided or was revoked. You must answer this question, or a validation message appears reminding you to answer the question. Refer to MEPD Bulletin 17-11, deny an application, redetermination or request for a program transfer if the applicant, recipient, or an individual whose assets are considered in the eligibility determination does not provide AVS consent, or if consent is revoked in writing. Individual Information PVERSIGHT 97 TX-HHSC-20-0960-A-000212 MEPD New Hire Part 1 January 2020 Process for Requesting an AVS Response After EDBC has been run and the individual is determined eligible for benefits, staff: • Use the Left Nav to return to the Individual Household LUW. • Edit the individual for whom an AVS report is required to display the Edit Existing Individual ID Information page. Request an AVS response by clicking the AVS icon in the title bar of the Edit Existing Individual ID Information page in the Individual Information LUW, an AVS Info window will open and display a Report Link. Data Broker provides the AVS response. There may be a delay in the response for up to seven minutes. Refer to MEPD and Texas Works Bulletin 17-2. The response will either provide details of the individual's assets from the AVS network or a message that AVS did not find accounts for the individual. In addition to the immediate AVS response, Data Broker now provides enhanced AVS responses. These enhanced responses offer further financial information reported from additional banking institutions that were not included in the immediate AVS response. The enhanced AVS response is provided 16 days after the initial AVS request. Note: A Form H1020 may be necessary if the AVS response provides new or discrepant information. Follow current procedures to put the case on delay if required. If the information does not make the applicant or recipient ineligible, do not pend for verification. Staff must enter the new information in the Liquid Resource - Details Logical Unit of Work, select the verification source Other Acceptable, and dispose the case. If the individual is potentially ineligible due to the enhanced AVS response, staff must pend the case and request verification of the new or inconsistent information. If the individual fails to provide verification of new or inconsistent AVS information, staff must use the appropriate AVS denial reason codes. If a prior AVS response exists, staff must request new AVS information only for the months between the last AVS response and the current transaction date. Individual Information PVERSIGHT 98 TX-HHSC-20-0960-A-000213 MEPD New Hire Part 1 January 2020 Click the Report Link to access the AVS response. Once the AVS response is accessed, click on the second Report Link to view the AVS response. +++ View Report Link • ► Repon Unk lnd lvtdual Id ► Requested Oate 2016-09-27 08:41 :00.0 Repor t Li nk fo r AVS returns information for all accounts found matching the individual's; TIERS Individual ID, name, current address, previous address if available, and the financial institution name or name(s) entered in the Liquid Resources - Details page, and the TOA for which the individual is requesting. Request Details lrdi vtdud Id: lip: 1111'>llttt -.;ln,1114b ,~lhf !$Yu i U en) boit l< 1:r ,;;,f'llh v, i,111 .-;>;Qll 't Cfl ONo Ciccloced A: eounts Rna1da hstl:ut lffl Individual Information 99 TX-HHSC-20-0960-A-000214 MEPD New Hire Part 1 January 2020 AVS Search Results displays a Response Summary and information about the accounts found in AVS, including whether the account is Open or Closed. The Response Summary displays the date the Response was returned and count of the Disclosed and Undisclosed accounts found in AVS. Information about resources found in AVS will include: • • • • Financial Institution name Type of account Account balance Account balances as of the first of the month Each asset is labeled with the status of the account, including: • • • • Open - the account is active with the financial institution and has a balance Closed - the account is inactive with the financial institution and has a balance Disclosed - the account was disclosed by the individual and entered on the Liquid Resources - Details page Undisclosed - the account was not disclosed by the individual and was not entered on the Liquid Resources - Details page If the AVS response returns the name of a financial institution without balances, the individual has an account but balance information is not available. To view more than three months of balances, click the “+” sign next to Date below the account type and number. A ccou nt Search Req vesl Oete ils e•- "_, R es u lts ,u,,'14,_ --_ ____ _ e- •$,,I: (¢L0Sl0 OOC-J/0/H l<.ll.lWO(.t». UN OI SCI.OSIID ) ..... .. ---· ~., -· f)-4- ReapoMe $unvne,y ______ _ ,, $.M..1• (OPEN UN018 Cl. 0 8EO ) --Individual Information .,OVERSIGHT 100 TX-HHSC-20-0960-A-000215 MEPD New Hire Part 1 January 2020 When no accounts are found through AVS that match the individual’s information submitted by TIERS when the AVS response is triggered, AVS displays a message that no accounts were found for this individual. When this message is received, follow current procedures and process the case. Document in Case Comments that no AVS information was returned. If an AVS response has not been received by the application due date, dispose the case following current procedures and process the case. Additional AVS information received after disposition should be treated as a change. Enhanced Response Additional asset information may be available via the enhanced response after 15 days. Enhanced responses are provided on day 16, as AVS Request day is “day 0”. If day 16 is a non-HHSC business workday, the AVS task will be created the next HHSC business workday. When enhanced AVS information exists, TIERS triggers a change task with task comments of: “Asset Verification System (AVS) enhanced financial data received for individual {Last Name}, {First Name}. Review the AVS enhanced financial data record using the Data Broker Case History link accessible within the Data Broker Portal and take appropriate action.” The enhanced AVS response can be retrieved from the Case History in the Data Broker Portal. Click “View” on the Case History page next to the description “AVS enhanced response” to open the response screen, which will show the additional accounts listed. Read MEPD Bulletins 16-05 and 17-07 in the Resources tab for information on processing immediate and enhanced AVS responses. Information Provided on AVS Response - ---"""' __ .., ----- -m ----- Individual Information RIG'' pVFRSIGHT El 101 TX-HHSC-20-0960-A-000216 MEPD New Hire Part 1 January 2020 Texas Workforce Commission (TWC) Inquiry The Data Broker report provides access to information from TWC, which collects employment/income information and administers unemployment benefits. Income reported by the employer is collected quarterly by TWC and can be found under Wage Details. This can be used as a verification source of earned income. When using TWC Inquiry as proof of earned income, specific questions need to be discussed with the client to determine if: • The wages are still representative of the most recent quarter's earning showing on the report, and • The client agrees that the gross amount calculated for the client's pay frequency is representative of current and future anticipated earnings In addition to being a source of verification for earned income, TWC Wage Details can also be used to identify possible case clues. Unreported income in this section must be reviewed and addressed with the client. Individual Information AMERICAN PVERSIGHT 102 TX-HHSC-20-0960-A-000217 MEPD New Hire Part 1 January 2020 Information displayed under Claimant Status is reported by TWC when a claim of Unemployment Insurance Benefits (UIB) is established. Although UIB authorizes a Weekly Benefit Amount (WBA), payments are made to the claimant on a bi-weekly basis. When determining the amount of UIB to budget, you must be mindful of the following: • • • • Amount of the WBA versus the actual amount being distributed Any Overpayment (OP) amounts Any amounts being deducted from the gross UIB amount Initial UIB payments and second payments that include the extra "waiting week" payment The remaining balance of UIB • Results for the TWC request will display multiple sections of information in a single report. Below are examples of Claimant Status, Benefits Payments and Wage Details. Jll•.11""' -· ... ,., tu 1u,, o.....,.,U•J(-ol1 .. u, IIIU.:c.-t, ,_,.a~ 1,w ,. 1 :.k1 u, a,i•-.i ~• ti- flt; l,l.'f'l ~:1, U "-'\' fw,t ll•N•U W ,eUM, Nllf'Uff r:.. '" I'll •Ha C:iA ;n,ou : : t:M ttl U•l'•U '••• 111,,1 tcU tl,o 1.o• fOI ·-cu, 00 Jl•:•,n lit: a.~..,, -.~, lut! 1011,00 ....... Ml IN ... Hu.• ,~1,1,11;, .i,1 .. :, •• .... -• ~•Ill ---•ur 1 :... ... , tu, .. , ,.., (1,1 ,_. frtt.t ltt ftl n r~i.-I\ ff••U ... -.... lit .. ! a-1 ... I.on .. ,_,., --••••-• M-lt'lou-f t'.a """';ill :·, ll·:"--ll Oil ?ca.c-wtlU M: k!U'l'l• UC I • lo"t l-.:' I Ill) - ~ ..-•14 ».:n IOl:11, .. ... ~• U I~ tl\'II IP'llm I I ,., ...... flUl•t~II -•ll'I' !Ill __ ,,:,01 t•l"•I n.- U•U•ll :i-, e:.icrt au,u; ....:. t;, "-t ~ot)-U .. ,... Individual Information .. .. ......... ........ ... n '" o .. ... u, I........ •U .. tf· 1 ""' I t •I• U M-11 , ... u If tt> K •• .. t<> ,.,:,r H••U I ..,._,,,······,_. ~:-t.1•:~ -••--•• - -UIJ --tx 01 .... t.•fll I I••• .. ,• nn. :.~ .,., I I •: -..,..,t, lt-tt•U I ' •••• '' • ••I ,_ JIY N "' '. ··• .,......... a-,l •1•U•I"' .. •• .•, ' •1·,.,"' .. ' ,........... ..'" "'... ... ,".... ',, ,. .. ...',. ,.... I 11• l4·U • l.l U .,_. U•U ... ........ , •. u .. ,; t II M I ....... , ...... ....,..... •IO ,- •J.l•UY o IN IN-'" .. •• oI M ft ,,,.,. ,o ·U u• r Of ~ .. 11'1'"' 1" '" ••• .''"''· ' .......... ... , .. l•tUt< O•>O It • •» r "' .....' '........ ..... ., .. " o ,, I I ~111 , to h.1,, ~U:4.to -• ..au , ....... ,,.. I .. I• I ..... ........ .......... , .... ............ Qo I..,,,. 11 U""' .. I I .. N•U•U •II " I ... ,H.J• I I ........... ......., . .............. II I '". ,,.u, o•-u• t< "' 1•·11 ° l._,.-, .. , u-1•111· 0,0 ... ." .. ''"""' ""••" , .. oo •~ "' I""' u .. 1u .. ..,., ,:♦.oo , .. (" ... 11 _,,, IUll.00 O,.u,-1 ~• t1 ► U-, I • lo .... , 11" "U" ., .... I ll -··:1,ll ..... I ...•. u .... K LI OU•.,.,"' liu OlllfU'l1 C'la I•• Ollt I ,l II e; =-,,., :-: :-.-t.., u-:1-:: Fll• .. ,.,, ftl.l riJ. i., t;i c:,, •I I o ,<·IJ =<-1 J~W IC• U•Jt,U ,n "' •• M ..I UOUHIJ '" I •ft-1-J., .............. ,..' ..., .."' ...,.,...~,........... .. .... ...... ......,...... .......... I ' •·U•U '"••• ..,,n,ec,.,.t,, ... f ,• .,, -'·••-u ac ,.-1 ,,_..,..... ' ...''"""" W◄1•ll -•1 U "'1 .....- ..... , -·- 1..1 t•tt I ~ IU•t n,1,, 1:C.* :-.o-11 ,_., Ulll,00 •••IIM• •-•• IIJ fll,H,_,.H ~·-u 'l'q1j l>·)'·H wm :nJVOI ~ _ I t: u-i••n ,., ,., n r11, "' 11t,U+f> , .. .,, K ,, ' u ... ... II Ii,, .,,u n·• p o,;:, ~n• f •• ._ -·----··-· LiH .. L.,.1 -kr.1 ~•IITM.t•I e'.a ,r,,.::,:1 :: I ... l ii,: ~p »I toWflM -• , .:♦ :.: , n:£ _.,eu .., .. M'U h; .., -~:·!·:; :r::~:: I 11·11 .,., M •• ......... ,,, MffUI ~ .' ·14·>¥ :.>" ,..,~... ., .i .............. -- -····- -· ......... ...... ..,_.,. • ...... , .... ,. n I l'•U .. • l.t .. n•»·U • I lt-U• • o o I U .. •II .... •n •II • ..... •· 0 1-1. 111u, n .. -U• ... • o ... . .......,...... ,,o Ut oo •• , ,1-1,1 .. , II • I.I .. ... • ul I i, ;1 • ., t ... ............. .' .... ... ' ' • ' I.I • ... u ..... . 103 TX-HHSC-20-0960-A-000218 MEPD New Hire Part 1 .,... OC-:A:~1 ··- January 2020 Incomereported by theemployer is collectedquarterly by TWC under Wage Details. This canbeused asa verificationsource of Eara~~ln~Q□l~. 1 . Aceov.nt. °'' ····----·,.,, ,_., OO•J U Oto-, ◄ •H oo-u,,, •., 4-10 l·U 2•11 . . . . J·U 4 •11 H·U0 401•C S 10 • •10 W• O•• _ J,117,11 - 2•0(' l•00 o,-u,a,-1 )•00 4•00 MS •o i.u-::oor, n,no.oo u. , Al)t lite , ':'Mole UCN u,,. 14 , 101.IO PO IOX I AUfT &.OUU , HO fUH•f'J ('JOJ) lf1•1 U f U ,4 U.U r,1.u , r 1MA1te1 At. t ta v:eu U , ULU \ 1'.U.X Uc,,t PO IOlC 20 )00,00 l'f,H0,00 tllU 0l•0tOU•C I\H J , 144 ,H , . u2.01 IAUtt -··- OY.,1" H- DllplOYH tUWtC' t l , .. H Lt ?MC r.ovU, HO fUff·02U 1H•t0tf no1. on ,.,,o.u no .n Dof>loy. .- =t. on ,.o,o.,, 1, lU . U u av:cu bpl ♦V-r Ul e tu . The following sources continue to be the preferred methods of wage verification if they are available without having to pend the case to obtain them: • • Two representative check stubs within 45 days of the file date or interview date, Form H1028, Employment Verification. If the preferred sources of verification listed above are not available during the interview and it would be necessary to pend for wage verification, specialists must use TWC quarterly wage information as verification if the TWC quarterly wage information meets all the criteria below. The most recent TWC quarterly wage information meets verification criteria if the individual: • • • • Was employed at that job for all months of the most recent quarter posted on the TWC Wage Details screen, Continues to be employed by the same employer, Did not incur a salary or rate change during that quarter or since then, and States that the gross pay amount reported on the TWC Wage Details screen is representative of wages the individual anticipates earning during the certification period. Individual Information pVERSIGHT 104 TX-HHSC-20-0960-A-000219 MEPD New Hire Part 1 January 2020 In order to utilize the TWC quarterly wage information for the required pay periods the specialist must: 1. Convert the amount in TWC to a monthly figure by dividing the TWC quarterly wage by three. Once the monthly figure is calculated the advisor must, 2. Calculate a pay period amount by the applicable conversion factor. Once the average gross pay amount is calculated the advisor must, 3. Discuss with the individual whether the amount is representative of future earnings. If the client states wage information is representative of anticipated pay, budget the income and continue with the eligibility determination. Pend for other required verifications, if necessary. If the client states the TWC quarterly wage information is not representative of anticipated wages, then pend the case for another source of earned income verification, such as Form H1028 or pay stubs. Note: TWC data is not an acceptable source of verification for situations in which a client reports a recent change in earned income, such as a change in wage rate or number of hours worked per week. Individual Information AMERICAN PVERSIGHT 105 TX-HHSC-20-0960-A-000220 MEPD New Hire Part 1 January 2020 TWC Wage Detail Screen Here is a sample TWC Detail Screen from Data Broker: Applicant’s name. Note that name could be different due to marriage, divorce, etc. Unemployment Insurance - Wage Details Wage Detail Inquiry by SSN BNZ 755!0 EGS Name The quarter of the year in which the applicant earned the income. 12- 18- 11 09 :28 05 Total Wages : SSN 412- 11-9999 B SPEARS Employer Name and Address. Usually the Corporate or DBA name of Employer. Account 07-77955 1-0 Qtr ~ Wages Employer Name and Addr ess -----------------1536 .86 Ii-iii ::========~ ~ 10-665359 -3 5052.46 1268.35 2247.25 1111 WW ALNUT AVE VISALIA CA 93277-6233 559-555- 1313 LABOR READY CENTRAL INC ATTN PAY ROLL TAX DEPT PO BOX0000 TACOMA WA 9840 1-29 10 253-555- 12 12 *** End of Data *** ! =Hp 3=Ex CMD ----------1 The total amount earned for the Quarter. Quarters contain 3 months. 7=Up 8=Dn Notes: • When reading the TWC Wage Details screen, it is helpful to know that quarters are coded as: • 1 = January–March • 2 = April–June • 3 = July–September • 4 = October–December • The code is then followed by the two-digit year in which the quarter was earned. • The employer name on the TWC Wage Details screen may not match the employer name listed on the application due to a different corporate or legal company name. Individual Information PVERSIGHT 106 TX-HHSC-20-0960-A-000221 MEPD New Hire Part 1 January 2020 TWC Inquiry Kathy Lee Jones is interviewed by telephone on August 5, 2011, for benefits. Ms. Jones did not provide income verification with the mailed-in application. The client states that she has been working full-time with VF Jeans since July 2010 and is paid bi-weekly. She states her last hourly income raise was effective January 1, 2011. Ms. Jones does not provide other wage verification at the interview and it would otherwise be necessary to pend for verification of her earned income; therefore, the specialist must follow the steps below to determine if the most recent TWC wage record can be used as verification. WAGE DETAILS· Name Account Qtr-Year" Wages Employer Name and Address KL JONES 00-000000-0 4-05 1-06 4,510.74 3,769 44 SMITH SYSTEM MFG CARTER CRAFT MFG CO PO BOX 860415 PLANO TX 75086-0415 972-424-6591 00-000000-0 3-06 3038 5 VF JEANSWEAR INC PO BOX 21527 GREENSBORO NC 27420 KL JONES 00-000000-0 2-07 KL JONES 3-07 1,500 00 1,450 00 JOSE LUIS PEREZ ET A L 11330 SHEFFIELD DR KL JONES 00-000000-0 3-10 4-10 Most recent Quarter 1-11 that has posted. Current Quarter is 12-11 6,400.46 7 737 87 7 186.35 1.354.64 VFJ VENTURES INC ET A L VF JEANSWEAR LP % BA RNETTASSOClATES PO BOX 7340 GARDEN CITY NY 11530- I 3rd Quarter of 2011. I I Individual Information pVERSIGHT 107 TX-HHSC-20-0960-A-000222 MEPD New Hire Part 1 January 2020 There are some questions you would need to ask Kathy in order to help her determine if the last quarter is most representative of her future pay: Did the client receive pay for full pay periods in all months of the most recent quarter posted from the current employer? Yes Continue Is the client still employed by the employer listed on the most recent TWC quarter? Yes Continue Is the client's pay rate the same now as it w as for each month of the most recent quarter reported to TWC? Yes Continue Divide most recent quarter amount by 3 and then divide the result by pay frequency conversion factor (4.33, 2.17, or 2). $7,354.64 divided by 3 $2,451.55. This amount divided by 2.17 $1,129.75 bi-week ly. = = Does client agree that the result is representative of anticipated futur e gross w ages per pay period? No - Pend for other wage verificat ion Yes - Use TWCwage record as verification Another way is to simply ask what her wages are right now. Let’s say you ask Ms. Jones the following questions: • What do you make an hour? $15.00/hour. • How many hours per week do you work? Around 35-40 per week. • Do you earn overtime? No. • Do you anticipate continuing to earn this average in the future? Yes. 35+40=75/2=37.50 average hours per week. Ms. Jones is paid every two weeks, so this gives her an average of 75 hours per pay period. 75*$15= $1,125.00 Gross Biweekly Pay Average. This is closer in line with what is showing in Wage Details. Therefore, you could use the wage information rather than pend the client and delay certification of the case. In TIERS, you would use $1,129.75 calculated from actual amounts for the required pay dates. Individual Information 108 TX-HHSC-20-0960-A-000223 MEPD New Hire Part 1 January 2020 Calculating Gross TWC Wages WAGE D:::TAI LS : Name Acc ount Ot r - Year* Wages Empl oyer Name and Address K L J ONE:S 00 - 000000 - 0 3-09 KL J ONE:S KL J ONE:S 00 - 000000 -0 2-10 1 , 5 00 . 00 J OSE: LUI S PE:RE: Z E:T AL 1.,..tS.0.,..0.0..... 11 33 0 ...SHE:FFE LD.. ll.:R 3-10 ............. KL J ONE:S 00 - 000000 -0 3-11 4-11 ,.... 1-~1.2___ 1 2-12 ~----------'· 303 . 85 VF J E:ANSWE:AR I NC PO SOX...2.15 2.7 GRE:E: NS80RO NC 2 7 ~2 0 - 6 , ~00 . ~ 6 VFJ VE:NTURE:S I NC E:T AL 7 , 7 3 7 . 8 7 VF J E:ANSWE:AR LP 7....., 1~ - 8= 6 ~. 3~ 5._, % SAR.N ETT ASSOCIATES 7 , 3 5~ . 6~ Po GARDE:N CI TY NY 11 5 3 0 - I .so. K..n .~.o. Ms. Jones states she is paid weekly and worked a full three months in the second quarter. Use her reported income above from second quarter (April-June) of year 2012 to calculate her average gross pay. TWC Wage Details – Possible Case Clues The individual states that he has not worked in two years, but the Wage Details lists income in the most recent quarter. This income might be a case clue of unreported income and would need to be reviewed and addressed. Possible questions to ask: • • Is this a new job or a short-term employment, such as seasonal? Is this a second job? Review the Wage Details and determine whether the name in Wage Details matches the individual’s name? If not, this could mean a reporting error from the Employer to TWC or someone else using the individual’s Social Security number. Individual Information 109 TX-HHSC-20-0960-A-000224 MEPD New Hire Part 1 January 2020 Using Data Broker TWC Claimant Status as Verification of Unearned Income Information displayed under Claimant Status is reported by TWC when a claim of Unemployment Income (UI) Benefits is established. Below is a view of a report. TWC Wages SSN : 222 - 33 - 4 44 4 011.TA FILT E.ll_: and Benefits D, - 36 5 CLlUMll.NT ST.11 .TUS : Narr,e : 1l.dam St e en s C\ 0 : Jl.dd r ess : 2 1 4 0 All an d a l e Rd Apt 11 0 Ci t : Jl. u s t i n St a t e : TX Zi p : 8 5 6 La s t Ch ang e d : 03- 0 8 - 2 1 3 Ph on e : ( 5 1 2 ) 36 9 - 55 55 Ta .x Wit h.riold. i n g : Y Dir e c t Depo si t : N Cn il d Supp o rt: N Pg 2 SSN : 222 - 33 - 4 4 44 Jl.dam St e e n s l rr. S ta : VOID ED l m St a Dt : 1 0- . 6- 12 Pgm : RE • l m ID : 1 0 - 0 8- . 2 l m Dt : 1 0 - 08- 12 Su b Pgm : UI l m Typ e : I Rl t -d I C : . 0- 0 8 - 06 Pa y St : TX Fi l e Dt : 10- 16- 12 Fil e :~e th : TEL: Fil e Loe : 64 0 u r r e nt Mon e t a ry -------------- --- La s t Ec,r .p l o y e r - ----1'.cct : 0 8- 0 94 5 38 - 8 l m Typ e / Dt : I / Name : Bes t Bu, Inc . Add r : P O BOX , 5 32 San P._rit ni -o, Te xa s 3 216 Sep Typ e : LP PERHJ!.NE N T 11'.Y Not i ce : Work ed : 0 5 - 0 5 - 84 Thru 1 0 - 0 8 - 11 Ti t l e : Jl.UDI T R Eli g i b l e : 11 - 0 3 - 1 2 --- ----- --- Jl. l t Ba se : N Pe nd i ng Is s u e : N 1 0 - 08 - 12 2 4 3 . 00 i s qu a l : WBJ! .: MBJ! . : 28 6 3 . 0 0 e rprr .t : Ba l nc : 2863 . 00 Re co v ro : Pa i d : Pbalnc : Red.et : 10 - 16 -. 2 --------No n 11on e ta ry ---------SOC : 5. 0 Pe nd I nv s tn : N S t a t u s : Non Pa y i ng De t Sep : Pg 3 SSN : 222 - 33 - 44 4 4 Jl.dam St e · e n s L.~ Sta : COMPLETE Cl m Sta Dt : 0 1 - 1 0- 1 2 Pgm : TRJ!. CL.,r. ID : T0 5 5 9 Jl. Sub Pgm : UI L.~ Typ e : I L.,r. Dt : 0 1 - 0 8- 1 2 Rltd IC : . 0 - 0 9 - 11 Pa y St : TX Fil e Dt : 01-. 0-. 2 Fil e :~e th : PJ!.PE Fil e Loe : 5 4-1 -------- Cu rr e nt ~1one t.ary ------- ----------- --- La st Ec,r .p l o y e r - ----1'.cct : 0 8 - 0 9 4 5 38 - 8 CLor, Typ e / Dt : I C / Nam.e : Jl.d.dr : ----- --- 1'. l t Ba se : N Pe nd i n g I ss u e : N 0 .- 0 8 - 12 WBil. : 2 5 1 . 00 Di s qu a l : MBA: 68 8 . 00 e rpmt : Ba l nc : Re c rd : Pa i d.: 6 8 8 . 0 0 Pb a l nc : Red.e t : 0 1 - · o- 2 Sep Typ e : LP PER.'-llil.NENT Lil.Y Not i c e : 1 0 - 1 - 12 --------Non :~on e t a r ---------Wor k e,d : Th r u 1 0- 0 - . 1 SOC: 51 0 P e nd I nv s tn : N St at u s : N/ 1'. Ti t l e : SXO De t Sep : Eli gib l e : 11 - 0 3 - 1 2 1 0- 06- . 3 Pmt End : Pg 4 SSN : 22 2 - 33 - 4 444 l>cdam St e e n s 1m St a : MPLETE Pgm : TXT CL.'f. ID : T0 55 9 Jl. Sub Pgm : UI Cl m Typ e : Rl td IC : . 0 - 0 9 - 11 Pa y St : TX Fil e Dt : 01- 10- 12 Fi l e ~~e t h : -------- 1m St a t : 0 - 0- 1 2 C L.,r. Dt : 0 1 - 0 8- 1 2 Fil e Loe : 0000 cur rent ~on e t ary Jl. l t Ba s e: N Pe nd i n g Is s u e: N --------------La s t Empl o y e r -------------A.cct : 0 8 - 0 94 5 38 - 8 Cl m Typ e / Dt : I C / 1 0 - 08 - 12 WBA : 2 5 1 . 00 Dis qu a l : Name : Be s t Bu y , Inc , :161' . : 13 0 5 2 . 00 e rp mt : Bal .nc : 8 8 5 . 00 Re co ·rd.: Addr : P O BOX 9 5 32 San p._rn;on i o, T exa s 32 1 6 Pa i d : 4 2 6 . 00 OPb a l n c : Re de t : 1 - 10 - 1 2 --------Non 11onet .a ry ---------Sep Typ e : LP PERMANENT Lil.Y No t i c e : Work ed : 0 5 - 0 5 - 84 Thr u 1 0 - 0 8- 11 SOC: 5 0 Pe nd In v s tn : N S t a tu s : Non Pa y i ng De t Sep : Ti t l e : AUDIT R Eli g i b l e : 1 0 - 1 5 - 1 2 Fmt Emi. : 1 0- . 3 - 1 3 Individual Information VERSIGHT 110 TX-HHSC-20-0960-A-000225 MEPD New Hire Part 1 January 2020 Viewing TWC Wages and Benefits Confirm SSN and name of claimant. TWC Wages lssN: 222 - 33- 4444 DATA FI LTER: and Benefits D,- 365 CLAIMl'.NT STATUS: I Na~e : Adam St even! C\ 0 : Addr ess : 2140 All anda l e Rd Apt 1107 Ci t y : Aus t i n St at e : TX Zi p : 787 5 6 La s t Cha ng ed : 03- CS- 2 013 Phone : ( 512 ) 36~-5555 ITa x Wi thhold i ng : Y Dir e ct De po s i t : N Chi ld Support : N Pq 4 SSN: 222- 33- 4444 Act= St evens Clm Sta : C0:1PETE Clm Sta Dt : Oc - 10- 12 IP= : rxn c1mD : T05597A S:.Jb Pgm: UI Clm Typ e : Cl.il Jt : o: - os - 12 Rll:d IC : 10- 09- 11 Pay St : TX file Dt : 01- 10- 12 Fil e ~e th : Fil e Loe: 0000 -------- Cu:~ent ~o~~tary ------- ---- ----- ---- -- Las t ~~pl oye= - ---- ----- ---- Alt Base : N Pendi ng I s s ue : K Ace~ : 0 8- 0 9~538 - S Clm Type / Dt.: IC I 10 - 08 - 12 I w""BA: 2s: . oo JDisqu al : Ku.~: S!! t Suy, In c. 130 52.00 0-✓e:p:nt: Md: : PO SOX 9532 loaln c : 878 5 . 00 IReeovrd : Paid : ~267 . 00 OPbalnc : San ;=u-.tonio, Texa ~ 78216 Redet : 0 : - : 0- 1 2 lsep Typ e : LP PEP,J1~t~l LAYI Not.ic e : --- ----- - ·~ SOC: 51 0 Pend In vstn : K Statu s: Pay inq Worked: 05- 05-84 ~ l0- 08-11 Title : A!JJITOR Elig ibl e : 10 - :5 - 12 =, The report lists last employer and reason for separation only and cannot be used as verification because TWC received this information from the claimant. Further details may be needed on separation such as last workday, final check amount and received date. Compare the Weekly Benefit Amount (WBA) listed against the amount of payment. Next, check the claimant’s balance to determine if benefits will continue. If the balance is low, the claimant may be close to exhausting his benefits and have limited weeks left to claim. A claimant files a claim every week and is potentially eligible for the benefit amount. UIB is distributed to the claimant on a bi-weekly basis. The example above shows WBA (of $251.00. The claimant will receive biweekly payments of $502.00 (251.00 x 2 = 502.00). Individual Information VERSIGHT 111 TX-HHSC-20-0960-A-000226 MEPD New Hire Part 1 January 2020 Benefit Payments At the start of the benefit payments, one initial payment is processed as a paper warrant (see ); there is a waiting week, then the next payment will include three payments together. (A regular bi-weekly payment plus the waiting week amount). Afterwards, all payments are bi-weekly. BENEFIT PAYMENTS : A BWE 1 212 12 12 12 11 11 11 11 1 0- 29 22 15 08 0 124 1 710 03 27 - File 12 12 12 12 12 12 12 12 12 12 Week St s Da te 0 1- 02 12- 26 12- 26 12 - 12 12- 12 11 - 28 11 - 28 11 - 1 411 - 1 41.0 :-3 1- 13V 12V 12V 12V 12V 12V 12V 12V 12V 12V -~ .~ ... :;,. Q. .-: ~.,....... --'i.~ ,,,/·· - ,, : ,,.,.•.,A\ _.:i •'-'•-•v-.••/ •,- ,__,,,,,_.t'• 02 0 10 10 10 112 12 12 12 12 - d4 28 2 114 07 3 124 1 703 10 - 12 12 12 12 12 11 11 11 11 11 0 2 - 0 80 2 - 0 80 1- 25 0 1- 25 0 1- 11 0 1- 11 0 1 - 03 0 1 - 03 12- 1 412- 1 4- Amt Erng s PD PD PD PD PD PD PD PD PD PD PD·1 PD PD PD PD PD PD PD PD PD .-·✓-·, •• ,,,,,. --- Pgm - -----Ddct TUC TUC TUC TUC TUC TUC TUC TUC TUC TUC - .,.-.- -- ,.-r if ",./l\,.,.. 12V 12V 12V 12V 12V 12V 12V 12V llV llV O,> ,,,.,...p.,.,,.v.,,. _ ,,.;,,, ,,._.-·-- ,·• 1,< i::,.~ : ._,... REG REG REG REG REG REG REG REG REG REG - ---Payment --- - ------ -Di s t Arnt Date Id 42 6 42 6 42 6 42 6 42 6 42 6 42 6 426 42 6 426 0 1- 03 ~2 - 27 12- 27 12- 17 12- 1 7~ 1- 29 ~ 1- 29 1- 1 51- 1 511 - 0 1- __J,--_ ,.r- --. ..r'<).~ -~ ~ ",'" ·-..-..,-,_,_. --+ 13 BO 12 BO 12 BO 12 BO 12 BO 12 1B0 12 . BO 12 BO 12 BO 12 BO * * -~ .g-,...,. ,.r -,,r , ,i._- ..•,-.. ✓--,;,_.,,..,.,,.,:,./'1...~ ,- .. ,,.._ .~,, "42 6 0 2'-·C)' g'.'..1 2 BO 426 0 2 - 09 - 12 BO 426 0 1- 26 - 12 BO 426 0 1- 26 - 12 BO 42 6 0 1- 12 - 12 BO 42 6 0 1- 12 - 12 BO 42 6 0 1- 0 4- 12 BO 42 6 0 1- 0 4- 12 BO 42 6 0 1- 0 4- 12 BO 42 6 12- 1 9- 11 W4 . .- .. Benefit Payments Code Definitions (TWH C-825.15) BWE Benefit Week Ending (Saturday) File Date Date the claimant files request: V-filed by voice; P-filed by paper Week Sts Status code (PD-Paid IE-Ineligible WW-waiting week served and paid) OP Amt Amount overpaid, if any Erngs Earnings reported by claimant during week, if any Program under which the claim was filed (REG-regular; TRX-extended trade Pgm affected, etc.) Ddct Deducted amount from benefit (child support, etc.) Dist Distributed amount to 3rd party (recouped from claimant, overpayment, IRS) Amt Amount issued to claimant Date Date of UI benefit issued (two weeks issued together-biweekly) Payment ID beginning with letter W – Paper Warrant issued (at the initial eight day verification period) Id D – Debit Card (Chase UI card) B – Bank Direct Deposit into claimants’ personal checking/savings account Individual Information PVERSIGHT 112 TX-HHSC-20-0960-A-000227 MEPD New Hire Part 1 January 2020 Claimant Access to Benefits Following the initial request for direct deposit by the claimant, TWC provides the bank or credit union eight business days to verify the direct deposit information provided by the claimant. Direct deposit UIB payments are made available to the claimant one business day after the payment date listed on the TWC inquiry Benefit Payment Summary screen. The Payment ID number on the TWC inquiry screen will display a “B” for UIB payments direct deposited into a personal checking or savings account. When a claimant is scheduled to receive a UIB payment during the initial eight-day verification period, TWC will issue a paper check for the UIB payment. The Payment ID number on the TWC inquiry screen displays a “W.” Availability of UIB payments issued by paper check are also determined by adding one business day to the payment date listed on the Benefit Payment Summary screen within the TWC inquiry. Count these UIB payments as unearned income in the month they are received, but not as a resource in the same month. BENEFIT PAY!1 ENTS: ================= A BWE - -------12- 29 - 12 12- 15 - 12 12- 29 - 12 12- 15 - 12 12- 29 - 12 12- 15 - 12 12- 08 - 12 12- 01 - 12 0 4- 21 - 12 0 4- 1 4- 12 0 4- 07 - 12 03- 31 - 12 03- 2 4- 12 03- 17 - 12 Op / Fil e Dat e Wee k Sts F1nt Erngs Pgm 01- 02 - 1 3V 12- 26 - 1 2V 01- 02 - 1 3V 12- 26 - 1 2V 01- 02 - 1 3V 12- 26 - 1 2V 12- 26 - 1 2V 12- 12 - 1 2V 0 4- 25 - 1 2V 0 4- 25 - 1 2V 0 4- 11 - 1 2V 0 4- 11 - 1 2V 03- 28 - 1 2V 03- 28 - 1 2V PD PD PD PD PD PD PD PD PD PD PD PD PD PD 0 0 0 0 0 0 0 0 45 0 45 0 0 0 0 0 --------- 0 0 0 0 0 0 0 0 420 420 0 0 0 0 • • REG REG REG REG REG REG REG REG REG REG REG REG REG REG ---------------Id ----------Payment DO.ct Di s t F1nt Dat e -------- --------- 120 120 120 120 27 6 27 6 27 6 27 6 426 426 41 4 12 426 426 426 426 426 426 426 01- 1 7 - 13 01- 1 7 - 13 01- 0 3 - 13 01- 0 :3- 13 12- 2 7 - 12 12- 2 7 - 12 12- 1 7 - 12 12- 1 7 - 12 0 4- 2 6 - 12 0 4- 2 6 - 12 0 4- 1 2 - 12 0 4- 1 2 - 12 03- 29 - 12 03- 29 - 12 0532 0311 2 0532 0311 2 0532 81526 0532 81526 000 2 8188 0 000 2 8188 0 000 1 8 61 42 000 1 8 61 42 D487 00 607 D487 00 607 0 48 619317 0 48 619317 0 485 40128 0 485 40128 Count as unearned income the gross benefit less any amount being recouped for a UIB overpayment. In the example above, UIB benefits were received until April 2012, when claimant began working and reported earnings; resulting in an overpayment. The claimant then re-filed a claim in December 2012 and the overpayment was recouped. The countable gross amount of $12.00 is received on pay date of 12/18/2012 (next business date). If the claimant has child support, withholding taxes or FICA taxes deducted from UIB, the “Amt” column represents the net income and specialists must include the deducted amount for the countable gross benefits amount (120 + 276 = 396 is the countable gross weekly benefit). Individual Information 113 TX-HHSC-20-0960-A-000228 MEPD New Hire Part 1 January 2020 Lesson 5: Individual Information in TIERS Data Collection is the TIERS functional area you use to record detailed information from the application. In this lesson, you will use information from the application packet and SOLQ interface. You can only perform Data Collection after completing Application Registration. In Application Registration, TIERS created a case number. You need that number to begin Data Collection. Interview Modes You must “initiate” Data Collection by entering the case number and selecting the Intake Interview mode. Data Collection uses different modes, depending on the action being taken. For a new application, you must use the “Intake” mode. For a review, you must use “Complete Action”. For a change to an existing case, you must use “Change Action”. The interview mode (also called “case mode”) also appears on some Inquiry pages in TIERS, to indicate the case’s current mode. For example, a case mode of “Ongoing” means the case has been processed and disposed, and there is no current action being taken on the case. Review the Interview Modes Handout to understand the various modes you can use in Data Collection and the situation to which each applies. Information A\11 ICIndividual A PVERSIGHT 114 TX-HHSC-20-0960-A-000229 MEPD New Hire Part 1 January 2020 Logical Units of Work TIERS organizes information in Logical Units of Work, or LUWs. There is a lot of information to be recorded, and sometimes the information is too much to display on one page. TIERS organizes multiple related pages into a LUW, which is organized by tabs. Each tab corresponds to a page within the LUW. For example, the Individual Demographics LUW contains five pages: • • • • • Summary (which appears only after records are recorded) Citizen Residency SSN/Armed Services Conviction/Rehabilitation Each page contains a specific subset of individual demographic information. Each page is indicated by a tab at the top of the LUW. You navigate between pages using Next and Previous and may be able to also navigate by clicking on the corresponding tab (if there is no information yet recorded on the page, you will not be able to go there). When completing a LUW, it is important to remember that TIERS usually does not save the information in the LUW until you have completed the entire LUW. You usually do this by moving off that LUW to another LUW through the Next or Previous button. Therefore, make sure you complete all necessary pages in the LUW and use Next or Previous to move to another LUW, otherwise the information may not be saved. Each tab represents a page within the Logical Unit of Work. !HiiiH+i Wi§f I ~ 7 ual Information Name : Ind ividu al #: J Dates • Effective Beg in Date ►Reported on ~~:~:~n : I jo7 ,[o, ,[2w fi"o,~ ,[2w rro-,~ ,[2w End Date t Date Client Became Aware : r ,r ,r,;v The entire set of pages and the information they contain is the Logical Unit of Work (LUW). fi"o,~ ,[2w Individual Demographic Informa t ion Identification Number: Stale" G Mar ital Status· ID vermcatiOn : IdentityvermcatiOnComments: Individual Information VERSIGHT 115 TX-HHSC-20-0960-A-000230 MEPD New Hire Part 1 January 2020 Summary/Detail Most LUWs in Data Collection contain one or more records. For example, you may enter more than one person on the Individual LUW, or you may record more than one bank account on the Liquid Resources LUW. When you want to go to the detail page for an individual, a specific bank account, or other record, TIERS needs to know which one you want to access. Therefore, most Data Collection LUWs have a Summary page that lists the various records for which you can view details. You select a particular record by clicking its Edit icon, which then takes you to the Details pages and displays information for that particular record. During Intake, there are usually no existing records, so TIERS takes you straight to the Details page to enter information. You may not see Summary pages in Intake mode. However, when you later go to that LUW, TIERS always takes you straight to the Summary page. From there, you can select and view a particular record, or add a new record. Individual Information AMERICAN PVERSIGHT 116 TX-HHSC-20-0960-A-000231 MEPD New Hire Part 1 January 2020 Click Edit to reach Details • Summary ---- iving Arrangement/Domicile • Summary G) @ Case Name : 8 ca se Mode : Case St at us : • Name • Individual # • Living . Arr angement Type • Begin Date • End Date ◄ Previous iii•} • Last Updated • Updated On By Summary iiiMi+i iiifl Case Mode : Ca se Name : Pik e , Dwa y n e Individual Information tlame : Pike,Dwayne 72M Begin Date: Upclatecl Date: Individual # : Imm ,~ ijyyyy Get Other Agency Data Dates •Effective Begin Date: •Reported On: .Verification Received On: V ,~ d2010 F IV d2010 F ,V d20 10 F,r,r End Date: •Date Client Became Aware: V ,fo'T"" , 12010 J Living Arrangement Details •Living Arrangement Type: IAt home I Unmarried minor parent meets TANF living arrangements? . •Verification: l.. v I . ...c-::. 1-ie ::. -::. n-::. ts -::. t-::. at-e-::. ::.m-::. e__n_t_________________________________ -.=-------------- "=! Verification Comments: Contact's Name: Contact's Address: Individual Information 117 TX-HHSC-20-0960-A-000232 MEPD New Hire Part 1 January 2020 Driver Flow Data Collection contains dozens of LUWs. When you are entering all the information on an application, it can be hard to keep track of them all, and difficult to know which ones to go to. TIERS makes this process easier by using a driver flow. The driver flow keeps track of where you are in the process, and it identifies which LUW to display next. This allows you to focus on entering information and not on trying to keep track of LUWs in TIERS. You simply click Next once you’ve completed an LUW, and the driver flow takes you to the next LUW in the process. If you need to return to a previous LUW, you can always use the Left Navigation Bar to navigate to that LUW. When you click Next, TIERS returns to the driver flow and displays the next LUW in the process. Question/Detail LUWs Part of the way in which the driver flow works is through Questions and Details LUWs. At certain points in Data Collection, the driver flow presents you with a Questions LUW, containing several related questions. For example, the Resource Questions LUW contains questions about various types of resources the individual may own. When you answer Yes to a question, the driver flow schedules the corresponding Details LUW. If you answer No to a question, the driver flow skips the corresponding Details LUW. When you click Next to move forward, the driver flow only displays Details LUWs related to those questions to which you’ve answered Yes. This makes it easier for you to navigate and track the correct LUWs. Dates in TIERS What Date Is Used Individual Information pVERSIGHT 118 TX-HHSC-20-0960-A-000233 MEPD New Hire Part 1 Dates t EffectiVe Begin Date: t Reported On: tVerification Received On: January 2020 r ,,=-,r rc ,r ,!E'" e- ,r ,1-=i End Date: t 0ate Client Became Aware: j mm 1~1jyyyy'"' rc=-,i::-,r, One of the most important types of information you enter in TIERS is dates. There are various dates you enter, and they all affect how the system counts information when determining eligibility. The most common of these dates are: Effective Begin Date (EBD) Almost every LUW in TIERS requires you to enter an Effective Begin Date. The Effective Begin Date is the date TIERS uses to define when to begin using that information to determine eligibility. It is a required field – every record MUST have a begin date, from which that record becomes valid. The EBD is typically the date the information applies to the household. For a new application with no prior history, type the first day of the month, 3 months prior to the File Date, or the actual date the information in the record began, whichever was later. End Date The End Date is the date when TIERS no longer uses the information for determining eligibility. It is the date the information no longer applies for the household. Usually there is no need to enter End Dates during an initial application. Rarely, there may be situations where information changes or stops during that period. Then, an end date is required. Date Client Became Aware The Date Client Became Aware is the date the client became aware of the information. Usually it is the same as the Reported On date. It cannot be a future date, nor can it be later than the Reported On. During an initial application, the Date Client Became Aware defaults to the current date for cases with no benefit history. Review and update the Date Client Became Aware on each page. Individual Information PVERSIGHT 119 TX-HHSC-20-0960-A-000234 MEPD New Hire Part 1 January 2020 Reported On The Reported On is the date new or changed information is reported to HHSC. It cannot be before the Date Client Became Aware, nor can it be a future date. In an initial application, the Reported On defaults to the current date. Generally, you should not need to change it. Verification Received On The Verification Received On is the date that either the verification was received or is the Reported On when verification is “Client Statement” or “Not Verified”. The Verification Received On is a mandatory field, even if you don’t receive the verifications that day. It can never be a future date. In an initial application, the Verification Received On defaults to the current date. Leave the current date if you do not have the actual verifications, then select “Not Verified” from the Verification field. Individual Information AMERICAN PVERSIGHT 120 TX-HHSC-20-0960-A-000235 MEPD New Hire Part 1 January 2020 Individual Information in TIERS The Data Collection functional area is very large, and therefore it is divided into smaller sections. These appear on the Left Navigation Bar, under the Data Collection heading. Each section contains related LUWs. For example, the Resources section contains LUWs for various resources, such as Real Property, Burial Resources, Vehicles, and so on. The first section of Data Collection is called Individual Information. This contains the first LUWs that appear in the driver flow when you initiate an intake. These are also the LUWs in which you enter much of the non-financial information for an application. This module covers the first half of individual Information, up to the Individual Questions LUW. The remainder of the Individual Information section, along with the Non-Financial section, is covered in the Non-Financial Information module. SOLQ SOLQ can be requested through TIERS, after adding all individuals in the Individual Household LUW. Clicking the RS icon on the Household page submits the SOLQ request for all individuals. You can also view an SOLQ report for an individual by using the View SOLQ Reports LUW in the Interfaces functional area. You search by Individual # or SSN. You can then go to the Individual Information page for a specific individual and click the SQ to open that individual’s SOLQ report in a separate window. SOLQ can also be accessed by clicking on the SQ icon on different screens throughout the driver flow. Data Broker You request Data Broker from the Edit Existing Individual ID Information page of the Individual Household LUW. Answer YES to the question on the Edit Existing Individual ID Information page Request for data broker information? Once you have requested the report, you can click the DB icon on specific TIERS pages to bring up information relevant to that page (for example, Vehicle, Real Property, and so on). Note: Clicking the Data Broker icon does not request a Data Broker but instead allows you to review a Data Broker report AVS You request an AVS Response from the Edit Existing Individual ID Information page of the Individual Household LUW. Answer YES to the question on the Edit Existing Individual ID Information page Was asset verification consent provided for Individual? Individual Information AMERICAN PVERSIGHT 121 TX-HHSC-20-0960-A-000236 MEPD New Hire Part 1 January 2020 Age The DOB is first entered in Application Registration. When you complete the Individual Information section of Data Collection, check the DOB on the Individual Information page. You will also request and view SOLQ on that page and verify the DOB through SOLQ. Disability In TIERS, you will also record the following information: Information TIERS LUW Disability benefits Aged/Disability Benefits LUW Disability details/request for disability determination Disability LUW Medicare Part A information Medicare LUW Residence The address is entered on the Address LUW. You can verify residence on the Residency page in the Individual Demographics LUW. Citizenship Record citizenship information and verification on the Citizen page of the Individual Demographics LUW. L-1 Verified by SSA (SOLQ, WTPY, HUB) is a valid choice in the Verification field. Social Security Number The individual SSN is recorded on the Individual Information page of the Individual Household LUW. When you request SOLQ, the interface with SSA automatically verifies the SSN and places a checkmark in the Verified by SSA field. If the individual does not have an SSN, record information about the individual’s application for an SSN on the SSN/Armed Service page of the Individual Demographics LUW. SOLQ and SSA Benefits Information about most SSA benefits such as RSDI, SSI and Medicare, is found in the SOLQ report. Use the information from this report to complete the related LUWs in TIERS. SOLQ can also provide information such as disability detail. Individual Information VERSIGHT 122 TX-HHSC-20-0960-A-000237 MEPD New Hire Part 1 January 2020 Support and Maintenance Identify a potential support and maintenance situation by reviewing the application questions that ask whether the applicant is living with someone else or in another person’s home. You may need to contact the applicant and get more information to determine whether support and maintenance is applicable. Using the information you get from the applicant, use the Support and Maintenance Worksheets (Appendix XIV) to calculate the support and maintenance amounts. TIERS contains an LUW for recording Support and Maintenance. TIERS uses the amounts you record there to calculate the amount of support and maintenance to treat as income. Medicare Part A Recording Medicare Part A information in TIERS is covered later in this module. Application for Other Benefits In TIERS, the Residency page of the Individual Demographics LUW contains the question “Is the Individual cooperating with applying for other benefits?” It defaults to YES. Individual Information AMERICAN PVERSIGHT 123 TX-HHSC-20-0960-A-000238 MEPD New Hire Part 1 January 2020 Work Flow Data Collection N o n- Fl nan cla l Data Collection l ndlvldua l In formation Data Co ll ection Resources Data Collection & In come Expenses TIERS In quiry View Correspondence Individual Information Run Eligibility Verify & & Results Add Case Comments and Dispose 124 TX-HHSC-20-0960-A-000239 MEPD New Hire Part 1 January 2020 Business Process Redesign Operational Guide Library Verification Job Aid Access and review the Verification job aid in the BPR Operational Guide library in the LOOP. You must use this job aid to guide you during the interview process. This job aid ensures you: • • • • Pend appropriately when required Avoid requesting unnecessary or excessive verification Have quick access to acceptable verification sources Have a list of the various methods an applicant/client can submit requested verification (as shown on the last page). This job aid promotes case accuracy, ensures you meet your completion rate and service time standards, and maintains consistent case processes. Activity – Review the Verification Job Aid Instructions: Access and review the Verification job aid in the BPR Operational Guide library in the LOOP and discuss the verification requirements listed in the following sections: • • Household Address Individual Information Pike Walk Through Exercise Individual Information Using the case number you recorded on your Data Sheet and application for Dwayne and Sue Pike, follow along with instructor to complete the Individual Information in TIERS. Individual Information VERSIGHT 125 TX-HHSC-20-0960-A-000240 MEPD New Hire Part 1 January 2020 Enter Individual Information in TIERS Using the Individual Information section of Dwayne and Sue Pike, follow along with the instructor to enter the corresponding data in TIERS. Begin Data Collection In order to begin Data Collection, you will need: • • ' Disaster SNAP \ App lication ©·Self Service © •Application Registra tion ©•Scheduling The case number. The application packet. To initiate Intake in Data Collection, select Data Collection – Initiate Interview from the Left Navigation Bar. EJ. Data Collection · •-+ Initiate Interview ' ...Case Comm ents • .f S SNAP !"·Custom ize Driver $ •Individua l l Information iiJ.TOA Specffic $ •Non Fina ncia l $ ·Absent Pa rent ©•Sa nctions Individual Information 126 TX-HHSC-20-0960-A-000241 MEPD New Hire Part 1 January 2020 Initiate Interview This LUW is the first LUW to appear in the driver flow. This is where you select the appropriate interview mode. You must have the application number to begin the process. 3 Initiate Interview ► Interview Mode: >Case or Application It. Ilnlake lyour case I 1 2 Begin Date: :... Disas ter SNA P Ad ministrat ion Praeid'anti.al Em arg s nc End Date: View All Records: □ View All Inactive Records: □ 1±1 -Seff Service [±I-App licat ion Reg istration 1±1 · Scheduling ..:.. . Data Coll ect ion ... Initiate Interview Ca-se Co mments FS SNAP lm11 Special Driver Flow Do you want to reconcile MEPD Income/IME? :-. Customize Driver ,fdddwYY~ 0 i ;WM WIMIJ 3 $ ·Individua l Informatio n iii·TOA Specific ~ -No n Financ ial ~ -A bs ent Parent Steps: 1. Interview Mode - Intake. 2. Enter Case or Application #. 3. Click Next. Individual Information pVERSIGHT 127 TX-HHSC-20-0960-A-000242 MEPD New Hire Part 1 January 2020 Application Received Date This LUW only appears this one time in Intake and allows you to change the File Date for the application. You cannot get back to the page once you leave. This is your only opportunity to change the file date. Cas e # : 18 00 13 0 4 19 2 IApplication Received Date Current Application Received Date: 1 01 ►Does the Application Received Date IW•• New Application Received Date: . need to be changed? v ,. , 0 11¥11 2 IJI [ii) Time Received: Steps: 1. Does the Application Received Date need to be changed? - NO. 2. Click Next. Individual Information J)VERSIGHT 128 TX-HHSC-20-0960-A-000243 MEPD New Hire Part 1 January 2020 Household Information This LUW contains information originally entered in Application Registration. If an Authorized Representative was added for the application, the information appears on the Authorized Representative page. If the individual wants to add an Authorized Representative at this time, you can do so by answering Yes to the question “Is there an authorized representative”. Review the information and verify it against the application. Case Name : Pike, Ov,ayne 2 Case Information ~ I f'7 Date Received: Special Accommodations: ► ,12017 ICl) Telephone Interview Colonias "' Designated Staff v Facility Interpreter Language: V IEnglish Notice Language: Primary Applicant Prefix: IEf ► First: !Dwayne ► Last: j Pike Suffix: IEf Household Contact Information Home# : f51'2"" .j555 j5555 Work #: Cell #: 111 E-Mail: Is there an authorized representative? Is the worker unable to locate the household? Is this application submitted through a CBO? Is this application submitted with the help of a certified navigator or assister? 1 ► All members live in the same household? Renewal of Coverage in Future Years? El jN O El jN O El jN O j YESE) 1B __,,,, 0 2 Steps: 1. All members live in the same household? - YES 2. Verify the information is correct and click Next. Individual Information PVERSIGHT 129 TX-HHSC-20-0960-A-000244 MEPD New Hire Part 1 January 2020 Household Authorized Representative When an Authorized Representative is entered at Application Registration, the information appears on the Authorized Representative page. Review the information and verify it against the application. 6 IAuthorize d Representati ve Inform ation Prefix: • First: Middle: jJoe Last: j Pike Organization: ► Authorize d Representati ve Id Verification: Authorize d Representati ve Id: ► 1 Signed Medicaid application .------• 03 Type of Authorize d Representati ve: Other designation ► Verification of Authorize d Representati ve: Client signature on the applicati , • IAdd ress Inform ation Fraction: Sir Tyne· Address Line 2: Texas State: ► Coun ty: Is address validation reQuired? • • 02 Is the Medicaid ID card and other agen cy correspondence going to be sent to the authorized ntative?: a ' YES • 4 . . ~trP.P.t Travis Zip Code: j 78751 NO • Suffix: - w Dir.: n w P.llingTynP.· City: . #r---- jAustin I 5 Contact Inform ation Phone # ~ j 555 j 5555 i iMiii■iiiii·Hi WillJ Ill Steps: 1. 2. 3. 4. 5. Enter Authorized Representative information. Authorized Representative ID Verification: Signed Medicaid application Type of Authorized Representative: Other designation Verification of Authorized Representative: Client signature on the application Is address validation required?: This is defaulted to YES. In the training environment we must select NO 6. Click Next. Individual Information PVERSIGHT 130 TX-HHSC-20-0960-A-000245 MEPD New Hire Part 1 January 2020 Household Address Summary This LUW contains address information originally entered in Application Registration. Review the information and verify it against the application. You may also verify the address against the SOLQ report later. If information needs to updated, click the Edit icon and update the address. If a different address is needed for mailing, click the Add button. AM·I itiiiH+i Type Address 909 (8) Phy s i c a l w 45 t h Begin Date End Date St r eet Aus t in , Texas 78 75 1 - 2 80 3 ♦Mi I ~ itiiiH+i Steps: Verify the information is correct and click Next. Individual Information J)VERSIGHT 131 TX-HHSC-20-0960-A-000246 MEPD New Hire Part 1 January 2020 Permission(s) for ELDS Service . ,_ Perm1ss1 on(s) for ELDS Service ,- ' c,-,,; , Pa. » .<><1 , 090.,. H Sponsor(s)• Permission(s)providedfor ELDS ServiceQ) @ 8 g;;;;;.;++ WillI Case Individuals: l?i ke, s ue 68F l?i k e,D h•ay ne 68M ELDS Permission Required: Individual Provided Permission for ELDS Seivice: NO NO iliiiH+iWill I This screen is primarily used for Texas Works cases; MEPD currently is not required to answer the questions in this LUW. Click Next to continue. Note: ELDS (electronic data sources) SAVE will receive information verifying if an alien has a sponsor or is likely to have a sponsor. This information will be reported regardless of whether the alien reports it or not. Individual Information PVERSIGHT 132 TX-HHSC-20-0960-A-000247 MEPD New Hire Part 1 January 2020 Editing Existing Individual ID Information This LUW also contains demographic information entered in Application Registration. Review and update the information. You also need to add verification for the Date of Birth and SSN. The Validated by SSA field automatically fills in once the interface with SSA verifies the SSN. Review demographic information and SSCN information (if it was added). You can also add household members at this time, if they were not added during Application Registration. TIERS conducts File Clearance for new individuals added here. This LUW is also where you request SOLQ and Data Broker. You actually request SOLQ from the Individual Household Summary Page. You have to complete or review all individuals first, click Next to exit the LUW, then click Previous to return to the Household page. There, click the RS icon at the top of the page. Once you’ve requested SOLQ, you can return to the Edit Existing Individual ID Information page and click the SQ icon to view the SOLQ report for the individual. You may need to do this for each individual. You also request Data Broker from the Edit Existing Individual ID Information page. You: • • Answer YES to the question Request for data broker information? Click the DB icon After submitting the request here, you can access Data Broker from specific TIERS LUWs by clicking the DB icon on the LUW. Individual Information AMERICAN PVERSIGHT 133 TX-HHSC-20-0960-A-000248 MEPD New Hire Part 1 January 2020 Request SOLQ from Individual Household (Summary) To request SOLQ, you must return to the Individual Household page of the Individual LUW. There, click the RS icon in the title bar of the page. 1 2 Ca.s e N a m e: Pike , Dv1ayne t•iiMi·Hi 3 1 Current Household Members -------------------------------------------- • Client# • Date of Birth P i ke,Dway n e 68M 194-04-6367 • SSN 901480442 07 / 01 / 1946 ~I ~ I )2015 P i ke,sue 68F 194-04-6115 901480445 05 / 25 / 1946 ~ / ~ / )201 5 • Name ® ® • Name Effective Begin Date Effective End Date m.11 / dd / yyyy • Client# No lnActive lndividual (s ) Exist. Steps: 1. On the Head of Household LUW, click Edit. 2. On the Individual Household page, click the RS icon. 3. Click Next. Individual Information VERSIGHT 134 TX-HHSC-20-0960-A-000249 MEPD New Hire Part 1 January 2020 4 wee W@#ii@I I Individual Information Pike ,Dwayne OM Name : Individ ual#: Individual Name Prefix: r"""'G •First: !Dwayne Middle: I Demographic Information • Gender: I Male [_g• Date of Birth: SSN j -1 • Ethnicity: I Non-Hispanic ' CHIP Client Id: Suffix : lw ~o~c:r~N .I"] , 1 SSN Verification: -1 • Last: jP ike 1 ~ 11 • Verification(s): !v erified by SSA (SOLO, WPTY, LJ v,- B B 1 ~~, American lndlan orAlaskan Native Asian 2 • Race i"""'G Black or African American English Spanish Language(s): Vietnamese ,F,I YYYY ~ lf deceased, dateo f death: Imm Maiden Name: Deceased Verification: v Mothe( s Maiden Name: Other Information Does the individual have other names? B lvEsG INo B INo B INo Does the individual have SSCN or Railroad Retirement Number information? Is the individual an HHSC employee? Is the individual a sta te employee Participating In Employee Retirement System ? Employee #: Is the Individual a Public school district employee participating in Teachers Retirement System? 3 IYESB equest for data broker information? Do you wi sh to request a Credit Report? I NO v INO EJ Is the individual a member of a federally recognized Indian tribe? Tribe Name: Verification: v I NO • ELDS Permission Required? ~ ~6v;,d~! ~~~~ ded ~ Permission for □ Do you want to request SOLO through ELDS? [_g C riteria: Is this individual high-need or high- I profile? Was the individual in Foster Care on their 18th Birthday? If Yes, State: 5 Was asset verification consent provided for individual? w as asset Verification consent revoked for individual? loOid individual have good cause for not providing consent? Type of Conservatorship: V V V v IYES B DFPS Conservalorship Verification: ~ V ICPC Agreement Verification: v Consent Received Dale: Imm",~,l yyyy ~ Consent Revoked Date: ~ [NoE 06 ,fa'["" ,li»I!CJ 0 iMM Ei:HiiWM•M ii@iiii4H+4 ri@iii@i Individual Information pVERSIGHT fNoE V V Verification: Did the individual receive Non-Federal Match Fosler Care Medicaid on their 18th birthday? Did the individual age out of Foster Care under an ICPC agreement? Y [g Is the individual enrolled in DSHS Children with Special Health Care Needs program? 7 135 TX-HHSC-20-0960-A-000250 MEPD New Hire Part 1 January 2020 Click on SQ for SOLQ 1. 2. 3. 4. 5. 6. 7. Verification(s) – Verified by SSA (SOLQ, WTPY, HUB). SSN Verification – Verified by SSA (SOLQ, WTPY, HUB). Request for Data Broker information? – YES. Click DB. Was asset verification consent provided for individual? YES Consent Received Date: Application date Click Next. Note: When requesting AVS, several conditionally mandatory questions will be enabled depending on the answer to the question, Was asset verification consent provided for individual? If answered YES: Consent Received Date is enabled and a validation message that reads: Please enter value for 'Consent Received Date' displays if the Specialist tries to navigate off the page without entering the consent received date. If answered NO: Did the individual have good cause for not providing consent? is enabled. Options in the drop-down menu are YES or NO. ***Currently there is no good cause, answer NO. You must answer this question, or a validation message appears reminding you to answer the question. Was asset verification consent revoked for individual? is enabled. Options in the drop-down menu are YES or NO. One conditionally mandatory question will be enabled if the answer to: Was asset verification consent revoked for individual? is answered YES. Consent Revoked Date is enabled. A validation message that reads: Please enter value for 'Consent Revoked Date' field displays if the Specialist tries to navigate off the page without entering a consent revoked date. TIERS actions are based on how questions are answered for AVS TOAs applications and redeterminations. For AVS applicable TOAs, request AVS only after running eligibility and determining the individual is eligible for the AVS TOA. Individual Information VERSIGHT 136 TX-HHSC-20-0960-A-000251 MEPD New Hire Part 1 January 2020 Individual Household Status This page allows you to indicate when the individual joined the household. This determines the date from which the individual may be eligible for benefits. For a new application (an existing household), the Household Status Date should always be on or before the earliest request date. For example, if the individual is requesting MSP for three months prior (12/01/2009), the Household Status Date should be on or before 12/01/2009. If you enter a date after that (such as 01/01/2010), TIERS only considers the individual eligible from that date. 7 ESi:Hii IIndividual Information Name: Pike.Dw ayne Househol d Status 1 ►Household Status Date: 2 ►Reported On: I /I /I I /I /r ►Verification Received On: J i) 4 5 6 ►Househol d Status: lfillJEnd Date: 3 Imm IV Ii;;;;-tfili) jfiljJ ►Date Client Became Aware: , ,, ,, tfiliJ ii- ifilll In Househol d ►Is still part of MAGI househol d? Tempo rarily Absent? Intend to return? If tempo rarily absent , reason? Tempo rary Absence Verification: Date Expected to Return: Location: tfiliJ fmm ,f,iii"""" , r,;;n- 0 7 &Si:Hii iiii%·i+i Hillj Individual Information pVERSIGHT 137 TX-HHSC-20-0960-A-000252 MEPD New Hire Part 1 January 2020 Steps: 1. 2. 3. 4. 5. 6. 7. Household Status Date: – _________________ Reported On: – _________________ Date Client Became Aware: – _________________ Verification received On: – _________________ Household Status – In Household. See note below Is still part of MAGI household? Click Next. Note: When you answer the question Household Status as "In Household," this field becomes inactive. MAGI may apply to TW EDGs. Individual SSCNs IIndividual Information Name : IIndividual Information - SSC Indiv idual # : s / RRB Numbers • Type: SSCN: RRB Number: !Type SSCN / RRB umber SSCM Check all SSCNs for accuracy. Click the edit when needed. Individual Information VERSIGHT or delete icons to correct SSCNs 138 TX-HHSC-20-0960-A-000253 MEPD New Hire Part 1 January 2020 Individual APTC Information IIndividual Information --SHBI .;.,■ 5 i·iii\·hi Ht11I Name: Eligible to receive services from TribaVlndian Health Services? V Received services, from TribaVlndian Health Services? V Total Annual Income (Current): $ 10,00 Total Annual Income (Next Year): $ 10,00 - iii:Hii#PH I ifii%·hi ifiiJ Step: Click Next APTC information is related to some Medicaid programs, and is not applicable for Community Programs. It shows up in the driver flow for all programs. Complete the same process for Sue Pike. Individual Information pVERSIGHT 139 TX-HHSC-20-0960-A-000254 MEPD New Hire Part 1 January 2020 Head of Household TIERS requires that a member of the household be identified as the Head of Household. TIERS regards this individual as the payee for the Eligibility determination Group (EDG) and the person to whom it addresses correspondence. TIERS assumes that the first individual entered into the system is the Head of Household. That person appears here. Since many MEPD households consist of one person, this does not necessarily cause any issues. However, if there are multiple individuals in the household, make sure that the individual applying for assistance is the Head of Household (TIERS may not correctly determine eligibility, otherwise). You can change the Head of Household here. ifi:Hiiiiii%·i+i Individual Information ► Name: lncliviclual # : y Dates ►Head of Household Begin Month: Imm / IYYYY~ Head of Household End Month: Head of Household Name @ Pike,Dw ayne 641,1 HOHBegin Date HOHEnd Date -- Imm / IYYYY~ Inactive/Invalidated MM/DD/YYYY ifi:Hiilliliiii~ Steps: Verify the information is correct and click Next. Individual Information J)VERSIGHT 140 TX-HHSC-20-0960-A-000255 MEPD New Hire Part 1 January 2020 Individual Interviewed Although client statement is accepted for community cases, Specialist are required to attempt to reach the client via a cold call. Follow the process in the EOPM under: COLD CALLS FOR NON-INTERVIEW PROGRAMS. This is a good time to quickly review the application with the client in case they didn’t understand some of the questions and clear missing information or information that doesn’t match. TIERS requires you to complete this LUW for every application. For a non-interview program, only one attempt must be noted in this page. If it is an interview program, then two attempts must be made and entered. If cold call was unsuccessful, answer NO. If cold call was successful or the client came into the office and an interview was held, answer YES and complete the remaining information to identify the individual interviewed. 1 In erview Cond ucted ~w as lntelView Conduced? IIndividual Information ~In erview Date: ~I~ f Name: µorr~ Individual # : V Individual Detail Information Prefix : !"""BFirst Middle: I Last: Suffix: l"""B Relatio ship to Client: ID V erifi cation: 2 Steps: 1. Was Interview Conducted? 2. Click Next. Individual Information VERSIGHT 141 TX-HHSC-20-0960-A-000256 MEPD New Hire Part 1 January 2020 Program This LUW displays the program request information recorded in Application Registration. You can add, update or delete programs or individuals. Review programs against what is listed on the application. The Summary should display a section for Medicare Cost Share, Medicaid, or both, based on the programs requested. Verify that prior months were selected, if the individual requested them. If one or more prior months are missing, you can add them here. Use the Program Action dropdown to select the appropriate action. You can Add Program, Add/Remove Individual, Read Only, Withdraw a program. After selecting the action, click the Edit icon to go to the Detail pages. You can only read/update one program at a time. To read or edit multiple programs (including multiple prior months), you must return to the Summary page and select one program request at a time. Individual Information AMERICAN PVERSIGHT 142 TX-HHSC-20-0960-A-000257 MEPD New Hire Part 1 January 2020 •◄ Previous • od Stamps Program ... I . . • .• ApplicationDate Individuals . (Individual) . N ext ► I ProgramAction ~ Program (Individual) Program Requested ProgramAction ApplicationDate Individuals ProgramAction ApplicationDate Individuals ProgramAction 11/ 28/ 2011 P ke, sue 64F P1ke, oway ne 64M 1 Read Only kliiiH+i Steps: 1. For Medicare Cost Share - Read Only 2. Click the Edit icon Individual Information pVERSIGHT 143 TX-HHSC-20-0960-A-000258 2 MEPD New Hire Part 1 January 2020 Program – Details This page displays details for the program selected on the Summary page. Depending on the action selected, you can withdraw a request or reactivate a denied/terminated EDG. Review the Effective Begin Date and Application Date for correctness. ifi:Hii IDates ► Effective Begin Date: ~,~,l 2011tGl ► Status Date: End Date : Imm / ~,jyyyytGJ ► Conversion Date: 04/01/20 17 Programs ► Program(s): Medica re Cost Share Sub Program : MC ~I~,1 2017 0 Test AII 0 Test Adult • Applicati on Date : CHIPE DG: ► Prog ram tOiJ Ty pe : Prog ram Status : Specialized Ap plic ation s: j ongoing V I Requested V 0 3038P D MBCC IReuse App lication Reuse Application Indic ator: D Reuse Application Date: V Prior Reuse Ap plication Date: IReactivate Program - Complete This Section to Reactivate Denied I Terminated Programs I/ I /I Reactivation Date ~ : ~etermination Application Imm / t!JlJ Reactiv ation Reaso n: ~ / I YYYY [1lJ Reinstatement Date: Imm / Jdd ,jyyyyIDJ IWithdraw Progr am The household requests to withdraw from !his program? I m V Wrthdraw Date: W ithdraw Reaso n: V CHIP Is the progr am referred by CHIP? CHIP Application #: One Time Grandparent Subsidy Do y ou wish to request one time Grandparent subsidy? I El ifi:HiiiiiiiH+i iiiil Step: Click Next. Individual Information pVERSIGHT 144 TX-HHSC-20-0960-A-000259 MEPD New Hire Part 1 January 2020 Program – Individuals This page displays the household individuals and indicates which individuals have requested the program. You can add or remove individuals. To change an individual’s status, click the Edit icon for the individual. In the Aid Requested field, choose YES or NO. Update the Date Requested, if necessary. Click the Update button. Verify that the Aid Requested column shows the correct option for that individual. Individual Information AMERICAN PVERSIGHT 145 TX-HHSC-20-0960-A-000260 MEPD New Hire Part 1 January 2020 8 ifi:HiiiiiliH+i Program Effecti ve Begin Dat e: 04/01/2017 End Date: Program(s) : Medicare Cost Share Program Type: Ongoing Applicati on Date : 04/17/2017 Sub Program: MC Individual Information ► Name: ►Effective Date: ►Date Individual # : V Begin Requested: Separate Food Stamp Assistance: Forfeit Effective Date: Include in MA Budget Only: Chip End Date Received from Interface: Medicaid Request /Special application type: Receives CHIP/CHIP Perinatal Coverage: Is this a QH/QE PE determination: ~,jo1t1 ~,f17t1 2017 tOiJ End Date: 2017 tOiJ Reminder: If the Foster/PCA Caregiver chooses to exclude the Foster/PCA child from Food Stamps, enter 'No' to aid requested I B frTim dctd d YYYYtDiJ I V I B ►Aid drrrv tEiiJ Imm I ~ I Requested: ' CHIP Client Id: tOiJ MA_PRA Disqualification Removal c=- r::;:;-dd r.::::Request Date: 1mm / Iuu / JYYYY Imm / ~ d YYYY CHIP End Date Continuous QMB Begin Month: v l3J jmm / jyyyy t!liiJ V US/MSP Application Number: MSP Referral From: Program-Individuals Summary • Name • Effective Begin Date • End Date • Date Requested t Aid Requested t PE • Include in • Separate MA Budget Food Stamp Only Assistance Pike,Dwayne 89M 04/01/20 17 04117/20 17 YES NO Pike,Sue 89 F 04/01/20 17 04117/20 17 YES NO @ @ 0 8 hfi:Hii iiii% ·i+iiiiiJ Steps: Verify the information is correct and click Next. Individual Information pVERSIGHT 146 TX-HHSC-20-0960-A-000261 MEPD New Hire Part 1 January 2020 Program – Summary ••• Program Program Status Application Date Individuals Program Program Status Application Date Individuals Prog ram Action Program Program Status Application Date Individuals Prog ram Action Program Program Status Application Date Individuals Medi car e cost sha r e (lndlVIOUal) Prog ram Action Pi ke , sue 68F Pi ke , o,,ayne 68M iiiiMH+i ±fill Individual Information PVERSIGHT 147 TX-HHSC-20-0960-A-000262 MEPD New Hire Part 1 January 2020 Appointment This LUW always appears in the driver flow. When an Interview is requested, you can view or add information from the Summary page. • Appointment • Appointment Type • Case/App Number • Program • Appointment Status iiii!H+i ±fill Step: 0 Click Next. Individual Information PVERSIGHT 148 TX-HHSC-20-0960-A-000263 MEPD New Hire Part 1 January 2020 Relationship Details This LUW appears whenever there are two or more people in the household. It must be completed for all individuals. Use this to establish the relationships between all household members. This can affect how eligibility is calculated for couple or companion cases. A couple case is one in which both spouses are applying for benefits. Depending on the program, eligibility may consider the financial information of both spouses when determining eligibility for one or the other. A companion case is one in which only one spouse is applying for or is eligible for benefits. Eligibility may still consider the financial information of the other spouse when determining eligibility for the applicant. If a spousal relationship is not recorded between individuals in a household, TIERS will not establish a couple or companion case and will not budget accordingly. Use this page to establish the relationships among all household members. This includes individuals living in the household but not applying for, or eligible to receive assistance. Correctly establishing the household relationships is critical. When the relationship of each individual is not entered correctly, it affects benefit issuance. Enter a valid relationship for each individual and their relationship to all other household members. Data you enter into the top grid is populated in the bottom grid, and the opposite is true as well. Individual Information AMERICAN PVERSIGHT 149 TX-HHSC-20-0960-A-000264 MEPD New Hire Part 1 January 2020 Field Notes The question, “If yes, physically able to purchase/prepare separately?” Refers to disabled individuals age 60 or over who purchase and prepare with other individuals. The question, “Fills Parental Role?” determines if: • • • A child’s earned income is counted or exempted. A student meets eligibility criteria by being responsible for the care of a dependent. All household members are counted in the EDG The question Provides care for determines: • • Employment Service exemption Whether a student meets eligibility criteria of “responsible for the care of a dependent child” Note: Only one parent may provide care for a dependent at any given time. You can correct entries in the Household Relationship Grid or in the Relationship Information section of the page using Retrieve and Update. Click Save to save information you have entered. TIERS will place a “Y” in the Record Completed column to indicate records you have saved. If you exit the page before you submit the record, TIERS does not save any information you entered but did not save. Be sure to check and revise entries in the bottom grid to reduce errors before you finish and exit this page. After completing and saving all information, click Next to move forward in the driver flow. Individual Information AMERICAN PVERSIGHT 150 TX-HHSC-20-0960-A-000265 MEPD New Hire Part 1 January 2020 itiiiH+i ii@IJ - Hide Mass Data Ent 3 1 is Spouse Pike.S ue 67F P,ke.Dwa ne 67M • of 02 E&i:iiii Dates 4 ffective Begin Date: 6 eported On: 2014 ~ ~,~d ~I~, !2014 8 ~,~d 2014 ~ 9 @ Yes e>No e>Yes @ No e>Yes @ No urchase/prepare together ? 11 13 15 rovides carefor? arriage Date (If within the last 6 Imm Months): 5 End Date DD ~ 7 D 10 D If yes, physicall y able to purchase/prepare separately? B 14 Provides support for? e) Yes @ No Living Together? @ Yes e>No 17 - Source Relationship Reference Name Type Name ~ Pi ke,o wayne ~ 6 7M 901135088 No e) Yes @ No Collapse All Record ~ 10 0 e> Tax Dependent? 1V dYYYY16 Wife @ Yes d 2014 12 House hold Relationship Grid ~ Pi ke,sue ~ 6 7 F 901135089 ~,rs ate Client Became Aware: Relationship Verification: Expand All i)dd dYYYY mm Imm 18 Effective Begin Date Completed End I Pi ke ,Dh•ayne 6 7M 901135088 y ~/ ~/ j2014 ~ Imm / )dd Pi ke,sue y ~I ~I j2014 ~ Imm / )dd 6 7F 901 1 35089 19 Ill ' Individual Information. ✓ Support and Maintenance . Health Concerns ,Home Environment . Medicaid Waiver/CA ✓ Medicare Clai j Part A an d B . Medicare Claim Part C and D . Prior Medicaid Coverage ' ...Tax Status Information ©·TOA Specffic $ •Non Financial $ ·Absent Parent ©•Sanctions $ •Resources $ •Income $ •Expenses © •W rap Up j I±),Miscellaneous 1±1 ·Eligibiltty Individual Information pVERSIGHT 167 TX-HHSC-20-0960-A-000282 MEPD New Hire Part 1 January 2020 Individual Questions This page contains questions about the specific conditions or situations that may apply to an individual. When you answer YES to a question, the driver flow schedules the appropriate LUW. If you answer NO, the driver flow skips that LUW. You can also choose PEND, if there is a likelihood that the condition applies to the individual, but the individual has not provided details. When you choose PEND, the EDG remains in Pending status and benefits are not issued. To remove the Pend, select NO or select YES and complete the related LUW. When you select PEND, the information appears on the Form H1020, Request for Missing Information or Action, to let the applicant know the specific type of information that the applicant must provide. Individual Information AMERICAN PVERSIGHT 168 TX-HHSC-20-0960-A-000283 MEPD New Hire Part 1 January 2020 • \ 9 lnct1v1ctu al Individual - Questions Q) @ a.a,g, • .,,.,,., 8 @@ \ L. \ t.ogo,,t , -,,,, Ill■ iiiliH+i Tax Status ► Do you want to collect Tax Status Information? IAged I Disability Benefits ►Is there anyone in the househOld receivi!l g disability benefits such as SSI or RSDI? UDIII B IYES B INo B INo B INo B INo B INo B INo B IYES B INo B INo 0 IFoster Care/PCA ► Is there any foster care/PCA child? Disability ► Is anyone in the household disabled? MBCC ► Is anyone in the household applying for MBCC? IOut of State Benefit ► H as anyone in the household received benefits from another state? Pregnancy ► Is anyone in the household currently pregnant? IRoomand Board ► Does anyone in the household pay for room and/or board? ISupport and Maintenance ► Ba sed on Living Arrangement, is Support and Maintenance applicable? IHealth Concerns ► Does anyone in the household have health concerns that need to be noted? IHome Environment ►Does anyone in the household nave a home environment that needs to Ile noted? IMedicare Claim ► Is anyone in the household currently enrolled in Medicare Part A or B? IYES ► Is anyone in the household currently enrolled in Medicare Part C or D? INo B B INo B INo B IMedicaid Waiver/CA ► Is there any Waiver/CA request? IPrior Medicaid Coverage ► Does anyone in the household need prior Medicaid coverage? Steps: 1. Is there anyone in the household receiving disability benefits such as SSI or RSDI? – YES. 2. Is anyone in the household currently enrolled in Medicare Part A or B? – YES. 3. Based on Living Arrangement, is Support and Maintenance applicable? – YES. Note: This question must be answered YES when testing an individual for programs where Support and Maintenance policy applies. 4. Prior Medicaid Coverage is defaulted to YES. There is no Prior Medicaid Coverage requested for this case so change to NO. 5. Click Next. Individual Information VERSIGHT 169 TX-HHSC-20-0960-A-000284 MEPD New Hire Part 1 January 2020 Aged/Disability Benefits If an individual receives aged or disability benefits (for example, RSDI or SSI), answer the corresponding question on the Individual Questions LUW and complete the Aged/Disability Benefits LUW. Record only general information here. TIERS uses this information to determine eligibility for SSI-related programs (including programs for individuals who were denied SSI). Record actual benefit amounts and payments in the Unearned Income LUW. ifi:Hii♦Mi I iiii%·i+i 11119 Individual Informa tion 1 2 3 ,,, , ~ ,,, , ~ ,,, , ~ ,,, , ~ Pike .Dw a yne 64M v Dates ►E ffective Begin Date: ►Re ported On: 940110836 lncliviclual # : End Date: ►Da te Client 4 RP.r.::im P.Aw::irP: [jii 5 Disab ility Ass istance 6 8 ►Be ne fitType : Benefit Begin Date: Verification: Denial Date: SSI Appli cation Date: .,.,. RSDI Retirement 7 ►Status: 9 Claim Numb er: SOLQ/WTPY y 10 Reas on: . ,. ,IJI C] D g_ Steps: V iii·%·+♦ ifi:Hii -,,,a 11 1. Name – Select Pike, Dwayne. 2. Effective Begin Date – _______________________ 3. Reported On – ______________________________ 4. Date the Client Became Aware – ______________ 5. Verification Received On – __________________ 6. Benefit Type – RSDI Retirement. 7. Status – Approved. 8. Benefit Begin Date – ________________________________ 9. Claim Number – Select the individual’s claim number from the list. 10. Verification – SOLQ/WTPY. 11. Click Add►. Individual Information J)VERSIGHT 170 TX-HHSC-20-0960-A-000285 MEPD New Hire Part 1 January 2020 Enter Sue’s RSDI A blank Aged / Disability Benefits Details page should appear. Enter the information for Sue’s RSDI. Use your Data Collection Worksheet for the information. When done, click Next to save the record and continue forward. Individual Information VERSIGHT 171 TX-HHSC-20-0960-A-000286 MEPD New Hire Part 1 January 2020 Other TIERS LUWs These LUWs do not appear in the current scenario but may occur for an MEPD applicant. Disability If an individual is disabled, answer the corresponding question on the Individual Questions LUW and complete the Disability LUW. Only record general information here. TIERS uses disability information to determine eligibility for MSP and certain other MEPD programs (if the individual is not 65 or over). The SOLQ report usually provides disability information. In some situations when there is not a disability established by SSA or Railroad Retirement, the Disability Determination Unit (DDU) may need to make a disability determination. Individual Information AMERICAN PVERSIGHT 172 TX-HHSC-20-0960-A-000287 MEPD New Hire Part 1 -. January 2020 a, .~:""'""' :_.: • Details Disability - Details 0 @ 8 @ @ @) Individual Information ► Name: Ind ivid ual # : V Oates ►Effective Begin Date: ►Reported On: ►Verific ation Received On: Imm tfcictdYYYY ~ fo4",J17"d 2011 ~ fo4",J17"d 2011 ~ fcicidYYYY ~ End Date: Imm I ►Date Client fo4°I fiT"°" tj 20 17 ~ Became Awa re: IDisability Information ► Type r ind Deaf Mental of Disability: ►Verific ation: V fcicidYYYY ~ I fcici dYYYY ~ I fcici dYYYY ~ Date of the Oocto( s Statement Form: Imm I Review Date: Imm ►Begin Date: Imm ►Does disability conform to Social Security standards?i-G' ,------------------------,.- Verification: ► Is individual perm anenuy incapacitated? ► Is individual perm anenUy housebound? ► D oes the individual require regular Aid and Attendance? ► Is annual review required? ► Ind ivid u al requires a disability determ ination? Individual's earned income more than 5970 for the previous quarter?: Individual making FICA conlli butions from earnings?: ►Percent Disabled: Form 1836-A has been received for TANF disability employm ent services disability exemption: Is disability expected to last for more than 180 days? Is disability due to pregnancy? i-B i-B 1B 1B 1B 1B 1B ' 1B 1B 1B Verification for disability due to pregnancy: V Verified Date: Imm I fcjd""I JWYY ~ Ind ivid ual needed i n the h ome t o p rovid e ca re fo r th e d i sabled ind ivid ual : Verification for individual needed in the home to provide care for the disabled individual: I fcicidYYYY ~ Imm / Was form H1859 provided and explained? i-G' g- pVERSIGHT Ind ivid ual # : V Verified Date Individual Information v"' ESHII #Gd I iiiiiH+i iiiil 173 TX-HHSC-20-0960-A-000288 MEPD New Hire Part 1 January 2020 Disability Determination Most MEPD applicants with a disability will already have had the disability established through SSA. This information appears on the SOLQ report. HHSC considers this information verified when it is received from SSA. Occasionally, an individual claims disability but has not had the disability established by SSA. In these instances, the Disability Determination Unit (DDU) may make a determination. The Disability Determination LUW appears when a specialist answers the Disability Determination question on the Disability LUW. Authorized personnel complete the Disability Determination page. DDU staff completes the DDU page after the disability determination is completed. Individual Information AMERICAN PVERSIGHT 174 TX-HHSC-20-0960-A-000289 MEPD New Hire Part 1 January 2020 Individual Information lndMdual#: • Name: Dates •Effective Begin Date: •Reported On: •Verification Received On: 88/VSSI Imm ,~ 1lwwm End Date: r ,r ,n m , ,, ,rm Imm •Date Client Became Aware: Date Applied for RSDI : Is approved for SSA? Date Applied for 881: Is approved for 881? ,~d wwm , ,, ,rm ..:.J Disability •Month needed for onset of DISABILITY: ISocio-Economic Imm ,~d wwm Information Physical Appearance: :;J Degree of Ambulation : El d Ability to engage in activities in home and in community: .=..I Medical History Past Major Disabilities or Diseases and Effect on the Patient: Present Major Disabilities or Diseases and Effect on the Patient: :;J I .=..I • Individual Information VERSIGHT Add ► ◄ Prev ious N ext ► 175 TX-HHSC-20-0960-A-000290 MEPD New Hire Part 1 January 2020 Support and Maintenance Support and maintenance occurs when: • • an individual is living in a household with another individual and is not paying certain expenses that the individual would normally pay, such as rent, utilities or food, or an individual lives alone and receives assistance with household expenses. Based on questions on the application form and information gathered through additional client contact, you may determine that support and maintenance exists. Use the Details page to record general information about the situation. • bmer.' e m e R When testing for programs that use Support and Maintenance policy, on the Individual Questions page, you must answer "Yes" to the question, "Based on Living Arrangement, is Support and Maintenance applicable?" This triggers TIERS to add the Support and Maintenance LUW to the driver flow. If you fail to answer "Yes" to this question, when testing for community programs for any month or a program that applies Support and Maintenance policy, the case will pend for Support and Maintenance to be addressed. Individual Information 176 TX-HHSC-20-0960-A-000291 MEPD New Hire Part 1 January 2020 The Details page asks specific questions to determine if the applicant is paying their pro-rata share of household expenses or what type of Support and Maintenance policy to apply to the case. In this case scenario, the individuals live in their own home and pays all household expenses, therefore no Support and Maintenance. When either question "Does client/spouse live in their own home and pay all household and food expenses?" OR "Is the client/spouse living in a total Public assistance household?" is answered YES, the remainder of the Support and Maintenance LUW will no longer be in the driver flow. This is because Support and Maintenance is not applicable for this case. 6%:Hii i·ii@H+i.a I1ndividual (s) Information tlame : Pike.Dw ayne 68M Updated Date : I~ Is this Support and Maintenance applica ble for a couple ? YES • 1 "--JI Spouse 's name: Pike, Sue Dates 2 ► Effective Begin Date: 5 ►Verification Received On: f /J /f l.W) End Date ImmI JdddYYYY I.WJ J /J /f UQ 3 oate Client Beca me Awa,e. f /J /f u]) 4 J /J /J l.wlJ Suppo rt and Maintenance Questions ► Does clien Uspouse live in their ow n home and pay all househol d and foo d expenses ? 6 Is the clien Uspouse living in a total Public assistance househol d? Is the clien Uspouse living w ith another person in that person 's househol d? Number of people in househol d: Does the clienU spouse ow n or have an ow nership interest in his/her ow n house or have rental liability for it? If no ow nership interest , w hat is CMRV? 7 Head of househol d or responsi ble party IManual Suppo rt and Maintenance ► Is Support and Maintenance calculate d manually? Manual Amount: Reason for manual or system calculation : iiiiiH+i Individual Information PVERSIGHT 177 TX-HHSC-20-0960-A-000292 8 MEPD New Hire Part 1 January 2020 Steps: Note: Make sure Head of Household is always selected. 1. 2. 3. 4. 5. 6. Is this Support and Maintenance applicable for a couple? – YES Effective Begin Date – _______________________. Reported On – ________________________________ Date Client Became Aware – _________________ Verification Received On – _____________________ Does client/spouse live in their own home and pay all household and food expenses? – YES 7. Verification: – Head of household or responsible party 8. Next Individual Information AMERICAN PVERSIGHT 178 TX-HHSC-20-0960-A-000293 MEPD New Hire Part 1 January 2020 Support and Maintenance – Expenses The Expenses page will only display if you answered NO to either one of the questions discussed on page 168. Use the Expenses page to record specific dollar amounts related to Support and Maintenance. TIERS uses these amounts to determine the amount to treat as income. IIndividual Information ifiiil·+i ii@IJ Efi:Hii D u In divid ual # : Name : Updat ed Date : Dates ► Effective Beg in Dat e: En d Dat e: ► Date Cl ient Became ► Reported On: Aware: Ver ificat io n Received On : IAdditional Questions for Minor Clients Does client live with parent(s)? V How many parents does client live with? How many other minor children of the parents live in the home? -- ----~ How many other people live in the home? I1temized/Total Expenses Expense Type: ~ ~ General / u old nses: ~ nt/house ayment: Taxes on home: Insurance on home: Electricity: Gas: ,~ 1~ne, \,; ~ coal, d Wat~ Garbage er ' Food: Total: n~ Pays : __... e/Parent Other In side Hou seho ld sjo.ocl * 00 sjo.oo sjo.oo sjo.oo sjo.oo sj,0.-00__ 00 00 00 00 00 00 00 00 00 oo * * * * _ * Sl~□-.□-0 --* sjo.oo * sj,_ o-.o-o__ _ * ~ * sjo.oo"o.-::c oo :c-=- -.._- ---. * a D PVERSIGHT Househo l d ......., Pays: $jo.oo $jo.oo $jo.oo $jO.OO $jo.oo $jo.oo $jo.oo $jo.oo $jo.oo $jo.oo $jooo --~ -Ffl:Hil Are payments made for Rent/house payment, or Taxes on home voluntary? Individual Information ........ Total: Pays: sjooo sjooo sjooo sjooo sjooo sjooo sjooo sjooo sjooo ,. _,,,,,,,,, --- +'66 V Bfiiil·+i iii· J 179 TX-HHSC-20-0960-A-000294 MEPD New Hire Part 1 January 2020 Medicare Claim If an individual is receiving or has applied for Medicare, answer the corresponding question on the Individual Questions LUW and complete the Medicare Claim LUW. TIERS uses this information to determine eligibility for MSP and certain other MEPD programs. Record information about denied Medicare here, as this information may affect eligibility. Medicare receipt is listed on the application. Use the SOLQ report to verify Medicare information. ~ Details Changef'asswordLogou ~ - Medicare Claim - Details (2) @ 8 @ ® @ ii\:Hil Individual # : 1 [li9'Jj2T [li9',p 4 2 ,j 2010 • Date Client Became Aware · 'o9', 127', l2010 1uo 3 IL' , 12010 i"""B 5 6 Claim#: 7 ~ / io,-1 12010 lmm 1~ r- 8 1~ f~tjww End Date· jmm Buy -In End Date : lmm 1~ 1~ V Enrolled Date: NO Individual has received letter f rom SSA notifyin g of imminent term ination of Medicare Part A? Medicare Dat es Last Updated By : kiiiiiiHI iii IJ iii:Hii Steps: 1. 2. 3. 4. 5. 6. 7. 8. 9. V MMA 9 Name – Pike, Dwayne. Reported On – ____________ Date Client Became Aware – ________________ Verification Received On – _____________ Type –Part A. Claim # - Select from the dropdown list (This is the SSCN you recorded earlier). Begin Date – ________________ Verification – SOLQ. Click Add►. Individual Information PVERSIGHT 180 TX-HHSC-20-0960-A-000295 MEPD New Hire Part 1 January 2020 Enter Dwayne’s Medicare Part B A blank Medicare Claim Details page should appear. Enter the information for Dwayne’s Medicare Part B. Use your Data Collection Worksheet for the information. When done, click Add► to save the record and open a blank LUW. Enter Sue’s Medicare Part A and Part B A blank Medicare Claim Details page should appear. Enter the information for Sue’s Medicare Part A. Use your Data Collection Worksheet for the information. When done, click Add► to save the record and open a blank LUW. Enter Sue’s Medicare Part B information. When you’ve entered all of the four Medicare records, click Next to continue forward in the driver flow. Individual Information VERSIGHT 181 TX-HHSC-20-0960-A-000296 . MEPD New Hire Part 1 January 2020 ,.,.. R un El1g 1b1l1 ty a.a,g, • .,,.,,., 0 Individual Information - Run Eligibility @ ,.... ' 1.ogo<,t , .,,,, 8 ICase Information ►Case#: System Determined Eligibility Date: j01/0 1/2017 Manually Select Eligibility Det erm ination Date?: ►Do you want to assign a spec ific FS EDG used to issue EBT bene fits on lhe ATA to !his TIERS Case? : O ~ ATA EDG #: vj Begin Date: V Select Process @ EDG 0 Non Financial 0 Resource 0 Financial 0 EDBC (Non Financial, Re source, Financial) Re-Evaluate Medicaid?: Request Restored Benefit?: 0 0 0 if§fj Individual Information pVERSIGHT 182 TX-HHSC-20-0960-A-000297 MEPD New Hire Part 1 January 2020 • \. "ICV Summary Cha,g,, Pa;s,""' Individual Information - Eligibility Summary Q) @ Vie ws : I Awaiting EOG# Case # : Re-Build EOG TOA Benefit Period 90 1236569 MC - SL MB 90123656 9 MC - SLMB 90 1236570 MC - QMB 06/01/2017- 90 1236570 MC -Q MB 05101/2017-05/31/2017 05/01/2017- 1±101/01/2017-04/30/2017 Benefit Amount ($) I ALL Pr o grams: Eligi bility CG Status (PRA Size Appeal w ith cont.benefit) Pending Authorization Status VCL other (Overridden ) 0 NA 2 0 NA 2 0 NA 0 Willi Case Status : Pending Case Hod e : Int a ke I ., I Oispo-sition \.... t.ogo,A H, 8 Run EDBC Case Na m e : Pike, Dw ayne , .... I ., I Authorization Date 2 .. .91,MiP.id.lZ STOP! This completes this section of the Walk-Through. You will move forward to the next section in the next module. Individual Information PVERSIGHT 183 TX-HHSC-20-0960-A-000298 I MEPD New Hire Part 1 January 2020 [;J ----- Matthews: Self Paced Exercise Individual Information Using the case number from your Data Sheet and the application for Elizabeth Matthews, complete the Individual Information in TIERS. Individual Information VERSIGHT 184 TX-HHSC-20-0960-A-000299 MEPD New Hire Part 1 January 2020 Conclusion In this section of Individual Information, you entered basic demographic information for individuals and recorded program request information. You also made requests for SOLQ and Data Broker reports. In the remainder of Individual Information, you enter specific information about disability, disability benefits, Medicare and other factors that may affect eligibility for the requested program. You may use information from the SOLQ request to complete some of these LUWS in TIERS. Later, you enter financial information about the individual’s resources and income. You use information from the Data Broker request to review and verify nonfinancial and financial information. Individual Information AMERICAN PVERSIGHT 185 TX-HHSC-20-0960-A-000300 Texas Works Handbook A-1521 (https://hhs.texas.gov/book/export/html/4658) A-1500, Reminders Revision 20-1; Effective January 1, 2020 A—1510 General Reminders Revision 19-3; Effective July 1, 2019 All Programs Before certifying applicants and recertifying recipients, staff must:  Ensure that the applicant completes each item and signs and dates the application or renewal form. Note: If the applicant indicates changes during the interview, or application or renewal processing, document the nature of the change and when the person expects the change to occur. People on TP 08, TP 43, TP 44 and TP 48 complete the administrative renewal process explained in B-122.4, Medical Program Administrative Renewals, and may not be required to provide a signed renewal form.  Give the applicant Form H1019, Report of Change. Explain that the applicant must report changes within 10 days after the household knows about the change. Indicate the appropriate reporting requirement on page 1.  A ICA Refer the applicant to other programs the applicant might be eligible for, such as: o family planning; o Supplemental Security Income (SSI); o Women, Infants and Children (WIC); and PVERSIGHT TX-HHSC-20-0960-A-000301 o  Social Security. Refer people who are elderly or have disabilities and who are ineligible for Medical Programs for families and children to the Texas Health and Human Services Commission (HHSC) Medicaid for the Elderly and People with Disabilities (MEPD) programs. Note: If a person indicates they need services that Texas Works does not provide, and the advisor does not have a resource number, they should be advised to call 2-1-1 for information and referral services.  Inform the applicant of the right to appeal any HHSC action that affects the applicant’s eligibility or amount of benefits.  Check for unpaid overpayments from prior certifications.  Inform applicants that the information they provide is subject to verification by third parties. TANF Staff must:  Explain federal and state time limits on Temporary Assistance for Needy Families (TANF) benefits.  Inform the person that a Choices noncompliance penalty makes them ineligible for a TANF state time limit hardship exemption during their five-year freeze-out period.  Explain that members need to be employed or apply for other sources of income. Encourage individual independence.  Explain the requirement to seek other income the person is eligible for, as explained in A1311.1, Requirement to Pursue SSI/RSDI, and A-1311.1.1, SSI/RSDI Application Assistance. Provide Form H1859, Social Security Administration Benefits for People with Disabilities Receiving TANF. Explain that the individual must apply for and provide verification by the next TANF redetermination. A ICA PVERSIGHT TX-HHSC-20-0960-A-000302  Explain the option to receive One-Time TANF (OTTANF) instead of TANF. Offer this option to households eligible for TANF but not currently receiving TANF. See A-2400, One Time Payments.  Inform the household of the one-time grandparent payment if the household is potentially eligible. See A-2400.  Inform people with a Choices noncooperation, who reapply for TANF while in pay for performance, to contact the local workforce solutions office within 10 days. This allows sufficient time to demonstrate 30 days of cooperation before the 40th day after the interview date. See A-2151, Open Penalty at Reapplication in Pay for Performance. SNAP Staff must:  Explain the Supplemental Nutrition Assistance Program (SNAP) time limits to people subject to these limits.  Give Form H1805, SNAP Food Benefits: Your Rights and Program Rules, to all households at application and redetermination. Respond to any questions the applicant has about the form.  Give Form H1019, Report of Change, to all streamlined reporting households. o Explain that these households are only required to report changes in residence and when their ongoing gross income exceeds 130 percent of the Federal Poverty Income Limit (FPIL) for the household size. o Explain that changes must be reported within 10 days after the household knows of the change. o Explain that these households must respond to all notices and letters from the employment program as directed, even if they are employed. o A ICA PVERSIGHT Indicate the appropriate reporting requirement on page 1. TX-HHSC-20-0960-A-000303 TP 43, TP 44 and TP 48 Staff must:  Mail Form H0025, HHSC Application for Voter Registration, with the initial eligibility notice to a newly certified family. Note: Also, mail Form H0025 at subsequent redeterminations.  Inform the family that when HHSC processes an application and determines the child is ineligible for Medicaid but eligible for the Children’s Health Insurance Program (CHIP), the family is notified on Form TF0001, Notice of Case Action. Form TF0001 also informs the household that the CHIP enrollment packet will be sent to the household.  Inform new caretakers about the requirement to participate in a health care orientation. Include Form TF0001. This one-time requirement applies only to caretakers who have not been included as a certified or budget group member of a Medical Programs Eligibility Determination Group (EDG) within the past two years.  Inform caretakers of Medicaid children under age19 that they are required to comply with the regimen of care prescribed by the Texas Health Steps program. The requirement applies to children starting at age 2. Begin checking for compliance with the first redetermination after the caretaker is informed of the requirement. Related Policy Registering to Vote, A-1521 A—1521 Registering to Vote Revision 15-4; Effective October 1, 2015 A ICA PVERSIGHT TX-HHSC-20-0960-A-000304 All Programs HHSC must offer individuals an opportunity to register to vote at application, redetermination and any time the individual has a change of address. The individual is provided with Form H0025, HHSC Application for Voter Registration, with each application/redetermination packet, if not already provided. Additionally, the individual will be provided with Form H0025 whenever the individual reports a change of address. System-generated application and redetermination packets contain Form H0025. If the individual declines the opportunity to register to vote, the individual is given Form H1350, Opportunity to Register to Vote, to sign and decline to register to vote. Advisors should indicate in the Texas Integrated Eligibility Redesign System (TIERS), Voter Registration Information section of the Individual Demographics page, that the individual declined and document that Form H1350 was mailed to the individual. When the individual returns Form H1350, advisors are to send the form for imaging. The imaged, signed form must be retained for at least 22 months. The individual is not required to sign Form H1350 if the individual has signed the form within the last 22 months. A—1521.1 Who Cannot Register to Vote Revision 15-4; Effective October 1, 2015 All Programs To register to vote, a person must be: A ICA  a U.S. citizen; and  at least age 17 years and 10 months. PVERSIGHT TX-HHSC-20-0960-A-000305 Staff should not offer a voter registration application to an applicant or recipient if the individual states or the advisor has proof that the individual does not meet these two requirements. A—1521.2 Staff Requirements for Voter Registration Revision 15-4; Effective October 1, 2015 All Programs Staff must tell the individual the following:  HHSC will offer the same help and services when aiding the individual with voter registration activities as when aiding the individual with agency forms, whether HHSC provides the service in the office, outside of the office or at the individual's home.  The decision to register or to decline to register to vote does not affect eligibility or benefit amount, and HHSC will keep all voter registration information confidential and only use it for voter registration purposes.  The individual may decide whether or not to seek help from staff to fill out the voter registration application form, or the individual may fill out the application form in private.  The individual may return the completed application form to: o the Secretary of State (SOS), by mail using the postage-paid, self-addressed application form; o the local voter registrar, by mail or in person; or o the advisor. AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000306  The individual may ask additional voter registration questions or file a voter registration complaint by contacting the Elections Division of the Secretary of State, P.O. Box 12060, Austin, TX 78711, 1-800-252-8683. Staff must not:  influence an individual's political preference or party registration;  display any political preference or party affiliation;  make any statement to discourage the individual from registering to vote;  make any statement to an individual or take any action for the purpose or effect to make the individual believe that a decision to register or not to register has any bearing on the availability of services or benefits; or  pend the EDG or delay or deny benefits if the individual fails or refuses to complete the voter registration information on any form, or fails to return Form H0025, HHSC Application for Voter Registration, or Form H1350, Opportunity to Register to Vote. Austin Imaging Center Staff If the individual inadvertently sends Form H0025 to the Austin processing center with other documents, Austin staff will forward Form H0025 to the correct local voter registrar within five days of receipt. A—1521.3 Voter Registration During Interviews Revision 15-4; Effective October 1, 2015 All Programs A ICA PVERSIGHT TX-HHSC-20-0960-A-000307 The following chart should be used by staff in addressing voter registration during the interview: If … then … determine the reason why the individual doesn't wish to register. Ask the individual to sign Form H1350, Opportunity to Register to Vote, attesting that the individual does not wish to register to vote. Sign and mark the appropriate box in the Agency Use Only: Voter Registration Status section of Form H1350 documenting the reason the individual declined to register. Send the form for imaging. the individual responds, "I do not When completing a telephone interview, mail Form wish to register," H1350 to the individual. Indicate in TIERS, Voter Registration Information section of the Individual Demographics page, that the individual declined and document that Form H1350 was mailed to the individual. When the individual refuses to sign Form H1350, mark the Client Declined box in the Agency Use Only: Voter Registration Status section of Form H1350. Send the form for imaging. TIERS will automatically mark that the individual the individual is not a U.S. citizen does not meet citizenship and/or age requirements in and at least age 17 years and 10 the Valid Reason, Voter Registration Information months, section of the Individual Demographics screen. VERSIGHT TX-HHSC-20-0960-A-000308 If … then … provide the individual with Form H0025, HHSC Application for Voter Registration, to complete to register to vote. Advise the individual that the completed form can be returned directly to SOS, the local voter registrar or the local office. The local office liaison forwards to the local voter registrar. TIERS automatically sends the individual Form H0025 if the worker answers Yes to the question, the individual answered Yes to the “Send Voter Registration Application?” in the Voter question on the application, Registration Information section of the Individual redetermination or change report Demographics screen. form, "Do you wish to register to Enter the actions taken to provide the individual with vote?" and meets citizenship and age the opportunity to register to vote by answering the requirements, questions in the Valid Reason, Voter Registration Information section of the Individual Demographics screen. When interviewing an authorized representative (AR) or representative payee, ask the AR or representative payee to give the form to the individual. Enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, Client to Mail. VERSIGHT TX-HHSC-20-0960-A-000309 If … then … review the form for completeness. Return the form to the individual for any corrections, if necessary. When the individual has fully completed Form H0025, forward the form to the local office liaison. The local the individual completes and returns Form H0025 before leaving the office liaison will review the form for completeness and send to the local voter registrar within five days. office, Enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, the actions taken to provide the individual with the opportunity to register to vote. A—1521.4 Voter Registration During Non-Interviews Revision 15-4; Effective October 1, 2015 All Programs The following chart should be used by staff in addressing voter registration during noninterviews: If … then … the individual "does not wish to mail the individual a return envelope and Form register" on the H1350, Opportunity to Register to Vote, to sign VERSIGHT TX-HHSC-20-0960-A-000310 If … then … application/redetermination or attesting that the individual declined to register to change report form, vote. Enter in the Valid Reason, Voter Registration Information section of the Individual Demographics screen. If the individual returns Form H1350, sign and mark the Client Declined box in the Agency Use Only: Voter Registration Status section of Form H1350. Send the form for imaging. TIERS automatically marks that the individual does the individual is not a U.S. citizen not meet citizenship and/or age requirements in the and at least age 17 years and 10 Valid Reason, Voter Registration Information section months, of the Individual Demographics screen.  if the individual did not return Form H0025, HHSC Application for Voter Registration, enter in the Valid Reason, Voter Registration Information section of the Individual the individual answered Yes to the Demographics screen, the actions taken to question on the provide the individual with the opportunity to application/redetermination form, register to vote. "Do you wish to register to vote?",  when the individual returns Form H0025 to the local office, review the form for completeness. Return the form to the individual for any corrections, if necessary. Enter in the Valid Reason, Voter Registration Information VERSIGHT TX-HHSC-20-0960-A-000311 If … then … section of the Individual Demographics screen, the actions taken to provide the individual with the opportunity to register to vote. Forward the fully completed Form H0025 to the local office liaison. The local office liaison reviews the form for completeness and sends to the local voter registrar within five days. Enter Yes to the question, "Send Voter Registration Application?" in the Voter Registration Information the individual answered Yes to the section of the Individual Demographics screen. question, "Do you wish to register to TIERS automatically sends the individual Form vote?" on the change report form, H0025. This documents the actions taken to provide the individual with the opportunity to register to vote. A—1521.5 Local Office Liaison Duties Revision 15-4; Effective October 1, 2015 All Programs The local office liaison must: VERSIGHT TX-HHSC-20-0960-A-000312  Maintain in stock, the office supply of Form H0025, HHSC Application for Voter Registration, and Form H1350, Opportunity to Register to Vote.  Maintain the local voter registrar list to provide the name and address of the local voter registrar to staff and individuals. See www.sos.state.tx.us/elections/voter/county.shtml for information regarding the local voter registrar.  Review Form H0025 for completeness.  Send completed Form H0025 to the designated local voter registrar within five days of receipt. A—1521.6 Documentation Revision 15-4; Effective October 1, 2015 All Programs All actions taken to provide the individual with an opportunity to register to vote must be documented at application, redetermination, and change of physical address in TIERS in the Voter Registration Information section of the Individual Demographics — Citizen page. A—1522 Personal Responsibility Agreement Revision 19-3; Effective July 1, 2019 TANF Staff must inform adult caretakers and second parents that they must: A ICA PVERSIGHT TX-HHSC-20-0960-A-000313  participate in the Choices programs unless exempt;  cooperate with child support requirements;  not voluntarily quit a job;  have their child(ren) screened through the Texas Health Steps program;  have their child(ren) immunized, unless exempt;  have their child(ren) attend school;  attend parenting skills training, if referred; and  not abuse drugs or alcohol. Staff must inform payees and disqualified adults that they must:  cooperate with child support requirements;  have their child(ren) screened through the Texas Health Steps program;  have their child(ren) immunized, unless exempt;  have their child(ren) attend school; and  not abuse drugs or alcohol. A—1523 Child Support Responsibilities Revision 15-4; Effective October 1, 2015 TANF and TP 08 Staff must ensure that applicants read and understand the information on Form H1712, Explanation of Child/Medical Support, Family Violence and Good Cause, and that the applicant A ICA PVERSIGHT TX-HHSC-20-0960-A-000314 understands that signing an application for TANF or TP 08 constitutes the assignment of rights to child and medical support. A—1524 Earned Income Deduction Revision 15-4; Effective October 1, 2015 TANF Staff must inform the applicant that if the individual goes to work and reports the job in a timely manner, the individual may be eligible for extra deductions. A—1525 Voluntary Quit Revision 15-4; Effective October 1, 2015 SNAP Staff must explain the voluntary quit policies in A-1850, Voluntary Quit, to applicants and individuals, including: A ICA  primary wage earner determination;  how to establish good cause; and  reapplication after voluntary quit. PVERSIGHT TX-HHSC-20-0960-A-000315 A—1526 Family Violence Revision 15-4; Effective October 1, 2015 TANF and TP 08 Staff must explain to applicants and recipients that if family violence or the potential for family violence exists, HHSC may grant an exemption from the requirement to cooperate with child support, and Choices staff may grant good cause for noncompliance with Choices participation for TANF. Related Policy Explanation of Good Cause, A-1130 Determining Good Cause, A-1860 A—1527 The Texas Works Message Revision 15-4; Effective October 1, 2015 TANF During the redetermination process, staff deliver the Texas Works message to TANF recipients explaining that: A ICA  TANF is temporary and has time limits;  there are alternatives and options for the recipient instead of TANF benefits; PVERSIGHT TX-HHSC-20-0960-A-000316  a TANF recipient should consider jobs and other resources such as child support rather than continuing TANF;  if a TANF recipient chooses to continue receiving assistance, the recipient is requesting help finding a job; and  if a TANF recipient chooses not to continue receiving assistance, the recipient may still qualify for medical assistance and SNAP to support employment while working toward self-sufficiency. Judgment must be used when deciding which messages are appropriate for a particular recipient. A—1528 Handbooks Revision 13-2; Effective April 1. 2013 A—1528.1 Availability of Handbooks for Client Review Revision 13-2; Effective April 1, 2013 All Programs A Texas Works Handbook is available for review upon request. Individuals may view an electronic version of the handbook. All sections of the handbook must be easily accessible to the individual. A—1529 Interactive Voice Response (IVR) System AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000317 Revision 13-2; Effective April 1, 2013 All Programs Eligibility staff must review and understand information currently available to individuals through 2-1-1 and encourage individuals to use the self-service options. Encouraging individuals to use the self-service options will help reduce workload in local offices. Individuals can get answers to basic questions 24 hours a day, seven days a week through the automated phone system, the IVR. Additional information can be accessed by visiting the Texas Health and Human Services Commission, "How to Get Help" website at hhs.texas.gov/services/safety/2-1-1-disasterassistance. The 2-1-1 Texas Finding Help In Texas job aid describes how an individual accesses various types of information via the 2-1-1 IVR System. A—1530 Medical and Dental Benefits Revision 07-1; Effective January 1, 2007 A—1531 Texas Health Steps Revision 19-3; Effective July 1, 2019 TP 43, TP 44, TP 45 and TP 48 A ICA PVERSIGHT TX-HHSC-20-0960-A-000318 The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service is Medicaid's federally-required comprehensive preventive child health service (medical, dental, and case management) for persons from birth through 20 years of age. In Texas, EPSDT is known as Texas Health Steps. Through Texas Health Steps, children and young adults receive regularly scheduled medical and dental checkups. The Texas Health Steps program:  facilitates early detection and treatment of medical and dental problems;  provides health supervision for infants; and  enables persons to establish links with primary health care providers who can meet future needs for care. Texas Health Steps' mission is to:  expand the public’s and recipients’ awareness of existing Texas Health Steps services;  encourage and increase use of Texas Health Steps services; and  make comprehensive services available through private and public providers so that infants, children, and adolescents can receive medical and dental care before health problems become chronic and irreversible damage occurs. Texas Health Steps services comprise the following: Medical Checkups— Texas Health Steps medical checkups include:  a comprehensive health and developmental history (including developmental and mental health, nutrition and tuberculosis screenings);  a complete physical examination;  laboratory tests (including lead screening);  routine immunizations;  health education;  dental screening and referral to a dentist; AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000319  vision screening;  hearing screening; and  referrals to other health care providers as needed. Texas Health Steps offers checkups according to a recommended schedule. The frequency varies according to the stages of growth. In addition to an inpatient newborn screening, children and young adults may receive up to 29 outpatient checkups. The recommended schedule for periodic medical checkups is:  Birth to 35 months — 11 health checkups to ensure: o proper growth and development; and o immunizations are administered according to the Advisory Committee on Childhood Immunization Practices (ACIP) recommended schedule;  3 years through 5 years — three health checkups (once a year);  6 years through 10 years — five health checkups (once a year); and  11 years through 20 years — 10 health checkups (once a year). Dental Services — Texas Health Steps provides comprehensive dental care, including emergency, preventive, therapeutic, and orthodontic services. Children and young adults are eligible to receive routine dental checkups every six months starting at six months of age. Emergency or medically necessary dental services are available to children and young adults at any time from birth through age 20. Vision Services — Each Texas Health Steps medical checkup includes:  a vision screening;  diagnosis and treatment, including eyeglasses every two years for defects in vision; and  one eye examination per state fiscal year (September through August). AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000320 Lost or destroyed eyeglasses are replaced with no limit on the number of replacements. The person may receive additional services that are medically necessary because of a vision change. Hearing Services — Texas Health Steps medical checkups also include a hearing screening. Additional testing for hearing problems, as well as diagnosis, treatment, and hearing aids, are available through the Medicaid Program. Case Management for Children and Pregnant Women — To encourage the use of costeffective health and health-related care, Case Management for Children and Pregnant Women provides services to children from birth through age 20 who have a serious health condition or who are at risk of developing a serious health condition. Services are also provided to high-risk pregnant women of all ages. Together, the case manager and the family assess the medical, social and educational needs of the eligible recipient. Texas Health Steps Comprehensive Care Program (CCP) — This program provides expanded benefits to Texas Health Steps persons. Under CCP, people under age 21 are eligible for any medically necessary and appropriate health care service covered by Medicaid. Limitations of the current Texas Medicaid Program do not apply to these people. Expanded benefits include durable medical equipment and supplies, prosthetics, orthotics, private-duty nursing, and therapeutic services. A—1531.1 Accessibility of Texas Health Steps Services Revision 19-3; Effective July 1, 2019 Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56) HHSC’s Texas Health Steps Outreach and Informing contractors and local Texas Works staff provide initial and periodic outreach and information to help people access Texas Health Steps AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000321 services. For example, the contractors and local Texas Works staff can help find a Texas Health Steps provider or provide information about HHSC’s Medical Transportation Program (MTP). The Texas Health Steps Outreach and Informing contractor can also help with scheduling a Texas Health Steps appointment. When a person under 21 is certified for Medicaid, the enrollment broker sends written information to households that include a welcome notification at certification and letters when a child’s checkup is due per the Texas Health Steps periodicity schedule. MTP provides non-ambulance transportation to a doctor or dentist office, hospital, drug store, or any place a person may receive Medicaid services. MTP is available to Medicaid-eligible people and necessary attendants when they have no other means of transportation. Children 14 and under must travel with a parent or guardian, and children 15–17 may travel alone if a parent or guardian fills out the proper consent form. An HHSC contractor or a private contractor of the person's choice, such as a parent, friend, neighbor or volunteer may provide transportation. A private contractor:  must have a written agreement with the MTP before providing the service; and  will be reimbursed for mileage to an authorized facility at the state rate. If it is medically necessary for a person through age 20 to be away from home overnight, MTP approves cost-effective meals, lodging, and up-front funds for the person and the person's attendant. Households may contact MTP by calling toll-free 877-633-8747. Complete Form H1093, Texas Health Steps Extra Effort Referral, if a household requests help accessing MTP services. For more information on MTP and a list of frequently asked questions visit the MTP page. A ICA PVERSIGHT TX-HHSC-20-0960-A-000322 A—1531.2 Texas Health Steps Service Providers Revision 19-3; Effective July 1, 2019 Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56) Texas Health Steps is a Medicaid health care program for children from birth through age 20. The Texas Health Steps services are delivered by both public and private providers. Physicians, dentists, advance practice nurses, physician assistants, clinics, hospitals, Federally Qualified Health Centers (FQHCs) and others offer Texas Health Steps services to eligible people. Providers must enroll in Medicaid and enroll as a Texas Health Steps provider. A—1531.3 Program Administration Revision 19-3; Effective July 1, 2019 Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56) To comply with the Frew lawsuit requirements, staff play a role in educating people about the Texas Health Steps program. Within the Texas Health Steps program, "outreach" and "informing" are terms applied to efforts, strategies, plans, events, organized activities, and courses of action taken to advertise, educate and increase the number of Texas Health Steps checkups. AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000323 A—1531.4 Explanation of Benefits Revision 20-1; Effective January 1, 2020 Medical Programs (except TP 08, TA 31, TP 32, TP 33, TP 34, TP 35, TP 36, TP 42 and TP 56) To help inform Medicaid recipients, Texas Health Steps Outreach and Informing staff provide the following materials to HHSC:  A desk reference containing Texas Health Steps program information. The desk reference has toll-free numbers, call center hours and website addresses for Texas Health Steps and the Medicaid Transportation Program. The desk reference contains information that is consistent with the current Texas Health Steps periodicity schedule.  The Texas Health Steps brochure, "Don't Miss a Beat," presents easy to understand information about the Texas Health Steps program.  The Appointment Education Brochure, known as “Keep Your Child's Checkups in Check,” provides helpful tips to make doctor or dentist visits a positive experience.  A current Texas Health Steps wallet card, “Checkups Help Children Stay Healthy!” is given to every Medicaid-eligible household with a child through age 20. Families use the cards as a quick reference for when a child is due for a Texas Health Steps dental or medical checkup, based on the child's age. The back of the card provides important information on immunizations. Each household is given the brochures and a wallet card at:  initial certification or any time there is a reapplication; AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000324  renewal, if the household has not complied with Texas Health Steps requirements and a face to face interview is required; or  any time a household requests them. The materials can be sent by mail if the person is interviewed by phone or when no interview is conducted. Texas Health Steps materials may be ordered online. Supervisors must ensure that all staff have the following Texas Health Steps materials and use them as required:  a desk reference;  "Don't Miss a Beat" and "Keep Your Child's Checkups in Check " brochures;  "Checkups Help Children Stay Healthy!" Texas Health Steps wallet cards; and  Form H1093, Texas Health Steps Extra Effort Referral. This form is used to help people who need: o to schedule a Texas Health Steps checkup or appointment; o more information on Texas Health Steps medical, dental and case management services; and o services other than those listed above. Fax Form H1093 to Texas Health Steps Outreach and Informing staff at 512-533-3867. A—1531.5 Compliance Requirements Revision 20-1; Effective January 1, 2020 A ICA PVERSIGHT TX-HHSC-20-0960-A-000325 TP 44 and TP 48 Starting at age 2, children under age 18 must comply with the regimen of care prescribed by the THSteps Program. At the first redetermination, advisors should check for overdue dates. If one exists, the advisor should contact the caretaker and allow the caretaker to self-declare that the child:  had the screening;  is scheduled for the screening; or  has not been screened, but has good cause. If the advisor is unable to contact the caretaker by phone, the advisor must send Form H1024, Subject: Self-Declaration Notice, to obtain the information. If the household does not return Form H1024, deny the EDG for failure to provide. If the household returns Form H1024 indicating noncompliance, the advisor should schedule the caretaker for a phone interview and emphasize the importance of the checkups. Staff must use the appropriate script located in C-1118, Health Care Orientation Quick Reference Guide and Enrollment Script, when a recipient has a phone interview due to a THSteps or Health Care Orientation noncompliance. If the person does not keep the appointment, the EDG is denied for failure to provide. Note: The denial applies to all children's Medicaid EDGs for the household, except TP 45 for newborns. At the next redetermination, if TIERS still shows the same overdue date for the child, the caretaker must provide verification that the child had the check-up or has a phone interview appointment before redetermination. When adding a sibling to a case and the redetermination is due on the existing EDG, the change is processed in Change Action mode through Disposition, the review is initiated and the redetermination is processed on both EDGs. TIERS will match the EDG end dates. A ICA PVERSIGHT TX-HHSC-20-0960-A-000326 If a child has a THSteps overdue date, the caretaker must comply, show good cause, or have a phone appointment, or the advisor must deny the Medicaid EDGs for all the children in the family, except TP 45 coverage for newborns. A parent or caretaker may self-declare on the Form H1024 or via phone if there is a good cause reason that the child has not had the check-up. Related Policy Continuous Medicaid Coverage, A-832 General Reminders, A-1510 Processing Children's Medicaid Redeterminations, B-123 A—1532 Medicaid Revision 16-4; Effective October 1, 2016 Medical Programs Applicants must be informed that:  they will receive a Your Texas Benefits Medicaid ID card if certified;  they must show the Medicaid ID card to medical providers;  each individual can receive three paid prescriptions a month; Exception: The following Medicaid recipients are eligible for unlimited paid prescriptions: A ICA o managed care individuals; o nursing facility residents; and PVERSIGHT TX-HHSC-20-0960-A-000327 o individuals under age 21, through the month of their 21st birthday. Note: Lost or destroyed prescriptions may be replaced by contacting the pharmacy that originally filled the prescriptions. The pharmacy can call the vendor drug toll-free pharmacy provider line to obtain procedures for overriding the system.  if they lose their Medicaid ID card, they can request a new one by calling 1-855-8273748 (providers can still verify Medicaid eligibility without the card); and  Medicaid will not reimburse them for any bills they pay. Note: If the household has members who are elderly or have disabilities who wish to apply for Medicaid, but who do not qualify for any Medical Programs for families and children, refer them to HHSC's MEPD programs. Staff must provide the household with the address and telephone number of the nearest office, or the self-service website www.hhsc.state.tx.us/help/index.shtml. Medical Programs (except TA 31, TP 32, TP 33, TP 34, TP 35, TP 36 and TP 56) Applicants living in a managed care area must be informed that they are required to select a managed care plan and primary care physician. Emergency Medicaid Staff must explain that Medicaid coverage is limited to the dates of the emergency medical condition. TP 40 Encourage the pregnant woman to start receiving prenatal care. A—1532.1 Spend Down EDGs A ICA PVERSIGHT TX-HHSC-20-0960-A-000328 Revision 15-4; Effective October 1, 2015 TP 56 and TP 32 For applications with spend down, staff are required to verbally explain the following:  Children or pregnant women in the certified group are not eligible for Medicaid until spend down is met (i.e., the household's excess income is depleted with medical expenses incurred by members of the budget group).  TIERS mails Form H1120, Medical Bills Transmittal/Insurance Information, and Form H3087S, Spend Down Medicaid Identification, to the individual. Form H1120 provides the Medically Needy Clearinghouse with information needed to determine spend down for clients and provides the individual with information needed to submit medical bills to the Clearinghouse. Form H3087S summarizes the spend-down amount and potential eligible months and explains to providers how they can assist the individual by submitting bills.  The household or a provider must submit bills to the Medically Needy Clearinghouse. The Clearinghouse must receive the bills within 30 days of the later of the following dates: o the day Form TF0001, Notice of Case Action, processes; or o the last day of the application month. The individual should be advised to contact the Clearinghouse if the 30-day time limit is near and there is a delay getting bills from a provider, third-party resources (TPR) information, etc. The Clearinghouse allows bills paid during the month(s) of potential eligibility by: o A ICA PVERSIGHT members of the household composition, and TX-HHSC-20-0960-A-000329 o state or local government agencies (County Indigent Health Care, Children with Special Health Care Needs, MIHIA, etc.). o The Clearinghouse also allows unpaid bills that are itemized regardless of when they were incurred. Itemized bills must include: o name of the provider, o date the service was provided, o date(s) and amount(s) paid toward the bill, and o balance due. If a bill was incurred 60 days or more before the applicant submits it, the applicant must provide a current itemized statement. Staff should assist the individual in determining whether bills are current, itemized, and complete, if requested.  The individual must submit claims to TPRs, if any, before submitting the bills to the Clearinghouse. When submitting the bills, the individual must provide the Clearinghouse with verification that a TPR will not pay certain bills or portions of bills. An Explanation of Benefits (EOB) provides this information.  The individual must answer the Clearinghouse's request for additional information no later than 30 days after the: o last day of the application month, or o date of the Clearinghouse's request. AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000330 Staff should advise the applicant of the types of assistance available to help the individual with the spend-down process. On the same day the advisor approves the EDG, the advisor gives or TIERS mails to the individual:  Form TF0001, Notice of Case Action;  Form H3087S, Spend Down Medicaid Identification;  Form H1120, Medical Bills Transmittal/Insurance Information; and  a preaddressed Clearinghouse envelope for the applicant to use to submit bills to the Clearinghouse. Do not give Form H1120 to anyone other than the applicant or the applicant's AR. Explain that it is best to submit all bills at the same time because the Clearinghouse must establish a hierarchy when processing bills to meet spend down. This hierarchy ensures that spend down is met by nonreimbursable bills before reimbursable bills because nonreimbursable bills:  were incurred before a month of potential eligibility, or  are not for Medicaid-covered services. A—1533 Transitional and Post Medicaid Revision 15-4; Effective October 1, 2015 TP 08 The individual should be informed that the household may be eligible for additional months of transitional Medicaid and child care if TP 08 is denied because of earned income (TP 07). A ICA PVERSIGHT TX-HHSC-20-0960-A-000331 The household should be informed that they may be eligible for four additional months of post Medicaid if TP 08 is denied because of spousal support income. The individual should also be informed that if the household is not eligible for transitional or post Medicaid, the household may be eligible for other medical program coverage. A—1534 Requirement to Report Accidents Revision 15-4; Effective October 1, 2015 Medical Programs Staff should instruct the individual to report accidents. This is to determine whether the individual has any TPRs other than Medicaid that could cover medical expenses. A—1540 Redeterminations Revision 13-2; Effective April 1, 2013 A—1541 Periodic Redeterminations and Special Reviews Revision 15-4; Effective October 1, 2015 TANF and TP 08 A\11 ')IC,/\ PVERSIGHT TX-HHSC-20-0960-A-000332 Staff should explain to the individual that:  an advisor will periodically redetermine the individual's EDG, and  HHSC will send an appointment for the redetermination. TANF Staff delivers the Texas Works Message to TANF recipients. A—1542 Special Reviews Revision 15-4; Effective October 1, 2015 All Programs Staff explains to the individual:  that a special review is set for the individual's EDG,  the purpose of the special review, and  how and when HHSC will notify the individual of the special review. A—1543 Notice of Expiration Revision 15-4; Effective October 1, 2015 SNAP A ICA PVERSIGHT TX-HHSC-20-0960-A-000333 TIERS automatically sends an expiration notice to households before their certification ends. Exceptions: The individual may be given Form H1830, Application/Review/Expiration/Appointment Notice, and Form H1010, Texas Works Application for Assistance — Your Texas Benefits, at certification if the advisor approves an EDG for:  one or two months, or  three months and the advisor completes the certification after cutoff in the first benefit month. A—1550 Issuance and Use of Benefits Revision 04-1; Effective January 1, 2004 A—1551 Advisor Responsibilities Revision 15-4; Effective October 1, 2015 TANF and SNAP Staff should inform the individual about: A ICA  how HHSC issues TANF and SNAP benefits,  how the individual uses those benefits, and  the individual's responsibilities. PVERSIGHT TX-HHSC-20-0960-A-000334 Cover each item listed in C-1131, Advisor Guide for Explaining EBT. A—1552 EBT Issuance Staff Responsibilities Revision 15-4; Effective October 1, 2015 TANF and SNAP Staff are responsible for informing the individual about each item listed in C-1132, Issuance Staff Guide for EBT Issuance and Training. This includes the TANF cash withdrawal policy and procedures if the individual applies for TANF and has any questions about the advisor's explanation. A—1553 Use of TANF Benefits Revision 15-4; Effective October 1, 2015 TANF Staff should explain that TANF benefits can only be used to purchase goods and services essential or necessary for the welfare of the family. This includes food, clothing, housing, utilities, furniture, transportation, telephone, laundry, medical supplies not paid by Medicaid, and incidentals such as household equipment, supplies, and recreation for children. Staff must advise recipients that failure to use the benefits as required may result in HHSC establishing a protective payee (as explained in A-222, Who Is Not Included). A ICA PVERSIGHT TX-HHSC-20-0960-A-000335 A—1554 Use of SNAP Benefits Revision 15-4; Effective October 1, 2015 SNAP Staff must explain the following rules regarding use of SNAP benefits:  SNAP benefits may be used to purchase food items and garden seeds at retailers approved by the U.S. Department of Agriculture (USDA). They may not be used for hot, ready-to-eat foods or food marketed to be heated in the store (except as listed in B-400, Special Households).  SNAP benefits may not be used to pay off charge accounts.  Change is not given on EBT food account purchases.  Sales tax may not be charged on any item purchased with SNAP benefits. A—1555 Use of One-Time Temporary Assistance for Needy Families (OTTANF) Benefits Revision 15-4; Effective October 1, 2015 OTTANF Staff should ensure that OTTANF applicants understand that OTTANF benefits are intended as emergency cash assistance for families who do not currently receive TANF but who are A ICA PVERSIGHT TX-HHSC-20-0960-A-000336 otherwise eligible. In addition to meeting TANF requirements, the household must meet one of the four crisis criteria explained in A-2440, Determining Crisis Criteria (OTTANF). HHSC issues a $1,000 payment with the intent that it will:  resolve a short-term crisis,  keep the household connected to the workforce, and  serve as a diversion from ongoing TANF. Staff shall explain the 12-month ineligibility period and obtain original signatures on Form H1072, One Time Temporary Assistance for Needy Families (OTTANF) Acknowledgement. A—1560 Documentation Requirements Revision 19-3; Effective July 1, 2019 All Programs The following must be documented:  the nature of expected changes and when the person expects the change to occur;  the status of overpayments, and an explanation of recoupment action;  the refusal or failure to sign Form H1350, Opportunity to Register to Vote, in TIERS Case Comments; and  in the Valid Reason, Voter Registration Information section of the Individual Demographics screen, that staff gave or mailed Form H0025, HHSC Application for Voter Registration, to the person, authorized representative or representative payee, providing the person with an opportunity to register to vote. A ICA PVERSIGHT TX-HHSC-20-0960-A-000337 Related Policy Registering to Vote, A-1521 TANF The following situations must be documented if the person:  has good cause for not cooperating with Texas Health Steps services;  does or does not want Texas Health Steps services; and  chooses to withdraw from the TANF program because of Texas Works activities. Related Policy Documentation, C-940 The Texas Works Documentation Guide A ICA PVERSIGHT TX-HHSC-20-0960-A-000338 MEPD Handbook C-7000 (https://hhs.texas.gov/book/export/html/4478) C-7000, National Voter Registration Act of 1993 Revision 10-3; Effective September 1, 2010 The National Voter Registration Act of 1993 mandates that HHSC provide the applicant or recipient with an opportunity to register to vote at application, redetermination or when reporting a change of address. Staff must provide all applicants or recipients with an opportunity to register to vote, if the person desires to do so. Staff must:  help the applicant or recipient complete Form H0025, HHSC Application for Voter Registration; or  provide Form H0025 to the person to complete at home. The applicant or recipient may choose to:  return the completed form to HHSC staff to forward to the local voter registrar; or  leave the completed form with HHSC staff. At the person's request, HHSC staff will provide the same degree of assistance, including bilingual assistance, in completing Form H0025 as provided for the completion of other HHSC forms. Document in the Agency Use Only section of the application or recertification form any actions taken regarding voter registration. HHSC staff will not make a determination about the person's eligibility to vote. However, HHSC staff will not be required to offer the opportunity to register to vote to those applicants and recipients who: A ICA PVERSIGHT TX-HHSC-20-0960-A-000339  indicate on the application that they are not U.S. citizens; or  are not of voter registration age (that is, under age 17 years and 10 months), as identified by case record information. HHSC is prohibited from influencing a person's political preference or party registration, displaying any political preference or party affiliation, or making any statement to a person, the purpose or effect of which is to discourage a person from registering to vote. If the person has any questions regarding the voter registration process that cannot be answered, give the person the Secretary of State's toll-free number at 1-800252-8683 or the telephone number of the local county voter registrar. If a person files a completed mail-in voter registration application during a face-toface interview, an appropriate HHSC employee will review it for completeness in the presence of the person. If the mail-in voter registration application does not contain all the required information and\or the required signature, the HHSC employee will return the application to the person for completion. HHSC staff will transmit the completed Form H0025 to the local office liaison who will forward it to the appropriate county voter registrar within five days of receipt. Do not pend, delay or deny benefits:  if the person fails or refuses to complete the voter registration information on any form; or  when Form H0025 or Form H1350, Opportunity to Register to Vote, is given to the applicant or recipient, the authorized representative or representative payee for completion; or  when Form H0025 or Form H1350 is mailed to the applicant or recipient for completion. A ICA PVERSIGHT TX-HHSC-20-0960-A-000340 Change of Address Reported In the office Share the mail-in Form H0025 with the person. If the person declines to register to vote, ask the person to sign Form H1350. File Form H1350 in the case record when returned, and retain the form for 22 months. Via a formal report of change form Form H0025 will be mailed to the applicant or recipient at the new address. If the person contacts the local office to decline the opportunity to register to vote after receipt of Form H0025, mail Form H1350 to obtain the person's signature. File Form H1350 in the case record when the person returns the form, and retain the form for 22 months. Notes:  This does not apply to Form H3618-A, Resident Transaction Notice for Designated Vendor Numbers, or Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution, submitted by nursing facilities, intermediate care facilities for persons with mental retardation, or state supported living centers reporting admissions/discharges.  As a result of the initiative to integrate application and eligibility determination processes, a face-to-face interview is no longer required in determining eligibility for Medicaid programs within this handbook. See Section B-6100, Face-to-Face and Telephone Interviews. A ICA PVERSIGHT TX-HHSC-20-0960-A-000341 Master - Interview Job Aid - Master Institutional/Waiver MSP/Community MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. SNAP TANF Medical Programs TW A = Application B = Both Application and Redetermination R = Redetermination Individual Information Household B Ensure application is signed appropriately (taking into account situations where someone besides the client signs). Authenticate the individual/Authorized Representative (child's SSNs, child's DOB, DL/ID number, etc.). If unable to authenticate the caller refer to TWH A-2020.2 and A-2020.3; MEH C-2210 B B B B B B B B B Confirm that the phone numbers in TIERS are correct (home, work, and other). B B B B B Who, if anyone, do you want to act on your behalf, as an authorized representative for your case? B B B B B B B B B B B B B B B Household Address Is your address still (TIERS address)? Is your physical address the same as your mailing address? If not, at what address would you like to receive mail? Is there an apartment or lot number? Where do you live, what is your currect address? Does everyone you are applying for live at this address? MAGI (If no, ask for names and addresses) TANF/TP08/TA31 (Address Domicile) Are there any other people, living at this address temporarily or permanently, that you are not applying for? Does everyone living in your home purchase and prepare meals together? B Program B What benefits are you applying for? Who are you applying for? B Are you or were you or anyone in your household ever in Foster Care? B* a. Is the individual applying for Medicaid? If so, Ongoing Medicaid, 3 month prior or Emergency Medicaid? *TP08 and TA 31 (Parents and Caretakers Relatives - Emergency) require an interview b. Is the individual under 26 years of age? c. Does the application indicate the individual was formerly in foster care? i. If yes, go to “(d)”. ii. If no, review the Individual Medicaid History and go to “d”. d. Did the individual receive Foster Care – Federal Match – No Cash (TP-93) / Foster Care – Federal Match – With Cash (TP-94) when they aged out of foster care at age 18 or older? i. If yes and if all other eligibility requirements are met, the individual is eligible for FFCC. Document the findings correctly in TIERS. ii. If no, the individual is not eligible for FFCC. Relationship A A A B B A A What is the relationship of each of your household members? Education What is your Highest level of education? (Collect this information for all household members.) VERSIGHT Page 1 of 10 TX-HHSC-20-0960-A-000343 Revised: February 2019 Master - Interview Job Aid - Master B Institutional/Waiver B* B MSP/Community SNAP MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. TANF Medical Programs TW [ATTACHMENT 9] A = Application B = Both Application and Redetermination R = Redetermination Is anyone in your household attending school, including higher education or vocational school? If so, who and what school do they attend? *Impacts TP08 when the only child is 18. TANF-Does the HH contain only ONE 18 year old child in HIGH SCHOOL? If so, will they graduate BEFORE their 19th birthday? VERSIGHT Page 2 of 10 TX-HHSC-20-0960-A-000344 Revised: February 2019 Master - Interview Job Aid - Master TANF SNAP MSP/Community Institutional/Waiver MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. Medical Programs TW [ATTACHMENT 9] B B B B B B B B B B If not a US Citizen, are you/others in your household documented aliens? (If yes, collect card type, expiration date, alien number, registration number, and date of entry.) Do you have a sponsor? (If yes, collect name and income information of sponsor.) B B B B B Would you like to register to vote at this time? B B B B Do you intend to remain in Texas? B B B B A = Application B = Both Application and Redetermination R = Redetermination Individual Demographics Are you and everyone in your household U.S. Citizens? Does anyone have a felony drug conviction? (Disqualification for TANF if offense date is after April 1, 2002; SNAP - conviction after 9/1/15, if not complying with parole/community supervision, subsequent conviction while on SNAP). Is the individual on Parole or Community Supervision, if so, are they in compliance with their parole or community supervision? A A Disability Is anyone in your home disabled? Out of State Benefits A A A A A Are you or anyone in your household receiving any benefits from another state currently or in the recent past? If yes, what state and when did you last receive benefits in that state? Verify termination of benefits and document. Who lived with you in the other state? Pregnancy B B* B Is anyone listed on your application pregnant? If yes, gather the pregnancy details. *For TANF and TP08 collect information about the father, name and last know address. Support and Maintenance B B Do you live in your own home or the home of a friend/relative? Do you contribute toward household expenses? B Medicare Claim Part A and B Does anyone receive Medicare? Tax Status Information VERSIGHT Page 3 of 10 TX-HHSC-20-0960-A-000345 Revised: February 2019 Master - Interview Job Aid - Master B Institutional/Waiver MSP/Community MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. SNAP TANF Medical Programs TW [ATTACHMENT 9] A = Application B = Both Application and Redetermination R = Redetermination Do you file taxes? If yes, do you file separately or with someone? If you file with someone, are you married? If you file separately, who claims the children? Does the person claiming the children live outside the home? VERSIGHT Page 4 of 10 TX-HHSC-20-0960-A-000346 Revised: February 2019 Master - Interview Job Aid - Master Institutional/Waiver MSP/Community MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. SNAP TANF Medical Programs TW R B At application, inform the applicant of Personal Responsibility Agreement (PRA) and about the workforce orientation. B R B Is anyone in home unable to work due to disability, caring for someone in the household who is disabled (Employment Services Exemption) or newborn (TANF caretaker exemption ) or enrolled in ESL or employment training with a Voluntary Agency (VOLAG)? Do you or anyone in your household have private health insurance (TPR) or injury liability insurance that pays medical expenses? B Who is the primary wage earner? B Are you or anyone in your household working, volunteering, or participating in a work program at least 20 hours a week? If not, explore if individual is fit to participate in E&T activities. Absent Parent Obtain absent parent's name, date of birth, phone number, information on relationship (married/divorced/never married/deceased) , and at least one of the following: SSN, address, or employer. If unavailable, explore good cause. Good cause must be explored and explained at each application and redetermination. *Child support requirements also apply to TP08. Voluntary for CMA. B* B B* B A = Application B = Both Application and Redetermination R = Redetermination Non Financial Are the children up to date on their immunizations? Are the children up to date on their Texas Health Steps screening? If not, are the children scheduled for their Texas Health Steps screenings? If not, do you have a good cause reason for not being up to date? (For CMA, check compliance at the first complete renewal. For TANF, check at each complete review after the PRA is signed.) CMA TP48 & 44: if overdue date, contact the client to allow them to self-declare the child had the screening, is scheduled for screening or has good cause. If unable to contact - send Form H1024.) TANF: If overdue, see A-2124.2.1; If applying in Pay-for-Performance, see A-2150. R B [ATTACHMENT 9] B Sanctions Inform household of any penalties/sanctions/disqualifications and requirements to cure or regain eligibility. *Child support requirements apply to TP08. VERSIGHT Page 5 of 10 TX-HHSC-20-0960-A-000347 Revised: February 2019 Master - Interview Job Aid - Master MSP/Community Institutional/Waiver B* B B B B B* B B B B Medical Programs SNAP MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. TANF TW [ATTACHMENT 9] A = Application B = Both Application and Redetermination R = Redetermination Resources Please provide the year, make, model, and amount owed for any vehicles. (Clear any discrepancies with Data Broker or in the TIERS case record.) *Only required for Children on TP32 - Medically Needy with Spenddown Emergency & TP56 - Medically Needy with Spenddown Do you, or anyone in your household, have a checking account, savings account, trust funds, cash on hand, stocks, bonds, or life insurance, etc. ? (life insurance only applies to MEPD, see resource guide) *Only required for children on TP32 - Medically Needy with Spenddown - Emergency & TP56 - Medically Needy with Spenddown Income Employment B B B B B Who in your household is working? (Employer’s name, business address, phone number, contact person, rate of pay, hours worked per week, frequency of pay, and the day of the week they are paid.) Does anyone in your househould receive tips? B B B B B Are all of the provided checks/pay dates representative? Do they fluctuate, has the pay rate changed during the pay periods, document and explain why? Explore work exemptions, for applicable household member(s) that are not employed. (NOTE: On 1028-If box is checked NO to FICA or FIT withheld, budget as Self-Employed.) B B B B B Have you recently quit or lost a job? If so, why? What was your last day of employment? When did you receive or expect to receive your final paycheck? Do you expect another check (e.g. vacation, 401K, etc.) ? Have you applied for UIB, Worker's Compensation, etc? Self-Employment B B B B B Is anyone in your household self-employed? If yes, what type of business? When did it start? What is the frequency of the self-employment (irregularly, daily, weekly, monthly, or less often) ? Did you file taxes on this income for a full year (less often than monthly) ? What self-employment expenses do you have? Is there any income from rental property or from the sale of property? B B B B B Does anyone perform odd jobs? Unearned Income VERSIGHT Page 6 of 10 TX-HHSC-20-0960-A-000348 Revised: February 2019 Master - Interview Job Aid - Master TANF SNAP MSP/Community Institutional/Waiver MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. Medical Programs TW [ATTACHMENT 9] B B B B B A = Application B = Both Application and Redetermination R = Redetermination What other income do you or anyone in your household have? (i.e. Social Security, VA payments, child support, gifts or contributions, unemployment benefits, workers compensation, alimony, interest, etc.) Gifts or Contributions-Does anyone pay a bill for you or provide items for you (additional food, non-food items, etc? If so, document and verify) VERSIGHT Page 7 of 10 TX-HHSC-20-0960-A-000349 Revised: February 2019 [ATTACHMENT 9] Master - Interview Job Aid - Master Institutional/Waiver MSP/Community MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. SNAP TANF Medical Programs TW A = Application B = Both Application and Redetermination R = Redetermination Expenses Do you or anyone in your household pay any of the following expenses MAGI Expenses: B Alimony; Educational Expenses/Student Loan Interest; Moving Expenses; Tuition or GI Bill Deduction; Educator Expenses; Expenses of Fee-Basis Gvt. Officials/Performing Artists/Reservists; Health Savings Account; Deductible Part of Self-Employment Tax; Self-Employed IRA/Simple IRA/Qualified Plan Deductions; Self-Employed Health insurance; Penalty on Early Withdrawal; IRA Deduction; Domestic Production Activities Deduction. Dependent Care B B Do you or anyone in your household pay for child or adult care? (name/address/phone number of the provider, amount paid, and frequency) What is the relationship between the childcare provider and the child? Medical Expenses B B Do any elderly or disabled household members have out-of-pocket/unpaid medical expenses? (i.e.transportation to/from medical appointments, prescription costs, over the counter drugs, dental care, insurance/Medicare premiums, adult diapers, etc.) Note: Ensure you capture the amounts, frequency, and exact types. A A Do you or anyone in your household have any unpaid medical expenses in the past 3 months? If yes, obtain all actual income and medical bills for the prior applicable months. Support Expenses B B Do you or anyone in your household pay child support? Is it legally obligated(SNAP only)? B* B B* B B B B B Shelter Expenses Do you rent, own, or are you buying your home? How much is your rent/mortgage? Obtain landlord name and/or address along with other shelter costs. Are your property taxes, property insurance, home owners' association fee included in your mortgage payment? What does your property insurance cover, the contents of your home or the structure? Are you required to pay renter's insurance, pest control fee, cable etc. as a condition of your lease? If so, verification is required that such expenses are mandatory.* Is the amount of rent you listed on the application the amount you pay? Do you share the expenses? Does anyone pay the expenses for you? If so, whom (name, address and/or phone number)? Do you pay heating or cooling costs separate from your rent or mortgage? Does the rent/mortgage amount include any utilities? What utilities do you pay (gas, water, and electric) ? B Do you pay for phone service (cell or landline)? B Management/Financial Management Management (TW) – ask detailed questions when negative or questionable. * All programs except TP40 and Children's Medicaid. Does apply to TP08 and TA 31. VERSIGHT Page 8 of 10 TX-HHSC-20-0960-A-000350 Revised: February 2019 Master - Interview Job Aid - Master MSP/Community Institutional/Waiver MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. SNAP TANF Medical Programs TW [ATTACHMENT 9] B B A = Application B = Both Application and Redetermination R = Redetermination Financial Management (MEPD) - If the client does not have a reported bank account, ask how is income received? Who manages your money? VERSIGHT Page 9 of 10 TX-HHSC-20-0960-A-000351 Revised: February 2019 Master - Interview Job Aid - Master B B B B B B Institutional/Waiver MSP/Community MEPD Please use these questions as a guide for conducting interviews, as required for listed programs. These questions may vary based on the program(s) requested; some programs do not require an interview. These questions are applicable to all members of a household. Be sure to address NEW individuals with questions for applications. When verification is available (i.e. check stubs, bank statements, utility bills etc.), inquire if accurate/representative and clear discrepancies. Enter all information into TIERS while the client is available. Do not take notes to enter at a later time. SNAP TANF Medical Programs TW [ATTACHMENT 9] A = Application B = Both Application and Redetermination R = Redetermination Wrap up/Miscellaneous Do you have an EBT card? (If not, follow procedures for issuance or replacement) . B Ask any questions needed to clear blanks and/or discrepancies between application form, TIERS history, electronic data sources, or any TIERS documentation. Note: Conclude interview by reviewing the appropriate program reminders which can be found in TIERS data collection wrap up. Provide the client with Form H1805 and explain Rights and Responsibilities. If missing information is requested, issue/mail a Form H1020 and inform the household that the case cannot be completed until the required verification is received. Ensure Form H1808 is sent to client when applicable. Explain to the applicant/recipient that verification can be submitted by: * Logging in to yourtexasbenefits.com and uploading the documents; * Uploading the information from their personal email to their yourtexasbenefits.com account; * Using a smart phone to take a picture of the document and uploading it using the Your Texas Benefits app; * Faxing it to 877-447-2839; * Mailing it to Austin (provide them a postage paid return envelope); * Providing it in person at a local office. VERSIGHT Page 10 of 10 TX-HHSC-20-0960-A-000352 Revised: February 2019 TEXAS TexasHealthandHumanServices Commission Healthand Human Services Dr. Courtney N. Phillips ExecutiveCommissioner March 9, 2020 The Honorable Jamie Raskin Chairman Subcommittee on Civil Rights and Civil Liberties Committee on Oversight and Reform U.S. House of Representatives 2157 Rayburn House Office Building Washington, DC 20515-6143 Dear Chairman Raskin: Thank you for your letter on February 24, 2020, requesting information about Texas’ compliance with the National Voter Registration Act (NVRA) requirements. We appreciate the opportunity to explain the process in Texas and demonstrate that the state’s Medicaid recipients undergoing the automated renewal process are offered the opportunity to register to vote as required by federal and state law. In Texas, the Health and Human Services Commission (HHSC) is designated as a voter registration agency. In August 2019, HHSC updated the Texas Health and Human Services (HHS) NVRA Implementation Plan. The Medicaid program is listed in the HHS NVRA Implementation Plan 2019 as one of the programs that provides public assistance and is required to provide voter registration services. Please find HHSC’s responses to your inquiries below. 1. A description of how Texas Medicaid recipients of voting age are provided with an opportunity to register to vote during the annual renewal process. The HHS NVRA Implementation Plan 2019 (Attachment 1)1 provides general direction for carrying out voter registration requirements under federal and state law, including how Texas Medicaid recipients of voting age are provided with an opportunity to register to vote during the annual renewal process. The Medicaid eligibility and renewal process has been automated via the Texas Integrated Eligibility Redesign System (TIERS). Through TIERS, HHSC sends renewal packets to all active Medicaid recipients via mail as they are approaching the end of their certification period, including those who qualify for auto-renewal. 1 Attachments 2 and 3 provide supporting documentation related to the HHS NVRA Implementation Plan P.O. Box 13247 • Austin, TX 78711 • hhs.texas.gov VERSIGHT 10/2018 TX-HHSC-20-0960-A-000353 The Honorable Jamie Raskin March 9, 2020 Page 2 Medicaid renewal packets include: 1) a Medicaid renewal form (Attachment 4), which includes a section where the recipient is asked whether he or she would like to register to vote; and 2) a voter registration form (Attachment 5). Medicaid recipients may respond to the renewal packet in person or via mail, fax, or online. Both voter registration options described in the paragraph above are available to recipients, no matter which method they choose to complete the Medicaid renewal process. Those who choose to complete the voter registration form provided in their Medicaid renewal packet can submit the completed voter registration form in person or by mail to the voter registrar or a local HHSC office, or in person to a volunteer deputy registrar in the county where the applicant resides. They may also mail or hand-deliver their completed voter registration forms to an HHSC office, in which case HHSC staff will mail the completed forms to the voter registrar of the county in which the agency office is located within five days of receipt. Those who indicate on their Medicaid renewal form that they would like to register to vote will be provided by HHSC staff with a voter registration form to complete. HHSC staff are required to provide assistance in completing the form, if requested. The options for submitting the completed voter registration form are the same as those described in the paragraph above. 2. For each voter registration process described in your response to item (1) above, when TDHHS first implemented that process. The general voter registration process has been in place since the state’s voter registration law was first passed in 1995. Prior to the updated HHS NVRA of 2019, the HHSC NVRA of 2010 (Attachment 6) was on file with the Secretary of State. The process of providing voter registration forms with all Medicaid renewal packets has been in place since 2011. The automated Medicaid renewal process went into effect in 2015. 3. For each year from 2012 through 2019, the number of Texas Medicaid renewals completed in total and using the automated process permitted under the Affordable Care Act. Data for Medicaid renewals between 2012 and 2019 are listed in the chart below: AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000354 The Honorable Jamie Raskin March 9, 2020 Page 3 Medicaid Renewal Application Medicaid Renewals Medicaid Auto Year Packets Sent* Completed Renewals** 2012 3,117,368 2,530,852 2013 3,086,943 2,592,941 2014 2,337,175 1,901,864 2015 3,307,604 2,468,920 306,575 2016 3,304,915 2,539,928 325,387 2017 3,376,850 2,537,933 320,964 2018 3,456,484 2,656,440 368,399 2019 3,311,241 2,490,410 308,338 *A voter registration form is included in each Medicaid renewal packet. **Auto renewals started in 2015. 4. For each year from 2012 through 2019, the number of voter registration forms distributed by TDHHS to Medicaid recipients whose benefits were renewed using the automated process described above. As noted in the answer to question 1, HHSC sends renewal packets to all active Medicaid recipients as they are approaching the end of their certification period, including those who qualify for auto-renewal. Each Medicaid renewal packet includes a voter registration form. See the answer to question 3 for the number of Medicaid renewal packets (and voter registration forms) that were distributed in each year from 2012 to 2019. 5. For each year from 2012 through 2019, the number of voter registration forms submitted to TDHHS by Medicaid recipients whose benefits were renewed using the automated process described above. HHSC does not track the number of voter registration forms submitted to HHSC by Medicaid recipients. 6. For each year from 2012 through 2019, the number voter registration forms submitted to the Texas Secretary of State by TDHHS. Pursuant to 52 U.S.C. §20506(a)(4)(A) and Texas state law (Texas Election Code §20), completed voter registration applications are submitted to the voter registrar of the county in which the agency office is located, not to the Texas Secretary of State. HHSC does not track the applications submitted from each office to the voter registrar. VERSIGHT TX-HHSC-20-0960-A-000355 The Honorable Jamie Raskin March 9, 2020 Page 4 7. The most recent training provided to employees of TDHHS to carry out the duties required of voter registration agencies under the NVRA in the context of automated renewals of Medicaid coverage. HHS staff who are responsible for the Medicaid application and renewal processes receive voter registration training during the Basic Skills Training (BST) program for the TIERS system. TIERS handles the application/renewal process for a wide variety of federal programs, including Medicaid, Medicaid for the Elderly and People with Disabilities (MEPD), and Supplemental Nutrition Assistance Program (SNAP). Employees take the SNAP or MEPD training module first, as those modules cover many processes (including voter registration) that are required in other program application processes (including Medicaid). Voter registration is covered in SNAP Module 6 (Attachment 7) and in MEPD Part 1 Module 9 (Attachment 8). Further voter registration details for these modules are provided in Texas Works Handbook A-1521 (Attachment 9) and MEPD Handbook C-7000 (Attachment 10). In addition, the Interview Job Aid (Attachment 11) provides specific voter registration instructions for HHSC staff. 8. All documents reflecting communications within TDHHS, or between the Department and others, since 2012 about how the Department would implement the requirements of the NVRA in its Medicaid renewal process. HHSC has experienced significant organizational change since 2012. While there are tens of thousands of potentially responsive documents to this question, HHSC identified the attached documents as being the most representative communications. This was done to ensure a timely response and minimize burden on your staff; however, should more information be needed HHSC can provide additional documents. If you have any further questions about the process and procedures used by HHSC to ensure compliance with the NRVA, please contact Amanda Martin, Director of Government & Stakeholder Relations, at Amanda.Martin04@hhsc.state.tx.us or (512) 487-3300. Sincerely, Michelle Alletto Chief Program & Services Officer PVERSIGHT TX-HHSC-20-0960-A-000356 The Honorable Jamie Raskin March 9, 2020 Page 5 Enclosures cc: The Honorable Chip Roy AMERICAN PVERSIGHT TX-HHSC-20-0960-A-000357