3200, Processing an Application

On Form 3064, Application for Health Care Assistance or other HHSC-approved application, document the date that the identifiable application is received. This is the application file date.

Step 2: Determine if an interview is needed.

Eligibility may be determined without interviewing the applicant if all questions on the application are answered and all additional information has been provided.

Step 3: Interview the applicant or their representative face-to-face or by phone if an interview is necessary.

If an interview appointment is scheduled, issue Form 3067, Appointment Notice, including the date, time and place of the interview. If the applicant fails to keep the appointment, reschedule the appointment, if requested, or follow the Denial Decision procedure in Step 8.

Step 4: Check that all information is complete, consistent and sufficient to make an eligibility determination.

Step 5: Request needed information pertaining to the four eligibility criteria: residence, household, resources and income.

• Decision Pended – If eligibility cannot be determined because components that pertain to the eligibility criteria are missing, issue Form 3068, Request for Information, listing the due date and additional information that needs to be provided. If the requested information is not provided by the due date, follow the Denial Decision procedure in Step 8. If the requested information is provided by the due date, proceed with Step 6.
• Decision Pended for a Supplemental Security Income (SSI) Applicant – If eligibility cannot be determined because the person is also an SSI applicant, issue Form 3068, listing the due date and additional information that needs to be provided, including the SSI decision. If the SSI application is denied for eligibility requirements, proceed with Step 6 whether or not the SSI denial is appealed.

Step 6: Repeat Steps 4 and 5 as necessary.

Step 7: Determine eligibility based on the four eligibility criteria.

Document information in the case record to support the decision.

Step 8: Issue the appropriate form, either Form 3082 or Form 3077.

• Denial Decision – If any one of the eligibility criteria is not met, the applicant is ineligible. Issue Form 3082, Notice of Ineligibility, including the reason for denial, effective date of the denial, if applicable, and an explanation of the procedure for appealing the denial. Reasons for denial include, but are not limited to:
  • not a resident of the county;
  • a recipient of Medicaid;
  • resources exceed the resource limit;
  • income exceeds the income limit;
  • failed to keep an appointment;
  • failed to provide information requested;
  • failed to return the review application;
  • failed to comply with requirements to obtain other assistance; or
  • voluntarily withdrew.
  • The applicant may be retroactively eligible in any of the three calendar months before the month the identifiable application is received if all eligibility criteria are met.
  • Issue Form 3077, Notice of Eligibility, including the eligibility effective date.

  3210, Reporting Changes

  Revision 23-4; Effective Sept. 22, 2023

  Changes are situations that occur in a household that may affect the eligibility of the household. An applicant must report changes which affect eligibility within 14 days of becoming aware of the changes.

  Follow the steps in Section 3200, beginning with Step 4, Check that all information is complete, consistent and sufficient to make an eligibility determination, to determine the effect of the change on the household’s eligibility.
  If a change results in the household’s ineligibility, the eligibility end date is the date that Form 3082 is issued to the household.