STATEMENT OF UNDERSTANDING

All Benefit Programs

Facts HHSC has about me

HHSC uses facts about people applying for benefits to decide: (1) who can get benefits, and (2) the amount of benefits. HHSC checks facts with the federal Income and Eligibility Verification System. If any facts don’t match, HHSC will check other sources (banks, employers, etc.). If anyone applying for benefits has an immigration registration number, HHSC must check with the U.S. Citizenship and Immigration Services’ (USCIS) system. HHSC will not give anyone’s facts to USCIS.

In most cases, I can see and get facts HHSC has about me. This includes facts I give HHSC and facts HHSC gets from other sources (medical records, employment records, etc.). I might have to pay to get a copy of these facts. I can ask HHSC to fix anything that is wrong. I do not have to pay to fix a mistake. To ask for a copy or to fix a mistake, I can call 2-1-1 or my local HHSC benefits office.

Keeping my facts private

HHSC will keep my facts private if they were collected:

• By HHSC staff or contracted provider staff.
• To find out if I can get state benefits.

HHSC can share facts about me:

• When needed for me to get state health-care benefits.
• With phone and utility companies. They will find out if my bill amount can be lowered. HHSC will give them my name, address, and phone number.

Reporting changes

I agree to let HHSC know, within 10 days, about any changes to my case. This includes changes in facts I give on this form such as money I get, things I own or are paying for, where I live, or insurance I have (including health insurance premiums).

Cash Help for Families (TANF)

Child support or alimony

I agree to:

• Let the state keep any child support or alimony money owed to anyone during the time they get TANF.
• Let the state keep this money after TANF benefits end, if the TANF amount anyone got still needs to be paid off.
• Tell HHSC about money anyone gets.
• Work with HHSC to get this money; if I don’t, I am breaking the law.

The state will keep only the amount allowed by law.

If I give false information

If I choose not to tell the truth, I might:

• Be charged with and punished for a crime. (This could include going to prison for up to 10 years or community supervision)
• Have to repay benefits.
• Never get TANF again.

Food Benefits (SNAP)

Telling the truth

Facts anyone tells or gives HHSC

HHSC uses the facts anyone tells or gives HHSC, including Social Security numbers to:

• Check if that person can get benefits.
• Check that person’s facts with computer matching programs and credit reporting agencies.
• Make sure that person is following benefit program rules.
• Help other agencies check if that person can get other benefits.
• Recover benefits that person wasn’t supposed to get.
• Share facts about that person: (1) with other state and federal agencies (for example, the Texas Workforce Commission, the Social Security Administration, and the Internal Revenue Service); (2) with law enforcement officials so they can find people on that person’s benefits case (the household) who are wanted for fleeing the law; and (3) with federal, state, and private claims collecting agencies for food benefit overpayment claims collection action.

(Food and Nutrition Act of 2008, as amended, 7 U.S.C. 2011-2036.)

Your Right to be Treated Fairly

This institution is prohibited from discriminating on the basis of race, color, national origin, disability, age, sex and in some cases religion or political beliefs.

The U.S. Department of Agriculture also prohibits discrimination based on race, color, national origin, sex, religious creed, disability, age, political beliefs or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

Supplemental Nutrition Assistance Program (SNAP)

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027), found online at:

http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992.

Submit your completed form or letter to USDA by:

• Mail: U.S. Department of Agriculture
  Office of the Assistant Secretary for Civil Rights
  1400 Independence Avenue, SW
  Washington, D.C. 20250-9410
  
• Fax: (202) 690-7442; or
• Email:program.intake@usda.gov

For any other information dealing with Supplemental Nutrition Assistance Program (SNAP) issues, persons should either contact the USDA SNAP Hotline Number at (800) 221-5689, which is also in Spanish or call the State Information/Hotline Numbers (click the link for a listing of hotline numbers by State); found online at:
http://www.fns.usda.gov/snap/contact_info/hotlines.htm

Medicaid and Temporary Assistance for Needy Families

To file a complaint of discrimination regarding a program receiving federal financial assistance through the U.S. Department of Health and Human Services (HHS), write: HHS Director, Office for Civil Rights, Room 509F, 200 Independence Avenue, S.W., Washington, D.C. 20201 or call (800) 368-1019 (voice) or (800) 537-7697 (TTY).

This institution is an equal opportunity provider.

You also can file a complaint with the Texas Health and Human Services Commission, Civil Rights Office. Email HHSCivilRightsOffice@hhsc.state.tx.us, call 888-388-6332, fax (512) 438-5885, or write Texas Health and Human Services Commission, Civil Rights Office, 701 W. 51st St., MC W206, Austin, Texas 78751.

Medicaid

If I give false information

If I choose not to tell the truth, I might:

• Be charged with a crime.
• Have to repay benefits.

The same is true if I let someone else use my medical card or Medicaid ID.

Giving out facts about me

I agree to let Medicaid health care providers (doctors, drug stores, hospitals, etc.) give out any facts about me to HHSC. This will allow the providers to be paid by Medicaid.

Medical and child support payments

Depending on my benefits case, the Attorney General (the state) might check that I am getting the right amount of child or medical support payments and coverage.

• If only my child gets Medicaid, I can decide if I want the state to help me get any payments and coverage we should get, but don’t get right now.
• If my child and I both get Medicaid, I must;
• Help the state get any payments and coverage we should get, but don’t get right now. If I don’t help the state, my child can get Medicaid, but I might not.
• Identify who the child’s other parent is.
• Allow the state to keep any medical support payments.

If I get Medicaid, HHSC will keep medical services payments I can get from other sources, such as:

• My health insurance.
• Money I got because of injuries.
• Money collected for me or my children by the Office of Attorney General.

I must tell HHSC about these sources. If I don’t, I am breaking the law.

HHSC will only keep the amount of medical support and service payments allowed by law. I will work with HHSC to get these funds.