2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0261. Continuous Eligibility

Sec. 32.0261.  CONTINUOUS ELIGIBILITY.  (a) This section applies only to a child younger than 19 years of age who is determined eligible for medical assistance under this chapter.
(b)  The executive commissioner shall adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as amended, to provide for two consecutive periods of eligibility for a child between each certification and recertification of the child's eligibility, subject to Subsections (f) and (h).
(c)  The first of the two consecutive periods of eligibility described by Subsection (b) must be continuous in accordance with Subsection (d).  The second of the two consecutive periods of eligibility is not continuous and may be affected by changes in a child's household income, regardless of whether those changes occurred or whether the commission became aware of the changes during the first or second of the two consecutive periods of eligibility.
(d)  A child remains eligible for medical assistance during the first of the two consecutive periods of eligibility, without additional review by the commission and regardless of changes in the child's household income, until  the end of the six-month period following the date on which the child's eligibility was determined, except as provided by Subsections (f)(1) and (h).
(e)  During the sixth month following the date on which a child's eligibility for medical assistance is certified or recertified, the commission shall, in a manner that complies with federal law, including verification plan requirements under 42 C.F.R. Section 435.945(j), review the child's household income using electronic income data available to the commission.  The commission may conduct this review only once during the child's two consecutive periods of eligibility.  Based on the review:
(1)  the commission shall, if the review indicates that the child's household income does not exceed the maximum income for eligibility for the medical assistance program, provide for a second consecutive period of eligibility for the child until the child's required annual recertification, except as provided by Subsection (h) and subject to Subsection (c); or
(2)  the commission may, if the review indicates that the child's household income exceeds the maximum income for eligibility for the medical assistance program, request additional documentation to verify the child's household income in a manner that complies with federal law.
(f)  If, after reviewing a child's household income under Subsection (e), the commission determines that the household income exceeds the maximum income for eligibility for the medical assistance program, the commission shall continue to provide medical assistance to the child until:
(1)  the commission provides the child's parent or guardian with a period of not less than 30 days to provide documentation demonstrating that the child's household income does not exceed the maximum income for eligibility; and
(2)  the child's parent or guardian fails to provide the documentation during the period described by Subdivision (1).
(g)  If a child's parent or guardian provides to the commission within the period described by Subsection (f) documentation demonstrating that the child's household income does not exceed the maximum income for eligibility for the medical assistance program, the commission shall provide for a second consecutive period of eligibility for the child until the child's required annual recertification, except as provided by Subsection (h) and subject to Subsection (c).
(h)  Notwithstanding any other period prescribed by this section, a child's eligibility for medical assistance ends on the child's 19th birthday.
(i)  The commission may not recertify a child's eligibility for medical assistance more frequently than every 12 months as required by federal law.
(j)  If a child's parent or guardian fails to provide to the commission within the period described by Subsection (f) documentation demonstrating that the child's household income does not exceed the maximum income for eligibility for the medical assistance program, the commission shall provide the child's parent or guardian with written notice of termination following that period.  The notice must include a statement that the child may be eligible for enrollment in the child health plan under Chapter 62, Health and Safety Code.
(k)  In developing the notice, the commission shall consult with health care providers, children's health care advocates, family members of children enrolled in the medical assistance program, and other stakeholders to determine the most user-friendly method to provide the notice to a child's parent or guardian.
(l)  The executive commissioner may adopt rules as necessary to implement this section.
Added by Acts 2001, 77th Leg., ch. 584, Sec. 4, eff. Sept. 1, 2002.
Amended by:
Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 23, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 3.02, eff. August 29, 2005.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.090, eff. April 2, 2015.
Acts 2021, 87th Leg., R.S., Ch. 820 (H.B. 2658), Sec. 8, eff. September 1, 2021.