reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter A - GENERAL INFORMATION › Section 358.103 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 have the following meanings unless the context clearly indicates
					 otherwise:
(1)
										§1915(c) waiver
				  program--A home or community-based service authorized for use in Texas by the
				  Centers for Medicare and Medicaid Services in accordance with §1915(c) of
				  the Social Security Act.
(2)
				  Adverse action--A termination, suspension, or reduction of Medicaid eligibility
				  or covered services.
(3) Annual
				  review--The process of redetermining a person's continued eligibility for
				  Medicaid.
(4) Appeal--A request for
				  a review of an action or failure to act by the Texas Health and Human Services
				  Commission (HHSC) that may result in a fair hearing.
(5) Applicant--A person seeking benefits
				  under a Medicaid-funded program for the elderly and people with disabilities
				  (MEPD) who is not currently receiving MEPD services.
(6) Application for assistance--A form
				  prescribed by HHSC that a person uses to apply for MEPD or to have MEPD
				  eligibility redetermined.
(7)
				  Assets--All items a person owns that have monetary value. Assets include both
				  income and resources.
(8)
				  Authorized representative--An individual:
(A)
				  who assists and represents a person in the application or eligibility
				  redetermination process, and who is familiar with that person and that person's
				  financial affairs; or
(B) who is a
				  representative payee for an applicant or recipient for another federal
				  benefit.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter A - GENERAL INFORMATION › Section 358.105 - General Medicaid Eligibility Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) To be determined eligible for a
				  Medicaid-funded program for the elderly and persons with disabilities (MEPD), a
				  person must:
(1) meet the criteria for an
				  eligible coverage group, as described in §
											RSA 358.107 of
				  this subchapter (relating to Coverage Groups);
(2) comply with the Texas Health and Human
				  Services Commission's application and redetermination requirements, in
				  accordance with Subchapter D of this chapter (relating to Application and
				  Eligibility Determination);
(3)
				  meet the nonfinancial eligibility requirements in Subchapter B of this chapter
				  (relating to Nonfinancial Requirements); and
(4) meet the financial eligibility
				  requirements in Subchapter C of this chapter (relating to Financial
				  Requirements).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.201 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
				  describes the nonfinancial Medicaid eligibility criteria for a Medicaid-funded
				  program for the elderly and people with disabilities (MEPD).
(b) Financial Medicaid eligibility criteria
				  for MEPD are described in Subchapter C of this chapter (relating to Financial
				  Requirements).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.203 - Citizenship and Qualified Alien Status

Current through Reg. 49, No. 28; July 12, 2024
(a) In accordance with
				  RSA
				  435.406, to be eligible for a Medicaid-funded
				  program for the elderly and people with disabilities (MEPD), a person must be:
(1) a citizen or national of the United
				  States (U.S.);
(2) an alien who
				  entered the U.S. before August 22, 1996, who has lived in the U.S. continuously
				  since entry, and who meets the definition of a qualified alien at
				  RSA
				  1641; or
(3) an alien who entered the U.S. on or after
				  August 22, 1996, who has lived in the U.S. continuously since entry, and who
				  meets the definition of a qualified alien at
				  RSA
				  1641 with the eligibility limitations in
				  RSA
				  1612 and §
											RSA
				  1613.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.205 - Alien Status for Treatment of an Emergency Medical Condition

Current through Reg. 49, No. 28; July 12, 2024
(a) Title XIX of the Social Security Act
				  (RSA
				  1396 et seq.) and
				  RSA
				  440.255 require the state to provide Medicaid
				  for the treatment of an emergency medical condition to an alien who is
				  ineligible for regular Medicaid due to immigration status. The Texas Health and
				  Human Services Commission administers the program in Texas.
(b) To qualify for Medicaid for the treatment
				  of an emergency medical condition, an alien must:
(1) be:
(A)
				  a qualified alien as defined in
				  RSA
				  1641 and not meet the requirements to receive
				  Medicaid as described in
				  RSA
				  1612 and §
												RSA
				  1613; or
(B) an undocumented non-qualifying alien as
				  described in
				  RSA
				  1611;
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.207 - Residence

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for a Medicaid-funded program for the
					 elderly and people with disabilities, a person must be a resident of the United
					 States (U.S.) and the state of Texas.
(1) U.S. residence. The Texas Health and
				  Human Services Commission (HHSC) follows
				  RSA
				  416.1603 in determining a person's U.S.
				  residence.
(A) The U.S. residence requirement
				  does not apply to:
(i) a child who is a
				  citizen and is living with a parent who is a member of the U.S. Armed Forces
				  assigned to permanent duty ashore outside the U.S.; or
(ii) to certain persons temporarily abroad
				  for study.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.209 - Social Security Number

Current through Reg. 49, No. 28; July 12, 2024
In accordance with
					 RSA
					 435.910, a person must give his or her social
					 security number to the Texas Health and Human Services Commission as a
					 condition of eligibility, except as provided in §
										RSA
					 358.205(c) of
					 this subchapter (relating to Alien Status for Treatment of an Emergency Medical
					 Condition).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.211 - Aged, Blind, or Disabled

Current through Reg. 49, No. 28; July 12, 2024
(a) To be
				  eligible for a Medicaid-funded program for the elderly and people with
				  disabilities (MEPD), a person must be aged, blind, or disabled, according to
				  the following criteria:
(1) Aged. A person
				  must be 65 years of age or older to be considered aged, in accordance with
				  RSA
				  1382c(a)(1)(A).
(2) Blind.
(A) To be considered blind for eligibility
				  purposes, a person must meet the criteria in
				  RSA
				  1382c(a)(2).
(B) There is no minimum age requirement for a
				  person who is blind.
(C) A person
				  must have a medical determination of blindness before the Texas Health and
				  Human Services Commission (HHSC) can determine eligibility.
(3) Disabled.
(A) To be considered disabled for eligibility
				  purposes, a person must meet the criteria in
				  RSA
				  1382c(a)(3).
(B) There is no minimum age requirement for a
				  person who is disabled, unless the person lives in an institution for mental
				  diseases as described in §
												RSA
				  358.213 of this subchapter (relating to
				  Resident of an Institution for Mental Diseases).
(C) A person must have a medical
				  determination of a disability before HHSC can determine eligibility.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.213 - Resident of an Institution for Mental Diseases

Current through Reg. 49, No. 28; July 12, 2024
A person who lives in an institution for mental diseases
					 must be 65 years of age or older to be eligible for a Medicaid-funded program
					 for the elderly and people with disabilities.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.215 - Inmates of Public Institutions

Current through Reg. 49, No. 28; July 12, 2024
An inmate of a public institution, including a jail,
					 prison, reformatory, or other correctional or holding facility, as defined in
					 RSA
					 435.1009 and §
										RSA
					 435.1010, is not eligible for Medicaid
					 payment for Medicaid-covered services received while residing in the public
					 institution.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.217 - Application for Other Benefits

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for a Medicaid-funded program for the
					 elderly and people with disabilities, a person must apply for and obtain, if
					 eligible, all other benefits to which the person may be entitled, in accordance
					 with
					 RSA
					 1382(e)(2).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter B - NONFINANCIAL REQUIREMENTS › Section 358.219 - Third-Party Resources

Current through Reg. 49, No. 28; July 12, 2024
(a) Medicaid is
				  considered the payor of last resort for a person's medical expenses. As a
				  condition of eligibility, in accordance with
				  RSA
				  433.138 -
				  RSA
				  433.148, an applicant or recipient must:
(1) assign to the Texas Health and Human
				  Services Commission (HHSC) the applicant's or recipient's right to recover any
				  third-party resources available for payment of medical expenses covered under
				  the Texas State Plan for Medical Assistance; and
(2) report to HHSC any third-party resource
				  within 60 days after learning about the third-party resource.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 1 - INTRODUCTION › Section 358.301 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
					 describes:
(1) the financial eligibility
					 criteria for a Medicaid-funded program for the elderly and people with
					 disabilities (MEPD); and
(2) the
					 budgeting process for determining financial eligibility and a co-payment
					 amount, if applicable.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.321 - General Treatment of Resources

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 The Texas Health and Human Services Commission (HHSC) follows §1613 of the
					 Social Security Act (RSA 1382b) and
					 RSA 416.1201
					 regarding the general treatment of resources.
(b) HHSC follows
					 RSA
					 416.1207 regarding the determination of
					 resources. Resource determinations are made as of 12:01 a.m. on the first day
					 of the month.
(c) If a person's
					 countable resources exceed the resource limit as of 12:01 a.m. on the first day
					 of the month, the person is not eligible for the entire month. Eligibility may
					 be reestablished no sooner than the first day of the next month.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.322 - Conversion of Resources

Current through Reg. 49, No. 28; July 12, 2024
If a person converts one type of resource to another, the
						new resource is counted according to the policy governing that type of
						resource. Cash received from the sale of a resource is counted as a resource,
						not as income. This includes proceeds from the sale of a natural resource, such
						as cutting timber from the person's home property and selling it as firewood,
						except as follows:
(1) If the owner
					 leases the land or resource rights, the income received from the lease is
					 unearned income.
(2) If the sale of
					 the natural resource is part of the person's trade or business, the income
					 received is self-employment income.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.323 - Resource Limits

Current through Reg. 49, No. 28; July 12, 2024
A person or a couple meets resources eligibility criteria
						if the value of all countable resources does not exceed the resource limits in
						RSA
						416.1205.
(1) Individual resource limit. The individual
					 resource limit applies to:
(A) an adult who
					 is single, even if he or she lives with relatives;
(B) a child; and
(C) a person whose spouse lives in a
					 different household.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.324 - Deeming of Resources

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas
					 Health and Human Services Commission (HHSC) follows deeming of countable
					 resources in accordance with
					 RSA
					 416.1202.
(b) If a parent is a caretaker or a recipient
					 in the Temporary Assistance for Needy Families Program, the parent's resources
					 are not counted when considering deeming to a child.
(c) If a member of a household is temporarily
					 absent as defined in
					 RSA
					 416.1167, HHSC continues to consider the
					 absent person a member of the household for the purposes of deeming during a
					 temporary absence, in accordance with
					 RSA
					 416.1167.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.325 - Ownership Interest and Legal Right to Access a Resource

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission (HHSC)
						follows
						RSA
						416.1201(a)(1)
						when considering whether a person has the right, authority, or power to
						liquidate a property or the person's share of the property.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.326 - Unknown Assets

Current through Reg. 49, No. 28; July 12, 2024
If a person is unaware of the ownership of an asset, the
						asset is not counted as a resource for the period during which the person is
						unaware of the ownership. The asset is counted as income in the month that the
						person discovers the ownership. The asset is counted as a resource effective
						the first of the month after the month of discovery.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.327 - Transactions Involving Agents

Current through Reg. 49, No. 28; July 12, 2024
(a) An
					 action by a fiduciary agent is the same as an action by the person for whom the
					 fiduciary agent acts.
(1) An asset held by a
					 fiduciary agent for another person is not a countable asset to the fiduciary
					 agent.
(2) An asset held by a
					 fiduciary agent for another person is a countable asset to the person for whom
					 the fiduciary agent acts, unless otherwise excludable.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.331 - General Exclusions from Resources

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						RSA
						416.1210 in determining what resources to
						exclude, and also excludes:
(1)
					 patrimonial assets that are irrevocably turned over to a religious order
					 following a vow of poverty, which are not considered a transfer of
					 assets;
(2) reparation payments
					 received under Sections 500 - 506 of the Austrian General Social Insurance
					 Act;
(3) payments received under
					 the Netherlands' Act on Benefits for Victims of Persecution 1940 - 1945;
					 and
(4) payments made in the class
					 settlement of the
Susan Walker v. Bayer Corporation
lawsuit.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.333 - Treatment of Employment- and Retirement-Related Annuities

Current through Reg. 49, No. 28; July 12, 2024
(a) In this section:
(1) an employment-related annuity means an
					 annuity that provides a return on prior services, as part of or in a similar
					 manner to a pension or retirement plan; and
(2) a retirement-related annuity means an
					 annuity purchased by or on behalf of an annuitant in an institutional
					 setting.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.334 - Treatment of a Nonemployment-Related Annuity with a Purchase or Transaction Date before February 8, 2006

Current through Reg. 49, No. 28; July 12, 2024
(a) This
					 section describes the Texas Health and Human Services Commission's (HHSC's)
					 treatment of nonemployment-related annuities purchased or having a transaction
					 date before February 8, 2006. In this section, a nonemployment-related annuity
					 means a revocable or irrevocable annuity a person may purchase to provide
					 income.
(b) A nonemployment-related
					 annuity is not a countable resource if the annuity:
(1) is irrevocable;
(2) pays out principal in equal monthly
					 installments and pays out interest in either equal monthly installments or in
					 amounts that result in increases of the monthly installments at least
					 annually;
(3) is guaranteed to
					 return within the person's life expectancy at least the person's principal
					 investment plus a reasonable amount of interest (based on prevailing market
					 interest rates at the time of the annuity purchase, as determined by
					 HHSC);
(4) names the state of Texas
					 or HHSC as the residual beneficiary of amounts payable under the annuity
					 contract, not to exceed any Medicaid funds expended on the person during the
					 person's lifetime, except as described in subsection (c) of this section;
					 and
(5) is issued by an insurance
					 company licensed and approved to do business in the state of Texas.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.335 - Treatment of Annuities with a Purchase or Transaction Date on or after February 8, 2006

Current through Reg. 49, No. 28; July 12, 2024
(a) This section
					 describes the Texas Health and Human Services Commission's (HHSC's) treatment
					 of nonemployment-related annuities purchased or having a transaction date on or
					 after February 8, 2006. In this section, a nonemployment-related annuity means
					 a revocable or irrevocable annuity a person may purchase to provide
					 income.
(b) A nonemployment-related
					 annuity is not a countable resource if the annuity:
(1) is irrevocable;
(2) is nonassignable;
(3) provides for payments in equal amounts
					 during the term of the annuity, with no deferral and no balloon payments
					 made;
(4) is guaranteed to return
					 within the person's life expectancy at least the person's principal investment
					 (that is, it is actuarially sound, as determined in accordance with actuarial
					 publications of the Office of the Chief Actuary of the United States Department
					 of Health and Human Services); and
(5) names the state of Texas as the remainder
					 beneficiary in the first position for at least the total amount of Medicaid
					 paid on behalf of a person in an institutionalized setting.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.336 - Treatment of Testamentary or Inter Vivos Trusts

Current through Reg. 49, No. 28; July 12, 2024
(a) In this section, the following words have
					 the following meanings, unless the context clearly indicates otherwise.
(1) Testamentary trust--A trust established
					 by will.
(2) Inter vivos trust--A
					 trust established while the person creating the trust is still
					 living.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.337 - Treatment of a Medicaid-Qualifying Trust

Current through Reg. 49, No. 28; July 12, 2024
(a) A
					 Medicaid-qualifying trust (MQT) is a trust that a recipient, the recipient's
					 spouse or guardian, or anyone holding the recipient's power of attorney
					 establishes using the recipient's money. The recipient is the beneficiary of an
					 MQT. A trust meeting this definition that was established between June 1, 1986,
					 and August 10, 1993, is an MQT. A trust meeting this definition that was
					 established before June 1, 1986, is treated as a standard inter vivos
					 trust.
(b) Except as described in
					 §358.338 of this division (relating to Treatment of a Trust Established
					 with
Zebley v. Sullivan
Settlement Funds), the Texas Health
					 and Human Services Commission (HHSC) counts potential distributions from an MQT
					 as resources available to a person, whether or not distributions are actually
					 made.
(1) The amount available to the person
					 is the maximum amount the trustee could distribute under the terms of the
					 trust.
(2) If distribution is not
					 made, the maximum amount the trustee may distribute under terms of the trust is
					 considered an available resource.
(3) If a trust does not specify an amount for
					 distribution, and if the trustee has access to and use of the principal, then
					 HHSC counts:
(A) the corpus of the trust as a
					 resource; and
(B) payments from the
					 trust to or for the benefit of the person as income only if the payments would
					 ordinarily be counted as income in accordance with
					 RSA
					 416.1102.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.338 - Treatment of a Trust Established with Zebley v. Sullivan Settlement Funds

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
					 Commission excludes a Medicaid-qualifying trust established for a minor child
					 using a lump sum payment received in the settlement of
Zebley v.
					 Sullivan
from countable resources under undue hardship provisions.
					 Undue hardship exists because the minor child would otherwise be forced to
					 spend the settlement funds on services now covered by Medicaid when the funds
					 will be needed once the minor child reaches majority.
(b) A trust established using
Zebley
					 v. Sullivan
settlement funds is excluded under undue hardship policy,
					 even when the trust is set up on or after August 11, 1993.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.339 - Treatment of Trusts on and after August 11, 1993

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction. The Texas Health and Human
					 Services Commission (HHSC) follows §1917(d) of the Social Security Act
					 (RSA
					 1396p(d))
					 regarding the treatment of trusts established on or after August 11, 1993,
					 using a person's assets. The trust provisions apply to a person receiving
					 benefits under a Medicaid-funded program for the elderly and people with
					 disabilities (MEPD), whether the person is in an institutional or a
					 noninstitutional setting. However, transfer-of-assets provisions apply only to
					 a person in an institutional setting.
(b) Limited partnerships.
(1) A limited partnership is a "similar legal
					 device" to a trust. In accordance with the definition of a trust in
					 §1917(d)(6) of the Social Security Act (RSA
					 1396p(d)(6)),
					 HHSC treats a limited partnership as a trust and applies the provisions of this
					 section to a limited partnership. The general partners of a limited partnership
					 act as trustee, and the limited partners are the equivalent of beneficiaries of
					 an irrevocable trust. To the extent that the general partners can make each
					 limited partner's ownership interest available to him, that interest is a
					 countable resource and not a transfer of assets. However, a transfer of assets
					 has occurred to the extent that:
(A) the
					 value of the share of ownership purchased by the limited partner is less than
					 the amount the limited partner invested; and
(B) the general partners cannot make the
					 limited partner's share available to the limited partner.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.345 - Entrance Fees for Continuous Care Retirement Communities

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						§1917(g) of the Social Security Act (RSA
						1396p(g))
						regarding the treatment of entrance fees of a person residing in a continuous
						care retirement community.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.346 - Funds Held in Financial Institution Accounts

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						RSA
						416.1208 regarding the treatment of funds
						held in financial institution accounts, except the balance of funds in a
						financial institution account as of 12:01 a.m. on the first day of the month is
						reduced by the amount of any funds encumbered before that time, including any
						checks written, that have not yet been processed by the financial
						institution.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.347 - Nonliquid Resources

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						RSA
						416.1201(c)
						regarding the definition and treatment of nonliquid resources, except with
						regard to the treatment of an automobile as described in §358.354 of this
						division (relating to Automobiles).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.348 - Exclusion of a Home

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas
					 Health and Human Services Commission follows
					 RSA
					 416.1212 regarding the treatment of a home,
					 except HHSC does not count the equity value of a home that is the principal
					 place of residence of an applicant or recipient or the applicant's or
					 recipient's spouse:
(1) if the home is in
					 Texas, and the applicant or recipient occupies or intends to return to the
					 home; or
(2) if the home meets the
					 criteria in §
												RSA
					 358.415(b) of
					 this subchapter (relating to Calculation of the Spousal Protected Resource
					 Amount).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.349 - Exceptions to Treatment of Excess Real Property

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
					 Commission (HHSC) follows
					 RSA
					 416.1245 regarding the treatment of excess
					 real property, except the property continues to be excluded for as long as:
(1) the person continues to make reasonable
					 efforts to sell it; and
(2)
					 including the property as a countable resource would result in a determination
					 of excess resources.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.350 - Life Estates and Remainder Interest

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission (HHSC)
						counts both a life estate and a remainder interest in property as resources,
						except as described in paragraph (3) of this section.
(1) Life estates. A life estate provides a
					 person, for the person's lifetime, certain rights in a property, while
					 transferring ownership of the property to another person. The duration of a
					 life estate is measured by the lifetime of the owner of the life estate, or by
					 the occurrence of some event. The contract establishing a life estate, however,
					 may restrict one or more rights of the owner of the life estate. The owner of a
					 life estate does not have fee simple title to the property nor the right to
					 sell the entire property. In most situations, the owner of a life estate has
					 the right to:
(A) possess the
					 property;
(B) use the
					 property;
(C) get profits from the
					 property; and
(D) sell his or her
					 life estate interest.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.351 - Mineral Rights

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas
					 Health and Human Services Commission counts the equity value of a person's
					 ownership of or interest in mineral rights as a resource, unless the mineral
					 rights are:
(1) connected with property
					 excluded as a home; or
(2) excluded
					 as property essential to self-support under
					 RSA
					 416.1220,
					 RSA
					 416.1222, and
					 RSA
					 416.1224.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.352 - Burial Spaces

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						RSA
						416.1231 regarding the definition, treatment,
						and exclusion of burial spaces, except that a burial space purchased by a
						person is:
(1) excluded from countable
					 resources if it is held for the person, the person's spouse, or anyone of the
					 person's choosing; and
(2) counted
					 as a resource if the purchase was made for investment purposes.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.353 - Term and Burial Insurance

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission does not
						count term insurance or burial insurance as a resource, except as described in
						paragraphs (3) and (4) of this section.
(1) Term insurance is a contract of temporary
					 protection. The insured pays relatively small premiums for a limited number of
					 years, and the company agrees to pay the face amount of the policy only if the
					 insured dies within the time specified in the policy. It has no cash surrender
					 value.
(2) Burial insurance is a
					 form of term insurance. By its terms, burial insurance can only be used to pay
					 the burial expenses of the insured.
(3) If a term insurance policy has been
					 purchased by a life insurance company and premiums are used to purchase
					 separate whole life coverage, the whole life coverage is subject to the
					 provisions of
					 RSA
					 416.1230.
(4) If a term insurance policy is a
					 participating life insurance policy, any dividend accumulation at interest is a
					 countable resource.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.354 - Automobiles

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
					 Commission (HHSC) follows
					 RSA
					 416.1218 regarding the definition, treatment,
					 and exclusion of automobiles.
(b)
					 In addition to the one automobile HHSC excludes regardless of value, HHSC
					 excludes a second automobile, in accordance with
					 RSA
					 416.1218(b)(1),
					 if:
(1) the automobile has been modified to
					 accommodate a person with a disability, and there is a household member (other
					 than the applicant or recipient) who has a disability and must use the
					 automobile; or
(2) the household is
					 made up of more than one person and:
(A) a
					 household member (other than the applicant or recipient) requires an additional
					 automobile for transportation to and from work; and
(B) the applicant or recipient requires one
					 automobile available for medical use at all times.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.355 - Qualified Long-Term Care Partnership Program Insurance Policies

Current through Reg. 49, No. 28; July 12, 2024
(a) This section describes the Long-Term Care
					 Partnership Program under which a person's resources are disregarded in the
					 eligibility determination equal to the amount of benefits paid to or on behalf
					 of a person by a Long-Term Care Partnership policy.
(b) The Texas Health and Human Services
					 Commission (HHSC) administers the Long-Term Care Partnership Program.
(c) In this section, the following words and
					 terms have the following meanings, unless the context clearly indicates
					 otherwise:
(1) "Long-Term Care Partnership
					 Program" means the program established under the Texas Human Resources Code,
					 Chapter 32, Subchapter C.
(2)
					 "Qualified plan holder" means the beneficiary of a qualified long-term care
					 benefit plan that meets the requirements set forth in subsection (d) of this
					 section.
(3) "Resource disregard"
					 means the total equity value of resources not exempt under rules governing
					 Medicaid eligibility that are disregarded in determining eligibility for
					 Medicaid.
(4) "Resource protection"
					 means the extension to a plan holder of an approved plan of a dollar-for-dollar
					 resource disregard in determining Medicaid eligibility.
(5) "Dollar-for-dollar resource disregard"
					 means a resource disregard in which the amount of the disregard is equal to the
					 sum of benefit payments made on behalf of the approved plan holder.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.356 - Tuition Savings Programs

Current through Reg. 49, No. 28; July 12, 2024
(a) The
					 following words and terms, when used in this section, have the following
					 meanings, unless the context clearly indicates otherwise.
(1) Tuition savings program--
(A) a prepaid tuition program or higher
					 education savings plan authorized under Chapter 54, Subchapter G, H, or I of
					 the Texas Education Code; or
(B) a
					 qualified tuition program of any state that meets the requirements of §529
					 of the Internal Revenue Service Code of 1986.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.357 - Achieving a Better Life Experience Program

Current through Reg. 49, No. 28; July 12, 2024
(a) The following words and terms, when used
					 in this section, have the following meanings, unless the context clearly
					 indicates otherwise:
(1) Achieving a Better
					 Life Experience (ABLE) program--
(A) the ABLE
					 program authorized under Chapter 54, Subchapter J, of the Texas Education Code;
					 or
(B) an ABLE program of any
					 state that meets the requirements of §529A of the Internal Revenue Code of
					 1986.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.358 - School-Based Savings Program

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission excludes
						from the calculation of countable resources funds held in a school-based
						account or bond as described by Texas Education Code §
											RSA
						28.0024 and authorized by Texas Human
						Resources Code §
											RSA
						32.02611.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 2 - RESOURCES › Section 358.371 - Treatment of Other Resources

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						the federal regulations indicated in the table in this section regarding the
						treatment of resources not otherwise described in this division:
Attached
						Graphic
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.381 - General Treatment of Income

Current through Reg. 49, No. 28; July 12, 2024
(a) The
					 Texas Health and Human Services Commission (HHSC) follows §1612 of the
					 Social Security Act (RSA
					 1382a) and
					 RSA 416.1101
					 -
					 RSA 416.1104
					 regarding the definition and general treatment of income for the purpose of
					 determining financial eligibility and calculating a co-payment.
(b) A lump sum payment is countable income in
					 the month of receipt and is a resource thereafter.
(c) A person in an institutional setting may
					 retain a personal needs allowance (PNA) in an amount set by the HHSC executive
					 commissioner in accordance with Chapter 32 of the Texas Human Resources Code.
(1) The PNA is not applied toward the cost of
					 medical assistance furnished in an institutional setting.
(2) For a person receiving the reduced SSI
					 federal benefit rate, HHSC issues a supplement to give the person a PNA at the
					 minimum level set by the HHSC executive commissioner.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.382 - Variable Monthly Income

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission averages
						monthly countable income that is predictable but varies in amount from month to
						month.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.383 - Deeming of Income

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						RSA
						416.1160 -
						RSA
						416.1166 regarding the definition and
						treatment of deemed income for a person in a noninstitutional
						setting.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.384 - Temporary Absence

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						RSA
						416.1149 and §
											RSA
						416.1167 regarding the definition and
						treatment of a temporary absence from a person's living arrangement for deeming
						purposes for a person in a noninstitutional setting.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.385 - Cafeteria Plan Benefits

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission exempts
						cafeteria plan benefits as defined in and based on §125 of the Internal
						Revenue Code (IRC), except that:
(1)
					 cash received under a cafeteria plan in lieu of benefits is not exempt, but is
					 counted as earned income; and
(2)
					 payroll deductions used to purchase cafeteria plan benefits in addition to or
					 instead of those purchased under a salary reduction agreement are not exempt,
					 but are part of the employee's wages and are counted as earned
					 income.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.386 - Reduction of Pension and Benefit Checks for Recoupment of Overpayments

Current through Reg. 49, No. 28; July 12, 2024
If a person's pension or benefit checks are reduced
						because of recovery of overpayments, the following apply:
(1) All overpayments except Retirement,
					 Survivors, and Disability Insurance (RSDI).
(A) If a person was receiving Supplemental
					 Security Income (SSI) or assistance under a Medicaid-funded program for the
					 elderly and people with disabilities (MEPD) at the time of overpayment, the
					 Texas Health and Human Services Commission (HHSC) disregards as income the
					 amount being recovered. HHSC counts the net amount of the benefit (that is, the
					 gross benefit minus the amount being recouped) for the purpose of determining
					 eligibility and calculating a co-payment.
(B) If a person was not receiving SSI or
					 assistance under MEPD at the time of overpayment, HHSC counts the recovered
					 amount as income. HHSC counts the gross amount of the benefit for the purpose
					 of determining eligibility and calculating a co-payment.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.387 - Income Exclusions

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas
					 Health and Human Services Commission (HHSC) follows
					 RSA
					 416.1112 and §
											RSA
					 416.1124 regarding income exclusions, except
					 when testing income eligibility under the special income limit HHSC does not
					 allow the exclusions:
(1) in
					 RSA
					 416.1112(c)(4), (5), and
					 (7); or
(2) in
					 RSA
					 416.1124(c)(12),
					 unless:
(A) the person meets the criteria
					 under §1929(b)(2)(B) of the Social Security Act (RSA
					 1396t(b)(2)(B));
					 and
(B) the Centers for Medicare
					 and Medicaid Services has authorized HHSC to allow the exclusion.