reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter F - MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH › Section 366.627 - 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,
					 as defined in
					 RSA
					 435.1010, is eligible for Medicaid payment
					 for Medicaid covered services received only while residing in the institution
					 for mental diseases to the extent allowed by federal law.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter F - MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH › Section 366.629 - 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 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter F - MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH › Section 366.631 - Eligibility Renewal

Current through Reg. 49, No. 28; July 12, 2024
At 12 months, HHSC determines if the recipient is still
					 eligible to receive Medicaid coverage.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter F - MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH › Section 366.633 - Information from Other Agencies

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
				  and other state and federal agencies compare the information they have stored
				  on computer files.
(b) After
				  comparing information with another agency, HHSC contacts the Medicaid applicant
				  or recipient if the information does not match so that HHSC can confirm the
				  correct information.
(1) If the mismatch of
				  information does not affect eligibility, HHSC does not take action to adjust or
				  deny Medicaid.
(2) If the mismatch
				  of information affects eligibility, HHSC takes appropriate action to adjust or
				  deny Medicaid and sends a written notice of action taken to the applicant or
				  recipient.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter F - MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH › Section 366.635 - Requirement to Report Changes

Current through Reg. 49, No. 28; July 12, 2024
(a) A recipient
				  must report:
(1) a change of address;
				  and
(2) the start of adequate
				  health coverage.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter F - MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH › Section 366.637 - Right to Appeal

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant or
				  recipient has the right to appeal HHSC decisions. Appeals are governed by
				  HHSC's fair hearing rules contained in Chapter 357 of this title (relating to
				  Hearings).
(b) HHSC provides an
				  action notice regarding an HHSC decision to applicants and recipients. The
				  action notice includes information about how to file an appeal and the
				  availability of free legal representation.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.701 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
				  establishes the eligibility criteria and participation requirements for the
				  Medicaid for Parents and Caretaker Relatives Program.
(b) Nothing in these rules shall be construed
				  to violate the maintenance of eligibility requirements of §5001 of the
				  American Recovery and Reinvestment Act of 2009 (Public Law 111-5)
				  and make eligibility standards, methodologies, or procedures under the Texas
				  State Plan for Medical Assistance (or any waiver under §1115 of the Social
				  Security Act (RSA 1315))
				  more restrictive than the eligibility standards, methodologies, or procedures,
				  respectively, under such plan (or waiver) that were in effect on July 1,
				  2008.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.703 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
(1) Applicant--A person
				  seeking assistance under the Medicaid for Parents and Caretaker Relatives
				  Program who:
(A) has never received Medicaid
				  and is not currently receiving Medicaid; or
(B) previously received Medicaid but
				  subsequently was denied and reapplies for Medicaid.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.705 - General Eligibility Requirements

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for the Medicaid for Parents and Caretaker
					 Relatives Program, a person must:
(1)
				  meet the criteria for an eligible group as described in §
										RSA 366.707 of
				  this subchapter (relating to Eligible Group) and the provisions of Subchapter K
				  of this chapter (relating to Modified Adjusted Gross Income
				  Methodology);
(2) comply with
				  HHSC's initial and renewal application requirements in this subchapter;
				  and
(3) meet all other eligibility
				  and participation requirements in this subchapter.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.707 - Eligible Group

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for the Medicaid for Parents and Caretaker
					 Relatives Program, a person must be a parent or caretaker relative of a
					 dependent child who receives Medicaid. The spouse of a parent or caretaker
					 relative is also eligible for the Medicaid for Parents and Caretaker Relatives
					 Program, if living with such parent or other caretaker
					 relative.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.709 - Application Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) To receive
				  benefits under the Medicaid for Parents and Caretaker Relatives Program, an
				  applicant, authorized representative, or person acting responsibly must:
(1) use the application prescribed by HHSC
				  and complete it according to HHSC instructions:
(A) in writing, using a paper application
				  obtained via telephone, Internet request, or other means;
(B) online, using the application process
				  available over the Internet;
(C)
				  over the telephone, through the State's toll-free telephone number;
				  or
(D) in person, by visiting an
				  HHSC benefits office;
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.711 - Application Processing

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC processes
				  Medicaid for Parents and Caretaker Relatives Program applications received
				  electronically, by paper, or by telephone.
(b) HHSC allows any office of a state health
				  and human services agency to accept an initial application.
(c) HHSC contracts with third parties to
				  accept applications from hospital districts (including state-owned teaching
				  hospitals), federally qualified health centers, and county health
				  departments.
(d) HHSC requires an
				  interview with an initial applicant.
(e) HHSC reopens a denied initial
				  application, so long as the applicant complies with the missed requirements
				  within 60 days after the date the application was submitted. HHSC otherwise
				  requires the applicant to file a new application.
(f) HHSC reconsiders the eligibility of a
				  recipient who is terminated for failure to submit a renewal form or necessary
				  information, so long as the recipient complies with the missed requirements
				  within 90 days after the date of termination. HHSC otherwise requires the
				  recipient to file a new application.
(g) HHSC may reopen an application for three
				  months prior coverage if:
(1) within two
				  years after the application was filed, the applicant requests that the
				  application be reopened; and
(2) a
				  Medicaid eligibility determination was not previously made for the three-month
				  prior period.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.713 - Citizenship

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for the Medicaid for Parents and Caretaker
					 Relatives Program, an applicant must be:
(1) a citizen or national of the United
				  States;
(2) an alien who legally
				  entered the United States before August 22, 1996, and who meets the eligibility
				  criteria in
				  RSA
				  1641(b) or
				  (c);
(3) an alien who legally entered the United
				  States on or after August 22, 1996, and who meets the eligibility criteria in
				  RSA
				  1612(b) and
				  §
										RSA
				  1613, except that a legal permanent resident
				  alien is eligible after residing in the United States for five years only if
				  the alien meets one of the following eligibility requirements:
(A) the alien is an honorably discharged
				  veteran or active duty military personnel;
(B) the alien is a spouse, unmarried
				  surviving spouse, or minor unmarried child of an honorably discharged veteran
				  or active duty military personnel (if a surviving spouse of a deceased veteran
				  or active duty military person, the surviving spouse must not have
				  remarried);
(C) the alien entered
				  the United States before August 22, 1996, and remained continuously present in
				  the United States (a single absence from the United States of more than 30 days
				  or a combined absence of more than 90 days interrupts the "continuous
				  presence") since at least August 21, 1996, until obtaining qualifying immigrant
				  status (an alien who entered the United States without proper documents or
				  overstayed his or her visa, is treated the same as an alien who entered and
				  remained in the United States with valid immigration documents);
(D) the alien entered the United States with
				  a status described in the
Texas Works Handbook,
Item A-342,
				  Chart C and meets those eligibility criteria, or meets the criteria in the
Texas Works Handbook,
Item A-343, How to Determine Eligibility
				  for Battered Aliens; or
(E) the
				  alien meets the 40 qualifying quarters requirements in the
Texas Works
				  Handbook,
Item A-354, Verifying 40 "Qualifying Quarters," and five
				  years have passed since the alien's legal date of entry; or
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.715 - Social Security Number

Current through Reg. 49, No. 28; July 12, 2024
An applicant or recipient must provide or apply for a
					 social security number. Prior to denying eligibility, HHSC allows a period of
					 reasonable opportunity for an applicant or recipient to provide or apply for a
					 social security number.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.717 - Residence

Current through Reg. 49, No. 28; July 12, 2024
An applicant or recipient must be a resident of Texas. HHSC
					 follows
					 RSA 435.403 in
					 determining a person's state residence.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.719 - Relationship and Domicile

Current through Reg. 49, No. 28; July 12, 2024
(a) To be
				  eligible for the Medicaid for Parents and Caretaker Relatives Program, a
				  caretaker must live in a home with and care for a dependent child for which the
				  caretaker has the required degree of relationship as described in subsection
				  (c) of this section.
(b) A home is
				  a family setting maintained or being established, as evidenced by continuation
				  of responsibility for day-to-day care of a child.
(c) A person meets the relationship
				  requirement, if the person is by law, marriage, or adoption a child's:
(1) father or mother;
(2) grandparent, to the degree of a "great,
				  great, great" grandparent;
(3)
				  brother or sister;
(4) uncle or
				  aunt, to the degree of a "great, great" uncle or aunt;
(5) first cousin;
(6) nephew or niece, to the to the degree of
				  a "great, great" nephew or niece;
(7) stepfather or stepmother;
(8) stepbrother or stepsister; or
(9) first cousin once removed.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.721 - Medical Support

Current through Reg. 49, No. 28; July 12, 2024
(a) As a condition
				  of eligibility, a recipient must comply with medical support requirements, as
				  provided by §1912(a)(1) of the Social Security Act (RSA
				  1396k(a)(1)).
(b) Good cause for noncooperation exists if:
(1) the child was conceived as a result of
				  incest or rape;
(2) adoption
				  proceedings for the child are pending;
(3) the parent of the child, for three months
				  or less, has been working with an agency to decide whether to place the child
				  for adoption;
(4) the child may be
				  physically or emotionally harmed by cooperation;
(5) the parent may be physically harmed, or
				  emotionally harmed to the extent of impairing the parent's ability to care for
				  the child, by cooperation; or
(6)
				  the requirement is waived under
				  RSA
				  260.52(c) in
				  accordance with the requirements of Texas Human Resources Code §
											RSA
				  31.0322.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.723 - Income Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
				  determines income eligibility for the Medicaid for Parents and Caretaker
				  Relatives Program after application of the methodology in Subchapter K of this
				  chapter (relating to Modified Adjusted Gross Income Methodology).
(b) To be eligible for the Medicaid for
				  Parents and Caretaker Relatives Program, an applicant or recipient must have
				  household income for the applicable household size that is equal to or less
				  than the amount determined by HHSC and listed in the Texas Works
				  Handbook.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.725 - Third-Party Resources

Current through Reg. 49, No. 28; July 12, 2024
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 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 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.727 - Medicaid Eligibility Effective Date

Current through Reg. 49, No. 28; July 12, 2024
HHSC determines the Medicaid eligibility effective date as
					 the earliest day of the application month on which the applicant meets all
					 eligibility criteria.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.729 - 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,
					 as defined in
					 RSA
					 435.1010, is eligible for Medicaid payment
					 for Medicaid covered services received only while residing in the institution
					 for mental diseases to the extent allowed by federal law.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.731 - 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 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.733 - Retroactive Coverage

Current through Reg. 49, No. 28; July 12, 2024
To qualify for retroactive coverage, applicants and
					 recipients must meet the requirements of §1902(a)(34) of the Social
					 Security Act (RSA
					 1396a(a)(34)).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.735 - Four Months Post-Medicaid Eligibility

Current through Reg. 49, No. 28; July 12, 2024
A recipient is eligible for four months post-Medicaid
					 coverage, as provided by §1931 of the Social Security Act (RSA
					 1396u-1), if the recipient received Medicaid
					 under §1931 of the Social Security Act (RSA
					 1396u-1) and then was denied Medicaid because
					 of receipt of child support or spousal support.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.737 - Twelve-Month Transitional Medicaid

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  recipient, certified as required by §1931 of the Social Security Act
				  (RSA
				  1396u-1) and §
										RSA
				  32.0255 of the Texas Human Resources Code,
				  who is denied because of new or increased earnings may be eligible for 12-month
				  transitional Medicaid, as provided by §1925 of the Social Security Act
				  (RSA
				  1396r-6).
(b) To remain eligible for 12-month
				  transitional Medicaid, a recipient must report changes in the fourth, seventh,
				  and tenth months.
(c) A recipient
				  who reports changes is denied only for one or more of the following reasons:
(1) no eligible child is in the
				  home;
(2) on the seventh- or
				  tenth-month report, the caretaker relative had no earnings in one of the
				  previous three months; or
(3) the
				  average monthly income exceeds 185% of the Federal Poverty Level on the
				  seventh- or tenth-month report.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.739 - Eligibility Renewal

Current through Reg. 49, No. 28; July 12, 2024
At 12 months, HHSC determines if the recipient is still
					 eligible to receive Medicaid coverage.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.741 - Information from Other Agencies

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
				  and other state and federal agencies compare the information they have stored
				  on computer files.
(b) After
				  comparing information with another agency, HHSC contacts the Medicaid applicant
				  or recipient if the information does not match so that HHSC can confirm the
				  correct information.
(1) If the mismatch of
				  information does not affect eligibility, HHSC does not take action to adjust or
				  deny Medicaid.
(2) If the mismatch
				  of information affects eligibility, HHSC takes appropriate action to adjust or
				  deny Medicaid and sends a written notice of action taken to the applicant or
				  recipient.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.743 - Requirement to Report Changes

Current through Reg. 49, No. 28; July 12, 2024
A recipient must report the following changes within 10
					 days after learning of the change:
(1)
				  residence;
(2) a source of
				  income;
(3) household
				  composition;
(4) wage rate or
				  status for employed household members;
(5) the amount of non-exempt unearned income
				  of any household member;
(6)
				  private medical insurance coverage;
(7) circumstances other than employment that
				  affect a recipient's eligibility; and
(8) address, job, or other information
				  related to an absent parent.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM › Section 366.745 - Right to Appeal

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant or
				  recipient has the right to appeal HHSC decisions. Appeals are governed by
				  HHSC's fair hearing rules contained in Chapter 357 of this title (relating to
				  Hearings).
(b) HHSC provides an
				  action notice regarding an HHSC decision to applicants and recipients. The
				  action notice includes information about how to file an appeal and the
				  availability of free legal representation.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.801 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
				  establishes the eligibility criteria and participation requirements for the
				  Medically Needy Program in accordance with §1902(a)(10)(C) of the Social
				  Security Act (RSA
				  1396a(a)(10)(C)).
(b) Nothing in these rules shall be construed
				  to violate the maintenance of eligibility requirements of §5001 of the
				  American Recovery and Reinvestment Act of 2009 (Public Law 111-5)
				  and make eligibility standards, methodologies, or procedures under the Texas
				  State Plan for Medical Assistance (or any waiver under §1115 of the Social
				  Security Act (RSA 1315))
				  more restrictive than the eligibility standards, methodologies, or procedures,
				  respectively, under such plan (or waiver) that were in effect on July 1,
				  2008.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.803 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
(1) Applicant--A person
				  seeking assistance under the Medically Needy Program who:
(A) has never received Medicaid and is not
				  currently receiving Medicaid; or
(B) previously received Medicaid but
				  subsequently was denied and reapplies for Medicaid.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.805 - General Eligibility Requirements

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for the Medically Needy Program, a person
					 must:
(1) meet the criteria for an
				  eligible group as described in §
										RSA 366.807 of
				  this subchapter (relating to Eligible Groups) and the provisions of Subchapter
				  K of this chapter (relating to Modified Adjusted Gross Income
				  Methodology);
(2) comply with
				  HHSC's initial and renewal application requirements in this subchapter;
				  and
(3) meet all other eligibility
				  and participation requirements in this subchapter.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.807 - Eligible Groups

Current through Reg. 49, No. 28; July 12, 2024
To qualify for Medically Needy Program benefits, an
					 applicant must:
(1) be:
(A) a pregnant woman; or
(B) a child under 19 years of age;
				  and
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.809 - Application Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) To receive
				  Medically Needy Program benefits, an applicant, authorized representative, or
				  person acting responsibly must:
(1) use the
				  application prescribed by HHSC and complete it according to HHSC instructions:
(A) in writing, using a paper application
				  obtained via telephone, Internet request, or other means;
(B) online, using the application process
				  available over the Internet;
(C)
				  over the telephone, through the State's toll-free telephone number;
				  or
(D) in person, by visiting an
				  HHSC benefits office;
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.811 - Application Processing

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC processes
				  Medically Needy Program applications received electronically, by paper, or by
				  telephone.
(b) HHSC allows any
				  office of a state health and human services agency to accept an initial
				  application.
(c) HHSC contracts
				  with third parties to accept applications from hospital districts (including
				  state-owned teaching hospitals), federally qualified health centers, and county
				  health departments.
(d) HHSC may
				  conduct an interview with an initial applicant.
(e) HHSC reopens a denied initial
				  application, so long as the applicant complies with the missed requirements
				  within 60 days after the date the application was submitted. HHSC otherwise
				  requires the applicant to file a new application.
(f) HHSC reconsiders the eligibility of a
				  recipient who is terminated for failure to submit a renewal form or necessary
				  information, so long as the recipient complies with the missed requirements
				  within 90 days after the date of termination. HHSC otherwise requires the
				  recipient to file a new application.
(g) HHSC may reopen an application for three
				  months prior coverage if:
(1) within two
				  years after the application was filed, the applicant requests that the
				  application be reopened; and
(2) a
				  Medicaid eligibility determination was not previously made for the three-month
				  prior period.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.813 - Citizenship

Current through Reg. 49, No. 28; July 12, 2024
In accordance with
					 RSA
					 435.406, to be eligible for the Medically
					 Needy Program, a person must be:
(1) a
				  citizen or national of the United States;
(2) an alien who legally entered the United
				  States before August 22, 1996, and who meets the eligibility criteria in
				  RSA
				  1641(b) or
				  (c);
(3) an alien who legally entered the United
				  States on or after August 22, 1996, and who meets the eligibility criteria in
				  RSA
				  1612(b) and
				  §
										RSA
				  1613, except that a legal permanent resident
				  alien is eligible after residing in the United States for five years only if
				  the alien meets one of the following eligibility requirements:
(A) the alien is an honorably discharged
				  veteran or active duty military personnel;
(B) the alien is a spouse, unmarried
				  surviving spouse, or minor unmarried child of an honorably discharged veteran
				  or active duty military personnel (if a surviving spouse of a deceased veteran
				  or active duty military person, the surviving spouse must not have
				  remarried);
(C) the alien entered
				  the United States before August 22, 1996, and remained continuously present in
				  the United States (a single absence from the United States of more than 30 days
				  or a combined absence of more than 90 days interrupts the "continuous
				  presence") since at least August 21, 1996, until obtaining qualifying immigrant
				  status (an alien who entered the United States without proper documents or
				  overstayed his or her visa, is treated the same as an alien who entered and
				  remained in the United States with valid immigration documents);
(D) the alien entered the United States with
				  a status described in the
Texas Works Handbook,
Item A-342,
				  Chart C and meets those eligibility criteria, or meets the criteria in the
Texas Works Handbook,
Item A-343, How to Determine Eligibility
				  for Battered Aliens; or
(E) the
				  alien meets the 40 qualifying quarters requirements in the
Texas Works
				  Handbook,
Item A-354, Verifying 40 "Qualifying Quarters," and five
				  years have passed since the alien's legal date of entry; or
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.815 - Social Security Number

Current through Reg. 49, No. 28; July 12, 2024
An applicant or recipient must provide or apply for a
					 social security number.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.817 - Residence

Current through Reg. 49, No. 28; July 12, 2024
An applicant or recipient must be a resident of Texas. HHSC
					 follows
					 RSA 435.403 in
					 determining a person's state residence.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.819 - Relationship and Domicile

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				  applicant or recipient who is a child must live in a home with a caretaker who
				  is present in the home and supervises and cares for the applicant or recipient.
				  A home is a family setting maintained or being established, as evidenced by
				  continuation of responsibility for day-to-day care of the applicant or
				  recipient.
(b) A caretaker must be
				  the applicant's or recipient's:
(1) father or
				  mother;
(2) grandparent, to the
				  degree of a "great, great, great" grandparent;
(3) brother or sister;
(4) uncle or aunt, to the degree of a "great,
				  great" uncle or aunt;
(5) first
				  cousin;
(6) nephew or niece, to the
				  to the degree of a "great, great" nephew or niece;
(7) stepfather or stepmother;
(8) stepbrother or stepsister; or
(9) first cousin once removed.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.821 - Child Support and Medical Support

Current through Reg. 49, No. 28; July 12, 2024
An applicant who is a child under 19 years of age or a
					 pregnant woman is not required to cooperate to find absent parents to obtain
					 child or medical support.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.823 - Income Limits

Current through Reg. 49, No. 28; July 12, 2024
(a) To be eligible
				  for the Medically Needy Program, an applicant or recipient must meet the
				  applicable Medically Needy Income Limit (MNIL) as provided in the following
				  table after application of the methodology in Subchapter K of this chapter
				  (relating to Modified Adjusted Gross Income Methodology):
Attached
					 Graphic
(b) An
				  applicant whose household income, as calculated under §
										RSA
				  366.1113 of this chapter (relating to
				  Calculation of Household Income), exceeds the applicable MNIL may, in
				  accordance with
				  RSA 435.831,
				  spend down the excess amount of income to pay unpaid medical bills and qualify
				  for the Medically Needy Program with spend down.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.825 - Third-Party Resources

Current through Reg. 49, No. 28; July 12, 2024
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 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 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.827 - Medicaid Eligibility Effective Dates

Current through Reg. 49, No. 28; July 12, 2024
HHSC determines Medicaid eligibility effective dates for an
					 applicant as follows.
(1) Medicaid
				  coverage begins on the earliest day of the application month on which the
				  applicant meets all eligibility criteria.
(2) Retroactive coverage may begin as early
				  as three months before the application month.
(3) The Medicaid coverage of an applicant
				  whose household income, as calculated under §
										366.1113 of this chapter (relating
				  to Calculation of Household Income), exceeds the Medically Needy Income Limits
				  (MNIL) may spend down the excess amount of income to pay unpaid medical bills
				  and qualify for Medicaid. Medicaid begins on the earliest day of the month of
				  potential eligibility on which spend down requirements are met.
(4) Once a pregnant woman meets spend down,
				  she remains continuously eligible through her pregnancy and the end of the
				  month in which the 12-month postpartum period ends and is not required to meet
				  spend down again until the end of her 12-month postpartum period.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.829 - 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,
					 as defined in
					 RSA
					 435.1010, is eligible for Medicaid payment
					 for Medicaid covered services received only while residing in the institution
					 for mental diseases to the extent allowed by federal law.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.831 - 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 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.833 - Exemption for Newborns

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  described in subsection (b) of this section, a newborn is exempt from the
				  following:
(1) child support and medical
				  support requirements in §
											RSA
				  366.821 of this subchapter (relating to Child
				  Support and Medical Support);
(2)
				  school attendance; and
(3) social
				  security number requirements in §
											RSA
				  366.815 of this subchapter (relating to
				  Social Security Number).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.835 - Comprehensive Health Care Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  parent or guardian of an applicant must:
(1)
				  attend a health care orientation;
(2) accompany the child on a visit to a
				  health care provider; or
(3) meet
				  with an HHSC representative to discuss the child's eligibility and, as
				  appropriate, receive counseling on the child's need for comprehensive health
				  care.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.837 - Information from Other Agencies

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
				  and other state and federal agencies compare the information they have stored
				  on computer files.
(b) After
				  comparing information with another agency, HHSC contacts the Medicaid applicant
				  or recipient if the information does not match, so that HHSC can confirm the
				  correct information.
(1) If the mismatch of
				  information does not affect eligibility, HHSC does not take action to adjust or
				  deny Medicaid.
(2) If the mismatch
				  of information affects eligibility, HHSC takes appropriate action to adjust or
				  deny Medicaid and sends a written notice of action taken to the Medicaid
				  applicant or recipient.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.839 - Requirement to Report Changes

Current through Reg. 49, No. 28; July 12, 2024
(a) A recipient
				  must report the following changes within 10 days after the recipient learns of
				  a change:
(1) in income, including the source
				  of income and the amount of income;
(2) in household composition, including new
				  household members and household members who leave the home;
(3) of address;
(4) to medical insurance;
(5) in information relating to an absent
				  parent (such as a new job or residence address); and
(6) in circumstances, other than employment,
				  that affects benefits.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.841 - Right to Appeal

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant or
				  recipient has the right to appeal HHSC decisions. Appeals are governed by
				  HHSC's fair hearing rules contained in Chapter 357 of this title (relating to
				  Hearings).
(b) HHSC provides an
				  action notice regarding an HHSC decision to applicants and recipients. The
				  action notice includes information about how to file an appeal and the
				  availability of free legal representation.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.843 - Resources

Current through Reg. 49, No. 28; July 12, 2024
(a) In determining eligibility, HHSC counts
				  the resources of the applicant or recipient and all members of the applicant's
				  or recipient's household composition. For those who are subject to this
				  Subchapter (relating to the Medically Needy Program):
(1) the resources of any household
				  composition member who is not the parent or spouse of the applicant or
				  recipient are not counted; and
(2)
				  the resources of an alien's sponsor and the sponsor's spouse are counted to the
				  extent allowed by federal law in the case of an applicant or recipient 19 years
				  of age and older who is an alien or has a sponsored alien in his or her
				  household composition.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES › Subchapter H - MEDICALLY NEEDY PROGRAM › Section 366.845 - Vehicles

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC considers the value of a vehicle to
				  be its fair market value.
(b) HHSC
				  exempts the value of the highest valued countable vehicle from countable
				  resources.
(c) HHSC exempts the
				  value of a vehicle from countable resources, if:
(1) it is income producing;
(2) it is used for a disabled household
				  member;
(3) its equity value is
				  equal to or less than $1,500;
(4)
				  it is used for long distance travel for employment;
(5) it is used as the applicant or
				  recipient's home; or
(6) it is
				  necessary to carry fuel or water anticipated to be the primary source of fuel
				  or water for the applicant or recipient during the certification
				  period.