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 358.107 - Coverage Groups

Current through Reg. 49, No. 28; July 12, 2024
(a) General. This
				  section describes the groups of people who are categorically eligible for a
				  Medicaid-funded program for the elderly and people with disabilities (MEPD)
				  under the Texas State Plan for Medical Assistance.
(b) Mandatory coverage groups. In accordance
				  with 42 CFR Part 435, Subpart B, the Texas Health and Human Services Commission
				  (HHSC) determines eligibility for MEPD for a person who falls into at least one
				  of the following mandatory coverage groups:
(1) Supplemental Security Income (SSI)
				  eligible. In accordance with
				  RSA
				  435.120, this mandatory coverage group covers
				  a person who is aged, blind, or disabled and is receiving SSI or deemed to be
				  receiving SSI. The Social Security Administration (SSA) determines eligibility
				  for SSI under Title XVI of the Social Security Act. If SSA determines that a
				  person is eligible for SSI, HHSC accepts SSA's determination as an automatic
				  determination of eligibility for Medicaid.
(2) Coverage for certain aliens. In
				  accordance with
				  RSA
				  435.139, an alien, as defined in
				  RSA
				  435.406, is provided services necessary for
				  the treatment of an emergency medical condition, as defined in
				  RSA
				  440.255.
(3) Disabled adult child. In accordance with
				  §1634(c) of the Social Security Act (RSA
				  1383c), this mandatory coverage group covers
				  a person who:
(A) is at least 18 years of
				  age;
(B) became disabled before 22
				  years of age;
(C) is denied SSI
				  because of receipt of or an increase in Retirement, Survivors, and Disability
				  Insurance (RSDI) disabled children's benefits received on or after July 1,
				  1987, and any subsequent increase; and
(D) meets current SSI criteria, excluding the
				  RSDI benefit described in subparagraph (C) of this paragraph.
(4) Historical 1972 income
				  disregard. In accordance with
				  RSA
				  435.134, this mandatory coverage group covers
				  a person who:
(A) was receiving both public
				  assistance and Social Security benefits in August 1972; and
(B) meets current SSI eligibility criteria,
				  excluding from income the October 1972 cost-of-living adjustment (COLA)
				  increase in Social Security benefits but not excluding subsequent COLA
				  increases in Social Security benefits.
(5) Title II COLA disregard (Pickle). In
				  accordance with
				  RSA
				  435.135(a) -
				  (b), this mandatory coverage group covers a person who:
(A) has been denied SSI for any reason since
				  April 1977; and
(B) meets current
				  SSI eligibility criteria, excluding from countable income any Social Security
				  COLA increases received after the person last received both SSI and Social
				  Security benefits in the same month.
(6) Disabled widow's or widower's COLA
				  disregard. In accordance with
				  RSA
				  435.137, this mandatory coverage group covers
				  a person who:
(A) is 50 to 60 years of
				  age;
(B) is ineligible for
				  Medicare;
(C) was denied SSI due to
				  an increase in a disabled widow's or widower's and surviving divorced spouse's
				  RSDI; and
(D) meets SSI eligibility
				  criteria, excluding from countable income the RSDI benefit and any subsequent
				  COLA increases in RSDI.
(7) Early age widow's or widower's COLA
				  disregard. In accordance with
				  RSA
				  435.138, this mandatory coverage group covers
				  a disabled person who was denied SSI due to early receipt of Social Security
				  widow's or widower's benefits and:
(A) is at
				  least 60 years of age;
(B) is not
				  eligible for Medicare; and
(C)
				  meets current SSI eligibility criteria, excluding from countable income the
				  RSDI benefit and any subsequent COLA increases in RSDI.
(8) SSI denied children. In accordance with
				  §1902(a)(10)(A)(i)(II) of the Social Security Act (RSA
				  1396a(a)(10)(A)(i)(II)),
				  this mandatory coverage group covers a person who:
(A) is under 18 years of age;
(B) was receiving SSI on August 22,
				  1996;
(C) was subsequently denied
				  SSI because of the change in disability criteria implemented by the Personal
				  Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law
				  104-193); and
(D) meets SSI eligibility criteria, including
				  the disability criteria in effect before August 22, 1996.