Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - HEMOPHILIA ASSISTANCE PROGRAM › Section 354.5 - Program Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a) Client
				Requirements. In order to be determined eligible for program benefits,
				applicants must meet the medical, age, residency, financial, and other criteria
				in this section, and submit a complete application for program benefits.
(1) Medical criteria. A physician must
				certify that the applicant has a diagnosis of hemophilia.
(2) Age. The applicant must be 18 years of
				age or older.
(3) Residency. The
				applicant must be a Texas resident.
(4) Financial criteria. Financial criteria
				are determined at least annually or as directed by the program. Financial
				criteria are based upon the determinations of income and family size. Income
				must be at or below 200% of the FPL.
(5) Other criteria. The applicant must not be
				eligible for Medicaid or the Children's Health Insurance Program (CHIP). The
				program may require an applicant currently not enrolled in Medicaid, Medicare,
				CHIP, SSDI, or the CSHCN Services Program to apply for any of these applicable
				programs when the applicant's age, income, or medical disability determination
				meets the eligibility criteria for any of these programs and, if eligible, to
				participate in those programs.
(6)
				Health Insurance. All health insurance coverage insuring the applicant must be
				attested to on the application. Noncompliance with this requirement may result
				in the termination of program benefits.
(A)
				The program may require an applicant currently not enrolled in a health
				insurance plan to apply for an available insurance plan that is accessible and
				provides comprehensive coverage. The program may provide program benefits for
				ongoing clients during insurance application, enrollment, or limited or
				excluded coverage periods.
(B)
				Before canceling, terminating, or discontinuing existing health insurance or
				electing not to enroll in available health insurance, the client, or person who
				has a legal responsibility for the client, must notify the program 30 days
				prior to cancellation, termination, discontinuance, or end of the enrollment
				period, whenever possible.
(7) Application.
(A) To be considered by the program, a
				complete application must be made on forms required by the department. The
				application must have the signature or mark of the applicant, or the
				applicant's legally authorized representative, and the physician's
				signature.
(B) The program will
				make the determination of an applicant's eligibility using the information
				provided with the application. The program will verify information on the
				application, including required documentation of diagnosis, income, attestation
				of other coverage, date of birth, and residency.
(C) The program may request additional
				documentation to verify information provided by the applicant to establish
				eligibility. The program will notify the applicant, or the applicant's legally
				authorized representative, in writing when specific documentation is required.
				It is the responsibility of the applicant, or the applicant's legally
				authorized representative, to provide the required documentation.
(D) The program will determine eligibility
				when a completed application is received.
(8) Eligibility Date. The effective date of
				eligibility for program benefits is the date of receipt of a complete, approved
				application.
(9) Program
				Termination. If program coverage is terminated, the eligibility date for any
				subsequent eligibility period will be the date on which the program receives a
				subsequent completed application for program benefits.