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 H - MEDICALLY NEEDY PROGRAM › Section 366.847 - Exempt Resources

Current through Reg. 49, No. 28; July 12, 2024
HHSC exempts the following from countable resources:
(1) funds in a retirement account (even if
				  accessible, so long as the funds remain in the account);
(2) balances in the Texas Guaranteed Tuition
				  Plan (formerly called the Texas Tomorrow Fund) even if accessible, so long as
				  the funds remain in the account;
(3) crime victim's compensation
				  payments;
(4) earned income tax
				  credit (EIC) payments to applicants the month of receipt and the following
				  month, and to recipients the month of receipt and the following 11 months,
				  unless there is a break in certification of more than 30 days, in which case
				  any remaining portion of the EIC payment is counted as a resource;
(5) payments or allowances made under any
				  federal law for the purpose of energy assistance;
(6) federal disaster payments and comparable
				  disaster assistance provided by states, local governments, and disaster
				  assistance organizations if the applicant or recipient is subject to legal
				  penalties if the funds are not used as intended;
(7) transitional living allowances;
(8) any resource federal law
				  excludes;
(9) funds from veterans
				  payments earmarked as a housebound allowance or as an aid and attendance
				  allowance;
(10) the cash value of
				  life insurance policies;
(11) an
				  amount up to $7,500 per person of prepaid burial insurance (or of a prepaid
				  funeral plan);
(12) loans, if the
				  circumstances satisfy HHSC that there exists an understanding the money will be
				  repaid, and the applicant or recipient reasonably explains to HHSC how the
				  money will be repaid;
(13) personal
				  possessions HHSC determines are essential for daily living, such as clothing,
				  jewelry, furniture, livestock, and farm equipment;
(14) burial plots;
(15) the homestead and surrounding real
				  property, including:
(A) any structure,
				  including a houseboat or a motor home, the applicant or recipient uses as its
				  primary residence;
(B) surrounding
				  real property divided by a public right-of-way (such as a street or road) but
				  not divided by real property owned by others; and
(C) the homestead if it is temporarily
				  unoccupied due to employment, training for future employment, illness,
				  casualty, or natural disaster, as long as the household intends to
				  return;
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 I - EMERGENCY MEDICAL SERVICES FOR ALIENS INELIGIBLE FOR REGULAR MEDICAID › Section 366.901 - Legal Basis

Current through Reg. 49, No. 28; July 12, 2024
(a) Title XIX of
				  the Social Security Act (RSA
				  1396 et seq.) and
				  RSA
				  435.139 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 applicant must meet the eligibility
				  requirements in this subchapter and Subchapter K of this chapter (relating to
				  Modified Adjusted Gross Income Methodology).
(c) 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 I - EMERGENCY MEDICAL SERVICES FOR ALIENS INELIGIBLE FOR REGULAR MEDICAID › Section 366.903 - Application and Eligibility Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) To apply for Medicaid for the treatment
				  of an emergency medical condition, a person completes an application for
				  assistance and returns it to a Texas Health and Human Services Commission
				  office or representative.
(b) To
				  qualify for Medicaid for treatment of an emergency medical condition, a person
				  must:
(1) be:
(A) a qualified alien as defined in
				  RSA
				  1641 who does not meet the requirements to
				  receive Medicaid under the Texas State Plan for Medical Assistance, which is a
				  document describing the Medicaid-funded services provided in Texas in
				  accordance with §1902 of the Social Security Act (RSA
				  1396a); or
(B) an undocumented non-qualified alien as
				  described in
				  RSA
				  1611;
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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1001 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
This subchapter establishes the eligibility criteria for
					 the Former Foster Care Children's Program, in accordance with Social Security
					 Act §1902(a)(10)(A)(i)(IX) (RSA
					 1396a(a)(10)(A)(i)(IX)).
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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1003 - 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 Former Foster Care Children 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1005 - Program Administration

Current through Reg. 49, No. 28; July 12, 2024
HHSC administers the Former Foster Care Children's Program
					 in cooperation with the Texas Department of Family and Protective
					 Services.
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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1007 - Legal Basis

Current through Reg. 49, No. 28; July 12, 2024
The Former Foster Care Children's Program is authorized by
					 Social Security Act §1902(a)(10)(A)(i)(IX) (RSA
					 1396a(a)(10)(A)(i)(IX)).
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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1009 - General Eligibility Requirements

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for the Former Foster Care Children's
					 Program, a person must:
(1) meet the
				  criteria for an eligible group as described in §
										RSA 366.1011 of
				  this subchapter (relating to Eligible Group);
(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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1011 - Eligible Group

Current through Reg. 49, No. 28; July 12, 2024
To be eligible for the Former Foster Care Children's
					 Program, a person must:
(1) have been
				  under the conservatorship of a State upon attaining age 18;
(2) have received Medicaid at the time he or
				  she left foster care; and
(3) be 18
				  to 25 years of age (coverage continues through the month of his or her 26th
				  birthday).
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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1013 - Application Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Except for
				  an applicant described in subsection (b) or (c) of this section, the Texas
				  Department of Family and Protective Services certifies an applicant's
				  eligibility and notifies HHSC to authorize Medicaid coverage.
(b) An applicant who meets the criteria for
				  an eligible group and who aged out of foster care in this State prior to
				  implementation of the Former Foster Care Children's Program must apply to HHSC
				  as described in subsections (d) - (f) of this section.
(c) An applicant who previously received
				  benefits under the Former Foster Care Children's Program and seeks to reapply
				  for the Former Foster Care Children's Program, must reapply to HHSC as
				  described in subsections (d) - (f) of this section.
(d) For an applicant described in subsections
				  (b) or (c) of this section, the applicant, authorized representative, or person
				  acting responsibly must:
(1) use the
				  application for assistance prescribed by HHSC and complete it according to HHSC
				  instructions:
(A) in writing, using a paper
				  application obtained via Internet request, telephone 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1015 - Application Processing

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC processes
				  Former Foster Care Children's Program applications received electronically, by
				  paper, or by telephone.
(b) HHSC
				  reopens a denied initial application, so long as the applicant complies with
				  the missed requirements within 90 days after the date the application was
				  submitted. HHSC otherwise requires the applicant to file a new
				  application.
(c) 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.
(d) HHSC reopens 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 prior
				  three-month 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1017 - Citizenship

Current through Reg. 49, No. 28; July 12, 2024
In accordance with
					 RSA
					 435.406, to be eligible for the Former Foster
					 Care Children's Program, a person must be:
(1) a citizen 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1019 - 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1021 - Residence

Current through Reg. 49, No. 28; July 12, 2024
An applicant or recipient must be a resident of Texas. HHSC
					 determines a person's state residence according to
					 RSA
					 435.403.
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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1023 - 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1025 - Medicaid Eligibility Effective Dates

Current through Reg. 49, No. 28; July 12, 2024
(a) Medicaid
				  eligibility begins the first month the person meets all eligibility criteria as
				  long as the person is not eligible for and receiving other Medicaid
				  coverage.
(b) A person eligible for
				  the Former Foster Care Children's Program is also eligible for retroactive
				  coverage but no earlier than January 1, 2014.
(c) A pregnant recipient in the Former Foster
				  Care Children's Program remains continuously eligible through the duration of
				  the member's pregnancy and the end of the 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1027 - 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1029 - 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1031 - Eligibility Renewal

Current through Reg. 49, No. 28; July 12, 2024
(a) At 12 months,
				  HHSC determines whether the recipient is still eligible to receive Medicaid
				  coverage.
(b) If the recipient is
				  pregnant and eligible to receive continuous eligibility, a renewal review will
				  be conducted at the end of the recipient's 12-month postpartum period to
				  determine if the individual 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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1033 - 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 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
				  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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1035 - Requirement to Report Changes

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  recipient must report changes:
(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 J - FORMER FOSTER CARE CHILDREN'S PROGRAM › Section 366.1037 - 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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1101 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
This subchapter establishes income eligibility requirements
					 for Medicaid programs in accordance with §1902(e)(14) of the Social
					 Security Act (RSA
					 1396a(e)(14)).
					 This subchapter applies to the following Chapter 366 Medicaid programs:
					 Subchapter C (relating to Pregnant Women's Medicaid), Subchapter E (relating to
					 Children's Medicaid), Subchapter F (relating to Medicaid for Transitioning
					 Foster Care Youth), Subchapter G (relating to Medicaid for Parents and
					 Caretaker Relatives Program), Subchapter H (relating to Medically Needy
					 Program), and Subchapter I (relating to Emergency Medical Services for Aliens
					 Ineligible for Regular 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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1103 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
In this subchapter, words and terms have the following
					 meanings, unless the context clearly indicates otherwise:
(1) Applicant--A person seeking assistance
				  from a Medicaid program to which this subchapter applies 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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1105 - Methodology

Current through Reg. 49, No. 28; July 12, 2024
(a) In general, HHSC determines income
				  eligibility for a Medicaid Program subject to this subchapter by:
(1) determining the applicant's or
				  recipient's household composition in accordance with §
											RSA
				  366.1107 of this subchapter (relating to
				  Determination of Household Composition);
(2) calculating the individual income of each
				  person in the applicant's or recipient's household composition in accordance
				  with §
											RSA
				  366.1109 of this subchapter (relating to
				  Calculation of Individual Income);
(3) determining if the individual income of
				  each individual in the applicant's or recipient's household composition is
				  included in the calculation of household income in accordance with §
											RSA
				  366.1111 of this subchapter (relating to
				  Determination Regarding Including an Individual's Income in the Household
				  Income); and
(4) calculating the
				  applicant's or recipient's household income in accordance with §
											RSA
				  366.1113 of this subchapter (relating to
				  Calculation of Household Income).
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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1107 - Determination of Household Composition

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  To determine household composition, an individual is designated as:
(1) a taxpayer;
(2) a tax dependent who does not meet any
				  exceptions;
(3) a tax dependent who
				  meets one or more of the exceptions set out in
				  RSA
				  435.603(f)(2);
				  or
(4) not a taxpayer or tax
				  dependent.
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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1109 - Calculation of Individual Income

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
				  calculates individual income in accordance with Internal Revenue Code
				  §36B(d)(2)(B), with adjustments for lump sum payments, certain income of
				  American Indians/Alaskan Natives, and scholarships, awards, and fellowship
				  grants used for education purposes.
(b) Assets tests do not apply to groups
				  subject to the provisions of this subchapter, except for those subject to
				  Subchapter H of this chapter (relating to Medically Needy Program). HHSC may
				  collect information on assets and resources from Medicaid program applicants
				  and recipients during the eligibility determination process.
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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1111 - Determination Regarding Inclusion of Individual Income in the Household Income

Current through Reg. 49, No. 28; July 12, 2024
(a) Individual
				  income is counted as part of the household income unless:
(1) the individual is a child who is included
				  in the household composition of a parent and is not required to file a federal
				  income tax return for the taxable year in which Medicaid eligibility is
				  requested; or
(2) the individual is
				  a tax dependent and is not required to file a federal income tax return for the
				  taxable year in which Medicaid eligibility is requested.
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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1113 - Calculation of Household Income

Current through Reg. 49, No. 28; July 12, 2024
(a) For
				  each applicant or recipient, the household income is:
(1) the sum of the individual income (as
				  calculated under §
											RSA
				  366.1109 of this subchapter (relating to
				  Calculation of Individual Income)) for each individual in the applicant's or
				  recipient's household composition (as determined under §
											RSA
				  366.1107 of this subchapter (relating to
				  Determination of Household Composition)); and
(2) less a standard income disregard equal to
				  five percentage points of the Federal Poverty Level for the applicable
				  household size, as permitted by
				  RSA
				  435.603(d)(4).
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 K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY › Section 366.1115 - Modification

Current through Reg. 49, No. 28; July 12, 2024
HHSC may modify or implement additional income eligibility
					 policies developed pursuant to this subchapter consistent with state and
					 federal laws.
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 L - MEDICAID FOR YOUTH UNDER THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN › Section 366.1201 - Purpose and Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas
				  Health and Human Services Commission (HHSC) provides medical assistance for a
				  reasonable category of former foster care youth under the age of 21, in
				  accordance with
				  RSA
				  1396a(a)(10)(A)(ii)(I)
				  and
				  RSA
				  435.222, who had been placed inside or
				  outside of Texas under the Interstate Compact on the Placement of Children
				  (ICPC).
(b) To be eligible for
				  Medicaid under this subchapter, an applicant must:
(1) be in foster care and in a placement
				  under ICPC in accordance with Texas Family Code § 162.102 when he or she
				  leaves conservatorship of a State;
(2) be 18 - 20 years of age (coverage
				  continues through the month of his or her 21st birthday); and
(3) not be covered by a health benefits plan
				  offering adequate benefits, as HHSC defines adequate benefits.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter A - PROGRAM ADMINISTRATION › Section 370.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) This chapter implements the State
				  Children's Health Insurance Program (CHIP), authorized under the Texas Health
				  and Safety Code, Chapters 62 (relating to Child Health Plan for Certain
				  Low-Income Children) and 63 (relating to Health Benefits Plan For Certain
				  Children), in a manner that is timely, efficient, fair, and that promotes
				  access to quality and economical health and dental care for eligible children
				  and their families in Texas.
(b)
				  This chapter also defines requirements for CHIP managed care organizations
				  (MCOs). An MCO must comply with this chapter and the terms of its contract with
				  HHSC.
(c) CHIP is a state-designed
				  child health insurance plan authorized under Title XXI of the federal Social
				  Security Act (RSA
				  1397aa, et seq.), and the Texas Health and
				  Safety Code, Chapters 62 (relating to Child Health Plan For Certain Low-Income
				  Children) and 63 (relating to Health Benefits Plan for Certain Children), which
				  provides access to low-cost preventive and primary health and dental care to
				  children, including children with special health care needs, in certain
				  low-income families of this state.
(d) CHIP is administered, in part, in
				  accordance with the state plan for children's health insurance, filed by HHSC
				  with the federal Secretary of Health and Human Services, which describes the
				  general conditions under which joint federal state child health insurance
				  program funds will be administered in Texas.
(e) The rules in this chapter must be read in
				  conjunction with:
(1) federal and state
				  statutes;
(2) rules relating to
				  CHIP; and
(3) except where
				  otherwise indicated, Texas Department of Insurance rules regarding:
(A) regulation of health maintenance
				  organizations at 28 TAC Chapter 11 (relating to Health Maintenance
				  Organizations); and
(B) exclusive
				  provider benefit plans at 28 TAC Chapter 3, Subchapter KK (relating to
				  Exclusive Provider Benefit Plan).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter A - PROGRAM ADMINISTRATION › Section 370.4 - 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) Action--
(A) In the context of an eligibility or
				  disenrollment determination by HHSC or its designee, action is defined as:
(i) denial of Children's Health Insurance
				  Program (CHIP) eligibility;
(ii)
				  disenrollment from CHIP; or
(iii)
				  the failure of HHSC or its designee to act within 45 days on an applicant's
				  request for CHIP eligibility determination.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter A - PROGRAM ADMINISTRATION › Section 370.10 - Duties and Responsibilities of HHSC

Current through Reg. 49, No. 28; July 12, 2024
HHSC is the single state agency responsible for the CHIP
					 Program. The responsibilities include, but are not limited to the
					 following:
(1) maintaining a
				  state-designed Program to obtain health care and dental coverage for children
				  in low-income families in a manner that qualifies for federal funding under
				  Title XXI of the Social Security Act;
(2) making policy, including policy related
				  to covered benefits provided under the Program, a duty which the Commission may
				  not delegate to another agency or entity;
(3) contracting with appropriate individuals
				  and organizations to provide health care and dental coverage, and other
				  services related to the implementation or operation of the Program;
(4) conducting a review of each entity that
				  enters into a contract with the Commission to ensure that the entity is
				  available, prepared, and able to fulfill the entity's obligations under the
				  contract; and
(5) ensuring that
				  amounts spent for CHIP administration do not exceed any limit on administrative
				  expenditures imposed by federal law.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter A - PROGRAM ADMINISTRATION › Section 370.12 - Maternal Depression Screening

Current through Reg. 49, No. 28; July 12, 2024
The covered services under CHIP must include a maternal
					 depression screening for an enrollee's mother, regardless of whether the mother
					 is also an enrollee, that is performed during a covered well-child or other
					 office visit for the enrollee that occurs before the enrollee's first
					 birthday.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 1 - APPLICATION PROCESSES › Section 370.20 - Application Availability and File Date

Current through Reg. 49, No. 28; July 12, 2024
(a) The application may be obtained via the
					 following methods:
(1) in writing using an
					 Application obtained via telephone, an internet request, or other
					 means;
(2) by computer using
					 printable Applications or an online application process available over the
					 Internet;
(3) by telephone through
					 the State's toll-free telephone number or through TDD; or
(4) in person, by visiting an HHSC authorized
					 agent.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 1 - APPLICATION PROCESSES › Section 370.21 - Application Assistance

Current through Reg. 49, No. 28; July 12, 2024
An applicant applying for health care and dental coverage
						under this chapter may obtain assistance completing the application by
						telephone or in person from HHSC or its designee during hours that are posted
						on the websites of HHSC and its designee or published in applications,
						brochures, or other marketing media issued or approved by
						HHSC.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 1 - APPLICATION PROCESSES › Section 370.22 - Completion of Telephone Applications

Current through Reg. 49, No. 28; July 12, 2024
HHSC allows an applicant to submit an application over
						the telephone.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 1 - APPLICATION PROCESSES › Section 370.25 - Missing Information

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC or its
					 designee enters incomplete applications into the State's database and sends a
					 follow-up letter to the Applicant, requesting the missing information and
					 stating a deadline by which it must be provided.
(b) Disposition.
(1) HHSC will certify or deny an Application
					 no later than 45 calendar days from the application file date.
(2) If missing information is not provided by
					 the deadline as explained in subsection (a) of this section, HHSC may deny the
					 application by the deadline.
(3) An
					 application that is denied based on missing information may be reopened, upon
					 request, within 60 calendar days of the file date.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 2 - APPLICANT RIGHTS AND RESPONSIBILITIES REGARDING APPLICATION AND ELIGIBILITY › Section 370.30 - Applicant Rights and Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) An Applicant has the right to:
(1) be treated fairly and equally regardless
					 of race, color, religion, national origin, gender, political beliefs, or
					 disability;
(2) request a review of
					 an action; and
(3) file a complaint
					 with HHSC or its designee within 30 working days from the date of an
					 incident.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 4 - ELIGIBILITY CRITERIA › Section 370.42 - Age Limits

Current through Reg. 49, No. 28; July 12, 2024
(a) A child can be
					 eligible for CHIP from the day the child is born until the end of the month in
					 which the child reaches age nineteen.
(b) A pregnant CHIP member is eligible to
					 receive coverage until the end of their 12-month postpartum period even if the
					 member turns nineteen years old.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 4 - ELIGIBILITY CRITERIA › Section 370.43 - Citizenship and Residency

Current through Reg. 49, No. 28; July 12, 2024
(a) An eligible
					 child must be a United States citizen or a non-citizen who is a Qualified
					 Alien.
(b) An eligible child must
					 be a Texas resident. A child is a Texas resident if:
(1) the child's fixed residence is located in
					 Texas and the child's family intends for the child to return to Texas after any
					 temporary absences;
(2) the child
					 has no fixed residence but the child's family intends to remain in the state;
					 or
(3) the child has recently moved
					 to Texas and the child's family intends to remain in the state.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 4 - ELIGIBILITY CRITERIA › Section 370.44 - Income and Assets

Current through Reg. 49, No. 28; July 12, 2024
Income eligibility is determined according to Subchapter
						I of this chapter (relating to Modified Adjusted Gross Income Methodology). To
						qualify for CHIP, a child must have income less than or equal to 200% of the
						Federal Poverty Level for a family of the size involved.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 4 - ELIGIBILITY CRITERIA › Section 370.45 - Medicaid Eligibility

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC or its
					 designee will review all applications to determine eligibility for either
					 Medicaid or CHIP.
(1) All children on the
					 Application requesting health care coverage will be tested for Medicaid
					 eligibility. If any child meets Medicaid eligibility criteria, the child will
					 be determined Medicaid eligible.
(2) If a child does not meet Medicaid
					 eligibility, the Application will be tested for CHIP eligibility. If any child
					 meets CHIP eligibility criteria, the child will be determined CHIP
					 eligible.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 4 - ELIGIBILITY CRITERIA › Section 370.46 - Waiting Period

Current through Reg. 49, No. 28; July 12, 2024
(a) The waiting
					 period is a delay in the start of health care coverage that:
(1) applies to a child who was covered by a
					 health benefits plan at any time during the 90 days before the date of
					 application for coverage; and
(2)
					 extends for a period of 90-days after the last date on which the applicant was
					 covered under a health benefits plan.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 4 - ELIGIBILITY CRITERIA › Section 370.47 - 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 (SSN). 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 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 4 - ELIGIBILITY CRITERIA › Section 370.49 - Pregnant CHIP Members

Current through Reg. 49, No. 28; July 12, 2024
A pregnant CHIP member may be determined eligible for
						Medicaid. A pregnant CHIP member who is determined to be Medicaid eligible will
						be disenrolled from CHIP. Medicaid coverage will be coordinated to begin when
						CHIP enrollment ends to avoid gaps in health care coverage. In the event HHSC
						or its designee remains unaware of a member's pregnancy until delivery, the
						delivery will be covered by CHIP. HHSC or its designee will set the mother's
						eligibility expiration date at the later of:
(1) the end of the twelfth month after the
					 end of a pregnancy; or
(2) if the
					 CHIP member voluntarily elects to end the member's CHIP enrollment during the
					 member's extended postpartum period, the individual is not eligible to receive
					 continuous eligibility in Medicaid for the remainder of the member's 12-month
					 postpartum period.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 5 - REVIEW AND RECONSIDERATION OF ELIGIBILITY DENIALS AND TEMPORARY ENROLLMENT › Section 370.50 - Matters Subject to Review

Current through Reg. 49, No. 28; July 12, 2024
An applicant may request review of an
						action.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 5 - REVIEW AND RECONSIDERATION OF ELIGIBILITY DENIALS AND TEMPORARY ENROLLMENT › Section 370.51 - Deadline and Method for Requesting Review

Current through Reg. 49, No. 28; July 12, 2024
An applicant may request review of a determination of
						denial of eligibility or of HHSC's failure to make a timely determination by
						contacting HHSC in writing within 30 working days from the notice of the
						action.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 5 - REVIEW AND RECONSIDERATION OF ELIGIBILITY DENIALS AND TEMPORARY ENROLLMENT › Section 370.52 - Disposition of a Request for Review

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
					 must complete its review within established timeframes upon receipt of the
					 request for review.
(b) HHSC must
					 notify the requester in writing of the results of its review. The written
					 notification must:
(1) explain the reason for
					 the action;
(2) inform the
					 requester whether the action was reversed following the review; and
(3) explain any applicable rights to
					 reconsideration or review of the determination or state that the determination
					 is final.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM › Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT › Division 5 - REVIEW AND RECONSIDERATION OF ELIGIBILITY DENIALS AND TEMPORARY ENROLLMENT › Section 370.54 - Temporary Enrollment Pending Disposition of Review or Reconsideration

Current through Reg. 49, No. 28; July 12, 2024
(a) There is no retroactive enrollment in
					 CHIP.
(b) If HHSC determines that
					 an applicants request for review indicates the action was in error, HHSC may
					 approve temporary enrollment of the child pending completion of the review and
					 reconsideration by HHSC.
(c) A
					 child will remain enrolled until the review and any HHSC reconsideration is
					 complete.
(d) If the
					 review/reconsideration upholds the action, the child is disenrolled as of the
					 next cut-off date.
(e) Temporary
					 enrollment for a child on the basis of a review is limited to only once every 6
					 months.
(f) If a child who is
					 temporarily enrolled under this section ultimately is determined ineligible for
					 CHIP, no repayment for health care costs during the period of temporary
					 enrollment will be sought by HHSC's or its designee.