reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.388 - Tuition Savings Programs

Current through Reg. 49, No. 28; July 12, 2024
(a) The
					 following words and terms, when used in this section, have the following
					 meanings, unless the context clearly indicates otherwise.
(1) Tuition savings program--
(A) a prepaid tuition program or higher
					 education savings plan authorized under Chapter 54, Subchapter G, H, or I of
					 the Texas Education Code; or
(B) a
					 qualified tuition program of any state that meets the requirements of §529
					 of the Internal Revenue Service Code of 1986.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.389 - Achieving a Better Life Experience Program

Current through Reg. 49, No. 28; July 12, 2024
(a) The following words and terms, when used
					 in this section, have the following meanings, unless the context clearly
					 indicates otherwise.
(1) Achieving a Better
					 Life Experience (ABLE) program--
(A) the ABLE
					 Program authorized under Chapter 54, Subchapter J, of the Texas Education Code;
					 or
(B) a qualified ABLE program of
					 any state that meets the requirements of §529A of the Internal Revenue
					 Code of 1986.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.390 - School-Based Savings Program

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission excludes
						from the calculation of countable income interest earned on funds held in a
						school-based account or bond as described by Texas Education Code §
											RSA
						28.0024 and authorized by Texas Human
						Resources Code §
											RSA
						32.02611.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 3 - INCOME › Section 358.391 - Treatment of Other Income

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						the federal regulations indicated in the table in this section regarding the
						treatment of income not otherwise described in this division:
Attached
						Graphic
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 4 - TRANSFER OF ASSETS › Section 358.401 - Transfer of Assets on or after February 8, 2006

Current through Reg. 49, No. 28; July 12, 2024
(a) This section applies to a person in an
					 institutional setting whose date of application or program transfer request
					 date is on or after October 1, 2006, and who takes an action defined by this
					 section to be a transfer of assets on or after February 8, 2006.
(b) The Texas Health and Human Services
					 Commission (HHSC) uses the definitions under the provisions of §1917(e) of
					 the Social Security Act (RSA
					 1396p(h)).
(1) Assets include all income and resources
					 of a person and of the person's spouse, including any income or resources that
					 the person or the person's spouse is entitled to but does not receive because
					 of action:
(A) by the person or the person's
					 spouse;
(B) by an individual,
					 including a court or administrative body, with legal authority to act in place
					 of or on behalf of the person or the person's spouse; or
(C) by any individual, including any court or
					 administrative body, acting at the direction or upon the request of the person
					 or the person's spouse.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 4 - TRANSFER OF ASSETS › Section 358.402 - Transfer of Assets before February 8, 2006

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction.
(1) The Omnibus Budget Reconciliation Act of
					 1993 (OBRA 1993) (P.L.
					 103-66) revised policy for transfers of assets
					 that occur on or after August 11, 1993, when an uncompensated value
					 remains.
(2) The penalty for
					 transfers of assets affects payments for institutional facility services
					 (nursing facility (NF) care, intermediate care facility for persons with mental
					 retardation or related conditions (ICF/MR) provider services, care in state
					 supported living centers and state centers, and care in institutions for mental
					 diseases (IMD)) and eligibility for §1915(c) waiver program services. Both
					 the recipient and the service provider are notified of the penalty
					 period.
(3) Except for residents of
					 state supported living centers and state centers, persons in an institutional
					 setting remain eligible for all other Medicaid benefits and continue to receive
					 monthly identification forms for the length of the penalty period. For
					 residents of state supported living centers and state centers, Medicaid
					 eligibility is denied for any penalty period resulting from an uncompensated
					 transfer of assets. This is because the only Medicaid benefit a resident of a
					 state supported living center or state center receives is provider
					 payments.
(4) If the Medicaid
					 eligibility of a person receiving services under a §1915(c) waiver program
					 requires receipt of waiver services, then the person is ineligible for all
					 Medicaid benefits for the length of the penalty period. Denial of §1915(c)
					 waiver program services based on an uncompensated transfer of assets does not
					 disqualify the person for pure Qualified Medicare Beneficiary (QMB) or
					 Specified Low-Income Medicare Beneficiary (SLMB) benefits, as described in
					 Chapter 359 of this title (relating to Medicare Savings Program).
(5) A person in a noninstitutional setting
					 who is eligible for Medicaid may transfer assets without penalty, provided the
					 person does not become institutionalized or apply for §1915(c) waiver
					 program services. A transfer of assets does not affect eligibility for QMB or
					 SLMB benefits.
(6) In spousal
					 situations, if assets are transferred to a third party before
					 institutionalization or by the community spouse, the Texas Health and Human
					 Services Commission (HHSC) does not include the uncompensated amount of the
					 transfer in calculating the spousal protected resource amount or countable
					 resources upon application for Medicaid.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.411 - Purpose and Application

Current through Reg. 49, No. 28; July 12, 2024
(a) This
					 division establishes the criteria under which income and resources are
					 protected for a community spouse, in accordance with
					 RSA
					 1396r-5.
(b) This division applies to an
					 institutionalized spouse whose continuous period in an institutional setting
					 begins on or after September 30, 1989. For this division only, a reference to
					 an institutional setting includes the receipt of services under the Program of
					 All-Inclusive Care for the Elderly (PACE).
(c) This division applies to a person who is
					 in an institutional setting and has a community spouse. It is not necessary for
					 the community spouse to meet citizenship and residency requirements.
(d) This division does not apply to a couple
					 with a void or annulled marriage.
(e) In the case of a divorce, the provisions
					 of this division apply through the end of the calendar month of the court order
					 granting the divorce.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.412 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
In this division, the following words and terms have the
						following meanings, unless the context clearly indicates otherwise.
(1) Community spouse--The spouse of an
					 institutionalized spouse who is not living in a setting that provides medical
					 care and services.
(2) Dependent
					 family member--A minor or dependent child, dependent parent, or dependent
					 sibling of an institutionalized spouse or a community spouse who resides with
					 the community spouse.
(3)
					 Institutional setting--In this division only, a living arrangement in which a
					 person applying for or receiving Medicaid:
(A) lives in a Medicaid-certified long-term
					 care facility;
(B) receives
					 services under a §1915(c) waiver program; or
(C) receives services under the Program of
					 All-Inclusive Care for the Elderly (PACE).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.413 - Spousal Impoverishment Treatment of Income and Resources

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						§1924 of the Social Security Act (RSA
						1396r-5), regarding the treatment of income
						and resources for certain institutionalized spouses in institutional
						settings.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.414 - Assessment of Resources to Determine a Spousal Protected Resource Amount

Current through Reg. 49, No. 28; July 12, 2024
(a) Assessment. Upon request of either the
					 institutionalized spouse or the community spouse, or either spouse's authorized
					 representative, the Texas Health and Human Services Commission (HHSC) assesses
					 the couple's resources to determine the spousal protected resource amount
					 (SPRA). The request and assessment may be made any time from the beginning of
					 the continuous period in an institutional setting to the date of application
					 for Medicaid.
(b) Assessment
					 request. If the request described in subsection (a) of this section is not part
					 of an application for Medicaid, the couple must provide information on their
					 resources and verification as required by HHSC. If the couple does not provide
					 the verification within the time frame requested by HHSC, HHSC does not
					 complete the assessment and takes no further action.
(c) Assessment date. HHSC assesses the
					 couple's combined countable resources as of 12:01 a.m. on the first day of the
					 month in which the first continuous period in an institutional setting began.
					 When determining the first day of the month in an institutional setting for the
					 SPRA, HHSC may count days the person spent in a hospital if the person admits
					 directly from the hospital to an institutional setting. After the continuous
					 period begins, hospital stays and therapeutic home visits are not considered as
					 breaks in the 30-consecutive-day period.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.415 - Calculation of the Spousal Protected Resource Amount

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
					 Commission (HHSC) calculates the spousal protected resource amount (SPRA) as of
					 the assessment date described in §358.414(c) of this division (relating to
					 Assessment of Resources to Determine a Spousal Protected Resource
					 Amount).
(b) When determining the
					 SPRA, HHSC excludes the following resources regardless of value:
(1) one automobile; and
(2) a home, if:
(A) the community spouse or dependent family
					 member continues to live in the home while the person is in the institutional
					 setting;
(B) the community spouse
					 lives in another state on out-of-state property, whether or not the
					 institutionalized spouse has ownership interest; or
(C) the community spouse had been living in
					 the out-of-state property as a home but is not residing there during the
					 assessment and initial eligibility period and the community spouse signs a
					 statement of intent to return to the home.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.416 - Initial Application and the Spousal Protected Resource Amount

Current through Reg. 49, No. 28; July 12, 2024
(a) Upon receiving an application for
					 Medicaid, the Texas Health and Human Services Commission (HHSC) calculates the
					 couple's combined countable resources, without regard to community or separate
					 property laws or the spouses' respective ownership interests, as of 12:01 a.m.
					 on the first day of the month in which eligibility is being determined. HHSC
					 follows the resource exclusions for an automobile and a home, regardless of
					 value, as described in §358.415 of this division (relating to Calculation
					 of the Spousal Protected Resource Amount).
(b) If an assessment of resources to
					 determine the spousal protected resource amount (SPRA) has not previously been
					 completed, HHSC determines the SPRA at initial application, in accordance with
					 §358.415 of this division.
(c)
					 HHSC deducts the SPRA from the couple's combined countable resources calculated
					 in subsection (a) of this section. HHSC follows §1924(a)(3) and
					 §1924(c)(2) of the Social Security Act (RSA
					 1396r-RSA
					 5(a)(3) and
					 RSA
					 1396r-RSA
					 5(c)(2)) when
					 determining resource eligibility of the institutionalized spouse at the initial
					 eligibility determination.
(d) If
					 the SPRA determined at assessment is either the federal minimum or maximum
					 resource amount, and the federal minimum or maximum resource amount increases
					 before completion of the initial application for Medicaid, HHSC uses the
					 federal minimum and maximum resource amounts in effect at the time of
					 completion of the initial application.
(e) If the institutionalized spouse is found
					 ineligible for Medicaid at the initial application and reapplies, HHSC deducts
					 the same SPRA for subsequent applications.
(f) If an institutionalized spouse, after
					 having been certified, is subsequently denied and reapplies for Medicaid:
(1) if the institutionalized spouse should
					 never have been certified and was denied because of unreported resources, HHSC
					 calculates a new SPRA at reapplication, taking into account the previously
					 unreported resources; and
(2) if
					 the institutionalized spouse was denied for any other reason, HHSC does not
					 deduct the SPRA and counts only the institutionalized spouse's resources at
					 reapplication.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.417 - Treatment of Resources of the Institutionalized Spouse after the Initial Eligibility Period

Current through Reg. 49, No. 28; July 12, 2024
After the initial eligibility period of the
						institutionalized spouse, the Texas Health and Human Services Commission does
						not apply the spousal protected resource amount and counts only the
						institutionalized spouse's resources for the purpose of eligibility
						redetermination, in accordance with Division 2 of this subchapter (relating to
						Resources).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.418 - Refusal of a Community Spouse to Cooperate

Current through Reg. 49, No. 28; July 12, 2024
(a) If a community spouse refuses to
					 cooperate in providing information to establish a spousal protected resource
					 amount (SPRA) during an assessment as described in §358.414(b) of this
					 division (relating to Assessment of Resources to Determine a Spousal Protected
					 Resource Amount), the Texas Health and Human Services Commission (HHSC) does
					 not complete the assessment and takes no further action.
(b) If an assessment is undertaken in
					 conjunction with an eligibility determination at the initial application, and a
					 community spouse refuses to furnish information, HHSC determines the living
					 arrangement before the continuous period in an institutional setting began.
(1) If the couple was living in the same
					 household, HHSC denies the application based on the couple's failure to furnish
					 information. Living in the same household includes temporary
					 separations.
(2) If the couple was
					 not living in the same household, HHSC determines the purpose of separation,
					 the length of separation, and resources or income commingled or managed jointly
					 by one spouse or a third party.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.419 - Separation to Circumvent Medicaid Policy

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
					 Commission (HHSC) evaluates the information provided by a couple to determine
					 if a couple separated before the continuous period in an institutional setting
					 began to avoid the pooling of resources under Medicaid spousal impoverishment
					 provisions, if:
(1) the separation occurred
					 after a change in the health of the institutionalized spouse;
(2) the community spouse potentially owns
					 separate resources; or
(3) the
					 ownership of commingled resources was changed recently.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.420 - Expanding the Spousal Protected Resource Amount

Current through Reg. 49, No. 28; July 12, 2024
(a) This section applies to an
					 institutionalized spouse whose continuous period in an institutional setting
					 begins on or after September 1, 2004.
(b) An institutionalized spouse may request
					 that HHSC expand the spousal protected resource amount (SPRA) to produce
					 additional income for the community spouse. To determine whether to expand the
					 SPRA, HHSC considers the countable amount of non-resource-produced and
					 non-investment income of the community spouse and compares the countable amount
					 of non-resource-produced and non-investment income to the minimum monthly
					 maintenance needs allowance (MMMNA). The MMMNA is the minimum income level for
					 a community spouse set by the Centers for Medicare and Medicaid Services.
(1) If the community spouse's countable
					 non-resource-produced and non-investment income is less than the MMMNA, HHSC
					 considers the available income (countable non-resource-produced income minus
					 the personal needs allowance) of the institutionalized spouse and adds the
					 institutional spouse's available income to the community spouse's countable
					 non-resource-produced and non-investment income and compares the combined
					 incomes to the MMMNA.
(2) If the
					 total amount of the community spouse's own income plus the amount of available
					 income diverted from the institutionalized spouse is equal to or greater than
					 the MMMNA, then HHSC does not expand the SPRA.
(3) If the total amount of the community
					 spouse's own income plus the amount of available income diverted from the
					 institutionalized spouse is less than the MMMNA, then HHSC determines an
					 expanded SPRA as described in subsections (c) - (e) of this section.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.421 - Treatment of Income for Eligibility and Co-Payment

Current through Reg. 49, No. 28; July 12, 2024
(a) To be eligible for Medicaid, an
					 institutionalized spouse must have countable income that does not exceed the
					 special income limit for an individual and meet all other eligibility
					 criteria.
(b) In determining the
					 income of an institutionalized spouse or community spouse for purposes of
					 determining a co-payment, the Texas Health and Human Services Commission
					 follows §1924(b)(2) and (d) of the Social Security Act (RSA
					 1396r-5(b)(2) and
					 (d)). See also Division 6 of this
					 subchapter (relating to Budgeting for Eligibility and Co-payment).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.422 - Notice and Fair Hearing

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
						§1924(e) of the Social Security Act (RSA
						1396r-5(e))
						concerning notices and fair hearings for matters relating to spousal
						impoverishment.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 5 - SPOUSAL IMPOVERISHMENT › Section 358.423 - Transfer of Assets and Spousal Impoverishment

Current through Reg. 49, No. 28; July 12, 2024
See Division 4 of this subchapter (relating to Transfer
						of Assets) for requirements governing a transfer of assets under spousal
						impoverishment circumstances.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.431 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
In this division, the following words and terms have the
						following meanings, unless the context clearly indicates otherwise.
(1) Child--Has the meaning given in
					 RSA
					 416.1856.
(2) Couple--Two persons who live together
					 and:
(A) present themselves to the community
					 as married , intend to be married, and are considered to be married;
(B) are determined to be married for purposes
					 of receiving Social Security benefits; or
(C) are recognized as married.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.432 - Eligibility Budgets

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission (HHSC)
						prepares an eligibility budget to determine a person's financial eligibility
						for Medicaid. The type of eligibility budget HHSC prepares depends on:
(1) where the person lives and whether a
					 person is married or not married at the beginning of each month;
(2) whether a person is considered a child;
					 and
(3) whether a person is
					 considered another person's parent.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.433 - Special Income Limit

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission uses a
						special income limit to determine income eligibility under circumstances
						established in this section. The special income limit for a person is equal to
						or less than 300 percent of the full individual Supplemental Security Income
						(SSI) federal benefit rate. The special income limit for a couple is twice the
						special income limit for an individual.
(1) To qualify for the special income limit,
					 a person or couple must have countable income that exceeds the reduced SSI
					 federal benefit rate; and:
(A) must:
(i) reside in:
(I) a Medicaid-certified long-term care
					 facility for 30 consecutive days; or
(II) a Medicaid-certified institution for
					 mental diseases for 30 consecutive days, if the person is 65 years of age or
					 older; and
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.434 - Budget Types for a Noninstitutional Setting

Current through Reg. 49, No. 28; July 12, 2024
(a) Individual budget. The Texas Health and
					 Human Services Commission (HHSC) prepares an individual budget for a person in
					 a noninstitutional setting if the person is:
(1) single;
(2) widowed;
(3) divorced; or
(4) married and is:
(A) an applicant separated from his or her
					 spouse at the time of application; or
(B) a recipient separated from his or her
					 spouse during the previous month.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.435 - Noninstitutional Eligibility Budgets

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Scope. The Texas Health and Human Services Commission (HHSC) prepares a
					 noninstitutional eligibility budget to determine financial eligibility for a
					 person or couple in a noninstitutional setting, if the person or couple:
(1) applies for retroactive
					 coverage;
(2) applies for or has
					 eligibility redetermined under a federally mandated Medicaid-funded program for
					 the elderly and people with disabilities as described in §
												RSA 358.107 of
					 this chapter (relating to Coverage Groups); or
(3) applies for or has eligibility
					 redetermined under §1929(b)(2)(B) of the Social Security Act.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.436 - Budget Types for an Institutional Setting

Current through Reg. 49, No. 28; July 12, 2024
(a) Individual budget. The Texas Health and
					 Human Services Commission (HHSC) prepares an individual budget for a person in
					 an institutional setting if the person is:
(1) single;
(2) widowed;
(3) divorced; or
(4) married and meets the criteria in
					 subsection (c) of this section, but the community spouse refuses to cooperate
					 in providing information and circumstances indicate possible abuse or neglect
					 by the community spouse.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.437 - Institutional Eligibility Budgets

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Scope. The Texas Health and Human Services Commission (HHSC) prepares an
					 institutional eligibility budget to determine financial eligibility for a
					 person or couple in an institutional setting, if the person or couple:
(1) applies for retroactive coverage;
					 or
(2) applies for or has
					 eligibility redetermined under a federally optional Medicaid-funded program for
					 the elderly and people with disabilities as described in §
												RSA 358.107 of
					 this chapter (relating to Coverage Groups).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.438 - Determination of Co-Payment

Current through Reg. 49, No. 28; July 12, 2024
(a) After a
					 person or couple in an institutional setting is determined eligible for a
					 Medicaid-funded program for the elderly and people with disabilities, the Texas
					 Health and Human Services Commission (HHSC) determines the person's or couple's
					 co-payment in accordance with:
(1) Section
					 1902(a)(17) of the Social Security Act (RSA
					 1396a(17)),
					 relating to the general authority;
(2) Section 1902(a)(50) and (q) of the Social
					 Security Act (RSA
					 1396a(50) and
					 (q)), relating to personal needs;
					 and
(3) Section 1924 of the Social
					 Security Act (RSA
					 1396r-5), relating to institutionalized
					 spouses with community spouses.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.439 - Guardianship Fee

Current through Reg. 49, No. 28; July 12, 2024
In determining the co-payment for a person receiving
						services in an institutional setting, the Texas Health and Human Services
						Commission (HHSC) may deduct a guardianship fee, if any, up to an amount set by
						the court, from the person's total countable income.
(1) The deduction is limited to
					 guardianship-related costs and fees, subject to the limitations of §
											RSA
					 32.02451 of the Texas Human Resources Code,
					 Section
					 RSA 670 of the Texas
					 Probate Code, and this section, as determined by HHSC.
(2) HHSC deducts the guardianship-related
					 costs and fees from total countable income after deducting the personal needs
					 allowance, but before deducting any other allowances.
(3) The deduction is effective the later of:
(A) the month the judge signs the court order
					 awarding guardianship-related costs and fees;
(B) the first month of eligibility for which
					 the person has a co-payment; or
(C)
					 the first day of the month that the applicant or recipient provides HHSC with a
					 copy of the court order awarding the guardianship-related costs and
					 fees.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.440 - Dependent Allowance

Current through Reg. 49, No. 28; July 12, 2024
(a) In determining
					 a person's co-payment, the Texas Health and Human Services Commission (HHSC)
					 may deduct a dependent allowance from a person's total countable income.
(1) For a person with at least one dependent
					 relative at home, HHSC allows the individual Social Security Income (SSI)
					 federal benefit rate for each dependent relative and deducts the individual SSI
					 federal benefit rate from the dependent relative's countable income.
(2) For a person with a spouse and a least
					 one dependent relative at home, when spousal impoverishment provisions apply,
					 HHSC determines the dependent allowance in accordance with
					 RSA
					 1396r-5.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter C - FINANCIAL REQUIREMENTS › Division 6 - BUDGETING FOR ELIGIBILITY AND CO-PAYMENT › Section 358.441 - Payroll Deductions

Current through Reg. 49, No. 28; July 12, 2024
(a) In determining
					 a person's co-payment, the Texas Health and Human Services Commission (HHSC)
					 calculates earned income each month by subtracting the following mandatory
					 payroll deductions:
(1) income tax;
(2) social security tax;
(3) required retirement withholding;
					 and
(4) required uniform
					 expenses.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.501 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
				  establishes the application and eligibility determination processes for a
				  person seeking health care benefits from a Medicaid-funded program for the
				  elderly and people with disabilities (MEPD).
(b) This subchapter applies to both initial
				  applications for assistance and eligibility redeterminations for MEPD, unless
				  the context clearly indicates otherwise.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.505 - Application Process Overview

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  Texas Health and Human Services Commission (HHSC) gives anyone the opportunity
				  to apply for a Medicaid-funded program for the elderly and people with
				  disabilities (MEPD), in accordance with
				  RSA 435.906.
				  A person can apply for MEPD by submitting:
(1) an application for assistance to HHSC;
				  or
(2) an application for
				  Supplemental Security Income (SSI) to the Social Security
				  Administration.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.510 - Authorized Representative

Current through Reg. 49, No. 28; July 12, 2024
In accordance with
					 RSA
					 435.908, an authorized representative may
					 accompany, assist, and represent an applicant or recipient in the application
					 or eligibility redetermination process.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.515 - Application Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) To apply
				  for a Medicaid-funded program for the elderly and people with disabilities
				  (MEPD) under the application submittal process described in §
										RSA
				  358.505(a)(1) and
				  (b) of this subchapter (relating to
				  Application Process Overview), and in accordance with
				  RSA
				  435.907, an applicant, authorized
				  representative, or someone acting responsibly for the applicant (if the
				  applicant is incompetent or incapacitated) must:
(1) use the application prescribed by the
				  Texas Health and Human Services Commission (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 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES › Subchapter D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.520 - Date of Application

Current through Reg. 49, No. 28; July 12, 2024
(a) The date of
				  application is the date on which:
(1) the
				  Texas Health and Human Services Commission receives an application for
				  assistance in accordance with subsection (c) of this section; or
(2) an application for Supplemental Security
				  Income is filed with the Social Security Administration.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.525 - Previously Completed Application for Assistance

Current through Reg. 49, No. 28; July 12, 2024
An application for assistance remains valid for 90 days
					 after a date of denial, if the Texas Health and Human Services Commission
					 denies eligibility. An applicant may use his or her previously completed
					 application to reapply during the 90-day period, in accordance with HHSC
					 instructions.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.530 - Eligibility Determination

Current through Reg. 49, No. 28; July 12, 2024
(a) Time frame
				  for determination. After an applicant or authorized representative provides all
				  information and verification documents requested, the Texas Health and Human
				  Services Commission (HHSC) makes an eligibility determination within the
				  following time frames, in accordance with
				  RSA
				  435.911:
(1) by the 90th day after the date of
				  application if the applicant is applying on the basis of a
				  disability;
(2) by the 45th day
				  after the date of application for all other applicants; or
(3) beyond the time frames established in
				  paragraphs (1) and (2) of this subsection under unusual circumstances, such as
				  those set forth in
				  RSA
				  435.911.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.535 - Notice of Eligibility Determination

Current through Reg. 49, No. 28; July 12, 2024
(a) After making an initial eligibility
				  determination, the Texas Health and Human Services Commission (HHSC) sends the
				  applicant, in accordance with
				  RSA
				  435.912:
(1) a written notice of eligibility,
				  including notice of any co-payment the person must pay and the medical
				  effective date described in §
											RSA
				  358.540 of this subchapter (relating to
				  Medical Effective Date); or
(2) a
				  written notice of ineligibility, explaining the reason for the decision and the
				  specific provision supporting the decision.
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.540 - Medical Effective Date

Current through Reg. 49, No. 28; July 12, 2024
(a) If a person
				  is eligible for a Medicaid-funded program for the elderly and people with
				  disabilities (MEPD), the Texas Health and Human Services Commission (HHSC)
				  includes in the notice of eligibility the date that the person's Medicaid
				  benefits will begin, which is known as the medical effective date.
(b) HHSC determines the medical effective
				  date:
(1) in accordance with
				  RSA 435.914, as
				  the first day of the month in which a person meets all eligibility criteria,
				  which may be up to three months before the date of application if:
(A) during the three months before the month
				  of application, the person received MEPD services covered under the Texas State
				  Plan for Medical Assistance; and
(B) would have been eligible for MEPD at the
				  time the services were received if the person had applied (or someone had
				  applied on behalf of the person), regardless of whether the person is alive
				  when application for MEPD is made; or
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 D - APPLICATION AND ELIGIBILITY DETERMINATION › Section 358.545 - Eligibility Redetermination

Current through Reg. 49, No. 28; July 12, 2024
(a) In
				  accordance with
				  RSA
				  435.916, the Texas Health and Human Services
				  Commission (HHSC) redetermines a person's eligibility for a Medicaid-funded
				  program for the elderly and people with disabilities (MEPD):
(1) at least every 12 months;
(2) after HHSC receives information about a
				  change in the person's circumstances, such as living arrangement, income, or
				  resources, that may affect MEPD eligibility; and
(3) at the appropriate time based on an
				  anticipated change in the person's circumstances.
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 E - RIGHTS AND RESPONSIBILITIES OF APPLICANTS AND RECIPIENTS › Section 358.601 - Rights

Current through Reg. 49, No. 28; July 12, 2024
An applicant or recipient has the right to:
(1) be treated fairly and equally regardless
				  of race, color, religion, national origin, gender, political beliefs, or
				  disability;
(2) have information
				  collected for determining his or her eligibility to be treated as
				  confidential;
(3) request a review
				  of an action;
(4) have his or her
				  eligibility tested for other programs before HHSC denies eligibility;
(5) review all information that contributed
				  to an eligibility decision; and
(6)
				  request a fair hearing to appeal an action by HHSC.
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 E - RIGHTS AND RESPONSIBILITIES OF APPLICANTS AND RECIPIENTS › Section 358.602 - Disclosure of Official Records and Information

Current through Reg. 49, No. 28; July 12, 2024
The Texas Health and Human Services Commission follows
					 RSA
					 401 -
					 RSA
					 403 concerning disclosure of information
					 about a person, both with and without the person's consent; the maintenance of
					 records; and the general guidelines in deciding whether to make a
					 disclosure.
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 E - RIGHTS AND RESPONSIBILITIES OF APPLICANTS AND RECIPIENTS › Section 358.603 - Release of Medical Information

Current through Reg. 49, No. 28; July 12, 2024
A person requesting assistance on the basis of disability
					 must complete a medical information release form.
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 E - RIGHTS AND RESPONSIBILITIES OF APPLICANTS AND RECIPIENTS › Section 358.604 - Responsibility To Provide Information and Report Changes

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant or recipient must provide
				  the Texas Health and Human Services Commission (HHSC) the necessary
				  documentation and information to determine eligibility for Medicaid.
(b) An applicant or recipient must report to
				  HHSC certain events that affect benefits in accordance with 20 CFR Subpart
				  G.
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 E - RIGHTS AND RESPONSIBILITIES OF APPLICANTS AND RECIPIENTS › Section 358.605 - Fraud Referral and Restitution

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  Texas Health and Human Services Commission (HHSC) follows
				  RSA
				  455.13 -
				  RSA
				  455.16 for issues governing fraud referral
				  and restitution.
(b) HHSC evaluates
				  a person's willful withholding of information for fraud, including:
(1) willful misstatements, oral or written,
				  made by the person or the person's authorized representative in response to
				  oral or written questions from HHSC concerning the person's income, resources,
				  or other circumstances that may affect the amounts of benefits, including
				  understatements or omission of information about income and resources;
				  and
(2) willful failure by the
				  person or the person's authorized representative to report changes in income,
				  resources, or other circumstances that may affect the amount of benefits, if
				  HHSC has clearly notified the person or the person's authorized representative
				  of the person's obligation to report these changes.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 359 - MEDICARE SAVINGS PROGRAM › Section 359.101 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) This chapter
				describes the assistance available and eligibility requirements for the
				Medicare Savings Program. Authorized under
				RSA
				1396a(a)(10)(E),
				the Medicare Savings Program uses Medicaid funds to help eligible persons pay
				for all or some of their out-of-pocket Medicare expenses, such as premiums,
				deductibles, or coinsurance.
(b)
				The Texas Health and Human Services Commission (HHSC) manages the Medicare
				Savings Program, which consists of the following:
(1) the Qualified Medicare Beneficiary (QMB)
				Program;
(2) the Specified
				Low-Income Medicare Beneficiary (SLMB) Program;
(3) the Qualifying Individual (QI) Program;
				and
(4) the Qualified Disabled and
				Working Individual (QDWI) Program.