Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009 Page: 5,505
5445-5614 p. ; 28 cm.View a full description of this periodical.
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(A) is under 18 years of age;
(B) was receiving SSI on August 22, 1996;
(C) was subsequently denied SSI because of the change
in disability criteria implemented by the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (Public Law 104-193);
and
(D) meets SSI eligibility criteria, including the disabil-
ity criteria in effect before August 22, 1996.
(c) Optional coverage groups. In accordance with 42 CFR Part
435, Subpart C, HHSC determines Medicaid eligibility for MEPD for a
person who falls into an optional coverage group described in this sub-
section. Although federal regulations may allow other optional cover-
age groups, HHSC does not provide benefits to a member of an optional
coverage group unless the group is included in the Texas State Plan for
Medical Assistance.
(1) Institutional. In accordance with 42 CFR 435.211, this
optional coverage group covers a person who would be eligible for
SSI, as specified in 42 CFR 435.230, if the person were not in an
institutional setting.
(2) Institutional special income limit. In accordance with
42 CFR 435.236, this optional coverage group covers a person who
has lived in an institutional setting for at least 30 consecutive days,
as described in 358.433 of this chapter (relating to Special Income
Limit), and is eligible under the special income limit.
(3) 1915(c) waiver program. In accordance with 42 CFR
435.217, this optional coverage group covers a person who would be
eligible for Medicaid if institutionalized, but is living in the community
and receiving services under a 1915(c) waiver program.
(d) Other. In accordance with the Texas State Plan for Medi-
cal Assistance, HHSC determines Medicaid eligibility for MEPD for a
person who meets the criteria for one of the following services:
(1) Primary home care services. This is a person who
needs primary home care services and meets the criteria established in
1929(b)(2)(B) of the Social Security Act (42 U.S.C. 1396t(b)(2)(B))
but is not otherwise eligible for Medicaid.
(2) Program of All-Inclusive Care for the Elderly (PACE).
In accordance with 42 CFR Part 460, this is a person who is enrolled
in a PACE program under a PACE program agreement.
(3) Susan Walker v. Bayer Corporation services. A person
who has received payments from the class action settlement of Susan
Walker v. Bayer Corporation may be eligible for Medicaid as a result of
excluding from countable resources the payments from the settlement.
(e) Retroactive coverage. In accordance with 42 CFR
435.914, HHSC may determine eligibility for retroactive coverage:
(1) for up to three months before the date of application for:
(A) an applicant;
(B) a person who has been denied SSI;
(C) a deceased person, if a representative for the de-
ceased person requests that HHSC determine eligibility for retroactive
coverage; and
(D) a person eligible under the SSI-denied-children
coverage group in subsection (b)(8) of this section; and
(2) for up to two months before the month in which an SSI
recipient's Medicaid coverage automatically begins.(f) Medicare Savings Program. In accordance with 42 U.S.C.
1396a(a)(10)(E) for this mandatory coverage group, HHSC may de-
termine eligibility for a person who meets the criteria in Chapter 359 of
this title (relating to Medicare Savings Program) for a Medicare Sav-
ings Program, which uses Medicaid funds to help the person pay for
all or some of the person's out-of-pocket Medicare expenses, such as
premiums, deductibles, or coinsurance.
(g) Medicaid Buy-In Program. In accordance with
1902(a)(10)A)(ii)(XIII) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(ii)(XIII)) for this optional coverage group, HHSC
may determine eligibility for a person with a disability who is working
and earning income and meets the criteria established in Chapter 360
of this title (relating to Medicaid Buy-In Program).
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of the Secretary of State on August 3, 2009.
TRD-200903253
Steve Arag6n
Chief Counsel
Texas Health and Human Services Commission
Effective date: September 1, 2009
Proposal publication date: May 22, 2009
For further information, please call: (512) 424-6900
SUBCHAPTER B. NONFINANCIAL
REQUIREMENTS
1 TAC 358.201, 358.203, 358.205, 358.207, 358.209,
358.211, 358.213, 358.215, 358.217, 358.219
The new sections are adopted under Texas Government Code,
531.0055, which provides the Executive Commissioner of
HHSC with rulemaking authority; and 531.021, which au-
thorizes HHSC to administer the federal medical assistance
(Medicaid) program in Texas.
358.207. Residence.
To be eligible for a Medicaid-funded program for the elderly and people
with disabilities, a person must be a resident of the United States (U.S.)
and the state of Texas.
(1) U.S. residence. The Texas Health and Human Services
Commission (HHSC) follows 20 CFR 416.1603 in determining a per-
son's U.S. residence.
(A) The U.S. residence requirement does not apply to:
(i) a child who is a citizen and is living with a parent
who is a member of the U.S. Armed Forces assigned to permanent duty
ashore outside the U.S.; or
(ii) to certain persons temporarily abroad for study.
(B) Once eligible for benefits, a person must maintain
a presence in the U.S. in accordance with 42 U.S.C. 1382(f)(1). If a
person has been outside the U.S. for 30 consecutive days, the person
is not eligible for benefits until the person has been in the U.S. for 30
consecutive days.
(2) Texas residence. HHSC follows 42 CFR 435.403 in
determining a person's state residence.ADOPTED RULES August 14, 2009
34 TexReg 5505
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Texas. Secretary of State. Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009, periodical, August 14, 2009; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth90865/m1/58/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.