Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009 Page: 5,515
5445-5614 p. ; 28 cm.View a full description of this periodical.
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See also Division 6 of this subchapter (relating to Budgeting for Eligi-
bility and Co-payment).
358.422. Notice and Fair Hearing.
The Texas Health and Human Services Commission follows 1924(e)
of the Social Security Act (42 U.S.C. 1396r-5(e)) concerning notices
and fair hearings for matters relating to spousal impoverishment.
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-200903259
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
DIVISION 6. BUDGETING FOR ELIGIBILITY
AND CO-PAYMENT
1 TAC 358.431 - 358.441
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.
358.433. Special Income Limit.
The Texas Health and Human Services Commission uses a special in-
come limit to determine income eligibility under circumstances estab-
lished 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 cou-
ple 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
(ii) receive a level of care or medical necessity de-
termination that qualifies the person or couple for Medicaid; or
(B) must be approved by a Texas health and human ser-
vices agency to receive services under a 1915(c) waiver program and
receive the services within one month after approval.
(2) The 30 consecutive days described in paragraph (1)(A)
of this section are not disrupted if the person:
(A) makes a three-day therapeutic home visit with a
planned return to the facility;(B) is admitted to a hospital with a planned return to the
facility; or
(C) moves from a facility described in paragraph
(1)(A)(i) of this section:
(i) to a 1915(c) waiver program; or
(ii) to another Medicaid-certified facility.
(3) If a person dies before meeting the 30-consecutive-day
requirement without moving to a noninstitutional setting, the person is
considered to have met the requirement for application of the special
income limit.
358.435. Noninstitutional Eligibility Budgets.
(a) Scope. The Texas Health and Human Services Commis-
sion (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 fed-
erally mandated Medicaid-funded program for the elderly and people
with disabilities as described in 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.
(b) Individual budget. In preparing an eligibility budget for a
person who meets the criteria in 358.434(a) of this division (relating
to Budget Types for a Noninstitutional Setting), HHSC:
(1) counts the person's income in accordance with 1612
of the Social Security Act (42 U.S.C. 1382a);
(2) counts the person's resources in accordance with 1613
of the Social Security Act (42 U.S.C. 1382b);
(3) applies the individual resource limit in accordance with
20 CFR 416.1205; and
(4) applies the appropriate income limit, effective the
month of eligibility determination, as follows:
(A) for a person who meets the criterion in subsection
(a)(1) or (2) of this section, the income limit is the full individual Sup-
plemental Security Income (SSI) federal benefit rate; and
(B) for a person who meets the criterion in subsection
(a)(3) of this section, the income limit is the special income limit based
on 300 percent of the full individual SSI federal benefit rate.
(c) Couple budget. In preparing an eligibility budget for a cou-
ple who meets the criteria in 358.434(b) of this division, HHSC:
(1) counts the income of both spouses in accordance with
1612 of the Social Security Act;
(2) counts the resources of both spouses in accordance with
1613 of the Social Security Act;
(3) applies the couple resource limit in accordance with 20
CFR 416.1205; and
(4) applies the appropriate income limit, effective the
month of eligibility determination, as follows:
(A) for a couple who meets the criterion in subsection
(a)(1) or (2) of this section, the income limit is the full couple SSI
federal benefit rate; andADOPTED RULES August 14, 2009
34 TexReg 5515
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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/m1/68/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.