Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 353 - MEDICAID MANAGED CARE
Subchapter L - TEXAS DUAL ELIGIBLES INTEGRATED CARE DEMONSTRATION PROJECT
Section 353.1105 - Eligibility
Universal Citation: 1 TX Admin Code ยง 353.1105
Current through Reg. 49, No. 38; September 20, 2024
(a) Enrollment in the Dual Demonstration is optional for dual eligible individuals who live in the designated counties and meet the following criteria:
(1) eligible for
STAR+PLUS, including those eligible for STAR+PLUS home and community-based
waiver services;
(2) enrolled in
Medicare Parts A, B, and D; and
(3)
age 21 or older.
(b) The following dual eligible individuals cannot participate in the Dual Demonstration:
(1) under age 21;
(2) individuals not eligible for STAR+PLUS,
including individuals:
(A) residing in an
intermediate care facility for individuals with an intellectual disability or
related conditions;
(B) receiving
services under the following Medicaid 1915(c) waivers:
(i) Home and Community-based Services
(HCS);
(ii) Community Living
Assistance and Support Services (CLASS);
(iii) Texas Home Living (TxHmL); or
(iv) Deaf Blind with Multiple Disabilities
(DBMD);
(C) not eligible
for full Medicaid benefits; or
(D)
in the conservatorship of the Texas Department of Family and Protective
Services.
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