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
Universal Citation: 1 TX Admin Code ยง 358.435
Current through Reg. 49, No. 38; September 20, 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.
(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
(RSA
1382a);
(2) counts the person's resources in
accordance with §1613 of the Social Security Act (RSA
1382b);
(3) applies the individual resource limit in
accordance with
RSA
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 Supplemental 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 couple 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
RSA
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; and
(B)
for a couple who meets the criterion in subsection (a)(3) of this section, the
income limit is twice the special income limit based on 300 percent of the full
individual SSI federal benefit rate.
(d) Companion budget. In preparing an eligibility budget for a person who meets the criteria in §358.434(c) 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) deems the ineligible
spouse's income and resources;
(4)
applies the couple resource limit in accordance with
RSA
416.1205; and
(5) 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 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.
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