Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - HEMOPHILIA ASSISTANCE PROGRAM
Section 354.5 - Program Eligibility
Universal Citation: 26 TX Admin Code ยง 354.5
Current through Reg. 49, No. 38; September 20, 2024
(a) Client Requirements. In order to be determined eligible for program benefits, applicants must meet the medical, age, residency, financial, and other criteria in this section, and submit a complete application for program benefits.
(1) Medical criteria. A physician must
certify that the applicant has a diagnosis of hemophilia.
(2) Age. The applicant must be 18 years of
age or older.
(3) Residency. The
applicant must be a Texas resident.
(4) Financial criteria. Financial criteria
are determined at least annually or as directed by the program. Financial
criteria are based upon the determinations of income and family size. Income
must be at or below 200% of the FPL.
(5) Other criteria. The applicant must not be
eligible for Medicaid or the Children's Health Insurance Program (CHIP). The
program may require an applicant currently not enrolled in Medicaid, Medicare,
CHIP, SSDI, or the CSHCN Services Program to apply for any of these applicable
programs when the applicant's age, income, or medical disability determination
meets the eligibility criteria for any of these programs and, if eligible, to
participate in those programs.
(6)
Health Insurance. All health insurance coverage insuring the applicant must be
attested to on the application. Noncompliance with this requirement may result
in the termination of program benefits.
(A)
The program may require an applicant currently not enrolled in a health
insurance plan to apply for an available insurance plan that is accessible and
provides comprehensive coverage. The program may provide program benefits for
ongoing clients during insurance application, enrollment, or limited or
excluded coverage periods.
(B)
Before canceling, terminating, or discontinuing existing health insurance or
electing not to enroll in available health insurance, the client, or person who
has a legal responsibility for the client, must notify the program 30 days
prior to cancellation, termination, discontinuance, or end of the enrollment
period, whenever possible.
(7) Application.
(A) To be considered by the program, a
complete application must be made on forms required by the department. The
application must have the signature or mark of the applicant, or the
applicant's legally authorized representative, and the physician's
signature.
(B) The program will
make the determination of an applicant's eligibility using the information
provided with the application. The program will verify information on the
application, including required documentation of diagnosis, income, attestation
of other coverage, date of birth, and residency.
(C) The program may request additional
documentation to verify information provided by the applicant to establish
eligibility. The program will notify the applicant, or the applicant's legally
authorized representative, in writing when specific documentation is required.
It is the responsibility of the applicant, or the applicant's legally
authorized representative, to provide the required documentation.
(D) The program will determine eligibility
when a completed application is received.
(8) Eligibility Date. The effective date of
eligibility for program benefits is the date of receipt of a complete, approved
application.
(9) Program
Termination. If program coverage is terminated, the eligibility date for any
subsequent eligibility period will be the date on which the program receives a
subsequent completed application for program benefits.
(b) Determination of continuing eligibility for program benefits. Income criteria, residency, and attestation of other coverage must be documented annually or as directed by the program for the recertification of program eligibility and benefits.
(1) Clients are notified of program deadlines
for recertification of eligibility.
(2) If an ongoing client does not meet
program deadlines for submitting information required for the determination of
continuing eligibility, the client's eligibility for the program will
end.
(3) If a former client
re-applies to the program, a new medical certification is not required, and
their new eligibility date is determined to be the date the completed
application is received.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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