Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 365 - KIDNEY HEALTH CARE
Section 365.3 - Client Eligibility Requirements
Universal Citation: 26 TX Admin Code ยง 365.3
Current through Reg. 49, No. 38; September 20, 2024
(a) A person must meet all of the following requirements to be eligible for program benefits:
(1) have a diagnosis of ESRD; and
(A) require a regular course of chronic renal
dialysis treatments; or
(B) have
received a kidney transplant;
(2) satisfy the Texas residency criteria as
specified in subsection (b) of this section and not be:
(A) in the custody of or incarcerated by a
city, county, state, or federal entity; or
(B) a ward of the state;
(3) not be eligible for drug, transportation,
and medical benefits under the Texas Medicaid Program;
(4) submit a complete application for
benefits; and
(5) satisfy the
financial criteria as specified in subsection (c) of this section.
(b) Residency Requirements.
(1) The following conditions must be met by
an applicant and maintained by a client to satisfy the residency requirements
in this section:
(A) physically reside within
the state; and
(B) maintain a home
or dwelling within the state.
(2) If the applicant is residing with a
person establishing residency on behalf of the applicant (such as a parent,
legal guardian, managing conservator, sibling, adult child, or spouse), then
that person must meet all of the requirements of paragraph (1) of this
subsection.
(3) All documents
acceptable to meet residency requirements, as specified by the program, must be
in the applicant's name, or in the name of the person establishing residency
for the applicant, provide some verification of a Texas address or domicile,
and be in English or be accompanied by an accurate English
translation.
(c) Financial Criteria. The applicant or the person(s) who has a legal obligation, as defined by state law, to support the applicant must have an annual gross income of less than $60,000. Income reported as "joint income" is considered as one income.
(d) Maintenance of Benefits Eligibility.
(1) A client must meet
the following requirements within the first 3 months of program eligibility:
(A) apply for medical, drug, and
transportation benefits and Medicare Savings Plans (QMB, SLMB and QI) under
Title XIX, Social Security Act (Medicaid);
(B) apply for Medicare hospital and medical
benefits under Title XVIII, Social Security Act (Medicare);
(C) enroll in Medicare Part D benefits and
apply for Low Income Subsidy under the Medicare Prescription Drug Improvement
and Modernization Act of 2003, if Medicare eligible;
(D) provide authorization for Medicare
premium payments by the program as specified in §61.5 of
this title (relating to Benefits and Limitations), if obligated to pay the Part
A premium.
(2) A client
must meet the following requirements to continue benefit eligibility:
(A) continue premium payments to health
insurance plans under Medicare, individual or group health insurance plans, and
prepaid medical plans, where enrollment was effective prior to program
eligibility;
(B) re-apply for LIS
as required by the Social Security Administration;
(C) re-apply for Medicaid benefits as
requested by the program if there are changes in the client's status that would
make the client potentially eligible for Medicaid benefits;
(D) re-apply for Medicare hospital and
medical benefits as requested by the program if there are changes in the
client's status that would make the client potentially eligible for Medicare
benefits; and
(E) notify the
program within 30 days of changes in the following:
(i) permanent home address;
(ii) treatment status;
(iii) coverage under Medicaid, Medicare,
individual or group insurance, Veterans programs, or any other health benefits
coverage;
(iv) location of
treatment; and
(v)
income.
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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