§9.556: Eligibility Criteria

(a) An applicant or individual is eligible for the TxHmL Program if:

(1) the applicant or individual meets the financial eligibility criteria as defined in subsection (b) of this section;

(2) the applicant or individual meets the eligibility criteria for the ICF/MR LOC I as defined in §9.238 of this chapter (relating to Level of Care I Criteria) as determined by DADS according to §9.560 of this subchapter (relating to Level of Care (LOC) Determination);

(3) the applicant or individual has had a determination of mental retardation performed in accordance with state law (THSC, Chapter 593, Admission and Commitment to Mental Retardation Services, Subchapter A) or has been diagnosed by a licensed physician as having a related condition as defined in §9.203 of this chapter (relating to Definitions) before enrollment in the TxHmL Program;

(4) the applicant or individual has been assigned an LON 1, 5, 8, or 6 in accordance with §9.562 of this subchapter (relating to Level of Need (LON) Assignment);

(5) the applicant or individual has an IPC approved in accordance with §9.558 of this subchapter (relating to Individual Plan of Care (IPC));

(6) the applicant or individual is not enrolled in another waiver program under §1915(c) of the Social Security Act;

(7) the applicant or individual has chosen, or the applicant's or individual's LAR has chosen, participation in the TxHmL Program over participation in the ICF/MR Program;

(8) the applicant's or individual's service planning team concurs that the TxHmL Program services and, if applicable, non-TxHmL Program services for which the applicant or individual may be eligible are sufficient to ensure the applicant's or individual's health and welfare in the community; and

(9) the applicant or individual lives in the applicant's or individual's own home or family home.

(b) An applicant or individual is financially eligible for the TxHmL Program if the applicant or individual:

(1) is categorically eligible for Supplemental Security Income (SSI) benefits;

(2) has once been eligible for and received SSI benefits and continues to be eligible for Medicaid as a result of protective coverage mandated by federal law;

(3) is under 20 years of age and:

(A) is financially the responsibility of DFPS in whole or in part; and

(B) is being cared for in a foster home or group home:

(i) that is licensed or certified and supervised by DFPS or a licensed public or private nonprofit child placing agency; and

(ii) in which a foster parent is the primary caregiver residing in the home;

(4) is currently receiving Medicaid for Youth Transitioning Out of Foster Care (Transitional Medicaid) because the applicant or individual formerly received foster care through DFPS and was under the financial responsibility of DFPS; or

(5) is a member of a family who receives full Medicaid benefits as a result of qualifying for Temporary Assistance for Needy Families.

Comments

Source Note: The provisions of this §9.556 adopted to be effective January 5, 2003, 27 TexReg 12254; amended to be effective March 11, 2004, 29 TexReg 2317; amended to be effective August 31, 2004, 29 TexReg 8352; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective March 1, 2007, 32 TexReg 544; amended to be effective June 1, 2008, 33 TexReg 4340