§9.557: Calculation of Co-payment

(a) The method for determining an individual's or couple's co-payment is described in subsection (b) of this section and documented on HHSC's Waiver Program Co-Pay Worksheet.

(b) The co-payment amount is determined by HHSC and is the individual's or couple's remaining income after all allowable expenses have been deducted.

(1) The co-payment amount is applied only to the cost of home and community-based services funded through the TxHmL Program and specified on each individual's IPC.

(2) The co-payment must not exceed the cost of services actually delivered.

(3) The co-payment must be paid by the individual or couple, authorized representative, or trustee directly to the program provider in accordance with the HHSC determination.

(4) When calculating the co-payment amount for an individual or couple whose income exceeds the maximum personal needs allowance, the following are deducted:

(A) the personal needs allowance, which must be equivalent to 300% of the current Supplemental Security Income benefit;

(B) the cost of the maintenance needs of the individual's or couple's dependent children, which is an amount equivalent to the Temporary Assistance for Needy Families (TANF) basic monthly grant for children or a spouse with children, using the recognizable needs amounts in the TANF Budgetary Allowances Chart; and

(C) the costs incurred for medical or remedial care that are necessary but are not subject to payment by Medicare, Medicaid, or any other third party, including the cost of health insurance premiums, deductibles, and co-insurance.


Source Note: The provisions of this §9.557 adopted to be effective January 5, 2003, 27 TexReg 12254; 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