SECTION 366.811. Application Processing

(a) HHSC processes Medically Needy Program applications received electronically, by paper, or by telephone.

(b) HHSC allows any office of a state health and human services agency to accept an initial application.

(c) HHSC contracts with third parties to accept applications from hospital districts (including state-owned teaching hospitals), federally qualified health centers, and county health departments.

(d) HHSC may conduct an interview with an initial applicant.

(e) HHSC reopens a denied initial application, so long as the applicant complies with the missed requirements within 60 days after the date the application was submitted. HHSC otherwise requires the applicant to file a new application.

(f) HHSC reconsiders the eligibility of a recipient who is terminated for failure to submit a renewal form or necessary information, so long as the recipient complies with the missed requirements within 90 days after the date of termination. HHSC otherwise requires the recipient to file a new application.

(g) HHSC may reopen an application for three months prior coverage if:

(1) within two years after the application was filed, the applicant requests that the application be reopened; and

(2) a Medicaid eligibility determination was not previously made for the three-month prior period.

(h) For a pregnant applicant who is potentially eligible but unable to provide proof of eligibility, HHSC:

(1) postpones verifications and provides Medicaid coverage to ensure access to medical care within 30 days after the application date;

(2) continues the coverage of women who provide postponed verifications by the 30th day after the application date; and

(3) denies the coverage of those who fail to meet the 30-day deadline.

(i) There are no conditions limiting the designation of an authorized representative.

Source Note: The provisions of this §366.811 adopted to be effective January 1, 2014, 38 TexReg 9467; amended to be effective June 1, 2014, 39 TexReg 3981