SECTION 380.201. Eligibility

(a) The following prior authorized Medical Transportation Program (MTP) clients are eligible to receive reasonable transportation to covered health care services if no other means of transportation are available, the mode of transportation is the most cost-effective mode available, and the facility is reasonably close and meets the client's health care needs:

(1) current Medicaid clients authorized and identified by the Health and Human Services Commission (HHSC) as eligible for Medicaid services under a specific category;

(2) Children with Special Health Care Needs (CSHCN) services program clients; and

(3) Transportation for Indigent Cancer Patients (TICP) Program clients.

(b) Eligibility for participation in the TICP Program must be determined by HHSC. The individual:

(1) must reside in Webb, Zapata, Starr, Jim Hogg, Hidalgo, Cameron, Willacy, or Nueces County and provide a copy of a federal or state ID (driver's license or identification card) and one of the following as proof of residency:

(A) a copy of a utility bill under the applicant's name; or

(B) if residing with a family member, a written verification from that family member stating that the applicant resides in the household and proof that the household is in an eligible county;

(2) must not be eligible for Medicaid;

(3) must not be eligible for CSHCN services program;

(4) must be at or below 100% of federal poverty guidelines. Before program services are provided, the monthly household gross income shall be verified by:

(A) financial information obtained through HHSC;

(B) check stub or other written verification for each person in the household who is employed. This form must contain the name, address of employer, income and dates covered for each pay period; or

(C) award letter or other written verification of unearned income (such as Social Security, Worker's Compensation, Unemployment or Veteran's Administration benefits);

(5) is permitted the following allowable deductions from the total monthly household gross income:

(A) $120 standard deduction per person in household who is employed (the standard deduction per person will be the rate set by HHSC); and

(B) dependent care:

(i) up to $200 per child under two years of age; or

(ii) up to $175 per child two years of age and older;

(6) is not permitted to take deductions on unearned income;

(7) if over the age of 18 and residing with a family member, the family member's household income is not considered. The applicant's gross income, less standard deductions, is used to determine the applicant's eligibility;

(8) has zero income and shall therefore submit written verification from two family members or individuals who can attest that the household receives no monthly earned or unearned income. Unearned income refers to monetary assistance provided by family, friends, charitable organizations, and such given to the client for household expenses;

(9) must provide initial confirmation of cancer or cancer-related diagnosis by a licensed medical physician to HHSC. The following restrictions apply:

(A) the applicant is eligible for up to four diagnostic visits to a licensed medical physician to determine cancer or cancer-related diagnosis if HHSC is provided written verification that diagnostic visits are to rule out the possibility of cancer or cancer-related illness; and

(B) confirmation of cancer or cancer-related diagnosis must be provided on or following the last diagnostic visit for transportation services to continue; and

(10) must be accepted for evaluation or treatment by a medical institution in Texas capable of providing quality cancer services.

Source Note: The provisions of this §380.201 adopted to be effective April 10, 2001, 26 TexReg 2720; amended to be effective May 11, 2003, 28 TexReg 3722; transferred effective March 1, 2004, as published in the Texas Register April 30, 2004, 29 TexReg 4267; amended to be effective August 6, 2013, 38 TexReg 4888; amended to be effective September 1, 2014, 39 TexReg 5731