SECTION 382.7. Client Eligibility

(a) Criteria. A female is eligible to receive services through HTW if she:

(1) meets the following age requirements:

(A) is 18 through 44 years of age, inclusive; or

(B) is 15 through 17 years of age, inclusive, and has a parent or legal guardian apply, renew, and report changes to her case on her behalf;

(2) is not pregnant;

(3) has countable income (as calculated under §382.11 of this subchapter (relating to Financial Eligibility Requirements) that does not exceed 200 percent of the federal poverty level;

(4) is a United States citizen, a United States national, or an alien who qualifies under §382.9(g) of this subchapter (relating to Application and Renewal Procedures);

(5) resides in Texas;

(6) does not currently receive benefits through a Medicaid program, Children's Health Insurance Program, or Medicare Part A or B; and

(7) does not have creditable health coverage that covers the services HTW provides, except as specified in subsection (c) of this section.

(b) Age. For purposes of subsection (a)(1)(A) of this section, an applicant is considered 18 years of age on the day of her 18th birthday and 44 years of age through the last day of the month of her 45th birthday. For purposes of subsection (a)(1)(B) of this section, an applicant is considered 15 years of age the first day of the month of her 15th birthday and 17 years of age through the day before her 18th birthday. A female is ineligible for HTW if her application is received the month before her 15th birthday or the month after she turns 45 years of age.

(c) Third-party resources. An applicant with creditable health coverage that would pay for all or part of the costs of covered services may be eligible to receive covered services if she affirms, in a manner satisfactory to HHSC, her belief that a party may retaliate against her or cause physical or emotional harm if she assists HHSC (by providing information or by any other means) in pursuing claims against that third party. An applicant with such creditable health coverage who does not comply with this requirement is ineligible to receive HTW benefits.

(d) Period of eligibility. A client is deemed eligible to receive covered services for 12 continuous months after her application is approved, unless:

(1) the client dies;

(2) the client voluntarily withdraws;

(3) the client no longer satisfies criteria set out in subsection (a) of this section;

(4) state law no longer allows the female to be covered; or

(5) HHSC determines the client provided information affecting her eligibility that was false at the time of application.

(e) Transfer of eligibility. A female who received services through the Texas Women's Health Program is automatically enrolled as an HTW client and is eligible to receive covered services for as long as she would have been eligible for the Texas Women's Health Program.

(f) Auto-Enrollment. A female who is receiving Medicaid for pregnant women is enrolled into HTW at the end of her Medicaid for pregnant women certification period. Program coverage begins on the first day following the termination of her Medicaid coverage. A female enrolled into HTW has the option to opt out of receiving HTW. To be auto-enrolled, a female must:

(1) be 18 to 44 years of age, inclusive, as defined in subsection (b) of this section;

(2) not be receiving active third-party resources at the time of auto-enrollment; and

(3) be ineligible for any other Medicaid or CHIP program.

Source Note: The provisions of this §382.7 adopted to be effective July 1, 2016, 41 TexReg 4623