The Texas Health and Human Services Commission uses a special income limit to determine income eligibility under circumstances established in this section. The special income limit for a person is equal to or less than 300 percent of the full individual Supplemental Security Income (SSI) federal benefit rate. The special income limit for a couple is twice the special income limit for an individual. (1) To qualify for the special income limit, a person or couple must have countable income that exceeds the reduced SSI federal benefit rate; and: (A) must: (i) reside in: (I) a Medicaid-certified long-term care facility for 30 consecutive days; or (II) a Medicaid-certified institution for mental diseases for 30 consecutive days, if the person is 65 years of age or older; and (ii) receive a level of care or medical necessity determination that qualifies the person or couple for Medicaid; or (B) must be approved by a Texas health and human services agency to receive services under a §1915(c) waiver program and receive the services within one month after approval. (2) The 30 consecutive days described in paragraph (1)(A) of this section are not disrupted if the person: (A) makes a three-day therapeutic home visit with a planned return to the facility; (B) is admitted to a hospital with a planned return to the facility; or (C) moves from a facility described in paragraph (1)(A)(i) of this section: (i) to a §1915(c) waiver program; or (ii) to another Medicaid-certified facility. (3) If a person dies before meeting the 30-consecutive-day requirement without moving to a noninstitutional setting, the person is considered to have met the requirement for application of the special income limit. |
