|(a) A person is financially eligible for the program
if he or she:
(1) is not covered for approved program medication(s)
under the Texas Medicaid Program, or has exhausted Medicaid pharmacy
benefits for the given month;
(2) does not qualify for assistance or receives less
than full coverage for approved program medication(s) under any State
compensation program or under any other state or federal health benefits
(3) meets the program's payer of last resort criteria;
(4) has an annual gross income (minus the adjustments
described in subsection (b) of this section) that does not exceed
200% of the most recently published federal poverty income guidelines.
(b) Formula for adjusting annual gross income.
(1) An applicant's annual gross income (if single),
or the combined annual gross income of the applicant and his or her
spouse, minus the program's annualized cost of the prescribed medication(s).
(2) For a minor child, the (combined) annual gross
income of the child's parent(s), minus the program's annualized cost
of the prescribed medication(s). Only the income of the parent(s)
living in the same household as the child at the time of application
or recertification will be used to determine financial eligibility.
(3) For an emancipated minor, financial eligibility
is determined as set forth in paragraph (1) of this subsection.
(c) The department shall periodically verify the financial
status of a recipient to determine if the recipient continues to meet
the financial eligibility criteria of the program.
|Source Note: The provisions of this §98.109 adopted to be effective August 28, 2003, 28 TexReg 6855; amended to be effective December 16, 2007, 32 TexReg 9128; amended to be effective November 20, 2013, 38 TexReg 8244