<<Prev Rule

Texas Administrative Code

Next Rule>>
TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 98TEXAS HIV MEDICATION PROGRAM
SUBCHAPTER CTEXAS HIV MEDICATION PROGRAM
DIVISION 1GENERAL PROVISIONS
RULE §98.109Financial Eligibility Criteria

(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 program;

  (3) meets the program's payer of last resort criteria; and

  (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

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page