| (a) Individuals and eligible couples determined to
be financially eligible based on the special institutional income
limit may be required to share in the cost of HCS Program services.
The method for determining the individual's or couple's co-payment
is described in subsections (b) and (c) of this section and documented
on the HHSC Waiver Program Co-Pay Worksheet.
(b) The co-payment amount as determined by HHSC is
the individual's or couple's remaining income after all allowable
expenses have been deducted. The co-payment amount is applied only
to the cost of HCS Program services specified on each individual's
IPC. The co-payment must not exceed the cost of services actually
delivered. The co-payment must be paid by the individual or couple,
authorized representative, or trustee directly to the program provider
in accordance with the HHSC determination. When calculating the co-payment
amount for an individual or a couple whose income exceeds the maximum
personal needs allowance, the following are deducted:
(1) the cost of the individual's or couple's maintenance
needs, which must be equivalent to the special institutional income
limit for eligibility under the Texas Medicaid program;
(2) the cost of the maintenance needs of the individual's
or couple's dependent children, which is an amount equivalent to the
TANF basic monthly grant for children or a spouse with children, using
the recognizable needs amounts in the TANF Budgetary Allowances Chart;
and
(3) the costs incurred for medical or remedial care
that are necessary but are not subject to payment by Medicare, Medicaid,
or any other third party, which include the costs of health insurance
premiums, deductibles, and co-insurance.
(c) When calculating the co-payment amount for individuals
with community spouses, HHSC determines the amount of the recipient's
income applicable to payment in accordance with §1924 of the
Social Security Act and 42 CFR §435.726.
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