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RULE §98.105Eligibility Determination Process

(a) New applicants to THMP. An individual meeting the eligibility requirements must submit a complete application for benefits to THMP, in the format specified by THMP, certifying that the statements made within the application are factual and true, submitted as instructed, and accompanied by the required supporting documentation. To request an application packet, please follow current procedures on THMP's webpage found at www.dshs.texas.gov/hivstd/meds.

(b) Renewals. An individual must renew enrollment in THMP according to the procedures established by THMP. An individual must demonstrate continuing eligibility using THMP's renewal application and comply with all associated deadlines and requirements for accompanying documents.

(c) Eligibility Determination.

  (1) Approved. If approved, the applicant is eligible for THMP services.

  (2) Incomplete. Any application that does not meet all requirements of this section is considered incomplete. Incomplete applications are not processed further, and the applicant is contacted concerning the insufficiency of the application.

  (3) Pending. THMP may, at the time of application and at any time during enrollment, verify the eligibility status of an enrolled individual to determine if the individual is continuing to meet the eligibility criteria of THMP. The individual must furnish requested documentation to THMP as directed. Until this is completed, the status of enrollment is considered pending.

  (4) Denial, non-renewal, and termination of benefits. An individual may be denied enrollment, be denied renewal, or have enrollment in THMP terminated for any of the following reasons:

    (A) failure to maintain Texas residency, or upon request, furnish evidence of such;

    (B) failure to continue to meet income requirements for eligibility or to provide income data as requested, as THMP shall periodically verify the financial status of an enrolled individual to determine if the individual continues to meet financial eligibility criteria;

    (C) failure to initially meet or continue to meet the medical requirements for eligibility;

    (D) become eligible for the full-LIS under Medicare Part D;

    (E) become incarcerated in a city, county, state, or federal jail or prison, in accordance with Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87), Health Resources and Services Administration (HRSA) Policy Clarification Notice (PCN) #18-02, and Texas Code of Criminal Procedure Article §104.002(a);

    (F) admitted or committed to a Texas state hospital or state supported living facility;

    (G) determined by THMP that the individual has made a material misstatement or misrepresentation on the individual's application or any document required to support the individual's application or renewal, or on submissions made to comply with subsection (a) or (b) of this section;

    (H) failure to notify THMP of changes to permanent home address or insurance coverage;

    (I) notified THMP in writing that the individual no longer wants to receive THMP benefits;

    (J) failure to request or use services during any period of six consecutive months; or

    (K) exhausted THMP program funds.

(d) Denial, modification, suspension, or termination of services. An applicant or individual is governed by the procedures required by §98.106 of this title (relating to Appeal Process and Exceptions).

Source Note: The provisions of this §98.105 adopted to be effective November 17, 2022, 47 TexReg 7557

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