| (a) The department shall give priority to participation
in THMP to eligible women and infants and to individuals younger than
18 years of age as specified in 42 U.S.C. 300ff-21, and Texas Health
and Safety Code §85.062.
(b) An individual is eligible to participate in THMP
if the individual meets the following eligibility criteria:
(1) provides proof of diagnosis of HIV;
(2) is under the care of a physician, physician's assistant,
or advanced practice nurse licensed to practice in the United States;
(3) is a Texas resident; and
(4) is at or below 200% of the federal poverty level
and meets the financial eligibility criteria established by THMP Policy
220.001 https://www.dshs.texas.gov/hivstd/policy/policies/220-001.shtm;
and:
(A) is not covered for approved THMP medications under
the Texas Medicaid Program, or has exhausted Medicaid pharmacy benefits
for the given month;
(B) does not qualify for assistance, receives less
than full coverage, or needs assistance with out-of-pocket costs for
approved THMP medications under any state compensation program, qualifying
private health insurance policy, or under any other state or federal
health benefits program;
(C) meets THMP's payor of last resort criteria that
is in accordance with state law, department policy, and corresponding
federal grant conditions, in which Ryan White HIV/AIDS Treatment Extension
Act of 2009 (Public Law 111-87) (RWHAP) or State Services funds cannot
be used as a payment source for any service that can be paid for or
charged to any other billable source, and providers are expected to
make reasonable efforts to secure other funding instead of RWHAP Part
B or State Services funding, whenever possible; and
(D) has an annual income that meets guidance as determined
by:
(i) an applicant's annual gross income (if single),
or the combined annual gross income of the applicant and the applicant's
spouse, minus a standard deduction applied in accordance with program
policy;
(ii) for a minor child, the (combined) annual gross
income of the child's parent or parents, minus a standard deduction,
and only the income of the parent or parents living in the same household
as the child at the time of application or renewal is used to determine
financial eligibility; and
(iii) for an emancipated minor, financial eligibility
is determined as set forth in this paragraph.
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