| (a) Criteria. A female is eligible to receive services
through HTW if she:
(1) meets the following age requirements:
(A) is 18 through 44 years of age, inclusive; or
(B) is 15 through 17 years of age, inclusive, and has
a parent or legal guardian apply, renew, and report changes to her
case on her behalf;
(2) is not pregnant;
(3) has countable income (as calculated under §382.11
of this subchapter (relating to Financial Eligibility Requirements)
that does not exceed 200 percent of the federal poverty level;
(4) is a United States citizen, a United States national,
or an alien who qualifies under §382.9(g) of this subchapter
(relating to Application and Renewal Procedures);
(5) resides in Texas;
(6) does not currently receive benefits through a Medicaid
program, Children's Health Insurance Program, or Medicare Part A or
B; and
(7) does not have creditable health coverage that covers
the services HTW provides, except as specified in subsection (c) of
this section.
(b) Age. For purposes of subsection (a)(1)(A) of this
section, an applicant is considered 18 years of age on the day of
her 18th birthday and 44 years of age through the last day of the
month of her 45th birthday. For purposes of subsection (a)(1)(B) of
this section, an applicant is considered 15 years of age the first
day of the month of her 15th birthday and 17 years of age through
the day before her 18th birthday. A female is ineligible for HTW if
her application is received the month before her 15th birthday or
the month after she turns 45 years of age.
(c) Third-party resources. An applicant with creditable
health coverage that would pay for all or part of the costs of covered
services may be eligible to receive covered services if she affirms,
in a manner satisfactory to HHSC, her belief that a party may retaliate
against her or cause physical or emotional harm if she assists HHSC
(by providing information or by any other means) in pursuing claims
against that third party. An applicant with such creditable health
coverage who does not comply with this requirement is ineligible to
receive HTW benefits.
(d) Period of eligibility. A client is deemed eligible
to receive covered services for 12 continuous months after her application
is approved, unless:
(1) the client dies;
(2) the client voluntarily withdraws;
(3) the client no longer satisfies criteria set out
in subsection (a) of this section;
(4) state law no longer allows the female to be covered;
or
(5) HHSC determines the client provided information
affecting her eligibility that was false at the time of application.
(e) Transfer of eligibility. A female who received
services through the Texas Women's Health Program is automatically
enrolled as an HTW client and is eligible to receive covered services
for as long as she would have been eligible for the Texas Women's
Health Program.
(f) Auto-Enrollment. A female who is receiving Medicaid
for pregnant women is enrolled into HTW at the end of her Medicaid
for pregnant women certification period. Program coverage begins on
the first day following the termination of her Medicaid coverage.
A female enrolled into HTW has the option to opt out of receiving
HTW. To be auto-enrolled, a female must:
(1) be 18 to 44 years of age, inclusive, as defined
in subsection (b) of this section;
(2) not be receiving active third-party resources at
the time of auto-enrollment; and
(3) be ineligible for any other Medicaid or CHIP program.
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