| (a) HTW Program Criteria. A female applicant is eligible
for the HTW program if she:
(1) meets the following age requirements:
(A) is 18 through 44 years of age; or
(B) is 15 through 17 years of age and has a parent
or legal guardian apply, renew, and report changes to her case on
her behalf;
(2) is not pregnant;
(3) meets the income eligibility requirements for the
HTW program as determined by HHSC in accordance with Chapter 366 Subchapter
K of this title (relating to Modified Adjusted Gross Income Methodology)
and her household income is equal to or less than 204.2 percent of
the federal poverty level;
(4) is a:
(A) United States citizen;
(B) a United States national; or
(C) an alien who qualifies under §366.513 of this
title (relating to Citizenship);
(5) resides in Texas;
(6) does not currently receive benefits through another
Medicaid program, CHIP, or Medicare Part A or B; and
(7) does not have creditable health coverage that covers
the services provided in the HTW program, except as specified in subsection
(f) of this section.
(b) HTW Plus Criteria.
(1) A client in the HTW program may also qualify to
receive HTW Plus covered services if the client:
(A) meets the criteria in subsection (a) of this section;
and
(B) has been pregnant within the past 12 months.
(2) HTW Plus services are available to a client for
a period of not more than 12 months after the date of enrollment in
the HTW program.
(c) Age.
(1) For purposes of subsection (a)(1)(A) of this section,
a female 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.
(2) For purposes of subsection (a)(1)(B) of this section,
a female 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.
(3) A female applicant is ineligible for the HTW program
if her application is received the month before her 15th birthday
or the month after she turns 45 years of age.
(d) Period of eligibility. A client is deemed eligible
to receive covered services for 12 continuous months from the earliest
day of the application month on which the female applicant meets all
eligibility criteria, 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 client to be covered;
or
(5) HHSC determines the client provided information
affecting her eligibility that was false at the time of application.
(e) Automatic Eligibility Determination.
(1) A client who is receiving Medicaid or CHIP is automatically
tested for eligibility for the HTW program at the end of her Medicaid
or CHIP certification period if she is not eligible for another Medicaid
program or CHIP.
(2) Program coverage begins on the first day following
the termination of her Medicaid or CHIP coverage.
(3) A client enrolled in the HTW program may opt out
of the HTW program.
(f) Third party resources. All female applicants eligible
for the HTW program must comply with §354.2313 of this title
(relating to Duty of Applicant or Recipient to Inform and Cooperate).
A female applicant with creditable health coverage or other third
party resources that would pay for all or part of the costs of covered
services may affirm, in a manner satisfactory to HHSC, her belief
that someone 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 resource. A female
applicant with such creditable health coverage who does not comply
with §354.2313 of this title is ineligible to receive HTW benefits.
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