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TITLE 1 - ADMINISTRATION
PART 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER H - MEDICALLY NEEDY PROGRAM
SECTION/RULE §366.811 - Application Processing
Chapter Review Date 08/23/2024

(a) HHSC processes Medically Needy Program applications received electronically, by paper, or by telephone.(b) HHSC allows any office of a state health and human services agency to accept an initial application.(c) HHSC contracts with third parties to accept applications from hospital districts (including state-owned teaching hospitals), federally qualified health centers, and county health departments.(d) HHSC may conduct an interview with an initial applicant.(e) HHSC reopens a denied initial application, so long as the applicant complies with the missed requirements within 60 days after the date the application was submitted. HHSC otherwise requires the applicant to file a new application.(f) HHSC reconsiders the eligibility of a recipient who is terminated for failure to submit a renewal form or necessary information, so long as the recipient complies with the missed requirements within 90 days after the date of termination. HHSC otherwise requires the recipient to file a new application.(g) HHSC may reopen an application for three months prior coverage if:(1) within two years after the application was filed, the applicant requests that the application be reopened; and(2) a Medicaid eligibility determination was not previously made for the three-month prior period.(h) For a pregnant applicant who is potentially eligible but unable to provide proof of eligibility, HHSC:(1) postpones verifications and provides Medicaid coverage to ensure access to medical care within 30 days after the application date;(2) continues the coverage of women who provide postponed verifications by the 30th day after the application date; and(3) denies the coverage of those who fail to meet the 30-day deadline.(i) There are no conditions limiting the designation of an authorized representative.

Source Note: The provisions of this §366.811 adopted to be effective January 1, 2014, 38 TexReg 9467; amended to be effective June 1, 2014, 39 TexReg 3981.

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