25 Tex. Admin. Code § 98.103 - THMP Eligibility Criteria

(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.

Notes

25 Tex. Admin. Code § 98.103

The provisions of this §98.103 adopted to be effective February 4, 1999, 24 TexReg 567; amended to be effective August 28, 2003, 28 TexReg 6855; amended to be effective December 16, 2007, 32 TexReg 9128; amended to be effective November 20, 2013, 38 TexReg 8244; Amended by Texas Register, Volume 43, Number 38, September 21, 2018, TexReg 6286, eff. 9/24/2018; Adopted by Texas Register, Volume 47, Number 45, November 11, 2022, TexReg 7558, eff. 11/17/2022