Revision 09-4; Effective December 1, 2009

 

D-1100 Related Texas Administrative Code Rules

Revision 09-4; Effective December 1, 2009

 

§358.211. Aged, Blind, or Disabled.

(a) To be eligible for a Medicaid-funded program for the elderly and people with disabilities (MEPD), a person must be aged, blind, or disabled, according to the following criteria:

(1) Aged. A person must be 65 years of age or older to be considered aged, in accordance with 42 U.S.C. §1382c(a)(1)(A).

(2) Blind.

(A) To be considered blind for eligibility purposes, a person must meet the criteria in 42 U.S.C. §1382c(a)(2).

(B) There is no minimum age requirement for a person who is blind.

(C) A person must have a medical determination of blindness before the Texas Health and Human Services Commission (HHSC) can determine eligibility.

(3) Disabled.

(A) To be considered disabled for eligibility purposes, a person must meet the criteria in 42 U.S.C. §1382c(a)(3).

(B) There is no minimum age requirement for a person who is disabled, unless the person lives in an institution for mental diseases as described in §358.213 of this subchapter (relating to Resident of an Institution for Mental Diseases).

(C) A person must have a medical determination of a disability before HHSC can determine eligibility.

(b) A person under 65 years of age who has applied for Supplemental Security Income, and subsequently applies for retroactive coverage, must have a medical determination of blindness or a disability effective during any month of coverage that the person was under 65 years of age.

 

D-1200 Age

Revision 09-4; Effective December 1, 2009

 

In determining age for aged, blind, or disabled individuals, the age is reached the day before the anniversary of birth. This affects the month a disability determination is required for persons born on the first day of the month. Example: The person turns 65 on Jan. 1, and is eligible for Medicare Dec. 1, before the person’s 65th birthday in January. If the person meets all other eligibility criteria, the person can be certified for benefits for December without a disability decision.

Determine a person's age by the person’s statement on the application. Compare the reported information with Social Security Administration records using systems in place to exchange or request data. Other acceptable evidence includes such readily available sources as:

  • insurance policies;
  • family Bible;
  • marriage record;
  • child's birth certificate;
  • hospital admission record;
  • driver's license;
  • hunting license;
  • fishing license; or
  • voter registration card.

 

D-1210 Definition of a Child

Revision 09-4; Effective December 1, 2009

 

A child is neither married nor a head of a household and is either:

  • under age 18; or
  • under age 22 and a student regularly attending school, college or training that is designed to prepare him/her for a paying job.

Child status ceases effective with the month after the month of attainment of age 22 (age 18, if not a student) or the month after the month the person last meets the definition of child.

SSI policy defines full-time student as an individual attending at least:

  • 12 hours per week if in high school or under;
  • 12 hours per week if in a technical or vocational school (shop practice is not included in the course);
  • 15 hours per week if in a technical or vocational school (shop practice is included in the course); or
  • eight hours per week per semester if in a college or university.

A student is deemed to be in regular school attendance during normal vacation periods if he attends regularly during the month immediately following the vacation period. A person may be considered a full-time student without attending the required number of hours per week, if the person is disabled and physically unable to attend full-time, has difficulty obtaining transportation or is taking all that is needed to complete the person's education.

The age requirements involved in identifying a child apply only to a person who is otherwise eligible. A blind or disabled applicant who meets these age requirements, however, can become eligible for Medicaid, even though the person does not meet the definition of a child.

 

D-1300 Blindness

Revision 09-4; Effective December 1, 2009

 

In determining blindness for aged, blind or disabled individuals, blindness is met if a person is considered “legally blind” as defined by the Social Security Administration. Based on a medical determination of blindness, a person is considered blind if the visual acuity in the person's better eye is 20/200 or less with corrective lenses, or if the person has tunnel vision that limits the field of vision to 20 degrees or less.

 

D-1400 Disability

Revision 09-4; Effective December 1, 2009

 

In determining disability for aged, blind or disabled individuals, disability is met if the person is considered disabled as defined by the Social Security Administration. Based on a medical determination of disability, a person is considered disabled if the person is unable to engage in any substantial, gainful activity because of a medically determinable physical or mental impairment that can be expected to result in death or has continued or can be expected to continue for at least 12 months. A child who is not engaged in substantial, gainful activity is considered disabled if the child suffers from any medically determinable physical or mental impairment of comparable severity to that which would preclude an adult from engaging in substantial, gainful activity.

Note: A person who lives in an institution for mental diseases (IMD) must be 65 years of age or older to be eligible for an MEPD program. Do not establish a medical determination for blindness or disability for a person who lives in an IMD who is less than 65 years old.