TITLE 1. ADMINISTRATION
PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 358. MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES
SUBCHAPTER
D.
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §358.540, concerning Medical Effective Date.
BACKGROUND AND PURPOSE
The proposal is necessary to comply with federal requirements. Federal regulations at 42 CFR §435.926 require HHSC to provide 12 months of continuous Medicaid coverage for all children under 19 years of age, regardless of most changes in family income or circumstance.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §358.540 adds new subsection (c) to align HHSC policy with 42 CFR §435.926 requirements. Proposed subsection (c) provides newborns and all recipients under 19 years of age receiving Medicaid, continuous eligibility for 12 months, regardless of changes in family income or circumstances. Proposed subsection (c) establishes when the 12 months of continuous eligibility begins and ends for a newborn and recipients under 19 years of age.
FISCAL NOTE
Trey Wood, Chief Financial and Operations Officer, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.
GOVERNMENT GROWTH IMPACT STATEMENT
HHSC has determined that during the first five years that the rule will be in effect:
(1) the proposed rule will not create or eliminate a government program;
(2) implementation of the proposed rule will not affect the number of HHSC employee positions;
(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;
(4) the proposed rule will not affect fees paid to HHSC;
(5) the proposed rule will create a new regulation;
(6) the proposed rule will not expand, limit or repeal an existing regulation;
(7) the proposed rule will not change the number of individuals subject to the rule; and
(8) the proposed rule will not affect the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS
Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the proposed rules do not apply to small businesses, micro-businesses, or rural communities.
LOCAL EMPLOYMENT IMPACT
The proposed rule will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons; is amended to reduce the burden or responsibilities imposed on regulated persons by the rule; and is necessary to receive a source of federal funds or comply with federal law.
PUBLIC BENEFIT AND COSTS
Molly Regan, Chief of Family Resources and Eligibility Services, has determined that for each year of the first five years the rule is in effect, the public benefit will be extending continuous 12-month coverage for Medicaid eligible children 19 years and younger regardless of most changes in circumstance.
Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because there are no requirements to alter current business practices and there are no new fees or costs imposed on those required to comply.
TAKINGS IMPACT ASSESSMENT
HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
PUBLIC COMMENT
Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.
To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 25R048" in the subject line.
STATUTORY AUTHORITY
The amendment is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §32.021, which requires the executive commissioner to adopt rules related to the administration of Medicaid.
The amendment affects Texas Government Code §524.0151.
§
358.540.
(a) If a person is eligible for a Medicaid-funded program for the elderly and people with disabilities (MEPD), the Texas Health and Human Services Commission (HHSC) includes in the notice of eligibility the date that the person's Medicaid benefits will begin, which is known as the medical effective date.
(b) HHSC determines the medical effective date:
(1) in accordance with 42 CFR §435.914, as the first day of the month in which a person meets all eligibility criteria, which may be up to three months before the date of application if:
(A) during the three months before the month of application, the person received MEPD services covered under the Texas State Plan for Medical Assistance; and
(B) would have been eligible for MEPD at the time the services were received if the person had applied (or someone had applied on behalf of the person), regardless of whether the person is alive when application for MEPD is made; or
(2) as approved by the Centers for Medicare and Medicaid Services for a §1915(c) waiver program.
(c) HHSC provides a continuous eligibility period of 12 months, regardless of changes in family income or circumstances:
(1) beginning on a newborn's Medicaid eligibility effective date to the last day of the month of the newborn's first birthday; and
(2) for recipients under 19 years of age:
(A) beginning with the recipient's Medicaid eligibility effective date, or the date of the most recent renewal or redetermination of eligibility; and
(B) ending on the last day of the month of the 12-month certification period or the recipient's 19th birthday, whichever is sooner.
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on June 22, 2026.
TRD-202602525
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: August 2, 2026
For further information, please call: (512) 354-9912
CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §366.527, concerning Medicaid Eligibility Effective Date; and §366.711, concerning Application Processing.
BACKGROUND AND PURPOSE
The proposal is necessary to comply with federal requirements. Federal regulations at 42 CFR §435.926 require HHSC to provide 12 months of continuous Medicaid coverage for all children under 19 years of age, regardless of most changes in family income or circumstance.
Additionally, 42 CFR §435.907(e)(1) only permits states to request information from an applicant that is necessary to make an eligibility determination. HHSC current policy requires an interview with an initial applicant for the Medicaid for Parents and Caretaker Relatives Program. The proposed amendment to §366.711 removes this requirement.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §366.527 aligns HHSC policy with 42 CFR §435.926 requirements by reformatting the rule to add new subsection (b). Proposed new subsection (b) provides newborns and all recipients under 19 years of age receiving Medicaid, continuous eligibility for 12 months. Proposed new subsection (b) establishes when the 12 months of continuous eligibility begins and ends for a newborn and recipients under 19 years of age.
The proposed amendment to §366.711 removes subsection (d) to align HHSC policy with 42 CFR §435.907(e)(1). As amended, HHSC will no longer require an interview with an initial or renewal application for Medicaid for Parents and Caretaker Relatives benefits. The proposed amendment renumbers the remaining subsections in the rule.
FISCAL NOTE
Trey Wood, Chief Financial and Operations Officer, has determined that for each year of the first five years that the rules will be in effect, there will be an estimated additional cost to state government as a result of enforcing and administering the rules as proposed. Enforcing and administering the rules does not have foreseeable implications relating to costs or revenues of local governments.
The effect on state government for each year of the first five years the proposed rules are in effect is an estimated cost of $52,769 in State funds and $103,260 in Federal funds in fiscal year (FY) 2025, $0.00 in FY 2026, $0.00 in FY 2027, $0.00 in FY 2028, and $0.00 in FY 2029.
GOVERNMENT GROWTH IMPACT STATEMENT
HHSC has determined that during the first five years that the rule will be in effect:
(1) the proposed rules will not create or eliminate a government program;
(2) implementation of the proposed rules will not affect the number of HHSC employee positions;
(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;
(4) the proposed rules will not affect fees paid to HHSC;
(5) the proposed rules will create a new regulation;
(6) the proposed rules will repeal an existing regulation;
(7) the proposed rules will not change the number of individuals subject to the rule; and
(8) the proposed rules will not affect the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS
Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the proposed rules do not apply to small businesses, micro-businesses, or rural communities.
LOCAL EMPLOYMENT IMPACT
The proposed rules will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does not apply to these rules because the rules do not impose a cost on regulated persons; is amended to reduce the burden or responsibilities imposed on regulated persons by the rules; and is necessary to receive a source of federal funds or comply with federal law.
PUBLIC BENEFIT AND COSTS
Molly Regan, Chief of Family Resources and Eligibility Services, has determined that for each year of the first five years the rules are in effect, the public benefit will be extending continuous 12-month coverage for Medicaid eligible children 19 years and younger regardless of most changes in circumstance, and streamlining the process for applicants of Medicaid for Parents and Caretaker Relatives by removing the interview requirement will potentially increase access to health care for adults.
Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because there are no requirements to alter current business practices and there are no new fees or costs imposed on those required to comply.
TAKINGS IMPACT ASSESSMENT
HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
PUBLIC COMMENT
Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.
To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 25R048" in the subject line.
SUBCHAPTER
E.
STATUTORY AUTHORITY
The amendment is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §32.021, which requires the executive commissioner to adopt rules related to the administration of Medicaid.
The amendment affects Texas Government Code §524.0151.
§
366.527.
(a) HHSC determines the Medicaid eligibility effective date for an applicant as follows. [:]
(1) Medicaid coverage begins on the earliest day of the application month on which the applicant meets all eligibility criteria.
(2) Retroactive coverage may begin as early as three months before the application month, except that a newborn's coverage begins no earlier than the child's date of birth.
[(3) A recipient is continuously eligible for Medicaid for six months or through the month of the recipient's 19th birthday, whichever is earlier. A recipient who is a newborn has continuous eligibility through the month of his or her first birthday. If the applicant is eligible in the application or process month, the child is eligible for continuous coverage beginning the first month the applicant meets the eligibility criteria.]
(b) HHSC provides a continuous eligibility period of 12 months, regardless of changes in family income or circumstances:
(1) beginning on a newborn's Medicaid eligibility effective date to the last day of the month of the newborn's first birthday; and
(2) for recipients under 19 years of age:
(A) beginning with the recipient's Medicaid eligibility effective date, or the date of the most recent renewal or redetermination of eligibility; and
(B) ending on the last day of the month of the 12-month certification period or the recipient's 19th birthday, whichever is sooner.
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on June 22, 2026.
TRD-202602526
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: August 2, 2026
For further information, please call: (512) 354-9912
SUBCHAPTER
G.
STATUTORY AUTHORITY
The amendment is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §32.021, which requires the executive commissioner to adopt rules related to the administration of Medicaid.
The amendment affects Texas Government Code §524.0151.
§
366.711.
(a) HHSC processes Medicaid for Parents and Caretaker Relatives 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 requires an interview with an initial applicant.]
(d) [(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.
(e) [(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.
(f) [(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.
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on June 22, 2026.
TRD-202602527
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: August 2, 2026
For further information, please call: (512) 354-9912
CHAPTER 370. STATE CHILDREN'S HEALTH INSURANCE PROGRAM
SUBCHAPTER
I.
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §370.807, concerning Determination of Household Composition.
BACKGROUND AND PURPOSE
The purpose of the proposed amendment to §370.807(h) is to accurately describe the population of persons referred to in the rule by replacing "pregnant individual" with "pregnant woman."
The proposed amendment is also necessary to use the same terminology, "pregnant woman," used in 1 TAC §366.1107, Determination of Household Composition, related to Pregnant Women's Medicaid, and in 42 CFR §435.603(b) in the definition of "family size" related to determining the family size of a pregnant woman.
FISCAL NOTE
Trey Wood, Chief Financial and Operations Officer, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.
GOVERNMENT GROWTH IMPACT STATEMENT
HHSC has determined that during the first five years that the rule will be in effect:
(1) the proposed rule will not create or eliminate a government program;
(2) implementation of the proposed rule will not affect the number of HHSC employee positions;
(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;
(4) the proposed rule will not affect fees paid to HHSC;
(5) the proposed rule will not create a new regulation;
(6) the proposed rule will not expand, limit, or repeal existing regulation;
(7) the proposed rule will not change the number of individuals subject to the rule; and
(8) the proposed rule will not affect the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS
Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the proposed rule does not apply to small businesses, micro-businesses, or rural communities.
LOCAL EMPLOYMENT IMPACT
The proposed rule will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons; is amended to reduce the burden or responsibilities imposed on regulated persons by the rule; and is necessary to receive a source of federal funds or comply with federal law.
PUBLIC BENEFIT AND COSTS
Molly Regan, Chief of Family Resources and Eligibility Services, has determined that for each year of the first five years the rule is in effect, the public benefit will be clarity of program regulations.
Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because there are no requirements to alter current business practices and there are no new fees or costs imposed on those required to comply.
TAKINGS IMPACT ASSESSMENT
HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
PUBLIC COMMENT
Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.
To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 25R048" in the subject line.
STATUTORY AUTHORITY
The amendment is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §32.021, which requires the executive commissioner to adopt rules related to the administration of Medicaid.
The amendments affect Texas Government Code §524.0151.
§
370.807.
(a) To determine household composition, an individual is designated as:
(1) a taxpayer;
(2) a tax dependent who does not meet any exceptions;
(3) a tax dependent who meets one or more of the exceptions; or
(4) not a taxpayer or tax dependent.
(b) If the individual is a taxpayer, the following individuals are included in the taxpayer's household composition:
(1) the taxpayer;
(2) the taxpayer's spouse, if the taxpayer and the spouse live together;
(3) the taxpayer's spouse, if the taxpayer and spouse file a joint federal income tax return; and
(4) any individual the taxpayer expects to claim as a tax dependent for the taxable year in which CHIP eligibility is requested.
(c) If the individual is a tax dependent, the following individuals are included in the tax dependent's household composition:
(1) the tax dependent;
(2) the taxpayer's household claiming the tax dependent; and
(3) the tax dependent's spouse, if the tax dependent and the spouse live together.
(d) The rules in subsection (e) of this section apply to a tax dependent who:
(1) is not the taxpayer's spouse or the taxpayer's child;
(2) is a child who lives with both parents whose parents did not file a joint federal income tax return and was claimed as a tax dependent by one parent; or
(3) is a child who is claimed as a tax dependent by a non-custodial parent pursuant to 42 CFR §435.603(f)(2).
(e) The household composition of an individual who is not a taxpayer or a tax dependent includes:
(1) the individual;
(2) the individual's spouse;
(3) the individual's children; and
(4) if the individual is a child, the individual's parents and siblings.
(f) A spouse is included in an individual's household composition if living together or filing a joint federal income tax return.
(g) Subsection (c) of this section applies to an individual who is both a tax dependent and taxpayer.
(h) The number of unborn children a pregnant woman [individual] is expected to have [deliver] is counted as part of the pregnant woman's [included in the] household when determining who is in the household, as stated in [composition of that pregnant individual or an applicant under] §370.401 of this chapter (relating to Perinates).
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on June 22, 2026.
TRD-202602530
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: August 2, 2026
For further information, please call: (512) 354-9912