Texas § GV.542.0116 - RECIPIENT ENROLLMENT, PARTICIPATION, AND ELIGIBILITY

§ GV.542.0116. RECIPIENT ENROLLMENT, PARTICIPATION, AND ELIGIBILITY

RECIPIENT ENROLLMENT, PARTICIPATION, AND ELIGIBILITY. (a) The commission, in collaboration with the advisory committee and pilot program work group, shall develop pilot program participant eligibility criteria. The criteria must ensure that pilot program participants: (1) include individuals with an intellectual or developmental disability or a cognitive disability, including: (A) individuals with autism; (B) individuals with significant complex behavioral, medical, and physical needs who are receiving home and community-based services through the STAR+PLUS Medicaid managed care program; (C) individuals enrolled in the STAR+PLUS Medicaid managed care program who: (i) are on a Medicaid waiver program interest list; (ii) meet the criteria for an intellectual or developmental disability; or (iii) have a traumatic brain injury that occurred after the age of 21; and (D) other individuals with disabilities who have similar functional needs without regard to the age of onset or diagnosis; and (2) do not include individuals who are receiving only acute care services under the STAR+PLUS Medicaid managed care program and are enrolled in the community-based ICF-IID program or another Medicaid waiver program. (b) An individual who is eligible to participate in the pilot program will be enrolled automatically. The decision to opt out of participating may be made only by the individual or the individual's legally authorized representative. (c) Before implementing the pilot program, the commission, in collaboration with the advisory committee and pilot program work group, shall develop and implement a process to ensure that pilot program participants remain eligible for Medicaid for 12 consecutive months during the pilot program. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.