1. (a) The following prior authorized Medical Transportation Program (MTP) recipients are eligible to receive reasonable transportation to health care services if medical necessity exists, no other means of transportation are available, the mode of transportation is the most cost-effective mode available that does not endanger the recipient's health and the facility is reasonably close to the prior authorized health care service that meets the recipient's health care needs:

   1. (1) current Medicaid recipients authorized and identified by the Health and Human Services Commission (HHSC) as eligible for Medicaid services under a specific category;
   2. (2) Children with Special Health Care Needs (CSHCN) recipients; and
   3. (3) Transportation for Indigent Cancer Patients (TICP) Program recipients.

2. (b) To be eligible for participation in the TICP Program, the individual:

   1. (1) must reside in Webb, Zapata, Starr, Jim Hogg, Hidalgo, Cameron, Willacy, or Nueces County and provide a copy of a federal or state ID (driver's license or identification card) and one of the following as proof of residency:

      1. (A) a copy of a utility bill under the applicant's name; or
      2. (B) if residing with a family member, a written verification from that family member stating that the applicant resides in the household and proof that household is in an eligible county;
   2. (2) must not be eligible for Medicaid;
   3. (3) must not be eligible for CSHCN-CIDC;

   4. (4) must be medically indigent (at or below 100% of federal poverty guidelines). Before program services are provided, the monthly household gross income shall be verified by:

      1. (A) financial information obtained through HHSC;
      2. (B) check stub or other written verification for each person in the household who is employed. This form must contain the name, address of employer, income and dates covered for each pay period; or
      3. (C) award letter or other written verification of unearned income (such as Social Security, Worker's Compensation, Unemployment or Veteran's Administration benefits);

   5. (5) is permitted the following allowable deductions from the total monthly household gross income:

      1. (A) $120 standard deduction per person in household who is employed (the standard deduction per person will be the rate set by HHSC); and

      2. (B) dependent care:

         1. (i) up to $200 per child under 2 years of age; or
         2. (ii) up to $175 per child 2 years of age and older;
   6. (6) is not permitted to take deductions on unearned income;
   7. (7) if over the age of 18 and residing with a family member, the family member's household income is not considered. The applicant's gross income, less standard deductions, is used to determine the applicant's eligibility;
   8. (8) has zero income and shall therefore submit written verification from two family members or individuals who can attest that the household receives no monthly earned or unearned income. Unearned income refers to monetary assistance provided by family, friends, charitable organizations, and such given to the recipient for household expenses;

   9. (9) must provide initial confirmation of cancer or cancer-related diagnosis by a licensed medical physician. The following restrictions apply:

      1. (A) the applicant is eligible for up to 4 diagnostic visits to a licensed medical physician to determine cancer or cancer-related diagnosis if HHSC is provided written verification that diagnostic visits are to rule out the possibility of cancer or cancer-related illness; and
      2. (B) confirmation of cancer or cancer-related diagnosis must be provided on or following the last diagnostic visit for MTP services to continue; and
   10. (10) must be accepted for evaluation or treatment by a medical institution in Texas capable of providing quality cancer services.

Source Note:The provisions of this §380.201 adopted to be effective April 10, 2001, 26 TexReg 2720; amended to be effective May 11, 2003, 28 TexReg 3722; transferred effective March 1, 2004, as published in the Texas Register April 30, 2004, 29 TexReg 4267; amended to be effective August 6, 2013, 38 TexReg 4888.