1. (a) In order for a person to receive oral health services, he/she must meet the following criteria:

   1. (1) The person must be a bona fide resident of Texas.

   2. (2) A bona fide resident is a person who:

      1. (A) is physically present within the geographic boundaries of the state;
      2. (B) has an intent to remain within the state, whether permanently or for an indefinite period;
      3. (C) actually maintains an abode within the state (i.e., house or apartment, not merely a post office box);
      4. (D) does not claim residency in any other state or country;
      5. (E) is a minor child residing in Texas and his/her parent(s) or managing conservator or the court-appointed guardian is a bona fide resident of Texas;
      6. (F) is a person residing in Texas who is the legal dependent spouse of a bona fide resident; or
      7. (G) is an adult residing in Texas and his/her legal guardian is a bona fide resident.

2. (b) The person must establish a financial need for program services. Financial need is established on the basis of family income, as follows:

   1. (1) the family income used to determine eligibility is the gross annual income of the applicant and his/her spouse, if applicable, or the gross annual income of person(s) legally obligated to support the applicant;
   2. (2) gross annual income includes earned wages, pensions or retirement benefits, child support payments received, alimony, unemployment compensation, worker's compensation, income from rental properties, or any monies received on a regular basis for family support purposes;
   3. (3) income guidelines are based on and may not exceed current United States Department of Agriculture (USDA) poverty guidelines for determining eligibility for free meals (school full-free lunch program guidelines); and
   4. (4) the guidelines are adopted by reference in §49.17 of this title (relating to Income Guidelines).

3. (c) Following preapproval of an application in accordance with §49.4(c)(1)-(2) of this title (relating to Application Process), an applicant will be referred to a provider for a dental examination. The following criteria apply.

   1. (1) An applicant must have a demonstrable need for emergency care, confirmed by a licensed dentist or physician to whom the applicant has been referred.
   2. (2) The licensed dentist or physician shall certify to the department that he/she has examined the individual and he/she has reason to expect that the treatment services provided will prevent or reduce the probability of the individual's experiencing pain, infection, or disease.
   3. (3) If the applicant meets the dental criteria, the provider will perform the necessary treatment services as authorized by the State Fee for Service Dental Care Program Manual for Providers of Services.
   4. (4) If the applicant does not meet the dental criteria, the provider will be paid only for the examination services provided, according to the fees authorized by the State Fee for Service Dental Care Program Manual for Providers of Services.
4. (d) Notwithstanding the provisions of subsection (c) of this section, the final determination concerning an applicant's eligibility and authorized services shall be made by the regional dental director or, in his/her absence, the state dental director.
5. (e) If the regional dental director or, in his/her absence, the state dental director, determines that an applicant meets the dental criteria and the program services delivered were authorized, the applicant's eligibility date shall be the date upon which the application was preapproved as stated in §49.4(c)(1)-(2) of this title (relating to Application Process). Eligibility will be effective for the remainder of the state fiscal year in which eligibility is established. Eligibility must be reestablished for each subsequent state fiscal year in which program services are sought. To maintain eligibility for program services, the individual must continue to be a bona fide resident of the state and be in financial need in accordance with this section.

Source Note:The provisions of this §49.5 adopted to be effective September 9, 1986, 11 TexReg 3793; amended to be effective March 23, 2003, 28 TexReg 2327.