1. (a) Eligibility for Residential Care (RC) is based on the following criteria.

   1. (1) The person must be income eligible or Medicaid-eligible, not in an institution.
   2. (2) The person must meet the functional need criteria as set by HHSC. HHSC uses a standardized assessment instrument to measure the person's ability to perform activities of daily living. This yields a score, which is a measure of the person's level of functional need. HHSC sets the minimum required score for a person to receive RC, which HHSC may periodically adjust commensurate with available funding. HHSC will seek stakeholder input before making any change in the minimum required score for functional eligibility.
   3. (3) The person's needs may not exceed the facility's capability under its licensed authority.
   4. (4) The person must have financial resources at or below the level established by HHSC.

2. (b) The client must contribute to the total cost of the care that the client receives, including payment for room and board. The room and board amount is calculated from the client's gross income. The client is responsible for paying this amount directly to the provider agency. The client may be required to pay a copayment based on the amount of income remaining after all allowances are deducted.

   1. (1) The client keeps a monthly allowance for the client's personal and medical expenses. The Medicaid client keeps $123; a qualified Medicare beneficiary, non-Medicaid, keeps $182; and the non-Medicaid, non-QMB client keeps $211 and the part B Medicare premium fee.
   2. (2) In addition to the monthly allowance, a client with earned income keeps all of the earned income up to a maximum of $65 per month.
   3. (3) The client's contribution must not, when added to HHSC's payment, exceed the rate established for residential care.
3. (c) The client is eligible for 14 days of personal leave from the residential care facility each calendar year. If the client does not pay the bedhold charge for days of personal leave that exceed the limits, the client may lose their space in the facility.
4. (d) To reserve the client's space in the facility during hospital, nursing home, or institutional stays, the client must pay the copayment or the facility's bedhold charge, whichever is lower. If the copayment amount is less than the bedhold charge, HHSC pays the difference. Nursing home and institutional stays are limited to 30 days. There is no limit to the length of hospital stays.

Source Note:The provisions of this §271.85 adopted to be effective December 5, 1986, 11 TexReg 4755; amended to be effective April 15, 1990, 15 TexReg 1070; amended to be effective January 1, 1992, 16 TexReg 6860; amended to be effective March 15, 1999, 24 TexReg 1193; amended to be effective September 1, 2003, 28 TexReg 6951; amended to be effective August 31, 2004, 29 TexReg 8376; transferred effective September 15, 2023, as published in the August 18, 2023, issue of the Texas Register, 48 TexReg 4523; amended to be effective September 10, 2025, 50 TexReg 5936.