This section sets medical assistance application rules, including automatic eligibility for some recipients and duties for the executive commissioner and commission.
Sec. 32.025. APPLICATION FOR MEDICAL ASSISTANCE. (a) A recipient of benefits under Chapter 31 or supplemental security income from the federal government is automatically eligible for medical assistance, and an application for benefits under these programs constitutes an application for medical assistance. (b) The executive commissioner shall prescribe application forms for persons who are not recipients of benefits under Chapter 31 or supplemental security income from the federal government and shall adopt rules for processing the applications. (c) The commission shall inform applicants for nursing facility care of any community services which might be available under the community care for the aged and disabled program. (d) The executive commissioner shall adopt an application form and procedures for a request for medical assistance provided to a child under 19 years of age. To the extent allowed by federal law and except as otherwise provided by this section, the application form and procedures must be the same as the form and procedures adopted under Section 62.103, Health and Safety Code. The executive commissioner shall coordinate the form and procedures adopted under this subsection with the form and procedures adopted under Section 62.103, Health and Safety Code, to ensure that there is a single consolidated application for a child under 19 years of age to seek medical assistance or to request coverage under the state child health plan under Chapter 62, Health and Safety Code. (e) The executive commissioner shall permit an application requesting medical assistance for a child under 19 years of age to be conducted by mail instead of through a personal appearance at an office, unless the executive commissioner determines that the information needed to verify eligibility cannot be obtained in that manner. The executive commissioner by rule may develop procedures requiring an application for a child described by this subsection to be conducted through a personal interview with a commission representative only if the executive commissioner determines that information needed to verify eligibility cannot be obtained in any other manner. (f) The executive commissioner by rule may develop procedures by which: (1) any office of a health and human services agency may accept an application requesting medical assistance for a child under 19 years of age; and (2) the commission may contract with hospital districts, hospitals, including state-owned teaching hospitals, federally qualified health centers, and county health departments to accept applications requesting medical assistance for a child under 19 years of age. (g) The application form, including a renewal form, adopted under this section must include: (1) for an applicant who is pregnant, a question regarding whether the pregnancy is the woman's first gestational pregnancy; (2) for all applicants, a question regarding the applicant's preferences for being contacted by a managed care organization or health plan provider by telephone, text message, or e-mail about eligibility, enrollment, and other health care matters, including reminders for appointments and information about immunizations or well check visits; and (3) language that: (A) notifies the applicant that, if determined eligible for benefits, all preferred contact methods listed on the application and renewal forms will be shared with the applicant's managed care organization or health plan provider; (B) notifies the applicant that the applicant may opt out of being contacted by telephone, text message, or e-mail by notifying the applicant's managed care organization or health plan provider; and (C) explains the security risks of electronic communication. (h) For purposes of Subsections (g)(2) and (3), the commission shall implement a process to: (1) transmit the applicant's preferred contact methods and consent to the managed care organization or health plan provider; (2) allow an applicant to change the applicant's preferences in the future, including providing for an option to opt out of electronic communication; and (3) communicate updated information to the managed care organization or health plan provider. Acts 1979, 66th Leg., p. 2350, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979. Amended by Acts 1989, 71st Leg., ch. 1085, Sec. 5, eff. Sept. 1, 1989; Acts 2001, 77th Leg., ch. 584, Sec. 2; Acts 2003, 78th Leg., ch. 376, Sec. 2, eff. June 18, 2003; Acts 2003, 78th Leg., ch. 1251, Sec. 7, eff. June 20, 2003. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.089, eff. April 2, 2015. Acts 2017, 85th Leg., R.S., Ch. 852 (H.B. 2466), Sec. 2(a), eff. September 1, 2017. Acts 2021, 87th Leg., R.S., Ch. 622 (S.B. 1911), Sec. 1, eff. June 14, 2021. Acts 2021, 87th Leg., R.S., Ch. 624 (H.B. 4), Sec. 10, eff. June 15, 2021. Acts 2023, 88th Leg., R.S., Ch. 582 (H.B. 2802), Sec. 2, eff. September 1, 2023.