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Revision 26-2; Effective Sept. 1, 2026
Grantees must determine and document PHC eligibility before rendering services. Grantees must have a policy that outlines the procedures to determine program eligibility and the staff member(s) responsible for eligibility screening.
To assess eligibility for PHC, grantees must use the most recent version of Form 3029, Application for Program Benefits, or an HHSC-approved eligibility screening form substitute, such as in-house form, electronic form or phone interview that contains the required information for determining eligibility.
Alternate Eligibility Screening Tool
An Alternate Eligibility Screening Tool (AEST), created by the grantee may be used in place of Form 3029 with prior written approval by the PHC program.
To apply for approval, grantees must send a request to the PHC program mailbox with AEST Request in the subject line.
The HHSC PHC program contact will send grantees an AEST Request Form to complete. Grantees must complete the form and return it to the program mailbox with the proposed AEST.
The AEST must contain all required elements of Form 3029
HHSC must review and approve before use. Grantees must use Form 3029 until they have received written approval of the proposed AEST from HHSC. The grantee must maintain and retain proof of approval and must make the approval available during Quality Assurance visits.
Once a grantee receives approval for the use of the AEST, the following requirements apply:
- Grantees must request approval from the PHC program for any revisions to their eligibility screening tool and include a copy of the revised tool.
- The AEST is only approved for use during the current grant term. If a grantee is awarded funding under a subsequent grant, the grantee must resubmit the AEST for review and written approval, even if no changes have been made to the tool since the last written approval.
- Any changes made to Form 3029 that are considered requirements for eligibility by HHSC must be incorporated into the grantee-developed AEST. Grantees must submit their AEST with the incorporated changes within 60 calendar days after notification of a change to Form 3029 for rereview and approval.
The PHC program reserves the right to request edits or withdraw its approval of the use of an alternate eligibility tool. The PHC program will notify the grantee of the decision in writing and include the date the AEST must be discontinued.