Presumptive Eligibility Policies and Procedures Handbook

Table of Contents
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Overview
Definitions
Qualification and Requirements (+)
Conflict of Interest
Steps to Complete PE Determinations
Due Dates
Eligibility Policy (+)
Eligibility Dates
Systems Support
Case Example
Forms

Overview

Presumptive eligibility is a process that allows qualified hospitals and qualified entities to determine if an individual can get Short-term Medicaid. It provides individuals with Medicaid coverage while HHSC processes their application for regular Medicaid.

You can find information here on the:

Qualification requirements and process for hospitals and entities
Steps for completing presumptive eligibility determinations
Eligibility policies and forms

Presumptive eligibility for Medicaid for Breast and Cervical Cancer (MBCC) is a separate process with additional requirements and is not included.