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Table of Contents
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Overview
Definitions
Qualification and Requirements (
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Requirements
Qualification Process
Notice of Intent
Medicaid Provider
Memorandum of Understanding
Training
Conflict of Interest
Steps to Complete PE Determinations
Due Dates
Eligibility Policy (
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)
Groups Eligible for PE
Citizenship and Immigration Status
Residence
Household Composition
Income
Periods of PE
Current Medicaid Recipients
Verification
Eligibility Dates
Systems Support
Case Example
Forms
Presumptive Eligibility Policies and Procedures Handbook
Definitions
Qualified hospital (QH):
A hospital that is a Medicaid provider, notifies HHSC of its election to make presumptive eligibility determinations, and agrees to make determinations for children, pregnant women, parents and caretaker relatives, and former foster care children according to HHSC policies and procedures.
Qualified entity (QE):
An organization that notifies HHSC of its election to make presumptive eligibility determinations and agrees to make determinations for pregnant women only according to HHSC policies and procedures.
Presumptive eligibility:
Process that allows qualified hospitals and qualified entities to determine if an individual can get Short-term Medicaid.
Presumptive eligibility determination:
Qualified hospital or entity decision that an individual meets the criteria for Short-term Medicaid. The QH/QE then enters the individual's demographic information and the type of Medicaid the person is eligible for into the portal.
Presumptive Eligibility Portal:
HHSC-run portal where QH/QE staff submits determinations, view limited Medicaid history, view determinations submitted by their location, and link those determinations with the application for regular Medicaid.
Third-party entity (contractor):
An organization, also known as a contractor, employed by a qualified hospital or entity to help with business processes. A third-party entity or contractor is assigned the role of QHQE Resource in the PE process. They can assist the QH/QE in the PE process, but cannot make final PE determinations.
YourTexasBenefits.com:
Website where applications for regular Medicaid and Children's Health Insurance Program (CHIP) are submitted to HHSC. Individuals may also view their account status on this website.
Presumptive Eligibility website:
Website where qualified hospitals and entities:
Submit notices of intent to participate in the program
Submit an electronic Memorandum of Understanding
Access training and policy
Receive ongoing communications from HHSC