Presumptive Eligibility Policies and Procedures Handbook

Requirements for Qualified Hospitals and Qualified Entities

Qualified Hospital

To make presumptive eligibility determinations as a qualified hospital, an organization must: Qualified hospitals may designate any clinic owned by the hospital to participate in the presumptive eligibility process.

Qualified hospitals may make presumptive eligibility determinations for the following groups:
  • Children
  • Parents and caretaker relatives
  • Former foster care children
  • Pregnant women

Qualified Entity

Most qualified entities are Medicaid providers. Other types of organizations have the option to become qualified entities without becoming a Medicaid provider. The organizations that may participate as qualified entities are listed at Title 1, Texas Administrative Code (TAC), Part 15, Chapter 366, §366.251.

To be a qualified entity, an organization must fall into one of the categories above and must: