Presumptive Eligibility Policies and Procedures Handbook

Table of Contents
(Print Current Section)

Requirements for Qualified Hospitals and Qualified Entities

Qualified Hospital

To make presumptive eligibility determinations as a qualified hospital, an organization must:

Be a hospital
Be a Medicaid provider
Submit a Notice of Intent (NOI)
Agree to make presumptive eligibility determinations in accordance with HHSC policies and procedures
Sign a Memorandum of Understanding (MOU)
Have staff complete required training

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:

Submit a Notice of Intent (NOI).
Agree to make presumptive eligibility determinations in accordance with HHSC policies and procedures.
Sign a Memorandum of Understanding (MOU).
Have staff complete required training.