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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
Qualification Process
Hospitals and entities must complete the qualification process to make presumptive eligibility determinations. Hospitals and entities interested in becoming qualified can find information on and initiate the qualification process on the Presumptive Eligibility website.
In general, the following must occur for a hospital or entity to be considered qualified:
Submit a Qualified Hospital/Qualified Entity Presumptive Eligibility Notice of Intent to HHSC through the Presumptive Eligibility website.
HHSC must verify that the hospital/entity is a Medicaid provider.
The Memorandum of understanding (MOU) must be signed, first by the hospital/entity and then by HHSC.
HHSC provides access to training.
Once the hospital/entity has successfully completed training, HHSC provides systems logins and qualified hospital/entity can submit Medicaid presumptive eligibility determinations.