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

Due Dates and Processing Timeframes

Within one business day of making a presumptive eligibility determination, the qualified hospital/qualified entity must submit the determination to HHSC through the Presumptive Eligibility Portal. The application for regular Medicaid must also be submitted within one business day of making the presumptive eligibility determination. The presumptive eligibility information should be viewable in the portal 24 - 48 hours after submission.

Note: The determination must be submitted through the Presumptive Eligibility Portal for the individual to be able to print a Medicaid ID card through YourTexasBenefits.com. Any delay in submission of the determination will delay the availability of the Medicaid ID card.