Presumptive Eligibility Policies and Procedures Handbook

Periods of Presumptive Eligibility

For children, parents and caretaker relatives, and former foster care children, an individual is allowed no more than one period of presumptive eligibility per two calendar years, 24 months (January - December). For example, if an individual received Short-term Medicaid anytime in 2015, they are ineligible for a presumptive eligibility determination until the year 2017. Pregnant women are allowed one presumptive eligibility period per pregnancy. This means a woman applying for Pregnant Women Presumptive could potentially receive presumptive eligibility more frequently than once per two calendar years. If a woman is now applying for Presumptive Eligibility as a child, parent or caretaker relative, or a former foster care child, and received Presumptive Eligibility as a pregnant woman, do not count her receipt of Presumptive Eligibility as a pregnant woman as a period of Presumptive Eligibility. Note: Check the Presumptive Eligibility Portal to determine if individuals received a presumptive eligibility determination within two calendar years or within the same pregnancy for pregnant women.

Three Months Prior Coverage

Eligibility for three months prior Medicaid will be determined when HHSC eligibility staff makes the determination for regular Medicaid.