Presumptive Eligibility

Thank you for your interest in becoming a Qualified Hospital / Qualified Entity. What are the differences between a qualified hospital and qualified entity?

Qualified Hospitals	Qualified Entities
Qualified hospitals are Medicaid provider hospitals that go through the qualification process and agree to make presumptive eligibility determinations consistent with HHSC policies and procedures. They must meet HHSC standards.	Most qualified entities are Medicaid providers. For a full list of eligible organizations, visit Policy. Qualified entities must go through the qualification process and agree to make presumptive eligibility determinations consistent with HHSC policies and procedures.
Qualified hospitals can make Medicaid presumptive eligibility determinations for: • Pregnant women • Children under age 19 • Low income parent and caretakers • Former Foster Care Children (FFCC)	Qualified entities can make presumptive eligibility determinations only for Medicaid for pregnant women.
Qualified hospitals may allow any clinic owned by the hospital to make Medicaid presumptive eligibility determinations.

For your organization to become a qualified hospital or entity: Step 1, Notice of Intent

• Notify HHSC of intent to make presumptive eligibility determinations. The Notice Of Intent must be submitted electronically. See the Notice Of Intent Instructions for information on how to complete the Notice of Intent. All information must be provided on the Notice of Intent so HHSC may verify status as a Medicaid provider and begin the provisioning process for provider staff.

Step 2, Memorandum of Understanding

• The Notice of Intent must identify who will be signing the Memorandum of Understanding (MOU) , including the individual's name, title, and email address. When the Notice of Intent is submitted, an email will be sent to the address with instructions and a link to sign the MOU. Once HHSC has signed the MOU, a PDF version will be available to the provider.
  Memorandum of Understanding sample for Qualified Hospitals
  Memorandum of Understanding sample for Qualified Entities

Step 3, Training

• Once the MOU is signed, provider staff whose information has been provided by the hospital or entity will get an email explaining how to complete training.

Step 4

• Once training has been completed, staff will get an email with instructions to login to the portal to submit presumptive eligibility determinations to HHSC.

For more information on how to become a qualified hospital or qualified entity visit Policy.