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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.4 Presumptive Eligibility (PE) : 4.4.4.1 PE Medicaid Identification

4.4.4.1
PE indicates clients with presumptive eligibility. PE clients may be identified by visiting the Your Texas Benefits Medicaid card web site at www.YourTexasBenefitsCard.com. Medicaid coverage for PE continues through the last day of the month indicated on the Your Texas Benefits Medicaid card web site. The Your Texas Benefits Medicaid card website at will indicate that Medicaid-covered services during the PE period do not include labor, delivery, inpatient services and THSteps medical and dental services. The PE ID indicates eligibility for limited Medicaid services during the PE period (e.g., eye exams, eyeglasses, hearing aids, and family planning services).
A woman who is certified for regular Medicaid receives the regular Your Texas Benefits Medicaid card. Other family members who are determined to be eligible for Medicaid receive a separate Your Texas Benefits Medicaid card from the one issued to the pregnant woman.
Claims filing procedures for clients with PE are the same as those for all clients with Medicaid.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.