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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) : Services
Medicaid-covered services during the PE period are limited to medically necessary medical services provided during pregnancy and certain preventive services such as family planning.
Labor, delivery, inpatient services, and THSteps medical or dental services are not covered during the PE period. If the woman is determined eligible for regular Medicaid for the same period of time, regular Medicaid coverage overlays the PE period providing the full range of services. Client eligibility for PE coverage must be determined by a PE provider. Once eligibility is determined, services may be obtained from any enrolled Medicaid provider.

Texas Medicaid & Healthcare Partnership
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