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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.4 Presumptive Eligibility : Process
A qualified provider designated by HHSC requests that the pregnant woman complete a Medicaid application form. The qualified provider determines eligibility for PE coverage based on verification of pregnancy and a determination that the family’s income is at or below the current Medicaid limit for pregnant women.
The same application used to determine the woman’s PE is forwarded to the local HHSC office for determination of regular Medicaid coverage for the pregnant woman and any other household members. The pregnant woman must follow through with the regular Medicaid application process and be eligible under those requirements to continue receiving Medicaid.
The period of PE begins on the date the qualified provider makes the determination and ends when HHSC makes the final Medicaid determination.

Texas Medicaid & Healthcare Partnership
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