Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
Subchapter B - PRESUMPTIVE MEDICAID FOR PREGNANT WOMEN PROGRAM
Division 1 - GENERAL
Section 366.201 - Purpose and Scope

Universal Citation: 1 TX Admin Code ยง 366.201

Current through Reg. 49, No. 38; September 20, 2024

(a) This subchapter establishes the criteria:

(1) for a pregnant woman, a child under the age of 19, a parent or caretaker relative, or a former foster care child to receive medical care under the Presumptive Medicaid Program; and

(2) for a qualified hospital or qualified entity as defined in §366.203 of this division (relating to Definitions) to provide services under the Presumptive Medicaid Program.

(b) In accordance with RSA 435.1102 and § RSA 435.1103, the Presumptive Medicaid Program provides medical coverage as described in subsection (c) of this section, for a limited time, to individuals whose presumptive eligibility has been determined by a qualified hospital or qualified entity. The Texas Health and Human Services Commission administers the program through qualified hospitals and qualified entities , as provided in § RSA 366.251 of this subchapter (relating to Qualified Hospital and Qualified Entity Eligibility Requirements).

(c) In accordance with RSA 435.1102 and § RSA 435.1103, the Presumptive Medicaid Program provides partial or full Medicaid coverage for a limited time.

(1) For pregnant women, the Presumptive Medicaid Program covers all medically necessary services, except labor, delivery, inpatient services, and Texas Health Steps services; and

(2) For children under the age of 19, parents and caretaker relatives, and former foster care children, the Presumptive Medicaid Program provides full Medicaid coverage.

(d) Nothing in this subchapter shall be construed to violate RSA 1396 (gg)(2), which requires states to retain eligibility standards, methodologies, or procedures that were in effect on March 23, 2010.

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