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 2 - ELIGIBILITY REQUIREMENTS
Section 366.215 - Application Requirements and Processing

Universal Citation: 1 TX Admin Code § 366.215

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

(a) An applicant, authorized representative, or someone acting responsibly for the applicant applies for presumptive eligibility at a qualified hospital or qualified entity site.

(b) The qualified hospital or qualified entity electronically submits the presumptive eligibility determination to HHSC.

(c) The qualified hospital or qualified entity must assist the individual in submitting an electronic Medicaid application to HHSC if the individual wishes to apply for regular Medicaid.

(d) For individuals determined to be presumptively eligible, the qualified hospital or qualified entity must notify the individual in writing and orally if appropriate that if a Medicaid application:

(1) is not filed by the last day of the month following the presumptive eligibility determination, then presumptive eligibility will end on that last day; and

(2) is filed by the last day of the month following the presumptive eligibility determination, then presumptive eligibility will end on the day that a decision is made on the Medicaid application.

(e) For individuals determined not to be presumptively eligible, the qualified hospital or qualified entity must notify the individual in writing and orally if appropriate:

(1) of the reason for the determination; and

(2) that he or she may file an application for Medicaid with HHSC.

(f) A recipient is limited to:

(1) one presumptive eligibility period per pregnancy; or

(2) no more than one presumptive eligibility period within two calendar years for children under age 19, parents and caretaker relatives, and former foster care children.

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