SECTION 366.201. Purpose and Scope

(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 42 C.F.R. §435.1102 and §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 §366.251 of this subchapter (relating to Qualified Hospital and Qualified Entity Eligibility Requirements).

(c) In accordance with 42 C.F.R. §435.1102 and §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 42 U.S.C. §1396(gg)(2), which requires states to retain eligibility standards, methodologies, or procedures that were in effect on March 23, 2010.

Source Note: The provisions of this §366.201 adopted to be effective June 9, 2010, 35 TexReg 4661; amended to be effective January 18, 2015, 40 TexReg 31