SECTION 366.215. Application Requirements and Processing

(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.

Source Note: The provisions of this §366.215 adopted to be effective June 9, 2010, 35 TexReg 4661; amended to be effective January 18, 2015, 40 TexReg 31