| (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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