| (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.
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