Medicaid Presumptive Eligibility

Medicaid Presumptive Eligibility (PE) is a process that allows qualified hospitals (QH) and other qualified entities (QE) to determine if a Medicaid-eligible person can get short-term Medicaid. The Affordable Care Act (ACA) requires states to allow QH/QE groups that have gone through the qualification process to make PE determinations consistent with HHSC policies and procedures.

The QH or QE will provide the person with the Short-term Medicaid Notice (HHS Form H1266) if the person is determined to be presumptively eligible. The person may present the pharmacy with this form. This form is not a substitute for the Medicaid Eligibility Verification (Form 1027-A) or the Your Texas Benefits Medicaid card. In order for a person to receive pharmacy benefits after receiving a Form H1266, the person should:

• Request a Medicaid Eligibility Verification (Form 1027-A) at an HHSC benefits office, or
• Print a Medicaid card at YourTexasBenefits.com.

To learn more about presumptive eligibility please visit TexasPresumptiveEligibility.com.