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This version of the form is not currently in use and is provided for reference only. Download this version of
Form H1265
for the current year.
Form H1265 Presumptive Eligibility (Pe) Worksheet - Texas
What Is Form H1265?
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form H1265?
A: Form H1265 is the Presumptive Eligibility (PE) Worksheet used in Texas.
Q: What is Presumptive Eligibility (PE)?
A: Presumptive Eligibility (PE) is a temporary Medicaid coverage that allows certain qualified individuals to receive immediate healthcare services while their full Medicaid application is being processed.
Q: Who can use Form H1265?
A: Qualified healthcare providers can use Form H1265 to determine if an individual is eligible for Presumptive Eligibility (PE) in Texas.
Q: How is Form H1265 used?
A: Form H1265 is completed by the healthcare provider to gather information about an individual's income, household size, and other relevant details to determine their eligibility for Presumptive Eligibility (PE).
Form Details:
- Released on February 1, 2015;
- The latest edition provided by the Texas Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form H1265 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
Download Form H1265 Presumptive Eligibility (Pe) Worksheet - Texas
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