DHCS ACWDL 14-14: Implementation of the Hospital Presumptive Eligibility (HPE) Program

This letter provides preliminary information on Hospital Presumptive Eligibility.  Effective January 1, 2014, qualified hospitals can temporarily enroll certain individuals into MAGI Medi-Cal.  Application is by one-page attestation, and qualified hospitals complete the process through online Hospital PE portal; eligibility is made in real time.

Enrollment is limited to once per 12-month period for 60 days of HPE coverage; pregnant women are permitted one HPE period per pregnancy for ambulatory prenatal services.  HPE providers are required to provide HPE individuals an insurance application prior to leaving the hospital, which must be completed no later than the end of the next month.  HPE eligible individuals will receive full-scope Medi-Cal benefits unless eligibility is based on pregnancy.