Hospital Presumptive Eligibility Program
On January 1, 2014, the Hospital Presumptive Eligibility Program (HPE) was implemented. The HPE Program provides qualified individuals immediate access to temporary, no-cost Medi-Cal while applying for permanent Medi-Cal coverage or other health coverage. To qualify for HPE, individuals must meet the rules below.
- Have income below the monthly limit for household size.
- Be a California resident.
- Not already have Medi-Cal.
- If not pregnant, have not received PE Enrollment benefits from any Medi-Cal PE Program up to the maximum limitation allowed within the past 12 months of applying. If pregnant, have not had a PE Enrollment during the current pregnancy of applying.
And, be eligible in one of the following HPE groups below:
- Children under 19 years old
- Parents and Caretaker Relatives
- Pregnant Women (benefits are limited to ambulatory prenatal services.)
- Former Foster Youth between ages 18 to 26 years old, who were in foster care in any state on their 18th birthday or older. (No income limit)
- Adults between ages 19-64, not pregnant, not in Medicare, and not eligible for any group stated above.
- Adults ages 65 or older, not pregnant and not in Medicare.
To apply for HPE benefits, an individual must visit a hospital that is a qualified HPE Provider. The HPE Provider submits the individual’s information via the HPE Medi-Cal Application online portal and eligibility is determined in real-time.
Hospital Presumptive Eligibility (HPE) provides temporary full-scope Medi-Cal on a fee-for-service basis for all aid codes except HPE for Pregnancy. HPE for Pregnancy provides limited scope coverage and only covers ambulatory (walk-in), outpatient prenatal care, outpatient abortion, and prescription drugs for conditions related to pregnancy.
The HPE enrollment period begins on the date the individual is determined eligible for HPE, which is the day the HPE Medi-Cal Application is submitted via the online portal.
If you are approved for HPE, your provider must check your eligibility to know your scope of coverage. Medi-Cal may cover expenses for services you have already received if you apply for Medi-Cal and complete the enrollment process within three (3) months of receiving those services.
Inquiries regarding the HPE Program may be directed to: DHCSHospitalPE@dhcs.ca.gov
Claim address:
PO BOX 13029
SACRAMENTO, CA 95813