CHA News Article

DHCS Implements Hospital Presumptive Eligibility Program
Releases Provider Election Form and Agreement

 The California Department of Health Care Services (DHCS) has released the Hospital Presumptive Eligibility (PE) Program Provider Election Form and Agreement. This agreement will allow hospitals to notify DHCS of their intention to participate in the hospital PE program. A copy of the agreement is attached.

Under the hospital PE program, hospitals will have a unique opportunity to use presumptive eligibility to provide temporary, full-scope Medi-Cal benefits for up to two months to individuals newly eligible for Medi- Cal under the Affordable Care Act (restricted scope Medi-Cal benefits for pregnant women). The presumptive eligibility determination will be based on income, household size and state residency. In order to participate, hospitals must do the following:

  • Agree to the program requirements as prescribed in the agreement;
  • Complete, sign and return the agreement to DHCS; and
  • Complete the hospital PE training program (an online training environment that hospitals will be able to access after they submit the agreement to DHCS).

Please note that the Hospital PE Program Provider Election Form and Agreement has not yet been approved by the Centers for Medicare & Medicaid Services (CMS).  To the extent that CMS requires changes to the agreement, hospitals will be required to submit a new agreement to DHCS in order to continue participating in the hospital PE program.

For more information about the hospital PE program, please visit the DHCS website. Additional inquiries regarding the Hospital PE Program Provider Election Form and Agreement, or questions about the hospital PE program may be submitted to DHCS at .

CHA News will resume its regular publishing schedule Monday, January 6.