CHA News Article

DHCS Issues List of Approved Hospital Presumptive Eligibility Providers

The Department of Health Care Services (DHCS) has released a list of approved Hospital Presumptive Eligibility (HPE) providers. The list includes the names of the  hospitals that have been approved to participate in the HPE program but does not reflect the actual number of hospitals actively processing HPE applications, which − according to DHCS − is much lower (98 hospitals). DHCS reports that the discrepancy between the number of hospitals approved to participate in the HPE program and those actively processing HPE applications is related to hospitals not finalizing the web-based training to become an active HPE provider.

Hospitals are encouraged to confirm that their hospital is an active HPE provider ­ − including that their contract has been approved by DHCS and that their staff have completed the web-based training − by contacting the DHCS Telephone Service Center at (800) 541-5555, Monday – Friday, between 8 a.m. and 5 p.m. (PT). When calling, follow these phone prompts: first, choose option 1 (providers); then choose option 4 (technical help desk); then choose option 2 (hospital presumptive eligibility).

The HPE program is a vital tool, under the Affordable Care Act, for hospitals to provide individuals potentially eligible for Medi-Cal with temporary, full-scope Medi-Cal benefits for up to two months (restricted scope Medi-Cal benefits for pregnant women). The HPE determination is conducted in real-time and is based on income, household size and state residency. Those potentially eligible for HPE benefits are:

  • Children (ages 0-18)
  • Parents and caretaker relatives
  • Pregnant women
  • “New adults” (ages 19-64, not pregnant, not on Medicare and not eligible for any other mandatory group)
  • Former foster care children between the ages of 18 and 26

Any hospital that participates as a provider under the Medicaid state plan or a Medicaid 1115 Demonstration may apply to participate in the HPE program, including an entity on the hospital’s license. To become an HPE provider, hospitals must:

  • Agree to the program requirements as prescribed in the HPE Program Provider Election Form and Agreement (see link below);
  • Complete, sign and return the agreement to DHCS; and
  • Complete the HPE training program (online training that hospitals will be able to access after they submit the agreement to DHCS).

To apply to become an HPE provider, visit http://files.medi-cal.ca.gov/pubsdoco/aca/aca_HPE_landing.asp.

As of April 12, DHCS reports the following data:

  • Total hospital contracts received: 338
    • Hospital contracts approved: 182
    • Hospital contracts denied for more information: 156
    • Hospitals actively processing HPE: 98
  • Total HPE transactions submitted to DHCS: 45,059
    • Patients approved for HPE: 34,879
    • Patients denied for HPE: 6,038
    • Patients rejected for HPE due to incomplete information provided: 4,142

Inquiries regarding the HPE program may be directed to DHCSHospitalPE@dhcs.ca.gov.

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