CHA News Article

DHCS Updates List of ‘Active’ Hospital Presumptive Eligibility Providers
Providers not on list encouraged to contact DHCS to check status of application

The Department of Health Care Services (DHCS) has released an updated list of “active” Hospital Presumptive Eligibility (HPE) providers. The list includes hospitals that have been approved and trained to participate in the HPE program as of Oct. 14 but does not reflect hospitals that may have applied to participate but that have not yet finalized the web-based training to become an active HPE provider. Hospitals not on the Oct. 14 list are encouraged to confirm with DHCS 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 one (providers); then choose option four (technical help desk); then choose option two (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 self-attestation of 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); and
  • Former foster care children between the ages of 18 and 26

Any hospital that is a licensed Medi-Cal provider (including an entity on the hospital’s license) may apply to participate in the HPE program. 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 review an updated list of HPE providers, visit the DHCS website. To apply to become an HPE provider, visit http://files.medi-cal.ca.gov/pubsdoco/aca/aca_HPE_landing.asp.

Resources

  • For questions about the HPE program, benefits and claims, contact the DHCS telephone service center at (800) 541-5555 (see voice menu instructions above).
  • Submit HPE application web portal and training portal problems to DHCS at CA-MMISQuestions@acs-inc.com.

To order insurance affordability applications, visit www.dhcs.ca.gov/formsandpubs/forms/Forms/MC0026.pdf.

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