Hospital Presumptive Eligibility (HPE) Program
Back to Medi-Cal Eligibility
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.
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.
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.
To obtain coverage prior to the HPE start date, individuals must apply for full scope Medi-Cal and mark the box that indicates the individual has medical expenses in the last three months and needs help to pay.
Inquiries regarding the HPE Program may be directed to: DHCSHospitalPE@dhcs.ca.gov
Providers & Partners
HPE Provider Lists
To apply for HPE benefits, an individual must visit a hospital that is a qualified HPE Provider. The Qualified HPE Providers list is below. Providers, if your hospital is not listed and it should, please call (916) 552-9467.
If you have any questions, please call the Telephone Service Center: 1-800-541-5555 (outside of California, please call 916-636-1980)
(Monday - Friday, 8:00 A.M. to 5:00 P.M.)
- Option 1: for Provider
- Option 2: for Hospital Presumptive Eligibility
- Option 3: for the Technical Help Desk
Last modified on:
5/6/2016 8:48 AM