Presumptive Eligibility for Pregnant Women
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Welcome to the Presumptive Eligibility (PE) for pregnant women web site. This site provides access to information and forms related to PE for pregnant women.
The PE for pregnant women program allows Qualified Providers (QP) to grant immediate, temporary Medi-Cal coverage for ambulatory prenatal care and prescription drugs for conditions related to pregnancy to low-income, pregnant patients, pending their formal Medi-Cal application.
Information For Women Interested In This Program
The PE for pregnant women program is designed for low-income California residents who believe they are pregnant and who do not have health insurance or Medi-Cal coverage for prenatal care.
Information For Providers
A Qualified Provider is allowed to grant immediate, temporary Medi-Cal coverage and care to pregnant patients pending their formal Medi-Cal application.
Changes were made to the Presumptive Eligibility (PE) for Pregnant Women program. Revisions to the program’s application, supplemental forms and manual are in review. These changes are immediately applicable to women seeking PE for Pregnant Women program eligibility.
Applicants can have Other Health Insurance.
The question on the MC 263 PE for Pregnancy - Application for Presumptive Eligibility Only page will only ask if the applicant has Medi-Cal.
Medical verification of pregnancy is not necessary.
The MC 263 - PE for Pregnancy Provider Instructions, number 5 will not require the provider to ask for medical verification of pregnancy for purposes of enrollment into the PE for Pregnant Women program. The provider may conduct a pregnancy test only if the beneficiary request one.
Proof of a full Medi-Cal application is not needed to get PE extensions. Self-attestation is accepted.
Providers should accept the beneficiary’s self-attestation that she has submitted an application for Medi-Cal or insurance affordability programs. Qualified providers should extend the PE coverage until a full eligibility determination is made.
Do not count child support or cash gifts as income in determining eligibility.
Providers shall disregard child support income or cash gifts in determining household income.
The Federal Poverty Level (FPL) has increased.
The FPL for the PE for Pregnant Women program is 213%. You can obtain the new FPL on the PE for Pregnant Women program website at http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_currentQP.aspx
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