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Information for Qualified Providers for the PE Program

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If you are already a Qualified Provider (PE) for the Presumptive Eligibility for Pregnant Women program you will be able to access useful information to you from this website.  If you can't find the information you need, please call the PE Support Unit at 1-800-824-0088.

What's New?

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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MC 263 - PE For Pregnancy Application Changes

The Presumptive Eligibility (PE) for Pregnancy application package, MC 263 and all supplemental forms used to enroll patients into the program have been revised.  The old MC 263 applications are still valid and should continue to be submitted until they are gone. Do not destroy old forms. Providers should order the new MC 263 forms only after the old supply is depleted.

How to Order New Forms:

All orders must be on the MC 285 (09/2011) revised order form. To avoid common delays, please fill out the form completely.  You must include the following information:

1. The entire NPI number (all 10 digits)
2. PE provider number (One letter followed by three numbers, i.e; A123)
3. County number (two digits)

If you do not have the above information, please request it by contacting the PE for Pregnant Women Program Unit by fax at 916 440-5666 or email at PE@dhcs.ca.gov before ordering.

Fax or email completed order forms to (916) 364-6612 or medpublicationorders@maximus.com.  

New Option For Qualified Providers:

As a qualified provider, you now have the option of assisting your patients in submitting the short Medi-Cal application included in the MC 263 PE for Pregnancy application package.  As a new option, you can now fax the Medi-Cal application directly to the county Medi-Cal office. Please note the phone numbers provided below are for the PE for Pregnancy application package ONLY.

County PE only - FAX numbers <Attention: Do Not Use This Number To Fax Other Items To Any County>

Last modified on: 5/7/2014 2:19 PM