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Information For Women Interested In Presumptive Eligibility (PE) For Pregnant Women

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The Program

Presumptive Eligibility (PE) for Pregnant Women is a Medi-Cal program designed to provide immediate, temporary coverage for prenatal care to low-income pregnant women pending a formal Medi-Cal application.

Who is eligible?

Any woman who thinks she is pregnant and whose family income is under a certain amount is eligible for Presumptive Eligibility (PE) for Pregnant Women.  However, she must seek this care through a participating provider and they will determine if you are eligible for this program.  Ask your provider if he/she offers this coverage and how to apply.

What Kind of Prenatal Care Can I receive When Enrolled In The PE Program?

PE offers specific ambulatory (walk-in) prenatal care and prescription drugs for conditions related to pregnancy.

What care is NOT covered by the PE Program?

PE is a temporary Medi-Cal program that does not cover labor and delivery, or inpatient care.  That is why it is important for PE patients to apply for Medi-Cal on a timely basis.

Who will help me enroll in the PE program?

To find a provider who will enroll you in the PE program, ask your doctor or the perinatal coordinator at your county health department for a list of PE providers in your area.  Then contact the PE provider for an appointment to be enrolled in PE. 

What happens at the first appointment?

The PE provider will ask you to complete a Statement of California Residency and then a “Presumptive Eligibility for Pregnancy Only” application.  If you are determined eligible for PE, the provider will then complete your pregnancy test.  If your pregnancy test is negative, you will not be eligible for PE.  If your test is positive, you will be issued a temporary Medi-Cal card (paper) for PE only (up to 2 months).  This card IS NOT A MEDI-CAL CARD.  It is only for specific PE services.  The provider will complete your examination and then schedule you for your next appointment.

What next?

You must formally apply for Medi-Cal at the County Department of Social Services and provide proof of application to your PE provider before the expiration date on your temporary Medi-Cal card (paper).  The PE provider will then extend your temporary Medi-Cal card for up to 2 months.  The county will determine if you are eligible to receive Medi-Cal.  If you are determined to be eligible for Medi-Cal you will be mailed a Medi-Cal Beneficiary Identification Card.

What do I do with the Medi-Cal card when it comes in the mail?

You should notify your PE provider/Medi-Cal provider that you now have Medi-Cal.  You should stop using your temporary Medi-Cal Card (paper) and begin using your new Medi-Cal card.

What if I have more questions about the PE program?

You can contact a PE provider or contact the PE Support Unit at 1-800-824-0088

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Last modified on: 3/4/2014 4:48 PM