Provider Contact Information for Presumptive Eligibility (PE)
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Instructions To Determine If Applicant Qualifies For PE Services:
- Find the PE applicant’s total family income and family size as it is stated on the Provider Use Only section of the MC 263 PE for Pregnancy - Application For Presumptive Eligibility Only.
- Compare the applicant’s income and family size to the 2011-2012 Federal Poverty Level Chart above.
- Remember: The Unborn Child is counted as a member of the family.
- A pregnant women who lives alone requests PE services. Her monthly income is $2,000. The mother and her unborn child would be counted as a two-person (2) family household. Comparing her income of $2,000 to the chart’s income for a family size of two ($2,754), she would qualify for PE services.
- A pregnant woman with two children requests PE services. Her annual income is $55,000. The mother, her unborn child, and her two children would be counted as a four-person (4) family household. Comparing her annual income of $45,000 to the chart’s annual income for a family of four ($50,162), she would not qualify for PE services. The provider should direct the patient to apply for health insurance affordability programs, including Medi-Cal, at CoveredCA.gov.
- If you have questions regarding this chart or the program, contact the PE Support Unit, California Department of Health Care Services, 1501 Capital Avenue, Bldg #171, MS-4607, Sacramento, CA 95814, 1-800-824-0088, Fax 1-800-409-1498 or 916-440-5660.
For Presumptive Eligibility Providers
Other Important PE Contacts
PE Billing questions:
- HP Enterprises OB Hotline - 1(800) 257-6900
- Medi-Cal Provider Enrollment - (916) 323-1945
- Medi-Cal Provider Updates - 1(800) 541-5555
- PE Training - 1 (800) 541-5555
Presumptive Eligibility (PE) Support Unit
1501 Capitol Avenue, MS 4607
Sacramento, CA 95814
1 (800) 824-0088
FAX: 1 (800) 409-1498 or (916) 440-5666
Presumptive Eligibility Analyst
Phone: (916) 552-9499
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