What Is Children’s Presumptive Eligibility?

Children’s Presumptive Eligibility allows certain health care providers to approve temporary health coverage for eligible applicants using an electronic application. Children’s Presumptive Eligibility determinations are based on the family’s self-attestation of facts and no other forms of proof are required.

Children’s Presumptive Eligibility provides immediate temporary, full-scope benefits on a Fee-For-Service basis for up to 60 days for those who qualify. Families should apply for health coverage programs and complete the application process to find a long-term health insurance program that fits their needs. See below for ways to apply for health coverage.

What is Fee-For-Service?

Fee-For-Service means you or your child are not enrolled in a health care plan. To avoid paying out-of-pocket for health care services, ask your doctor if they take Fee-For-Service Medi-Cal before scheduling visits. 

Who Is Potentially Eligible to Children’s Presumptive Eligibility?

Individuals are potentially eligible for Children’s Presumptive Eligibility if they are:

• Under the age of 19
• A California resident
• Not already enrolled in Medi-Cal
• Within the income limits for their household size, and
• Have not exceeded two Presumptive Eligibility enrollment periods in the last 12 months.

Who Will Help Enroll Me into Children’s Presumptive Eligibility?

To apply for Children’s Presumptive Eligibility, you must visit a provider who participates, known as a “Qualified Provider.”

You can find a Qualified Provider from this list:

CPE Approved Qualified Providers List

Children’s Presumptive Eligibility applications are only accepted when trained staff are available during the health care visit. Please call ahead to schedule an appointment.

Resources

Children’s Presumptive Eligibility flyer (English)
Arabic, Armenian, Cambodian, Chinese, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thai, Ukrainian, Vietnamese

Ways to Apply for Medi-Cal and other Health Coverage Programs

You can apply for Medi-Cal:

Online on Covered California or BenefitsCal.
By phone with Covered California at (800) 300-1506
By phone with your county social service agency. Find contact details for your local county social services agency office here.       .
In Person – contact Covered California at (800) 300-1506 for a list of offices.
In Person – find and visit a nearby county social service agency office here.
Download and print a Covered California Application:
Fax to (888) 329-3700
Mail to 
Covered California
P.O. Box 989725
West Sacramento, CA 95798

Questions

We cannot answer questions related to your Medi-Cal eligibility or look up your case, but we can let you know if a specific location participates in Children’s Presumptive Eligibility and answer general questions.

For general questions please e-mail ChildrenPE@dhcs.ca.gov.