​​​​COVID-19 Presumptive Eligibility Program

As of March 18, 2020, the House Resolution (H.R.) 6201 Families First Coronavirus Response Act, Section 6004, authorized State Medicaid Programs to provide access to coverage for COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care at no cost to the individual. 
 
Presumptive Eligibility (PE) for COVID-19 was implemented on April 8, 2020 and is available to individuals to seek the necessary COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care such as the associated office, clinic, or emergency room visits related to COVID-19 at no cost to the individuals.  A new aid code will be used for this program. PE COVID-19 is available to individuals with no insurance or currently have private insurance that does not cover diagnostic testing, testing-related services, and treatment services, including all medically necessary care as a result of COVID-19 and are a California resident. The covered diagnostic test, testing-related​​ services, and treatment services, including all medically necessary care such as the associated office, clinic, or emergency room visit are paid up to the maximum fee-for-service (FFS) rate, in the FFS delivery system. Individuals in this program will not be enrolled in a Medi-Cal managed care plan. This new aid code will provide access to COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care such as the associated office, clinic or emergency room visit, without regard to immigration status, income, or resources and will have date specific eligibility.

A Qualified Provider (QP) will enroll the individual on the date of application and their PE eligibility period will end on the last calendar day of the month in which the 60th day falls from the date of their PE application. This program will utilize existing QP(s) allowed under approved California's existing State Plan in relation to PE programs.

Effective immediately, if an individual goes to a QP and requests COVID-19 related medically necessary care, which includes diagnostic testing services, testing-related services, and treatment services, and does not meet the eligibility criteria of the PE program in which the QP oversees, DHCS is instructing QPs to send application referrals directly to DHCS for processing. 

For guidance on how to process the PE for COVID-19 Application when an individual does not meet the eligibility criteria of the PE program, please reference.

Questions

Questions concerning COVID-19 aid code should be sent to­­­­­­­­­­­­ COVID19Apps@dhcs.ca.gov​.​
Last modified date: 6/19/2020 10:05 AM