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​​​​​​​​​​​​​​​​Hospital Presumptive Eligibility Program

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What is Hospital Presumptive Eligibility?​

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

What Coverage Does Hospital Presumptive Eligibility Provide?​​

Hospital Presumptive Eligibility provides immediate, temporary benefits on a Fee-For-Service basis for up to 60 days for those who qualify. 
  • Hospital Presumptive Eligibility provides full-scope coverage to all eligible individuals except those who are pregnant. 
  • ​​​​Hospital Presumptive Eligibility for Pregnancy provides limited scope coverage and only covers ambulatory (walk-in), outpatient prenatal care, outpatient abortion, and prescription drugs for conditions related to pregnancy.
If you are approved for Hospital Presumptive Eligibility, your provider must check your eligibility to know your scope of coverage. Covered services are subject to change so it is important to ask your provider if your service(s) will be covered, especially if you receive Hospital Presumptive Eligibility for Pregnancy.
Hospital Presumptive Eligibility is temporary. You should apply for health coverage programs and complete the application process to find a long-term health insurance program that fits your needs. See below for ways to apply for health coverage.

What is Fee-For-Service?​​

Fee-For-Service means you 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 Hospital Presumptive Eligibility?​​

To qualify for Hospital Presumptive Eligibility, you must:

  • Have low monthly income​;
  • Live in California;
  • Not currently be receiving Medi-Cal;
  • Have not received Presumptive Eligibility more than the maximum number of times allowed within the past 12 months;
    • If pregnant, you have not received Presumptive Eligibility during your current pregnancy.

And, be eligible in one of the following Hospital Presumptive Eligibility groups below:

  • Children under 19 years old
  • Parents and Caretaker Relatives
  • Pregnant People
  • Former Foster Youth between ages 18 to 26 years old, who were in foster care in any state on their 18th birthday or older. (No income limit)
  • Adults aged 19 years and older who are not pregnant, not receiving Medicare, and not eligible for any group stated above.

How Often Can I Receive Presumptive Eligibility?

Presumptive Eligibility includes Hospital Presumptive Eligibility, Children's Presumptive Eligibility and Presumptive Eligibility for Pregnant People. ​

Presumptive Eligibility Group

How Often

Child groups

Twice (2) per 12 months 

Adult groups

Once (1) per 12 months

Pregnant people

Once (1) per pregnancy

Who Will Help Enroll Me into Hospital Presumptive Eligibility?

To apply for Hospital Presumptive Eligibility, you must visit a provider who participates, known as a “Qualified Provider."

You can find a Qualified Provider from this list:

Hospital Presumptive Eligibility applications are only accepted when trained staff are available during the health care visit. If Hospital Presumptive Eligibility is not available during your visit, you must apply for Medi-Cal to potentially pay for your services. Retroactive Medi-Cal may cover expenses for services you have already received if you apply for Medi-Cal and complete the enrollment process within three (3) months of receiving those services.

Is Hospital Presumptive Eligibility included in the public charge test? 

The public charge test is an assessment that immigration officers use to determine if a noncitizen is likely to become dependent on government for support. The U.S. Department of Homeland Security (DHS) and U.S. Citizenship and Immigration Services (USCIS) generally do not consider health, food, and housing services to be part of the public charge determination. Therefore, using Medi-Cal benefits, except nursing home or mental health institution care, will NOT hurt impact your immigration status.

Please note that DHCS and county social services agencies cannot provide legal services or advice related to immigration status or public charge laws. If you have questions about your immigration status and Medi-Cal benefits, talk to a qualified immigration lawyer.  

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| TTY: (888) 889-4500.
  • By phone with Covered California (Español) at (800) 300-0213.
  • By phone with your county social service agency.
  • In Person – contact Covered California at (800) 300-1506 for a list.
  • In Person – find a county social service agency office.

Download and print a Single Streamlined Application:

Fax to

(888) 329-3700

Mail to

Covered California
P.O. Box 989725

West Sacramento, CA 95798​​​

What Should I Do If I Get a Bill While I Had Hospital Presumptive Eligibility Coverage?  ​

Follow these steps if you get a bill you think should be covered: 

  1. Confirm Coverage: Confirm that the date of service on the bill falls within the time you were covered by Hospital Presumptive Eligibility.
    1. Check the Hospital Presumptive Eligibility coverage period and scope of coverage listed on the paper Immediate Need card or
    2.  If you no longer have your Immediate Need card or aren't sure about your coverage period, contact your county social services office to request verification of eligibility for the date of service on the bill.
  2. Contact the Provider and Share Proof of Eligibility: Call the hospital, clinic, or doctor's office that sent the bill. Let them know you had Hospital Presumptive Eligibility for the date of service on the bill and provide: 
    1. ​The BIC ID number listed on your Immediate Need card or  
    2. The BIC ID number listed on your plastic BIC or 
    3. Other proof of eligibility, such as what you requested from your county social services office.  
  3. ​​Ask for Further Assistance: The provider may resubmit the bill to Medi-Cal for payment. If they cannot help, ask for their billing department for further assistance. 
  4. Contact DHCS: If the issue isn't resolved, reach out to the DHCS Telephone Service Center at (800) 541-5555 for support.  
  5. Keep Records: Save all correspondence, bills, and proof of coverage for your records. 

Questions

General questions may be sent to DHCSHospitalPE@dhcs.ca.gov. We cannot answer questions related to your Medi-Cal eligibility or look up your case. ​

Last modified date: 2/27/2025 8:30 AM