​​Information If You Are Interested In Becoming A Qualified Provider

To become a Presumptive Eligibility provider for the purposes of offering Presumptive Eligibility (PE) for pregnant women to your pregnant patients, an application, QUALIFIED PROVIDER APPLICATION FOR PRESUMPTIVE ELIGIBILITY PARTICIPATION, MC311, provided below, must be completed, submitted, and approved by the Department of Health Care Services, Presumptive Eligibility Support Unit.

• APPLICATION FOR PRESUMPTIVE ELIGIBILITY PARTICIPATION, MC311
  For Presumptive Eligibility Participation and Agreement.