Information on the Presumptive Eligibility for Pregnant Women
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Presumptive Eligibility for Pregnant Women (PE4PW) is a Medi-Cal program designed to provide immediate, temporary coverage for prenatal care to low-income pregnant patients pending a formal Medi-Cal application.
Who is eligible?
Any patient who thinks they are pregnant and whose family income is under a certain amount is eligible for PE4PW. Eligibility for this program is determined through a participating QP. Ask your doctor if he/she offers PE4PW and how to apply.
What kind of prenatal care can I receive when enrolled in the PE4PW program?
PE4PW offers specific ambulatory (walk-in) prenatal care and prescription drugs for conditions related to pregnancy.
What care is NOT covered by the PE4PW program?
PE4PW is a temporary Medi-Cal program that does not cover labor and delivery, or inpatient care. That is why it is important for PE4PW patients to apply for Medi-Cal on a timely basis.
Who will help me enroll in the PE4PW program?
To find a provider who will enroll you in the PE program, ask your doctor if he/she participates. If your doctor does not participate, you can find a participating QP on the Find a Qualified Provider to Enroll page. Then, contact the PE provider for an appointment to be enrolled in PE4PW.
To qualify you must:
• Have income below the monthly limit for household size as listed on the Federal Poverty Level Chart
• Be a California resident
• Not be currently receiving coverage through Medi-Cal
• If pregnant, not have had a PE enrollment period during the current pregnancy
What happens at the first appointment?
The PE provider will assist you in completing the PRESUMPTIVE ELIGIBLITY FOR PREGNANT WOMEN PROGRAM APPLICATION to determine eligibility. If you are eligible and then self-attest or are determined to be pregnant through a pregnancy test, you will be issued a temporary immediate needs card (paper) for PE4PW services only. This card is NOT a Med-Cal Card. It is only for specific PE4PW services.
You must formally apply for Medi-Cal. If you are determined to be eligible for Medi-Cal you will be mailed a Medi-Cal Beneficiary Identification Card.
You can apply for Medi-Cal:
• Phone 1-800-300-1506
• In Person - contact Covered California on-line or with the 800 number for a list of places
• County social service agencies
• Download and print a CoveredCA Application.
P.O. Box 989725
West Sacramento, CA 95798
What do I do with the Medi-Cal card when it comes in the mail?
You should stop using the PE4PW immediate needs card and begin using the Medi-Cal Benefits Identification Card.
What if I have more questions about the PE program?
You can contact the PE4PW Support Unit by emailing us at PE@dhcs.ca.gov .
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