Provider Contact Information for Presumptive Eligibility (PE)

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• Federal Poverty Level (FPL) Chart for PE
  Effective April 1, 2014 through March 31, 2015

Instructions To Determine If Applicant Qualifies For PE Services: 

1. Find the PE applicant’s total family income and family size as it is stated on the Provider Use Only section of the MC 263 PE for Pregnancy - Application For Presumptive Eligibility Only.
   
   
2. Compare the applicant’s income and family size to the 2011-2012 Federal Poverty Level Chart above.
   

• Remember:  The Unborn Child is counted as a member of the family.

Examples

• A pregnant women who lives alone requests PE services. Her monthly income is $2,000. The mother and her unborn child would be counted as a two-person (2) family household. Comparing her income of $2,000 to the chart’s income for a family size of two ($2,754), she would qualify for PE services.
  
  
• A pregnant woman with two children requests PE services. Her annual income is $55,000. The mother, her unborn child, and her two children would be counted as a four-person (4) family household. Comparing her annual income of $45,000 to the chart’s annual income for a family of four ($50,162), she would not qualify for PE services. The provider should direct the patient to apply for health insurance affordability programs, including Medi-Cal, at CoveredCA.gov.
  
  
• If you have questions regarding this chart or the program, contact the PE Support Unit, California Department of Health Care Services, 1501 Capital Avenue, Bldg #171, MS-4607, Sacramento, CA  95814, 1-800-824-0088, Fax 1-800-409-1498 or 916-440-5660.
  

For Presumptive Eligibility Providers

• How to order PE forms

Other Important PE Contacts 

PE Billing questions:

• HP Enterprises OB Hotline - 1(800) 257-6900 
• Medi-Cal Provider Enrollment - (916) 323-1945
• Medi-Cal Provider Updates - 1(800) 541-5555
• PE Training - 1 (800) 541-5555 (outside of California, please call 916-636-1980)

Presumptive Eligibility (PE) Support Unit
1501 Capitol Avenue, MS 4607
Sacramento, CA  95814
1 (800) 824-0088
FAX:  1 (800) 409-1498 or (916) 440-5666
Email: PE@dhcs.ca.gov

Presumptive Eligibility Analyst
Cynthia Cannon
Phone: (916) 552-9499
Email:  cynthia.cannon@dhcs.ca.gov 

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