What is Medi-Cal presumptive eligibility?

Presumptive Eligibility (PE) programs provide qualified individuals immediate temporary Medi-Cal coverage based on the individual's self-attested preliminary information. Qualified PE providers approved by the Department of Health Care Services (DHCS) make presumptive eligibility determinations.

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Presumptive Eligibility for Pregnant Women FAQ

San Bernardino California Presumptive Eligibility for Pregnant Women FAQ

Name: San Bernardino California Presumptive Eligibility for Pregnant Women FAQ
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The PE for Pregnant Women program allows Qualified Providers (QPs) to grant immediate, temporary Medicaid coverage for ambulatory prenatal care and prescription drugs for conditions related to pregnancy to low-income, pregnant patients, pending their formal Medicaid application.

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Medicaid can also deny pregnant women because their household size is too small relative to the total income. Therefore, you do not want to omit a dependent unknowingly or include an extra wage earner and hurt your eligibility.

The PE provider will ask you to complete a Statement of California Residency and then a Presumptive Eligibility for Pregnancy Only application. If you are determined eligible for PE, the provider will then complete your pregnancy test. If your pregnancy test is negative, you will not be eligible for PE.

Presumptive means speculation or unconfirmed. These are signs of pregnancy the woman is experiencing that makes her suspicious she may be pregnant.

Presumptive Eligibility (PE) programs provide qualified individuals immediate temporary Medi-Cal coverage based on the individual's self-attested preliminary information. Qualified PE providers approved by the Department of Health Care Services (DHCS) make presumptive eligibility determinations.

Presumptive signs of pregnancy possibility of pregnancy Amenorrhea (no period) Nausea with or without vomiting. Breast enlargement and tenderness. Fatigue. Poor sleep. Back pain. Constipation. Food cravings and aversions.

200bPresumptive Eligibility for Pregnant Women The PE4PW program allows Qualified Providers (QPs) to grant immediate, temporary Medi-Cal coverage for ambulatory prenatal care and prescription drugs for conditions related to pregnancy to low-income, pregnant patients, pending their formal Medi-Cal application.

Medi-Cal Coverage for Pregnant Women includes: Eligible pregnant women are required to enroll in a Medi-Cal managed care health plan unless they opt to remain with their physician in Fee-for-Service throughout their pregnancy and postpartum period.

Positive signs of pregnancy are those signs that are definitely confirmed as a pregnancy. They include fetal heart sounds, ultrasound scanning of the fetus, palpation of the entire fetus, palpation of fetal movements, x-ray, and actual delivery of an infant.

San Bernardino California Presumptive Eligibility for Pregnant Women FAQ

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