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ACA Hospital Presumptive Eligibility (PE) Program

The Patient Protection and Affordable Care Act (ACA) established the Hospital Presumptive Eligibility (PE) program. Under the Hospital PE program, hospitals can assist patients who are getting services from or being admitted to the hospital in applying for temporary fee-for-service Medi-Cal benefits. Depending on the patient's answers during the application process, they may be presumed eligible for Medi-Cal. Qualified hospitals have the option as qualified entities to make presumptive eligibility determinations.

The documents available on this page are updated on an ongoing basis to ensure that they contain up-to-date information. Please refer to this page often for current Hospital PE program documentation.

For questions regarding the Hospital Presumptive Eligibility (PE) program, hospitals may call the Medi-Cal Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Hospitals may navigate through the menu prompts by selecting the appropriate option for language (English or Spanish), option 1 for provider, option 4 for the Technical Help Desk and option 2 for Hospital Presumptive Eligibility. Hospitals are encouraged to print the TSC Main Menu Prompt Options and keep it near their phones for faster access to TSC resources.


Frequently Asked Questions



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