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New Presumptive Eligibility Medi-Cal Coverage for Adults

January 21, 2014

The information below has been updated since it originally published.

For Providers:

Due to the large number of Medi-Cal applications received through the Covered California website, the Department of Health Care Services (DHCS) will provide temporary Medi-Cal eligibility for many individuals and families while their applications are being verified. This temporary coverage, called presumptive eligibility, will allow adults to receive Medi-Cal coverage through the 8E Accelerated Enrollment aid code starting January 1, 2014, while their applications are being verified.

For Medi-Cal applicants who were pending in the Covered California Web portal on or before December 14, they will likely get this temporary Medi-Cal coverage. If so, DHCS will send them a letter to inform them of their status. Their Medi-Cal Benefits Identification Cards (BICs) are in the process of being mailed, and their coverage will begin January 1, 2014.

Some applications with incomplete or incorrect information in their Covered California applications may not have temporary Medi-Cal coverage. Even if applicants do not get the temporary coverage, once their eligibility is confirmed by the county, their coverage will become effective as of January 1, 2014.

If individuals need medical care in early January, and don’t get temporary coverage through the process described above, they may be able to get medical care through temporary Medi-Cal coverage in the following ways:

  • Some hospitals can provide temporary Medi-Cal coverage for adults, pregnant women, children, and former foster youth.
  • Pregnant women can get temporary Medi-Cal coverage from certain Medi-Cal providers and clinics.
  • Children can get temporary Medi-Cal coverage from certain Medi-Cal providers and clinics who see children.