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PE for Pregnant Women Automation Effective April 1, 2017

March 20, 2017

Effective April 1, 2017, the application process for Qualified Providers (QPs) in the Presumptive Eligibility for Pregnant Women (PE4PW) program, which is used to help applicants apply for interim Medi-Cal services, is automated. QPs are encouraged to begin using the automated Presumptive Eligibility for Pregnant Women Program Application (MC 263), which will be available in the Transactions area of the Medi-Cal website. QPs will be able to use the MC 263-P (paper) form to gather the applicant's information prior to inputting it in the automated system. The MC 263-P is available in both English and Spanish.

Note:

The current paper application process using form MC 263 version 06/2016 will remain available for six months (through September 29, 2017) to ensure all providers have time to transition to the new process. After that date, paper MC 263 forms will not be used/available.

Provider Manual Update: Helping Patients Qualify for Temporary Medi-Cal
The new Presumptive Eligibility for Pregnant Women Program Process manual section contains the automated process instructions providers follow to help patients apply for temporary Medi-Cal (and all other health insurance affordability programs), pending a final eligibility determination.

Provider Manual Update: Provider Enrollment
Additionally, the new Presumptive Eligibility for Pregnant Women Provider Enrollment Instructions section and associated form, Presumptive Eligibility for Pregnant Women Provider Enrollment Checklist, contain instructions to help providers enroll as PE4PW providers.

PE for Pregnant Women Forms
Many of the forms listed on the Presumptive Eligibility for Pregnant Women Web page of the Medi-Cal website will remain in use for dates April 1, 2017 through September 29, 2017. Due to automation, after that date the following forms will no longer be used/available:

  • Statement of California Residency (MC 263-SR, English and Spanish)
  • Patient Directions for Presumptive Eligibility for Pregnant Women Program Application (MC 265, English and Spanish)
  • Directions to Apply for Medi-Cal (MC 266)
  • Explanation of Ineligibility for the Presumptive Eligibility for Pregnant Women Program (MC 267, English and Spanish)
  • Weekly Presumptive Eligibility (PE) for Pregnant Women Enrollment Summary (MC 283)
  • Forms Order Presumptive Eligibility (PE) for Pregnant Women Program (MC 285)
  • Presumptive Eligibility for Pregnant Women Provider Fact Sheet (MC 286)

The older version of the provider enrollment form MC 311 (version 10/07) will be removed from the website and substituted with a newer version (Qualified Provider Application and Agreement for Participation in the Presumptive Eligibility for Pregnant Women (PE4PW) Program [version 12/16]) on both the Presumptive Eligibility for Pregnant Women Web page and the Forms Web page.

References
For more details about form MC 263 automation and MC 311 changes, providers may refer to the Presumptive Eligibility for Pregnant Women Frequently Asked Questions and the February 2017 bulletin article Automation of PE for Pregnant Women Program. For questions about the PE4PW program, providers may contact 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, as follows:

  • Select Option 1, English; or Option 2, Spanish
  • Select Option 1, Provider
  • Select Option 4, Technical Help Desk
  • Select Option 2, Presumptive Eligibility for Pregnant Women