Incorrect “Ineligible” Status for Select Individuals Enrolled with Presumptive Eligibility

September 2, 2021

Between August 26, 2021, and August 31, 2021, all Presumptive Eligibility (PE) programs were affected by a technical problem that affected both eligibility and the paper authorization card. The technical problem has since been resolved for eligibility granted after 9:51 a.m. on August 31, 2021. Individuals enrolled via presumptive eligibility after 9:51 a.m. on August 31, 2021, should not have the following issue.

For eligibility granted to individuals between midnight on August 26, 2021 and 9:51 a.m. on August 31, 2021, providers may be presented with a paper authorization card that has a future effective date of September 10, 2021. Potential programs that may have been affected are Presumptive Eligibility for Pregnant Women (PE4PW), Hospital Presumptive Eligibility (HPE), Child Health Disability and Prevention (CHDP), COVID and Breast and Cervical Cancer Treatment Program (BCCTP).

Additionally, if an eligibility verification is performed for individuals who present these cards, the eligibility inquiry will incorrectly return a response of “Ineligible.” If an individual has presented a paper authorization card with the future effective date of September 10, 2021, providers are instructed to provide services and pharmacy related benefits, without an eligibility verification, to those individuals.

The Department of Health Care Services (DHCS) is diligently working to fix the system issue that is still affecting individuals presumptively enrolled within the August 26, 2021, through August 31, 2021, timeframe. Until the issue is resolved, providers should follow the direction stated above when interacting with those individuals. Medi-Cal apologizes for the inconvenience.