2022 Income Eligibility Guidelines for PE4PW
May 9, 2022
Effective January 1, 2022, through December 31, 2022, Presumptive Eligibility for Pregnant Women (PE4PW) program providers must use the following income guidelines to make PE4PW eligibility determinations. Providers should disregard all previous PE4PW income eligibility guidelines charts.
Presumptive Eligibility for Pregnant Woman Program
2022 Monthly Income Levels
|
Household Size
|
213 Percent Monthly
|
213 Percent Annually
|
| 2 |
$3,251 |
$39,001 |
| 3 |
$4,090 |
$49,054 |
| 4 |
$4,927 |
$59,108 |
| 5 |
$5,764 |
$69,162 |
| 6 |
$6,603 |
$79,215 |
| 7 |
$7,441 |
$89,269 |
| 8 |
$8,278 |
$99,322 |
| 9 |
$9,117 |
$109,376 |
| 10 |
$9,954 |
$119,430 |
| 11 |
$10,791 |
$129,483 |
| 12 |
$11,630 |
$139,537 |
| Each Additional Person in Family Household Size |
$840 |
$10,054 |
Note: The 2022 Federal Poverty Levels (FPL) dollar values are rounded up to the next higher dollar amount. The 2022 FPL dollar values are valid through December 31, 2022 and are updated annually in January.
These changes will be reflected in the provider manual in an upcoming Medi-Cal Update.
