Hospital Presumptive Eligibility (HPE) Program

The Patient Protection and Affordable Care Act (ACA) established the Hospital Presumptive Eligibility (HPE) program, which was implemented by the Department of Health Care Services (DHCS) on January 1, 2014. The HPE program provides qualified individuals immediate access to temporary, no-cost Medi-Cal services while individuals apply for permanent Medi-Cal coverage or other health coverage. Qualified HPE providers approved by the DHCS make HPE determinations via the HPE Application Web Portal. For further information about the HPE program process and/or how to become a HPE provider, please refer to the HPE Program Provider Resources section below.

For questions regarding the HPE 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. To reach a representative, follow the HPE automation prompt options below.

HPE Automation Prompt Options

• Select Option 1, English; or Option 2, Spanish
• Select Option 1, Provider
• Select Option 4, Technical Help Desk
• Select Option 2, HPE
• Select Option 1, Provider; or Option 2 for Submitter
• Enter NPI #
• Select Option 3, HPE and stay on the line for a representative

HPE Program Provider Resources

HPE Frequently Asked Questions

HPE Program Provider Forms and Documents

• HPE 2022 Income Eligibility Guidelines Table
• HPE 2021 Income Eligibility Guidelines Table
• HPE Program Process
• HPE Program Provider Election Form and Agreement
• HPE Provider Enrollment Instructions
• HPE Provider Enrollment Checklist
• HPE Provider Intake Advisor Verification Form
• HPE Application Web Portal User Guide

Order the Single Streamline Application

• Medi-Cal Order Form (MC 0026)

HPE Program Articles

• Hospital Presumptive Eligibility (HPE) Federal Poverty Level (FPL) Updates
• COVID-19 Uninsured Group Program Off-Premise Flexibilities
• Incorrect “Ineligible” Status for Select Individuals Enrolled with Presumptive Eligibility
• 2022 HPE Income Eligibility Guidelines
• 2021 HPE Income Eligibility Guidelines
• 2020 HPE Income Eligibility Guidelines
• Hospital Presumptive Eligibility (HPE) Flexibilities due to COVID-19
• Update Regarding Access Into the HPE Application Portal
• Update: HPE Application Portal System Modifications and User Requirements
• Hospital Presumptive Eligibility Medi-Cal Application Available in Spanish
• Modifications to the HPE Computer Based Training and HPE Application Portal
• Hospital Presumptive Eligibility Application Now Available in Spanish

Medi-Cal Learning Portal

Medi-Cal Transactions Services