The enrollment period begins on the day in which the individual is determined eligible for the PE4PW program.
The enrollment period ends either:
If an individual does not submit an insurance affordability application prior to the PE end date, PE ends on the last day of the following month in which the individual was determined eligible for PE.
- For example, if an individual is determined eligible on March 3, 2017, PE coverage ends on April 30, 2017.
If an individual submits an insurance affordability application prior to the PE end date, PE coverage ends on the day in which the eligibility determination is made based on the insurance affordability application (approved or denied).
- For example, if an individual was determined eligible on July 3, 2017, and submitted an insurance affordability application prior to the PE end date of August 31, 2017, and a determination was made on August 25, 2017, PE coverage ends on August 25, 2017.
||PE eligibility cannot be backdated regardless of the reason. Individuals must apply for full scope Medi-Cal and mark the box on the application that indicates the individual had medical expenses in the last three months and needs help to pay.
Providers can verify eligibility by using the Automated Eligibility Verification System, a Point of Service device or the Medi-Cal website.