Presumptive Eligibility Provider Manual Section Revised

February 16, 2017

Information and forms in the Presumptive Eligibility section have been outdated for some time. The section has been updated to reflect current practices.

The section is now called Presumptive Eligibility for Pregnant Women. A new abbreviation has been introduced in the section, PE4PW. The new abbreviation is coming into use with the automation of the process that allows pregnant women to become presumptively eligible for Medi-Cal until it is determined if they qualify for Medi-Cal.

Providers should anticipate the Presumptive Eligibility for Pregnant Women section to be updated again soon. New PE4PW automation information will be added as appropriate. The section will retain existing information for adjudicating older claims and appeals until the Department of Health Care Services directs its removal.