This letter provides preliminary information on Hospital Presumptive Eligibility.  Effective January 1, 2014, qualified hospitals can temporarily enroll certain individuals into MAGI Medi-Cal.  Application is by one-page attestation, and qualified hospitals complete the process through online Hospital PE portal; eligibility is made in real time.

Enrollment is limited to once per 12-month period for 60 days of HPE coverage; pregnant women are permitted one HPE period per pregnancy for ambulatory prenatal services.  HPE providers are required to provide HPE individuals an insurance application prior to leaving the hospital, which must be completed no later than the end of the next month.  HPE eligible individuals will receive full-scope Medi-Cal benefits unless eligibility is based on pregnancy.

This letter provides guidance on verifying applicant citizenship/immigration eligibility through the federal data hub before sending out the MC 13 Status Form.

This letter, available here, clarifies when counties should send the MC 13 for immigration status.  Applicants who claims to be citizens/nationals or have adequate immigration status on their applications will be run through the federal data hub in CalHEERS.  If status can be verified this way, the MC 13 is not necessary, and the county can grant full-scope benefits.  If status cannot be verified through the hub, applicants will be provided a 90-day reasonable opportunity period to resolve the matter before having benefits reduced.

Earlier this year, the CMSP Governing Board issued guidance regarding eligibility for CMSP after the expansion of Medi-Cal and implementation of Covered California.  All applicants will be considered for MAGI Medi-Cal and Covered California before being evaluated for CMSP.  For full details, read the letter here.

For applications subject to the Covered California open enrollment period, applicants not otherwise eligible for Medi-Cal must provide evidence to the county of a Covered California application and, when required, evidence of the first month’s premium payment.

• Applicants who provide the evidence will receive CMSP coverage for the period between the application date and the start of Covered California coverage.
• Applicants who fail to provide evidence will be denied eligibility for CMSP due to non-compliance.  The start date of CMSP aid will be the first of the month after Covered California enrollment ends.

For applications not subject to the Covered California open enrollment period, applicants not otherwise eligible for Medi-Cal must provide evidence that any Covered California coverage was terminated due to lack of monthly premium payment and attestation that no special circumstances for enrollment exist.

• If no special circumstances exist, the county will determine an applicant’s CMSP eligibility.
• If a special circumstance exists, the applicant must provide evidence of application to Covered California and evidence of the first month’s premium payment.
• If no evidence is provided, the county will deny the CMSP application.