Hospital Presumptive Eligibility Program (HPE)

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On January 1, 2014, the Hospital Presumptive Eligibility Program (HPE) was implemented.  The HPE Program provides qualified individuals immediate access to temporary, no-cost Medi-Cal while applying for permanent Medi-Cal coverage or other health coverage. To qualify for HPE, individuals must meet the rules below.

  • Have income below the monthly limit for household size.
  • Be a California resident.
  • Not already have Medi-Cal.
  • If not pregnant, have not received PE Enrollment benefits from any Medi-Cal PE Program up to the maximum limitation allowed within the past 12 months of applying. If pregnant, have not had a PE Enrollment during the current pregnancy of applying.

And, be eligible in one of the following HPE groups below:

  • Children under 19 years old
  • Parents and Caretaker Relatives
  • Pregnant Women (benefits are limited to ambulatory prenatal services.)
  • Former Foster Youth between ages 18 to 26 years old, who were in foster care in any state on their 18th birthday or older. (No income limit)
  • Adults between ages 19-64, not pregnant, not in Medicare, and not eligible for any group stated above.

To apply for HPE benefits, an individual must visit a hospital that is a qualified HPE Provider. The HPE Provider submits the individual’s information via the HPE Medi-Cal Application online portal and eligibility is determined in real-time.